Concept of growth and development

Growth (QUANTI)

- increase In body size eight and weight this occurs through cell division and protein synthesis
- measure

Development (QUALI)

- gradual growth from a lower to a more progressive and capacity to function (cognitive and
moral)

maturation

- state of readiness where body to prepared to fulfill its function

- addition then multiplication ( emotionally and dimensions

mass specific differentiation

- also called gross refined

- the child masters simple operations before complex functions

ex: child learn put shoes before shoelace

principles of growth and development

1. principle of asynchronous growth

- not all parts of the body grow at once and at the same time (head to toe
- stages of development (2 months –head, 3 months –chest,6 months-sit)
2. growth and development
- continuous process begin in conception to ends death

3. play

- universal language and central to the life of child

- expression
- essential

4.Practice

- great deal of skill and behavior

5. each child

- unique

FACTORS INFLUENCING HUMAN GROWTH AND DEVELOPMENT

1. GENETIC FACTOR
- Basic genetic make up of an individual that makes a child unique
- Heredity
- Ex: skin color
2. RACE
 - Some are tall, short (genetic make up
3. Sex/gender
- Girls=lighter boys= by ounce or 2 height can also influence by gender
- Boys=muscles
4. Intelligence level
- Children intelligent do not grow physciall and excel in advancement skill
(MOTOR DEVELOPMENT DECREASED
5. Health
- Child inherits genetically transmitted dieases not grow as rapid as the others
- Parents sakitin
6. Environmental influences
- Child not grow than genetically program height potential allows other factors may hinder
growth
- - dirty envi sakitin child
7. Socio economic level
- child rich= afford things child poor=poor nutrition diseases (vaccine)
8. ordinal position in the family
- eldest/only child=develops language skills to adults /healthy /attention/funds
- young childlearn by watching other child but eldest= poor on toilet training
9. parent child relationship
- child love=thrive better
- disrupted parent child rel=loss desire to eat and play
10. illness and injury
- poor growth= hyperthyroidism & DM
11. exercise and stimulation
- child no excersise= hindered growth
12. Nutrition
- Poor nutrition=limit growth and intellegines
- DIET influences growth

STAGES OF GROWTH DEVELOPMENT

PICTURE

PATTERNS OF GROWTH AND DEVELOPEMNT

1. General growth
- Respi,digestive,renal,musculetal,cirulatpry)
- Proceeds SMOOTHLY AND GRADUALLY during childhood however there are some body parts
wihich faster than the others
a. Neurologic tissues
- Brain and spinal cord
- Grow rapid in 1st 2 to 5yrs
b. Lymphoid tissues
- Grow during infancy and childhood to provide protection to child against infection
c. Reproductive tissues
 - grow in contrast, show little growth until puberty

THEORIES OF GROWTH AND DEVELOPEMNT

1. theory
- systematic statement of principles that provide framework fro explain phenomena
2. developmental task
- skill growth responsibility arising at particular time of an individual life achievement of each
task lead to accomplishment

FREUDS THEORY OF PSYCHOSEXUAL DEVELOPMENT

SIGMUND FREUD (1856-1939)

- australlian neurologist and founder of psychoanalysis (maadaptuve behavior)

- he propsed psychosexual theory based oin mentally disturbed clients

behavior

- an instinctive drive(libido) with response to the

- ego=reality (detachment of reality, iscoprinia)
- id =self (impulsive, mental disorder,isoprenia)
- superego=conscience(self confidence, being lacks)

psychosexual/psychoanalytical theory

- child development is a series of psychosexual stages in which a child sexual gratification

becomes focused on a particular body part

ex: mouth,anus,genitals,latent c,genital stage-adult

fixation

- condition which person fails to meet a certain task

Age group Play Psychosexual stage Implications

Infant Solitary Oral stage - Provide oral
(reflexes and - explore mouth stimulation
senses) - suck=enjoyment - Give pacifiers
relief of tension (no infant pacifiers)
and nourishment - Don’t be discourage
- rooting reflex- thumb sucking
nipple breastfeed - Breastfeeding
Toddler Parallel Anal stage - Help achive a
(no share toys - Child learns and bowel /bladder
but wants to find pleasure to control without
have control urination undue emphasis on
playmates) and defecation. its importance
2 yrls old (self independence)
- Toilet training - Provide autonomy
- Don’t be too lax/strict
 - Elimination takes (lead to behavioral
new importance problem
- Self discovery and Pabaya=disorganized,
way of exerting strict=organized)
independence - Start and bladder
(say NO) training (toilet
Signs theyre ready toilet traning
training
- Basa diaper
- Scuat for toilet
training
- Verbalize she or
wants to poop
Preschool age Associative Phallic stage - accept sexual interest
(interact with - sexual identity (fondling of genitals)
others) trhough as normal area of
awareness of exploration
genital area - offer a;thernatives
masturbation/exhibitionism and set limits
- normal and - do not humillate the
explore child
- don’t pagbawalan (child will be
exhibitionism
pagpapakita ng
genitals
Oedipal complex (male)
- toddler sexually
attracted to
mother
- child tries to
become father
- father is rival
elekta complex (female)
- also called penis
envy
- girl attracts to
father
- affection to father
- mother is rival
School age Competitive Latent stage - help child have
(chinise garter - libido appears non positive experience to
=win or lose) active and boost his self esteem
dormant to prep him for the
- attention=learning conflicts of
new skills and adolescene
knowledge and ( cricticlal preschhol
physical activities toddler and infant
 latent means lazy can affect schhopl
- libido converted age child)
to concreate thing - teachers and parents
and physical act play an integral role
- schhol works and in building the
chores character of the
schooler
(environment factor
since build character)
Adolescent Intellectual Genital stage - provide appropriate
(quiz - Learns sexual opportunity for the
bee,scrable) maturity and childq to relate with
establishes the opposite sex
satisfactory (limitation
relationship with relationship)
opposite sex - let them verbalize
(bf and gf) feelings egardinf new
relationships
(peers)

