NEONATAL PERIOD

The neonatal period is the transitional time from

intrauterine to independent existence.
Defined as approximately the first 4 weeks after
delivery.
INFANCY PERIOD
Infancy period, traditionally, is the time from 1
month to 1 year of age.
Because of the growth and learning potential that
occurs, the first year of life is a crucial one.

REFLEXES (discussed by Jose Raphael Delos

Santos)
automatic responses to certain stimuli
happen through the reflex arc
sustain lifes functions
Reflexes that are adaptive
1. Rooting
facilitates feeding
disappears by 4 months
2. Sucking reflex
essential for feeding
disappears by 2 months as they
gain control over the burst-pause
pattern
3. Moro reflex
evolutionary roots as primates
weakens by 5 months and
disappears by 8 months
4. Grasping reflex
basic to the complex skill of grabbing and
letting go
develops to palmar grasp, to mitten grasp and
to pincer grasping movement

Other reflexes that change or disappear with

Neurological Maturity
1. Babinski- toes fan out when stroked on soles
Tonic neck- arm and leg stretch out where
the infant is facing while lying on back; the
opposite side flexes
Stepping- feet step rhythmically when held
upright
Plantar- all toes plantar flex when applied
pressure on heel
Startle- response like moro reflex when loud
noise was heard
Crawling- crawling movement when placed
on abdomen
Permanent reflexes against harm
Blinking- blink on light flashed in eyes or on
brushed eyelashes
Pharyngeal/Gag- contraction of the back
throat
Withdrawal- pulls foot away when pricked

NEONATAL ASSESSMENT (discussed by Patricia

Diaz De Rivera)
PHYSICAL CHANGES ASSESSMENT
Conversion from fetal to infant heart-lung
circulation
Apgar scores assess adjustment to extra uterine
life
Score of 0, 1 and 2
Affected by prematurity and maternal
medication
First period of reactivity covers initial 6 to 8
hours
1st stage: highly active
2nd stage: calms down

 Second period of reactivity infants are alert and

responsive
New Ballard Scale determine gestational age in
premature infants
if newborns are small or large for their
gestational age
Rated from s1 to r5 in 13 areas
Accurate gestational age and birth weight
BEHAVIORAL ASSESSMENT
* Pre-adapted to interact with environment.
* Newborns can see!!
* Preferences:
- complex patterns
- light and dark patterns
- sound of human voices
At 3 days - can discriminate mothers voice
At 5 days identify mothers breast milk
4 Characteristics OF A COMPETENT INFANT
1. In-born psychological mechanisms enhance
survival
2. Organize behavior in response to stimuli
3. Respond selectively to certain stimuli
4. Contingency-seeking behavior
Brazelton Neonatal Behavioral Assessment (BNBAS)
1. T. Berry Brazelton
2. based on the 4 characteristics
3. Assess 28 newborn behaviors
5. 6 States of consciousness
1. Deep sleep
2. Light sleep
3. Drowsy
4. Quiet alert
5. Active alert
6. Crying
6. NEWBORN BEHAVIORAL OBSERVATION (NBO)

1.
2.
3.
4.
5.

Kevin Nugent
Based on BNBAS
Neurobehavioral assessment
Focus on infants behaviors
Encourages positive parenting

SELF-REGULATION AND INFANT LEARNING

Infant learning seek out contingencies and build
on reflexes
Sucking reflex increases in 1st few weeks
Self-regulation response to environmental stimuli
In-born capacity
Parents help regulate behavioral state
EARLY GROWTH AND DEVELOPMENT (discusses
Andrea Descalzo)
Principles of Development
Cephalocaudal Principle
-Brain grows rapidly before birth; A newborn
babys
head is disproportionately large.
-Sensory and motor development proceed
according to same principle.
Proximodistal Principle
-Growth and motor development proceed from the
center of the body outward.
-In the womb, head and trunk develop before the
arms and legs.
Changes in Human Body during Growth
During the first year, infants grow rapidly.
Head becomes smaller relative to the rest of the
body.
The increasing leg proportion is almost exactly the
reverse of the decreasing head proportion.
Development: First Year

