Growth & Development
pediatrics growth and development quick revision notesGrowth - Increase in physical size ( MCQ)
Development - Attainment of maturity of functions ( MCQ)
Principal of G&D:
- Universal & Unique
- growth and development is continuous and orderly process
- growth and development occur in cephalocaudal (direction of head neck arm leg ) and proximodistal (central to peripheral ) order
Growth is assessed by - Anthropometry ( MCQ)
Anthropometry
•(3 zones: Red, Yellow, Green)
Body mass index (BMI) ( MCQ)
BMI = Weight (kg) x100 ÷ Height (m2) ( MCQ)
skin-fold thickness is measured by Herpenden Caliper ( MCQ)
Growth Charts - Graphical representation of the growth norms.
Growth chart of choice is WHO growth chart
WHO growth chart
Exclusively breast fed children from 6 Month
Weight - Birth weight of an average (MCQ)
Indian baby - 2:8 kg
Suppose, at birth, weight is in W
-- At 5 months : 2W (Birth weight doubles at 5 months)
At birth = W
• At 5 months = 2 W (Doubles)
• At 1 year = 3W (Triples)
At 2 years = 4W
• At 3 years = 5W
• At. 5 years = 6W
• At 7 years = 7W
- At 10 years = 10W
Expected weight of a child < 1yr
EW= x+9 /2 (x = age in months)
example- 7 month old , EW = 7x+9 /2=8 kg
EW for 1-6 year =2x+8 (x = age in years)
EW for 7-12 year = 7x- 5 / 2 (x = age in year ) ,
Anthropometry
- Height
- Weight
- Head circumference
- Mid-arm circumference
- Body mass index
- Skin fold thickness
•(3 zones: Red, Yellow, Green)
- <11.5cm -> Red (malnutrition)
- 11.5 – 12.5cm -> Yellow ( borderline malnutrition )
- > 12.5 cm -Green (good nutrition)
BMI = Weight (kg) x100 ÷ Height (m2) ( MCQ)
skin-fold thickness is measured by Herpenden Caliper ( MCQ)
Growth Charts - Graphical representation of the growth norms.
Growth chart of choice is WHO growth chart
WHO growth chart
- came in 2006
- Based on MGRS
- M- Multicentre
- G- Growth
- R- Reference
- S- study
Exclusively breast fed children from 6 Month
Weight - Birth weight of an average (MCQ)
Indian baby - 2:8 kg
Suppose, at birth, weight is in W
-- At 5 months : 2W (Birth weight doubles at 5 months)
At birth = W
• At 5 months = 2 W (Doubles)
• At 1 year = 3W (Triples)
At 2 years = 4W
• At 3 years = 5W
• At. 5 years = 6W
• At 7 years = 7W
- At 10 years = 10W
Expected weight of a child < 1yr
EW= x+9 /2 (x = age in months)
example- 7 month old , EW = 7x+9 /2=8 kg
EW for 1-6 year =2x+8 (x = age in years)
EW for 7-12 year = 7x- 5 / 2 (x = age in year ) ,
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Height ( MCQ)
Device used is stadiometer (for height)
Length is measured by using Infantometer
Length of newborn at birth 50 cm
Maximum growth takes place in the first year of life
* Expected height = 6Y+77 cm (Y = age in years)
eg: 5yr — 6x5+77 = 107cm
Upper segment (US): Lower segment (LS)
At 3 years →1.3 : 1
At 7 years → 1:1
Endocrine causes GH deficiency
(In GH deficiency, US:LS is normal always)
Head circumference
* Also known as OFC (Occipito-frontal circumference)
Measured using non-stretchable measuring tape with millimetre markings too.
At birth = 33-35 cm (MCQ)
Rate of increase in HC
• First 3 months -- @ 2cm/month
• Next 3 months -- @ 1 cm/month
Next 6 months → @ 0.5cm/month
Next 2 years → @0.2 cm/month
so maximum increase at first 3 months
example -35 cm at birth, when it becomes 43 cm?
At birth - 35
< - 3 SD (standard deviation) of expected based on age & sex.
Macrocephaly
(Large head) & Defined as head circumference
> + 2 SD of expected according to age and sex
MCC of obstructive hydrocephalus in children Aqueductal stenosis
V-P shunt (ventriculo peritoneal shunt)
Dentition
Teeth development.
