5,6,7 Cmca

IMMEDIATE CARE OF
THE NEWBORN
CORE STEPS
Immediate and thorough
drying Properly timed cord clamping
CORE STEPS
Early skin-to-skin contact Non-separation of the newborn and mother for early
initiation of breastfeeding
4 CORE STEPS
I. Immediate and thorough drying
II. Properly timed cord clamping
III.Early skin-to-skin contact
IV.Non-separation of the newborn and
mother for early initiation of
breastfeeding
IMMEDIATE CARE
1. Establish and maintain a patent airway
2. Maintain appropriate body temperature
3. Immediate Assessment APGAR
APGAR SCORE
Appearance / Color
All infants appear cyanotic at the
moment of birth. They grow pink
shortly after the first breath.
= Acrocyanosis (cyanosis of the hands
& feet) is so common in newborns that
a score of one in this category is
normal.
APGAR SCORE
Pulse / Heart Rate
Auscultating a newborn heart
with a stethoscope is the best
way to determine the heart rate
=Heart rate also may be
obtained by observing &
counting the pulsations of the
cord at the abdomen if the cord
is still uncut.
APGAR SCORE
Grimace / Reflex Irritability
Newborn’s response to a suction
catheter in the nostrils or the
response to having the sole of
the feet slapped.
APGAR SCORE
Activity / Muscle Tone
Mature newborns hold their
extremities tightly flexed,
simulating their intrauterine
position.
= It is tested by observing their
resistance to any effort to
extend their extremities
APGAR SCORE
Respiratory Effort
Respirations are counted by
watching respiratory movements.
= A mature newborn usually cries
and aerates the lungs
spontaneously at about 30 secs.
after birth.
APGAR SCORING
CRITERIA 0 1 2
A-pperance/Color Blue Acrocyanosis Pink
P-ulse / Heart rate 0 <100 100 & above
G-rimace No response Grimace/ Good strong

Weak Cry cry; sneeze
A-ctivity Limp, flaccid Some flexion of
extremities
Well-flexed
extremities
R-espiratory effort Absent Weak cry Good, strong
cry
APGAR SCORE INTERPRETATION
0-3 Resuscitation ASAP!

4-6 Guarded →Continuous
monitoring & suctioning
7-10 Best possible condition
NEWBORN ROUTINE CARE
PREVENTION OF HYPOTHERMIA
• Dry the infant properly so that heat is not lost from
evaporation of moisture on the baby’s skin
• Hypoglycemia may result from hypothermia
• Hypothermia causes cold stress.

PROMOTING SAFETY & PREVENTING INJURY
• Eye care with the administration of erythromycin eye ointment is

done after birth.
• Assess the infant for indications of trauma
• Vit K is injected into the vastus lateralis to assist in blood clotting
PHYSICAL EXAMINATION
•HEART RATE (120-140 bpm)
•RESPIRATORY EFFORT (30-60 cpm)
•BP = 80/46 -100/50 mmHg after 10 days
ANTHROPOMETRIC MEASUREMENTS
• CHEST CIRCUMFERENCE (31-33 cm)
• HEAD CIRCUMFERENCE (33-
35 cm)
• ABDOMINAL CIRCUMFERENCE
( 31-33 cm)
Weight = 6.57.5.lbs
Length = 47.5 -53.75 cm (Ave:50 cm)
(3.0-3.4 kg)
Concepts of Growth and
Development
INTRODUCTION
• The process of human development is a
LIFELONG PROCESS involving physical,
behavioral, cognitive, and emotional
growth and development. This
encompasses the early stages of life—
from neonate to infancy, to childhood, to
adolescence, eventually to adulthood.
The process involves changes taking
place. Throughout the process, the child
develops attitudes and behaviors that
guide the formation of values and
principles (Advocates for Youth, 2019).
•
OBJECTIVES
At the end of the module, the students are expected to:
• 1. Describe the concepts of growth and development.
• 2. Explain the principles of growth and development
• 3. Enumerate the factors influencing growth and development
of a child.
• 4. Define the different periods of growth from prenatal to
postnatal period.
DEFINITION OF IMPORTANT TERMS
GROWTH – a physical change or Most rapid growth in INFANCY
QUANTITATIVE increase in size of
the whole body or any of its parts.
Growth spurt in
ADOLESCENCE
The best index of growth is WEIGHT
GROWTH takes place in the first 20 years of life

DEVELOPMENT are changes
that mark increase in
function and complexity and
progression of skill or
QUALITATIVE increase
Development continues after 20

years, even after GROWTH stops
MATURATION involves intrinsic
processes of development that are
GENETICALLY AND ORGANICALLY
programmed.
- depends on environmental
factors for its normal progress
DEVELOPMENTAL TASK is a specific task that arises at or about
a certain period in the life of the individual
Failure in achievement of developmental

tasks results in UNHAPPINESS, difficulty with
later tasks and disapproval from society
Successful achievement of developmental

tasks results in HAPPINESS and success in
the achievement of future task
PRINCIPLES OF GROWTH & DEVELOPMENT
A. Growth and Development are INFLUENCED by Many
FACTORS:
1. HEREDITY / GENETICS set the upper limits of growth:
a. Heredity makes all human beings similar yet unique
b. Genetic characteristics of individuals are established at
conception
c. The zygote that carries the potential to become an adult
human (though environment may affect its growth)
d. Racial traits are carried through the genes and remain
unchanged
2. The ENVIRONMENT alters the
limits set by the genes;
considered as the most
important factor
a. The FAMILY serves as the
FOUNDATION of the child’s
world
b. From the family, the child’s
world EXPANDS to the SCHOOL,
the CHURCH, and the
COMMUNITY
3. NUTRITION is a major influence on growth and development.
Influences the individual from prenatal to postnatal period and
even until death.
4. SOCIOECONOMIC STATUS affects many aspects of the child’s life
and therefore affects directly and indirectly his growth and
development
5. HEALTH and ILLNESS are major influences on the child’s growth
and development
a. Poor physical health
b. Presence of acute or chronic illness
B. GROWTH is a REGULAR, ORDERLY and PREDICTABLE
process occurring in a SYSTEMATIC and SEQUENTIAL
manner.
C. Growth proceeds in an orderly manner:
1. Cephalo-caudal or from head to toe
2. Proximodistal or from center to periphery
3. General to specific or simple to complex
D. Each individual grows at his own RATE and PACE
E.All body systems do not develop at the
same rate whereas certain tissue mature
more rapidly than others
F. Each child is competent and equipped with
the capacity for growth and development
G.Development is continuous throughout
life
H.There are CRITICAL periods of growth and
development
1. Optimum time for initiation of experiences or
learning
2. Neonatal reflexes must be lost before
development can proceed.
I. Upper limits of growth and development exist
and cannot be surpassed , but their attainment
may be hampered at any stage
REACTION PATTERN
1. Activity level
- differs widely from each other
2. RHYTHMICITY
- child with rhythmicity manifest regular rhythm in physiologic
functions
3. APPROACH
- refers to the child’s response on initial contact with new
stimulus / some children approach situation in an unruffled manner
REACTION PATTERN
4. ADAPTABILITY
- ability to change one’s reactions to stimuli over time.
5. INTENSITY OF REACTION
- some children react to situation with whole being
6. DISTRACTIBILITY
- children who are easily distracted or who can easily shift
to a new situation are easy to care for
REACTION PATTERN
7. ATTENTION SPAN AND PERSISTENCE
– ability to remain in a project or activity.
8. THRESHOLD OF RESPONSE
. – intensity level of stimulation that is necessary to evoke reaction.
Children with low threshold need little stimulation while with high
threshold need intense stimulation before they become upset over a
situation.
9. MOOD QUALITY
- happy baby or with temper trantrum
METHODS OF ASSESSING
4 DIFFERENT ASPECTS OF GROWTH
PHYSICAL GROWTH & DEVELOPMENT
1. Skeletal Age
2. Dental Age
3. Morphological Age
4. Secondary Sex Characteristics Age
PHYSICAL GROWTH AND DEVELOPMENT
SKELETAL AGE
BONE AGE is a general index of

