Growth and Development

AHMAD AYDI

Newborn Infant or Neonate (birth to 1 month)

Apgar score: Initial assessment of the newborn including

heart rate, respiratory effort, muscle tone, reflex

irritability and color at 1 and 5 minutes after birth. Each

item is given a score of 0, 1, or 2. Total score of 0–3 is

severe distress , 4–6 moderate distresses, and 7–10 good

adjustment.

APGAR SCORING CHART

Category 0 1 2Heart rate Absent Slow (less than 100

beats/min) More than 100 beats/min

Respiratory

effort

Absent Slow, irregular Good, crying

Muscle tone Flaccid Some flexion of

extremities

Active motion

Reflex

irritability

No

response

Weak cry or grimace Vigorous cry

Color Blue, pale Body pink, extremities

blue

Completely pink

Weight: Average birth weight: 2700–4000 grams. 10% of birth

weight is lost in first few days of life, primarily through fluid

losses and regained by the 2nd Week.

Length: Average birth length= 48–53 cm.

Head: Average neonatal head circumference is 33–35 cm.

—Molding, or overlapping of the soft skull bones, allows the fetal

head to adjust to the diameter of maternal pelvis; the bones readjust

within a few days producing

a rounded appearance; molding may alter head circumference.

—Fontanels; Anterior diamond shape; Posterior fontanel triangular

shape; (between the unfused bones of the skull); Fontanels should be

flat, soft, and firm; may bulge when crying. The posterior fontanel

closes at 2–3 months; anterior fontanel closes at 12–18 months.

Normal skin variations

•Vernix caseosa (white cheesy covering of the skin) in varying

amounts will be observed at birth. This material has a protective

quality. It will be removed during the initial bath or by being

rubbed onto clothing and blankets. It is not necessary to remove it

forcefully.

•Mongolian spot: A dark bluish discoloration seen on the buttocks

of dark-skinned individuals. This spot will fade by the age of 2

yrs.

•Milia: Obstructed sebaceous glands seen on the face, most

commonly on the nose. These white cysts should be left alone.

•Lanugo: Fine, downy hair seen on the less mature newborn.

•Mottling: Often associated with chilling, the skin color will appear

patchy.

•Petechiae: Small hemorrhages most commonly due to the pressures

of labor and delivery.

•Eccyhmoses: Bruises, usually from forceps.

•Birthmarks: Birthmarks vary widely in appearance and location.

—Transitions to extrauterine life include: physiologic

onset of breathing, initiated by chemical and thermal

stimuli; cough and sneeze to clear fluid present from

intrauterine life; pressure changes in the heart and lungs;

closure of fetal shunts; the foramen ovale; the ductus

arteriosus; increased pulmonary blood flow.

—Heart rate: 120–160 beats per minute and

irregular for the neonate; count apical pulse for one

full minute

—Respiratory rate: 30–60 breaths per minute and

irregular; count for one full minute; neonates are

abdominal breathers and obligate nose breathers.

Thermoregulation: Newborns are subject to heat loss and stress

from cold due to large body surface and thin subcutaneous fat; poor

development of sweating and shivering mechanisms; poor

temperature regulation. To compensate the infant has brown

adipose tissue or brown fat which has a greater capacity for heat

production than regular adipose tissue to help in heat regulation.

Also, the flexed position decreases the amount of surface area

exposed to the environment.

Heat Loss

Newborns have several characteristics that predispose them to heat loss:

• Thin skin with blood vessels close to the surface

• Lack of shivering ability to produce heat involuntarily

• Limited stores of metabolic substrates (glucose, glycogen, fat)

• Limited use of voluntary muscle activity or movement to produce heat

• Large body surface area relative to body weight

• Lack of subcutaneous fat, which provides insulation

• Little ability to conserve heat by changing posture (fetal position)

• No ability to adjust their own clothing or blankets to achieve warmth

• Inability to communicate that they are too cold or too warm

Heat exchange between the environment and the newborn

involves the same mechanisms as those with any physical

object and its environment. These mechanisms are

conduction, convection, evaporation, and radiation.

Elimination

•Meconium: infant's first stool should pass within the first 24–48

hours

•Transitional stools usually appear by 3rd day after initiation of

feeding

•Milk stool appears by 4th day, by 2nd week elimination pattern

associated with the frequency and amount of feeding. Breast fed-

yellow to golden stool; formula fed light brown, firmer consistency,

stronger odor.

•Urinary output 200–300 ml by the end of the 1st week

Neurological

•Assessment of reflexes is an essential component of

the neurological assessment, along with assessment of

posture, muscle tone, head control, and movement

Reflexes

•Gag in response to stimulation of posterior pharynx by

food or tube; causes infant to gag; reflex persists for life

Moro in response to sudden

loud noise; infant extends

then flexes arms and fingers;

decreases at 3–4 months,

disappears at 6 months

•Sucking in response to touching infant's lips; strong and

coordinated; disappears at 3–4 months

•Rooting in response to touching or stroking cheek along

side of mouth; causes infant to turn head toward that side

and begin to suck; disappears at 3–4 months

•Babinski in response to

stoking outer sole of foot

upward from heel and across

ball of the foot causes toes to

hyperextend and hallux, big toe

to dorsiflex; disappears after 1

year

•Tonic Neck Reflex:

appears about 2 months after birth,

disappears by about 6–7 months

after birth.

The baby’s head is turned to one

side, the arm on that side stretches

out and the opposite arm bends up at

the elbow

•Grasp reflexes: palmar grasp

and plantar grasp. The palmar

grasp reflex by placing a finger on

the newborn’s open palm. The

baby’s hand will close around the

finger.

Motor Development

•Movements are sporadic, symmetrical, and involve all

extremities

•Extremities flexes, knees flexed under abdomen

•Turns head from side to side when prone; briefly lifts head

off bed

Little head control

Sleep–wake pattern

•First hour of life quiet, alert, eyes wide opened with vigorous sucking

•Next 2–3 days sleeps most of the time, recovering from birth

•Sleep periods vary from 20 minutes to 6 hours, little day or night

variation

•Wake newborn to feed q4hours (recommended by most practitioners)

Sensory

•Focus on objects 8–10 inches away and can perceive forms

•Preference for human face apparent

•Auditory systems function at birth

Cognitive Development

•Newborn learns to turn to the nipple

•Learns that crying results in parents' response

Psychosocial Development

•Interactions during routine care between newborn and parent lay

foundation for deep attachment