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Weight gain: 2x = 5 – 6 mos. 3x = 1 year 4x = 2 – 2½ years
↑ - 1”/ mo – 1 – 6 mos ↑ - 1.5”/ mo – 7 – 12 mos ↑ - 50 % - 1st^ Year
HEIGHT COMPARISON 9 y/o male = female 12 y/o Male < Female 13 y/o Male > Female
GROWTH AND DEVELOPMENT
Growing complex phenomenon of a structure or whole
GROWTH
- Increase in physical size of a structure or whole
- Quantitative
- 2 parameters o Weight Most sensitive measurement for growth
o Height
ESTROGEN responsible for increase in height in female
TESTOSTERONE responsible for the increase in height in male
Stoppage of height coincide with the eruption of the wisdom teeth
DEVELOPMENT
- Increase in the skills or capacity to function
- Qualitatively
- How to measure development o By simply observing the child doing simple task o By noting parent’s description of the child’s progress
o Measure by DENVER DEVELOPMENTAL SCREENING TEST (DDST)
• MMDST
o Metro Manila Developmental Screening Test o Philippine Based exam
o LANGUAGE ability to communicate
o PERSONAL/ SOCIAL ability to interact
o FINE MOTOR ADAPTIVE ability to use hand movements
o GROSS MOTOR SKILLS ability to use large body movements
MATURATION
- Synonymous with development
- Readiness/ learning is effortless
COGNITIVE DEVELOPMENT
- Ability to learn and understand from experiences, to acquire and retain knowledge, to respond to a new situation and to solve problems
LEARNING change of behavior IQ= [Mental Age/ Chronological Age] x 100 Normal IQ = 90 - 110 GIFTED CHILD > 130 IQ level
BASIC DIVISIONS OF LIFE
- Prenatal o Conception to birth
- Infancy
o Neonatal first 28 days
o Formal Infancy 29 th^ – 1 year
o Toddler 1 – 3 y/o
o Preschool 4 – 6 y/o
o School Age 7 – 12 y/o
o Pre – adolescent 11 – 13 y/o
o Adolescent – 12 – 13 y/o to 21
PRINCIPLES OF GROWTH AND DEVELOPMENT
• Growth and development is a continuous process (WOMB TO TOMB PRINCIPLE)
begins from conception and ends with death
• Not all parts of the body grows at the same time or at the same rate
(ASSYCHRONOUS GROWTH)
- Each child is unique
- Growth and development occurs in a regular direction reflecting definite and predictable patterns or trends o Directional Terms Cephalocaudal/ Head to Tail It occurs along bodies long axis in which control over head, mouth and eye movemens and precedes control over upper body torso and legs Proximo – Distal/ Centro – Distal Progressing from center of the body to the extremities Symmetrical/ Each side of the Body Develop at the same direction at the same time and at the same rate Mass – Specific Differentiation – SIMPLE TO COMPLEX; BROAD TO REFINED
o Secondary prone to anemia
Two Primary Factors Affecting Growth and Development
o R ace
o S ex
o I ntelligence
o N ationality
o Q uality of Nutrition
o S ocio Economic Status
o H ealth
o O rdinal Position in the family
o P arent – Child Relationship
*Universal Principle: F are born < wt. than M by 1 oz.; F are born < lt. than M by 1 in.
THEORIES OF DEVELOPMENT
Developmental Task
- A skill or growth responsibility arising at a particular time in the individual’s life.
- The successful achievement of which will provide a foundation for the accomplishments of the future tasks
SIGMUND FREUD’S PSYCHOSEXUAL THEORY
• An Austrian Neurologist
- Founder of Psychoanalysis
• 1 st^ to introduce Personality Development
Phase Age Site of Gratificati on
Activities Task
Oral Phase
mos.
Mouth (^) • Biting
- Crying
- Sucking (enjoyment and release of tension)
• Provide oral stimulation even if
baby is place NPO (use pacifier)CBQ
- Never discourage thumb sucking
Anal Phase (stage where OC are develop ed)
19 mos. – 3 yrs.