growth status; assessed through X-
ray. Ossification centers, bone size
and morphological changes of
bones are noted.
Girls are more advanced than boys

in skeletal development at all ages
DENTAL AGE
• ASSESSED PRIMARILY THROUGH
TOOTH ERUPTION
7th fetal month - beginning
teeth calcification
5th-7th month - eruption of
first deciduous teeth
DENTAL AGE
6th-8th month - eruption of upper central incisors
1st year - 4 sets of primary or deciduous teeth
2 ½ year - complete primary deciduous teeth ( 20 or 10 pairs)
6th year – eruption of the first permanent teeth (6th year
molars)
- shedding of the first deciduous teeth
17th-22nd year – eruption of the third permanent molars
MORPHOLOGICAL AGE
- refers to the size (height)
and shape of bones
PHYSICAL GROWTH AND DEVELOPMENT
SECONDARY SEX
CHARACTERISTICS
AGE
PRENATAL
PERIOD(0-280 DAYS)
OF GROWTH
• PROCESS IN WHICH A HUMAN EMBRYO OR FETUS GESTATES
DURING PREGNANCY FROM FERTILIZATION UNTIL BIRTH
OVUM – (0-14 days) the female haploid gamete which fuses
with the sperm and develop into an organism after fertilization
EMBRYO – (14 days-9 weeks)
FETUS – (9 weeks –birth)
PERIOD OF GROWTH
NATAL
PREMATURE / PRETERM - babies born alive before 37 weeks of
pregnancy are completed
- greater risk for short and long term complications,
including disabilities and impediments in growth and mental
development.
MATURE / TERM – babies are born alive at 37 – 42 weeks
gestation
POST TERM - babies are born after 42 weeks gestation
PERIOD
POSTNATAL OF GROWTH
NEONATE / NEWBORN - an infant in the first 28 days after birth

INFANT - between the ages of 1 month and 12 months
TODDLER - a child between the ages of one and three
PRESCHOOLER – child between 3-6 years of age
SCHOOL AGE – child between 6-12 years of age
ADOLESCENT - teenage years between 12 to 18 and can be considered
the transitional stage from childhood to adulthood.
The process of human development is a lifelong process
involving physical, behavioral, cognitive, and emotional
growth and development. This encompasses the early stages of
life—from neonate to infancy, to childhood, to adolescence,
eventually to adulthood. The process involves changes taking
place. Throughout the process, the child develops attitudes and
behaviors that guide the formation of values and principles
(Advocates for Youth, 2019).
Normal Pediatrics and Adulthood
Theories of Development
The Personality Development

Dichotomized by the Major Developmental
Theories
Psychosexual theory- Psychoanalytical theory ( Sigmund Freud )
Psychosocial theory ( Erik Erikson )
Cognitive theory ( Jean Piaget )
Moral development theory (Lawrence Kohlberg)
Spiritual Development theory ( James Fowler )

Psychosexual theory
/Psychoanalytical theory ( Sigmund Freud )
Adolescence
ID
EGO
SUPEREGO
Psychosexual/Psychoanalytical
Five Stages of psychosexual development
oral
Anal
Phallic or Oedipal
Latency
Genital
Phase Age Focus
Oral 0- 1 yr Site of gratification: Mouth
Anal 1 - 3 yrs Site of gratification: Anus
Phallic 3- 5 years Site of gratification: Genitals
Latency 6- 12 years Site of gratification: (School Activities)
Genital 12 & above Site of gratification: Genitals

Phase Age Focus
Oral 0-1 year Major task: Weaning
Anal 1- 3 years Major task: Toilet training
Phallic 3- 5 years Major task: Oedipal & Electra complex

(family
romance)
Latency 6- 12 years Major task : School/Academics
Genital 12 & above Major task: Sexual intimacy

Phase Age Nursing implication
Oral infant Provide oral
stimulation
like pacifier
Do not
discourage
thumb
sucking
Breastfeeding provide more stimulation
than bottle feeding
Anal toddler Help children achieve with bowel control

Phallic Pre School Accept children curiosity on sexual interest such as fondling their
own genitals as a normal exploration of the area…Explain if there
are question of the differences
Latency School Age Help children to have positive experience with learning so that
self esteem will cont to
grow
Genital Adolescents Provide opportunities for child to relate with opposite sex;
Psychosocial theory ( Erik Erikson )

Erikson’s Psychosocial theory
• Each stage is characterized by a different conflict that must be resolved by
the individual.
• When the environment makes new demands on people, the conflicts

arise.
• "The person is faced with a choice between two ways of coping with each
crisis, an adaptive, or maladaptive way.
• Only when each crisis is resolved, which involves a change in the

personality, does the person have sufficient strength to deal with the next
stages of development“ (Schultz and Schultz, 1987).
• If a person is unable to resolve a conflict at a particular stage, they will

confront and struggle with it later in life.
Introduction to Erikson's 8 Stages
• Trust versus mistrust (0-1yr)
• Autonomy versus shame and doubt (1-3yrs)
• Initiative versus guilt (3-5yrs)
• Industry versus inferiority (6-12yrs)
• Identity versus role confusion (12-18yrs)
• Intimacy versus isolation (19-40 years old)
• Generativity versus stagnation (41-65)
• Ego integrity versus despair (65 and above)
Stage Age Basic conflict Important Event Summary
Oral Sensory 0-12 to 18 months Trust vs. Mistrust Feeding Infant must develop a
sens
e of
trust
Muscular Anal 18 mths to 3 yrs Auto Toilet Training master physical environment
nomy while maintaining self-
vs. esteem
Sha
me/D
oubt
Locomotor 3 to 6 years Initiative vs. Independence Begins to initiate not imitate
Guilt develops conscience and
sexual identity
Latency 6 to 12 years Industry vs. Inferiority School develop a sense of self-worth
by refining
skills
Adolescence 12 to 18 years Identity Peer Relationships self-image under role model
vs and peer
Rol pressure
e
Co
nfu
sio
n
Young Adulthood 19 to 40 years Intimacy vs. Love Relationships personal commitment to another
Isolation as spouse, parent or
partner
Middle Adulthood 40 to 65 years Generativity vs. Parenting satisfaction through productivity
Stagnation in career, family, and
civic interests
Maturity 65 years to death Ego Integrity vs. Despair Reflection on Reviews life accomplishments,
and acceptance of deals with loss and preparation
Age Task Achievements
0- 1 yr Trust vs Mistrust Optimism
1- 3 yrs Autonomy vs S/D Self-Control
3- 5 yrs Initiative vs Guilt Direction and purpose
6- 12 yrs Industry vs inferiority Competence and method
13- 18 Identity vs Role Confusion Devotion and fidelity

Age Task Achievements
19-40 yrs Intimacy vs. Isolation relationship
41-65 yrs Generativit Self confident

y vs.
stagnation
65 and above Integrity vs Despair Feeling good about

the life choices that
they made
Task Nursing Implication
Trust vs Mistrust Provide primary caregiver; experiences that add security such as
soft sounds, soft touch and visual stimulation for active child
involvement
Autonomy vs S/D Provide opportunity for decision making such as choices of clothes
etc. Praise of ability of making decision rather than judging
correctness of any decision
Initiative vs Guilt Provide opportunities for exploring new place or activities. allow play
to include activities involving water, clay for modeling or finger paint
Industry vs inferiority Allow child to assemble and compete short project so that child
feels rewarded for accomplishment
Identity Provide opportunities to discuss feelings about events

vs Role important to him/her. Offer support for decision making
Confusio
n
Piaget’s theory of Cognitive Development

