Psalm 118:8-9

It is better to trust in the Lord than

to put confidence in man. [It is]
better to trust in the Lord than to
put confidence in princes

 Growth is the increase in size of a structure. Human growth  IDENTIFICATION in NBs is important and done preferably in
is orderly and predictable, but not even; it follows a cyclical the presence of the parents. Several methods of
pattern. Development is the maturation of physiologic and identification include double banding, finger and footprints
psychosocial systems to more complex state. and birthmarks like hemangiomas.
 Phylogeny: development or evolution of a species or group;  Initial bathing is done using H20 with non-alkaline based
a pattern of development for a species. Ontogeny: soap to prevent destruction of acid mantle of the skin. Light
development of an individual within a species oil is used primarily only to allow spread of vernix caseosa.
 Growth and development occurs in cephalo caudal meaning Antimicrobial solution only when there is active infection.
development occurs throughout the body’s axis. Example,  Cord care principles include sterile clamping using Betadine
the child must be able to lift the head before he is able to and 70% alcohol to prevent OMPHALANGIA. It may be
lift his chest. removed after 24- 36 hours if in the hospital.
 Proximo-distal is development that progresses from center  Vitamin K is given intramuscularly with a dose of 1 mg for
of body to the extremities. Example, a child is able to term NBs and .5 mg in pre terms. Ideal site include the thigh
achieve control from the arm to the fingertips as proven in muscles, Vastus lateralis and Rectus Femoris.
the development of prehensile capability.  Correct sites for PR taking in NBs are the Apical pulse,
 During the oral stage of development, the infant receives Brachial and Femoral pulse. if weak or absent, a condition is
satisfaction, relieves tension and derives pleasure from present.
sucking and chewing. Non gratification results to fixations  BP of NBs is 80/46 mmHg at birth, at 10 days maybe 100/50
like smoking and excessive gum chewing. mmHg. Normally, their BP is higher in the LE and lower in
 To establish and maintain patency of the airway, suctioning the UE and can be taken by Doppler or Flush methods.
is done 4 – 5sec but not more that 10 sec in term babies,  In Physical assessment, a NB’s abdomen is shaped like a
less than 5 sec in pre term babies. Suctioning is always dome and cylindrical. A SCAPHOID shape indicates
mouth before the nose to prevent Gasp reflex. DIAPHRAGMATIC HERNIA.
 A NB should be positioned to the R side to increase pressure  The liver of a NB is palpable 2-3 cm BELOW RIGHT COSTAL
to the L side of the heart. This position favors the closure of MARGIN, the kidneys at about 1-2 cm above umbilicus and
Ductus Arteriosus and Foramen Ovale, and gastric emptying the spleen on the left quadrant
thereby preventing reflux of gastric contents and aspiration  Breastfed baby’s stool is golden yellow, mushy and soft, has
 Supine position is recommended for infants above 3 mos. a sweet odor, and passed every after breastfeeding. Bottle
Prone position is contraindicated because it may predispose fed baby stool is pale yellow, hard and formed, has an
the infant to SIDS. offensive, foul odor and passed once a day
 Temp of the NB at birth is 36.4- 37.2 o C. Their temperature  Care for infants with cardiac anomalies include: Improving
is usually unstable and takes 6-8 hours to stabilize. the efficiency of cardiac function thereby increase the
 Factors that influence circulatory changes after birth are: cardiac output, decreasing the cardiac workload, decreasing
Lung expansion and cutting of the umbilical cord. edema and Improving tissue perfusion.
 The purposes of breastfeeding includes: BONDING - a  In fetal circulation, foramen ovale is the opening b/n two
special mutual relationship between mother and infant atria, ductus venosus is the shunt from liver to the inferior
ideally started on the FIRST PERIOD OF REACTIVITY. It also vena cava, and your ductus arteriosus is the shunt from the
FACILITATES RELEASE OF COLOSTRUM AND BREAST MILK, pulmonary artery to the aorta.
STIMULATES PRODUCTION OF PROLACTIN AND OXYTOCIN  During the feto-placental circulation, the pressure in the
and PREVENT JAUNDICE heart is much higher in the right side, but once
 APGAR scoring is primarily done to determine the degree of breathing/crying is established, the pressure will shift from
acidosis and the need for CPR and to evaluate ability of the the R to L side, and will facilitate the closure of the Foramen
NB to adjust extrauterinely Ovale.
 The Silvermann – Andersen scoring is done to determine the  In an infant, feeding problems such as fatigue, tachypnea
degree of respiratory distress. This is commonly done to and irritability may be signs of congenital heart defects.
high risk babies as necessary. Infants with congenital heart defects are at higher risks for
heart failure.

