GENERAL PRINCIPLES Definition of Terms A. Growth: increase in size of a structure.

Human growth is orderly and predictable, but not even; it follows a cyclical pattern. B. Development: maturation of physiologic and psychosocial systems to more complex state. C. Cephalocaudal: head-to-toe progression of growth and development D. Proximodistal: trunk-to-periphery (fingers and toes) progression of growth and development E. Phylogeny: development or evolution of a species or group; a pattern of development for a species F. Ontogeny: development of an individual within a species Rates of Development A. Fetal period and infancy: the head and neurologic tissue grow faster than other tissues. B. Infancy and adolescence: fast growth periods C. Toddler through school-age: slow growth periods D. Toddler and preschool periods: the trunk grows more rapidly than other tissue. E. The limbs grow most during school-age period. F. The trunk grows faster than other tissue during adolescence. NEONATAL ASSESSMENT Initial Assessment Airway a suctioning and O2 if needed Body temperature Positioning a head lower than the trunk Apgar scoring Cord clamp a bleeding, AVA Voiding and meconium Footprints and fingerprints Identification bands Mother infant bonding APGAR SCORING Heart rate Respiratory effort Muscle tone Reflex irritability Skin color 1 minute a initial adaptation to extrauterine life 5 minutes a overall status

APGAR interpretation 7 to 10 a 4 to 6 a Good condition Fair condition

0 to 3 a In danger a resuscitation Ongoing Physical Assessment Vital signs: RR :30 to 60 bpm Apical Pulse 110 a sleeping Head Circumference: 13 14 inches Chest Circumference; 12 13 inches BEHAVIORAL ASSESSMENT Period of Reactivity 30 minutes after birth Awake and active VS are increased Mother infant bonding a breastfeeding Resting Period 2 to 4 hours VS returning to baseline 1 sleep and difficult to be aroused Second Period of Reactivity 4 to 6 hours NUTRITION GENERAL INFORMATION Loses 5 to 10% and regain within 10 days Gain of 28g /day a 1st 6 months Gain of 14g/day a Weight gain 2x a 6 months 3x a 1 year 2nd 6 months

4x a 2 year DAILY NUTRITIONAL REQUIREMENTS Calories a 100 to 200 kcal/kg Fluid a CHON a 150 to 180ml/kg 2.2g/Kg a 1.6g/Kg

Fat a 30 to 60% of daily calories HIGH RISK INFANTS According to size

LBW a ELBW a

< 2500g < 1000g

MLBW a < 1500g SGA Birth weight falls below 10th percentile on intrauterine growth curve LGA a above 90th % According to age Premature Full term Postmature DEVELOPMENTAL THEORIES Psychosexual model (Freud) 1. Oral a. 0-18 months b. Pleasure and gratification through mouth c. Behaviors: dependency, eating, crying, biting d. Distinguishes between self and mother e. Develops body image, aggressive drives 2. Anal a. 18 months - 3 years b. Pleasure through elimination or retention of feces c. Behaviors: touching of genitals, erotic attachment to parent of opposite sex d. Develops fear of punishment by parent of same sex, guilt, sexual identity 4. Latency a. 6 - 12 years b. Energy used to gain new skills in social relationships and knowledge c. Behaviors: sense of industry and mastery d. Learns control over aggressive, destructive impulses e Acquires friends 5. Genital a. 12 - 20 years b. Sexual pleasure through genitals c. Behaviors: becomes independent of parents, responsible for self d. Develops sexual identity, ability to love and work Psychosocial Model (Erikson) 1. Trust vs mistrust a. 0 - 18 months b. Significant relations: mother c. Psychosocial virtues: hope, faith

d. Maladaptations & malignancies: sensory distortion- withdrawal 2. Autonomy vs shame and doubt a. 18 months - 3 years b. Significant relations: parents c. Psychosocial virtues: will, determination d. Maladaptations & malignancies: impulsivity -- compulsion 3. Initiative vs guilt a. 3 - 5 years b. Significant relations: family c. Psychosocial virtues: purpose, courage d. Maladaptations & malignancies: ruthlessness -- inhibition 4. Industry vs inferiority a. 6 - 12 years b. Significant relations: neighborhood and school c. Psychosocial virtues: competence d. Maladaptations & malignancies: narrow virtuosity -- inertia 5. Identity vs role confusion a. 12 - 20 years b. Significant relations: peer groups, role models c. Psychosocial virtues: fidelity, loyalty d. Maladaptations & malignancies: fanaticism -- repudiation 6. Intimacy vs isolation a. 20 - 25 years b. Significant relations: partners, friends c. Psychosocial virtues: love d. Maladaptations & malignancies: promiscuity -- exclusivity 7. Generativity vs stagnation b. Significant relations: mankind or my kind c. Psychosocial virtues: wisdom d. Maladaptations & malignancies: presumption -- despair Interpersonal Model (Sullivan) 1. Infancy a. 0 - 18 months b. Others will satisfy needs 2. Childhood a. 18 months - 6 years b. Learn to delay need gratification 3. Juvenile a. 6 - 9 years