Piaget: Cognitive Development
Sensori-motor (birth to 2 )
Pre-operational (2-7)
Concrete operational (7-12)
Formal operational (12 to adulthood)

Jean Piaget
1. Sensorimotor Nursing Implication
Task
A. Stimuli are assimilated in the beginning mental images . Behaviour
Neonatal entirely reflexive.
Reflex 1
month
B. Primary circular Action 1- Hand-mouth and ear-eye coordination develop. Infant spend much
4 month time looking at objects and seperating self from them. Beginning
intention behaviour and find pleasure in it.
C.Secondary circular Learns to initiate, recognize and repeat pleasurable experience from
reaction 4-8 environment. Memory traces infant anticipates familiar events are
month coming like a parent is coming to pick him/her up.
D. Coordination of Can plan activities to attain specific goals. Perceives that others can
Secondary Reaction 8-12 cause activity and that activities of own body are separate from activity
month of objects. Can search objects that separates from view. recognizes
shapes and sizes of familiar objects…Separation anxiety
E. Tertiary circular Discover new property of objects and events. Capable of space and
reaction 12-18month time perception as well as permanence.
F. Intervention of new Transitional phase of preoperational thought period. Uses

means thru mental memory and imitaion to act. Can solve basic problems, foresee
combinations 18- 24 maneuvers that will succeed or fail. Good toys are blocks,
Jean Piaget
TASK Nursing Implication
2. Pre Operational Thought Thought become more symbolic; can arrive at answers mentally instead of
physically attempt. Comprehends simple abstraction but thinking is basically
2-7 years old concrete and literal. Child is Egocentric; Display static thinking; concept of Time
is NOW and concept of distance is as far as they can see.
Centering or focusing on a single object is cause by distorted reasoning. No
awareness of Reversibility.; unable to state cause and effect relationship,
categories and abstraction.
Good toy: items require imagination, such as modeling clay.
3. Concrete Operational Includes systematic reasoning. Uses memory to learn broad concepts like fruit and
Thought 7-12 subgroups of concepts are apples, guavas. Classifications involve sorting objects
years old according to increasing or decreasing measures such as weight, multiplication. Child
is aware of reversibility. Understands conversation, sees constancy despite
transformation (mass and quantity remains the same even if it change position or
shape.)
Good activity: collecting and classifying objects such as shells
Expose child to view points of others “how would you feel if you are a nurse and
would tell the boy to stay in the bed?
4. Formal operation Can solve hypothetical problem with scientific reasoning; understand causality and
thought 12 yrs. can deal with the past, present and future. Adult and mature thought.
Good activity: talk time to sort through attitudes and opinions.
KOHLBERG’S STAGES OF MORAL

DEVELOPMENT
Moral Theory
Pre-Conventional
Conventional
POST Conventional
PRECONVENTIONAL LEVEL
• Stage 1 Age Group: 2-3 years
• Description of morality:
• Punishment or obedience (heteronymous morality)
• A child does the right things because a parent tells

him or her to avoid punishment
• Child is UNABLE to understand other’s viewpoint

PRECONVENTIONAL LEVEL
• Stage 2 Age Group : 4-7 years
• Individualism- Hedonism
• Child carries out actions to satisfy own needs rather

than society’s.
• The child does something for another if that person

does something for him in return- “an eye for
an eye’(Taleon Law)
CONVENTIONAL LEVEL
• Orientation to interpersonal relations of mutuality-

CONFORMITY
• A child follows rules because of a need to be a good

person in own eyes and in the eyes of others
• “Good boy or Good girl”

CONVENTIONAL LEVEL
• Maintenance of social order, fixed rules and authority
• Child FOLLOWS RULES of authority figures as well

as parents to keep the system working
• LAW and ORDER

POSTCONVENTIONAL LEVEL
• Stage 5 Age Group : 12 and above
• Description:
• social contract, utilitarian law
making perspective
• child FOLLOWS STANDARDS OF SOCIETY for

the good of all people
CONVENTIONAL LEVEL
• Stage 6 Age :older than 12
• Descriptions:
• universal ethical principle orientation
• Respect and dignity of humanity
• Jesus, Mohammed, Gandhi, Buddha,
other Prophets
Kolhberg’s Stages of Moral Development
Age Nursing implication
Prec 2-3 years old Child needs help to determine what are right
on- actions. Give clear instruction to avoid
venti Stage 1: Punishment or obedience confusion.
onal (heteronymous morality)
Leve
lI
4-7 years old Child unable to recognize that like situations require
Stage 2: Individualism- Hedonism like actions. Unable to take responsibility for self
care because meeting own needs interferes with
this.
Convention 7-10 years old Child enjoys helping others because this is “nice
al Level II Stage 3: interpersonal behavior”. Allows child to help with bed making and
relations of mutuality- other like activities. Praise for desired behavior such
CONFORMITY as hearing.
10-12 years old Child often asks what are the rules and is something"
Stage 4; Maintenance of social right”. May have difficulty modifying a procedure
order, fixed rules and because one method may not be right. “Follows self
authority care measure only if someone is there to enforce him.
Kolhberg’s Stages of Moral Development
Age Nursing implication
Post Oder than 12 years Adolescents can be responsible for

conventi because they view this as a
o nal III Stage5: social standard of adult behaviour.
contract,
utilitarian law
making
perspective
Stage 6:universal Many adults do not reach this

ethical principle level of moral development.
orientation
Prof. James W. Fowler
Stages of Faith published in 1981

in which he sought to develop the
process in "human faith".
These stages of faith development were

along the lines of Jean Piaget’s theory
of cognitive development and Lawrence
Kohlberg's stages of moral
development.
Stages of faith development

1st STAGE:
PRIMAL or UNDIFFERENTIATED
First two years
Infant's initial awareness of God may come through church environment
The stimulus and safety of the environment may contribute to an overall

sense of trust and safety about the universe.
1st STAGE:
"Primal or Undifferentiated" faith (birth to 2 years)
Unconscious conclusions can inform their sense of the divine, and affect
the transition into the next stage.
“prestage”- in which the seeds of trust, courage , hope, love are joined to
combat such issues as possible “inconsistency and abandonment in the
infants environment.
particular relevance to the maternal-infant nurse concerned with issues of

parental infant bonding
If consistent nurture is experienced, one will develop a sense of trust and

safety about the universe and the divine.
2nd STAGE:
INTUITIVE-PROJECTIVE
Young children
Follow the beliefs of parents
Imagine or fantasize angels or other religious figures in stories as

characters in fairy tales
2nd STAGE:
"Intuitive-Projective" faith
3-6 years old)- an imitative “fantasy- filled” period in

which a young child is strongly influenced by examples,
moods, actions and stories of visible faith of primarily
related adults.
3rd STAGE:
MYTHICAL-LITERAL
Children – school age- Respond to religious stories

and rituals literally, rather than symbolically
Adolescence to young adulthood - Beliefs continue to

be based on authority focused outside themselves.
3rd STAGE:
Mythic-Literal" faith
" (7-12 years old) described as the time when the child
begins to internalize “stories, beliefs and
observances that symbolizes belonging to his or her
own faith community.
In working with slightly older pediatric patients, the

concepts of mythic-literal faith can help the nurse to
support the child’s participation in rites, rituals and
worship services of his or her tradition, which may
provide support and comfort in illness.
4th STAGE:
SYNTHETIC- CONVENTIONAL
Adolescence
Faith becomes more related to the way it affects relationships and overall
world
Create a social structure with peers who believe in similar things

and affirm truth by a majority of opinion.
4th STAGE:
“Synthetic-Conventional" faith
" (13-20 years old) describes the adolescents

experiences outside the family unit; at school ; at work
with peers and from the media and religion. Faith
provides for identity and outlook.
It provides an understanding of how the ill

adolescents to both internal ( family) and external
(peer) support and interaction during the crisis
situation.
Structure as the means to develop one’s own

personal relationship with God
May be forced to find a new social circle to guide them

and their beliefs
Tend to have a conformist acceptance of a belief with little

self-reflection on examination of these beliefs
Most people remain at this level. (Fowler, 1981; Kelly,

