MCN Finals
MCN Finals
MCN Finals
Newborn
A.k.a “neonate”
Undergoes profound/ intense physiologic changes at the moment of
birth
Sudden change of environment (from the uterine env’t to the
outside env’t)
Newborns undergo profound physiologic changes at the moment
of birth (and, probably, psychological changes as well), as they are
released from a warm, snug, dark, liquid-filled environment that
has met all of their basic needs into a chilly, unbounded, brightly lit,
gravity-based, outside world. Within minutes after being plunged
into this strange environment, a newborn has to initiate respiration
and adapt a circulatory system to extrauterine oxygenation.
Within 24H: complete functioning: Neurologic, renal, endocrine, GI, and metabolic sustain life
Neonatal Period
From the time the child was born to his/her 28 days of life
Other Advantages of BF
It contains ideal electrolytes and mineral composition for human infant growth
It is high in lactose- an easily digested sugar (rapid brain growth)
The ratio of cysteine to methionine in BM favors rapid brain growth in early months.
It contains more linoleic acid- an essential acid for skin integrity
It has less Na, K, Ca and P
It has better balance of trace elements like Zn.
BF helps prevent excessive weight gain in infants
Nursing Responsibilities:
a) Beginning Breastfeeding- should begin soon after birth (woman is still in
the birthing room while infant is in the first reactivity period)
Let-down reflex:
Called as milk ejection reflex
Continuous or spontaneous flow of milk due to oxytocin’s
action
Oxytocin is released from the PPG as the NB infant sucks at the breasts causing the
collecting sinuses (lactiferous sinuses) of the mammary gland to contract milk moves
forward through the nipples.
Oxytocin causes smooth muscle contraction (Uterine) prevents excessive bleeding; aids
in uterine involution
Breastmilk Transition:
1. Colostrum: First 2 – 4 days:
↓ CHO, ↓ Fat, ↑ CHON, ↑ Fat-soluble vitamins
thin, watery, yellow fluid composed of protein, sugar, fat minerals, vitamins and maternal
antibodies.easy to digest and capable of providing adequate nutrition
2. Transitional Milk: 4 – 14 days:
↑ lactose, ↑ minerals, ↑ water-soluble vitamins
3. Mature Milk:
beyond 14th day:
↑ CHO, ↑ Fats, ↓ CHON
New milk, called hind milk, is formed after the let-
down reflex. Hind milk, higher in fat than fore milk, is
the milk that makes a breastfed infant grow most
rapidly. Release of oxytocin has a second advantage
in that, by causing smooth muscle contraction, it
helps contract the uterus. As a result, a woman may
feel a small tugging or cramping in her lower pelvis
during the first few days of breastfeeding (afterpains)
(Pavone & Purinton, 2007).
Techniques of breastfeeding
Physical preparation such as nipple rolling,
advised in the past as a way of making a woman’s
nipples more protuberant, is not necessary
because few women have inverted or non
protuberant nipples. In addition, oxytocin, which is
released by this maneuver, could lead to preterm
labor (nipple rolling is used to create uterine
contractions for stress tests). The occasional
woman who has inverted nipples may need to
wear a nipple cup (a plastic shell) to help her
nipples become more protuberant.
Practicing breast massage to move the milk
forward in the milk ducts (manual expression of
milk) may be helpful. This can help a woman who
feels hesitant about handling her breasts grow
accustomed to doing so, and allows her to assist
with milk production in the first few days after birth.
Manual expression consists of supporting the
breast firmly, then placing the thumb and forefinger on the opposite sides of the breast, just behind the
areolar margin, first pushing backward toward the chest wall and then downward until secretions
begins to flow (Box 19.4). During the last months of pregnancy and immediately after birth, the fluid
obtained will be colostrum. By the third day of infant life, milk will be obtained. Teach women to wash
their breasts with clear water because soap tends to dry and crack nipples.
Formula Feeding
a) Preparing for formula feeding
Commercial Formulas
TYPES:
Milk based- formulas are used for the average newborn
Soy based- devised for infants who are allergic to cow’s milk protein
casein hydrolysate formulas have protein particles too small to be recognized by the immune
system
Elemental (fat, protein, and carb hydrate content is modified, such as in lactose-free formula)
Reminders!
