GROWTH AND DEVELOPMENT

GROWTH
DEVELOPMENT
MATURATION
DEVELOPMENTAL TASK
CRITICAL PERIODS
FACTORS INFLUENCING G & D
HEREDITY
Genes
Sex
Race & nationality
Intelligence Level
ENVIRONMENT
Pre-natal
Post-natal
PRINCIPLES
Life-long process
Orderly sequence & directional
Influenced by factors
Individualized
There are spurts of growth
Predictable stages are passed through
Learned by practice
Primitive reflexes must disappear
Behavior is the most sensitive & comprehensive
Play
Systems do not develop at the same time
There is a time for everything
THEORIES OF GROWTH & DEVELOPMENT
Psychosocial Devt acc to Erickson & Psychosexual Devt
acc to Freud
AGE
ERICKSON
FREUD
TRUST VS
INFANCY
ORAL
MISTRUST
AUTONOMY VS
TODDLER
ANAL
SHAME & DOUBT
INITIATIVE VS
PRE-SCHOOL
PHALLIC/OEDIPAL
GUILT
INDUSTRY VS
SCHOOL AGE
LATENCY
INFERIORITY
IDENTITY VS ROLE
ADOLESCENT
GENITAL
DIFFUSION
INTIMACY VS
YOUNG ADULT
ISOLATION
GENERATIVITY VS
MIDDLE AGE
STAGNATION
INTEGRITY VS
OLDER ADULT
DESPAIR
Moral Devt acc to Kohlberg & Tincel
PREStage 0 - 0-2 y/o
CONVENTIONAL
- Child does right to gain parents
LEVEL
approval
Stage 1 - 2-3 y/o
- Punishment-obedience
Stage 2 - 4-7 y/o
- Instrumental hedonism and concrete

Stage 3
Stage 4
POSTCONVENTIONAL
LEVEL

Stage 5

reciprocity
- 7-10 y/o
- Orientation to interpersonal relations
of mutuality
- 10-12 y/o
- Maintenance of social order, fixed
rules & authorities
- Over 12 y/o
- Social contract, utilitarian
- Follows standards of society

Stage 5B - Higher law & conscience orientation

Stage 6

- Universal ethical principle orientation

- Follows international standard of
conduct

Cognitive Devt acc to Piaget

SENSORIMOTOR
- 0-2 Y/O
- Reflexes used to interact w/ environment
- Learning is by trial and error
- Slowly become aware that objects have permanence
PRE-OPERATIONAL/PRECONCEPTUAL
- 3-7 y/o
- Use of language
- Thinks of self
- Unable to understand concrete relationship
INTUITIVE
- 5-7 y/o
- Magical thinking
- Egocentric
- Centering
CONCRETE OPERATIONS
- 8-12 Y/O
- Inductive reasoning
- Conservation
- Reversibility
FORMAL OPERATIONS
- 13-16 y/o
- Introspection
- Deductive reasoning
Spiritual Devt acc to Fowlers
Stage I
- infancy
- Primal faith
- Embodies trust between infants & parents
Stage II
- Early childhood (3-7 y/o)
- Intuitive-Projective faith
- Formation of long lasting images & feelings
Stage III
- Childhood & beyond (7y/o-adolescence)
- Mythic-Literal Faith
- Beliefs are derived from the perspectives of others
Stage IV
- Adolescent & beyond
- Synthetic conventional faith
- Persons experience extends beyond his immediate
circle

CARE OF THE ILL CHILD

NORMAL CHARACTERISTICS OF A NEONATE

Common Reactions:
1. Anxiety
2. Guilt
3. Regression
4. Covering-up
5. Aggression/Passivity

1.

ANTHROPOMETRIC MEASUREMENTS
(BODY MEASUREMENTS)
A. WEIGHT AND LENGTH
Americans - 53 cm ( 21 inches )
- 7.7 lbs.
Filipinos - 47.5 52 cm (50 cm ) or 19 20 inches
- 6.5 lbs or 3000 grams

AGE GROUP
INFANTS &
TODDLERS

CONCERN
Anxiety
Consistency

REXNS
Protest
Despair
Denial
Fantasies
( magical
thinkers )

PRESCHOOL

Separation
Mutilation
Rituals

SCHOOL
AGE

School
Helplessness

Phobia

ADOLESCENT

Dependence
Body Image
Helplessness

Denial
withdrawal
Anger

TOOLS
Room-in
CCG
Parent sub
Play Therapy
- dolls
Band-aids
Avoid terms
Group play
Honesty
Involvement
Independence
Privacy
Education