b. Learn to relate to peers 4. Preadolescence a. 9-12 years b. Learn to relate to friends of same sex 5. Early adolescence a. 12-14 years b. Learn independence and how to relate to opposite sex 6. Late adolescence a. 14-21 years b. Develop intimate relationship with person of opposite sex Cognitive Theory (Piaget) A. 0 - 2 years: sensorimotor -reflexes, repetition of acts B. 2 - 4 years: preoperational -no cause and effect reasoning; egocentrism; use of symbols; magical thinking C. 4 - 7 years: intuitive -beginning of causation D. 7 - 11 years: concrete operations E. 11 - 15 years: formal operations -reality, abstract thought -can deal with the past, present and future KOHLBERGS STAGES OF MORAL DEVELOPMENT PRECONVENTIONAL LEVEL Stage 1 Age: 2-3 Punishment or obedience (heteronomous morality) A child does the right things because a parent tells him or her to avoid punishment Stage 2 Age : 4-7 Individualism, Instrumentalism, and Exchange Child carries out actions to satisfy own needs rather than societys. The child does something for another if that person does something for him in return CONVENTIONAL LEVEL level 2 Stage 3 Age : 7-10 "Good boy/girl" Child follows rules of authority figures as well as parents to keep the system working POSTCONVENTIONAL LEVEL level 3 Stage 5 Age :older than 12 social contract, utilitarian law making perspective child follows standards of society for the good of all people

Stage 6 Age :older than 12 Principled Conscience universal ethical principle orientation child follows internalized standards of conduct NEONATAL REFLEXES Reflex: Symmetric tonic neck Stimulus: neck flexion, neck extension Response:arm flexion, leg extension, arm extension, leg flexion Onset: birth-1month Suppression: 4 mos NEONATAL REFLEXES positive supporting Stimulus: tactile contact and weight bearing on sole Response:leg extension for supporting partial body weight Onset: 2 months Suppression: 3-7 mos, replaced by volitional standing rooting Stimulus: stroking the corner of the mouth,upper or lower lip Response:moving the tongue, mouth and head towards the site of stimulus Onset: birth Suppression: 4 mos palmar grasp Stimulus: pressure or touch on the palm, stretch of finger flexors Response:flexion of fingers Onset: birth Suppression: 4-6 mos Plantar grasp Stimulus: pressure on the sole just distal to the metatarsal heads Response:flexion of toes Onset: birth Suppression: 12-18 mos Automatic neonatal walking Stimulus: contact of the sole in vertical position tilting the body forward and from side to side Response: automatic alternating steps Onset: birth Suppression: 3-4 mos INFANT REFLEXES Extrusion reflex a 4 months Cough reflex

Babinski reflex Moro reflex a 3 to 4 months Dance or step reflex a 3 to 4 weeks BREAST FEEDING ADVANTAGE Readily available Economical Promotes facial muscles, jaw and teeth Mother infant bonding Reduced incidence of allergies Reduced incidence of maternal breast cancer Transfer of maternal antibodies DISADVANTAGE Prevents other from feeding the infant Limits paternal role in feeding Compels the mother to monitor her diet carefully Maybe difficult to a working mother Digest quickly a more feeding ADEQUATE ??? Wets 6 to 8 diapers a day Gaining weight BOTTLE FEEDING ADVANTAGE Permits the father to feed Mother a medications Fewer feedings Feeding a public a embarrassment DISADVANTAGE Cost Greater preparation and effort Hands a clean Requires refrigeration and storage No transfer of maternal antibodies Doesnt benefit mother physiologically IMMUNIZATION BCG Infants: 0.05 ml Intradermal Right deltoid School Entrants: 0.1ml Intradermal Left deltoid DPT 6, 10 and 14 weeks 0.5ml Intramuscular Upper outer portion of the thigh Hepatitis 0, 6, and 14 weeks 0.5ml Intramuscular

Upper outer portion of the thigh OPV 6, 10 and 14 weeks 2 drops Mouth Measles 9 months 0.5ml Subcutaneous, Left outer part of the upper arm INFANCY (0 to 1 yr) I ron supplement (4 to 6 months), immunization N o choking hazard F ear of stranger peaks at 8 months D ont leave alone near the bathtub or swimming pool D oubt and shame V.S. Autonomy L earns about death @ age 3 E limination pattern R rituals and routines P ush-pull toys (mobile), parallel play (forget sharing) R rituals and routines (eyes and consistency), regression A utnomy VS shame and doubt, accidents (death) I nvolve parents S eparation anxiety E limination and explore COMMON ACCIDENTS P revent further absorption O ff, shower or wash off I - dentify S - upport O ngoing safety education N otify local poison control center PRESCHOOL (3 to 6 yr) P lay is associative/cooperative R gression is common E xplain procedures S ame age group for room assignment C - urious H ighly imaginative O bserve for initiative VS guilt O ff limits to the kitchen (risk for poisoning and burn) L oss of body part is a common fear M - utilation A associate play, abandonment G - uilt I nitiative, imaginary playmate, imagination C urious a Y SCHOOL AGE ( 6 to 12 yr) S ame sex stage C ompetitive play

H eroworship O bserve for industry VS inferiority O ff limits to vehicles L oss of control is a common fear E xplain procedurse R egression is common D eath (bogeyman), honesty a funerals and burials I ndustry VS inferiority (collections) M odesty (privacy) P eers (own sex) L oss of control a hospitalization, encourage decision making E - xplaination of procedures Childs Response to Death 1. toddlers - may insist on seeing a significant other long after that persons death. 2. Preschoolers - See death as temporary; a type of sleep or separation. 3. School-age See death as a period of immobility. - Feel death is punishment. 4. Adolescents - Have an accurate understanding of death.