Parents should be advised to purchase types with added iron to ensure that their newborn receives
enough of this element to prevent iron deficiency anemia (Marotz, 2009)
Formulas for term newborns contain 20 cal/oz when diluted according to directions (the same number
of calories as breast milk).
d) Use a comfortable chair (as does a nurse who feeds babies) and adequate time (at least half an hour)
to enjoy the process and not rush the baby.
Like breastfeeding, formula feeding an infant is a skill that must be learned. A parent needs a
comfortable chair (as does a nurse who feeds babies) and adequate time (at least half an
hour) to enjoy the process and not rush the baby.
e) Hold the baby with the head slightly elevated.
Holding the baby with the head slightly elevated reduces the danger of aspiration and
retention of air bubbles.
f) Ensure the nipple is kept filled so that the baby is sucking milk, not air.
A parent should be sure the nipple is kept filled so that the baby is sucking milk, not air. He or
she can be assured a baby is sucking effectively if small bubbles rise in the bottle.
g) Babies in the early weeks should be bubbled (burped) after every ounce of milk taken. The technique is
the same as that used for breastfed infants.
h) Do not to prop up bottles, because babies:
Remind parents not to prop up bottles, because babies are in danger of aspiration if a bottle
is propped. In addition, an increased incidence of otitis media has been associated with
bottle-propping, because the infant’s head is not upright and formula may enter the
eustachian tube. Propping also can limit the amount of parent–child interaction.
i) Do not to put a baby to bed with a bottle of formula, because this can lead to “baby-bottle syndrome,” or
cavities of the lower teeth
Abnormal Findings:
Low birth weight/ SGA: <2,500 grams
Very low birth weight: <1,500 grams
Extremely low birth weight: <1,000 grams
BW > 4000 g is known as Large for Gestational Age (LGA) infant.
Weight loss of more than 10%
Importance:
Identify NB who are at risk because of their small size
Separates small for gestational age (SGA- NB who have suffered IUGR) from preterm infants
(infants who are healthy but small only because they were born early)
Establishes a baseline for future evaluation.
Good determinants of health and normal nutrition (together with height)
Abnormal Findings:
HC < 32 centimeters = microcephaly in term infants
HC that is 4 centimeters and greater than CC or more than 37 centimeters = neurologic px
(Hydrocephalus)
VITAL STATISTICS: Chest Circumference
Term newborn: about 2 cm (0.75 to 1 in) less than the head circumference measured at the level of
the nipples.
A CC < than 30 cm indicates prematurity.
An enlarged heart may make the left side of the chest larger.
HYPERTHERMIA
NB are also at risk of hyperthermia (T= >37. 5̊C)
CAUSES:
Too hot external environment
Too many covers/ clothes on baby
Infection
S/Sx:
Irritability/ fussy
Abdomen and extremities are warm to touch
Red, flushed skin
Hot and dry skin
Lethargy
Stupor; at risk for convulsions (41 C)
Interventions:
Place NB in a cool environment (25-28 C)
Keep away from sources of heat (direct sunlight)
Undress the NB partially or fully, if necessary.
Measure the T q 1̊until within the N range
Sponge the baby if T > 39 C. Do not use cold/ ice water.
If the NB has been under a radiant warmer, reduce the T setting until it becomes N
Examine for signs of infection
AbN finding:
Calf systolic pressure 6-9 mmHg less than the systolic pressure in the UE may be indicative of
coarctation of the aorta
NOTE: For an accurate reading, the cuff width used must be no more than two thirds the length of
the upper arm or thigh.
Urinary System
The average newborn: voids within 24 hours after birth.
NB who does not void within this time should be examined for the possibility of urethral
stenosis or absent kidneys or ureters
Fetal kidneys produce urine as early as the 4th month in utero
NB Kidneys: do not concentrate urine well → usually light-colored and odorless
Sp Gr: ranges from 1.008 - 1.010
Diapers can be weighed to determine the amount of urine output. (1g= 1mL of urine)
Males should void with enough force to produce a small projected arc; females should
produce a steady stream
In 2- 3 days, she can void from at least 5 to 6 times per day. As she starts to feed with
adequate hydration after 1 week she can void 15 - 20 times per day
daily urinary output for the first 1 or 2 days: about 30 -60 mL total
Bladder capacity: 40mL
Pink tinge - uric acid crystal that were formed in bladder while infant was still in utero
Neuromuscular
Mature newborns demonstrate:
neuromuscular function by moving their extremities
attempting to control head movement
exhibiting a strong cry
demonstrating newborn reflexes
The brain is 10% of the total body weight at birth.
