Prenatal Period to 1 year

Chapter 6

What are the two main factors that influence growth and

development?A. Stress and FamilyB. Environment and StressC. Environment and HeredityD. Heredity and Gender

Heredity: Zygote formation

• Sperm & ovum – 23 chromosomes – Zygote

• Gender– X & Y Chromosomes

• Ovum – Always X

• Sperm – X or Y

Dominant & Recessive Genes

Dominant• Capable of expressing traits

over other genes

Recessive• Traits only appear if they

exist in pairs

Recessive disorders

• >700 recessive gene diseases– Sickle-cell disease– Tay-Sachs disease– Hemophilia

Environment

• “From the moment life begins, the environment begins to exercise its influence on the newly formed entity.”

For you personally, when does life begin?

A. ConceptionB. ImplantationC. When there is a heart beatD. When the fetus is viable if it was bornE. When the baby is born

Healthy Pregnancy

• Rest • Exercise – Continue

What is the best form of exercise for a pregnant women?

A. BicyclingB. WalkingC. SwimmingD. JoggingE. Kick-boxing

Teratogens

• Tobacco– Low birth rates– Growth restrictions

Teratogens

• Alcohol– *1st trimester– Fetal Alcohol Syndrome

(FAS)– Miscarriages– Growth restriction– CNS damage

Teratogens

• Bacteria, protozoan, viruses– Rubella

• Toxoplasmosis– Parasite – Eat well-cooked meat

Ova to Fetus

• Ovaries– Ova (pl)– Ovum (sing)

• Ovulation• Sperm• Conception/ Fertilization• Zygote • Implantation• Embryo• Fetus

What is the estimated length of human pregnancy?

A. 28 weeksB. 38 weeksC. 40 weeksD. 42 weeksE. 48 weeks

Stages of Labor & Delivery

• Stage 1– Dilation

• Dilation• Effacement

• Stage 2– Expulsion

• After-brith– placenta

Fetal membranes

• Amniotic sac• Amniotic fluid• Placenta• Umbilical cord– 2 arteries– 1 vein

Neonate

• 1st breath• Apgar score– 1 minute– 5 minutes

APGAR

• Activity• Pulse• Grimace• Appearance• Respiration

• activity and muscle tone• pulse• grimace response /

reflex irritability")• Appearance / skin

coloration• respiration

What is the highest score a neonate can get on a Apgar score?

A. 2B. 3C. 10D. 12E. 15

Head & Skull

• Head ¼ of total body length

• Ave circumference – 13-14 inch– 33-35.5 cm– 1 inch > chest

Skull

• 6 bones– 1 occipital– 1 frontal– 2 parietal– 2 temporal

• Separated by cartilage– Sutures

• Fontanels – Anterior– Posterior

Which fontanel is smaller?

A. AnteriorB. Posterior

When does the posterior fontanel “close” by?

A. 2 monthsB. 4 monthsC. 6 monthsD. 8 monthsE. 12 months or more

When does the anterior fontanel usually “close” by?

A. 6 monthsB. 12 monthsC. 18 monthsD. 2 yearsE. 3 years

What is the normal lengths of a full-term neonate?

A. 12 inchesB. 18 inchesC. 20 inchesD. 24 inchesE. 36 inches

How much does a normal infant grow in the first year?

A. ½ inch a monthB. 1 inch a month C. 1 ½ inch a monthD. 2 inch a monthE. 2 ½ inch a month

Normal Physiological Weigh Loss. How much weight on average does a

neonate loss in the first few days of life?

A. 5-10 % of birth weightB. 15-20% of birth weightC. 25 – 30% of birth weightD. There is no such thing as normal physiological

weight loss in a neonate

Skin

• Thin & pale• Acrocyanosis• Pigmentation

Mongolian Spot

• Usually fads by…– Age 4 years

• 6 month old

Lanugo

Vernix Cascosa

Milia

Physiological Jaundice

Genitals

• Breasts– Swollen

Genitals

• Scrotum– Lg & edematous

What is the medical term for undescended testicles?

• No – this is not multiple choice! Turn to your neighbor and tell them the answer.

Cryptorchidism

• Undescended testicle/s

Cryptorchidism

• The testes develop in the abdominal cavity in early fetal life. By 14 to 17 weeks of intrauterine life they migrate to an opening in the body wall known as the inguinal canal. After 28 weeks they pass through the canal and by 35 to 40 weeks reach the scrotum.

• Undescended testicles are fairly common in premature infants. They occur in about 3 - 4% of full-term infants. In most cases the testicles descend by the time the child is 9 months old.

• Increased risk of – Testicular cancer– Infertility

Genital

• Urethra• Circumcisions

Pseudomenstruation

• Blood-tinged vaginal discharge

Face

• Eyes swollen

• Eye treatment– Erythromycin– Silver nitrate

When do baby teeth start to come in?

