GROWTH is an increase in the number and size of cells as they synthesize new protein. Measured in terms of quantity.

Increase in the physical size of the whole body or any of its parts. Development can be viewed as a quantitative change in the child s capacity to function (skill) and that is achieved through growth, maturation and learning. Progressive increase in skills and capacity to function. MATURATION- increase in competence and adaptability; (aging) that makes it possible for the individual to begin functioning at a higher level. May be synonymous to development. FACTORS INFLUENCING GROWTH AND DEVELOPMENT HEREDITY- sex, genetic traits like height and weight, physical characteristics, personality (temperament), medical condition, race and nationality, intelligence. NEUROENDOCRINE FACTORS- growth centers in the hypothalamic region relating with the endocrine system growth hormones, thyroid hormone and androgens. NUTRITION- single most important influence on growth. Child s appetite fluctuates in relation to rate of growth. Adequate nutrition is closely related to good health throughout life. INTERPERSONAL RELATIONSHIP- plays a critical role in emotional, intellectual and personality development. mothering person- single most influential person during early infancy. parents- helps child ion sex-role behavior. SOCIOECONOMIC LEVEL- lack of knowledge and resources to provide an environment for optimum health. DISEASE- skeletal disorders, dwarfism, rickets, cretinism (congenital hypothyroidism) ENVIRONMENTAL HAZARD Internal infection. POST-NATAL- environment at home, in school, city, country PRINCIPLES OF GROWTH AND DEVELOPMENT A life-long process- from conception to death. Directional/ orderly sequence: -cephalocaudal -proximodistal -general to specific -single to complex Influenced by numerous factors Individualized Growth spurts- rapid growth Predictable stages at different rate Skills and behaviors are learned by practice. Primitive reflexes must disappear first before development can proceed. Behavior is the most sensitive and comprehensive indicator of developmental status. Play is central to the life of the child. All body systems do not develop at the same time. There is an optimum time for initiation of experience and learning. Oral (0-1 year) The child receives stimulation and pleasure through his mouth. Answering their cry helps develop trust. Behaviors to Observe Attempts to put everything into mouth Receives pleasure from sucking Tension reduced by sucking and biting

Differentiate self from mother Anal (18 months to 3 years) The child s interest is focused on the anal region and finds pleasure in holding on and letting go. Phallic (4-7 years) The Oedipal phase child turns toward the parent of the opposite sex fears by the same-sex parent Behaviors to Observe Exhibits interest in sex differences Exhibits preoccupation with loss of body parts and bodily injury. Asks many questions related to sexuality Latency (7-11 years) The sexual drive (libido) is controlled and repressed during this period. Interest on same sex only (Normal Homosexuals) Behaviors to Observe Emphasis during this period is on the development of skills and talents and socialization outside home Achievement oriented years Adult Sexuality Resurgence of sexual drives Behaviors to Observe Learns independence from parents Responsibility for self Develops relationships with members of the opposite sex. Initiative versus Guilt (3-6 years) Initiative develops if the child is allowed the freedom to initiate small activities and to ask questions Guilt develops if the child is made to feel that his activity is bad or wrong. Behaviors to Observe Starts many tasks; completes few Very imaginative Engages in fantasy play Very curious, asks many questions Boastful ERICKSON S PERIODS OF DEVELOPMENT

1. Trust vs. Mistrust 2. Autonomy vs. Shame and doubt 3. Initiative vs. guilt Behaviors to Observe Wants to learn to do things well and completely Participates in a variety of activities especially in school Takes pride in accomplishments ERICKSON S PERIODS OF DEVELOPMENT 4. Identity versus Role Confusion/ Diffusion (13-16) Identity develops if there is feeling of belongingness and being accepted by himself and others. Role Confusion develops when the adolescent is not sure who he is or what he can do. Behaviors to Observe

