SAN PEDRO COLLEGE — SCHOOL OF NURSING

Case Study
(Infancy )
Presented by BSN 2K Group 2-Subgroup 1

Kathleen Nicole A. Dublin, St.N

Jannah Mae B. Gacasan, St. N
Precious Adelaine Chantal Gacusana, St. N
Cydrex D. Gonzales, St. N
Raphael Ivar E. Hermo, St. N
Mariane Rose N. Jadraque, St. N
Ma. Pia Christine L. Jagurin, St. N
Overview
Introduction Reflexes
Objectives Language Development
Personal Data Conclusion
Computation of Age Nursing Implications
Description of test items References
General Observation Appendices
Personal Hygiene
Introduction
Infancy is the first and earliest stage of a human being’s life, covering the first to
12 months of it. This phase is where the child undergoes massive change since
they are rapidly growing physically.

In theory, Sigmund Freud described infants as being in the oral stage, which is the
initial stage of psychosexual development, during their early years. On the other
hand, According to Erik Erikson’s psychosocial theory, infants undergo a critical
developmental stage known as “Trust versus Mistrust.”
In addition, Jean Piaget proposed the theory of cognitive development,
he posited that children’s cognitive development transpires in stages. In this case,
the sensorimotor stage that focuses on children from birth to 2 years of age.
 Nurses with training in growth and development are trained with assessment
abilities to identify developmental delays using screening tests. The Metro Manila
Developmental Screening exam (MMDST) is a screening exam used to detect the
normalcy of a child's development as well as any delays in children aged 6 ½ years and
below.
 General Objectives

Objectives At the end of the school nursing rotation, the student

nurses in BSN 2K Group 1, Subgroup 1 from San Pedro
College aim to develop a deeper comprehension and
proficiency in addressing rotation-related challenges
and will be able to
evaluate the infant's developmental state and abilities
based on the various elements
and sectors provided, ensuring that clients receive
essential information pertaining to the infant’s health and
well-being.
 Specific Objectives

Objectives To fulfill the overarching objective, the student nurses have

targeted the following specific goals:

1. Cultivate a strong rapport with both the client and their

family.
2. Gather essential personal data concerning the child.
3. Accurately calculate the client's current age.
4. Execute the Metro Manila Developmental Screening Test
accurately.
5. Retrieve pertinent information about the mother's prenatal
history.
6. Collect details regarding the child's birth history.
7. Acquire knowledge about the newborn's neonatal history.
8. Conduct a comprehensive assessment of the infant's
nutrition and elimination.
9. Obtain information about the client's sleep patterns and
activity levels.
10. Evaluate the infant's growth and development
Personal Data

Patient I.G.A.C. is 2 months and 25 days born on August 28, 2023, and is the 3rd child of his parents. He
is currently residing at Bajada, Davao City. He is a Filipino and a Seventh Day Adventist. The patient’s
Mother is E.M.P.A., 31 years old, a vocational graduate and is a merchandiser. On the other hand, his
Father is H.M.C., 31 years old, a College graduate and is a grab delivery driver.
Computation of Age

Client I.G.A.C is 2 months and 25 days old on the day of assessment.

MMDST TOOL
Description of Test Items
Personal-Social
Smiles spontaneously
Administration: May pass by report ( R ). See or ask if the child smiles at tester
or parent without any stimulation, either by touch or sound.
Scoring: Passed by report.
Rationale: Tester asked the mother of the client if he smiles spontaneously
even if he is not triggered or prompted. The mother verbalized, "Oo, musmile ra
jud na siyag iyaha paminsan mutan aw pa man ganig salamin unya mag ngisi."
Fine Motor Adaptive
Grasps Rattle
Administration: Placed rattle touching the back or tips of the child's
fingers when the client was being held by his parent.
Scoring: Failed
Rationale: Client does not show any hint of interest for the rattle

Follows past midline

Administration: Placed child on back and held red yarn six inches in front of
child's face and shaked it to get the child's attention and moved from one side
to another in an arc over the middle of the child to the other side.
Scoring: Failed
Rationale: The red yarn was used to catch the attention of the baby. The
member observed that the eyes and head of the client does not follow the
yarn or give any interest towards it.
Follows 180°
Administration: Placed child on back and held red yarn six inches in front of child's
face and shaked it to get the child's attention and moved from one side in an arc
over the middle of the child's head.
Scoring: Failed
Rationale: The red yarn was used to get the child's attention, however, the child does
not in any way follow the direction of the red yarn.

