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Pediatrics Exam 1 Study Review: Newborn & Infant Development, Study Guides, Projects, Research of Pediatrics

Virginia State University (VSU)Pediatrics

A comprehensive study review for pediatrics exam 1, focusing on the growth and development of newborns and infants. It covers key principles of development, physical growth milestones (weight, height, head circumference), motor skills (gross and fine), language development, social and emotional development, and nutritional needs. The review also includes important concepts such as stranger anxiety, separation anxiety, and erik erikson's trust vs. Mistrust stage. It is a useful resource for nursing students preparing for exams or seeking a concise overview of infant development.

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Pediatrics Exam 1 Study Review

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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

oThe avg newborn weighs 3.4 kg (7.5lb) at birth

oNewborns 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

oMost infants double their birth weight by 4 months and triple by the

time they are 1 y/o

•Height

oAvg newborn is 50cm (20in) long

oLength grows more quickly over the 1st 6 months

oBy 12 months  length increased by 50%

•Head Circumference

oAvg head circumference of full term newborn  35cm (14in)

oIncreases rapidly during 1st 6 months

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Pediatrics Exam 1 Study Review

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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 1 st^ 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 1 st^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 1 st^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- 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 o Majority do not have teeth when born  1 st^ 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 1 st^ 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

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

Warning signs that may indicate probs w/language dev  infant doesn’t make sounds at 4 months, doesn’t laugh/squeal by 6 months, doesn’t babble by 8 month, doesn’t use single words w/meaning by 12 months
Social and Emotional Development
Newborn spends most of the time sleeping  by 2 months, ready to socialize
First real smile  2 months, should spend a great deal of time watching/observing what’s going on around
3 months  will start an interaction w/a caregiver by smiling widely and maybe gurgling  caregiver responds and child responds back w/more smiling, cooing, arm/leg mvmt
3-4 months  mimic parent’s facial mvmts  widening eyes, sticking tongue out  infant may cry when pleasant interactions stop
6-8 months  may enjoy socially interactive games like peek a boo
Nutrition pg. 977
Breast milk or formula supplies all of the infant’s daily nutritional requirements until 6 months of age, at which time solid foods may be introduced
Breast milk is the preferred method of newborn and infant feeding, it provides complete infant nutrition
Formula or breast milk for 1 year
After 6 months, infants usually require the nutrients available in solid foods in addition to breast milk or formula o Infant should be assessed for readiness to progress and parents need instruction in choosing the appropriate solid foods and support in the progression o Tongue extrusion reflex which is needed for sucking needs to be absent  introducing solids foods before 4-6 months will result in extrusion of the tongue o The ability to swallow foods doesn’t become completely functional until 4-6 months of age. Enzymes to appropriately digest solid food are also not present until 4-6 months of age o Solids should be fed w/a spoon in the upright position
Choosing appropriate solid foods o Iron fortified rice cereal mixed w/a small amount of breast milk or formula is a good choice for the 1 st^ solid food o The cereal is easily digested and the taste is generally well accepted o Once cereal is accepted, other pureed single foods may be introduced o Intro of one new food every 3-5 days is recommended  allows for identification of food allergies o Around 8 months  ready for more texture in foods  soft, smashed table food without large chunks o Finger foods  cheerios, soft green bean pieces, or soft peas  avoid hard food o 10-12 months  can intro strained, pureed, or mashed meats
No bottle propping  easy for them to choke