Intactness of the nervous system is demonstrated by:
State of alertness
Resting posture
Cry
Muscle tone
Motor activity
Nervous system: immature at birth but endowed with inborn reflexes important for protection
and survival
Myelinization is completed at 6-12 months
Intactness of the nervous system is demonstrated by the ff: state of alertness, resting posture,
cry, muscle tone, motor activity
REFLEXES
Involuntary actions/ movements
Disappears as voluntary control is developed
Identify normal brain and nerve activity
Elimination
Monitor first stool or voiding
Meconium
Within 24-48 hours
Negative: imperforate anus
Voiding
First voiding within 24 hours
Negative: dehydration, little intake for the first 24 hours, urethral stenosis, absent kidneys
or ureters
Change diapers as soon as soiled
Cuddling
Always support head
Baby should not be lifted in the arms or armpits until 3 months old
Do not apply vigorous shaking
Ways of carrying a baby:
a. Cradle carry
b. Shoulder carry
c. Hip carry—for older babies who have mastered head and neck control
d. Front-face carry
Integumentary System
All structures of the IS are present at birth but skin’s function is immature
Smooth and elastic with fair amount of subcutaneous tissues
Preterm infants have lesser subcutaneous tissues so skin appears almost transparent
subQ tissues are important for insulation
Brown fats - responsible for additionally, providing with insulation : located in perineum, chest
areas, intrascapular areas
Post-term infants have paler, dry, peeling skin
Skin Color
Ruddy complexion- ruddiness fades slightly over the first month
Bright red at the first day
Twin transfusion phenomenon
Acrocyanosis is normal for the first 24-48 hours; central cyanosis is not
central cyanosis, or cyanosis of the trunk, is always a cause for concern. Central cyanosis
indicates decreased oxygenation. It may be the result of a temporary respiratory obstruction or an
underlying disease state.
Mucus obstructing a newborn’s respiratory tract causes sudden cyanosis and apnea. Suctioning of
the mucus relieves this. Always suction the mouth of a newborn before the nose, because
suctioning the nose first may trigger a reflex gasp, possibly leading to aspiration if there is
mucus in the posterior throat. Follow mouth suctioning with suction to the nose, because the
nose is the chief conduit for air in a newborn.
Mottling
Irregular discoloration of the skin due to cold exposure, lack of fat, or hypoxia
Cutis marmorata—transient mottling when infant is exposed to decreased temperature
Hyperbilirubinemia
leads to jaundice, or yellowing of the skin (Beachy, 2007)
Globin is a protein component that is reused by the body and is not a
factor in the developing jaundice.
Heme is further broken down into iron (which is also reused and not
involved in the jaundice) and protoporphyrin.
Protoporphyrin is further broken down into indirect bilirubin.
Indirect bilirubin is fat soluble and cannot be excreted by the
kidneys in this state. For removal from the body, it is converted by
the liver enzyme glucuronyl transferase into direct bilirubin, which
is water soluble. This is incorporated into stool and then excreted in feces. Many newborns have such
immature liver function that indirect bilirubin cannot be converted to the direct form; it therefore
remains indirect.
As long as the buildup of indirect bilirubin remains in the circulatory system, the red coloring of the
blood cells covers the yellow tint of the bilirubin. After the level of this indirect bilirubin has risen to
more than 7 mg/100 mL, however, bilirubin permeates the tissue outside the circulatory system and
causes the infant to appear jaundiced.
If the level rises to more than 10 to 12 mg/100 mL, treatment is usually considered. Phototherapy
(exposure of the infant to light to initiate maturation of liver enzymes) is a common therapy. If this is
necessary, the incubator and light source can be moved to the mother’s room so that the mother is not
separated from her baby. Some infants need continued therapy after discharge and receive
phototherapy at home (Mills & Tudehope, 2009).
Harlequin’s sign
clear color division of the skin with lower half of the body
pinkish in color and the upper half pale when the infant is
on side lying position
Fair complexion
Pallor—d/t anemia
Pallor (pinkish) - reddish pink because of pulling of blood
Anemia -- poor nutrition of mother; destruction of fetal RBC
Excessive blood loss when the cord was cut
Inadequate flow of blood from the cord into the infant at birth
Fetal–maternal transfusion
Low iron stores caused by poor maternal nutrition during pregnancy
Blood incompatibility in which a large number of red blood cells were hemolyzed in utero. It also
may be the result of internal bleeding.