TOYS / PLAY
o Chronologic/Developmental age
o Capacity
o Therapeutic purpose
o Safety
PREPARING THE CHILD FOR DIAGNOSTIC PROCEDURES
o EMPATHY
o TRUST
o EXPLAIN IN SIMPLE, CLEAR TERMS
o LET CHILD EXPRESS HIMSELF
o EXPLAIN IN ADVANCE WHAT THE CHILD WOULD FEEL
PAIN - It is whatever the experiencing person says it is; existing
when the person says it does.
PAIN ASSESSMENT IN CHILDREN
Q - question the child
U - use pain rating scale
E - evaluate behavior and physical changes
S - secure parents involvement
T - take cause of the pain into account

Newborn loses 5 10% or 6 9% of his body weight during the first

few days of life due to:
a. withdrawal of hormones
b. voiding and passing out of stool
c. limited intake will regain weight in 10 14 days of age
later on, he will be gaining 1 lb/month for the 1st 6 months of life
thus:
2x @ 6 mos.
3x @ 1 year
4x @ 2 years
HEAD CIRCUMFERENCE
-33 35 cm or 13 14inches
- measured at the widest part, which is the occipito- frontal diameter,
located across the center of the forehead and most prominent
portion of the posterior occiput.
- increases by 50% at one year
CHEST CIRCUMFERENCE
- 31 33 cm or 12 13 inches
- usually measures about 2cm less than the HC
- tape measure placed at the level of the nipple
ABDOMINAL CIRCUMFERENCE
- same as CC
- measured at level of umbilicus
- must be cylindrical in shape and protrude slightly
2. VITAL SIGNS
-TPR are always obtained
-BP not routinely assessed unless there is a potential for cardiac,
bleeding or renal problems
A. TEMPERATURE
- 36.5 37 C or 97.7 98 F
In the past, it is taken per rectum to locate anal opening; thus ruling out
imperforate anus. Today, it is generally accepted that passage of
meconium is enough to indicate patent anus.
-Thus, taken per axilla for 3 minutes or with the use of electronic
thermometer per axilla, taken for 1 full minute.
-Should be taken after PR / RR have been taken already.
-If taken per rectum: Insert 1.5 cm for 3 mins. Lubricate first
B.RESPIRATION
- 30 60 breaths per minute
- Varies with state of alertness; are shallow, irregular and
abdominal in nature

-With periods of apnea lasting for 5 15 seconds. Thus, count RR for

1 full minute.
- If 60 place temporarily on NPO because of danger of
aspiration.
C.HEART RATE
- Fluctuates between 120 180 beats/minute
- Influenced by the NBs activity; irregular
- Taken between left nipple line and sternum for 1 min.
- In adults under the nipple, mid-clavicular line, 4-5 th ICS
D. BLOOD PRESSURE
-High immediately after birth and falls to a minimum within 3
hours after birth.
-67/41 mmHg 80/40
-By Doppler device preferred

-Otherwise: ordinary BP apparatus can be used, however: cuff should

be:
At birth to 1 yr = 1 1 cuff
2 to 8 yrs = 3 cuff
8 to 12 yrs= 4 cuff

congenital heart disease, Blue Baby

- to test for true cyanosis or acrocyanosis, rub the sole of the foot
true cyanosis does not turn pink
acrocyanosis turns pink; will disappear when baby cries
6.Harlequin sign
- appears red on dependent side and pale on upper side in an infant
lying on his side.
- transient phenomenon / no clinical significance
- change of position will change the color
7. Physiologic jaundice or Neonatal hyperbilirubinemia - appears in
50% of all newborns as a normal process of the breakdown of
RBC infants skin and sclera becomes yellowish in color

Full term = appears after 24, becomes definite bet 2 7 days;

disappears after 7th day
Pre term = appears after 18, becomes definite bet 3 10
days; disappears after the 9th 10th day

2. HEAD TO TOE ASSESSMENT

I. GENERAL APPEARANCE
- generally flexed posture
II. SKIN
Pre term thin, translucent, ruddy skin; with easily seenveins
and venules esp. over the abdomen.