No fruit juice until 6 months  limit to 2-4oz/day  larger amount can displace important nutrients from breast milk or formula
Foods to avoid in infancy o Honey o Egg yolk and meats (until 10 months) o Excessive amounts of fruit juice o Foods likely to cause choking  peanuts, popcorn, other small hard foods (raw carrots), grapes and hot dog slices (cut smaller) o Foods likely to result in allergic reaction  citrus, strawberries, wheat, cow’s milk, egg whites, peanut butter
Psychological Development pg. 967
Trust vs. Mistrust  Erik Ericson  birth to 1 year
Dev of a sense of trust is crucial in the 1 st^ year as it serves as the foundation for later psychological tasks
When the infant’s needs are constantly met, the infant develops this sense of trust  if this doesn’t happen, mistrust can dev
Cannot spoil  meet needs
Caregiver responds to basic needs  feeding, changing diapers, cleaning, touching, holding, and talking to the infant = trust
As the nervous system matures, infants realize they are separate from caregiver. Over time the infant learns to tolerate small amounts of frustrations and trusts that although gratification may be delayed, it will eventually be provided
Personality
Influences attachment
Easy, difficult, slow to warm up
Active, average, quiet
Promoting Growth & Dev Through Play pg. 975
Infants practice their gross and fine motor skills and language through play  it is a natural way for infants and children to learn
Play is critical in infant dev  opportunity to explore their environment, practice new skills, and solve problems
Newborn prefers to interact w/parent vs toys  parents should talk/sing to baby when participating in daily activities (feeding, bathing, etc.)  they love to watch people’s face and will mimic the expressions they see
Provide age appropriate toys to promote fine motor dev
Solitary play  when play w/toys, the infant usually doesn’t share w/other infants or directly play w/other infants
Onlooker  when a child watches others play but does not engage
Accident Prevention pg. 976
Anticipate development
Aspiration infants love to explore w/their mouth  small objects/hard foods pose a choking hazard
Safety in car  infant car seats should face the rear of the car until 12 months and weight of 9kg (20lb), seat should be secured in the center of the back seat

Safety in the home o Firm mattress that fits snuggly in the crib on a secure support, well fitting sheets o Crib side rails always raised when parent is not right next to the crib o Infant walkers are not recommended  may tip over and baby can fall out, also allows them to be in reach of things like hot stove and things on counters o As infant grows, new safety issues arise  safety gates should be at the top and bottoms of stairways o Cover electric outlets, gates to block rooms w/sharp edged furniture o Avoid stuffed animals w/eyes or buttons, keep floor free of small items o Suffocation  crib should not have pillows, comforter, stuffed animals, or other soft items in them o Keep window blinds and drapery out of reach  strangulation Ch. 45 Nursing Care of the Child with an Alteration in Tissue Integrity/Integumentary Disorder Seborrheic Dermatitis (SD)
Seborrhea is a chronic inflammatory dermatitis that may occur on the skin or scalp  occurs most often on the scalp, commonly referred to as cradle cap
The yeast in Pityrosporum ovale is believed to play a role in dev  genetic and environmental factors influence the course of the disease
Presents as dry, mild, white or yellow scales  more severe appear as dull, red plaques w/thick white or yellow scale in a diffuse distribution
In infants it may also manifest on the nose or eyebrows, behind the ears, nasolabial folds, inguinal areas, or in the diaper area  usually resolves over a period of weeks to months
Therapeutic mgmt  treating the skin lesions w/corticosteroid creams or lotions. Antidandruff shampoos containing selenium sulfide, ketoconazole, or tar are used to treat the scalp
Nursing Assessment o Health hx, determining onset and progression of skin and scalp changes o Inspect the scalp and forehead, behind the ears, and the neck, trunk, and diaper area for thick or flaky greasy scales
Nursing Mgmt o Wash or shampoo the affected areas w/a mild soap o Apply anti-inflammatory cream to lesions if prescribed o Apply mineral oil to the scalp, massage it well w/a washcloth, then shampoo 10-15 mins later, using a brush to gently lift the crusts Diaper Dermatitis pg. 1751 - Refers to an inflammatory reaction of the skin in the area covered by the diaper  nonimmunological response to a skin irritant that results in skin cell hydration disturbance - Prolonged exposure to urine and feces  skin breakdown

- Nursing Assessment o Determine if infant wears diapers o Ask about onset/progression of rash and tx and response o Inspect skin for erythema and maceration o Rash shouldn’t be bumpy; it starts as a flat red rash in the convex skin creases o May appear red and shiny and may or may not have papules o Untreated, it may become more widespread or severe - Nursing Mgmt o Prevention is best but topical ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum are helpful to provide a barrier to the skin - Prevention and Mgmt o Chg diapers frequently o Avoid rubber pants o Gently wash the diaper area w/a soft cloth, avoiding harsh soaps o Use baby wipes but avoid wipes that contain fragrance or preservatives o Once rash has occurred  allow child to go diaperless for a period of time each day to allow the rash to heal. Blow dry the diaper area/rash area w/the dryer set on the warm setting for 3-5 mins o Sitz baths  baking soda in tub several times/day for a few mins  pat area dry, apply ointment o For candida rashes  Lotrimin  avoid topical corticosteroid ointments o Bacterial infection  antibiotic  Mupirocin Atopic Dermatitis (Eczema)