Birthmarks
Hemangioma- vascular tumors of the skin
TYPES:
Stork bite — a macular purple or dark-red lesion present over the eyelids,
above the bridge of the nose, face and thighs; does not blanch with pressure;
does not fade with age.
A.k.a. port - wine strain
they can be covered by a cosmetic preparation later in life or removed
by laser therapy, although lesions may reappear after treatment (Berger,
2009).
Cavernous hemangioma
appears like strawberry hemangioma but primarily d/t dilated vascular spaces
consist of a communicating network of venules in subcutaneous tissue and do not fade with age
Present at birth or appear several months after
does not disappear with time
Mongolian Spots
are collections of pigment cells (melanocytes) that appear as slate-gray patches across the sacrum or
buttocks and possibly on the arms and legs.
They tend to occur in children of Asian, southern European, or African ethnicity.
They disappear by school age without treatment.
Be sure to inform parents that these are not bruises; otherwise, they may worry their baby sustained a
birth injury.
Bluish - to black; bluish to blue
Abused child - varying degrees of healing
Vernix Caseosa
is a white, cream cheese–like substance that serves as a skin lubricant in utero.
Formed from old cutaneous cells and secretions of sebaceous glands while in utero
Document the color of vernix, because it takes on the color of the amniotic fluid. For example, a yellow
vernix implies that the amniotic fluid was yellow from bilirubin; green vernix indicates that
meconium was present in the amniotic fluid.
Lanugo
is the fine, downy hair that covers a newborn’s shoulders, back and upper
arms, on the forehead and ears.
1 st appearance: 19 weeks of fetal life
Most obvious at 27- 28 weeks of fetal life
Babies born between 37 to 39 weeks of gestation: more lanugo than a
newborn of 40 weeks’ gestational age.
Disappears: 2 weeks post life
Rubbed away by: friction of bedding and clothes against the newborn’s skin
Desquamation
areas of peeling similar to those caused by sunburn.
Caused by drying of the NB skin within 24H of life
Particularly evident on the palms of the hands and soles of the feet.
Mngt: hand lotion to prevent excessive dryness if they wish.
Milia
All newborn sebaceous glands are immature. At least one pinpoint white papule (a
plugged or unopened sebaceous gland) can be found on the cheek or across the
bridge of the nose disappear by 2 to 4 weeks of age, as the sebaceous.
Teach parents to avoid scratching or squeezing the papules, to prevent secondary
infections
Erythema Toxicum
Appears in the first to fourth day of life but may appear up to 2 weeks of age.
Begins as papules that develop in a hive like elevations with a center containing
clear fluid as a reaction of the skin to the clothes and sheets; become erythema
by the second day, and then disappears by the third day.
Caused by a NB’s eosinophils reacting to the environment as the immune
system matures.
Requires no treatment
It is sometimes called a flea-bite rash because the lesions are so minuscule.
It is caused by a newborn’s eosinophils reacting to the environment as the
immune system matures. It requires no treatment.
Skin Turgor
An indicator of the hydration status of the NB
Well hydrated: feel resilient
Elastic and immediately returns back to normal contour when grasped b/n the thumb and fingers
EYES
Absence of tears (tear glands matures at about 3 months of age)
Corneal and blink reflexes in response to touch
Pupillary reflex in response to light
(+) strabismus and nystagmus until 4 months the sclera may be blue because of its thinness.
Infant eyes assume their permanent color between 3 and 12 months of age.