Anus • Elimination
- Retention/ Defecation of Feces - Help the child achieve bowel and bladder control even if the child is hospitalized - Principle of holding on and letting go - Mother wins or child wins - Child Wins o Holding on
o Child turns to be hardheaded, antisocial, stubborn, unreliable, irresponsible
- Mother Wins o Letting go o Child turns to be kind, obedient, perfectionist o Meticulous, OCs, reliable, responsible Phallic Phase
4 – 6 yrs. Genital (^) • May show exhibitionis m
- Have or increase knowledge of 2 sexes - Accept the child fondling his own genetalia as normal area of exploration - Divert attention from masturbation - Answer the child’s question directly - Human sexuality Latent Phase
7 – 12 yrs. School aged
- Period of suppression
- No obvious developmen t, slower growth
- Child’s energy or Libido is diverted into more concrete type of thinking - Help the child achieve (+) experiences so that he’ll be ready to face the conflicts of adolescents
Genital Phase
12 – 18 yrs Genitalia (^) • Achieve sexual maturity and learn to establish satisfactory relationship with the opposite sex
- Give opportunity to relate to opposite sex
ERIK ERICKSON’S STAGES OF PSYCHOSOCIAL THEORY
- Former student of Freud
- Stresses the importance of culture and society to the development of one’s personality
- “environment”
1. Sensorimotor - 0 – 2 years old - Also called Practical Intelligence o words and symbols are not yet available o communication through senses 1. Schema 1: Neonatal Reflex o 1 month o Early reflexes 2. Schema 2: Primary Circular Reaction o 1 – 4 months o Activities related to body; repetition of behavior Example: thumbsucking 3. Schema 3: Secondary Circular Behavior o 4 – 8 months o Activities not related to the body o Discover person and object’s permanence o Memory traces are present and anticipate familiar events 4. Schema 4: Coordination of Secondary Reaction o 8 – 12 months o Exhibit goal directed behavior
o ↑ sense of permanence and separateness
o Play activities: Throw and retrieve
5. Schema 5: Tertiary Circular Reaction o 12 – 18 months o use trial and error to discover characteristic of places and events o “Invention” of new means o capable of space and time perception 6. Schema 6: Invention of New Means thru Mental Coordination o 18 – 24 months o Symbolic representation o Transitional phase to the pre-operational thought period **2. Pre-operational Thought
- Pre – conceptual Thought** o 2 – 4 years old o Concrete, literal, static thinking
o CBQ EGOCENTRIC – unable to view anothers viewpoint
o CBQ (-) REVERSIBILITY – in every action there is opposite reaction; cause
and effect o Concept of time is only now and concept of distance is only as far as they can see
o CBQ ANIMISM – consider inanimate object as alive
2. Intuitive Thought o Beginning of causation 3. Concrete Operational o 7 – 12 years old
o SYSTEMATIC REASONING as solution to problems o Concept of (+) reversibility o Concept of Conservation – constancy despite of transformation o Activity recommended: Collecting and Classifying
4. Formal Operational o 12 years old and above o Period when cognition achieve its final form o Can solve hypothetical problem with SCIENTIFIC REASONING o Can deal with past, present and future o Capable of ABSTRACT, mature thought and formal reasoning o Activity recommended: talk time; focus on opinions and current events
KOHLBERG’S THEORY OF MORAL DEVELOPMENT
- Recognized the theory of moral development as considered to closely approximate cognitive stages of development
- Stages of Moral Development o Infancy o Premoral o Amoral o Pre-religious
Age Stage Descritption PRECONVENTIONAL (Level I) 0 – 3 yrs (^1) • PUNISHMENT/ OBEDIENCE/ ORIENTATION o Heteronomous morality o Child does right because PARENT tells him to and to avoid punishment 4 – 7 yrs. (^2) • INDIVIDUALISM o Instrumental purpose and exchange o Carries out action to satisfy own needs rather than society o Will do something for another if that person does something for the child CONVENTIONAL (Level II) 4 – 10 yrs. (^3) • ORIENTATION TO INTERPERSONAL RELATIONS OF
MUTUALITY o Child follows rules because of need to be a “good person” in own eyes and eyes of others 10 – 12 yrs.
