MCHN – PEDIA 4.

Blood Pressure
Physiologic Function & Appearance of Newborns
1. Temperature
- ranges from 36.5°C – 37°C (axillary)
- crying may elevate temp
- should stabilize 8-10 hours after delivery
- brown fat – tissue that regulates body temp
- mechanisms of heat loss:
conduction, convection, evaporation, radiation
- 80/46 mmHg
- varies with change in activity level
- use appropriate cuff size
- by the 10th day, rises to 100/50 mmHg
SPD:
- calf systolic pressure of 6-9 mmHg less than upper
extremities systolic pressure may indicate
coarctation of the aorta (which results to higher BP)

SPD: 5. Head Circumference

- temp is not reliable indicator of infection - 33 – 35 cm (13.4 – 14 inches)
- temp less than 36.5°C - should be2-3 cm larger than the chest
- molding may result in a lower head circumference
2. Heart Rate measurement
- ranges from 120 – 160 beats per minute - measure at the center of the forehead
- 100 when sleeping
- 180 when crying (maybe irregular) 6. Chest Circumference
- may turn pink with acrocyanosis (normal) - 30.5 – 33 cm (12-13 inches)
- head & chest circumference maybe equal for the
SPD: first 24-48 hours of life
- murmurs – extra heart sounds
- deviation from range 7. Weight
- faint heart sounds - 2500 – 4000 grams
- 3.4 kg for female
*acrocyanosis – caused by peripheral vasoconstriction; - 3.5 kg for male
blush color of hands and feet
2 types: 8. Length
a. primary – not harmful; caused emotional or - 48 – 53 cm
environmental factors - 49 cm for female
b. secondary – indicates underlying disease (PDA - 50 cm for male
or congenital heart defect)
9. Skin
3. Respiration - reddish, smooth, & puffy at birth
- ranges from 30-60 breaths per minute - at 24-36 hours, skin is flaky, dry, and pink
- bilateral bronchial breath sounds - edema around eyes, feet, & genitals
- moist breath sound may be present shortly after - good skin turgor with good recoil
birth - cord with 1 vein & 2 arteries
- hair silky & soft with individual strands
SPD: - nipples present at expected locations
- asymmetrical chest movements - nails at end of fingers & extend slightly beyond
- apnea for more than 15secs - presence of vernix caseosa – white covering of the
- diminished breath sounds baby
- seesaw respirations - presence of lanugo – thin, downy, fine hair
- grunting – low pitch sound; lung problems - may have acrocyanosis
- nasal flaring - may have mongolian spots – flock of dark blue spots
- retractions in color; disappears at school age
- deep sighing - mottling
- tachypnea - physiologic jaundice
- persistent irreg breathing - milia – tiny bumps across nose, chins, & cheeks
- excessive mucus - erythema toxicum – common rash; fades within a
- excessive fine crackles week
- stridor – high pitched sound; airway obstruction - petechia or bruises over presenting part
- skin tags
2 reflexes that clears airways: - harlequin coloring – monetary red color on half on
1. sneezing 2. Coughing the child’s body; 2-5 days after birth
SPD: SPD:
- jaundice within 24 hours - low ear placement
- forceps mark - clefts present
- general cyanosis - malformations
- cyanosis between feedinfs - cartilage absent
- petechiae or ecchymosis other than on the - preauricular sinus
presenting part
- all rashes with exception of erythema toxicum 13. Nose
- yellow vernix caseosa - nostrils patent bilaterally
- hemangioma – birth mark - obligate nose breathes
- pallor - no nasal discharges
- sneezes to clear nose
10. Head - bridge appears absent
- anterior fontanel : diamond shaped - thin white nasal mucus discharge
- posterior fontanel : triangularly shaped
- fontanels : soft, firm, & flat SPD:
- sutures palpable with small separation in between - cloanal atresia and discharge
- there may be caput succedaneum – edema in the congenital narrowing; blocks nasal passages
infant’s skull; harmless - malformation
- molding - nasal flaring beyond first few moments of birth

