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4. Neonatal & Infancy period.pptx

  1. 1. Pediatric Nursing (Seminar - 4) Growth & Development A. Neonatal & Infancy Period Tagreed Awad Khalid KU – Nursing Collage - PhD (4) 2016
  2. 2. Objectives At the end of this presentation, the objectives should be achieved are: 1. Discuss physical growth and Physical Development of newborn and infant • Growth Parameters. • Organ maturation • Reflexes • Sensory maturation
  3. 3. Introduction O The newborn (1-7days) and neonatal (8- 28days) O Infancy is defined as the period from 29days to 12 months of age. O Growth and development are interrelated, ongoing processes in infancy and childhood. O Growth and developmental changes in the first year of life are numerous and dramatic. O Physical growth, maturation of body systems, and gross and fine motor skills progress in an orderly and sequential fashion
  4. 4. Outlines: 1. Physical parameters. 2. Organs development. 3. Reflexes 4. Sensory development.
  5. 5. Physical Growth O Indicators of physical growth in the newborn and infant are - Weight - Length - Head and chest circumference
  6. 6. Physical Growth Weight O The average newborn weighs 7 lb 8 oz (3,400 g) at birth. O Newborns lose up to 10% of their body weight over the first 5 days of life. O Then gains about 20 to 30 g per day and regains his or her birth weight by 10 to 14 days of age. O Infants double their birth weight by 4 to 6 months of age O Triple their birth weight by the time they are 1 year old.
  7. 7. 17-7 Height O The average length of newborn at birth is 19 to 21 inches (48 to 53 cm) . O During the first 6 months, length increases by 1 inch (2.5 cm) per month, O Half-inch per month in the second 6 months. Physical Growth
  8. 8. Physical Growth O Head and Chest Circumference O Average head circumference of the full-term newborn is 13 to 14 inches (33 to 35 cm). O The head circumference is about 1 inch (2 to 3 cm) greater than the chest circumference, which averages 12 to 13 inches (30.5 to 33 cm). O The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 inch (1.5 cm) per month. O From 6 to 12 months of age, the head circumference increases an average of 0.2 inch (0.5 cm) monthly.
  9. 9. Physical Growth
  10. 10. Physical Growth O Organ System Maturation O The newborn and infant’s organ systems undergo significant changes as the infant grows. 1. Neurologic System O The infant experiences tremendous changes in the neurologic system over the first year of life. O Critical brain growth and continued myelinization of the spinal cord are occurring. O Involuntary movement progresses to voluntary control, and immature vocalizations and crying progress to the ability to speak as a result of maturational changes of the neurologic system.
  11. 11. Neurologic System States of Consciousness A normal newborn will ordinarily move through six states of consciousness: 1. Deep sleep: The infant lies quietly without movement. 2. Light sleep: The infant may move a little while sleeping and may startle to noises. 3. Drowsiness: Eyes may close; the infant may be dozing. 4. Quiet alert state: The infant’s eyes are open wide and the body is calm. 5. Active alert state: The infant’s face and body move actively. 6. Crying: The infant cries or screams and the body moves in a disorganized fashion
  12. 12. Brain Growth O Increase in head circumference is indicative of brain growth. O By 6 months of age the infant’s brain weighs half that of the adult brain. O At age 12 months, the brain has grown considerably, weighing 2½ times what it did at birth. O Usually, the anterior fontanel remains open until 12 to 18 months of age to accommodate this rapid brain growth. O Myelination of the spinal cord and nerves continues over the first 2 years. O Maturation of the nervous system and continued myelination are necessary for developmental skills that are achieved in the first 12 months.
  13. 13. Reflexes O Primitive reflexes are subcortical and involve a whole body response. O Reflexes are: 1. Primitive reflexes 2. Protective reflexes (postural responses or reflexes)
  14. 14. Primitive Reflexes 1. Rooting reflex: O When infant’s cheek is stroked, the infant turns to that side, searching with mouth O It appears at birth and disappear at 3months of age
  15. 15. Suck reflex O Reflexive sucking when nipple or finger is placed in infant’s mouth O It appears at Birth and disappears 2– 5 months of age
  16. 16. Primitive Reflexes Moro Reflex O With sudden extension of the head, the arms abduct and move upward and the hands form a “C.” O It appears at birth and disappears at 4months of age.
  17. 17. Asymmetric tonic neck reflex O While lying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexed (also called the “fencing” position). O It appears at Birth and disappears at 4 months.