May engage in group activities to be in Tries out different lifestyles 5. Intimacy versus Isolation Establishes relationship with partner 6. Generativity versus Stagnation Productivity at home, work and community 7. Integrity versus Despair Views past and remaining life as meaningful whole PIAGET S COGNITIVE DEVELOPMENT SENSORIMOTOR (0-2 years) Learning by sensation Reflex activity to repetitive behavior to imitative behavior Cause and effect, also trial and error Object permanence ASSESSMENT OF GROWTH : KNOWS BIRTHWEIGHT Less than 6 months age in months x 600 + birth weight in gms.= weight in grams Above 6 months age in months x 500 + birthweight = weight in grams Example: 5 months old infant with birth weight of 3,200 gms. 5 x 600 + 3,200 = 6,200 gms or 13.66 lbs (note: 1 lb = 454 grams) COMPUTING FOR EXPECTED WEIGHT (birth weight is UNKNOWN) 1 year : AGE IN MOS / 2 + 3 or 4 = weight (kg) 1 year : AGE IN YEARS x 2 + 8 = weight (kg) Q: Baby 4 months old with unknown bwt. should weigh what? A: 4 / 2 + 3 or 4 = 5 to 6 kg (if in lbs, x 2.2=11 to 12 lbs) COMPUTING FOR EXPECTED LENGTH Average birth length 50 cm. or 19.5 inches Total gain during first year 25 cm. Formula: - Height in cm = age in years x 5 + 80 - Height in inches = age in years x 2 + 32 2 years old 50% of adult height 4 years old double birth length 13 years old triples birth length TANNHAUSER S FORMULA weight for height Height in cm 100 = weight in kg. (note: less 10% for Filipinos) 5ft 2 inches tall . Normal weight? Convert height to cm = 5 x 12 inches = 60 inches + 2 = 62 inches x 2.54 = 157.48 less than 100 = 57.48 (less 10%) = 51.7 kg or 113.74 lbs. (normal weight for a Filipino with a height of 5 ft 2 inches)

Neonate/Newborn - from 0-28 days of life I. Principles in the immediate care of the neonate: 1. Establishing and maintaining respiration Techniques: a. wipe off nose and mouth b. suctioning with the use of a rubber bulb/catheter c. positioning d. others:  milking the trachea  stimulating the baby to cry A crying baby is a breathing baby. 2. Providing optimum temperature -- physiologic resilience -- homeothermic -- hypothermia Ways by which heat is lost:  Convection  Evaporation  Radiation  Conduction Ways to produce heat:  Shivering  Metabolism of brown fat  Glycogenolysis To provide warmth:  Dry skin, focus on head  Wrap, provide bonnet, mittens etc  Pre-heat bassinet or crib  Floorlamps/radiant warmer 3. Initial assessment of the newborn -- done on the 1st minute after birth low score 5 minutes after 1st higher than 1st 10 minutes=stable -- Tool: APGAR score -- developed by Dr. Virginia Apgar in 1952 Parameters: A. Heart rate  most important and last to be absent  evaluated by - palpating the pulsation of the u. cord - apical pulse (bet. left nipple & sternum @ 3rd-4th intercostals space  Range: 120-160/min

B.

Respiration  Range: 30-60 C. Muscle tone  normal tonus flexed extremities, held against the body; resist effort to extend  moderate not consistently flexed  flaccid in extremely poor condition D. Reflex irritability  Tested thru: gentle slap on foot/passing catheter thru the nose  Reaction when irritated: crying  Responses: - excellent condition cries vigorously - poor condition cries weakly - with severe CNS prob no response E. Color  with acrocyanosis

4. Prevention of infection and injury A. Cord Care a. Cut when baby starts to cry b. Checked for: A-V-A c. Care - Observe asepsis - Check for bleeding - Clamped 2.5 cm (1 inch) from the skin - Cleansed with betadine and alcohol B. Skin care - Oil (for hi-risk premature) - Soap & water (for full-term) C. Eye prophylaxis - To prevent ophthalmia neonatorum - With the use of  Ophthalmic antibiotic ointment  1% silver nitrate - Technique:  Inner to outer canthus, while exposing lower conjunctival sac D. Vit K (Hypoprothrombinemia prophylaxis) - for synthesis of prothrombin needed for the formation of clotting factors VII, IX, X - single dose of Vit K (Aquamephyton), IM, 1cc=1mg, vastus lateralis E. Hep B immunization - first of 3 doses given between time of birth-2 days for all newborns F. Newborn screening - heel punctures (done 24hrs after birth) - to detect genetic disorders during neonatal period like : phenylketonuria(PKU), hypothyroidism, galactosemia, sickle-cell