A. 2 monthsB. 4 monthsC. 6 monthsD. 8 monthsE. 12 months

Deciduous teeth

Which teeth normally erupt first?

A. Two lower central incisors

B. Two upper central incisors

C. Two lower lateral incisors

D. Two upper lateral incisors

By age 12 months the baby will have 6-8 teeth

Abdomen

• Neonate– Lg and flabby

• Umbilical cord– Cut– Clamped– Falls off– No tub bathing until…

Abdomen

• Digestion– Simple carbs

• Stomach can hole – Neonate

• 1-3 oz

– 12 months • 10 – 12 oz

Why do you have to “burp” the neonate?

• Cardiac sphincter

Bowel movementStoolFeces

• Meconium– Duration

• 1-2 days

– Characteristics• Green-black• Tarry• Odorless

Bowel movement, Stool or Feces

Formula Fed• Pasty yellow or tan• Odor

Breastfed• Mustard seed color• Sweet odor

Extremities

• Short• Flexed• Finger/sole prints• Nurses– ROM– Gluteal folds

Gluteal fold assymetry

Neurological Characteristics

• Newborns– Reflexes– Posture– Movement– Muscle tone

Protective reflexes

• Blinking• Sneezing• Swallowing• gag

Moro / Startle Reflex

• Sudden movement Extension & Adduction of extremities

• Disappears – 3-4 months

Tonic Neck Reflex

• Turn head to one side extend arm and leg on that side

• Disappears – 5 months

Rooting reflex

• Stroke cheek enfant turns toward that side and open mouth

• Disappears– 4-6 months

Sucking Reflex

• Sucking movement when anything touches their lips

• Diminishes – 6 months

Babinski

• When sole is stroked hyper-extened & fan out toes & big toe turns up

• Disappears– 3 months

Palmar grasp

• Grasp anything placed in hand

• Appears– 6 wks

• Disappears– 3 months

Spinal Bifida

Vision

• Newborn– Primative– Nystagmus

• 4 months– Binocular vision

• 6 months– 20/100– Depth perception

Hearing

• 6 wks– Recognize mom and turn

to respond

• 1 year– ID sounds and source

Touch

• Birth– Face– Hands and soles

• 1 yr– Withdrawal– Recognize source

Vital Signs - Newborn

• Temp– Initially low– Stabilized

• 97.7 -99.5• Axillary

• Pulse– 120 – 160 / min– Apical

• BP– 64 / 40

• Resp– 30 – 60 / min– Irregular– apnea

Motor Development

• Neonate– Purposeless– uncoordinated

Gross motor skills

• 2 months– Control head

• 4 months– Sit with support– Roll belly to back

• 6 months – Roll both ways

• 8 months– Sits alone

• 10 months– Laying to sitting– Creep

• 11 months– Pulls self up

• 12 months– walks

Fine motor skills

• Neonate– Grasp reflex

• 5 months– Purposeful reaching

• 6 months– Hold bottle

• 7 months– Hand preference– Pincer grasp

• 9– Cup– Spoon

• 12 months– Scribble– Tower – two blocks

Psychosocial Development: What theorist are we going to discuss?

A. FreudB. EriksonC. PaigetD. KohlbergE. Maslow

What stage of psychosocial development is a neonate?

A. AutonomyB. TrustC. InitiativeD. IndustryE. Identity

Parent-child relationship

Attachment Engrossment

Parent guidance / discipline

• 0-6 months– Distraction

• 6-12 months– More direct discipline

Cognitive development: Who’s theory are we going to be applying?

A. FreudB. EriksonC. PaigetD. KohlbergE. Maslow

What stage of cognitive development is an infant?

A. PreoperationalB. Concrete operationalC. SensorimotorD. Formal operational

Moral Development

• Neonate– No conscience– !00% ID

Communication: What “name” or word to baby’s say first (usually)

A. MaMaB. DaDa

Communication

• Birth– Crying

• 2 months– Smile– Coo

• 4-6 months– Babbling

• 8 months– Dada

• 10 months– Mama

• 12 months– 4-6 words

Nutrition

Sleep & Rest

Play

Safety: Aspiration

• Avoid small objects• Age aprop toys

Baby harm

• Sharp objects• Heavy objects • Animals• Shaken baby syndrome

Burns

• Check water temps• Smoke detectors• Handles of pans in• Cover electrical outlets

Drowning

• Bathtub never alone

Falls

• Mattress lowest position– firm

• Infant seat with restraint

• Infant seat on the ground

• Safe gaits– Slide – Not accordion

Poisoning

• Lead paint• Plants• Safety locks• Medicine• CO monitor

MVA

• Read facing car seat • 12 months