Mouth
opens evenly when crying
Presence of sucking, rooting, gagging, and extrusion reflexes
Absent or minimal salivation; tongue appears large and prominent in the mouth
** Epstein’s pearls
small round, glistening, well circumscribed cysts on the hard palate; d/t deposition of extra load of
calcium in utero
disappears within 1 week
It is highly unusual for a newborn to have teeth, but sometimes one or two (called natal teeth) will
have erupted. Any teeth that are present must be evaluated for stability. If loose, they are usually
extracted (they remove easily) to prevent possible aspiration during feeding.
a parent may mistake them for thrush, a Candida infection, which usually appears on the tongue and
sides of the cheeks as white or gray patches and needs therapy with an anti-fungal drug
ABDOMEN
Normal contour: Slightly protuberant
Scaphoid (sunken appearance) > diaphragmatic hernia
+ barrel chest, wherein intestines are positioned going to the chest; bowel goes to the chest
Bowel sound should be present within 1 hour after birth
Edge of liver palpable 1-2 cm below right costal margin
Edge of spleen palpable 1-2 cm below left costal margin
Cord stump 1st Hr: white, gelatinous structure marked with the blue and red streaks of the umbilical
vein and arteries
1 artery in cord = CHD or renal abnormality
Brown (after 2-3 hours)
black (2-3 days)
breaks free by day 7 - 10
Anogenital Area
Male genitalia
penis of newborns: appears small, approximately 2 cm
long
Scrotum: rugae present; deep pigmented; with 2 testicles
Cryptorchidism—absence of testicle or both
Causes of cryptorchidism:
Agenesis - absence of organ
Undescended testicles
Ectopic testis - scrutal sac is closed
Positive cremasteric reflex maybe absent until 10 days old
**Penis—2 cm or more
Epithelial pearls—small, firm, white lesions at the tip of prepuce
Erection or priapism
Chordee—lateral curvature of the penis
**Urethral opening
Hypospadias—urethral opening on the ventral surface of the penis
Epispadias—urethral opening on the dorsal surface of the penis
Female genitalia
Labia and clitoris usually edematous
Urethral meatus below clitoris
Vernix caseosa maybe found between labia
Pseudomenstruation—blood-tinged or mucoidal discharge d/t maternal hormone
Hymenal tag maybe present
Anus/rectum
Patent
Imperforate - An imperforate anus happens when the anus is missing or doesn't have a hole.
(+) anal reflex
Back
surface; no dimpling, opening, or masses
dermal sinus or spinal bifida occulta.
Tuft of hair along the spine
(+) trunk incurvation reflex
Extremities
Symmetrical
10 fingers and toes
Polydactyly - is the presence of one or more additional fingers or toes. These extra fingers are
often just cartilage or skin tags, and removal is simple and cosmetically sound.
Syndactyly - (two fingers or toes are fused), the fusion is usually caused
by a simple webbing; separation of the digits into two sound and
cosmetically appealing ones is usually successful.
Phocomelia - a rare birth defect characterized, in most instances, by
severe malformation of the extremities.
Hemimelia - born with a short or missing fibula (one of the two bones in the lower leg).
Fingertips should reach over the proximal thigh
Unusually short arms: achondroplastic dwarfism
Full ROM
Soft and smooth nails; Nailbeds pink, with transient cyanosis
immediately after birth
Simian crease—Down syndrome
Creases on anterior 2/3 of sole
Sole usually flat
Clonus—rapid alternating contraction and relaxation of the foot
after dorsiflexion; may indicate neurologic involvement
Hallux - hallux valgus (HV), also known as a bunion, is one of the most common forefoot deformities.
Ortolani’s sign—clicking sound upon upward rotation of the thigh
Neck
short and chubby, with creased skin folds
Head should rotate freely
Present tonic neck reflex
Torticollis (wry neck)—head held to one side with chin pointing to
opposite side as a result of injury to the sternocleidomastoid muscle
Nuchal rigidity - Nuchal rigidity simply refers to neck stiffness.
Fine motor skills are small movements --
such as picking up small objects and spoon--
that use the small muscle of the fingers, toes,
wrists, lips, and tongue.
Gross motor skills are the bigger movements
-- such as rolling over and sitting -- that use
the large muscles in the arms, legs, torso, and
feet.
Child's critical thinking is enhanced
Number literacy among kids develop
Communication literacy by simply
looking at pictures(colors, shape, fruit)
CONTRACEPTIVE METHODS
I. Natural Family Planning (NFP) Methods
A. Ovulation Method
Mode of Action: Allows a woman to determine her infertile and fertile periods by observing
and recording changes in her cervical mucus.
B. Basal Body Temperature (BBT)
Mode of Action: Allows a woman to determine her infertile and fertile periods by observing
changes in her Basal Body temperature.
C. Sympto-Thermal Method
Mode of Action: Allows a woman to determine her infertile and fertile periods by observing
and recording the characteristics of the cervical mucus, and other changes which occurs during
ovulation.