 By the second day of life, newborns lose 5% -10%

of their birth weight but steadily regain it in 14
days or two weeks.
Not a problem for healthy babies who are born
with a reserve of fat that helps them get through
the first few days of life until their mothers breast
milk supply is established.
Infants gain 680 g each month until 5 to 6
months. also the time when the birth weight
doubled
Height
During year 1, height has increased by 50 %.
First six months, height increases 2.5 cm per
month.
Growth in trunk, not in legs.
1 year old is approx. 76 cm tall high.
Birth height doubles by age of 4 years.
Head Circumference
Increases during the first year after birth from
33.00 to 33.5 cm to 46.5 cm.
Weight of brain doubled.
Genes of an infant inherits have a strong influence
on the childs growth.
Teething begins around 3 to 4 months, when
infant begins grabbing almost everything in sight
to put it into their mouths.
First tooth may not arrive until sometime between
5 to 9 months or even later.
Nutrition
Breastmilk
-Best diet for infants during 1st to 6th months.
-contains all the nutrients and maternal
antibodies.
Breastfeeding should start immediately after birth
and should continue at least one year.
Infant formulas are acceptable substitute but
not recommended.

BREAST FED BABIES

Less likely to contract infectious illnesses
(diarrhea, respiratory infections, otitis media,
staphylococcal bacterial, and urinary tract
infdections)
Lower risk of SIDS and of postneonatal death
Less risk of inflammatory bowel disease.
Better visual acuity, neurological development,
and long-term cardiovascular health, including
cholesterol levels.
Less likely to develop obesity, asthma, eczema,
diabetes, lymphoma, Leukemia, and Hodgkins
disease
Shows little or no language or motor delays; Score
higher on cognitive tests at school age and into
young adulthood.
Have fewer cavities and are less likely to need
braces.
BREAST FEEDING MOTHERS
Enjoy quicker recovery from childbrith with less
risk of postpartum bleeding.
More likely to return to their prepregnancy weight
and less likely to develop long-term obesity.
Have reduced risk of anemia and almost no risk of
repeat pregnancy while breast-feeding
Report feeling of confident and less anxious
Less likely to develop osteoporosis or ovarian and
premenopausal breast cancer
Breastfeeding is inadvisable if a mother is infected
with AIDS virus or any other infectious illnesses, if
she has untreated active tuberculosis, exposed to
radiation or if she is taking any drug.(note)
The risk of transmitting HIV infection to an infant
continues as long as an infected mother breastfeeds.(note)
Other Nutritional Concerns

 Iron-enriched solid foods are recommended to be

introduced gradually during the second half of the
first year.
In many low-income communities around the
world, malnutrition in early life is widespread and
often fatal.
Undernourished Children who survived their first 5
years are at risk for stunted growth and poor
health and functioning throughout life.
Being overweight has increased in infancy as in all
age groups.
Rapid gain weight during the first 4 to 6 months is
associated with future risk of overweight.
Factors:
The child has an obese parent ( Genes and
Environmental influences within the family)
Sleep
Newborns are in deep sleep for 4 to 5 hours each
day as intervals of 10 to 20 minutes.
Light sleep takes up to 12 to 15 hours of theur day
wih longer intervals of 20 to 45 minutes. (notes)
Infants develop a nocturnal sleep pattern .
By 3 to 4 months, infants sleep about 9 hours at
night and nap about three times a day for an hour
or so.(note)
SUDDEN INFANT DEATH SYNDROME
SIDS is the leading cause of death for infants
between 1 month and 12 months of age.
Many of these deaths occur when babies who are
used to sleeping on their backs at home are then
placed to sleep on their tummies by another
caregiver.(Unaccustomed tummy sleeping)
Failure to Thrive FTT
-usually diagnosed during the first year of life.
-in FTT, weight falls below 3rd to 5th percentile,
there is a deviation form the growth cruve and the

charactersitic posturing and interactive behavior

of infancy may be absent.
Organic FTT
-has physical causes (notes)
Nonorganic FTT
-caused by psychological factors (notes)
-difficult to treat
The Development of Posture
Posture a dynamic process that is linked with
sensory information in the skin, joints, and
muscles, which tell us where we are in space; in
vestibular organs in the inner ear that regulate
balance and equilibrium; and in vision and hearing
(Thelen & Smith, 2006).
Sensory and Perpetual Development
Sensationoccurs when information interacts with
sensory receptors.
Perceptionthe interpretation of what is sensed.
Visual Perception
What do newborns see? How does visual
perception develop in infancy?

