Growth and Development Ch' 6

1
Growth and Development Ch. 6

• Prenatal to 1 year
• Heredity- a childs inherited characteristics are
  determined at the time of conception
• Each sperm ovum contribute 23 chromosomes to
  the single-celled zygote
• Sperm X or Y Ovum X or X fig 6-1
• Environment- rest and exercise, eating well, good
  health practices and medical care
• Placenta allows transfer of both life-sustaining
  substances harmful or TERATOGENIC substances to
  the fetus.

2
Prenatal Period

• From fertilization to birth
• Ovaries produce ova (female sex cells)
• Ovulation occurs about every 28 days
• Testes produce sperm (male sex cells)
• Fig 6-3 morula or cell mass forms after
  fertilization which usually takes place in the
  fallopian tube
• After implantation in the uterine wall, the
  morula is called a blastocyst
• Blastocyst continues to develop becomes a
  embryo
• By the end of the 8th week is known as a fetus

3
Hormones Involved in Labor

• Progesterone-produced by the ovaries
• Oxytocin- produced by the hypophysis which is the
  posterior lobe of the pituitary gland
• Oxytocin has two functions it stimulates uterine
  contractions and prepares the breasts for breast
  feeding
• Prostaglandins- produced in various tissues in
  the body- uterine prostaglandins help stimulate
  contractions
• Labor begins approximately 280 days after
  conception 9 calendar months or 10 lunar months
  40 weeks

4
Fetal Growth- fig 6-4

• 1st month-arm and leg buds forming
• Liver formed
• Heart present
• Brain begins to form
• Primitive blood cells present

5
Fetal Growth

• 2nd Month
• Heart chambers begin to form
• Fingers and toes form
• Face develops
• GI tract developing
• Urogenital system forming
• Head large due to brain developing
• Organogenesis completed prior to this the fetus
  is more prone to deformities due to exposure to
  teratogens

6
Fetal Growth

• 3rd month- spontaneous movement begins
• Kidney secretion by the 10th week
• Bone marrow begins to form blood cells
• Palate completely fused
• Distinguishing sex traits evident
• Neck well defined

7
Fourth Month

• Fetus active,blood circulating, thyroid gland
  begins to function
• 5th month- heart sounds can be heard, scalp hair
  present, vernix caseosa a thick cheesy-like
  coating of the infants skin is present
• 6th month- lanugo which is a fine hair is
  covering entire body
• 7th month- subcutaneous fat present, testes at
  inguinal ring or below

8
Fetal Growth Continued

• 8th month- testicles in scrotal sac, labia majora
  small and separated, clitoris prominent
• 9th month- skin thicker, lanugo disappears,
  breast tissue develops beneath nipples
• 10th month- body plump, ears well defined,
  acquires antibodies from mother

9
Three Stages of Labor and Delivery

• First stage is dilation and effacement of the
  cervixusually the longest, lasts 12-24 hours.
  Begins with the onset of regular rhythmic uterine
  contractions and ends with the complete dilation
  effacement of the cervix to 10cm
• Stage 2- the expulsion stage lasts about 1.5
  hours. It is the most difficult stage

10
Labor and Delivery

• Stage 3- the shortest stage, lasts from 5 to 30
  minutes. Begins with the birth of the baby and
  ends with the delivery of the placenta.

11
Placenta

• Mother and child are linked via the placenta.
• The placenta produces hormones, transports
  nutrients and wastes, protecting the baby from
  harmful substances
• Umbilical Cord- the connecting link between the
  fetus and placenta
• Has three vessels-2 arteries 1 vein

12
Apgar Score table 6-1

• Index used by the nurse to assess neonate
• 5 categories color, reflex irritability, heart
  rate, respiratory rate and muscle tone.
• Assessments done at 1 minute after birth and
  again at 5 minutes after birth.
• Gives an immediate picture of the newborns
  overall status.

13
Physical Characteristics

• Head and skull- sutures, fontanels, molding,
  average circumference 13-14 . About 1 larger
  than the chest
• Average length 20
• Average weight 7.5
• infants usually grow 1 inch per month for the
  first year, the newborn loses 5 to 10 of its
  birth weight in the first few days of life. Known
  as normal physiological weight loss
• Newborn will double its birth weight by 5-6
  months and triple birth weight by first birthday

14
Skin

• Acrocyanosis temporary blueness of the hands
  feet
• Mongolian spot flat, irregular, pigmented area
  of the lumbar-sacral area fades becomes less
  noticeable after about 4 yrs of age
• Lanugo fine hair
• Vernix caseosa-white, cheeselike oily covering
• Milia small clusters of white spots mostly on
  the nose, chin forehead
• Physiologic jaundice yellow tinged skin occurs
  between 48-72 hours of birth disappears on own

15
Normal Newborn

• Genitals
• breasts of both genders may swollen due to
  mothers hormones
• undescended testicles
• pseudomenstruation

• Face
• eye ointment or silver nitrate gtts
• cleft palate
• deciduous or baby teeth come out about 6-7 mos
  old

16
Normal Newborn

• Abdomen
• umbilical cord care
• table 6-2 meconium 1st stool is thick, green
  or black, tarry, odorless
• breast fed infants stools are yellow, seedy

• Extremities
• short in proportion to rest of body kept
  flexed
• congenital hip dysplasia fig 6-9

17
Neurological Characteristics

• Exam done to compare gestational age by date of
  last menstrual period with what the infant
  actually looks like

• Reflexes present table 6-3
• moro
• tonic neck
• rooting
• sucking
• babinski
• palmar grasp

18
Normal Vital Signs

• Temperature axillary 97.7 99.5 some hospitals
  have 1st temp taken rectally to ensure anal
  patentcy
• Pulse should be counted apically for a full
  minute normal rate is 120-160
• Respirations count for a full minute normally
  irregular, shallow, from the belly, with brief
  periods of apnea normal rate 30-60 per minute
• Blood pressure usually not measured unless some
  problem is suspected, using a Dinamap or
  electronic machine should be 65/40

19
Gross Motor Skills fig 6-11

• Movements of the large muscles of the arms/legs
• follow head to toe or cephalocaudal pattern
• holding head up rolling over
• sitting with support, then alone
• creeping
• crawling
• cruising
• walking

20
Fine Motor Skills

• Movements of hands fingers
• grasp is a reflex in the newborn
• purposeful grasp 5 months
• hand preference usually occurs by the 7-8th
  month
• by 1 yr should be able to feed self scribble
  on paper

21
Psychosocial Development Temperament

• Eriksons stage is trust vs mistrust lays
  foundation for rest of the stages
• Attachment to parents
• Mother attachment fig 6-12
• Father engrossment
• Temperament is unique to each child
• Environment shapes the personality

22

• Communication
• crying
• cooing
• babbling
• by 1 yr should have vocabulary of 4-6 words
• signs that should be discussed with MD

• Nutrition
• breast feeding vs bottle feeding see table 6-4
• weaning off breast should be done gradually
• bottle-mouth syndrome or dental caries

23

• Sleep Rest table 6-6
• newborn sleeps 20 out of 24 hours
• by age 1 will need only about 12 hours of
  sleep/day
• establish bedtime routine
• SIDS babies should sleep on back or side

• Play
• very important part of childs growth,
  development socialization
• used to learn about objects in the surroundings
• safety prevent accidents

24
Health Promotion

• Encourage education for parents
• MD visit monthly for 1 year
• List of possible problems to report to MD
• Natural immunity for 1st 6 months then need
  immunizations see appendix B for recommended
  schedule