ERIKSOSN PSYCHOSOCIAL DEVELOPMENT THEORY

Erik erikson (1902-1996)

- trained under the PSYCHOSEXUAL theory and founded the psychosocial development theory
- a persons view of himself is more important than any instinctive drive in determining one
behavior
(personality)
- conflict of 2 opposing forces at each stage.
Resolution of each conflict or accomplishment of developmental task of that stage allows the
individual to go towards the stage
(before step up achive task) ex: infancy achive thing in positive thing

INFANT

Trust vs. Mistrust

TRUST

- child needs met,discomforts removed quickly,cuddled played with and talked child will
develops sense of trust
- (friendly,caring,trustworthy,compassionate,loving)

MISTRUST

- care is ininnosent,inadquete rejecting, child wil be mistrust

(loner,no friends,paranoid,divorced)
(palo ni mommy if agdawat ti makan)
Implication

- provide primary care giver: soft touch, and sounds visual stmulation and involvement
(touch.hearing and smell) (skin to skin contact=bonding and trust)

TODDLER

Autonomy vs. Shame/doubt

AUTONOMY

- self government or independence

- appreciate opening candy bottle flash toilet develops autonomy
(good leaders,independent,integrity)

NEGATIVISM/SHAME/DOUBT

- child always says NO defense mechanism in pursuit for independence

- parents impatient they do evryting for their children child not allowed what they want to do
start doubt capabilities and develops shame
(lax,dependent, push over,inferior)

Implication

- involve in descion making offerinf choicespraise activity don’t judge correctness of ones
decision

PRESCHOOLER

Initiative vs. guilt

INITIATIVE

- learn how to do things

- freedom to playa child and expores to material things like cla eand paint and answered when
he is asked and fantasize child learn Initiative
(excellent creative not affriad to do things and vocal)

GUILT

- child feel like [lay act is bad and questions is stupid develop guilt
(limited brainstorming,prob solving,need approval, introverts and soft spoken and
copycat)

Implication

- allow them to play do things they want always provide safety anf set limitations

SCHOOL AGE
Industry vs. INFERIORITY

INITIATIVE

- learn how to do things, child asked to do things well industrious

- child works are praised rewarded and achivemnts are acknowledged by parents they develop
sense of pride and send of insurty grows
(confident creative appreciative of others works and perfect crafts)

GUILT

- child is ignored, efforts not seen and products considered fruits of busy work they become
inferior
(inferiority complex, non appreciative poor on things not interested and repeated failures)

Implication

- give reward allow to participate in chores let child assemble small project so child feel
rewarded

ADOLESCENT

Identity vs. role confusion

IDENTITY

- integrates everything that they have learned in past to form SELF IMAGE
- able to do do so
(straight determined good decision making credible)

ROLE CONFUISION

- unable to do so=crisis identity

- uncertain what they do and who they want to be
(lax,no direction ambivalent poor decions)

Implication

- avoid giving negative identity pople without definite identity may prefer negative identity
rather than not giving aving identity.give opportuninyy to discuss their emoton and event
important to him. Offer suppory and praise for descion making

YOUNG ADULT

Intimacy vs. Isolation

INTIMACY

- ability to relate well with other people attain long lasting friendship
- strong sense of identity he is able to create deeper friendship with other
(able to keep commitment knows hot to love)

ISOLATION
 - cannot build long lasting rel. constat ffear of rejection an end fail love
(abortion divorce paranio and insecure)

Implication

- provide avenue for verbalization of lfeelings make them feel they belong endorse them to
groups may e help

MIDDLE ADULT

Generativity vs. STAGNATION

GENERATIVITY

- concern grows not just for themselves but families and community and wolrd
- assume diff. various role they regain self worth and generativity
(productive involved in nation building,active and renewd)

STAGNATION

- role unable to cope up with chage

(full time mother, life boring and antiquedted)

Implication

- alcounsel regarding community invovlemtn let them verbalize

OLD AGE

Integrity vs. Despair

INTEGRITY

- looks back at life appreciate choices made in past happy in present has intergrity
- assume diff. various role they regain self worth and generativity
(helpful in bringing up trusting granchild)

DESPAIR

- wishses relived all over again looks back past regret diffult accpt present despair
(diffult child rearing)

Implication

- alcounsel regarding community invovlemtn let them verbalize

THEORY OF MORAL DEVELOPMENT

LAWRENCE KOHLBERG 1972-1987

- psychologist who student reasoning ability of boys and based his studies on pigets theory.
 - His theory focused on the WAY CHILD GAIN KNOWLEGDE OF RIGHT AND WRONG (moral
reasoning

THEORYT OF MORAL DEVELOPMENT

- This can help identify how child may fell about illness how dependable he is in carrying out
self care

---------------------------------------------------------------------------------------------------------------------