By 8 weeks, and possibly by even 4 weeks, infants

can discriminate some colors
By 3 months of age, infants match voices to faces,
distinguish between male or female faces, and
discriminate between faces of their own ethnic
group and those of other ethnic groups.
Size Constancy
The recognition that an object remains the same
even though the retinal image of the object
changes as you move toward or away from the
object.
Shape Constancy

 The recognition that an objects shape remains

the same even though its orientation to us
changes
Other Senses
Other sensory systems besides vision also
develop during infancyhearing , touch and pain,
smell, and taste.
HEARING
Loudness
Immediately after birth, infants cannot
hear soft sounds quite as well as adults can; a
stimulus must be louder to be heard by a newborn
than by an adult
Pitch
Infants are less sensitive to low-pitched
sounds and are more likely to hear high-pitched sounds
Localization
Newborns can determine the general
location from where a sound is coming from, but by 6
months of age, their ability to localize sounds become
more proficient.
TOUCH AND PAIN
Newborns do respond to touch. (A touch to the cheek
produces a turning of the head; a touch to the lips
produces sucking movements.)
Newborns can also feel pain.
SMELL
In the experiment by MacFarlane (1975), 6-day-old
infants preferred to smell their mothers breast
pad rather than a clean one that had never been
used, but 2-day-old infants did not show
preference.
TASTE
In one study, even at only two hours of age, babies
made different facial expressions when they tasted
sweet, sour, and bitter solutions.
At about 4 months of age, they begin to prefer salty
tastes.

BRAIN DEVELOPMENT (discussed by Koreen

Corpuz)
3rd prenatal week - Neural induction
4th week - neural tube
5th week - cell proliferation
7th prenatal week - cell migration
During infancy, connections among the neurons
begin to increase notably
-100 to 1000 connections for each of the billions
of neurons
The baby's brain at birth is approx 1/4 of its adult
size, 50% at 6 months, 60% at 1y/o, 75% at 2y/o,
90% at 6y/o, 95% at 10y/o
Brain development follows a definite pattern
- Motor area is most advanced (for survival
purposes), then sensory area, visual area then the
auditory area
- Association areas are the slowest to develop
Frontal lobe - motor area
Parietal lobe - controlling center for the body's
sense areas
Temporal lobe - auditory functions
Occipital lobe - visual information analysis
only the lower part of the nervous system, the
spinal cord and the brain stem, is fully developed
at birth.
- reponsible for kicking, grasping, crying,
sleeping, rooting, and feeding
Birth
- can recognize human faces
- can discriminate happy or sad expressions
- can recognize mother's voice
First year
- cerebellum triples in size = rapid development of
motor skills
- develops full binocular vision

IMPLICATIONS FOR NURSES

It is important to recognize that the brain
development is not complete at birth for us to be
able to ensure continued growth which requires
stimulation from the environment.
Urge parents to vary stimulation auditory, visual,
tactile in their infants surroundings to provide a
rich texture for brain development.
COGNITIVE DEVELOPMENT (discussed by ChinChin Castelltort)
HOW DOES INTELLIGENCE DEVELOP?
Organization
Adaptation
Assimilation
Accomodation
Equilibration
4 ACCOMPLISHMENTS
1. Spatial Relationships
2. Time (Before and after)
3. Casuality (Cause and effect)
4. Object Permanence
SUBSTAGES OF SENSORIMOTOR PERIOD
1. Reflex Activity
BIRTH TO 1 MONTH
2. Primary Circular Reactions
1-4 MONTHS
3. Secondary Circular Reaction
4-8 MONTHS
4. Coordination of Secondary Circular Reactions
8-12 months
LANGUAGE DEVELOPMENT (discussed by Jose
Cafuir)
We have yet to understand fully the language
development (speech) of children from simple
sounds to an extensive vocabulary overtime.

Even without formal schooling, children can learn

words, meanings, and piece words together to
form words in a purposeful manner.
Children from all over the world follow a pattern in
which they first emit sounds, single words, two
words, phrases, then fairly complex sentences.