2 types:
1) primary (milk teeth)
2) Secondary (permanent teeth)
1st dentition begins usually begins at 6-7 months (6>7) (MCQ)
2nd dentition begins at 6 years
Milk teeth
* At 4 years
* At 5 years
Social milestones
* 1 month ~ looks at the mother, intently when talked to
* 2 months - Social smile appears
* 3 months → Recognizes mother
* 6 months - Mirror play (localizes and smile to his image )
* 7 months - Stranger anxiety appecze
* 8 months - object permanence happens
* 9 months - bye-bye
at 12 month kisses on request, plays a simple ball game
* At 15 months (2P)
* At 18 month (2D)
* At 2 years – Parallel play (2 babies, sit together plays their own)
* At 3 years - Joins & play, Knows name, age & gender
Dry during night (But nocturnal analysis when the baby continues involuntary passage of urine at night beyond 5y of age.)
* At 4 years
* At 5 year
• Starts helping us (bring water) in simple household tasks
• Distinguishes morning from evening.
Language milestones
* 1 month - Quietens when a bell is rang.
* 2 month - Vocalizes (MCQ)
* 3 months - Cooing (long musical) (MCQ)
* 4 months- laughs aloud
* 2 years Speak short sentences (2 word sentences) know 100 words with meaning
* 3 yeans - 3 word sentences
- Repeats 3 digits
• 4 year - Tells a story /poem, sings a song.
(2yr -2 word sentence, 3yr - 3 word sentence 4y- word sent. ... )
NEONATOLOGY
Neonate -- first 28 days ☆ Called as neonatal period
(I) According to gestational age.
(II) Based on birth weight. (MCQ)
•LBW (low birth weight) <2500gm (<2.5kg)
• VLBW (very low weight) < 1500 gm (<1.5 kg)
• ELBW (extremely low weight)< 1000 gm (<1 kg)
(1) Based on gestational age and birth weight:
Appropriate for date / appropriate gestational age (AFD /AGA) ~ birth weight is between 10th to 90th percentile of expected acc. to gestational age
a small for date -> birth weight 10th percentile of expected acc. to gestational age
* Large for date birth weight 90th percentile of expected ace to gestational age
Causes of Large for date
a healthy term neonate
* Birth wt -2.8kg
* Length - 50 cm
* US:LS 1.7-1.9:1
* HC - > 33-35 cm .
Peripheral cyanosis or acrocyanosis
* Short soft systolic murmur may be normally present (it is a blood flow to lungs not related with heart)
mcq→ Tool used to assess gestational age is a neonate is
ENBS (Expanded New Ballard score) (MCQ)
Characteristics of preterm neonate
General
Genitalia :
1. Rooting reflex (scratch side of mouth, baby opens mouth) (helps in breastfeeding)
- Appears at 32 wks
- Moro's reflex begins to appear at : 28 wks of gestation
- completely appears at 37 wks
- Disappear : 5-6 months
- Abnormal persistence of Moro's reflex indicates cerebral damage
causes of asymmetric Moro's reflex
• Appear - 28WK, disappear - 3 months
- Height - ≥ 2 yr age
- Length - < 2 yr age
Device used is stadiometer (for height)
Length is measured by using Infantometer
Length of newborn at birth 50 cm
- At 1 yr - 75cm
Maximum growth takes place in the first year of life
- At 2yr - 90 cm
- At 4yr - 100 cm
* Expected height = 6Y+77 cm (Y = age in years)
eg: 5yr — 6x5+77 = 107cm
Upper segment (US): Lower segment (LS)
- US - Part of body above symphysis pubis
- LS - Part of body below the symphysis pubis
At 3 years →1.3 : 1
At 7 years → 1:1
Endocrine causes GH deficiency
(In GH deficiency, US:LS is normal always)
Head circumference
* Also known as OFC (Occipito-frontal circumference)
Measured using non-stretchable measuring tape with millimetre markings too.
At birth = 33-35 cm (MCQ)
Rate of increase in HC
• First 3 months -- @ 2cm/month
• Next 3 months -- @ 1 cm/month
Next 6 months → @ 0.5cm/month
Next 2 years → @0.2 cm/month
so maximum increase at first 3 months
example -35 cm at birth, when it becomes 43 cm?
At birth - 35
- 1m- 37
- 2m - 39
- 3m - 41
- 4m - 42
- 5m -- 43cm
< - 3 SD (standard deviation) of expected based on age & sex.
Macrocephaly
(Large head) & Defined as head circumference
> + 2 SD of expected according to age and sex
MCC of obstructive hydrocephalus in children Aqueductal stenosis
V-P shunt (ventriculo peritoneal shunt)
Dentition
Teeth development.