INFANT TODDLER PRESCHOOLER SCHOOL AGE ADOLESCENT

PRERELIGIOUS PERIOD PUNISHMENT PRECONVENTIONAL CONVENTIONAL POSTCONVENTIONAL
- Motivating OBEDIENCE STAGE (stage of self DEVELOPMENT (STAGE OF SOCIAL
force= OREINATTION interest) GIRL/BOY STAGE CONTRACT)
PARENTS - Begin to - Child tends - Child - They
- Child learn formulate o be good engage in believe in
good if sense of out of his actions mutual
approved right and own that are benefit or
- Child wrong but interest NICE or reciprocity
scoleded reason is rather than fair - The
when its bad centered out true rather mature
Implication on mother intent to thnan form of
- Infants try and father do good right to moral
hard to says so (spiritual gain reasoning
please and Implication motivation) approval - Adolescent
their wrong - Is difficult EGOCENTRISM of friends are
doing are for child to - Child may AUTHORITY AND capable of
just due to follow do things SOCIAL ORDER STAGE abstract
immature insturctions for others - They thought
development from for learn that beging to
- TRUST – others let personal law is act right
bdevelop a parents gains enforced even if no
better instruct (if I fight by one is
spiritual toddles so my mother walking around
oreinattion as to follow wont like guards or (why is it
a caregiver me police bad to
TRUST –bdevelop a anymore) they steal
better spiritual Implication learn that because
oreinattion - Child there are my
imitate fixed ruls neighbor is
what they (you deprived
see don’t should by their
let them steal and possession
see bad police  They cary out
things will self care even
- Trade off aresst u) without being
actions Implication told because
should be - Child may they can not
used (sit lie only
there because inderstand the
while I they importance of
cook don’t the measure
breakfast) want to but alos
involved princeiples
in a not that certains
 nice or things should
fair be done
sitautaion because they
they may are right
not be
able to
provide
self caee
(if
somone
is
watching)

CONTRACEPTION: ETHICAL AND SOCIAL ISSUES

CONTRACEPTION

- deliberate use of methods to prevent pregnancy, raises a range of ethical and social
considerations that have implications for individuals, healthcare providers, and communities
as a whole

Ethical Issues:

1. Autonomy and Reproductive Rights: At the core of contraception is the principle of individual
autonomy. Every person has the right to make decisions about their reproductive health and
family planning. However, ethical dilemmas arise when considering the rights and beliefs of
both partners within a relationship. Nurses and healthcare providers must navigate discussions
about contraception while respecting the autonomy and choices of all involved.
2. Cultural and Religious Beliefs: Contraception choices can be
deeply influenced by cultural and religious beliefs. Some cultural and religious perspectives may
endorse specific methods, while others might view contraception as morally unacceptable.
Healthcare providers must approach these conversations with cultural sensitivity, offering
options that align with patients' values while providing accurate medical information.
3. Health Implications: Ethical considerations extend to the health impact of different
contraceptive methods. Some methods might carry potential risks or side effects that need to
be discussed transparently with patients. Balancing the benefits of preventing unintended
pregnancies with potential health concerns requires healthcare providers to offer
comprehensive information for informed decision-making.

Contraception

- a critical aspect of reproductive healthcare that encompasses a wide array of ethical and
social considerations. As healthcare providers, understanding and navigating these complex
issues is essential for providing patient-centered care. Let's delve into the ethical and social
dimensions of contraception:
Ethical Issues:

1. Autonomy and Informed Decision-Making

Respecting individual autonomy is a fundamental ethical principle. Contraception decisions should be

informed and voluntary, ensuring that individuals have access to comprehensive information about
various methods, their benefits, risks, and potential side effects. Ethical nursing practice involves
empowering individuals to make choices that align with their values, while

2. Reproductive Rights and Gender Equity:

Every individual has the right to decide whether, when, and how many children to have. Ensuring
equitable access to contraception promotes reproductive justice and gender equality. Nurses play a
vital role in advocating for these rights, addressing barriers to access, and engaging both men and
women in family planning discussions.

3. Cultural Competence and Sensitivity:

Cultural beliefs and practices significantly influence contraception decisions. Nurses must approach
these conversations with cultural competence, recognizing that diverse cultural backgrounds may
shape perspectives on contraception. Respecting cultural differences and tailoring discussions to
accommodate individual beliefs fosters trust and effective communication.

4. Confidentiality and Privacy:

Maintaining patient confidentiality is a core ethical principle. Contraception decisions often involve
personal and intimate information. Nurses must ensure that discussions and medical records are
handled with utmost confidentiality, creating a safe environment for patients to openly discuss their
choices without fear of judgment.

Social Issues:

1. Access and Socioeconomic Disparities:

Unequal access to contraception remains a significant social challenge. Socioeconomic factors can limit
access to certain methods, leading to disparities in reproductive health outcomes. Nurses must be
advocates for accessible and affordable contraception options, addressing barriers such as cost,
geographic location, and healthcare disparities.

2. Family and Relationship Dynamics:

Contraception decisions can impact family structures and relationship dynamics. Open communication
between partners is essential, yet differing opinions can lead to complex ethical considerations.
Nurses can facilitate healthy communication and shared decision-making, helping individuals navigate
these conversations and make choices that align with their values and relationships.
 3. Education and Public Health:
Nurses play a crucial role in educating individuals and communities about contraception and sexual
health. Promoting comprehensive sexual education, dispelling myths, and providing accurate
information contribute to informed decision-making and responsible sexual behavior. Public health
initiatives led by nurses can help reduce unintended pregnancies and improve overall reproductive
health.