  18. 18. Palmar grasp Reflex O Infant reflexively grasps when palm is touched. O Appears at Birth and disappears at 4–6 months
  19. 19. Plantar grasp Reflex: O Infant reflexively grasps with bottom of foot when pressure is applied to plantar surface. O Appears at Birth and disappears at 9 months
  20. 20. Babinski Reflex: • Stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension of the toes. • Appears at Birth and disappears 12 months
  21. 21. Step Reflex: O With one foot on a flat surface, the infant puts the other foot down as if to “step.” O Appears at Birth and disappears at 4–8 weeks
  22. 22. Protective reflex Neck righting Reflex O Neck keeps head in upright position when body is tilted. O Appears 4–6 months and Persists
  23. 23. Parachute (sideways) O Protective extension with the arms when tilted to the side in a supported sitting position O Appears at 6 months and Persists Protective Reflex
  24. 24. Parachute (forward) O Protective extension with the arms when held up in the air and moved forward. The infant reflexively reaches forward to catch himself or herself. O Appears at 6–7 months and Persists Protective Reflex
  25. 25. Protective Reflex Parachute (backward) O Protective extension with the arms when tilted backward O Appears at 9–10 months and Persists
  26. 26. O Coughing reflex Protect child from swallowing object that enter the trachea It is a permanent reflex Protective Reflex
  27. 27. O Sneezing reflex Protect child from air way obstruction by rejection of any object that enter the upper respiratory tract It is a permanent reflex Protective Reflex
  28. 28. O Swallowing reflex Protect child from swallowing object that that obstruct pharenx. It is a permanent reflex Protective Reflex
  29. 29. Organ Maturation Respiratory System O The respiratory system continues to mature over the first year of life. O The respiratory rate slows from an average of 30 to 60 breaths in the newborn to about 20 to 30 in the 12-month-old. O The respiratory system reach adult levels of maturity about 7 years of age.
  30. 30. O In comparison with the adult, in the infant: • The nasal passages are narrower. • The trachea and chest wall are more compliant. • The bronchi and bronchioles are shorter and narrower. • The larynx is more funnel shaped. • The tongue is larger. • There are significantly fewer alveoli.
  31. 31. Organ Maturation O Cardiovascular System O The heart doubles in size over the first year of life. O As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1- year-old. O Blood pressure steadily increases over the first 12 months of life, from an average of 60/40 in the newborn to 100/50 in the 12- month-old. O Over the first year of life, thermoregulation (the body’s ability to stabilize body temperature) becomes more effective
  32. 32. Organ Maturation Gastrointestinal System Teeth O Occasionally, an infant is born with one or more teeth (termed natal teeth) or develops teeth in the first 28 days of life (termed neonatal teeth). O On average, the first primary teeth begin to erupt between the ages of 6 and 8 months. O The primary teeth (termed deciduous teeth) are lost later in childhood and will be replaced by the permanent teeth. O The gums around the emerging tooth often swell. O The lower central incisors are usually the first to appear, followed by the upper central incisors O The average 12-monthold has four to eight teeth.
  33. 33. Organ Maturation Digestion O The newborn’s digestive system is not developed fully. O Small amounts of saliva are present for the first 3 months of life and ptyalin is present only in small amounts in the saliva. O Gastric digestion occurs as a result of the presence of hydrochloric acid and rennin. O The small intestine is about 270 cm long and grows to the adult length over the first few years of life.
  34. 34. O The stomach capacity is relatively small at birth, holding about one- half to 1 ounce., O By 1 year of age the stomach can accommodate three full meals and several snacks per day. O In the duodenum, three enzymes in particular are important for digestion.  Trypsin is available in sufficient quantities for protein digestion after birth.  Amylase (needed for complex carbohydrate digestion)  lipase (essential for appropriate fat digestion) are both deficient in the infant and do not reach adult levels until about 5 months of age.
  35. 35. O The liver is immature at birth. O The ability to conjugate bilirubin and secrete bile is present after about 2 weeks of age. O Conjugation of medications may remain immature over the first year of life. O Other functions of the liver, including - Gluconeogenesis - Vitamin storage - Protein metabolism, remain immature during the first year of life.
  36. 36. Stools O The consistency and frequency of stools change over the first year of life. O The newborn’s first stools (meconium) are the result of digestion of amniotic fluid swallowed in utero (dark green to black and sticky) O In the first few days of life the stools become yellowish or tan. O The formula-fed infant has stools the consistency of peanut butter. O Breastfed infants’ stools are usually looser in texture and appear seedy.
  37. 37. O Newborns may have as many as 8 to 10 stools per day O After the newborn period, the number of stools may decrease, and some infants do not have a bowel movement for several days. O Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement.
  38. 38. Organ Maturation O Genitourinary System O In the infant, extracellular fluid (lymph, interstitial fluid, and blood plasma) accounts for about 35% of body weight and intracellular fluid accounts for 40%, compared with the adult quantities of 20% and 40%, respectively O the infant is more susceptible to dehydration. Infants urinate frequently and the urine has a relatively low specific gravity. O The renal structures are immature and the glomerular filtration rate, tubular secretion, and reabsorption as well as renal perfusion are all reduced compared with the adult. O The glomeruli reach full maturity by 2 years of age.