2 types:
1) primary (milk teeth)
2) Secondary (permanent teeth)
1st dentition begins usually begins at 6-7 months (6>7) (MCQ)
2nd dentition begins at 6 years
Milk teeth
- begins 6-7 months
- 1st tooth is lower central incisor
- last - 2nd-mollar
- completes at 2.5 - 3yr (2.5 <3) (MCQ)
- Total 20 teeth
Permanent begins 6 years
First molar teeth
last-3rd molar - teeth (wisdom teeth)
completes at-12 yr (except 3rd molar tooth)
Total- 28 - 32
Normal puberty
Neonante→1st 28 days
Infant →1st year of life
Toddler →1-3 year
Preschool → 3-6 yr
Adolescence (BY WHO)- 10-19 (MCQ)
Normal puberty in females :
* First sign- Thelarche (breast bud development)
☆ Then pubarche (pubic & axillary hairs)
Growth spurt (peak increase in growth velocity (Second phase of a growth after 1 yr)
Menarche (beginning of menstrual periods)
Normal puberty in males:
* First sign of puberty →Testicular enlargement
Penile enlargement
Pubic hairs
Growth spurt
Auxiliary hairs
facial hairs
Device used to assess testicular size - Orchidometer
DEVELOPMENT
* DQ: Developmental quotient
* DQ -( Developmental age/Chronological age) x100
* Chronological age is actual age; dev. age is milestones he can do in reference to age
Q: DQ =50, chro.age = 6 find DA =?
50 = (dev.age/6) x100
dev.age = (50x6)/100
:Developmental age = 3 yr
* Developmental domains:
* Postures
* 1 month in ventral suspension (face down, back-up, arms loosely down ) head is below plane of body
No neck control
During 2 months→ in ventral suspension, head in the plane of rest of the body partial neck control appear
* 3 months → Neck control develops head above plane of rest of body (MCQ)
At around 5 months → bring feet to mouth (MCQ)
* 6 months → sitting with support, (sitting with support of his own hand - Tripod) and prone to supine (MCQ)
* 7 months → supine to prone
* 8 months → sitting without support (MCQ)
* 9 months →standing with support
* 10 months → crawling with abdomen
* 11 months → creeping (without abdomen)
(Pneumonia: a before e).
* 12 months - standing without support, walking with support ( - around edges of table, touching edges)(MCQ)
13 months -> Walking without support
* 15 months --- Creeps upstairs
* 18 months Goes upstairs and downstairs using side railing
* A 2 years Runs ,kicks ball, goes upstain & downstain
* At 3 year → Rides a tricycle (MCQ)
* At 4 years Goes upstairs and downstairs with alternative feet, skips on 1 foot
* At 5 years → Skips on both feet
Fine motor milestones
* At 1 month hands kept closed, palmar grasp reflex present (MCQ)
* At 3 month → hands kept open, palmar grasp reflex is lost), hand regard appears (bringing hands in midline & starts seeing) holds an object when placed in hand.
* At 4 months : Tries to reach for an object but overshoots
* At 5 months -Bidextrous grasp appears (Holding with both hands) (MCQ)
* At 6 months: Unidextrous / palmar grasp
* At 7 months -Transfers object from one hand to another hand
* At 9 months --> Immature / assisted pincer grasp (MCQ)
At 12 months → Mature / unassisted pincer grasp, casting (throwing objects down)
* At 15 months → Spontaneous scribbling
- Tower of two cubes
* At 18 months - feed himself with cup /spoon (MCQ)
* At 2 years
last-3rd molar - teeth (wisdom teeth)
completes at-12 yr (except 3rd molar tooth)
Total- 28 - 32
Normal puberty
Neonante→1st 28 days
Infant →1st year of life
Toddler →1-3 year
Preschool → 3-6 yr
Adolescence (BY WHO)- 10-19 (MCQ)
Normal puberty in females :
* First sign- Thelarche (breast bud development)
☆ Then pubarche (pubic & axillary hairs)
Growth spurt (peak increase in growth velocity (Second phase of a growth after 1 yr)
Menarche (beginning of menstrual periods)
Normal puberty in males:
* First sign of puberty →Testicular enlargement
Penile enlargement
Pubic hairs
Growth spurt
Auxiliary hairs
facial hairs
Device used to assess testicular size - Orchidometer
DEVELOPMENT
* DQ: Developmental quotient
* DQ -( Developmental age/Chronological age) x100
* Chronological age is actual age; dev. age is milestones he can do in reference to age
Q: DQ =50, chro.age = 6 find DA =?