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 1 -

 Blalock-Taussig is just a temporary or palliative surgery  10 month old infants crawl very well and start to use fingers
which creates a shunt between the aorta and pulmonary by showing pincer grasp. They indicate most of their wants
artery so that the blood can leave the aorta and enter the by using gestures and Dada – mama words are apparent.
pulmonary artery and this oxygenating the lungs and return  11 month old infants attempt standing alone for a few
to the left side of the heart, then to the aorta then to the seconds although cruising is well adapted. They are able to
body. follow simple directions because they enjoy imitating
 Mongolian spots are stale grey or bluish patches of other’s activities.
discoloration commonly seen across the sacrum or buttocks  12 month old infants reflect a 200% weight gain from their
due to accumulation of melanocytes and they disappear in 1 birth weight and may have gained 50% of the birth height.
year. They are not linked to steroid use or pathologic They jabber word-like sounds usually pertaining to food.
conditions. Standing is not a problem at this time though walking is
 NBs lose about 5 to 10% of their weight day 2 – 3 after birth attempted or may already be achieved. Preferred toys are
and regain it within 10 days. Their weight gain is 28g /day in big trucks with pulleys or cart that can be pushed.
the first 6 months, 14g/day from 6 months to 12 months.  Toddlerhood is considered a slow growth stage. Weight
 A normal pattern of weight gain in young infants is: 2x in 6 gain is approximately 11 lb (5 kg) during this time and birth
months, 3x in 1 year and 4x in 2 ½ year. weight is quadrupled by 2 1/2 years. Toddlers gain a height
 NBS involves several types of testing. Phenestix test is a of 20.3 cm (8 inches) and a head circumference of 19½ - 20
diagnostic which uses a fresh urine sample (diapers) and inches (49 - 50 cm) by 2 years. The anterior fontanel closes
mixed with ferric chloride. If (+), there will be a presence of by 18 months.
green spots at the diapers. Guthrie test is another test for  Toddlers vital signs are the following: Pulse 110; respirations
PKU and is the one that mostly used. The specimen used is 26; blood pressure 99/64. Primary dentition (20 teeth) is
the blood and it tests if CHON is converted to amino acid completed by 2 1/2 years and development of sphincter
 Infants have greater body surface area than adult, control starts at 18 – 24 months which is necessary for
increasing their risk to F&E imbalances. Also infants can’t bowel and bladder control.
concentrate a urine at an adult level and their metabolic  Cognitive tasks are apparent: REMEMBER: C R E A T I N G T
rate, also called water turnover, is 2 to 3 times higher than OTS
adult. Plus more fluids of the infants are at the ECF spaces  Centering, Ritualism, Exploration and elimination, Animism,
not in the ICF spaces. Temper Tantrums, I- me-myself age, Negativism and are
 1 month old infants can lift their heads, respond to sound, common in toddlers