  39. 39. Organ Maturation Integumentary System O Acrocyanosis (blueness of the hands and feet) is normal in the newborn; it decreases over the first few days of life O Mottling of the skin (a pink-and-white marbled appearance) because of their immature circulatory system, decreases over the first few months of life. O The newborn and young infant’s skin is relatively thinner than that of the adult, with the peripheral capillaries being closer to the surface.
  40. 40. O Hematopoietic System O At birth, fetal hemoglobin (HgbF) is present in large amounts. O After birth the production of fetal hemoglobin nearly ceases, and adult hemoglobin (HgbA) is produced in steadily increasing amounts throughout the first 6 months. O During the last 3 months of gestation, maternal iron stores are transferred to the fetus. The newborn typically has 0.3 to 0.5 g of iron stores available. Organ Maturation
  41. 41. O High hemoglobin concentration of the newborn decreases over the first 2 to 3 months, iron is reclaimed and stored. O These stores may be sufficient for the first 6 to 9 months of life
  42. 42. O Immunologic System O Newborns receive large amounts of IgG through the placenta from their mothers. O This confers immunity during the first 3 to 6 months of life for antigens to which the mother was previously exposed. O Infants then synthesize their own IgG, reaching approximately 60% of adult levels at age 12 months
  43. 43. O IgM is produced in significant amounts after birth, reaching adult levels by 9 months of age. O IgA, IgD, and IgE production increases very gradually, maturing in early childhood
  44. 44. O Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. O Though they mature at different rates, sight, smell, taste, and touch all continue to develop after birth. Sensory Development
  45. 45. Sight O The newborn is nearsighted, view objects at a distance of 8 to 15 inches. O Newborns prefer the human face to other objects and may even imitate the facial O At 1 month of age the infant can recognize by sight the people O The ability to fuse two ocular images into one cerebral picture (binocularity) begins to develop at 6 weeks of age and is well established by 4 months of age. O Full color vision develops by 7 months of age, as do distance vision and the ability to track objects. Sensory Development
  46. 46. O Hearing O The newborn’s hearing is intact at birth and as acute as that of an adult. O Newborns prefer the sound of human voices to nonhuman sounds. O By 1 month of age the infant can recognize the sounds of those he or she knows best. Sensory Development
  47. 47. O Smell and Taste O The sense of smell develops rapidly: the 7-day-old O infant can differentiate the smell of his or her mother’s breast milk from that of another woman and will preferentially turn toward the mother’s smell. Newborns prefer sweet tastes to all others. O This persists for several months, and eventually the infant will accept non- sweet flavors. Sensory Development
  48. 48. O Touch O The sense of touch is perhaps the most important of all the senses for newborn communication. O The infant prefers soft sensations to coarse sensations. O The infant dislikes rough handling and may cry. O Holding, stroking, rocking, or cuddling calms infants when they are upset and makes them more alert when they are drowsy. Sensory Development
  49. 49. Cognitive Development O The first stage of Jean Piaget’s theory of cognitive development is referred to as the sensorimotor stage (birth to 2 years) O Infants learn about themselves and the world through their developing sensory and motor capacities. O Infants’ development from birth to 1 year of age can be divided into four sub-stages within the sensorimotor stage: - Reflexes - Primary circular reaction, - Secondary circular reaction - Coordination of secondary schemes.
  50. 50. Sensorimotor (birth to 2 years) O Sub- stage 1: O use of reflexes (birth to 1 month) O Infant uses senses and motor skills to learn about the world. O Reflexive sucking brings the pleasure of ingesting nutrition. O Infant begins to gain control over reflexes and recognizes familiar objects, odors, and sounds
  51. 51. Sub- stage 2: O Primary circular reactions (1 to 4 months) O Thumb sucking may occur by chance; then the infant repeats it on purpose to bring pleasure. O Imitation begins. O Object permanence begins. (4 and 7 months ) essential for the development of self-image
  52. 52. Substage 3: Secondary circular reactions O 4 to 8 months Infant repeats actions to achieve wanted results (e.g., shakes rattle to hear the noise it makes). O The infant’s actions are purposeful but the infant does not always have an end goal in mind.
  53. 53. Sub-stage 4: Coordination of secondary schemes (8 to12 months) O Infants coordinate previously learned schemes with previously learned behaviors. They may grasp and shake a rattle intentionally or crawl across the room to reach a desired toy. Infant can anticipate events. O Object permanence is fully present at about 8 months of age. O The infant begins to associate symbols with events (e.g., waving goodbye means someone is leaving).
