Pediatrics Exam 1 2021/2022 with complete solution
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Cours
Pediatrics
Établissement
Pediatrics
Principles of Development
Continuous process through life
Orderly sequence
Predictable but unique ranges
Systems mature at different rates
More rapid in early periods
Cephalocaudal pattern grow longer, head to tail
Gross to refined skills
Newborn/neonatal...
Concepts Of Maternal-Child Nursing And Families (Nova Southeastern
University)
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Ch. 25 Growth & Development of the Newborn & Infant
Principles of Development
• Continuous process through life
• Orderly sequence
• Predictable but unique ranges
• Systems mature at different rates
• More rapid in early periods
• Cephalocaudal pattern grow longer, head to tail
• Gross to refined skills
• Newborn/neonatal period of infancy from birth to 28 days
• Infancy 28 days to 12 months
Growth & Development
• Nurse must be familiar w/normal development while obtaining health hx, nurse can ask
parent/caregiver if the skill is present and when it was attained
• Ill or premature infants may exhibit delayed acquisition of physical growth and dev skills
when assessing the growth and dev, use the infants adjusted age to determine expected
outcomes
• Adjusted age subtract the # of weeks that the infant was premature from the infant’s
chronological age
Physical Growth
• Ongoing assessments of growth are important so too rapid or inadequate growth can
be identified
• Infants grow rapidly over the first 12 months weight, length, head and chest
circumference are all indicators of growth
• Weight
o The avg newborn weighs 3.4 kg (7.5lb) at birth
o Newborns lose up to 10% of their body weight over the 1st week of life then gain
30g/day and regains birth weight by 10-14 days of age
o Most infants double their birth weight by 4 months and triple by the time they are
1 y/o
• Height
o Avg newborn is 50cm (20in) long
o Length grows more quickly over the 1st 6 months
o By 12 months length increased by 50%
• Head Circumference
o Avg head circumference of full term newborn 35cm (14in)
o Increases rapidly during 1st 6 months
o Avg of 10 cm (4in) gain from birth to 1 y/o
• Fontanel closure posterior 6-8 weeks (2 months), anterior at 9-18 months open for
brain to grow pg. 1179
• Teeth
o Occasionally and infant is born w/1 or more teeth natal teeth or dev them in 1st
28 days neonatal teeth
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o Majority do not have teeth when born 1st teeth erupt btwn ages 6 & 8 months
primary teeth (deciduous teeth)
▪ Causes ↑ saliva & drooling
▪ Enzyme released w/teething causes mild diarrhea, facial skin irritation
▪ Slight fever may be associated; not high fever (normal)
o Gums around emerging tooth will usually swell lower central incisors are usually
1st to appear followed by upper central incisors
o The avg 12-month old has 4-8 teeth
o Put toys in freezer to help w/inflammation or baby Orajel
• Stranger Anxiety pg. 973
o May develop at around the age of 8 months
o Previously happy and friendly infant may become clingy and whiny
when approached by strangers
o Stranger anxiety indicator that the infant is recognizing themselves as separate
from others
o As the infant becomes more aware of new people/places they may view a
stranger as threatening even if parent is there
o Fam members that don’t see the child often approach infant calmly and slowly
w/parent in sight sometimes will prevent a sudden crying spell
• Separation Anxiety
o May start is last few months of infancy
o Infant becomes distressed when parent leaves infant will eventually calm down &
become engaged w/caregiver
o 8 months’ protests loudly when mom leaves
• Adaptive Behaviors
• Gross Motor Skills pg. 968
• Large muscles head control, rolling, sitting, & walking
• Dev in cephalocaudal fashion ex. Baby learns to lift the head before learning to roll over &
sit
1 month Lifts and turns head to side in prone position, head lag when pulled to sit,
rounded back in sitting
2 months Raises head & chest, holds position. Improving head control
3 months Raises head to 45 degrees in prone, slight head lag in pull-to-sit
4 months Lifts head & looks around, rolls from prone to supine, head leads body
when pulled to sit
5 months Rolls from supine to prone and back again, sits w/back upright when
supported
6 months Tripod sits
7 months Sits alone w/some use of hands for support
8 months Sits unsupported
9 months Crawls, abdomen off floor
10 months Pulls to stand. Cruises
12 months Sits from standing position. Walks independently
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• Warning signs that may indicate probs w/motor dev arms and legs are stiff or floppy,
child cannot support head at 3-4 months of age, child reaches w/one hand only, child
cannot sit w/assistance at 6 months, child doesn’t crawl by 12 months, child cannot
stand supported by 12 months of age
• Fine Motor Skills pg. 969
• Includes the maturation of hand and finger use dev in a proximodistal fashion (center to
the periphery)
• Ex. A newborn’s hand movements are involuntary in nature whereas a 12-month old
is capable of feeding themselves
• By 12 months the infant should be able to eat with their fingers & assist w/dressing
(pushing an arm through the sleeve)
1 month Fists mostly clenched, involuntary hand mvmts
3 months Holds hand in front of face, hands open
4 months Bats at objects
5 months Grasps rattle
6 months Releases object in hand to take another
7 months Transfers object from one hand to the other
8 months Gross pincer grasps (rakes)
9 months Bangs objects together
10 months Fine pincer grasp. Puts objects into container and takes them out
11 months Offers objects to others and releases them
12 months Feeds self w/cup and spoon. Makes simple mark on paper. Pokes w/index
finger
• Language Development
• For several months, crying is the only means on communication of newborn and infant
crying = unmet needs
• 1 to 3 month coos, makes other vocalizations, and demonstrates differentiated crying
• 4 to 5 months simple vowel sounds, laughs aloud, “raspberries,” and vocalizes in
response to voices, responds to their name and begins to respond to “no”
• 4 to 7 months distinguishes emotions based on the tone of voice
• 6 months squealing and yelling, could be displeasure or joy
• 7 to 10 months babbling begins and progresses to strings (mamama, dadada) without
meaning, can respond to simple commands
• 9-12 months beings to attach meaning to “mama” and “dada” and starts to imitate other
speech sounds
• the average 12-month old uses 2-3 recognizable words w/meaning, recognizes objects
by name, and starts to imitate animal sounds
• very impt for caregiver to talk to infant to learn communication skills
• sometimes regression in language dev occurs briefly when the child is focusing energy
on other skills (crawling, walking)
• as long as hearing is normal, language should progress continually
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