see black and white patterns. Reflexes are apparent and  Toothbrushing during twenty, Offer choices, Talk with calm
indicate their neurologic maturity. and consistency, separation anxiety are common nursing
 2 month old infants vocalize by cooing and gurgling, hold interventions for toddlers.
their head at 45 deg angle, show social smile and appreciate  PASTA - Parallel play, Autonomy vs. Shame and Doubt,
mobile toys. Extrusion reflex starts and they may start mini Sensorimotor – pre operational stage, Toddlerhood, Anal
push-ups. A 3 month old infant shows minimal head stage are the stages in toddler age according to the
bobbing, and holds head for a longer period of time. Theorists.
 4 month old infants can hold head without lagging, may  Slower growth rate continues in pre-schoolers: Weight:
have eruption of first tooth, can turn to 1 side. They increases 4 - 6 lb (1.8 - 2.7 kg) a year and Height: increases
appreciate teething toys, nibbling and rattles. 2 1/2 inches (5-6.25 cm) a year. Birth length is doubled by 4
 5 month old infants amuse themselves by playing with years.
hands and feet, may distinguish BOLD colors, recognize their  Vital signs decrease slightly in preschoolers, Pulse: 90-100,
name and starts to turn to new sound. Mouthing objects Respirations: 24-25/minute, BP is systolic 85-100 mm Hg
and increased salivation due to teething persists. and diastolic 60-90 mm Hg.
 6 month old infants roll in both directions, imitate sounds  Changes in the lymphatic tissues increase, particularly the
and blow bubbles and loves sound producing toys. Weight tonsils. IgG and IgA antibodies also show significant
increases 100%, they start to sit and lunge forward as if increase. Heart size change in reference to the thorax as the
attempting to crawl. anteroposterior and transverse diameter of the chest reach
 7 month old infants reach for things with a sweeping adult proportions which may cause transient murmurs.
motion, start to combine syllables and may wave bye – bye.  Their Gross motor development include walking up the
Sitting becomes more frequent although not independently. stairs using alternate feet by 3 years, walking down stairs
 8 month old infants are able to sit and crawl, point to using alternate feet by 4 years, riding the tricycle by 3 years
objects and attempt an upright position without success. and standing on 1 foot by 3 years.
Cognitive development increases as manifested by object  Other gross motor skills include: Hopping on 1 foot by 4
permanence, fear of strangers and separation anxiety. years, Skipping and hopping on alternate feet by 5 years,
 9 month old infants combines syllables to a word-like sound balancing on 1 foot with eyes closed by 5 years, throwing
and they understand the word “NO”. Banging of objects is a and catching ball by 5 years, jumping off 1 step by 3 years
common pre occupation, so is the pat –a- cake game, and and jumping rope by 5 years.
cruising. Self-feeding is also seen during this time.  Fine motor development are indicated by Hand dominance
established by 5 years, Building tower of blocks by 3 years,