1995)
5th STAGE:
INDIVIDUATIVE-REFLECTIVE
Mid 20’s – 30’s
Begin a radical shift from dependence on others’ spiritual beliefs to

development of their own
"For a genuine move to stage 4 to occur there must be an interruption of

reliance on external sources of authority ... There must be ... a
relocation of authority within the self." (Fowler, p. 179).
5th STAGE:
INDIVIDUATIVE-REFLECTIVE
No longer defined by the groups to which they belong
Choose beliefs, values, and relationships important to

self-fulfilment
5th STAGE:
“Individuative-Reflective" faith
(21-30 years old) identifies period during which the

young adult begins to claim a faith identity no longer
defined by the composite of one’s role or meanings
to others.
This is a time of creativity and individualism that has

important implications for the nurse including patient
autonomy in planning care for the ill young adult
patient.
6th STAGE:
CONJUNCTIVE
Still rely on their own views but move from self

preoccupation or from dependence on fixed truths to
acceptanceof others’ points of view
Tend to be more tolerant and begin to consider

serving others
6th STAGE:
Conjunctive" faith
" (31-40 years old) a time of opening to the voices of

one’s “deeper self” and the development of one’s
social conscience.
Nurses caring for patients in this faith stage must be

sensitive to the adults more mature spirituality,
especially in relation to finding meaning in his or
her illness.
7th STAGE:
UNIVERSALIZING
Rare
As older adults, they begin to search for universal values, such as

unconditional love and justice.
Self-preservation becomes irrelevant. Mother Theresa and Mahatma

Gandhi are examples of people in this form of spiritual
development (Fowler, 1981).
7th STAGE:
“Universalizing" faith
(40 years and above )or what some might call

" The individual
would treat any person with compassion as
he or she views people as from a universal
community, and should be treated with
universal principles of love and justice.
THANK YOU!
Concepts of Growth
and Development
Concepts of Growth
and Development
Growth and Development

Objective
At the end of the session, the students are expected to:
Growth v.s Development
GROWTH DEVELOPMENT
Is physical change and increase in size. Is an increase in the complexity of function and skill
progression.
It can be measured quantitatively. It is the capacity and skill of a person to adapt to the
environment.
Indicators of growth includes height, weight, bone size, and Development is the behavioral aspect of growth
dentition.
Growth rates vary during different stages of growth and

development.
The growth rate is rapid during the prenatal, neonatal, infancy

and adolescent stages and slows during childhood.
Physical growth is minimal during adulthood.

Principle of Growth & Development
Growth and development Growth and development

are continuous processes proceed in an orderly
from conception until death. sequence.
Principle of Growth & Development
Different children pass All body systems do not

through the predictable develop at the same rate.
stages at different rates.
Developmental
is cephalocaudal.
Development
Development proceeds from proceeds from
proximal to distal body
parts. gross to refined
skills.
There is an optimum time for initiation
of experiences or learning.
. A great deal
Neonatal reflexes must be
of skill and
lost before development can
proceed.
behavior is
learned by
practice.
Genetics
Factors Gender
Influencing
Growth
&
Development Health
Intelligence
ENVIRONMENT
NUTRITION
TEMPERAMENT
Reaction Pattern
Activity level Rythmicity
- differs widely from each – a child with rythmicity

other manifest regular rhythm in
physiologic functions.
Approach adaptability
– ability to change one’s

– refers to the child’s reactions to stimuli over
response on initial contact time. Infants who are
with a new stimulus/ some adaptable can change their
children approach situation first reaction to a situation
in an unruffled manner. without exhibiting distress
Intensity of Reaction Distractibility
– some children react to - children who are easily

situation with whole being. distracted or who can easily
They cry loudly, thrash their shift to a new situation
arms and begin temper (distractibility) are easy to
tantrums when diaper are care for. Offer a new toy can
wet, when they are hungry, appeased but other
when their parents leave children cannot be
them. Others doesn’t’ distracted where parents
manifest such over called stubborn, willful or
symptoms of anger in unwilling to compromise
response to stress. because they refused to
adapt a change.
Attention span and Threshold of Response
persistence
.– intensity level of
– ability to remain in a stimulation that is necessary
project or activity. Some to evoke reaction. Children
infants keep trying to with low threshold need little
perform an activity even stimulation while with high
when they fail time after threshold need intense
time, other stops after one stimulation before they
unsuccessful attempt. become upset over a
situation.
Mood quality
.– a child who is always mood quality happy and ;laughing has a

positive, Parents tend to spend more time with a child who is happy than
a child with negative mood quality.
Categories
The Easy Child
The difficult Child
Slow to Warm Up
Nursing Implication to Temperament

Periods of Growth
Prenatal or antenatal development Zygote
Ovum Embryo
Periods of Growth
Fetus An unborn or unhatched vertebrate

especially after attaining the basic
structural plan of its kind
Natal
• Preterm
-Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
• Premature
-Premature birth is defined either as the same as preterm birth, or the birth of a baby before the developing
organs are mature enough to allow normal postnatal survival. Premature infants are at greater risk for short
and long term complications, including disabilities and impediments in growth and mental development.
A premature infant is a baby born before 37 completed weeks of gestation (more than 3 weeks before
the due date)
• At birth, a baby is classified as one of the following:
• Premature (less than 37 weeks gestation)
• Full term (37 to 42 weeks gestation)
• Post term (born after 42 weeks gestation)
• Post maturity is the condition of a baby that has not yet been born after 42 weeks of gestation, two
weeks beyond the normal 40
• Post mature birth do not have any harmful effects to Mother however fetus will suffer from malnutrition.
Postnatal
• Neonate
-The term infant is typically applied to young children between the ages of 1 month and 12 months;
however, definitions may vary between birth and 2 years of age
• A newborn is an infant who is only hours, days, or up to a few weeks old. In

medical contexts, newborn or neonate (from Latin, neonatus, newborn) refers to an
infant in the first 28 days after birth.
• Infancy
- latin word infans meaning “unable to speak” , a very young offspring of a human being.
• Toddler
- a child between the ages of one and three. The toddler years are a
time of great
cognitive, emotional and social development.
• Preschooler
- a child below the official school starting age, usually a child up to age five.
• School Age
- the age at which a child is considered old enough to attend school.