4 • MAINTAINANCE OF SOCIAL ORDER, FIXED RULES AND
AUTHORITY
o Child finds following rules satisfying o Following rules of authority figures as well as parents in an effort to keep the “system” working POST – CONVENTIONAL (Level III) Older than 12
5 • SOCIAL CONTRACT, UTILITARIAN LAW – MAKING
PERSPECTIVE
o Follows standards of society for the good of the people
- Looks at mobile; follows midline
- Alert to sound, regards face
2 months
- Holds head up when in prone
- Social smile, cries with tears, cooing sound
- Closure of posterior fontanel (2-3 months)
- Head lag when pulled to sitting position
- No longer clinches fist tightly
- Follows object past midline
- Recognizes parents
3 months
- Holds head and chest up when in prone
- Holds hands open at rest
- Hand regard, follows object past midline
- Grasp and tonic neck reflexes are fading
- Reaches for familiar people or object
- Anticipates feeding
4 months
- Head control complete
- Turns front to back; needs space to turn
- Laughs aloud; Babbling sound
- Babinski Reflex disappears
5 months
- Turn both ways (roll over)
- Teething rings, handles rattle well
- Moro reflex disappears (5 – 6 months)
- Enjoys looking around environment
6 months
- Reaches out in the anticipation of being picked- up
- Sits with support
- Puts feet in mouth in supine position
- Eruption of first temporary teeth ( Lower 2 central incisors)
- Vowel sounds “ah, eh”
- Uses palmar grasp; handless bottle well
- Recognizes strangers
7 months
- Transfer objects from hand to hand (6 – 7 months)
- Likes objects that are good sized for transferring
8 months
- Sits without support
- Peak of stranger anxiety
- Plantar reflex disappear (6-8 months)
9 months
- Creeps or crawls; need space for creeping
- Neat pincer grasp reflex, probes with forefinger
- Finger feeds, combine 2 syllables “mama & dada”
10 months
- Pulls self to stand
- Understand the word no
- Respond to name
- Peek – a – boo, pat a cake, since they can clap
11 months
- Cruising, stand with assistance
- Walking while holding to his crib’s handle
- One word other than mama and dada
12 months
- Stands alone
- Walk with assistance
- Drink from cup, cooperates in dressing
- Says two words other than mama and dada
- Pots & pans, pull toys and nursery rhymes
- Imitates actions, comes when called
- Follows one – step command and gesture
- Uses mature pincer graps, throws objects
Toddlerhood
- Parallel Play – 2 toddlers playing separately
- Provide 2 similar toys for 2 toddlers
- Toys o Squeaky frogs to squeeze o Waddling ducks to pull o Trucks to push o Building blocks o Pounding peg
- Fear: Separation Anxiety o Begins: 9 months o Peaks: 18 months o 3 stages Protest Despair Denial
• CBQ best time to bring the child to dentist: 2 – 3 years or when temporary teeth is
complete
30 months
- Makes simple lines or stroke or crosses with pencil
- Can jump down from chair
- Knows full name, holds up finger to show age
- Copy a circle
• CBQ Temporary teeth complete (posterior molar: last to erupt)
• CBQ 20 deciduous teeth
• CBQ tooth brushing: 2 – 3 years
36 months
- TRUSTING THREES
- Tooth brushing with little supervision
- Unbutton buttons
- Draws a cross, learns how to share
- Knows full name and sex
- Speaks fluently, 200 – 900 words
- NIGHTIME BLADDER CONTROL achieved
- Rides tricycle
Preschoolers
- Cooperative play – playhouse
- Role playing is usual
- Fears: o Castration/ Body Mutilation o Dark places and witches o Thunder and lightning o Ghost
- Curious, creative, imaginative and imitative
Preschooler’s Characteristic Traits
• Imaginary friend way of relieving tension and anxiety
• Sibling rivalry→ jealousy to a newly delivered baby
- Regression o Signs: bedwetting o Thumbsucking o Baby talk o Fetal position
- Masturbation o Sign of boredom o Divert attention o Offering toy