Term thick, pinkish, mottled because of temperature changes (Cutis

Marmorata)
Post term thick, parchment-like with peeling and cracking; few
blood vessels over the abdomen.
A. COLOR VARIATIONS:
1. Gray
- indicative of infection
2. Pallor - usually as a result of anemia, that is due to the following:
i. excessive blood loss @ the time the cord was cut
ii. inadequate flow of blood from cord into infant @ birth
iii. fetalmaternal transfusion
iv. low iron stores due to maternal nutrition during pregnancy
v. others: incompatibility, bleeding

3. Cutis Marmorata
4. Acrocyanosis - bluish discoloration of the hands and feet due
to poor peripheral circulation and vasomotor instability.
5. Cyanosis - may indicate disease state
- observed in crying /quiet state
a. cyanotic when quiet and
grows pink when cries
atelectasis
b. with normal color when quiet then cyanotic when crying

-If occurs less than 24 after birth; could be due to Rh/ABO or blood
incompatibility reaction, congenital enzyme deficiency, drug
induced hemolytic anemia.
-In fetal days, needs higher levels of RBC, Hgb, Hct for sufficient
oxygenation. After
birth, the need no longer arises since
lungs are functioning, destruction of excess RBCs.

-Serum unconjugated bilirubin does not exceed 12mg/100cc

Above 20mg/100cc, will cross the blood brain barrier interfere
with chemical synthesis of brain permanent cell damage and
possible mental retardation, epilepsy, cerebral palsy
KERNICTERUS

8.OTHERS:
LANUGO fine downy hair, common on pre-terms
VERNIX CASEOSA whitish, cheesy, odorless substances
covering the skin, usually on folds of the skin, more in full term. It
protects skin / prevents heat loss.
FORCEP MARKS circular or linear contusion matching the rim of the
blade of forceps on infants cheeks. It disappears in 2 3 days.
MILIA whitish, pinpoint papules on the nose/chin/cheeks. It
disappears as early as 2 or 3
4 wks.
NEVI ( STORKBITES ) red spots found at the back of the neck and
above eyelids.
MONGOLIAN SPOTS grayish blue patch at the lower back from the
accumulation of pigment cells, melanocytes. It disappears by
school age.
ERYTHEMA TOXICUM NEONATORUM newborn rash. Pink, popular
rash appearing all over the body within 24 - 48 after birth. It
disappears within a few days; no treatment needed.

DESQUAMATION dry peeling of the skin particularly on the palm and

soles, more in post terms
HEMANGIOMAS vascular tumor of the skin
i. nevus flammeus
ii. strawberry hemangioma
iii. cavernous hemangioma
III.HEAD
- proportionately large; of total length
- cranium is large and face relatively small
- has 8 bony plates, connected by suture lines. Growth of these
bones along the sides causes the head to in size

-Fontanels are opening at points of union of skull bones

i. Anterior is diamond shaped, closes @ 12 18 mos.
ii.Posterior is triangular in
shaped, closes @ 2 3 months
should be felt as a soft spot,flat and firm
-bulges when cries, coughs,but, when prolonged and tense, may
indicate ICP, hydrocephalus, subdural hematoma
- sunken and depressed may indicate dehydration
VARIATIONS IN THE HEAD:
1. MOLDING asymmetric adjustment in the shape of the head
to fit the cervix during delivery

2. CAPUT SUCCEDANEUM swelling or edema of the presenting

portion of the scalp; usually the occiput area; disappears after the
3rd day; no treatment needed

3. CEPHALHEMATOMA collection of blood between periosteum of

the skull bone and bone itself. Caused by rupture of a blood
vessel during delivery. Will take a week for absorption.
4. CRANIOTABES localized softening of cranial bones; can be
indented by pressure. More common in first born infants due to
pressure of fetal skull against mothers pelvic bone. No treatment
needed. Normal in newborn; but, pathologic in older children.
EYES
- gray or blue at birth; do not assume normal color till 3mos.
- should be clear, no redness, no purulent discharges

-Normal findings:
i.SUBCONJUNCTIVAL HEMORRHAGE due to pressure during
delivery causing rupture of
small capillaries; no treatment
ii.EDEMA OF EYELIDS for 2 3 days till kidneys are able to
excrete urine efficiently
iii. PSEUDOSTRABISMUS OR TRANSIENT STRABISMUS
cross-eyed
iv. DOLLS eyes eyes do not follow movement of the head.
Persists for 10 days, then disappear

EARS
- should be in line with the outer canthus of the eyes
- ears set lower are found in
those with chromosomal
aberrations like trisomy 18 and with mental retardation
NOSE
- appears large for his face
- should be patent, with thin, white mucoid nasal discharge

Abnormal: - non-patent, bloody nasal discharge, CHOANAL ATRESIA

MOUTH
- should open evenly when he cries, tongue appears large
- if one side moves more than the other: CRANIAL NERVE
INJURY