Extremely pruritic skin disorder involving cutaneous hypersensitivity  inflamed, reddened, and swollen skin  relapse and remitting in nature
The skin response occurs in response to specific allergens, usually food or environmental triggers
Contributions to flare ups  high or low ambient temps, perspiring, scratching, skin irritants, or stress
Genetic predisposition  if 1 parent has allergies  60% chance of AD, if both parents  80% chance of AD
Correlation btwn asthma and AD  atopy fam
Characteristic lesions dev secondary to trauma (scratching)
Self-image may be affected  psychological distress from chronic itching
Difficulty sleeping may occur bc of itching  irritable and difficulty concentrating and fam life disrupted
Parents stress ↑, child’s anxiety ↑= ↑ itching and scratching
Child may outgrow AD or can have difficulties into adult years
Nursing Assessment o Health hx  hx of asthma or allergic rhinitis, food/environmental allergies, disrupted sleep, scratch marks, dry skin

o Determine onset of rash, location, progression, severity, response to tx used

Clinical Manifestations

o Postop care  if severe, sx correction will be needed. IV fluids 24- 48 postop. Monitor UO through Foley (bloody initially) and clearing within 2-3 days. Encourage ambulation. Antibiotics for 1-2 months after sx. Check output from all drains and record, observe drainage from abdominal dressing Exstrophy of the Bladder pg. 1638

Congenital defect  bladder is open and exposed outside of the abdomen due to non- fusion of abdominal and anterior walls of the bladder during embryonic dev
Urine continuously leaks from an open urethra
Nursing mgmt  prev infection, skin breakdown, and provide post op care and catheterizing the stoma
Postop o Keep infant supine and quickly chg soiled diapers to prev contamination o Indwelling urethral cath or suprapubic tube will allow drainage and allow bladder to rest initially o Mgmt of bladder spasm  meds as ordered o Blood tinged urine clearing within hours to days
Catheterizing the Stoma o If bladder tissue is insufficient for repair, bladder is removed and a reservoir is created o A stoma is created on the abdominal wall and provides access to the reservoir  cath ~4 times/day to empty o Urine tends to be mucus-like and cloudier than urine from bladder o Teach parents cath procedure and to call Dr. if any s/s UTI occur
Side Note : children w/congenital urologic malformations are at high r/f dev of latex allergy. Primary prev of latex allergy is warranted in all children w/urological manifestations  use latex free gloves, tubes, and caths Hypospadias/Epispadias pg. 1639
Hypospadias  urethral defect in which opening is on ventral surface of the penis
Epispadias opening is on dorsal surface of penis
The opening may be near the glans of the penis, midway along the penis, or near the base
If left uncorrected  may not be capable of aiming urinary stream from standing position
May interfere w/disposition of sperm during intercourse, leaving man infertile
Self-esteem and body image may be damaged
Defect is usually repaired around 1 y/o  goal is to provide an appropriately placed meatus for normal voiding and ejaculation
Sx performed ages 3-9 months; 2 y/o for complex
Nursing Assessment o Hx of unusual stream o Inspect for chordae  fibrous band causing the penis to curve downward (causes constriction) o Palpate for presence/absence of testicles in scrotal sac bc cryptorchidism (undescended testicles) often occurs w/hypospadias as well as hydrocele and inguinal hernia
Nursing Mgmt o Newborn shouldn’t undergo circumcision until after sx repair of the

o Ensure drainage tube is carefully taped w/penis in upright position to prevent stress on urethral incision o Double diapering  protects the urethra and stent or cath after sx; also helps keep area clean and free from infection  inner diaper contains stool and outer contains urine o If child is discharged w/urinary cath, teach parents how to care for cath and drainage system o Tub baths typically prohibited until it’s time to remove penile dressing Cryptorchidism