4 years old
- FURIOUS FOUR
- Noisy, aggressive and stormy
- Buttons button
- Copy square
- Catches ball, jumps, skips
- Alternates feet going downstairs
- CBQ LACES SHOES
- Vocabulary of 1500, knows the basic color
- Says song or poem from memory
5 years old
- FRUSTRATING FIVES
- Jumps over low obstacles
- Spreads with a knife
- Draws 6 part man, copy triangle
- Imaginary playmates
- 2100 words
- Identification with same sex
- Attachment to opposite sex
School – Aged
- Competitive Play: Tug of war
- Fears
o School Phobia orienting child to his new environment
o Displacement from school o Death
- Significant Person o Teacher o Peer of same sex
- Stoppage of height coincide with the eruption of wisdom tooth
• Prone to fracture: Common Green stick
- Mature vision o 20/200 legal blindness
• They’ll Cheat → can’t afford to lose
6 years old
• Temporary teeth begins to fall, permanent teeth begins to appear (1st: First Molar)
- Tooth brushing alone
- A year of continuous motion, clumsy moving
• 1 st^ grade teacher becomes authority figure
o nail biting → sign of strict teacher
- Beginning interest with God
7 years old
D eepening of voice D evelopment of muscle I ncrease in size of penis and scrotum – 1st^ sign P roduction of viable sperm – last sign
Adolescence
- Fear o Acne o Obesity o Homosexuality o Death o Replacement from friends
• Peer of opposite sex significant other
- Experiences conflicts between his needs for sexual satisfaction and societal expectations
- Core Concern o Change of body image o Acceptance of the opposite sex
- Nocturnal Emission: Wet dreams o Hallmark of adolescence
• CBQ distinctive odor due to stimulation of apocrine gland
- Testes and scrotum increases until age 17
- Sperm is viable by age 17
- Breast of female and genitalia increases until age 18
- Signs of sexual maturity
- Characteristic traits o Idealistic, rebellious, reformers o Parent child conflict o Very conscious with body image o Peer pressure
- Problems o Vehicular accident o Smoking o Alcoholism o Drug Addiction o Pre Marital Sex
Concept of Death 6 years old death is reversible CBQ 7 – 9 years old personification of death, permanent loss of the corporal life
IMMEDIATE CARE OF THE NEWBORN
8 PRIORITIES OF THE NEWBORN IN THE FIRST DAYS OF LIFE
- Initiation and maintenance of respiration
- Establishment of extrauterine circulation
- Control of body temperature
- Intake of adequate nutrition
- Establishment of waste elimination
- Prevention of infection
- Establishment of an infant – parent relationship
- Developmental care that balance rest and stimulation for mental developmental
INITIATION & MAINTENANCE OF RESPIRATION
Alerts!
• Expulsion is @ 2nd^ stage of labor
- Most neonatal deaths w/in the first 24 hours is due to INABILITY TO INITIATE AIRWAY
- Lung function begins only after birth
How?
- Support head and remove secretion
- Proper suctioning with a catheter
o Place baby’s head to side facilitates drainage
o Suction the mouth first before nose newborns are nose breathers
o Period of 5 – 10 seconds, should be gentle and quick Prolonged suctioning can cause hypoxia, laryngospasm and bradycardia due to vagal nerve stimulation o Evaluate patency Cover 1 nostril, if newborn struggles, additional suctioning needed
• If not effective requires effective LARYNGOSCOPY to open airway. After deep
suctioning, and ET tube can be inserted and O2 administration by (+) Pressure Bag and mask with 100% O2 @ 40 – 60 bpm
Alerts in O2 Administration
• No Smoking O2 is combustible
• Must be humidified prevent drying of mucosa
- Cover the nose and mouth only
• Scarring Retina results Retinopathy (O2 overdose)
• Meconium Stain never administer O2 with pressure causes atelactasis
ESTABLISHMENT OF EXTRAUTERINE CIRCULATION
Alerts!