Hands together
Administration: Watch the child to see if he touches his hands together in the
midline and ask the parent whether her child has done this before.
Scoring: Passed by report and administration.
Rationale: The tester observed if the child had his hands together and there were
times that the infant was doing so. Additionally, the tester also asked the mother if
he had done this before and the mother replied, "Oo, kapila na jud na niya gibuhat."
Language
Laughs
Administration: Check whether the child laughs aloud without being tickled. This
may also be passed by report.
Scoring: Passed by report
Rationale: The tester asked the mother if the child laughs without being tickled
and as verbalized by the mother, "Sige jud nag katawa. Malipayon kaayo bataa."

Squeals
Administration: Check whether the child makes high-pitched, happy, and
squealing sounds.
Scoring: Passed by report.
Rationale: Tester asked the mother if her child makes squealing sounds and
she replied that her baby usually squeals if the baby is happy.
Gross Motor

Stomach (sto) lift head

Administration: Place the child on his stomach and check if he
momentarily lifts his head.
Scoring: Failed
Rationale: Tester asked the mother if the child has done this before and
she verbalized, "First time pajud na sa akong anak nga maghapa siya kay
wala kaayo nako na ginapahapa." Additionally, the test was administered
and the child can not indeed lift his head.
Stomach (sto) head up 45°
Administration: Place the child on his stomach and check if he momentarily lifts
his head at a 45° angle.
Scoring: Failed
Rationale: Tester asked the mother if the child has done this before and she
verbalized, "First time pajud na sa akong anak nga maghapa siya kay wala kaayo
nako na ginapahapa." Additionally, the test was administered and the child can not
indeed lift his head at a 45° angle.
Stomach (sto) head up 90°
Administration:Place the child on his stomach and check if he momentarily lifts his
head at a 90° angle.
Scoring: Failed
Rationale: Tester asked the mother if the child has done this before and she
verbalized, "First time pajud na sa akong anak nga maghapa siya kay wala kaayo
nako na ginapahapa." Additionally, the test was administered and the child can not
indeed lift his head at a 90° angle.
Stomach (Sto) chest up, arm support
Administration: Place the child on his stomach and observe if the child
lift his head and chest up with support from outstretched arms.
Scoring: Failed
Rationale: Since the child was not yet placed on his stomach before as
stated by the mother, the child was not able to lift his head and chest
up by using support of both arms.
Interpretation
By sector, Client I.G.A.C's Persona-Social result is normal. However, his
fine motor adaptive has 3 delays which result as questionable . On the
other hand, his Language is normal and lastly, Gross Motor sector has 4
delays interpreted as questionable.

The infant has had a total of 3 delays in Fine Motor and 4 delays in Gross
Motor, therefore, the infant's development is Abnormal. 2 or more sectors
with 2 or more delays is interpreted as abnormal.
General
Observation
A. Maternal/Obstetrics/Prenatal History

E.M.P.A., G3T3P0A0L3, the mother of the client I.G.A.C. undergone prenatal check-ups at Southern
Philippines Medical Center then switched to Dominicillary Lying-In. During her first and second trimester
she had her prenatal check-up once a month, and for the third trimester she had her check-ups every
week. On July 20, 2023, the mother had her Tetanus Toxoid vaccine (TT) and throughout her pregnancy
she took iron and calcium supplements and ferrous sulfate as her vitamins as prescribed by her physician.
She mentioned she does not have any complications during pregnancy. The mother of the client was in
labor for 3 hours and was able to deliver I.G.A.C. termed at 40 ⅔ weeks.
B. Birth History

The mother of the client, E.M.P.A. stated that she underwent normal spontaneous delivery and did not use
anesthesia for her third born, and underwent 3 hours of labor before delivering the client at Domiciliary
Lying-In in Obrero, Davao City. Additionally, the mother stated that the client, I.G.A.C. experienced cord
coiling during delivery but was immediately resolved. Presentation at birth is cephalic. The birth weight of
the client as stated by the mother was 3.35 kg.