Effectiveness Rate: 80%
Advantages of NFP Methods:
1. Inexpensive
2. No health-related side effects
3. Increases self-awareness and knowledge of reproductive functions
4. Acceptable to most religions
5. Not dependent on medically qualified personnel
Disadvantages of NFP Methods:
1. Requires high level of motivation
2. Extensive educational need
3. Requires abstinence for large part of each cycle
4. High risk of pregnancy from error
5. Many factors may change ovulation time
II. INJECTABLE CONTRACEPTIVES (ex. Depo-Provera)
Effectiveness: 99.7%
Mode of Action:
Inhibits ovulation
Thickens cervical mucus
Thins endometrial lining
Advantages:
1. Long-acting
2. Does not interrupt sex
3. Does not affect breastmilk
Disadvantages:
1. Must get an injection every three months
2. Client cannot discontinue the method on her own
3. May cause side effects and complications
4. Does not protect against STI/HIV transmission
Side Effects:
1. Weight gain
2. Delayed return to fertility
3. Menstrual disturbance, spotting and amenorrhea
WARNING Signs of Complications:
1. Signs of pregnancy
2. Menstrual periods become twice as long or twice as much as usual
BARRIERS
Mode of Action: Prevent sperm and egg from meeting
I. CONDOMS
Effectiveness Rate:
Male = 88%
Female = 79%
Advantages:
1. No prescription needed
2. Best protection available against STDs/HIV transmission
3. Inexpensive per single use
4. Can be carried discreetly
5. Quick and easy
6. Vaginal condom: Increases women’s control over contraceptive use and protection from
STIs
Disadvantages:
1. Must be checked for expiration date and holes
2. Can break or slip off
3. Can be used once only
4. Vaginal condom: May seem unattractive
II. DIAPHRAGM
Effectiveness Rate: 82%
Advantages:
1. Can be inserted several hours before coitus
2. Offers some protection against STI/HIV transmission
Disadvantages:
1. Initially: Expensive. Requires nurse, midwife, or physician to fit
2. Requires education on proper use
3. Added spermicide necessary for repeat coitus
4. Possibility of Toxic Shock
5. Must be refitted after each birth or weight change of 10 or more pounds
6. Pressure against bladder may cause infections
STERILIZATION
I. FEMALE STERILIZATION (BILATERAL TUBAL LIGATION)
Effectiveness Rate: 99.6%
Mode of Action: Prevents egg and sperm from meeting
Side Effects: Minor pain or swelling at operative site
WARNING Signs:
1. Signs of infection
2. Signs of pregnancy
TASKS:
A. trust vs mistrust – 0-18 months
foundations of all psychosocial task
to give and receive is the psychosocial theme
know to develop trust baby
Too much or too little satisfaction can lead to fixation
Principle of holding on and letting go
Oral receptive - stronger tendency of dissatisfaction; drink, smoke, overeat
Oral aggressive - manifesting the biting of nails; cope or address anxiety; tend to curse or
to bring harmful words to somebody; tend to enjoy gossiping; too dependent on others;
easily fooled
Anal retentive/ retention - type of fixation
Anal expulsive - messy; disorganized
a. satisfy needs on time - breastfeed
b. care must be consistent and adequate -both parents- 1st 1 year of life
c. give an experience that will add to security - touch, eye to eye contact, soft music
VALUES: Hope and Optimism
Development of thought
a. 0-2 yrs: sensorimotor
1. Neonatal reflex (1 mo.)
Stimuli are assimilated into beginning mental images; behavior entirely reflexive.
2. primary circular reactions (1–4 mo)
Hand–mouth and ear–eye coordination develops
Infant spends much time looking at objects and separating self from them.
Beginning intention of behavior is present (the infant brings thumb to mouth for a purpose:
to suck it).
Enjoyable activity for this period: a rattle or tape of parent’s voice.
3. secondary circular reactions (4–8 mo)
Infant learns to initiate, recognize, and repeat pleasurable experiences from environment.
infant anticipates familiar events like a parent coming near him will pick him up
Good toy for this period: mirror; good game: peek-a-boo
4. coordination of secondary schemata (8–12 mo.)
infant can plan activities to attain specific goals.
Can search for and retrieve toy that disappears from view.