50 = (dev.age/6) x100
dev.age = (50x6)/100
:Developmental age = 3 yr
* Developmental domains:
- Gross motor
- fine motor
- Social
- Language
* Postures
* 1 month in ventral suspension (face down, back-up, arms loosely down ) head is below plane of body
No neck control
During 2 months→ in ventral suspension, head in the plane of rest of the body partial neck control appear
* 3 months → Neck control develops head above plane of rest of body (MCQ)
At around 5 months → bring feet to mouth (MCQ)
* 6 months → sitting with support, (sitting with support of his own hand - Tripod) and prone to supine (MCQ)
* 7 months → supine to prone
* 8 months → sitting without support (MCQ)
* 9 months →standing with support
* 10 months → crawling with abdomen
* 11 months → creeping (without abdomen)
(Pneumonia: a before e).
* 12 months - standing without support, walking with support ( - around edges of table, touching edges)(MCQ)
13 months -> Walking without support
* 15 months --- Creeps upstairs
* 18 months Goes upstairs and downstairs using side railing
* A 2 years Runs ,kicks ball, goes upstain & downstain
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* At 4 years Goes upstairs and downstairs with alternative feet, skips on 1 foot
* At 5 years → Skips on both feet
Fine motor milestones
* At 1 month hands kept closed, palmar grasp reflex present (MCQ)
* At 3 month → hands kept open, palmar grasp reflex is lost), hand regard appears (bringing hands in midline & starts seeing) holds an object when placed in hand.
* At 4 months : Tries to reach for an object but overshoots
* At 5 months -Bidextrous grasp appears (Holding with both hands) (MCQ)
* At 6 months: Unidextrous / palmar grasp
* At 7 months -Transfers object from one hand to another hand
* At 9 months --> Immature / assisted pincer grasp (MCQ)
At 12 months → Mature / unassisted pincer grasp, casting (throwing objects down)
* At 15 months → Spontaneous scribbling
- Tower of two cubes
* At 18 months - feed himself with cup /spoon (MCQ)
* At 2 years
- - Copies horizontal vertical line
- - Makes tower of 6 cubes
- - copies a circle
- - Tower of 9 cubes .
- dress /undresses self except buttons (MCQ)
* At 4 years
- - copies a rectangle /plus sign
- - can button / unbutton
* At 5 years
- copies a triangle or Oblique Line
- multiplication sign
- . Ties shoe laces
Social milestones
* 1 month ~ looks at the mother, intently when talked to
* 2 months - Social smile appears
* 3 months → Recognizes mother
* 6 months - Mirror play (localizes and smile to his image )
* 7 months - Stranger anxiety appecze
* 8 months - object permanence happens
* 9 months - bye-bye
at 12 month kisses on request, plays a simple ball game
* At 15 months (2P)
- points to objects
- Indicates wet pants
* At 18 month (2D)
- Domestic mimicry
- Dry during day time (tell before passing urine)
* At 2 years – Parallel play (2 babies, sit together plays their own)
* At 3 years - Joins & play, Knows name, age & gender
Dry during night (But nocturnal analysis when the baby continues involuntary passage of urine at night beyond 5y of age.)
* At 4 years
- Ask questions
- Goes to toilet alone
* At 5 year
• Starts helping us (bring water) in simple household tasks
• Distinguishes morning from evening.
Language milestones
* 1 month - Quietens when a bell is rang.
* 2 month - Vocalizes (MCQ)
* 3 months - Cooing (long musical) (MCQ)
* 4 months- laughs aloud
5 months - Razzing
* 6 months - Speaks mono syllables - like ma, ba, da
* 9 months - Speaks bi syllables without meaning (mama, baba)
1 y – Speaks 2-3 words with meaning Imitates simple sounds -like that of a cow.
18 month- knows to word with meaning
* 6 months - Speaks mono syllables - like ma, ba, da
* 9 months - Speaks bi syllables without meaning (mama, baba)
1 y – Speaks 2-3 words with meaning Imitates simple sounds -like that of a cow.
18 month- knows to word with meaning
* 2 years Speak short sentences (2 word sentences) know 100 words with meaning
* 3 yeans - 3 word sentences
- Repeats 3 digits
• 4 year - Tells a story /poem, sings a song.
(2yr -2 word sentence, 3yr - 3 word sentence 4y- word sent. ... )
NEONATOLOGY
Neonate -- first 28 days ☆ Called as neonatal period
- Early NP -(1st 7 days)
- Late NP(day 7-28)
(I) According to gestational age.