C. Neonatal
The mother of the client E.M.P.A. stayed at Domiciliary lying-in for 12 hours and stated that the client,
I.G.A.C. underwent newborn screening test and was negative with the test. The mother also stated that
client, I.G.A.C. did not have any complications and was given bacille Calmette-Guerin (BCG) and Hepatitis
B vaccination immediately after birth
D. Infancy and Childhood
Client I.G.A.C never had any history of childhood diseases. Along with that, He has no report of congenital
complications. There have been no allergies noted, no previous hospitalization and no serious injuries. The
client’s mother reported that she gave Paracetamol (Tempra®) to the client for his fever as prescribed by
his physician. The client is currently up to date with his vaccinations which includes; bacille Calmette-
Guerin Vaccine, Hepatitis B Vaccine and two doses of Pentavalent, Oral Polio and Pneumococcal
Conjugate Vaccine.
General
Observation
D. Infancy and Childhood
E. Nutrition
The client’s mother E.M.P.A. continuously breastfeeds by demand and reported that she breastfeeds
approximately 6-7 times a day. The sucking strength as the mother reported is normal meaning her breast
does not hurt whenever the client is sucking her breast. The client I.G.A.C approximately drinks milk 6-7
times a day. With all the presented information, no feeding problem is found. The client does not have any
food preferences, meal patterns, appetite, and feeding problems as he is still not able to take solid food as
the mother reported and he also does not have any vitamin intake as of the moment..
Eating well is crucial for kids to grow and develop properly. So, checking their nutrition is a key part of
caring for every child
F. Activity & Sleep
Client I.G.A.C. normally goes to bed around 8 p.m. to 9 p.m. and wakes up at 8 a.m. to 9 a.m., averaging
twelve (12) to thirteen (13) hours of sleep every night. As reported by the client’s mother, He takes a nap
around 2-3 times a day for about one (1) to two (2) hours in the morning and afternoon. I.G.A.C. Daily
routine goes after waking up at 8 a.m. He usually drinks milk, enjoys tummy time, sleeps and is given a bath
by his mother, in the afternoon his routine is the same in the morning and in the evening he usually takes a
bath around 6 p.m. or 7 p.m and then drinks his milk. His nightly rituals consist of being rocked in a
hammock and sleeping around 8 p.m or 9 p.m.

According to the mother of the client, I.G.A.C usually plays with his hand and is entertained by peek-a-
boo.According to Amirali, Peekaboo serves as an interactive method for children to comprehend the idea
of object permanence. It involves multiple senses and contributes to the enhancement of motor skills. By
engaging in the game, children experience tactile sensations as they cover and uncover their eyes, thereby
stimulating their sense of touch. The act of concealing and revealing in peekaboo assists in the
comprehension of spatial relationships and cause-and-effect.
F. Growth & Development
Anthropometric measurementsClient I.G.A.C., At 2 months and 25 days old the client is at 53 cm at length
and appears to have a bigger head circumference, measuring at 34 cm, compared to the chest and
abdomen measuring 31 cm and 33 cm, respectively.
Cephalocaudal Appearance
Skin- The client's skin is smooth with a brown complexion that is consistent in tone and feels silky. The skin
is moist, and the body temperature is warm to the touch. The client's nails are well-trimmed, and he has no
visible sores, bruises or any ulcerations.
Head - The client's skull and scalp display symmetry, and his head is normocephalic. His hair is fine, evenly
distributed, and clean. Changing facial expressions are balanced. Both the anterior and posterior
fontanelles remain unclosed.
Eyes- I.G.A.C. The eyebrows move with symmetry and maintain a straight alignment. The lashes are evenly
curled outward. Examination of the lens and cornea of the sclera shows no signs of jaundice, the
conjunctiva appears pinkish, and both eyes are clear. Both of his pupils are normal and have swift
responses to light. His tear ducts also function normally.
Ears- The client's ears exhibit symmetry, and the student nurse does not detect any tenderness during
palpation. Upon observation, there is no visible cerumen in the external canal.
F. Growth & Development
Nose- The septum is at the midline, the nasolabial fold of the client is even on both sides, and the mucosa
appears pink, with both nostrils being patent and unobstructed.
Mouth- The client's lips are moist, displaying a rosy and symmetrical appearance. The mucosa, gums, and
palate exhibit a pinkish hue. Additionally, the client has not yet experienced the eruption of teeth.
Thorax- The client's thorax is normal, symmetrical, and free from over expansion. No lumps, discomfort, or
lesions were discovered.
Heart- I.G.A.C. cardiac rate is 140 beats per minute as auscultated. No murmurs, heaves or thrills heard.
Abdomen- Examining the client's abdomen reveals no rashes, purple striae, or other abnormalities.

Personal Hygiene
The client was examined physically while lying on his mother’s arms and on his bed. The infant has an
endomorph body built with the weight of 5 kg and 53 cm by height. As stated by his mother, she changes
client I.G.A.C. diaper 4-5 times/day and bathes him twice a day, once in the morning and once in the
evening.
Reflexes
moro reflex- During the assessment, the member observed that I.G.A.C. easily gets startled. The member
concludes that he is positive with moro reflex.
tonic reflex- as observed by the member while conducting the assessment, they observed that, when
I.G.A.C. turns his head on the side, his other arm is stretching while the other one is bending next to his
head.
Babinski Reflex -When the sole of the foot is stroked, the baby's toes fan out and then curl.