VARIATION:
i.EPSTEIN PEARLS whitish-yellow accumulation of epithelial
cells on hard palate, disappears in a week

Abnormal:
i.THRUSH ( Candida infection or Moniliasis ) whitish/ grayish
patches appearing on tongue and sides of cheeks. Acquired
through passage into the birth canal
ii.CLEFT LIP / PALATE
iii.PROTRUDING TONGUE
iv.DROOLING
v. INABILITY TO PASS NGT
NECK
-short and chubby ( thick ) surrounded by skin folds with tonic
neck reflex
Abnormal:
i. NUCHAL RIGIDITY
ii.CONGENITAL TORTICOLIS rigidity of neck due to injury to
sternocleidomastoid muscles during birth
IV.CHEST
-clavicles should be straight and symmetrical
-appears small since head is large; but, @ 2 yrs, CC is greater than
HC
-breast engorgement both for male and female, due to mothers
hormone
-occasionally, breast secretes thin watery fluid: Witchs milk (due
to lactating hormone from mother)
-Abnormal:
i. Funnel chest depressed sternum
ii. Pigeon chest abnormal
prominence of sternum
iii. Asymmetric chest expansion
LUNGS
- 30 60 breaths per minute; chiefly abdominal
- Abnormal: apnea more than 20 secs., dyspnea, rate above
60/min, grunting,
see-saw respiration

VI. HEART
-100 120 beats / minute
-between left nipple and sternum; 3 4th ICS
-Abnormal: Cardiomegaly, murmurs, persistent cyanosis
VII. ABDOMEN
- cylindrical in shape; liver, spleen, kidneys are palpable
- a sunken appearance may indicate missing abdominal contents

UMBILICAL CORD appears as a white gelatinous structure during

the first hour. Check for AVA.
After the first hour = begins to dry, shrink and become discolored
2 3rd day = turns black
6 10th day = sloughs off, should have no bleeding at site
VIII. ANO GENITAL AREA
FEMALE
- vulva may be swollen due to maternal hormones
- urinates within 24 hours

Variation: PSEUDOMENSTRUATION blood tinged discharge

Abnormal:
i. enlarged clitoris with urethral meatus at tip
ii. no vaginal opening
iii.fecal discharge per vaginal opening
iv.no urination

Abnormal:
i. Spina bifida ( Spinal hernia )
ii. Imperforate anus
iii. No meconium within 36 hours
X. EXTREMITIES
- arms / legs appear short, hands plump, fist clenched, fingernails
are soft, smooth and long
- ten fingers and toes
- full range of motion
- nail beds pink with transient cyanosis

-creases
creases in anterior 2/3 of the sole
-symmetrical extremities
-bilateral muscle tone / brachial pulse

Variations:
i. Webbing ( Syndactyly )
ii. Extra toes and fingers ( Polydactyly )
Major Abnormality:
i.Persistent cyanosis of nail beds; fractures; dislocations
ii.Short arms ( Achondroplastic dwarfism )
iii.Clubfoot ( Talipes deformity )
iv.Absence of extremities (Amelia )
v.Short extremities, wherein hands and feet appear to adhere to
the body (Phocomelia)

MALE
-urethral opening at the tip of the penis; testes palpable at each
scrotum
-scrotum usually large, edematous,
-deeply pigmented
-SMEGMA ( thick, cheesy, odoriferous secretions under the
prepuce )
-urinates within 24 hours

Variations:
i. Urethral opening covered by prepuce
ii.Inability to retract the foreskin ( PHIMOSIS )
iii.Erection or PRIAPISM
iv.Testes palpable at the inguinal canal

-Abnormal:
i. Hypospadia - urethral opening under the penis
ii. Epispadia urethral opening @ dorsum of penis
iii. Cryptochidism
iv. Inguinal hernia
IX.BACK / RECTUM
BACK spine intact; appears flat in the lumbar / sacral areas
- no openings, mass or prominent curves
RECTUM patent anal opening; passage of meconium within
24

