pediatric nursing

1. Pediatric Nursing
(Seminar - 4)
Growth & Development
A. Neonatal & Infancy Period
Tagreed Awad Khalid
KU – Nursing Collage - PhD (4) 2016

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. 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. Outlines:
1. Physical parameters.
2. Organs development.
3. Reflexes
4. Sensory development.

5. Physical Growth
O Indicators of physical growth in the newborn and infant are
- Weight
- Length
- Head and chest circumference

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. 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. 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. Physical Growth

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. 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. 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. 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. 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. 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. 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. 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. Palmar grasp Reflex
O Infant reflexively grasps when palm
is touched.
O Appears at Birth and disappears at
4–6 months

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. 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. 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. Protective reflex
Neck righting Reflex
O Neck keeps head in upright
position when body is tilted.
O Appears 4–6 months and
Persists

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. 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. Protective Reflex
Parachute (backward)
O Protective extension with the arms
when tilted backward
O Appears at 9–10 months and Persists

26. O Coughing reflex
Protect child from swallowing object that enter
the trachea
It is a permanent reflex
Protective Reflex

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. O Swallowing reflex
Protect child from swallowing object that that
obstruct pharenx.
It is a permanent reflex
Protective Reflex

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. 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. 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. 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.

34. 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.

35. 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.

36. 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.

37. 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.

38. 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.

39. 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.

40. 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.

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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.

51. 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

52. 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

53. 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.

54. 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).

55. 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.

56. Activities that promote a sense of trust in infancy:
- Feeding
- Changing diapers
- Cleaning
- Touching
- Holding
- Talking

57. 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

58. 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.

61. 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).

63. 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.

64. 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

65. 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

66. 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)

67. 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.

68. 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

69. 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,

70. 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.

71. 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

75. 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