anemia, and HIV G. Universal hearing screening 5. Mother-child bonding/attachment - the first social relationship for the infant - Entrainment- child-mother bonding - Engrossment- child-infant bonding 6. Identification - footprints- like thumbprints can never be the same - name tags/bracelets that includes: name of newborn, mother`s name, manner of delivery, attending MD 7. Nutrition - purposes: bonding, involution, breast-feeding stimulation - offer: plain sterile water 1-4 hrs after birth or colostrum or before, glucose water 8. Emergency baptism - Procedure: a. Pour Holy water or plain clean water on head b. Invoke: I baptize thee (say the name), in the name of the Father, the Son, and the Holy Spirit. Amen. c. If in doubt, whether dead or alive; If thou art alive, I baptize thee II. Normal characteristics of a Neonate A. Anthropometric measurement 1. Weight and Height (length) Americans 7.7 lbs 53cm or 21 inches Filipinos - 6.5 lbs 47.5 52 cm or 19-20 inches * newborn loses 5-10% of BW during first few days of life, then will gain 1lb/mo for the first 6 mos. Thus; weight 2x @ 6 mos 3x @1 yr 4x @ 2 yrs 2. Head circumference - 33-35cm or 13-14 inches - increases by 50% at one year - measured by placing the tape above the eyebrows, center of the forehead, around the head across the highest promontory of the posterior occiput. 3. Chest circumference - 31-33 or 12-13 inches - usually 2 cm less than the head circumference - tape measure is placed at the level of the nipple 4. Abdominal circumference - same as CC, measured at level of umbilicus B. Vital Signs - TPR are always obtained

- BP assessed when there is a potential for cardiac problem 1. Temperature - N= 36.5-37 C or 97.7-98 F - taken per axilla for 5 mins or the use of electronic thermometer per axilla for one full minute - if taken per rectum, insert 1.5 cm, hold for 3 mins, lubricate first 2. Heart Rate - N=120-160/min - taken bet left nipple and sternum for one min 3. Respiration - N= 30-60 breaths//min - is abdominal in nature, thus, observe for the rise and fall of abdomen NOT the chest - with periods of apnea lasting for 5-15 secs, thus count RR for one full min - more than 60/min, place temporarily on NPO because of danger of aspiration 4. BP - N= 65/41 mmHg in the arm - if to be taken: Doppler device preferred C. Head-to-Toe Assessment 1. General appearance 2. Skin  Pre term- thin, translucent, veins seen clearly  Term- thick, pinker, cutis marmorata  Post term- thick, parchment-like with peeling Color: a. Race Caucasians- red or dark pink Blacks- reddish black Orientals- tea-rose b. Variations 1. gray- indicative of infection 2. pallor- anemic 3. cutis marmorata 4. acrocyanosis 5. cyanosis 6. Harlequin sign 7. physiologic jaundice/neonatal hyperbilirubinemia c. Others 1. Lanugo 2. Vernix caseosa 3. Forceps marks 4. Milia 5. Nevi (storkbites) 6. Mongolian spots