4. Cultural Shifts and Societal Norms:

Societal norms and cultural shifts can influence attitudes toward contraception. Public perception,
media influence, and changing cultural values can impact the acceptability and accessibility of
contraception methods. Nurses should stay informed about these shifts and be prepared to address
emerging social considerations.

Assessment for Well-Being

APGAR Score

- used to assess the newborn's well being through observation and rating of its
- respiratory effort, muscle tone, reflex irritability and color.

done on the:

- first minute of life (to assess the immediate well being of a newborn) and on the 5th minute
of life (to assess how

NOTE: Apgar score of the following means:

 1-3 NB - serious danger. Needs rescucitation. (Do CPR, suctioning, give meds)
 4-6 – guarded, need supplementary oxygenation and clearing of the airway. (Give oxygen via
face mask or canulla)
 7-10 - condition is good,

NEWBORN ASSESSMENT

Review of Systems

1. cardiovascular system
- oxygenation of blood changes from placenta during intrauterine life to the lungs after birth.
- when the cord is clamped, the newborn is forced to take in oxygen via the lungs.

FETAL CIRCULATION

- allows the fetus to receive oxygenated blood and nutrients from the placenta. It is comprised of the
blood vessels in the placenta and the umbilical cord, which contains two umbilical arteries and one
umbilical vein
2. blood values
- Normal BV is 80-110ml/kg of weight or 300ml.

WBC

- Normal value is 15,000-45,000 wbc/ cubic millimeter. Increased in response to trauma of birth.
- -there is non-pathologic increase in WBC which makes Infection hard to rule-out.

blood Coagulation

- also called blood clotting. Infants have poor blood coagulation because of low level of Vitamin K.

Vitamin K

- necessary for blood coagulation. It is synthesized by the intestinal flora.

- -infants have low vitamin K because of sterile Intestines which is deficient of intestinal flora.
- -This is the reason why all infants are given an IM of Vitamin K (Aquamephyton) 0.01ml in the vastus
lateralis immediately after birth to prevent bleeding.

3. respiratory system
- first breath takes a large amount of energy because of the sudden shift of the center of
oxygenation and presence of fluids in the lungs.

NSD babies

- fluid is forced out by pressure of vaginal birth. Additional fluids are quickly absorbed by lung
vessels.

*CS babies

- fluids are not expelled thoroughly. They may have difficulty initiating 1st breath because
excessive fluid blocks air exchange space.

*surfactants

- fluids found in the lungs necessary for alveolar inflation. (lecithin & sphygomyelin)
- formed during the 7th month of the intrauterine life. Infants with low level of surfactants may
have lung collapse or atelectasis.
4. Gastrointestinal system
- Bacteria enter the tract through the child's mouth (airborne, vaginal, contact to beddings and
breast.
- bacteria in the GIT is necessary for digestion as well as vitamin K synthesis.

breast milk
- main food of the infant. (deficient in vitamin K.)
stomach
- can hold up to 60-90 ml of food & fluid.
Regurgitation
- refers to the backflow of food from stomach to mouth.
- -due to immaturity of sphincter between the stomach and esophagus.
 pancreas & liver
- have low enzyme production due to immaturity.

TYPES OF STOOL

1. Meconium
- first stool of the neonate. It is sticky to like blackish green, odorless.
- formed from mucus, vernix, lanugo and carbohydrates in the intrauterine life.
- passed within the 24 hours after birth. If the child fails to pass meconium, child may
have imperforate anus.
2. Transitional stool
- green and loose which may resemble diarrhea. Passed on the 2nd 3rd day.
3. Breast fed babies
- pass 3-4x stool/day. Light yellow, sweet smelling, soft stools which are high in lactic
acid.
4. Bottle-fed babies
- pass 2-3x stool/day. Bright yellow, formed stools with more noticeable odor than with
breastfed babies.
5. Babies under Phototherapy
- will pass stools because of increased bilirubin secretions.
6. Baby with milk allergy
- may pass stools which are combined with mucus. (lactose intolerance)
7. Gray-colored stools
- caused by bile duct obstruction. (bile metabolizes fats, bile can't enter intestinal tract
due to obstruction.)
8. Black/tarry stools
- suspect for internal bleeding. (swallowed maternal blood is passed on the 2nd day or
later.)
9. Blood-flecked stool
- indicates anal fissure.

5. Urinary System

- neonate voids within the first 24 hours after birth.

Anuria
- absence of urine. Decreased fluid intake of the neonate may delay voiding. Also check
for possible stenosis or absence of ureters.
urinary stream
- observed for possible obstruction of the urinary tract.
Males
- (Normal) small projected stream.
- (Abnormal)- strong arching projection. Indicative of obstruction.
Females
- (Normal) steady stream.
- (Abnormal)- continuous dribbling.
Urine

- light in color because kidneys cannot concentrate urine. Normal urine output is 30-
60ml/hour for the 1st 2 days.

6. Autoimmune system

- neonate has difficulty forming antibodies against infection up until 2 months. (need for
vaccination, colostrum.)

IgG

- antibodies from the mother which crossed the placenta during the intrauterine life.

*colostrum

- clear, light yellow milk initially produced by the mother. Rich in antibodies.