SPD: 14. Mouth & Throat

- cephalohematoma – accumulation of blood - uvula midline
- hydrocephalus – excessive build-up of cerebrospinal - minimal/absent salivation
fluid in the brain - tongue moves freely & does not protrude
- macrocephaly – overly large head - well-developed fat pads on both cheeks
- closed sutures – 1/more closed earlier - sucking reflex
- rooting reflex – follows the root of stroking
11. Eyes - gag reflex – prevents fr choking
- slate gray or blue eye color - extrusion reflex – pushes food out with tongue
- no tears - moist mucosa
- fixation at times - high arched palate
- red & blink reflex - Epstein’s pearls on ridges of the gums
- distinct
- distinct eyebrows SPD:
- cornea is bright & shiny - cleft lip/palate
- pupils are equal & reactive to light - circumolar pallor
- edematous eyelids - asymmetrical lip movement
- may focus for a few seconds - absent/incomplete reflexes
- uncoordinated movements - protruding tongue (indicates down syndrome)
- diminished tongue movement
SPD: - candida albicans
- discharges - pertrocious teeth
- opaque lenses
- absence of red reflex (cataract) 15. Neck
- epicanthal folds in nbs not of oriented descent - short & thick
- reflexes absent - turns easily on sides
- chemical conjunctivitis - clavicle intact
- subconjunctival hemorrhage – red spots - tonic ________ reflex present
- neck __________ reflex present
12. Ears - some head control
- loud noise elicits startle reflex
- flexible pinna with cartilage present SPD:
- pinna top on horizontal line with the outer canthus - torticollis stiff neck drawing head to one side
of the eye - resistance to flexion
- skin tags on or around the ears - webbing of neck
- large fat pad on the back of the neck
 - palpable crepitus, movement with palpation of the SPD:
clavicle - labia fused
- fecal discharge from vaginal opening
16. Chest - imperforated hymen
- evident xiphoid process - ambiguous genitalia
- bilateral synchronous chest movements - widely separated labia
- symmetrical nipples
- equal anteroposterior & lateral diameter 19. Male Genitalia
- Witch’s milk - urinary meatus at the tip of glans penis
- enlarged breasts - palpable testes in scrotum
- accessory nipples - large, edematous, pendulous scrotum, with rugae
- smegma beneath the prepuce
SPD: - stream adequate on voiding
- asymmetrical chest movements - prepuce covering urinary meatus
- depressed sternum - erections
- marked retractions - increased pigmentation
- absent breast tissue - edema & ecchymosis after breech delivery
- flattened chest
- supernumerary nipples SPD:
- nipples widely spaced - non palpable testes
- bowel sounds auscultated - hypospadias – urinary meatus is at the ventral
surface (underside the glans penis); surgery should
17. Abdomen be done at 3-18 months old
- dome shaped abdomen - epispadias – meatus is at the dorsal surface (above
- soft to palpation the glans penis)
- well-formed umbilical cord - scrotum is smooth
- three vessels in cord - ambiguous genitalia
- cord dry at base - chordee – head of the penis is curved downward or
- liver palpable 2-3 cm below the right costal margin upward
- bilaterally equal femoral pulses
- bowel sounds auscultated within 2 hours of birth 20. Back & Rectum
- voiding within 24-48 hours of birth - intact spine without masses or openings
- small umbilical hernia – protruding - trunk incurvature reflex
- potential anal opening
SPD: - wink reflex present
- absent bowel sounds - passage of meconium within 48 hours
- visible peristaltic waves
- abdominal distention SPD:
- palpable masses - limitation of movement
- scaphoid shaped abdomen - fusion of vertebrae
- omphalocele – organs are out of the belly - spina bifida – spine & spinal cord did not form
- base of cord with redness or drainage properly; a portion of the neural tube doesn’t
- cord with two vessels only develop; should be closed at 28 days
- tuft of hair
18. Female Genitalia - imperforate anus – anus is missing or blocked; can
- edematous labia & clitoris be caused by the rectum having an opening to other
- labia majora are larger & surrounding the labia structures, rectum is not connected to the anus, or
minora narrowing of the anus
- hymental tag - anal fissures – small tear on the mucus that lines
- pseudomenstruation the anus
- smegma – whitish covering (?) - pilonidal cyst
- vernix between labia
- increased pigmentation 21. Neuromuscular System
- ecchymosis & edema after breech birth - maintains position of flexion
- red, brick pink-stained urine within 24 hours - when prone, turns head side to side
- hold heat and back in horizontal plane when held
prone
 - ability to hold head momentarily erect - sterile at birth
- limited ability to digest fats
NORMAL REFLEXES: - immature cardiac sphincter between the stomach
 blink/corneal – involuntary blinking upon stimulus and the esophagus
 rooting – turns the face towards a stimulus (6 - immature liver functions
weeks) - meconium to transition stool
 sucking – paired with rooting; to suck on anything
nipple like; developed inside the womb *meconium consists of mucus, amniotic fluid, lanugo, and
 swallowing – the tongue moves the liquid to the bile
back of the mouth; from birth to 4 months *probiotics – good bacteria
 extrusion/tongue trust – prevents fr choking & *vitamin K – coagulant
clutch onto a nipple; works with sucking; develops
within 32-36 weeks of gestation 25. Urinary System
 palmar grasp – when object is placed on the palm, - voids within 24 hours after birth
they tend to grasp; disappears at 6 weeks - system does not fully mature until the first year of
 step in/dancing – when baby is held upright, they life
step; disappears at 2-3 months; helps with the
proper development of the legs 26. Immune System
 placing – knee brings the foot up when down; flexes - difficulty of antibody formation
the knee Growth & Development
 plantar grasp – 8-9 months in preparation for Growth
walking - the physical change & increase in size
 tonic neck – aka fencing reflex; last about 5-7 - measurable
months - height, weight, bone size, & dentition
 moro/startle – startled by a loud sound or own cry;
lasts about 2 months Development
 Babinski – when sole is firmly stroked, the toes fan - the behavioral aspect of growth
out; 2 years old; may appear as early as 12 months - capacity & skill of a person to adapt to the
 magnet – when sole is pushed, it is pushed back environment
(supine position)
 crossed extension – present until 36 weeks PRINCIPLES:
 trunk incurvation/galant – laterally flexed when 1. growth and development are continuous, orderly,
spine is stroked at prone position sequential processes influenced by maturational &
 deep tendon – tapping of the knee, looking for knee genetic factors
jerk 2. all humans follow the same pattern of growth and
 landau – happens when held in the air; fr birth – 12 development
months 3. the sequence of each stage is predictable, time of
onset, length of stage & effects of each stage vary
SPD: with person
- hypotonia – low muscle tone; aka floppy baby 4. learning can either hinder or help the maturational
syndrome process
- hypertonia – increased tightness of the muscles; 5. each developmental stage has its own
caused by motor damage characteristics
6. growth and development occur in a cephalocaudal
22. Cardiovascular System direction
- functional closure of the ductus areteriosus, 7. growth and development occur in a proximal to
foramen ovale, ductus venosus and umbilical artery distal direction
- blood volume ia 80-100ml/kg BW or total of 300ml 8. development proceeds from simple to complex
- high ESA, hgb, and WBC count 9. certain stages of growth and development are more
- prolonged coagulation or prothrombin time critical than others