7. Erythema toxicum neonatorum 8. hemangiomas 9. desquamation 3. Head - proportionately large; of total length - cranium is large, face small - Fontanels: Anterior- diamond-shaped, closes at 12-18 mos. Posterior- triangular-shaped, closes at 2-3 mos. - Variations:  Molding Brow presentation- prominent forehead Vertex- flattened CS operation- spherical  Caput succedaneum  Cepalhematoma  Craniotabes Eyes - gray or blue at birth; do not assume N color till 3mos - Normal findings:  Subconjunctival hemorrhage  Pseudostrabismus  Doll`s eyes Ears - pinna shd have instant recoil; in line with the outer canthus of the eyes Nose - large for his face - Abnormal:  Non-patent canal  Blood nasal, discharges  Choanal atresia Mouth - tongue appears large - if with one-sided movement, maybe due to cranial nerve injury - Variations:  Epstein Pearls - Abnormal:  Thrush (Candida infection)  Cleft lip/palate  Protruding tongue Neck - Abnormal:  Nuchal rigidity  Congenital torticolis 4. Chest - appears small since head is large; but at two years old, CC is greater than HC - with breast engorgement, M&F; witche`s milk - Abnormal:  Funnel chest (pectus excavatum)  Pigeon chest (pectus carinatum)

5. 6. -

 Asymmetric chest expansion Lungs Heart Variations:  Transient cyanosis when crying  Sinus arrhythmia Abnormal:  Cardiomegaly  Murmurs  Persistent cyanosis Abdomen Umbilical cord, appears as a white gelatinous structure during the 1st hour After the 1st hour = begins to dry, shrink, discolored 2-3rd day = turns black 6-10th day = sloughs off Ano-genital area Female: - Variation:  Pseudomenstruation - Abnormalities:  Enlarged clitoris with urethral meatus at the tip  No vaginal opening  Fecal discharge at vaginal opening  No urination Male: - large, edematous, deeply pigmented scrotum - smegma, urinates within 24 hrs - Variations:  Urethral opening covered by prefuce  Phimosis  Priapism  Testes palpable at the inguinal canal - Major abnormalities:  Hypospadia  Epispadia  Cryptorchidism  Inguinal hernia Back Abnormalities:  Spina bifida  Imperforate anus Rectum Extremities - Normal:  Arms/legs appear short, hands plump, fist clenched, fingernails are soft, smooth and long  Full ROM, symmetrical extremities, good muscle tone

7. -

8.

9. -

10. 11.

Variations:  Syndactyly  Polydactyly - Abnormalities:  Persistent cyanosis of nail beds, fractures  Achondroplastic dwarfism  Clubfoot (talipes deformity)  Amelia D. Systems Review I. Respiratory - in utero, lung is filled with 20 ml/kg pulmonary surfactant - initial breath, stimulated by: cold receptors; noise, light; low oxygen - Periodic apnea - obligatory nose breathers II. Cardiovascular - change from fetal to neonatal circulation - 4 structures that differentiate fetal from extrauterine circulation: umb.vein; foramen ovale; ductus arteriosus; umbilical arteries - Blood values: 1. blood volume= 80-110 ml/kg of weight 2. RBC= 6-8 mil/cu mm 3. Hgb= 15-20 g/100 ml (lower than 10 gm, physiologic anemia) 4. Hct= 45%-65% 5. Bilirubin level at birth= 1-4mg/100ml 6. WBC= 10,000-45,000/cu mm - Blood coagulation- hypoprothrombinemia III. Gastrointestinal - is sterile at birth - Normal NB`s gastric capacity= 60-90 ml - with limited capacity to digest fat & starch - regurgitates easily - with low glucose/protein serum levels Stools, characteristics: 1st 24 hours-- meconium 2-3rd day -- transitional stool 4th day -- if breast-fed: 3-4x/day, goldenlight yellow, loose; if formula-fed: 2-3x/day, soft but formed - Variations:  bright green if underwent phototherapy  with mucus milk allergy/other irritants  gray/clay-colored with bile duct obstruction  black, tarry stool if with intestinal bleeding - sucking pads (brown fat-deposits in each cheeks) IV. Urinary if not able to urinate within 24 hrs, inspect

observe for force of urinary stream: kidneys do not concentrate urine well, thus urine is light color and odorless 1-2 days = 30-60 ml, pink or dusky 1 wk = 300 ml
1. 2. 30-35% of neonate`s fluid is extracellular kidneys` immaturity cause failure to fully concentrate urine  Requirement: 160-200ml/kg body weight or 2.5-3.0 oz/lb in 24 hours