NEONATES
DEVELOPMENTAL TASKS:
1. BIOLOGIC TASKS
- establishing and maintaining respiration
- circulatory changes
- regulation of body temperature
- ingesting, retaining and digesting nutrients
- elimination of waste
- regulation of weight
2. BEHAVIORAL TASKS
- establishing a regulated behavioral tempo independent of
the mother
- processing, storing, and organizing multiple stimuli
- establishing a relationship with caregivers and the
environment
TRANSITION PERIOD
1. FIRST PERIOD OF REACTIVITY
A.FIRST STAGE lasts up to 30 minutes after birth
B. SECOND STAGE lasts 2 4
hours
2. SECOND PERIOD OF REACTIVITY between the 4th 8th
hour after birth
PRINCIPLES OF IMMEDIATE CARE
I. AIRWAY PATENCY
* most critical adjustment a newborn must make at birth
TECHNIQUES to maintain patent airway:
wipe off nose and mouth with sterile gauze
suctioning with the use of rubber bulb syringe or suction
catheter
positioning
i. if NSD without problem = TRENDELENBURG
ii.traumatic delivery = FLAT with head turned towards the sides
others: milking the trachea by stroking the neck in the
direction of the mouth
stimulating the newborn to cry
II. PROVIDE OPTIMUM TEMPERATURE
FOUR PROCESSES OF HEAT LOSS:
1. CONVECTION flow of heat from the body surface to cooler
ambient air
2. RADIATION loss of heat from the body surface to cooler
solid surfaces not in direct contact but in relative proximity to
each other
3. EVAPORATION loss of heat that occurs when a liquid is
converted to a vapor
4. CONDUCTION loss of heat from the body surface to cooler
surfaces in direct contact
POSSIBLE WAYS TO PRODUCE HEAT:
1. Shivering
2. Metabolism of brown fat
3. Gluconeogenesis
HOW TO PROVIDE WARMTH:
1. Dry, newborns skin
2. Wrap, using soft blanket

3. Use of pre heated bassinet or crib, radiant warmer, drop light

or floor lamp
III. INITIAL ASSESSMENT OF CONDITION
APGAR SCORING
was developed by Dr.Virginia Apgar in 1952
done on the 1st minute, 5 and 10 minutes after
based on 5 parameters, ranked in order of importance

A. HEART RATE
palpating the pulsation of the cord
listening to heartbeat with a stethoscope between the left
nipple and sternum @ 3 4th ICS for 60 secs.

B. RESPIRATORY EFFORT
a crying baby is a breathing baby
C. MUSCLE TONE
D. REFLEX IRRITABILITY
tested through a gentle slap on foot; passing catheter thru nose

E.

COLOR acrocyanosis

IV. PROPER IDENTIFICATION

- through footprints and name tag / bracelet
- done before leaving the delivery room, to prevent switching of
babies
- done before cord is cut
V. PREVENTION OF INFECTION AND INJURY
A. ASEPTIC TECHNIQUE
1. CORD CARE
Normal = 1 vein and 2 arteries ( AVA )
Abnormal = 2 A & 2 V Mongoloid
CARE:
a. asepsis should be observed - present care needs no dressing
after cord has been clamped or ligated and cut. If left exposed,
will dry because water is lost and separates more quickly than
when covered.
b. frequently inspect for bleeding
c. cord is clamped 2.5cm (1inch) from the skin. Using a
disposable clamp, ligature or cord tie
d. cleansed with betadine antiseptic during the initial care. 70% ethyl
alcohol can be used in the succeeding cord care.
2. SKIN CARE- done to prevent skin infection
oil bath high risk premature
soap/water bath full term
- ideally given when body temperature has stabilized at 37C

B. PROPHYLAXIS
1. EYE ( Credes prophylaxis)

> to prevent Ophthalmia Neonatorum or gonorrheal conjunctivitis

> use of:
a. silver nitrate 1 %
b. ophthalmic ointments like terramycin, tetracycline
TECHNIQUE:
- inner to outer canthus while exposing the lower
conjunctival sac
- should be delayed for 1 2 hours
- might interfere with the maternal and infant bonding which
should be stablished as soon as possible after birth.
2.HYPOPROTHROMBINEMIA prophylaxis
> prescribed with single dose
>1 m /0.1ml of Phytonadione solution (Aquamephyton) per IM,
vastus lateralis
> Aquamephyton, a Vit. K water soluble preparation acts as
preventive measure against neonatal hemorrhagic disease
-most newborns are born with prolonged coagulation
or prothrombin time due to blood levels of Vit. K.
-Vit.K is necessary for the formation of clotting factors VII, IX & X,
which are synthesized through the action of intestinal flora.
VI. MOTHER CHILD BONDING
an effective bond between mother and infant that is specific to
them from which both gain security
first social relationship for the infant
research shows mother and child need time immediately after
birth (a sensitive period when infant is awake, need parental
contact for optimal development)
interferences from bonding: sickness, caesarian section,
difficult labor