Adolescence
• Adolescence describes the teenage years between 13 to 19 and can be considered the
transitional stage from childhood to adulthood.
• However, the physical and psychological changes that occur in adolescence can start earlier,
during the preteen or “tween” years (age 9-12)
• Adolescence can be a time of both disorientation and discovery.
• The transitional period can bring up issues of independence and self identity
• Sometimes adolescents may be a experimenting with drugs and alcohol or sexuality. During
this time, peer groups and external appearance tend to increase in importance.
M6: Lesson 24 : Newborn: Immediate Care and Assessment
Immediate Newborn Care and

Newborn Assessment
Newborn are adjusting to the new environment. Newborn
needs to be warm by means of drying thoroughly and
putting in the mother’s abdomen which is the skin to skin
contact. Each newborn baby is carefully checked at birth for
signs of problems or complications. The healthcare provider
will do a complete physical exam that includes every body
system.
Newborn & Infant: Common
Health Problems
NCM 107: Module 32
Neonatal Common Health
Problems
Health Problem Definition Intervention
Constipation -more common -add more
bottle- fed infants, fluids
fluid deficient
or
carbohydrates/s
ugar
-adding foods
with bulk, such as

fruits and
vegetables
Common Health Problems
Constipation -more common -add more
bottle- fed infants, fluids
fluid deficient
or
carbohydrates/s
ugar
-adding foods
with bulk, such as

fruits and vegetables
-if anal sphincter is

Neontal Common Health Problems

Colic -a paroxysmal abdominal pain -feed by self demand
occurring in infants under 3 -burp the baby twice during
months of age a feeding
-face becomes red and flushed, - feed in upright position -
fists clenched, abdomen change milk formula, if
becomes tense needed
Causes: -reduce sugar content
- overfeeding
- gas distention
- too much carbohydrates tense
and unsure mother
Spitting up - due to poorly developed -feed in upright position
sphincter -position on right side
after feeding
- burp more frequently
Neonatal Common Health
Problems
Skin irritation -may be due to poor - expose to air
hygiene -irritation from - careful washing and
urine, feces or laundry rinsing of skin
products - starch bath (for
Miliaria or prickly-heat
rash)
Seborrheic dermatitis -involves sebaceous -apply mineral oil or
/cradle cap glands Vaseline on the scalp at
Infancy Common Health Problems

T -infant's chief pleasure and -during infancy and early
may not be satisfied by childhood, no need to restrain
h breast- or bottle-feeding nonnutritive sucking of the
u fingers unless the habit extends
-reaches its peak at age 18 to into the late preschool years
m
b 20 months and is most -Malocclusion may occur if
prevalent when the child is thumb sucking persists past 4 to
hungry, sick, or tired. 6 years or when the permanent
s
u teeth erupt pacifier use in
c infancy is associated with a
k
i higher incidence of
n malocclusion,

Teething -eruption of the -cold is soothing
deciduous (primary) -Giving the child a frozen
teeth teething ring or an ice
-age of tooth variation
considerable eruption among wrapped in a washcloth
cube
shows
helps
children relieve the inflammation.
-physiologic process; some nonprescription topical
discomfort is common as anesthetic ointments are
the available, such as Baby
crown of the tooth Ora- Jel
breaks through the
periodontal
membrane.
Health Problem
•-careful assessment is essential Definition Intervention
Sleep Problems
•-"Let the child1. Dyssomnias: the child has trouble
cry until falling asleep," is
either falling or staying asleep at
difficult to implement and
night, or has inappropriate
difficulty staying awakefor
certain conditions during the day.
•-parental presence at2.bedtime
Parasomnias, are characterized as
•-nurses must discuss confusional
infant sleeparousals,
problemssleepwalking,
with the mother
sleep
(and family) in addition terrors, nightmares, and
to other
rhythmic movement disorders; these
developmental aspects of newborn care.
typically occur in children 3 to 8 years
old encourage
parents to establish bedtime rituals that do not
problematic patterns.
foster
-placing infants awake in their own crib
-the bed should be used for sleeping only, not as
a playpen.
-advisable not to hang playthings over or on the
bed;
in this way the child associates the bed with
sleep, not with activity .

Head Banging -Rhythmically banging -pad the rails of crib
heads against bars of a so they cannot hurt
crib for a period of themselves
time before falling -reassure that this is a
sleep normal mechanism
-begins
half during
of the firstthe
year of life relief
for of tension
second
up to preschool period
-associated with naptime
or bedtime, lasting for
15 minutes (normal)
-use it to relax or fall
sleep

Miliaria or prickly -clusters of pinpoint, -Bathe infant twice a
heat rash reddened papules with day during hot weather
occasional vesicles and -small amount of
pustules surrounded by baking soda to be
erythema usually on added to the bath water
the neck to around the -reduce amount
ears and unto the face of clothing
down onto the trunk -lower room
-occurs most often in temperature
warm weather or when
babies are overdressed or
sleep in overheated
rooms
Infancy Common Health
Problems
Baby-Bottle Syndrome -putting an infant to bed with a -advise parents never to put
bottle can result in aspiration their baby to bed with a bottle
and decay of all the upper teeth -encourage to fill bottle with
and the lower posterior teeth water and use a nipple with
-liquid from the propped bottle a smaller hole to prevent
continuously soaks the upper the baby from receiving a
front teeth and lower back teeth amount of fluid.
large
-most serious when the bottle is -if refuses to drink anything
filled with sugar water, milk or
but milk, dilute the milk with water
fruit juice more and more each night until
-carbohydrate ferments to the bottle is down to water only.
organic acids demineralizing
the tooth enamel until it decays.
Neonate & Infant Common Health Problem
THANK YOU!
Immediate Care of the Newborn
including Assessment
NCM 107: Module 6

Essential Intrapartum Newborn Care
4 Core Steps
Immediate and thorough drying Properly timed cord clamping
Early skin-to-skin contact Non-separation of the newborn and

Icon Ic
monother for early initiation of
breastfeeding.
Immediate Care:
1. Establish and maintain a
patent airway
Image
Maintain appropriate body

temperature
3. Immediate Assessment
APGAR
APGAR
All infants appear cyanotic at the
moment of birth. They grow Muscle Tone
pink shortly after the first
breath. Mature newborns hold their
Image or icon Acrocyanosis (cyanosis of the hands Image or icon
extremities tightly flexed,
& simulating their intrauterine
feet) is so common in newborns that a
position. It is tested by observing
score of one in this category is
normal. their resistance to any effort to
Color extend their extremities
Heart Rate Reflex Irritability

Auscultating a newborn heart with a
stethoscope is the best way to Newborn’s response to a suction
Image or icon Image or icon
determine the heart rate; however, catheter in the nostrils or the
heart rate also may be obtained by response to having the sole of
observing & counting the pulsations
of the cord at the abdomen if the the feet slapped.
cord is still uncut.
APGAR
Respiratory Effort
Respirations are
counted by watching
Image or icon
respiratory
movements. A mature
newborn usually cries
and aerates the lungs
spontaneously at about
30 secs. after birth.
Image or icon
Heart Rate
• Auscultating a newborn
heart with a stethoscope is
the best way to determine
the heart rate; however,
heart rate also may be
obtained by observing &
counting the pulsations of
the cord at the abdomen if
the cord is still uncut.
Muscle Tone
• Mature newborns hold

their extremities
tightly flexed,
simulating their
intrauterine position. It
is tested by observing
their resistance to any
effort to extend their
extremities
Reflex
Irritability
• Newborn’s response
to a suction
catheter in the
nostrils or the
response to having
the sole of the feet
slapped.
Color
• All infants appear

cyanotic at the moment
of birth. They grow pink
shortly after the first
breath. Acrocyanosis
(cyanosis of the hands &
feet) is so common in
newborns that a score
of one in this category is
normal.
Criteria 0 1 2
Blue Acrocyanosis Pink
A-
ppearanc
e (Color)
0 <100 100 and
P- above
ulse
(Hear
Rate)
No response Grimace; weak cry Good, strong cry;
G - rimace sneeze
(Reflex
Score Interpretation:
0-3 Resuscitation ASAP!
4-6 Guarded → Continuous
monitoring & suctioning
7- 10 Best possible condition