Recognizes shapes and sizes of familiar objects.
infant experiences separation anxiety when primary caregiver leaves.
Good toy for this period: nesting toys (i.e., colored boxes).
5. Tertiary circular reaction (12–18 mo)
Capable of space perception and time perception as well as permanence.
Objects outside self are understood as causes of actions.
Good game for this period: throw and retrieve
6. Invention of new means through mental combinations (18–24 mo)
Transitional phase to the preoperational thought period.
use memory and imitation to act; solves basic problems, foresee maneuvers that will
succeed or fail.
Good toys for this period: blocks, colored plastic rings
Schema: refers to cognitive structures by which individuals intellectually adapt to and
organize their environment
DEVELOPMENTAL MILESTONES
A. Period of infancy
a. Play- Infancy- solitary plays
solo, mom interactive
facilitate motor and sensory dev’t
safety- important age appropriate
solitary play- mobile, teeter, music box, rattle
b. fear of infancy- stranger anxiety begin @ 6-7 mos, peaks @ 8 mos, diminishes @ 9 mos
Toddler
parallel play
2 toddlers playing separately
provide with similar toys
squeaky toy to squeeze
waddling duck to pull
trucks to push-push pull toy
building blocks, pounding peg
toys to ride on
fear- separation anxiety
begin 9 months
peak 18 months
3 phases of separation anxiety (in order)
1. p - protect
2. d - despair
3. d - denial
don’t prolong goodbye
say goodbye firmly to develop trust- say when you’ll be back
15 months
plateau stage
walks alone
lateness in walking- mild mental retardation
puts small pellets into small bowl
holds spoon well
seats self on chair
creeps up stairs
4 - 6 words
18 months
height of possessiveness
favorite word- “mine”
bowel control achieved (bowel 1st before bladder)
no longer rotates spoon
can run and jump in place
walks up and down stairs holding railing or persons hand
1-20 words
names body part
puts both feet on 1 step before advancing.
24 months
terrible two
can open doors by turning door knobs
unscrew lids
can walk upstairs alone –using both feet on same step at same time
50-200 words (2 words sentences)
daytime bladder control achieved (daytime
1 st - next night time bladder control)
30 months or 2 ½ years
makes simple lines or stroke for crosses with a pencil
can jump down from chairs
knows full name
copies a circle
holds up finger to show age
temp. teeth complete
post molar- last temp teeth to appear
deciduous teeth -20
beginning of toothbrush – 2-2 ½ yrs
tooth brushing with little assistance - 3 yrs
tooth brushing alone – 6 yrs
right time to bring to dentist- when temporary teeth complete
36 months or 3 yrs
“trusting 3”
unbutton buttons (unbutton before learn to button)
draw a +
learns how to share
knows full name and sex (gender identity)
speaks fluently
nighttime bladder control
300-900 words
ride a tricycle
4years old
“furious 4” , noisy, aggressive, stormy
can button buttons
copy a square
jumps and skips
laces shoes
vocabulary 1,500
knows four basic colors
5 years old
“frustrating 5”
copy a triangle
draw a 6-part man
imaginary playmates
2,100 words
School Age
Play- competitive play
Ex. Tug of war, track and field, basket ball
Fear
1. school phobia
orient to new environment
2. displacement from school
teacher and peer of same sex
3. loss of privacy
Wants bra
4. fear of death
7-9 yrs old: death is personified
death - permanent loss of life
Significant Development
Boys - prone to bone fracture; mature vision 20/20
6 years
temp teeth begin to fall
permanent teeth appear- 1 st molar
1 st temp teeth- 5 months
1 st perm teeth- 6 yrs
yr of constant motion
recognizes all shapes
1 st grade teacher becomes authority figure
nail biting
begin interest in God.
7 yrs
assimilation age
copy a diamond
enjoys teasing and playing alone
quieting down period
8 yrs
expansive age
smoother mouth
loves to collect objects
count backwards
9 yrs
coordination improves
tells time correctly
hero worship
stealing and lying are common
takes care of body needs completely
teacher finds this group difficult to handle
10 yrs
age of special talent
writes legibly
ready for competitive games
more considerate and cooperative
joins orgs.
well-mannered with adult
critical of adults
11-12 yrs
pre adolescents
full of energy and constantly active
secret language are common
share with friend’s secrets
sense of humor present
social and cooperative