VII. NUTRITION
Purposes:
a. Bonding
b. Involution
c. Breast feeding stimulation
- Bottle feeding is postponed until sucking and swallowing are well
coordinated, to prevent possible aspiration.
- Once feeding is started, give sterile water initially, to check for
coordination of sucking, swallowing and presence of gag reflex.
- Observe the neonates reaction, if there seems to be violent
reaction elicited when swallowing, stop the feeding.
- Breastfeeding infants are brought to their mothers as soon as
possible and are fed on demand basis
- Bottle-fed babies are given routine feeding of 2 3 oz / 4 hours
VII. BAPTISM OF INFANT
If there is a probability that the infant is in imminent danger and may
not live, question of baptism should be considered if family is Roman
Catholic.
Is an essential duty, means a great deal to the family.
Should be reported to the family after.

SELECTED CONDITIONS OF THE NEWBORN

HYPOGLYCEMIA
low blood sugar
CHO stores are low, glucose is the main source of the energy for the
first 4-6 hours
Prematurity, post maturity, inadequate intake, stresses (cold stress,
difficult birth)

Will fall rapidly then stabilize: from 50 to 60 mg/dl to 60 70 mg/dl

SX: jittery, apnea, tense, bulging fontanels absent MORO reflex
Tx:
1. ORAL GLUCOSE
2. Keep warm
3. Monitor the VS
4. Administer ordered 10%-25% IV glucose
HYPOPROTHROMBINEMIA (NEONATAL BLEEDING DISORDER)
ANEMIA
WEIGHT LOSS
PHYSIOLOGIC JAUNDICE OR HYPERBILIRUBINEMIA
Treatment:
1. early feeding- to speed passage of feces thus preventing
reabsorption of bilirubin in the bowels
2. phototherapy- exposure to light to initiate maturation
of liver enzymes
DESQUAMATION
Hepatitis B (HBV) vaccine administration
@ 6 weeks
@ 10 weeks
@14 weeks
Newborn Screening test for diseases
early screening and detection of genetic disorders such as
phenylketonuria (PKU), hypothyroidism, galactosemia, and sickle cell
educate the parents on the importance of screening and to collect
appropriate specimens at the recommended time (after 24 hours of
age)
Universal Newborn hearing screening
screens all newborn infants before discharge for hearing loss by
auditory brainstem response or evoked oto-acoustic emissions
Ballard Scale (Assessment of Gestational Age)
an abbreviated version of Dubowitz scale
measures gestational age 20-42 weeks
assesses 6 external physical and 6 neuromuscular signs

DAILY CARE OF THE NEWBORN

BATHING
hygiene and excellent time for observation of the neonate
performed after VS have been stabilized
involve the parents in the care of the child
preserve skins acid mantle
within an hour after delivery to remove the vernix caseosa

 then ONCE A DAY, before feeding in AM

Materials:
1. bath water- 37-38 C or 98-100 F, warm to the elbow room
temperature- 24 C or 75 F
2. oil
3. soap- mild, no hexachlorophene
4. basin, wash cloth towel, comb, clean diaper/clothes
Techniques:
- cleanest to the most soiled area
- wash hair daily
- each part should be washed and rinsed well
- include cord care
CORD CARE
cut the OS then place on the base of the cord
apply betadine 3x from the base
clamp cord 1 inch from the base
cut the cord 1 cm from the clamp
apply betadine 3x for the stump
wrap the cord with OS then pour 70% alcohol
remove the OS
daily cord care with ethyl alcohol
diapers are placed below the cord to prevent irritation
average cord separation time 10 to 14 days
CLOTHING
cotton, simple, comfortable, not restrictive, light colored materials
no snaps that may be accidentally removed and swallowed
appropriate to the kind of weather
SLEEP PATTERN
sleeps most of the time; wakes up for the physiologic need
averages 16-20 hours; 4 hours at a time
SKIN CARE
- meticulous skin care; otherwise may lead to infection
NUTRITIONAL ALLOWANCES
1. CALORIE
up to 2 mos of age=120 calories/kg body wt or 50-55 kcl/ lb every 24
hours for adequate amount of food for growthbeyond 2 mos, decreases
=100 kcal/kg or 45 kcal/lb/day
adults- 42 kcal/kg or 290 kcal/lb/day
2. CHON
first 2 mos is 2.2 g per kg body wt
cow's milk has more CHON (16 %) content than human milk (18%)
both contains an amino acid,HISTIDINE, necessary for infant growth
but not necessary for adult growth
main protein content in cows milk: CASEIN; human milk:
LACTALBUMIN; humans milk easier to be digested
3. CHO
LACTOSE, a disaccharide, the most easily digested carbohydrate
Improves calcium absorption and aids in nitrogen retention
It provides stools in which gram positive microorganism predominates
Adequate CHO levels in formula allows CHON to be used in
building new cells
cows milk: 29%; human milk: 37%