Immediate Care of the Newborn including
Assessment
THANK YOU!
Physical growth is an increase in size. Development is growth in function and capability. Both
processes highly depend on genetic, nutritional, and environmental factors.
As children develop physiologically and emotionally, it is useful to define certain age-based
groups. The following terminology is used:
•Neonate (newborn): Birth to 1 month
•Infant: 1 month to 1 year
The normal growth of babies can be broken down into the following areas:
•Gross motor - controlling the head, sitting, crawling, maybe even starting to walk
•Fine motor - holding a spoon, picking up a piece of cereal between thumb and finger
•Sensory - seeing, hearing, tasting, touching and smelling
•Language - starting to make sounds, learning some words, understanding what people say
•Social - the ability to play with family members and other children
Babies do not develop at the same rate. There is a wide range of what is considered "normal."
Your baby may be ahead in some areas and slightly behind in others. If you are worried about
possible delays, talk to your baby's health care provider.
Developmental milestones are behaviours or physical skills seen in infants and
children as they grow and develop. Rolling over, crawling, walking, and talking
are all considered milestones. The milestones are different for each age range.
There is a normal range in which a child may reach each milestone. For
example, walking may begin as early as 8 months in some children. Others walk
as late as 18 months and it is still considered normal.
Below is a general list of some of the things you might see children doing at
different ages. These are NOT precise guidelines. There are many different
normal paces and patterns of development.
Infant -- birth to 1 year
•Able to drink from a cup
•Able to sit alone, without support
•Babbles
•Displays social smile
•Gets first tooth
•Plays peek-a-boo
•Pulls self to standing position
•Rolls over by self
•Says mama and dada, using terms appropriately
•Understands "NO" and will stop activity in response
•Walks while holding on to furniture or other support
Infant :
Developmental
Milestones
Sofia Magdalena N. Robles, PhDNEd, RN
LEARNING OUTCOME
 Demonstrate knowledge on infant developmental

milestone.
CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2018

Advance Organizer
Infant : Developmental Milestones
Motor Development
Fine Motor Dvelopment
Socialization and Language
Time reflexes Fade
Play
INTRODUCTION
Developmental milestones are behaviors or physical skills seen in infants and children as they

grow and develop No two babies are exactly alike but most babies reach certain milestones at
similar ages. These are the Motor

achievement
Development
of the baby
Fine Motor Dvelopment
in their motor, sensory, communication and
Time reflexes Fade
feeding functions. Play

PRE TASK
Read Icon
: https://www.marchofdimes.org/baby/developmental-milestones-for-baby.aspx
Watch: https://www.youtube.com/watch?v=oI9WE1spJFs
Make a matrix of developmental milestone.

Motor Development
Month Motor Development
0-1 Largely reflex Actions
2 Icon
Holds heads up when prone
3 Holds heads and chest up when prone
4 Turns back to front no loner has head lag;

bears partial weight on feet
5 Should turn readily front to back and back

to front
6 Beginning to show ability to sit; first tooth

(central incisor) erupts

Motor Development
Month Motor Development
7 Reaches out to be picked up; Sits
alone but only when hands are held
Icon forward for balance
8 Sits securely without support
9 Creeps or crawl (abdomen off floor);

sit steadily thatthey can lean forward
& regain their balance.
10 Pulls self to standing

11 Cruises (walks with support)
12 Stands alone, some infants take first
step

Fine Motor Development
Month Fine Motor Development
0-1 Keeps hand fisted; able to follow object to
midline with eyes
2
Icon Hold object for few mins before dropping it
3 Follows object past midlines with eyes; reach for
attractive objects infront of them
4 Bring their hands together and pull at their

clothes. THUMB OPPOSITION
5 can reach & pick up toys without being offered&
often play with their toes as objects
6 Can hold objects in both hands. PALMAR GRASP&
TONIC NECK REFLEXES – completely faded

Fine Motor Development
Month Fine Motor Development

7
Icon
Transfer objects hand to hand
8 Advanced eye-hand coordination
9
10 Uses pincer grasp (thumb and
finger) to pick up small objects
11
12 Holds cup and spoon well; helps to
dress (pushes arm into sleeve)

Month Socialization and Language

0-1
Icon
2 Makes cooing sounds; differentiates
cry
3 Laughs out loud
4
5 Say simple vowel sounds (”goo-goo”;
”gah-gah”
6 May say vowel sounds (oh-oh)

Month Socialization and Language

7
Icon
Shows beginning fear of strangers
8 Fears of strangers peaks
9 Says first word da da
10 Infant masters another word such
as “ bye-bye” or “no”
11
12 Says 2 words plus ma ma and da
da; used this words with meaning

Time Reflexes Fade
Month Time Reflexes Fade

0-1
Icon
2 Grasp reflexes fading
3 Landau reflex is strong
4 Stepping, tonic neck extrusion

reflexes are fading
5 Tonic neck reflex fading
6 Moro and Tonic neck reflex have
completely faded

Times Reflexes Fade
Month Time Reflexes Fade

7
Icon
8
9
10
11
12 Landau reflexes fades

Play
Month Play
0-1 Enjoy watching face of primary caregiver; needs play time
Icon in prone position
2 Enjoys bright colored mobiles
3 Spends time looking at hands (hand regard); “tummy

time” important during the day
4 Needs space to practice turning

5 Handles rattle well
6 Enjoys bathub toys, rubber ring for teething

Play
Month Play
7 Likes objects that are good size for transferring
Icon
8 Enjoys manipulation, rattles, and toys of different
textures
9 Needs safe space for creeping
10 Plays games like patty-cake and peek-a-boo
11 Cruising can be main activity
12 Likes toys that fit inside each other (pots and pans);
nursery rhymes, will like pull toys as soon as walking

Summary of Infant Growth and Development
MONTH MOTOR DVELOPMENT FINE MOTOR SOCIALIZATION and TIME REFLEXES PLAY
DEVELOPMENT LANGUAGE FADE
0-1 Largely reflex Keeps hands Enjoys watching
actions fisted; able to face of primary
follow object to caregiver: needs
midline with eyes
2 Holds head up Demonstrates Makes cooing Grasp reflex Enjoys bright
Iconwhen prone social smile sounds;Icon feeding colored mobiles
differentiates cry
.
3 Holds head and Follows object Laughs out loud Landau reflex is Spends time
chest up when past midline with strong lookingnat hands
prone eyes (hand regard);
Icon Icon . “tummy time”
important during
time

4 Turns back to Stepping, tonic Needs space to
front, no longer neck, extrusion practice turning
has head lag; reflexes are
bears partial fading
weight on feet
Icon Icon
5 Should turn Tonic neck Handles rattle
readily front to . reflex fading well
back and back to
front
Icon Icon
6 Beginning to show Uses palmar May say vowel . Moro and tonic Enjoys bathtub
ability to sit; first grasp sounds (oh-oh) neck reflex toys, rubber ring
tooth (central for teething
incisor) erupts

7 Reaches out to be Transfers objects Shows Likes objects that
picked up; Sits from hand to beginning of are good size for
alone but only hand fears to transferring
when hands are strangers
held forward for
balance
Icon Icon
8 Sits securely Fears of Enjoys

without support strangers peaks manipulations,
Icon Icon .
rattles and toys of
different textures
9 Creeps or crawls Says first word Needs safe space
(abdomen off (da da) for creeping
floor)
10 Pulls self to Uses pincer grasp Plays game like
standing (thumb and patty – cake and
finger) to pick up peek-a-boo.
small objects
Icon Icon
11 “Cruises” (walk “Cruising” can be
with support) . main activity
12 Stands; alone Holds cups and Says two words Landau reflex Likes toys that fit
some infants take spoon well; helps plus ma-ma and fade insise each other
Iconfirst step to dress (pushes da-da Icon . (pots and pans);
arm into sleeves) nursery rhymes;
will like pull toys
as soon as walking