23. Respiratory System FACTORS:

- onset of breathing occurs as air replaces that fluis 1. genetics/heredity
filled the lungs during the intrauterine life 2. gender/sex
- the baby should take a breath 10 seconds after birth 3. race/national characteristics
4. environment
24. Gastrointestinal Tract a. external environment
 - cultural influences - annual growth of 2 inches, height 47-48 inches,
- socioeconomic status weight 50-51 lbs
- nutrition - good balance, advanced throwing, outdoor sports
- climate & season - penmanship becomes legible
- deviation from positive health exercise - able to bathe self
- position in family
b. internal environment (8-9 years)
- intelligence - gradual increase in height & weight
- hormonal influences - movements more graceful
- emotions - enjoys jokes & reading
- plays well alone or in groups
METHODS OF STUDYING G&D
1. cross-sectional technique (10-12 years)
2. longitudinal method - appearance of secondary sex characteristics
3. growth charts - tasks include emancipation fr parents &
4. denver developmental screening test development of self-concept
- evaluates children from birth to 6 years in a skill - understanding psychosexual differences
area - begin to see fat deposits increase
- to identify developmental issues
5. stereophotogrammetry  ADOLOSCENT
- production of contour maps for the whole body (12-15 years)
6. physio print - wide individual variations of growth maturation
- face, contour maps of the whole body - girls bt age 10 and 14, gain 2-8 inches, 15-55 lbs
7. newborn screening - menarche begins 2 years after growth spurt
- determines disorders (hypothyroidism, PKU, - boys growth spurt occurs at age 12-16, increase 4-
galactosemia, & sickle cell disease 12 inches in height & 15-65 lbs
8. intelligence test
- measures abilities (16-20 years)
9. goodenough-harris drawing test - spermatogenesis occurs by age 16, boys height
- intelligence test used to screen children bt ages 3- slowly increases, ceasing at 18-20 years
12 years old - girls growth stops at 16-17 years of age
10. binet-simon test SEXUAL MATURATION
- used to identify children who are unable to profit fr PUBERTY
normal classroom instructions - time of development of secondary sex
11. Stanford-binet test characteristics
- occurs in fairly predictable sequence
PATTERNS OF G&D: - address issues in a straightforward manner
1. NEONATAL STAGE (0-28 days)
- behavior is largely reflexive & develops to more DEFINITION OF TERMS:
purposeful behavior  adrenarche – appearance of pubic hair
 gynecomastia – breast enlargement & tenderness
2. INFANCY (1 month-1 year) in males
- Physical growth is rapid  menarche – 1st menstrual period
 pubertal delay – no breast development by age 13
3. TODDLERHOOD (1-3 years) in females; no enlargement of testes or scrotal
- motor development permits increased physical changes by age 13-14 in males
autonomy, psychosocial skills are increased  pubertal growth spurt – general acceleration of
growth
4. PRESCHOOLERS (3-6 years)  physiologic leucorrhea – increase in normal vaginal
- their world is expanding discharge
- new experiences social role are tried during play  thelarche – changes in the nipple & areola area
- physical growth is slower with development of a breast bud
THEORIES OF DEVELOPMENT
5. SCHOOL AGE
(6-7 years)
TANNER STAGES
- first permanent teeth
Females:
  stage 1 (pre-pubertal) – no signs of breast changes
or development or any pubic hair growth
 stage 2 (pubertal) – small breast buds; dark downy
hair begins to appear in genital area
 stage 3 – increase in size of breast & areola; dark,
coarse, curly pubic hair spread over the female
triangle
 stage 4 – secondary mound occurs in the breast at
the areola; pubic hair adult like
 stage 5 – breasts are mature
Males:
 stages 1 – no pubic hair or changes in genital area
 stage 2 – initial enlargement of scrotum & testicles;