Language
Crying
Cooing
Babbling
Single words
Two words
Phrases

Age
Since birth
2-5 months old
5-7 months old
12 months old
18 months old
2 years old

Lois Bloom (2000), a well known commentator of

language development, has divided the process
into three transitions, wherein:
First transition (approx. 1yr old): child transitions
from simple sounds to words; he also acquires
basic vocabulary
Second transition (approx. 2yrs old): starts when
child changes speech from one word at a time
to combining words to form phrases and simple
sentences.
Third transition: child moves from using simple
sentences to express one idea to complex
sentences
According to Steven Pinker (1994), a
neuropsychologist, not much linguistic interest

takes place during the first two (2) months, where

coughs, cries, and hiccups reflect the babys
general physical condition.
There is variation as to what age your child starts
to babble (approx. 5mo) up to what age they utter
their first words (approx. 11mo)
Cooing (vowel sounds mixed with consonants)
often start at the end of the second month and
into the third
At 3-4 months, the child starts to combine vowels
and consonants to form syllable-like sounds such
as ma and ba
Babbling (increased frequency of syllable-like
sounds) starts from 5-7 months, initially because
of biological maturation (due to ability of child to
control vocal tract)
By the 7th-8th month, syllables appear (eg. da-dada, ba-ba-ba) and will continue on up to the end of
the first year of life.
Vocables (sounds a child associate with an object)
often appear late in the babbling period, usually
at the 9th or 10th month.
The first words of a child are often spoken
between 10-13 months of age.
The words they know often refer to food, clothes,
or toys
This one-word stage may last for two months or
even a year.
By the 18th month of life, a word spurt occurs
wherein a child learns a new word in an average
of every two hours.
Before the start of the two-word period, children
begin to use holophrases (the use of one word in
many meanings) more often.

IMPLICATIONS ON NURSES

Be certain that the infants hearing ability is

normal.
Have family members help you interpret the
infants gestures and sounds.
If the infant and the family are from a different
culture with a different language, obtain help with
both language and any cultural practices that are
important to be able to be an effective health-care
provider.
FIRST RELATIONSHIPS
Relationships
Dimensions to a relationships
Ghosts in the Nursery
o Selma Fraiberg, 1959
Temperament
Stella Chess and Alexander Thomas, 1987
o Easy Children
o Difficult Chilren
o Slow-to-warm-up children
Three motives
o Bodily Needs
o Psychological Needs
o Adult Response Needs
IMPLICATIONS FOR NURSES
WE SHOULD BE AWARE OF THE QUALITY OF THE
RELATIONSHIPS THAT THESE INFANTS HAVE WITH
THEIR FAMILIES.
KNOWING THE EFFECTS OF EMOTIONS ON BABY,
WE SHOULD BE ABLE TO HADLE THEM MORE
WARMLY AND WITH CARE.
ATTACHMENTS (discussed by NJ Caguntas)
> Erikson's eight stages in psychosocial
development.
- 1st stage: trust vs. mistrust

 [ Attachment ]
- a reciprocal, enduring emotional tie between an
infant and caregiver, each of whom contributes to
the quality of the relationship.
[ Studying Patterns of Attachment ]
> John Bowlby
- mother - baby bond is important.
- against the concept of "mother and baby
separation".
> Mary Ainsworth
- "Strange situation" experiment.
~> laboratory based technique designed to
assess attachment patterns between an infant
and an adult.
~> 3 main patterns of attachment:
1.) Secure attachment
- infants were secure and used the mother
as a base from which to explore.
2.) Avoidant attachment
- infants rarely cried during separation
and avoided their mothers at reunion.
3.) Ambivalent (resistant) attachment
- infants manifest anxiety before
separation and more intensely distressed by the
separation.
4.) Disorganized-disoriented attachment
- manifests confused behavior on being
reunited with their mother.
[ How attachment is established ]
- On the basis of a baby's interaction with the
mother, the baby builds a "working model" of
what can be expected from her.
If mother acts the same -> model holds up
Mother's behavior changes -> baby revises the
model.
[ Alternative Methods of Attachment Study ]
> Waters and Deane Attachment Q-Set (AQS)