Language Development
In their home, they used Bisaya and English but the client’s mother mentioned that the client could only
utter the word, ‘anggi’

Words Uttered
“Anggi” - As stated by the mother, this was the word the child occasionally says, however, she has no idea
what the word means.
Conclusion
I.G.A.C., a 2-months and 25 days old infant, exhibits typical physical
measurements and feeding patterns for his age, with a smooth prenatal
and post-birth history, receiving standard care and vaccinations. Notably,
he experienced post-vaccination fever but otherwise has no history of
illnesses. Notably, the Metro Manila Developmental Screening Test
showed abnormalities, prompting attention. His lack of prone position
play affected neck muscle development, addressed through maternal
health teachings. Behavioral traits correspond to Freud's oral stage,
Erikson's Trust vs. Mistrust, and Piaget's perceptual learning phase. The
mother demonstrates good knowledge of infant care practices so further
health teachings aren't needed.
Nursing Implications
Nursing Education:
This case underscores the significance of incorporating comprehensive
developmental assessment training into nursing education. It highlights
the importance of understanding typical growth and development
milestones in neonates and the value of recognizing abnormalities.
Nursing Education especially in growth and development concept
should emphasize practical experiences and theoretical frameworks
like developmental theories (Freud, Erikson, Piaget) to equip future
nurses with the skills to conduct thorough assessments and provide
appropriate interventions for infants.
Nursing Implications
Nursing Practice:
Nurses need to adopt a holistic approach to infant care, focusing not
only on physical health but also on developmental milestones and
behavioral observations. Incorporating parental education and
guidance on activities that promote optimal infant development, such
as prone position play to encourage muscle development, is crucial.
Nurses should also prioritize building strong rapport with parents to
facilitate open communication and trust, enabling them to provide
tailored advice and support for infant care and developmental needs.
Nursing Implications
Nursing Research:
The importance of further research into the effectiveness of various
interventions for infants with developmental delays is crucial. Exploring
strategies to enhance developmental milestones and interventions to
support parents in facilitating their infant's optimal growth and
development would be beneficial. Researching the correlation between
developmental theories and actual infant behaviors can provide deeper
insights into understanding developmental trajectories in infant and
can aid in early identification and intervention for developmental
issues.
References
Mcleod, S., PhD. (2023). Freud’s Psychosexual Theory and 5 Stages of Human
Development.Simply Psychology.
Erik Erikson’s Stages of Psychosocial Development. (2022, November 3). Simply
Psychology.
Wilcock, Kim. (2019). Why the maternal history is important for the NIPE practitioner in
performing a safe and through examination. 10.4324/9781315111018-6.
Murray, M., & Richardson. (2019, November 31). Neonatology. Pregnancy
History.https://www.utmb.edu/Pedi_Ed/CoreV2/Neonatology/Neonatology3.html
Jiang, F. (2020). Sleep and early brain development. Annals of Nutrition and Metabolism,
75(Suppl. 1), 44–54. https://doi.org/10.1159/000508055
Gantan, E. F., & Wiedrich, L. (2023). Neonatal Evaluation. In StatPearls. StatPearls
Publishing.
References
Pérez-Escamilla, R., Tomori, C., Hernández-Cordero, S., Baker, P., Barros, A. J., Bégin, F.,
Chapman, D. J., Grummer-Strawn, L. M., McCoy, D., Menon, P., Ribeiro Neves, P. A., Piwoz,
E., Rollins, N., Victora, C. G., & Richter, L. (2023). Breastfeeding: Crucially important, but
increasingly challenged in a market-driven world. The Lancet, 401(10375), 472–485.
https://doi.org/10.1016/s0140-6736(22)01932-8
Zhu, Y., Ye, H., Feng, Y., Pan, L. Y., Fu, H. H., Liu, Y. M., Fei, J., & Hong, L. (2021). Assessment of
nutritional status in paediatric outpatients using bioelectrical impedance analysis and
anthropometric z-scores. Journal of paediatrics and child health, 57(8), 1274–1280.
https://doi.org/10.1111/jpc.15450
Hoecker, J. L. (2022). What’s normal when it comes to baby poop? Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-
answers/baby-poop/faq-20057971
References
Dauz-Williams P. A. Abad Santos A. B. Tungpalan L. B. Tuazon J. A. & University of the
Philippines Manila Research and Creative Writing Program. (1999). Metro manila
developmental screening test manual (2nd ed.). Research and Creative Writing Program
College of Nursing University of the Philippines Manila.
Appendices
APPENDIX A: ASSESSMENT
Appendices
APPENDIX B: MMDST TOOL
Age Line and included tests to be conducted
Appendices
APPENDIX C: Assessment Guide
Q&A Session

Thank you for listening!

Thank You!