- Term born b/w -37 weeks completed to < 42 weeks gestation
- pre-term-born- <37 wks
- Post- term born- ≥ 42 wks
(II) Based on birth weight. (MCQ)
•LBW (low birth weight) <2500gm (<2.5kg)
• VLBW (very low weight) < 1500 gm (<1.5 kg)
• ELBW (extremely low weight)< 1000 gm (<1 kg)
(1) Based on gestational age and birth weight:
Appropriate for date / appropriate gestational age (AFD /AGA) ~ birth weight is between 10th to 90th percentile of expected acc. to gestational age
a small for date -> birth weight 10th percentile of expected acc. to gestational age
* Large for date birth weight 90th percentile of expected ace to gestational age
Causes of Large for date
- Impact of diabetic mother
- Congenital hypothyroidism
a healthy term neonate
* Birth wt -2.8kg
* Length - 50 cm
* US:LS 1.7-1.9:1
* HC - > 33-35 cm .
Peripheral cyanosis or acrocyanosis
* Short soft systolic murmur may be normally present (it is a blood flow to lungs not related with heart)
mcq→ Tool used to assess gestational age is a neonate is
ENBS (Expanded New Ballard score) (MCQ)
Characteristics of preterm neonate
General
- decrease subcutaneous fat
- Generalized hypotonia - extended posture
- Skin - thin, translucents
- Abundant lanugo( hair)
- Head appears to be relatively large
- Large anterior fontanelle
- Soft ear
- Breast bud /neonate <5mm size
- But little Vernix caseosa ( cheesy whole on body after birth)
Genitalia :
- Males - Undescended testis & poorly formed scrotum
- females - labia majora is widely separated so that labia minora is clearly visible
- Absent deep creases on sole:
Response of body to stimuli
(Responsible system-CNS, due to immaturity of CNS)
Brain Immaturity causes reflex in Infant
Premature body:
Reflexes poor or not present
Maximum reflexes disappear at 6 month of age.
Reflexes that remain life long :- Coughing, Swallowing
- Present at birth
- Not present at birth, it appear after birth
1. Rooting reflex (scratch side of mouth, baby opens mouth) (helps in breastfeeding)
- Appears at 32 wks
- Starts disappearing at 1 month postnatal age.
Primitive reflex helps mother to feed the baby & earliest to disappear → Rooting reflex
2. Moro's reflex -The components are
Primitive reflex helps mother to feed the baby & earliest to disappear → Rooting reflex
2. Moro's reflex -The components are
- Symmetric abduction of extension of upper limbs
- Along with opening of hands
- Followed by abduction & flexion of upper limb
- extension of head and trunk
- •movement of lower limbs
- crying --
- Moro's reflex begins to appear at : 28 wks of gestation
- completely appears at 37 wks
- Disappear : 5-6 months
- Abnormal persistence of Moro's reflex indicates cerebral damage
causes of asymmetric Moro's reflex
- * In Erb's palsy
- congenital hemiplegia
- Fracture clavicle -. most common bone to in neonate Clavicle (MCQ)
- * Shoulder joint dislocation.
• Appear - 28WK, disappear - 3 months
5. Parachute reflex:
• Appear - 7-8 months age
• Never disappears (MCQ)
• Never disappears (MCQ)
- Reflex persists throughout the life is Parachute reflex
6. Grasping reflex:
Palmar - Grasp by hand (palm) 3-4 month
Plantar - Grasp by Fingers Fingers flexed. 8 month
7. Blinking
Eye blink for sometime ( for first few taps )
If continuously blink -
Indicate cerebral palsy (Asphyxia)
8. Babinski -Stroking on sole of feet from
heel to big toe (At lateral side)
finding = Fanning of toes (Extension) & foot Begins Dorsiflexion
disappear- 1 year
10) Tonic neck reflex (Fencing reflex)
Supine position
Turn the head to one side
Opposite side extremities flexion
Same side extremities Extension
disappear- 3-4 month
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APGAR SCORE
- Given by Dr. Virginia Apgar
- Should be taken at 1minute & 5 minute after birth (2 Times)
- Minimum score-0, Maximum score-10.
- Parameter- 5
APGAR score findings
(1) 7-10 :- normal
No need of Intervention
(2) 4-7 :- Asphyxia (moderate)
(3) 0-3 :- Severe asphyxia
Resuscitation needed
Head to toe assessment
Assessment should be done from less interference (Disturbing) to more interference.
Sequence of examination :- Respiration, Heart rate, Temperature & Ear Examination
1. General Observation:-Colour - Pink
2. Hair-Lanugo :-Fine hair distributed on body
Vernix caseosa:-Waxy material on body of newborn.
(Less vernix caseosa & more hair - In premature.) (MCQ)
3. Head : 33-35 cm (Head circumference).
Fontanelles = (Total = 6 fontanelle):- Clinically significant fontenelles-2
Anterior fontanelle (Large) (Bregma)
- Diamond shape
- 2.5 cm diameter.