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 2 -

 Tying of shoes by 5 years, copy circles, may add facial  The school age is considered a slow growth stage where
features by 3 years and copy a square, and trace a height gain is only 2 inches (5 cm) per year and weight is
diamond by 4 years. doubled over this period
 Their Caloric requirement is approximately 90  At age 9, both sexes assume the same size. At age 12, girls
calories/kg/day. They may demonstrate strong taste grow bigger than boys and the boys appear leaner than
preferences and more likely to taste new foods if they are girls.
given the chance to assist in the preparation.  Dentition shows significant change during this age. Lose of
 Their kind of play is predominantly associative play though first primary teeth start at about 6 years. They gain 28 teeth
they enjoy imitative and dramatic play. They imitate same- between 6-12 years old.
sex role functions in plays, they enjoy dressing up,  The caloric need of school age children diminish in relation
dollhouses, trucks, cars, telephones, doctor and nurse kits. to body size: 85 kcal/kg. “Junk” food may become a
Nurse should provide toys to help develop gross motor problem because they are exposed to these types of snack
skills: tricycles, wagons, outdoor gym; sandbox, wading in school. Obesity is a risk in this age group because a lot of
pool parents tend to overfeed their children and the fact that
 Pre schoolers are in the Phallic stage where self-stimulation they are not able to monitor the food intake of their
by fondling, masturbation, touching and looking at the children while in school.
genitals becomes a sense of release to the child. A child  Bone growth faster than muscle and ligament development
attaches better to the parent of the opposite sex thus, the so they become susceptible to bone fractures. This is the
Oedipal, Electra complex, according to Freud. best time for these children to undergo Scoliosis screening.
 This stage is marked also by a highly imaginative child which  Vision is completely mature which is indicated by a good
is manifested by increased fears of abandonment, the dark, hand-eye coordination. This development encourages
mutilation and separation. Likewise, the child uses smoothness and speed in fine motor control.
imagination to deal with fears by creating imaginary friends  School age children develop their Gross motor skills in a
and telling tall tales. certain pattern which predominantly involves large muscles.
 Due to the limitation of emotional expression, behavioral At this time, they are very energetic, have greater strength,
characteristics also become apparent during this age like coordination, and stamina. This capacity helps them sustain
regression, bruxism and sibling rivalry. A very good nursing athletic and physical games and activities.
intervention during this time would be PLAY therapy to  6 year old children compete actively in the classroom, play
allow non verbal self expression. in groups unless tired and under stress. They perform better
 The type of play in this age is cooperative play where the when they are given special and specific attention even for
child is able to play with other preschoolers. Associative play short periods of time only.
because they associate the “roles” they enact with their  Children of this age do not respond well to competition and
significant others. Imitative play because they assume the they react better to non competitive, group games. When
roles exactly how they see their significant other do it. they are exposed to individual games where they are
 Toys at this time should be gender specific. Gender identity expected to perform, they resort to cheating so as to win.
starts so this will help the child identify what objects or  7 year old children are more definitive so promises must be
activities identifies them with being a girl or a boy. kept because they view them as definite, firm
 According to Kohlberg, their idea of right and wrong is commitments. They also show intense attachment to
based on the approval or the disapproval of their significant people outside of the family such as the teacher.
other. At this time, a good role model is needed.  8 year old children seek the company of other children and
 Children at this age are most prone to different types of this is particularly seen in school where they perform better
child abuse because of their dependence to their significant as a group. This is also said to be the NATURAL
others. Presence of a responsible significant others is most HOMOSEXUAL stage where they would rather be with
important. friends of the same sex.
 Make believe is most appropriate because it enhances the  9 year old children take value of their peer group seriously
imitative play and imagination of the preschooler. C and d and this is called “gang age”. They particularly follow a
are for infants while letter B is recommended for schoolers common set of behavior geared towards attempting to
because it enhances competitive play. assume adult like behaviors. It may be manifested through
 According to Kohlberg, a preschooler is under pre- their choice of clothes, food, color and even interests.
conventional where a child learns about instrumental  10 year old children enjoy staying in groups as well as
purpose and exchange, that is they will do something do for privacy. A new cognitive development starts enhancing the
another if that person does something with this child in sense of ownership/property. This age is indicated by
return hoarding of toys, food, personal items and even common
 A 5y/o views death in “degrees”, so the child most likely will things found in the house.
say that “he is just a bit dead”. Personification of death like  Sense of humor is apparent during the school age period.
“boogieman” occurs in ages 7 to 9 as well as denying death Punishments and reprimands given to schoolers usually
can if they will be good. Denying death using jokes and result from this new behavioral characteristic.
attributing life qualities to death occurs during age 3-5.  11 year old children start an increasing interest in the
opposite sex in subtle ways. At this age, the development of