POST TASK
Image or icon Image or icon
Make a Scrap Book of Developmental

Milestones of your Infancy (Put
descriptions and pictures). . .. \
Infant : Developmental Milestones
THANK YOU!
NCM 107: Module 34

M7: Lesson 29: Infancy: IMCI program on feeding
The Integrated Management for Child Illness (IMCI) process can be used by doctors, nurses and other health professionals who see
sick infants and children aged from 1 week up to five years. It is a case management process for a first-level facility such as a clinic, a
health centre or an outpatient department of a hospital.
The IMCI guidelines describe how to care for a child who is brought to a clinic with an illness, or for a scheduled followup visit to
check the child’s progress. The guidelines give instructions for how to routinely assess a child for general danger signs (or possible
bacterial infection in a young infant), common illnesses, malnutrition and anaemia, and to look for other problems. In addition to
treatment, the guidelines incorporate basic activities for illness prevention.
Counsel the mother about feeding and fluids
For many sick infants and children, you will need to assess feeding and counsel the mother about feeding and fluids.
Recommendations on FOOD, FLUID and WHEN TO RETURN are given on the COUNSEL THE MOTHER chart (referred to in this
chapter as the COUNSEL chart). Additional recommendations for the young infant are given in the TREAT THE YOUNG INFANT
AND COUNSEL THE MOTHER section of the YOUNG INFANT chart.
29.1 Feeding recommendations
Feeding Recommendations During Sickness and Health are given on the COUNSEL chart. The recommendations are listed in column
for different age groups. You need to understand all of the feeding recommendations, but you will not need to explain them all to any
one mother. You will first ask questions to find out how her child is already being fed. Then you will give only the advice that is
needed for the child’s age and situation.
These feeding recommendations are appropriate both when the child is sick and when the child is healthy. During illness, children
may not want to eat much. However, they should be offered the types of food recommended for their age, as often as recommended,
even though they may not take much at each feeding. After illness, good feeding helps make up for weight loss and helps prevent
malnutrition. When the child is well, good feeding helps prevent future illness.
Sick child visits are a good opportunity to counsel the mother on how to feed the child both during illness and when the child is well.
INFANT GROWTH &
DEVELOPMENT
NCM 107: Module 33
Growth vs Development
GROWTH DEVELOPMENT
Is physical change and increase in size. Is an increase in the

It can be measured quantitatively. complexity of function and
Indicators of growth includes height, weight, skill progression.
bone size, and dentition.
It is the capacity and skill of a
Growth rates vary during different stages of
growth and development. person to adapt to the
The growth rate is rapid during the prenatal, environment.
neonatal, infancy and adolescent stages and slows Development is the behavioral
during childhood.
aspect of growth
Physical growth is minimal during adulthood.
• Icon
Principles of • 1.Growth and
Growth and development
are continuous
Development • processes
• from
conception until
death.
• Icon
Icon
3. Different children pass through the predictable
• 2. Growth and stages
development at different rates.
proceed in an
Icon
• o systems do not develop at the
4. All body
r same rate.
d
e
Principles of Growth and
Develop Icon
5. Developmental is cephalocaudal.
Icon
6. Development proceeds from proximal to
distal body parts.
ment Icon
7. Development proceeds from gross to

refined skills.
Icon
8. There is an optimum time for initiation of

experiences or learning.
Develop Icon
Icon
distal body parts.
ment Icon

refined skills.
Icon

Develop Icon
Icon
distal body parts.
ment Icon

refined skills.
Icon

Develop Icon
9. Neonatal reflexes must be lost

before development can
proceed.
Icon
10. A great deal of skill and behavior is learned by
practice.
ment Icon
Icon
Factors Influencing Growth and Development
1. GENETICS
2. GENDER 5. ENVIRONMENT
Icon Icon
3 .HEALTH 6. Nutrition
7. TEMPERAMENT
Icon 4. INTELLIGENCE Icon
PERSONALITY THEORY
THEORY AG FOCUS/TASK
PHASE E
Psychosexual/ Oral 0-1 year Major task:
Psychoanalytical Weaning
Erikson’s 0-12 to 18 Trust vs. Mistrust

Psychosocial months
Cognitive Theory 0- 2 sensorimotor

(Piaget) years:
INFANT GROWTH & DEVELOPMENT
THANK YOU!
IMCI PROGRAM FOR
INFANT FEEDING
NCM 107: Module 38

NUTRITION
The First 6 Month (Wong)
Human milk: most desirable Daily supplements of vitamin D

and vitamin B1, may be
comIcpnlete diet for the infant indicated if mother's intake of
these vitamins is inadequate
during the first 6 months .
A healthy term infant receiving breast milk from
a well nourished mother usually requires no
specific vitamin and mineral supplements except
iron by 4 to 6 months of age (when fetal iron
stores are depleted).
NUTRITION

 Daily supplement of 200
IU of vitamin D beginning in  Iron supplementation is recom-
Icthe first of life to all
months mended after 4 to 6 months if
infant is exclusively breast-fed to
2(including
o infants
those exclusively offset the decrease in
breast-fed) to prevent rickets available in human milk at
and vitamin D deficiency. iron
time
this and to enhance
erythropoiesis.
 Recommendation by the
American Academy of Pediatrics
(2003)
NUTRITION
 First 4 months of life, infants  Excessive intake of water in

who are breast or bottle-fed do infant may result in water
not require additional fluids, intoxication, failure to thrive, and
especially water or juice hyponatremia
 Fluoride supplementation
exclusively in not
breast-fed children
required for the first 6 months:risk
of dental fluorosis
American Academy of
Pediatrics (2003)
NUTRITION
 Daily supplement of 200 IU

of vitamin D beginning in the  Iron supplementation is
first n2 months of life to all recommended after 4 to 6
infants months if
infant is exclusively breast-fed to
(including those exclusively offset the decrease in iron
breast-fed) to prevent rickets available in human milk at this
and vitamin D deficiency. time and to enhance
erythropoiesis.
American Academy of
Pediatrics (2003)
NUTRITION
The SECOND 6 Month (Wong)
 Human milk or formula:  Fluoride supplementation

primary source of nutrition. begins depending on the
infant's intake
of fluoridated tap water

.
 if breast-feeding is discontinued,
a commercial iron-fortified
formula
should be substituted.
)
IMC
I
The Integrated Management of Childhood Illness (IMCI) is an integrated approach to child
health that focuses on the well-being of the whole child (IMCI aims to reduce death, illness
and disability, and to promote improved growth and development among infants and
children aged less than 5 years. IMCI includes both preventive and therapeutic elements
that are implemented by families and communities as well as by health workers in facilities.
Image
IMCI consists of numerous clinical algorithms and training materials that assist nurses and
other primary health-care workers to manage sick infants and children presenting to
health facilities, and were developed largely to suit low-resource settings. IMCI includes
growth charts for infants aged 0–2 months and 2–59 months. Nutrition assessment is
integral to the evaluation of sick infants and children and is also central to the care of the
well child and promoting their health and development. IMCI therefore includes algorithms
for use by health workers based at primary health-care facilities that reflect WHO
recommendations on anthropometric assessment and infant and child feeding.
Image
IMCI PROGRAM FOR INFANT FEEDING
THANK YOU!