FATS
human milk has 3x more content than cows milk
5. FLUID
needs sufficient fluid intake because rate of metabolism is high and
metabolism needs water
NB uses 45-50 kcal/kg in 24 hours for metabolism
30-35% of NBs fluid is extracellular and kidneys immaturity causes
failure to fully concentrate urine so large amount of water is lost
has larger surface of the body in relation to body mass, thus large
amount of water is lost during evaporation
Requirement: 160-200 ml/kg or 2.5-3 oz /lb/ 24 hours
6. CALCIUM
needed for bone growth
human milk has more than cows milk
IRON
maternal iron supplied to NB is enough to last for 3 mos, until he
starts to produce adult HGB
FEEDING
TYPES
a. breastfeeding
b. formula feeding
c. mixed feeding
Breastfeeding
Human milk is the preferred form of nutrition for the full-term infant
Physiology of Breastfeeding
A. Milk secretion reflex or prolactin reflex
- total emptying of the breasts is the best stimulus to more milk
secretion
B. Milk ejection reflex or letdown reflex
- relaxed and secured maternal feeling best stimulates letdown reflex
Prerequisite:
a) physiologic readiness
b) absence of emotional stress
c) sucking stimulates let down reflex
d) rest, exercise, diet
Maternal Contraindication
1. narcotic addiction
2. active PTB
3. acute contagious disease
4. cardiac disease
5. cancer
6. extensive surgery
Infant Contraindication
1. cleft lip
2. cleft palate
Essentials of Breastfeeding:
A. To start:
right on the delivery table PRIMARILY to promote bonding

 30 minutes after birth in normal spontaneous delivery

4 hours after CS
B. Duration:
5 minutes/ breast after establishment of feeding
the first 10 minutes= for NOURISHMENT
the 2nd 10 minutes= for SUCKING PLEASURE
CARE OF THE BREAST
daily bath towel dry
clean bra
use of nursing pads
no soaping; no alcohols on nipples
ADVANTAGES OF BREASTFEEDING
Mother
promotes bonding
promotes uterine involution
delays fertility (but not safe to use as sole means of FP)
economically saves time, money, effort
less incidence of breast cancer
Baby
contains antibodies (IgA) that protects NB from GI infections
always available in sterile form + correct temperature
less incidence of colic,
constipation, diarrhea, allergy
its protein, LACTALBUMIN, is easy to digest
contains TAURINE that enhances brain development
B. ARTIFICIAL FEEDING
recommended only if breastfeeding is not possible
ADVANTAGES:
1. provides an alternative to breastfeeding
2. more accurate assessment of intake
3. may meet the needs of working mothers
4. maybe indicated in cases of congenital deformities, inborn errors of
metabolism, allergies

I- MMEDIATELY AVAILABLE
N- UTRITIOUS
G-ASTROENTERITIS PREVENTED
COMMON SKIN DISORDERS
A. DIAPER DERMATITIS
1. diaper dermatitis- perianal irritation due to accumulation of
moisture, heat, and chemical substances
2. ammonia dermatitis- diffuse erythema in the perianal and gluteal
areas caused by breakdown of urea in the urine to ammonia by
bacteria in the feces
3. intertrigo maceration of any two skin surfaces in close opposition/
chafing of the skin
B. MILIARIA/ HEAT RASH/ PRICKLY HEAT
- bungang-araw
- due to overdressing, warm weather
C. SEBORRHEA DEMATITIS -cradle cap
- due to accumulation of sweat and dirt causing flat, adherent and
greasy scales with pruritus and crusting; usually indicates a secondary
infection
TREATMENT: mineral oil, ointment or lotion
D. IMPETIGO
- macules, papules, pustules, crusts- infection caused by bacteria due
to poor skin care, overcrowding, malnutrition
E. BOILS/FURUNCLES
- bacterial infection of hair follicles common in the face, neck, axilla,
buttocks
TREATMENT: personal hygiene; no squeezing; topical neomycin
cream; diet high in CHON, low in fats and CHO
F. ORAL MONILIASIS
- oral thrush; fungi infection of the mouth
- caused by Candida albicans
- seen as white patches on the tongue
PREVENTION: oral hygiene; care of maternal nipples
TREATMENT: mycostatin or nystatin oral swab