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 3 -

 secondary sex characteristics also starts which makes them within months. This is a common cause of embarrassment
particularly insecure. at this age.
 12 year old children are more comfortable in social  Early adolescence starts at age 12-14 years. This is the start
situations than before although they still feel uncomfortable of puberty and indicated by physical body changes resulting
being pushed into boy-girl situation until they know how to in an altered self-concept.
control their bodies better. More secondary sex  A common behavior during this stage is when adolescents
characteristics appear which worsens their incapacity to tend to compare their own body to others. Early and late
adjust. developers have anxiety regarding fear of rejection.
 According to Erik Erickson, the school age is in the Industry –  They also are prone to mood swing due to hormonal
inferiority stage of psycho social development. changes. Fantasy life, daydreams, crushes are all normal,
 Their cognitive development is indicated by the Period of and help in role play of varying social situations.
industry/concrete operational thoughts at 7 where there is  Nurses should reiterate to parents that this age may
increased interest in exploration and adventure. They like to indicate a behavior of increased independence. Teach them
indulge in activities that accomplishment or production, that acceptable limitations and consistent discipline is
which develops confidence. important.
 Developmental milestones include: DECENTERING –  Middle adolescence is indicated by separation of the child
projecting self into other people’s situation, from their parents (except financially). They are more able
ACCOMODATION – adapting thought process to fit what is to identify own values and can define self (self-concept,
perceived, CONSERVATION – change in shape does not strengths and weaknesses).
necessarily mean change in quantity and CLASS INCLUSION  This age group partakes in peer group and conforms to
– objects belong to more than 1 classification. values/fads. They also show increased heterosexual
 School age children have a more realistic fear than younger interest thru constant communication with the opposite sex
children. These include death, disease or bodily injury, and formation of “love” relationship.
punishment. School phobia may develop and usually results  Late adolescence stage is manifested by achieving a greater
in psychosomatic illness. independence. At this age, they start to chooses and focus
 Adolescent stage is described as a SPURT growth stage Girls on specific vocations.
show a height increase of approximately 3 inches/year. This  Unlike the earlier stages, a more selfless individual emerges
rate slows at menarche and stops at around age 16 to 18. as seen in participation in society activities, groups and
 Adolescent boys show a growth spurt which starts at around issues. They are able to find their own identity and mate.
age 13. Their height increase 4 inches/year and only slows  Late adolescence also indicates development of own
down in their late teens. Boys double their weight between morality which indicates complete physical and emotional
12 and 18 and this is closely related to their increasing maturity.
muscle mass.  Cognitive abilities of adolescent include development of
 As to body shape, boys become leaner with broader chest. abstract thinking abilities; scientific reasoning and formal
Girls have fat deposited in thighs, hips, and breasts while logic. They enjoy intellectual abilities and are able to view
their pelvis broadens. problems comprehensively.
 Both males and females develop hyper activity of their  Body image is a common characteristic of adolescents and
Apocrine glands causing increased body odor, hair growth threats include acne, obesity, injury or death and the
and sweating. This increased production of sebum and unknown.
plugging of sebaceous ducts causes a common problem in  Children’s response to death varies according to the age
preteens - acne bracket. Toddlers may insist on seeing a significant other
 Development of secondary sex characteristics and sexual long after that person’s death. Preschoolers see death as
functioning under hormonal control in both girls and boys. temporary; a type of sleep or separation. School-age see
 In girls, the breast development is first sign of puberty. The death as a period of immobility and feel death is
first stage is the bud stage where the areola around the punishment. Adolescents have an accurate understanding
nipple is protuberant.Breast development is complete of death.
around the time of first menses
 In boys, enlargement of testes is the first sign of sexual
maturation. It occurs at approximately age 13 or about 1
year before growth spurt. The scrotum and penis increase in
size until age 18.
 Boys reach reproductive maturity at about age 17, with a
viable sperm. Nocturnal emission is a physiologic reflex and
masturbation increases
 Pubic hair continues to grow and spread until mid 20s and
facial hair appears first on upper lip. Voice changes due to
growth of laryngeal, cartilage.
 Gynecomastia, the slight hypertrophy of breasts due to
estrogen production occurs in young boys but will pass

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/7350740 - 4 -