TYPES OF IMMUNITY

1. Natural/ innate immunity

- from the body's sources.
2. Artificial
- immunity from a synthetic source.
3. Active
- the body develops that certain immunity after exposure to a certain disease.
4. Passive
- body receives a readily active antibody.
5. Natural Active
- chicken pox exposure, etc.
6. Natural Passive
- colustrum/ IgG coming from the placenta.
7. Artificial Active
- vaccines. (anti-measles, etc.) they stimulate the production of antibodies.
8. Artificial Passive
- anti-serums, anti-rabies

7. Neuromuscular system

- manifested by control of body parts.

- Absence of which is never a normal finding. *twitching/flailing movement even without
stimulus is due to immaturity of the nervous system.

Reflexes

- are assessed to determine abnormalities in the neuromuscular functioning of a

newborn.
1.blinking reflex

- a reflex to protect the eye from any object coming near by rapid eye closure.

2.rooting reflex

- if the cheek is brushed/stroked near the corner of the mouth, a newborn will turn the
head in that direction.
- serves to help a newborn find food.
- -disappears at 6 weeks of life when baby's eyes start focusing.
3. sucking reflex

- when the baby's lips are touched, the baby makes a sucking motion. This reflex helps in
breast and bottle feing

4.swallowing reflex

- food that reaches the posterior portion of the tongue is automatically swallowed. gag,
cough, sneeze reflexes clear the airway.

5. extrusion reflex

- a newborn extrudes any substance that is placed on the anterior portion of the tongue.
- -a protective reflex for swallowing inedible substances. Disappears at 4 months when
the baby spits up or refuses solid foods placed on the mouth.

6. palmar grasp reflex

- newborns grasp an object placed on their palm by closing their fingers on it.

7. step/ walk-in reflex

- newborns who are held in a vertical position with their feet touching a hard surface will take a
few alternating quick steps.

8. placing reflex

- when the baby's anterior surface of his leg touches a hard surface, the newborn takes a few
quick lifting motions, as if to step on the table.

9. plantar grasp

- when an object touches the sole of a newborn's foot, the toes grasp in the same manner as the
fingers do.

10. tonic neck reflex

- when a newborn lies on their backs, head turned to one side, their arms and legs are extended
in the side where the head is turned, while the opposite arm and leg contract/fold
10. moro reflex
- startling a newborn with a loud noise by jarring the bassinet. NB abduct their heads, arms and
legs.
11. babinski reflex
- with the side of the sole of the feet stroked with an inverted J, the newborn fans the toes.
- -disappears at 12 months. (AbN in adults.)

13. Magnet reflex

- if pressure is applied to the soles of the feet of a newborn lying in a supine position, he or she
pushes back against the pressure. -indicates the integrity of the spinal cord.

14. crossed extension-

- if one leg of a newborn lying supine is extended and the sole of that foot is irritated with a
sharp object, the newborn raises the other leg as if trying to push away the hand irritating the
other leg.

15. trunk incurvating

- when a newborn lies in a prone position and are touched along the paravertebral area by a
probing finger, they flex their trunk, swing their pelvis towards the touch.

16. landau reflex

- a newborn who is held in a prone position with a hand underneath supporting the trunk, should
demonstrate some muscle tone.

17. deep tendon reflex

- tapping the patella with a fingertip. The newborn kicks or jerks his foot.

18. parachute reflex

- a newborn who is held in a prone position with a hand underneath supporting the trunk
spreads his extremities when suddenly lowered

APPEARANCE OF THE NEWBORN

1. Skin

Color
- most NB have ruddy complexion due to increased concentration of RBC (hematocrit) and
decrease in amount of subcutaneous fat, which makes the blood vessels more visible.
Cyanosis
- lips, hands & feet are likely cyanotic due to immature peripheral circulation. (mucus
obstruction, heart problems.)
acrocyanosis
- bluish discoloration of the extremities.
Hyperbilirubinemia
- increased bilirubin level in the blood.
- -may lead to jaundice/ yellowish discoloration of the skin.
physiologic jaundice
- occurs on the 2nd to 3rd day of life as a result of breakdown of fetal RBC. Normal.
indirect bilirubin
- end product of erythrolysis or RBC death. (RBC (heme & globin). Globin is reused. Heme (iron &
prothrombin). Iron is reused. Prothrombin → indirect bilirubin.)
causes jaundice
- Indirect bilirubin is fat soluble. Infants cannot excrete this because they have immature liver
which cannot produce glucoronyl transferase.
glucoronyl transferase
- an enzyme produced by the liver which converts the fat-soluble indirect bilirubin to water
soluble direct bilirubin. (integrates in feces and excreted.)
pathologic jaundice
- yellowish discoloration of the skin which appears on the 1st 24 hours of life. (Abnormal)
- -may be caused by anomalies in liver.
WOF

- kernicterus- indirect bilirubin permeates the brain, interfering its chemical synthesis and
functioning. (more than 7mg/100ml (N))

*pallor- usually results from Anemia.

1. excessive blood loss when the cord was cut.

2. inadequate blood flow from the cord into the infant at birth.
3. fetal-maternal transfusion.
4. low Fe stores due to poor maternal nutrition.
5. blood incompatibility (Rh, ABO incompatibility).
6. Large number of RBC are destroyed in utero.
7. internal bleeding. WOF: bruises, blood in stool, vomitus.
8. central nervous system damage- child may appear pale and cyanotic as well

*gray skin

- indicates infection or sepsis.