reddening & textural changes in the scrotum;
appearance of sparse, downy hair at the base of the
penis
 stage 3 – initial enlargement of the penis; pubic hair
darker, coarser & curly in larger area
 stage 4 – penis continues to grow in diameter with
development of glans; darkening of the scrotum;
pubic hair adult-like in appearance
 stage 5 – penis, scrotum, & pubic hair is like that of
an adult
FREUD’S PSYCHOSEXUAL STAGES
- used sexuality to identify stages of development
- used regions of the body
STAGES:
 oral (0-1 year) – mouth is the area of pleasure
 anal (1-3 years) – toilet training is significant
 phallic (3-6 years) - Oedipus & Electra Complex;
penis envy, castration anxiety; recognition of
differences of the sexes
 latency (6-12 years) – play & acquiring knowledge
 genital (12-19 years) – sexual maturation
*if the stages are completed successfully, the result is a
healthy personality.
*if certain issues are not resolved at the appropriate stage,
fixation may occur.
-- it is the persistent focus on an earlier psychosexual stage.
*until this conflict is resolved, the individual may remain
stuck in this stage.
Example: fixated at oral stage = smoking, drinking, eating
ERICKSON’S 5 STAGE MODEL OF PSYCHOSOCIAL
DEVELOPMENT
- development across the lifespan
- levels of achievement
- the greater the task achievement, the healthier the
personality
STAGES:
 infancy
- birth up to 18 months
- trust vs mistrust
- learning to trust others
 early childhood
- 18 months to 3 years
- autonomy vs shame & doubt
- self-control without loss of self-esteem; ability to
cooperate & to express oneself
 late childhood
- 3-5 years
- initiative vs guilt
- learning the degree to which assertiveness &
purpose influence the environment; ability to
evaluate one’s own behavior
 school age
- 6-12 years
- industry vs inferiority
- beginning to create, develop, & manipulate
- developing a sense of complete perseverance
 adolescence
- 12-20 years
- identity vs role confusion
- coherent sense of self; plans to actualize one’s
abilities
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
- cognitive development is a sequential, orderly
process whereas variety of new experiences must
exist before intellectual abilities can develop
- in each phase, individual must use assimilation and
adaptation
STAGES:
 sensorimotor stage – 0-2 years
 preoperational stage – 2-7 years
 concrete operational stage – 7-11 years
 formal operational stage – 12 and above years
KOHLBERG’S STAGES OF MORAL DEVELOPMENT
LEVELS & STAGES:
 level 1: preconventional
o stage 1 – punishment & obedience
orientation; activity is wrong = punished
o stage 2 – instrumental-relativist orientation;
action is taken to satisfy one’s needs
 level 2: conventional
o stage 3 – interpersonal concordance; action
is taken to please another & gain approval
o stage 4 – law & order orientation; right
behavior is obeying the law & following the
rules
 level 3: postconventional
 o stage 5 – social contract, legalistic
orientation; standard of behavior is based
on adhering to laws
o stage 6 – universal-ethical principles;
universal moral principles are internalized

SULLIVAN’S STAGES OF INTERPERSONAL DEVELOPMENT

STAGES:
 infancy
- birth to appearance of articulate speech
- Activity is primarily mouth centered

 childhood
- articulate speech to the need for playmates
- child integrates self-esteem & develops malevolent
transformation

 juvenile
- first 5-6 years
- child becomes social, competitive, cooperative, and
learns to supervise own behavior by external
controls

 preadolescence
- 7 years to adolescence
- child begins to form genuine human relationships

 early adolescence
- 12-14 years
- child develops patterns of heterosexuality activity

 late adolescence
- 15-18 years
- Person is initiated to privileges, duties, satisfaction
& responsibilities of social living