- Circulation id initiated by LUNG EXPANSION and PULMONARY VENTILATION
- Completed by cutting the cord
- Assess characteristics of cry
o Normal strong, vigorous, lusty cry
o Hypoglycemia/ Increased ICP high pitched, small cry
o Never stimulate crying before all secretion are remove to prevent aspiration
Alerts!
- The goal of temperature regulation is to maintain Temperature not less than 97.7 F or 36.7 C
Factors leading to the development of Hypothermia
• Preterm are born POIKILOTHERMIC (easily adapt the temperature of environment
due to immaturity of thermo regulating center of the body HYPOTHALAMUS)
- Inadequate subcutaneous tissues
- Newborn are not yet capable of shivering
- Newborns are wet
Process of Heat Loss
• Evaporation → body to air
• Conduction → body to solid objects (cold compress)
• Convection → body to a cooler surrounding object (fever, aircon)
• Radiation → body to a cold subject not in contact with the body (thermal shift)
Effects of Hypothermia (COLD STRESS)
• ↑ RR → first sign of hypothermia
• Hypoglycemia → due to utilization of glucose
o Normal 45 – 55 mg/ dl
o Average/ borderline → 40 mg/ dl
• Metabolic Acidosis → due to the catabolism of BROWN FAT (vest-like, best
insulators of newborns) leading to the formation of ketone bodies
• High risk for KERNICTERUS (bilirubin in the brain)
- Additional fatigue added to already stressful heart
Prevention of Cold Stress
- Dry and wrap the newborn
- Mechanical measures ( radiant warmer, acrylic sided incubator)
• Prevent unecesarry exposure→ cover areas not being examined
- In case of no electricity o Cover baby with thin foil
o Skin to skin contact → human blanket/ kangaroo care
ESTABLISHING ADEQUATE NUTRITION
Breastfeeding Best time
- NSD – ASAP
- CS – after 4 hours
Physiology of Breastmilk Production ↓ Estrogen, ↑ Progesterone → releases PROLACTIN → acts on ACINAR/ ALVEOLI CELLS
→ produces FOREMILK → store in LACTIFEROUS TUBULES/ COLLECTING TUBULES
Sucking → stimulates posterior pituitary gland → release oxytocin → causes Contraction of smooth muscles of Lactiferous Tubules → milk ejection reflex → let down reflex
Advantages of Breastfeeding
- Economical
- Promotes bonding
• Contains LACTOBACILLUS BIFIDUS → interfere the attack of pathogenic bacteria
in the GIT
• Helps in early involution of uterus → oxytocin causes contraction
• ↓ Incidence of breast cancer
- Breastfed babies have higher IQ than bottle fed ones
• Antibody → IgA
Disadvantages of Breastfeeding
- No iron
- Possibility of transfer of Hepa B, HIV, CMV (13 – 39% possibility)
• Father can’t bond with the mother and baby → instead, father can sing, suddle, kiss,
put baby to sleep
Alerts!
• Freezer → good for 6 mos./ don’t reheat
- Should be stored in a sterile plastic container
• Pre – Colostrums → 6 weeks
• Colostrums → 3
Stages of Breastmilk
- COLOSTRUM o Present 2 – 4 days o Contents
↓ fats
↓ CHO
↑ Immunoglobulin
↑ protein
↑ fat soluble vitamin
↑ minerals
• TRANSITIONAL MILK
o Present 4 – 14 days o Contents
↑ Lactose
↑ minerals
↑ water soluble vitamins
o Lactose Intolerance → deficiency in enzyme