*harlequin's sign

- due to immature circulation. Neonate lying on his side will have a red skin on the dependent
side and pale skin on the upper side.
- -this has no clinical significance. Goes back if child is repositioned or when the baby cries or
kicks vigorously.

2. BIRTHMARKS

*Desquamation

- -peeling of the skin; observed on baby's palm and soles; if present at birth, indicates
postmaturity.

*Mongolian spots
 - bluish black areas of pigmentation and more commonly noted at the back, buttocks upper arm
and shoulder; common among dark skinned individuals. Disappears at preschool period.

*Vernix caseosa

- cheese like substance; a product of sebaceous glands; serves as insulator after birth.

Milia

- clogged sebaceous glands; commonly described as small white pimples found at the tip of nose
and chin of the baby. Disappears after 2-4 weeks.

*Nevi

- know as stork bites or telangiectasis nevi; pink or red flat areas of capillary dilatation commonly
seen upper eyelids, nose, upper lip, lower occiput bone, nape and the neck. Disappears at 1st
and 2nd year.

*Erythema toxicum

- also known as erythema neonatorum, newborn rash or fleabile dermatitis; transient rash:
characterized as pink papules with vesicles seen on nape, back and buttocks. Appears at 2nd day
and disappears without treatment

Cutis marmorata

- transitory mottling of NB's skin when exposed to cold

*Strawberry mark/nevus vascularis

- 2nd most common type of capillary hemangioma. Lesion is elevated sharply demarcated and
bright or dark red, rough surface swelling. Remain until school age or even longer.

*Portwine stain or nevus flammeus- observed at birth; red to purple color; do not blanch on pressure
and do not disappear; commonly found on the face.

*Lanugo

- fine hair seen at shoulder and upper arrh and back. Disappears after 2 weeks.

*skin turgor

- if well hydrated, skin feels resilient, and if skinfold is grasped between the thumb and finger, it
feels elastic; and when released, falls back to form a smooth surface.

*poor turgor
- due to malnutrition, difficulty at sucking at birth, with certain metabolic disorders.
- Skin with decreased turgor remains elevated after being pulled up and released Pinched skin
3. Head
- disproportionately large at birth (1/4 of the total length.
- *adult's head is 1/8 of total length.
- *Forehead is large and prominent.
Hair
- if the child is well nourished, appears full bodied; but if the child is preterm/poorly nourished,
hair appears lifeless and stringy.
Fontanelles

- spaces or openings where skull bones join. (unossified bones)

a. Anterior fontanelles
- formed by 2 parietal and 2 frontal bones. -diamond in shape and measures 2-3cms in width and
3-4cms in length.
- -closes by 12-18months.
b. Posterior fontanelles
- junction at the parietal and occipital bones.
- -triangular in shape and measures 1cm in length.

WOF

- if fontanelles are bulging, it is a sign of increased ICP or hydrocephalus. (",) if fontanelles are
depressed, it is a sign of dehydration.

Sutures

- separating lines of the skull bones w/c allow molding.

Molding

- overriding of bones due to pressure exerted by passage through the birth canal. A N
phenomenon. -will return after a few days.

Abnormal Structures:

1. caput succedaneum

- edema of the scalp @ the presenting part of the head. This may involve a wide area of the head.
- -gradually disappears /reabsorbed @ 3rd day of life; needs no tx. And may cross the suture line.

2. Cephal hematoma

- collection of blood between the periosteum of the skull bone and the bone itself due to
pressure @ birth. -swelling is well outlined and discolored black and blue. Does not cross the
suture line.

3. craniotabes

- localized softening of the cranial bones. Needs no tx, condition corrects itself after months.
- -may be caused by pressure of the maternal pelvis to the fetal skull in utero

4. Eyes
- NBs usually cry tearlessly. (immature lachrymal glands)
- -assume their color on 3rd month of life. (gray/blue eyes)

*subconjunctival hemorrhage
 - rupture of the conjunctival capillary due to pressure @ birth.
- -appears as a red dot on the eyes. Needs no tx, bleeding is slight.

*periorbital edema

- common on the eyes on the 2nd-3rd day. Disappears if the NB's kidneys can evacuate fluids
efficiently.

5. Ears
- external ears are not yet completely formed; pinna may bend easily.

WOF

- if the NB sleeps with poor ear alignment, the ear may assume the position permanently.

NORMAL

- top part of the ear should be in level with the outer canthus of the eye.

Low-set ears

- found with certain chromosomal abnormalities.

Hearing test

- ring a bell 6inches away from the NB's ear. If baby reacts, blinks or startles, (+) hearing; if not, (-)

6. Neck
- short and often chubby.

*Nuchal rigidity

- seen in NB's whose membranes were ruptured 24hours before delivery. (meningitis)

*Neck Rigidity

- due to injury of the sternocleidomastoid muscle. The head cannot rotate freely. (congenital
torticolis)

Note

- infants may lag their heads when pulled to sitting position.

thymus gland

- slightly prominent. (due to rapid growth because of the production of Antibodies.)

7. Chest
- breasts may appear engorged. Witch's milk- thin, watery fluid secreted by the NB's breasts.
- (due to maternal hormones) WOF (",) do not express baby's milk. Can cause mastitis.
 - Chest should be symmetric.

lumps on the clavicle

- may indicate fracture during delivery.