V. Autoimmune - NBs have difficulty forming antibodies until 2mos. - receives maternal antibodies, Ig, that crossed placenta VI. Neuromuscular - Reflexes: A. Feeding  Rooting  Sucking  Swallowing  Spitting up/Extrusion B. Protective  Blinking  Sneezing and coughing  Yawning C. Others  Moro or startle  Doll`s eyes  Tonic-neck reflex  Palmar grasp  Landau  Trunk-incurvation  Plantar  Magnet  Crossed extension  Babinski  Darwin/Dancing VII. Senses - Vision= follows bright light; focuses on black/white - Hearing= able to hear in utero - Smell= least develop - Taste= sweets acceptable; acidic, bitter resisted - Touch= most developed at birth; most acute on the lips, tongue, ears, forehead III. Selected Conditions of the Neonate A. Hypoglycemia  CHO reserves are low; glucose is the main source of energy  Causes: prematurity, post-maturity, inadequate intake, stresses  Sxs: jittery,apnea,tense, bulging fontanels, absent moro reflex

 Tx: oral glucose; keep warm; monitor; administer ordered 10%-25% IV glucose B. Hypoprothrombinemia  Cause: low level of Vit K necessary for the formation of clotting factors VII, IX, X resulting in prolonged coagulation or prothrombin time  Tx: Vit K administration C. Anemia  Causes: excessive blood loss; inadequate flow of blood from the cord into the infant at birth; low-iron stores; blood incompatibility D. Weight loss E. Physiologic jaundice/Hyperbilirubinemia  Cause: accumulation of indirect bilirubin due to breakdown of fetal red blood cells  Level of bilirubin in neonate: - 1-4mg/100ml (normal) - >7mg/100ml (jaundice) - >10-12mg/100ml (treatment shd be considered) - >20mg/100ml (Kernicterus) IV. Daily Care Needs of the Neonate A. Bathing  ideally, in the morning, once a day, before feeding B. Clothing  cotton, simple, comfortable, not restrictive, lightcolored C. Sleep pattern  average: 16-20 hours; 4 hrs at a time D. Skin care  Common skin problems: 1. sebborhea dermatitis/cradle cap 2. oral moniliasis/oral thrush/fungi infection of the mouth 3. miliaria/heat rash/prickly heat 4. impetigo 5. boils/furuncles 6. diaper rash/diaper dermatitis ammonia dermatitis intertrigo V. Nutritional requirements of the Neonate A.1. Calorie  up to 2 mos of age = 120 calories/kg body weight or 50-55kcal/lb every 24 hours  > 2 mos, decreases = 100kcal/kg body weight or 45 kcal/lb/day

   

2. CHON first 2 mos = 2.2 g/kg body weight cow`s milk has more CHON content than human milk both contains an amino acid, histidine main protein content in cow`s milk: casein in human milk: lactalbumin 3. CHO
 lactose, the most easily digested carbohydrate  cow`s milk has lower CHO content than human milk

4. Fat  human milk has 3x more content than cow`s milk 5. Fluid  large amount of water is lost in the neonatefor the ff reasons: 1. has larger surface of the body in relation to body mass, thus large amount of water is lost during evaporation 2. uses 45-50 kcal/kg in 24 hrs for metabolism 6. Calcium  human milk has more calcium content than cow`s milk 7. Iron  maternal iron supplied to neonate is enough to last for 3 mos. B. Feeding 1. Types: a. Breastfeeding  Reflexes  Milk secretion reflex/Prolactin reflex  Milk ejection reflex/Let-down reflex  Essentials  To start: - Immediately after birth, to promote bonding - 30 mins after birth in NSD - 4 hours after birth in CS  Duration: - 5 mins/breast after establishment of feeding - first 10 mins, for nourishment nd - 2 10 mins. for sucking pleasure  Care of the breast  Advantages: B R E A S T F E E D I N G b. Bottlefeeding  Advantages  Factors to success - pasteurization of milk - sanitation during preparation  Special considerations - observe aspiration precaution - see to it that bottle is filled with milk - burp - demand feeding is preferred over scheduled feeding