- used sorted descriptive words or phrases

categorized from most to least characteristics of
the subject to compare the infant to a model of a
secured child.
[ The Role of Temperament ]
The mother's sensitivity and the baby's
temperament influence the attachment patterns.
[ Long-Term Effects of Attachment ]
> Secured infants
- confident to be actively engaged in their world.
> Securely attached toddlers
- more joyful
- have more positive interaction with peers
> Between ages 3-5
- curious, competent, empathic, resilient and
self-confident.
[ Intergenerational Transmission of Attachment
Patterns ]
> Adult Attachment Interview (AAI)
- an adult's early experiences may influence the
way they respond to their child.
- Interventions about caregiving
~> a way to break the cycle of insecure
attachment.
[ Emotional Communication with Caregivers ]
Mutual Regulation
- the ability of both infant and caregiver to
respond appropriately and sensitively to each
other's mental and emotional state.
~> infants send behavioral signals that
influence the caregiver's behavior.
[ Social Referencing ]
- seeking emotional information to guide
behavior.
IMPLICATIONS FOR NURSES
- Opportunity to model desirable behavior.
- ideal time to share ideas with mother.

1.
2.
3.
4.
5.

EMOTIONAL DEVELOPMENT
EMOTION
subjective reactions to experiences.
associated with physiological and behavioral
changes.
- building block of personality.
* NOTE: What causes childrens emotions changes
at different ages.
Newborns
* Easy to tell when they are unhappy, harder to
tell when they are happy.
* Typically quiet when they hear a human voice.
* May smile
Infants
* Respond more to people
FIRST SIGNS OF EMOTIONS:
DISGUST
CRYING
SMILING
FEAR
DISGUST
- a feeling of disapproval aroused by something
unpleasant.
CRYING
- an expression of sadness and distress
- most powerful way the infants can communicate
their needs.
4 patterns: Hunger cry, Angry cry, Pain cry,
Frustration cry
SMILING
Birth: faint smiles; involuntary smiles frequently
appear during periods of REM sleep.
2nd week: smiles drowsily after eating
3rd week: smile when they pay attention to
caregivers voice.
1st month: smiles are more frequent and more
social

2nd month: babies smile more at visual stimuli

FEAR
to be afraid and worried
Fear towards strangers and towards danger
VISUAL CLIFF EXPERIMENT
EMOTIONAL REFERENCING
- babies search for and use of emotional
information from significant others that help
regulate their behavior.
PARENTS SHOW FEAR: Infant does not cross the
visual cliff.
PARENTS SMILE: Infant crosses the visual cliff.
BRAIN GROWTH AND EMOTIONAL
DEVELOPMENT
1ST 3 MONTHS
Cerebral cortex becomes functional.
Differentiation of basic emotions.
Spontaneous neonatal smile diminishes.
9 to 10 months
Frontal lobes begin to interact with the limbic
system.
Hypothalamus and limbic system interact.
An infant can experience and interpret emotions
at the same time.
TEMPERAMENT
Persons characteristics
Biologically based way of approaching and
reacting to people and situations.
Describes the how of doing something.
SHYNESS AND BOLDNESS
JEROME KAGAN INHIBITION TO THE UNFAMILIAR
HIGH-RACTIVE (introverted, cautious, fearful)
LOW-REACTIVE (outgoing, sociable, fearless)
Easy Child

Has moods of mild to moderate intensity.

Responds well to change.
Quickly develops regular sleep and feeding
schedules.
Takes new food easily.
Smiles at strangers.
Adapts easily.
Difficult Child
Displays intense and negative moods.
Cries and laughs loudly.
Responds poorly to change.
Accepts new food slowly.
Suspicious of strangers.
Adapts slowly.
Slow-to-warm-up Child

Both positive and negative moods.

Responds slowly to change.
Sleeps and eats more regularly than the difficult
child, less regularly than the easy child.
Shows mildly negative response to new stimuli.
Gradually develops liking for new stimuli after
repeated, unpressured exposures.

IMPLICATIONS FOR NURSES

PATIENTS HAVE A WIDE VARIETY OF EMOTIONS.
UNDERSTANDING THE CONCEPT OF EMOTIONAL
DEVELOPMENT WILL HELP US ANALYZE HOW TO
REACT PROPERLY TO THE PATIENTS.
AN OPEN AND HONEST RELATIONSHIP WITH THE
CLIENTS SHOULD BE KEPT.