Infant: Health Needs and
Health Promotion
Activities
NCM 107: Module 35
Health Needs and Health
Promotion Activities for the
Infant
PHYSICAL NEEDS
BATHING CARE OF THE TEETH
Icon Icon
DIAPER-AREA CARE DRESSING

Icon Icon
Health Needs and Health Promotion Activities for the Infant
PHYSICAL NEEDS
SLEEP
EXERCISE
EMOTIONAL & SOCIAL NEEDS
4 months:
when a person who has been playing with
One month old: can and entertaining the infant leaves,
differentiate between faces an infant is likely to cry to
and other objects by show he or she enjoyed the interaction,
studying a face or a recognize the primary caregiver
pictucI roenof a face longer
than other objects
5 months:
maIcyonshow displeasure when an object
is taken away
EMOTIONAL & SOCIAL NEEDS
•6 months:
increasingly aware of the 9 month:
difference of people who aware of changes in tone
regularly care for them of voice,
and strangers, begin to cry when scolded not because
backIcon draw
from unfamiliar people they understand what is being
said
•7 months: but because they sense their
obvious fear of strangers parent’s displeasure
• Ic
months: 12 months:
fear of strangers at its fear of strangers overcomed,
height (eight-month alert and responsive when
approached
8o
anxiety)
n
Infant: Health needs and Health Promotion Activities
THANK YOU!
INFANT:
APPLICATION TO
NURSING PROCESS
NCM 107: Module 36

NCP: Assessment
Primary Source of Information: Mother

/Caregiver
Icon Nutrition n
. Growth and
Development
Sleep and Parent Adjustment

Activity
NURSING DIAGNOSIS
Image
NURSING DIAGNOSIS
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NURSING DIAGNOSIS
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OUTCOME/EVALUATION
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INFANT: APPLICATION TO NURSING
PROCESS
THANK YOU!
VACCINE REQUIREMENTSThere is no federal law that
requires vaccination. However, each state has their own laws
about which vaccines are required for children to attend public
or private school, daycare, or college. The CDCTrusted
Source (Links to an external site.) provides information on how
each state approaches the issue of vaccines.
Here are the essentials to know about each of these vaccines.

HepB protects against hepatitis B (Links to an external site.) (infection of the liver). HepB is givenin three shots. The
first shot is given at the time of birth. Most states require HepB vaccination for a child to enter school.
RV protects against rotavirus (Links to an external site.), a major cause of diarrhea. RV is given in two or three doses,
depending on the vaccine used.
DTaP protects against diphtheria (Links to an external site.), tetanus (Links to an external site.), and
pertussis (Links to an external site.) (whooping cough). It requires five doses during infancy and childhood. DTaP
boosters are then given during adolescence and adulthood.
Hib protects against Haemophilus influenzae type b. This infection used to be a leading cause of
bacterial meningitis (Links to an external site.). Hib vaccination is given in three or four doses.
•PCV protects against pneumococcal disease, which includes
pneumonia (Links to an external site.). PCV is given in a series of four doses.
•IPV protects against polio (Links to an external site.) and is given in four doses.
•Influenza (flu) protects against the flu. This is a seasonal vaccine that is given yearly.
Flu shots (Links to an external site.)can be given to your child each year, starting at age 6
months. Flu season can run from September through May.
•MMR protects against measles (Links to an external site.),
mumps (Links to an external site.), and rubella (Links to an external site.) (German
measles). MMR (Links to an external site.) is given in two doses. The first dose is
recommended for infants between 12 and 15 months. The second dose is usually given
between ages 4 and 6 years. However, it can be given as soon as 28 days after the first
dose.
•Varicella protects against chickenpox (Links to an external site.). Varicella is
recommended for all healthy children. It’s given in two doses.
•HepA protects against hepatitis A (Links to an external site.). This is given as two doses
between 1 and 2 years of age.
INFANT
IMMUNIZATION
NCM 107: Module 37
GENERAL PRINCIPLE FOR CHILD IMMUNIZATION
It is safe and immunologically effective to

The vaccination schedule should not
administer all EPI be restarted from the beginning even if
vaccine on the same day at different sites of the
the body. interval
Image or ic between doses exceeded the
rmI eacgoe mro mcioennded interval by months or
years.
Measles vaccine should be given as soon as Moderate fever, malnutrition, and

the child is 9 months old, respiratory infection, cough, diarrhea and
regardless of whether other vaccines will be vomiting
Image or ogniven on that
are not contraindications to
vaccination.
day.  Generally, one should immunize
unless the child is so sick that he
needs
Image or icon
to be hospitalized.
Then the hospital needs to decide
on when to immunize the child.
CONTRAINDICATION ON
IMMUNIZATION
DPT2 or DPT3 to a child

who has had convulsions
or shock within 3 days
of the previous dose
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BCG vaccine to a child

with clinical AIDS
Repeat BCG vaccination

if the child does not
develop
a scar after the 1st
injection.
Routine Immunization
Schedule for Infants
Vaccine Number of Doses
Minimum Age at
1st
Dos
e
Diphtheria- 6 weeks old 3 doses
Pertussis-
Tetanus
Vaccine
Oral Polio Vaccine 6 weeks old 3 doses
INFANT IMMUNIZATION
THANK YOU!

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IMMEDIATE CARE OF

P-ulse / Heart rate 0 <100 100 & above

G-rimace No response Grimace/ Good strong

0-3 Resuscitation ASAP!

• Hypoglycemia may result from hypothermia

• Hypothermia causes cold stress.

• Eye care with the administration of erythromycin eye ointment is

The best index of growth is WEIGHT

GROWTH takes place in the first 20 years of life

Development continues after 20

Failure in achievement of developmental

Successful achievement of developmental

BONE AGE is a general index of

Girls are more advanced than boys

NEONATE / NEWBORN - an infant in the first 28 days after birth

The Personality Development

Psychosocial theory ( Erik Erikson )

Cognitive theory ( Jean Piaget )

Moral development theory (Lawrence Kohlberg)

Spiritual Development theory ( James Fowler )

Oral 0- 1 yr Site of gratification: Mouth

Anal 1 - 3 yrs Site of gratification: Anus

Phallic 3- 5 years Site of gratification: Genitals

Latency 6- 12 years Site of gratification: (School Activities)

Genital 12 & above Site of gratification: Genitals

Anal 1- 3 years Major task: Toilet training

Phallic 3- 5 years Major task: Oedipal & Electra complex

Genital 12 & above Major task: Sexual intimacy

Anal toddler Help children achieve with bowel control

Psychosocial theory ( Erik Erikson )

• When the environment makes new demands on people, the conflicts

• Only when each crisis is resolved, which involves a change in the

• If a person is unable to resolve a conflict at a particular stage, they will

1- 3 yrs Autonomy vs S/D Self-Control

3- 5 yrs Initiative vs Guilt Direction and purpose

6- 12 yrs Industry vs inferiority Competence and method

13- 18 Identity vs Role Confusion Devotion and fidelity

19-40 yrs Intimacy vs. Isolation relationship

41-65 yrs Generativit Self confident

65 and above Integrity vs Despair Feeling good about

Identity Provide opportunities to discuss feelings about events

Piaget’s theory of Cognitive Development

Piaget: Cognitive Development

Concrete operational (7-12)

Formal operational (12 to adulthood)

F. Intervention of new Transitional phase of preoperational thought period. Uses

KOHLBERG’S STAGES OF MORAL

• Punishment or obedience (heteronymous morality)

• A child does the right things because a parent tells

• Child is UNABLE to understand other’s viewpoint

• Child carries out actions to satisfy own needs rather

• The child does something for another if that person

• Orientation to interpersonal relations of mutuality-

• A child follows rules because of a need to be a good

• “Good boy or Good girl”

• Maintenance of social order, fixed rules and authority

• Child FOLLOWS RULES of authority figures as well

• LAW and ORDER

• Stage 5 Age Group : 12 and above

• child FOLLOWS STANDARDS OF SOCIETY for

• Stage 6 Age :older than 12

Age Nursing implication

Post Oder than 12 years Adolescents can be responsible for