Growth and Development The Neonate/Infant Chapter 6

Growth and Development The Neonate/Infant Lesson 6 Polan - Chapter 6
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Neonate Period last from_____ to____?
Birth , 4 weeks
Infant Period lasts from_____ to____?
5th week to walking
Apgar Score is taken at?
1 minute after birth, and again 5 minutes later
APGAR Score 5 essential categories of functioning assessed?
color, reflex, irritability , heart rate, respiratory rate, and muscle tone. This score gives an immediate picture of the newborns overall status
Head/Skull size is ?
Large in proportion to rest of body Ave 14 inches (33 - 35.5 cm) diameter 1 inch larger than chest
Sutures -
6 soft bones separated by band of cartilage
Fontanels -
Two soft spots - anterior and posterior
Head/Skull Assessment
Palpate for presence of sutures and fontanels
Anterior (diamond shape) fontanel closes at ?
12-18 months
Posterior (triangular shape) fontanel closes at?
4 months
Molding is used when?
skull elongated or misshapen (for a few days after birth is temporary)
Neonates are Treated with erythromycin A birth because it -
prevents against blindness related to gonorrhea
Neonates Eye color -
slate grey to dark blue( No tears for 4 weeks)
Face characteristics of neonate?
Small ,Eyes swollen, Flat nose, receding chin Gums pink and moist
Teeth -
not present for 6/7 months usually bottom first
Length is measured -
From head to heel
Neonate Average length?
20" - range of 19 - 21" Grows 1"/month first year
Neonates Average Weight?
7.5 lb - range 5.5 to 10 lb
Normal physiological weight loss?
Loses 10% birth weight first few days of life (Regains initial wt loss)
Infants usually Doubles birth wt by ?
5-6 months
Triples birth wt by ?
first birthday
75% body weight consists of?
water
Acrocyanosis -
hands and feet blue
Mongolian spots -
irregular pigmented area in LS region, usually fades by age 4 years
Physiologic jaundice
yellow color to skin and sclera 48 - 72 hours after birth
Lanugo -
down like hair
Vernix caseosa -
cottage cheese like substance that protects fetus from amniotic fluid - "nature's hand lotion"
Milia -
white spots on nose, chin - retention of sebaceous material in sebaceous glands
Abdomen characteristics?
Large and flabby, Umbilical cord tied/clamped and cut falls off in 10 days (avoid tub bath until it falls off Wipe with alcohol after each diaper change)
Stools characteristics?
BM vary in color, consistency and general appearance average 4-6 BM/day
Meconium -
Stool in first 24 hours Black/green, sticky, tarry, odorless
Transitional Stool is?
Brown to yellow to green
Breastfed Stool is?
Light seeded mustard stool, sweet odor
Formula fed stool is?
Semisolid tan or pasty yellowish in color, distinct odor
Genitals Characteristics-
Scrotum large and edematous, Palpate for presence of testicles, Should descend by 7th month of fetal life If not - check regularly for several months Check penis for urethral opening, Labia - swollen, pseudomenstruation
Circumcision -
remove foreskin surgically
Breasts may be-
swollen in boys and girls May have some leakage of "milk" from nipples - "Witch's milk"
Neonate Voiding-
Within 24 hours after birth ( average 8-10 times per day)
Extremities Characteristics-
Short in proportion to rest of body, Keeps in tightly flexed position, Examine for ROM , symmetry, reflex, Check for extra gluteal fold in upper legs, Count fingers and toes, Check for deep creases deep in foot and palms, Preterm infants have fine lines
Neurological Characteristics-
Reflexes, Sensory Abilities, Nervous system is immature
Reflexes assessment helps to ?