  54. 54. O Psychosocial Development O Erik Erikson (1963) identifies the psychosocial crisis of infancy as Trust versus Mistrust. O Development of a sense of trust is crucial in the first year, as it serves as the foundation for later psychosocial tasks. O The parent or primary caregiver can have a significant impact on the infant’s development of a sense of trust. O The infant develops this sense of trust, When his needs are consistently met.
  55. 55. Activities that promote a sense of trust in infancy: - Feeding - Changing diapers - Cleaning - Touching - Holding - Talking
  56. 56. O Motor Skill Development O Infants exhibit phenomenal increases in their gross and fine motor skills over the first 12 months of life. Gross Motor Skills O The term “gross motor skills” refers to the use the large muscles (e.g., head control, rolling, sitting, and walking). O Gross motor skills develop in a cephalocaudal fashion (from the head to the tail
  57. 57. O The baby learns to lift the head before learning to roll over and sit . O First the infant achieves head control, then the ability to roll over, sit, crawl, pull to stand, and, usually around 1 year of age, walk independently.
  58. 58. O Fine Motor Skills O Fine motor development includes the maturation of hand and finger use. O Fine motor skills develop in aproximodistal fashion (from the center to the periphery) O The infant first bats with the whole hand, eventually progressing to gross grasping, before being capable of fine fingertip grasping O By 12 months of age the infant should be able to eat with his or her fingers and assist with dressing (e.g., pushing an arm through the sleeve).
  59. 59. O Communication and Language Development O For several months, crying is the only means of communication for the newborn and infant. O The basic reason for crying is unmet needs. O The 1- to 3-month coos, makes other vocalizations, and demonstrates differentiated crying. O At 4 to 5 months of age makes simple vowel sounds, laughs aloud, and vocalizes in response to voices.
  60. 60. O infant also responds to his or her own name and begins to respond to “no.” Between 4 and 7 months O The infant begins to distinguish emotions based on tone of voice. Squealing and yelling begin around 6 months of O age; these may be used to express joy or displeasure. O At age 7 to 10 months, babbling begins and progresses O to strings (e.g., mamama, dadada) without meaning. O The infant at this age is also able to respond to simple O commands. At 9 to 12 months of age the infant begins O to attach meaning to “mama” and “dada” and starts to O imitate other speech sounds
  61. 61. O The average 12-monthold: - Uses two or three recognizable words with meaning - recognizes objects by name - starts to imitate animal sounds. At this age, the infant pays increasing attention to speech and tries to imitate words
  62. 62. O It is very important for the parent or caregiver to talk to the infant in order for the infant to learn communication skills. O Sometimes regression in language development occurs briefly when the child is focusing energy on other skills, such as crawling or walking. O As long as the infant’s hearing is normal, language acquisition should continue to progress. O Infants in bilingual families may “language mix” (uses some words from each language)
  63. 63. O Social and Emotional Development O The newborn spends much of the time sleeping, but by 2 months of age the infant is ready to start socializing. O The infant exhibits a first real smile at age 2 months. O He or she spends a great deal of time while awake watching and observing what is going on around him or her. O By about 3 months of age the infant will start an interaction with a caregiver by smiling widely and possibly gurgling and responds with more smiling, cooing, and gurgles as well as moving the arms and legs.
  64. 64. O The 3- to 4-month-old will also mimic the parent’s facial movements, such as widening the eyes and sticking out the tongue. The baby may hesitate at first O The infant may cry when the pleasant interaction stops. O At 6 to 8 months of age the infant may enjoy socially interactive games such as patty-cake and peek-a-boo
  65. 65. O Stranger Anxiety O Around the age of 8 months the infant may develop stranger anxiety when approached by strangers or people not well known. O Stranger anxiety is an indicator that the infant is recognizing himself o herself as separate from others. O As the infant becomes more aware of new people and new places, he or she may view an interaction with a stranger as threatening and may start crying,
  66. 66. O Separation Anxiety O Separation anxiety may also start in the last few months of infancy. O The infant becomes quite distressed when the parent leaves.
  67. 67. The Nursing Role in newborn and infant growth and development 1. Promoting Healthy Growth and Development 2. Promoting Early Learning 3. Promoting Safety 4. Promoting Nutrition 5. Promoting Healthy Sleep and Rest 6. Promoting Healthy Teeth and Gums 7. Promoting Appropriate Discipline
  68. 68. References': O Suzan S- R, Terri-K, Suzan C (Maternity and Pediatric Nursing ), 2nd eddition,2013. O Adele Pillitteri (Maternal and Child Health Nursing- care of child bearing and child bearing family) 5th eddition,2010 O Terri –K (essential for pediatric Nursing) 1st eddition 2008