RR

- normally rapid 30-60cpm.

Retraction

- chest wall is drawn inside during inspiration. Abn. Indicates DOB. Increased force in pulling in air.

*ronchi

- harsh sound of air passing over mucus. (due to presence of secretions on the back of the
throath.) Ν.

*grunting

- Abn. Suggest respiratory distress syndrome

8. Abdomen
- dome in shape.

Sunken abdomen

- indicates missing abdominal organ or diaphragmatic hernia.

peristaltic sounds

- produced by the movements of the intestines. Heard w/in an hour after birth.

UMBILICUS

- 1st 24 hours: appears white, gelatinous structure w/ red blue streaks. (AVA
- inspect the clamp if it is secured. Cord dries up and turns to color gray-black. Stump breaks free
@ 7th-10th day.

NOTE:

- for bleeding @ the cord site. (loosened clamp, tugged cord.)

septicemia

- moist, odorous cord suggests infection-.

9. Anogenital area:

Anus

- temperature is taken via rectal thermometer to check for anal patency. (antiquated already)
*imperforate anus

- stenosis or membrane formation in the anus. Absence or orifice.

Best determinant

- -NB must pass meconium on the first 24hours of life.

Male genitalia

Scrotum

- edematous and rugaeted, deeply pigmented in black/violet.

*cryptorchidism

- undescended testicles.

*cremasteric reflex

- internal side of the thigh is stroked, testicles move upward. Tests for integrity of the spinal
nerve.

Penis

- appears small. 2cms.

Urethral meatus

- be on the tip of the glans penis.

*epispadias-

- meatus is on the dorsal surface.

*hypospadias

- meatus is on the ventral surface.

*phimoses

- adhesion of foreskin. If phimoses impedes urination, circumcision is done.

Female genitalia:

Vulva

- may appear swollen, secretion of blood-tinged mucus. (maternal hormones)

- Back: Normally flat when supine. Spinal curvatures appear when the child starts to sit.
- An infant assumes his position in utero. Back is rounded and extremities are flexed on the
abdomen and chest.

spina bifida

- for mass, hairy nodules or dimpling.

Extremities
- symmetric, of equal length, and moves in coordination. Arms assume a flexed position while
feet are bowed.
polyductilism
- extra digits
synductilism
- fused digits.
simian crease
- seen on downs syndrome. Single crease in the hands.
erb-ducheane paralysis
- inability to move upper extremities due to nerve damage during delivery

ESSENTIAL NEWBORN CARE

Initiation of breastfeeding

• Health workers should not touch the newborn unless there is a medical indication.
• Do not give sugar water, formula or other prelacteals.
• Do not give bottles or pacifiers.
• Do not throw away colostrum.
• If the mother is HIV-positive

December 2009- Francisco Duque

- Secretary of Department of health, signed Administrative Order 2009. 0025.

- mandates the implementation of the Essential Intrapartum Newborn Care.
- Giving your newborn the first embrace or "Unang Yakap and breastfeeding for the first six
months may be the best gift you give to your baby
 mandates the implementation of the Essential Intrapartum Newborn Care

UNANG YAKAP

- is a simple and evidenced- based interventions that may help in ensuring the survival of all
newborns and young infants.

procedure after delivery of the baby:

1. Call out the time of birth.

2. Place the baby on the mother's abdomen.
3. Use a clean and dry cloth thoroughly dry the newborn by wiping the eyes, face, head, scalp,
front and back, arms and leg
4. Assess the newborn's breathing or crying normally, do skin-to-skin contact.
5. However, if after 30 seconds the newborn is not breathing athing or is gasping, clamp and cut
umbilical cord,

Reminders:

1. Do not routinely suction the mouth and nose vigorous newborn unless the mouth/nose is
blocked by secretions.
 2. Do not ventilate within the first 30 seconds, unless the baby is both floppy/limp and not
breathing.
3. Do not slap, shake or rub the baby.
4. Do not hang the baby upside down.
5. Do not squeeze the baby's chest.
6. Do not wipe off the white greasy substance covering the newborn's body (vernix).

Skin-to-skin contact

- facilitate bonding between the mother and her newborn.

• Remove the mother's gown then place the newborn prone on the mother's chest, skin-to-skin
contact, with the head turned to one side to facilitate drainage of any secretions from the
mouth and nose.
• Cover the newborn's back with a dry blanket and head with a bonnet.
• Place the identification band on the ankle.
• Make sure that the room temperature is properly maintained at 25-28 Celsius and the baby's
temperature is between 36-37.5 Celsius.

Reminders:

 Do not separate the newborn from the mother if the newborn does not exhibit severe chest in-
drawing, gasping or apnea, and the mother does not need urgent medical or surgical
management.
 Do not put the newborn on a cold or wet surface.
 Do not foot printing.
 Check for multiple births as soon as the newborn is securely positioned on the mother.
• The first skin-to-skin contact should last interrupted for a at least one hour after birth or until
after the first full breastfeed.
• Skin-to-skin contact can re-start at any time if the mother and the newborn have to be parted
for any treatment or care procedures
 The placenta transfuses blood to the newborn after delivery, providing oxygen, nutrients, and
additional blood volume through the pulsating cord. Once this transfusion is completed, cord
pulsations will stop and the cord will flatten.

Remove the first set of gloves immediately prior to cord clamping.