Gauge response to environment indicates normal neuro system approximates gestational age
Neuro Assessment Checks -
Reflexes, Posture, Movement, Muscle tone
Protective Reflexes-
Blinking, Sneezing ,Swallowing ,Gag Reflex
Moro-
Sudden movement of jarring or position causes extension and adduction of extremities (disappears by 3-4 months)
Tonic Neck-
if head of newborn is turned to one side, infant will extend arm and leg on that side (disappears by 5 months)
Rooting-
When newborns cheek is gently stroked, infant turns toward that side and opens mouth (disappears by 4-6 months)
Sucking -
Newborn makes sucking movements when anything touches lips or tongue (diminishes by 6 months)
Babinski-
When newborn's sole is stroked, toes hyperextend and fan outward, big toe turns upward (disappears by 3 months)
Palmar Grasp-
Newborn briefly grasps any object placed in hands ( disappears by 3 months, present from age 6 weeks)
Plantar reflex-
This reflex occurs when you stroke the sole of baby's foot, his toes will spread open and the foot will turn slightly inward. It is also known as the Babinski reflex. This reflex is fun to watch. By the end of the first year this reflex is usually gone.
Vision Abilities-
Can track objects, React to light, Acuity - much less acute than adult Can focus 8-10" @ 4 months By 6 months 20/100 or better Movement is unequal - nystagmus 4 months binocular,Depth perception more precise at 7 months
Sensory Abilities Ears-
Check position, Loud, low frequency sounds 6-8 weeks recognize caregiver's voice
Taste Abilities -
-Can differentiate at birth
Smell ability is?
Present at birth
Normal Temp -
Axillary 97.7 - 99.5° F
Normal Pulse
Apical 120 -160 bpm (May go as low as 100 or as high as 180 Must be apical for one full minute)
Normal Respirations -
30 - 60 bpm (irregular, shallow, diaphragmatic Brief periods of apnea, Watch abdomen rise and fall)
Normal Blood Pressure -
Dinamap - 65/40
Head control in?
2 month
Roll over in?
4 months
Roll both ways in?
6 months
Sitting in?
7 months
Crawling in?
9 months
Creeping in?
10 months
Walking in?
12 - 15 months
Hold bottle by?
6 months
Hand preference by?
7-8 month
Pincer grasp by?
7th month
Attachment -
Bonding with mother
Engrossment -
bonding with father
Temperament -
inborn and Determines mood of infant and infant's willingness to interact with others
Parental guidance -
Need for discipline Distraction - up to 6 months, Direct - after 6 months - "NO", understands tone of voice, Focus on praising the positive, desirable behavior ,GOAL - Teach impulse control and set limits
Sensorimotor -
Understanding of environment by interacting with it Using observation and sensory perception Repetitive acts develop the child's ability to think
Moral Development-Infant ]
has no conscious or system of values React to pain and love and Judge behavior on basis of how it affects them Satisfaction of needs are the Motivational forces guiding behavior based on satisfaction
Infants Smile at?
2 months
Infants Babble at?
3 months
Infants first word?
"da da" at 8 months ( will say 4-6 words at 12 months)
Watch for Delays like?
Certain persistence of reflexes, No response to sounds, No grasp, Not meeting movements when expected, Delayed gesturing - waving
Nutrition needs -
Breast vs Bottle- Feeding, Solid foods by 6 months Introduction of Foods Slowly One at a time to prevent food allergy development
Infant needs include?
Sleep, Play, and safety
Normal sleep patterns Neonate -
20 hours
Normal sleep patterns At one year -
12 hours
Infant Needs Play for?
G&D, socialization(First year - non symbolic - helps infant gain information about objects ,Age appropriate playthings, Solitary Play
What requires medical attention?
Fever >101 F, Difficult, labored breathing, Unexplained rash, Absence of stools or urine, Persistent vomiting and/or diarrhea, Extreme lethargy or hyperirritability
Common Immunizations given include?
Hepatitis B (Hep B), Diptheria/Tetanus/Pertussis (DTaP), Inactivated Polio Vaccine (IPV), Haemophilus influenza (Hib), Pneumococcal Conjugate (PCV),Influenza
Possible Side effects to routine immunization Minor-
Localized tenderness, Irritability, Erythema,swelling at site
Possible Side effects to routine immunization Major-
Increased temp > 102° ,loss of consciousness, Paralysis, Persistent, inconsolable crying
Well Child Visits are Usually?
in line with immunization schedule 2, 4, 6, and 12 months)
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