- 18 month close.
- Triangular
- 1.5 cm diameter
- 1.5 month close (6 week) 2nd month of life
Spontaneously Disappear 72 hour after birth
Caput Succedaneum
- Edema of soft tissue Over bone
- Crosses suture line
- Subside within few days (24 hours)
- Swelling caused by bleeding into area b/w Bone & periosteum
- Don't cross suture line.
- Absorbed within 6 week
4. Eyes :Symmetry
Vision testing :- Snellen Chart 6/6 (6 Feet distance) or 20/20 (meters)
Colour blindness :- Ishihara chart
Infections of eye :- (Ophthalmia neonatorum) at birth.
- N. Gonorrhoea.
- Trachoma :- Chlamydia trachomatis.
Tetracycline (1%)
* Brashfield spot in Iris - Down Syndrome.
Telorism :-Widely Separated Eyes.
5. Face : - Symmetry.
* Nose :- Patency of nostrils.
DNS :- Deviated nasal Septum.
Epistaxis :- Nasal bleeding (main cause DNS)
kiesselbach plexus supply to nose, injury or irritation to these plexuses causes epistaxis.
Position provided in epistaxis :- Sitting with neck flexed with pinching nostrils.
Milia :- Small white Pinpoint-Sebaceous glands on nose, face, forehead. - No active management.
Nasal flaring :- Widening of nose in air hunger.
In Respiratory distress.
Lips :- By Inspection.
Cleft lip, Unilateral
Bilateral Cleft palate
Surgery - Cheiloplasty (as early as possible)
Diagnosis :- By Inserting finger.
Smile train project.-for cleft lip & palate
6. Ear :- Symmetry
Elastic cartilage
If Elastic cartilage is not properly developed,
Flat ear present, don't have curve, Indicate Renal disorder
A1V1 → Renal agenesis (One artery & one vein),
(Normal- 2A+1V)
Low set ear :- Down Syndrome (trisomy 21)(Simian crease)
Ear Infection :- Most common in Infant & children
Because Eustachian canal is short & straight`(B/w middle ear & nasopharynx)
Oral cavity:- Examination of palate-Cleft palate.
↓
Cause :- Large tongue in fetus & move upward.
Confirm by inserting a finger.
In case of epiglottitis - Do not examine by insertion of finger because it stimulates the closure of glottis & breathing problems may occur.
White patches in the oral cavity -
Indicate oral thrush (oral candidiasis Infection)
The patches are not scrubbed with cloth.
Tooth :- If in newborn → Teeth present →Remove teeth.
↓
Cause aspiration & swallow of teeth + b'coz if teeth fall
Q.: The communicable disease in which oral cavity examination is significant.
Ans. Measles - Koplik spot
8. Thorax :- Size & shape.
AP: T ratio = 1 : 1(Infant)
1:2 (Adult) Respiratory pattern.
Nipples :- absent (premature)
Milk secretion witch's milk) Due to maternal hormone (estrogen) withdrawal
Chest Circumference measure-At level of Nipple.
Anterior posterior : Transverse = 1 : 2 (Adult)
= 1:1 (Newborn)
Thorax :
Stork Bite :- Red area at the base of neck
Pink points - Talengactics.
9. Abdominal Examination :
Umbilical cord - 2 Artery + vein I
(Blue) (Red) - Oxygenated blood,
Q. A healthy newborn umbilical cord has many vessels.
(1) 1
(2) 2 Renal Agenesis (A1 V1)
(3) 3 (A2 V1)
(4) 6
answer -3
In first trimester (A2 V2) → In the 4th month 1 vein disappears
Abdominal Girth :- At the level of umbilicus.
Keep dry the umbilical cord
Omphelocele :- Abdominal organ herniated by umbilicus covered with skin.
Gastroschisis :- Not covered by skin & herniate near/side to umbilicus.
10. Extremities :
(↑ No.) * More fingers - Polydactyly.
(↓No.) * Less fingers – monodactyly.
* Webbing of finger - Joined fingers
↓
Syndically.
Allen sing :- To check patency of radial & ulnar artery
Homan sign :- In DVT.
Dislocation :
Hip Dislocation; Hip Dysplasia (Congenital dysplasia of hip)
Allis sign :- (Unequal level of knees) Knee
flexion- one knee is above & affected Knee is below
Ortolani sign :- When thigh flex & Abduction Clicking sound.
Barlow sign :- More gluteal folds on dislocated side
11. Palm & Sole :
Single transverse crease (Simian crease) - Down syndrome.