Undescended testicles  must descend by 9 months
Testes should be palpable in scrotum, may retract but are still present
If they don’t drop by 1 y/o  sx is indicated to preserve fertility  orchiopexy Clubfoot (congenital talipes equinovarus) pg. 1698 - The foot is twisted and fixed in an abnormal position  exact cause unknown - 4 categories o postural  often resolves w/a short series of manipulative casting o neurogenic  occurs in infants w/myelomeningocele o syndromic associated w/other syndromes, often resistant to tx o idiopathic  occurs in otherwise normal healthy infants - Therapeutic Mgmt o Goal  functional foot, tx starts ASAP o Weekly manipulation w/serial cast changes, later, cast chgs every 2 weeks o Other infants require corrective shoes or bracing o Sx in some infants  release of soft tissue  foot will be immobilized w/a cast for up to 12 weeks, then corrective shoes for several years - Nursing Assessment o Perform active ROM o X-ray obtained to determine bony abnormalities and progress of tx - Nursing Mgmt o Neurovascular assessment and cast care  teach fam cast care o Emotional support Developmental Dysplasia of the Hip (DDH) pg. 1701
DDH  abnormalities of the developing hip  dislocation, subluxation, and dysplasia of the hip joint. The femoral head has an abnormal relationship w/the acetabulum
Cause is unknown but genetic factors play a role
Frank dislocation  no contact btwn femoral head & acetabulum
Subluxation  partial dislocation, acetabulum is not fully seated w/hip joint
Dysplasia  acetabulum that is shallow or sloping instead of cup shaped. Continued dysplasia leads to limited abduction of the hip and contracture of the muscles
Can affect 1 or both hips
Laxity in the newborn’s hip allows dislocation and relocation of hip to

occur

Mechanical factors causing DDH  breech positioning, and presence of oligohydramnios
Genetic factors play a role  Native American and Eastern Europe

o Chg diaper while in harness o Put baby to sleep on back o Assess skin  keep dry and clean

o Once baby is permitted to be out of harness, you can bathe baby w/o it o Long knee socks and undershirt recommended to prev skin rubbing o Note location of markings for appropriate placement o Wash harness w/mild detergent by hand and air dry o Call Dr. if  feet are swollen or bluish, harness appears to be too small, skin is raw or rash dev, if baby is unable to actively kick legs Disorders of the Lower Airways Bronchiolitis pg. 1488

An acute inflammation of the bronchioles and small bronchi  acute viral infection
Almost always caused by RSV (respiratory syncytial virus)
Peaks during winter and spring
Virtually all children will contract RSV within the 1 st^ few yrs of life  occurs most often in infants and toddlers w/a peak at 6 months old
The frequency and severity ↓ w/age  repeated infections occur throughout life but are usually localized to upper resp tract after toddlerhood
RSV is a highly contagious virus and may be contracted through direct contact w/resp secretions or from particles on contaminated objects  droplet precaution
s/s  wheezing, retractions, crackles, worsening cough, dyspnea, tachypnea, and diminished breath sounds
Cell debris clogs and obstructs bronchioles and irritates airway airway lining swells and produces excess mucus  partial airway obstruction and bronchospasms
Small airways become variably obstructed and allows inspiration but prevents full expiration  leads to hyperinflation and atelectasis
Wheezing and crackles  noise is good = air exchange
Air trapped below obstruction also interferes w/normal gas exchange at r/f resp failure
Therapeutic Mgmt o Focuses on supportive tx o Supplemental O2, nasal and/or nasopharyngeal suctioning, oral or IV hydration, bronchodilator tx. Hospitalization only for severe cases
Nursing Assessment o Infant may appear air hungry, various degrees of cyanosis and respiratory distress including tachypnea, retractions, accessory muscle use, grunting, periods of apnea o Cough and audible wheezing, might appear listless and uninterested in feeding, surroundings, or parents o Labs and diags  pulse ox might be ↓, CXR might reveal hyperinflation and patchy areas of atelectasis or infiltration, blood gases  CO 2 retention and hypoxemia, nasal-pharyngeal washings  + RSV via ELISA or immunofluorescent antibody (IFA)
Nursing Mgmt

Pediatrics Exam 1 Study Review: Newborn & Infant Development, Study Guides, Projects, Research of Pediatrics

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Pediatrics Exam 1 Study Review

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