FACTORS TO SUCCESS:
1. pasteurization of the milk
2. sanitation in milk handling
3. adequate sterilization, refrigeration, storage
4. to be equal with mothers milk in nutrients: ADD sugar to increase
energy value, DILUTE with water to reduce minerals and CHON
concentration
SPECIAL CONSIDERATIONS
1.observe aspiration precaution
2.hold bottle in upright position so that the nipple is always filled with
milk
3.burp
4.demand feeding is preferred than scheduled
B- EST FOR BABY
R- EDUCES ALLERGY
E- MOTIONAL BONDING
A- NTIBODY PRESENT
S- TOOL INOFFENSIVE
T- EMPERATURE ALWAYS IDEAL
F- RESH
E- CONOMICAL
E- ASY ONCE ESTABLISHED
D- IGESTED EASILY

CARE OF THE INFANT

Maternal and Child Health Program

ASSESSMENT:

Weight
Gains 150-210 g per week
Doubles weight by 6 months
Triples BW by 12 months

Height
First 6 months: 1 inch/month
2nd 6 months: 50% of BL

Motor development
Fine motor
Gross motor

Special senses
Vision
Hearing
Language
Personal and social

Play

Under-Five Care Services

1. Breastfeeding Campaign
2. Philippine Nutrition Program
3. Expanded Program on Immunization
4. Integrated Management of Childhood Illness

AGE IN
MONTHS

LANGUAGE

Cries

Differential crying
Coos, gurgle

3
4
5
6
7
8
9
10
11
12

Squeals/laughs aloud
Coos, babble, chuckles
Laughs aloud
Vocalizes, talks, mood
Squeals, coos, vowels
with consonants
Imitates sounds,
monosyllabic words, self
reinforcement
Vowel sounds, chained
syllables- mama,dada
indiscriminately
Consonants t, d and w;
chained syllables;
emotions
Responds to simple
commands;
Mama and Dada has
meaning; knows byebye; single words
Speech sounds
3-5 words; knows objects
by name; understands
simple commands

Schedule of consultation
1st year of life (0-11 months) every month
2nd year of life (12-23 months) every 2 months
3rd year of life (24-35 months) every 3 months
4th year of life (36-47 months) every 6 months
5th year of life (48-59 months) once

SENSORY
Fixates on moving objects (810 inches); quiets-voice
Binocular fixation; searches to
locate a sound; turns head to
sound at ear level
Peripheral vision (180); turns
head; coordination
Begins eye-hand coordination;
established binocular vision
Follows a dropped object;
localizes sound below ear
Adjusts posture; localizes
sound above ear; turn, up or
down
Responds to own name;
fixates on small objects; depth
and space; head in an arch

Breastfeeding: The first step to raising a bright child

Statistics on Breastfeeding
Based on the 2003 National Demographic Health Survey (NDHS):

Only 54 percent of infants were initiated to breastfeeding

within an hour after birth.

33.5 percent of infants under six months old were

exclusively breastfed.

On the average, infants are breastfed exclusively only for

less than a month.

Breastfeeding a young child, on the average, lasted for 14

months only.
Promoting Breastfeeding
Laws
R.A. 7600: Rooming-In and Breastfeeding Act of 1992
Breastfeeding Week: August 1-7
E.O. 51: Milk Code
Health education
Advantages of breastfeeding
Technique of breastfeeding
Reflexes involved in breastfeeding
Prolactin reflex
Letdown reflex

Technique of breastfeeding
Position
Cradle Hold (also called Madonna or cross-chest) position
Localizes sound by turning
Football Hold (also called clutch) position
head diagonally
Side-lying position
How to help baby latch on to the breast
1. The mother holds her breast in a C-hold.
2. Stimulate the babys rooting reflex.
3. When the baby's mouth opens wide, put the nipple and as
Discriminates geometric forms;
much of the areola as possible into his mouth.
can follow rapidly moving
How to make baby let go of the breast
objects; sounds
1. Press down on the breast near his mouth.
2. Pull down on his chin and insert a small finger in the corner
of his mouth. This will break his seal on the nipple.
3. Then remove him from the breast.
Signs that the baby has latched on properly to the breast
1. The babys mouth is wide open.
2. The baby and the mother are in tummy to tummy position.

10

3.
4.
5.

Much of the mothers areola is inside the babys mouth.

The mother does not feel nipple pain.
The baby is relaxed and happy.

Frequency of breastfeeding
Signs of proper breastfeeding technique

11