Q.: Sampling in newborn -
Ans. Heel Stick Sampling (Puncture lateral of heel)
(because in median more nerve present)
12. Club foot :- Congenital anomaly of limbs. lost common is Talipes equino varus
Talipes Varus :- Inward deviation of hind foot
Talipes Valgus :- outward deviation of hind foot.
Equinovarus - Plantar flexion, forefoot twisted.
Equina Calcaneus :- Dorsiflexion (Toe bending toward & upper surface)
13. Genitals - Male :
During fetal life, testes are in the abdominal cavity.
Cryptorchidism - The undescended testes present in children,
the problem in future → infertility Scrotal temperature is < body temperature
Urethral opening - Normal-medial aspect
Ventral aspect (Lower) - Hypospadias.
Dorsal aspect (upper) - Epispadiasis.
Female Genitals :
Pseudomenstruation :- Due to withdrawal of estrogen.
Mongolian spot :- Bule/Purple spots on butiocks Disappear Spontaneously.
Intra Uterine Growth Retardation
IUGR:- <2.5 kg
Week, thin, more skin folds
Brown fat ↓; Production of heat diminished
Loungo :- More on face, Vernix Caseosa-less
Reflexes :- Poor
Nipple Absent
Labia minora :- Not Covered by L. majora.
VLBW - < 1.5kg Weight.
Extremely LBW - <1 kg Weight.
Q. What is priority care of a nurse while caring of LBW baby
(1) Hypothermia (2) Respiration r. (3) Nutrition (4) Infection.
ANSWER: 2
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Respiratory Distress Syndrome
↓
Surfactant ↓ (phospholipid) (32 to 37 week : formations occur)
Surfactant L/S (eriocitrin: Sphingomyelin >2 : 1)
Given Intra tracheal after birth of baby.
Action :- To ↓ surface tension of alveoli
Prevent collapse of alveoli
Suction - First mouth :- Then Nose. (MCQ)
Hypothermia
Risk factors are:
- Immature CNS
- Less brown fat
- Large BSA (Body surface area)
Q.: The priority action taken by a nurse to prevent hypothermia in LBW baby.
(1) Radiant warmer (2) Phototherapy
(3) KMC (4) Hot application.
ANSWER: 3
Nutritional management :- Poor Reflexes.
Use Large hole Nipple.
Paladai feeding : Katori - spoon - feed
Do Not give Cow milk <1 year of age Protein ↑, Iron - ↓, Vit C↓
EBF:- Exclusive breast feeding.
Plain water to clean the breast.
Use :- Asepto syringe for cleft lips & palate child.
Q. A child is admitted in Nursery more than 3 days & Infected with Pneumonia,
which infection may be present in child
(1) Opportunistic infection (2) HCAI.
(3) Concurrent Infection. (4) Terminal Infection.
ANSWER: 2
(1) Opportunistic infection (2) HCAI.
(3) Concurrent Infection. (4) Terminal Infection.
ANSWER: 2
Common HCAI in Newborn :
(1) Cystitis
(2) Pneumonia
(3) Urethritis
In Newborn
Urination starts in - 24 hours.
Fecal Elimination = 48 hour
MAS (Meconium aspiration Syndrome).
Meconium :- 1st stool of newborn.
Aspiration of meconium may Cause Pneumonia
Breastfeed & newborn = Colostrum (3 days)
↓ Provide.
Passive Natural Immunity,[IgA]
Transient milk - In beginning of feeding
Fore milk
Hind milk- later milk.
Q.: Which Ig does not develop passive Immunity as a newborn.
(1) IgG
(2) IgD
(3) IgA
(4) IgM
(1) IgG
(2) IgD
(3) IgA
(4) IgM
ANSWER: 2
(1) IgG = By placenta
(2) IgD = Rh Incompatibility
(3) IgA = By breast milk.
(4) IgM = Fetus Synthesis Itself
Level II ultrasound – for detection of congenital Malformation
C.T.scan of Fetus :- Findings
Cerebellar defect :- Banana sign
Congenital hydrocephalus. :-NTD, Amold cherri syndrome.
In USG :- yellow strips present = Lemon sing.
SIDS (Sudden Infant death Syndrome)
In prone position (cause aspiration) On soft
Common in Infant (0-1 year) →(2 to3 m) mostly
After overnight, in the morning the mouth is filled with blood & Frothy mucus & Infant dead.
Diaper is wet with urine & faeces.
Mostly in male infants.
Shaken baby syndrome:
In Infant (9-1 year).
Due to vigorous shaking to Infant, cerebral & Intracranial hemorrhage occurs & causes death.