• Palpate the umbilical cord and wait for cord pulsations to stop (typically at 1-3 minutes).
• After cord pulsations have stopped and the cord cord has flattened, clamp and cut the cord as
follows:
• Place the first plastic clamp/tie at 2 cm from the umbilical cord base and the second instrument
clamp/tie at 5 cm from the base.
• Cut the cord near the plastic clamp/first tie.
• Observe for oozing of blood. If there is, place a second the near the plastic clamp.

Reminders:

• Do not milk the cord towards the newborn.

 • Do not clamp the cord earlier than 1 minute after birth in both term and preterm babies who do
not require positive pressure ventilation.
• Do not used binder/"bigkis" or bandage the stamp.
• Do not apply any substance on the cord
• Keeping the newborn and mother together facilitates the newborn's early initiation to
breastfeeding and the transfer of colostrum.
• Leave the newborn on the mother's chest in continuous skin-to-skin contact.
• Do not leave the mother and baby alone during the first hour after delivery.
• Monitor the baby's breathing and take not of the presence of grunting, chest indrawing or fast
breathing.
• Wait until the mother feels strong uterine contractions before delivering the placenta by
controlled cord contraction with counter-action on the uterus.
• Administer erythromycin or tetracycline eye ointment or 2.5% povidone iodine drops to the
newborn's eyes within one hour after birth.
• Proceed to the physical examination and weighing of the newborn.
• This should be followed by the injections with vitamin k (IM), hepatitis B vaccine (IM), and BCG
(ID).
• Maternal procedures can be done with the newborn in skin-to-skin contact with the mother
unless the treatment requires sedation.

Reminders;:

• Postpone bathing until after 24 hours. Early bathing removes the vernix which is a protective
barrier to E.coli and Group B Strep. It also hinders the crawling reflex and leads to hypothermia.
• If problems are encountered in the first breastfeed:
 For newborns who do not breastfeed within one hour- examine the baby. If healthy,
leave the newborn with the mother to try breastfeeding later. Assess in three hours or
sooner if the newborn is small.
 For mothers who are ill and cannot breastfeed help the mother to express her
breastmilk and give the breastmilk to the baby by cup. On day 1,express breastmilk onto
a spoon and feed by spoon. 3. For mothers who cannot breastfeed at all - give the
newborn donated heat- treated breastmilk, if available, Raw donor breastmilk is the
next best aption, followed by artificial

Immediate Essential Newborn Care The First 90 Minutes

Time band: 2nd stage of labor

- At perineal bulging, with presenting part visible

Intervention

- Prepare for the delivery

Action:

• Ensure that delivery area is draft-free and room temperature between 25-28°C.
 • Wash hands with clean water and soap.
• Double glove just before delivery.

Prepare for Delivery

• 2 sets of sterile gloves

• Two clean and warm towels or cloth
• Self inflating bag and mask (normal and small newborn)
• Suction device
• Sterile cord clamp or ties
• Sterile forceps and scissors
• Rolled up piece of cloth
• Bonnet
• Clean dry warm surface

Skin-to-Skin Contact

- Effect on Immunoprotection
• Colonization with maternal skin flora
• Stimulation of the mucosa-associated lymphoid tissue system.
• Ingestion of colostrum

Properly timed clamping of the umbilical cord

- Reduces the risk of anemia in both term and preterm babies

Term babies

- less anemia in the newborn

- 24-48 hrs after birth
- RR 0.2 (95% CI 0.06, 0.6)
- NNT 7, (4.5-20.8)

Preterms babies

- less infant anemia

- RR 0.49 (95% CI 0.3, 0.81) NNT 3 (1.6-29.6)
- Ticip me mother and baby into a comfortabIC position

RA7600

- Rooming-in and breastfeeding. After delivery, the mother is moved onto a stretcher with her
baby and transported to their room. (the child is never separated from the mother)
- Correct Latch-on

4 POSITIONING THE NEWBORN FOR BREASTFEEDING

• Newborn's neck is not flexed or twisted

• Newborn is facing the breast
 • Newborn is close to mother's body
• Newborn's whole body is supported

Interventions:

- menadaftional HIN 90 min of age Provide care for a small baby or twin

Action:

- If the newborn is delivered 1 month early of is visibly small (1501-2499g)

KMC

- Special support for breastfeeding

- Discharge planning

1.cardiovascular system

- oxygenation of blood changes from placenta during intrauterine life to the lungs after birth.

cord is clamped

- newborn is forced to take in oxygen via the lungs.

FETAL CIRCULATION vs. NEONATAL CIRCULATION

- Since the fetus doesn't breathe air, his or her blood circulates differently than it does after birth:
The placenta is the organ that develops and implants in the mother's womb (uterus) during
pregnancy. The unborn baby is connected to the placenta by the umbilical cord.

2 Treatment for jaundice

a. Early breastfeeding- to speed up defecation so as to excrete bilirubin and reabsorption of

bilirubin.
b. Phototherapy/ bililight therapy- helps in the maturation of liver enzymes.

REMEMBER:

• check for the doctor's order.

• use batman's suit. cover eyes, genitalia of the newborn with gauze to prevent organ damage.
• turn the patient from side to side q 2 hours.
• feed the baby before and after bililight therapy to prevent dehydration.

exchange transfusion

- done in severe cases of jaundice. Umbilical blood vessels are used.

- -old blood is drained out of the baby and new blood is transfused

FIRST TOOTH FOOD

- Yougart, carrots, potatoes, ceareal