Counselling of parents
Q.: Maximum growth & development Stage is
1. Infancy
2. Toddler -Steady( slow G & D)
3. Preschool - Somewhat fast
4. puberty
C.T.scan of Fetus :- Findings
Cerebellar defect :- Banana sign
Congenital hydrocephalus. :-NTD, Amold cherri syndrome.
In USG :- yellow strips present = Lemon sing.
SIDS (Sudden Infant death Syndrome)
In prone position (cause aspiration) On soft
Common in Infant (0-1 year) →(2 to3 m) mostly
After overnight, in the morning the mouth is filled with blood & Frothy mucus & Infant dead.
Diaper is wet with urine & faeces.
Mostly in male infants.
Shaken baby syndrome:
In Infant (9-1 year).
Due to vigorous shaking to Infant, cerebral & Intracranial hemorrhage occurs & causes death.
Counselling of parents
Q.: Maximum growth & development Stage is
1. Infancy
2. Toddler -Steady( slow G & D)
3. Preschool - Somewhat fast
4. puberty
ANSWER: 1
(ll Maximum G&D. (Growth Spurt)
Epstein pearl :- white points present on palate
Developmental Theory (Psychosexual theory)
Sigmund Freaud
Oral → (0 to 1year) infant
Pleasure in sucking - Satisfy by sucking
To maintain sucking, artificial teats should be given
Anal →(1 to 3 year) (Toddler)
Pleasure by -Elimination control (firstly bowel control & then bladder )
Complete control
↓
up to 5 years
Phallic →(3-6 year) Preschool
Attraction for opposite gender parents.
(1) Oedipal complex -male child attract to mother
(2) Electra Complex - Female → Father
Latency →Puberty Changes
Genital →Maturation of secondary Sexual Character
Attraction towards the opposite gender
S.freud's Psychoanalytic theory.
ID
• Present at birth.
• Fantasy
• Immediate
• Gratification
Ego
• Develop 4-5 month
• Reality oriented
• I should do
Super Ego (You should do)
• Develop In phallic stage
Enuresis :- Bed wetting after 5 year
Encopresis :- Stool pass at any place after 5 year
Psychosocial theory :- Erik Erikson
Psychosocial theory
↓
up to 5 years
Phallic →(3-6 year) Preschool
Attraction for opposite gender parents.
(1) Oedipal complex -male child attract to mother
(2) Electra Complex - Female → Father
Latency →Puberty Changes
Genital →Maturation of secondary Sexual Character
Attraction towards the opposite gender
S.freud's Psychoanalytic theory.
ID
• Present at birth.
• Fantasy
• Immediate
• Gratification
Ego
• Develop 4-5 month
• Reality oriented
• I should do
Super Ego (You should do)
• Develop In phallic stage
Enuresis :- Bed wetting after 5 year
Encopresis :- Stool pass at any place after 5 year
Psychosocial theory :- Erik Erikson
Psychosocial theory
- 8 Stage.-Psychosocial theory Erik Erikson.
(2) Toddler. :- Autonomy V/S Shame. (may cause OCD)
(3) 3-6 Yr. Early :- Initiative V/S Guilt.
(4) 6-12 Yr. Early :- Industry V/S Inferiority
(5) 12-20 Yr. (Adolescence) :- Identity V/S role confusion.
(6) 20-35 Yr. (Early adulthood) :- Intimacy V/S Isolation
(7) 35-65 Yr. (Middle hood) :- Generativity V/S Stagnation.
(8) 65 Yr. to death. (Later hooc) :- Integrity V/S despair.
Cognitive development theory :- Jean Piaget
Moral development theory.:- Kohlberg
Play : SPICA
S →Solitary → Infant 0-1 year
P →Parallel → Toddler 1-3 year → Push & pull method.
- Imitation
I →Imaginary → Cooperative. Associative →Pre Schooler
3-6 year Group
C →Competitive → Schooler 6-12 year.
A →Athletic → > 12 year
Cognitive Developmental Theory
Given by Jean piaget
Total Phage = 4
1. Sensorimotor - 0-2 year
• Object permanent
• Learned by sense organ
2. Preoperative - 2-7 year
• Reasoning and thinking to solve the problem
3. Concrete operational - 7-11 year
• Concrete thinking develops
4. Formal operational - > 11 year
• Cognitive maturity
• Abstract thinking develop
• Able to find out the problem
Moral development theory
• Given by kohlberg
• Total level - 3
• Phage - 6
Level 1 - preconvesial
• Obedience and punishment
• Self interest
Level 2 - Convesial
• Interpersonal accordance
• Authority
Level 3 - Post convesial
• Social orientation
• ethical principle
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