1.
Temperature
2. Pulse
a. Fetus: 120 – 160
b. After birth: 120 – 140
i. Sleeping: 90 – 110
ii. Crying: ↑ 180
c. Apical pulse: 4th ICS
3. Blood Pressure
a. At bith: 80/40 mmHg → 100/50
b. Normal: 90/60 – 120/80
4. Respiration
a. Irregular and abdominal
b. At birth: 80 bpm; settles to 30 – 60 bpm
c. Obligate nose breathers until 2-4 months; 4-6 months: mouth breathers
(must correct)
d. Periods of apnea (Normal: 10 – 15 secs)
e. HR → PR → Temp
Caput Succedaneum
• Cone head
• Edema of the scalp
• Prolonged labor
• Crosses the suture line (both side)
• Usually disappear after 2-3 days
Cephal hematoma
• Collection of blood on the scalp
• Ruptured capillaries
• Does not cross the suture lines (one sided)
• Present after 24 hrs
• Disappear after 4 – 6 weeks
Growth and Development
Gross Motor Development
• Cephaloccaudal (Head to Toe)
0 – 1 month: Positive head lag
2 month: Lift the head (Prone postn)
3 – 4 months: Lift head and chest
5 months: Roll over (Risk for Fall)
6 months: Sit with support
7 months: Bouncing (To strengthen and stretch leg muscle)
8 months: Sit without support (Concept of balance)
9 months: Crawling
10 months: Stand with support
11 months: Cruising (Both hands)
Mom: Hold both hands of the baby → Baby walks forward
Baby: Holds the furniture → Baby walks sideward (Parallel walking)
12 months: Stand without support
Walk with support (While holding one hand of baby)
15 months: Walk without support
3 Years: Ride Tricycle
Fine Motor Development
• Proximodistal (Center to Side)
• Small muscles
1 – 3 months: Closed fist (Palmar grasp reflex)
5 months: Close-open
Toy: Rattle (To stimulate senses: Color, Sound, Texture)
7 months: Crude pincer grasp (Transfer object from 1 hand to another)
9 months: Neat pincer grasp (Pick small objects)
Thumb and pointing finger
Risk for aspiration
10 months: Points at object
11 months: Put object inside the container
12 months: Throw a ball
2 years old: Draw vertical horizontal line +
3 years: Cross, curve, circle
Starts with “C”
Unbuttons
4 years: Draw square, rectangle (4 angle shapes)
Buttons button
5 years: Star, Triangle, Diamond (Pointed shapes)
6 years: Draw all shapes
Tie shoelace
• Infant: 1 – 12 month (18 months: Psych)
0 – 28 days: Neonate (fastest growth and development)
• Toddler: 1 – 3 y/o
Ritualistic = Security object
Temper tantrums (act out their frustrations)
1. Safety
2. Ignore the behavior
Egocentric
No – Provide limited choices
• Practice autonomy
Toilet training – starts at 18 months
• Matured sphincter
• Bowel control before bladder
• Daytime bladder control before nighttime
Tooth brushing – Deciduous teeth/Milk/Baby teeth/Temporary
1st - 6 months (Lower central incisors)
2nd – 7 months (Upper central incisors)
3rd – 9 months (Upper lateral incisors)
• Preschool: 3+ - 6 y/o
Magical thinking
Imitative – Role playing
Sharing
Y = Why?
• School-age: 6+ - 12 y/o
Winner/Loser- Competitive play (Tag game)
Afraid of death
Teacher: Significant person
• Adolescent: 12+ - 18 y/o
Puberty
• Thelarche: Breast budding/enlargement
• Pubarche: Growth of pubic hair
• Menarche: 1st Menstruation
Body changes
Acne = ↑ hormones → ↑ oil production → Clog pores → ↑ Bacteria
Play
• Infant: Solitary
Promote sensory development
• Toddler: Parallel play
Promote physical development (toys)
• Preschool: Associative Play
Promote creativity (Lego, but not suitable for child with cast)
• School-age: Competitive play
Concept of winner/loser toys
Concepts of Death
0 – 12 months: No concept of death
1 – 3 y/o: Sleeping
4 – 6 y/o: Reversible
7 – 9 y/o: Form of punishment (Sense of finality)
↑ 10 y/o: Realistic thinking
Moral Theory
• Kohlberg
Level 1 – Preconventional
• Stage 1
o 0 – 3 y/o
o Punishment
• Stage 2
o 4 – 7 y/o
o Reward
Level 2 – Conventional
• Stage 3
o 7 – 10 y/o
o Interpersonal relations
o Good image
• Stage 4
o 10 – 12 y/o
o Law and Order
Level 3 - Post-conventional
• Stage 5
o > 13 y/o
o Social Contract
o Exception to rules
• Stage 6
o Universal ethical principle
o Social Conscience
Psychosexual Theory
• Sigmund Freud
Oral Phase
• 0 – 18 months
• Site of gratification: Mouth
• Promote breastfeeding
• If not met: Oral fixation (Smoking, Alcoholic, Vices via mouth)
Anal Phase
• 18 months – 3 y/o
• Site of gratification: Anus
• Toilet training
• Too rigid (Mom wins) → OCD (overdeveloped guilt)
• Too lax (Child wins) → Antisocial behavior (underdeveloped guilt)
Phallic Phase
• 3 – 6 y/o
• Site of gratification: Genitalia
• Masturbation
• Exhibitionism
• Introduce sex difference/ human sexuality
• Do not use flowery words
Latent Phase
• 6 – 12 y/o
• No site of gratification
• Period of suppression
Genital Phase
• 12 – 18 y/o
• Site of gratification: Genitals
• Sexual activity
Psychosocial Theory
1. Trust vs. Mistrust
• 0 – 12 months
• Foundation: Trust
• Satisfy the infant
2. Autonomy vs. Shame & Doubt
• 1 – 3 y/o
• Promote independence
• Offer choices
3. Initiative vs. Guilt
• 4 – 6 y/o
• Learn how to do BASIC things
4. Industry vs. Inferiority
• 7 – 12 y/o
• Learn how to do things well
5. Identity vs. Role Confusion
• 12 – 18 y/o
Fetal Circulation
Shunts
• Foramen ovale – shunt between 2 atria
• Ductus arteriosus – bypass lungs
- shunt between Pulmonary artery and aorta
• Ductus venosus – Bypass liver
- shunt: Liver → Inferior vena cava
O2 (Mom) → Placenta → Umbilical vein → Liver → Ductus venosus → Inferior vena cava → Right
atrium (100% O2) → Foramen ovale → Left atrium (70% O2) → Left ventricle (70%) →
Ascending aorta → Brain (O2 → CO2; 70%) → Superior vena cava → RA (30% O2; 70% deoxy) =
Heavy → RV → Pulmonary Artery → Lungs → Ductus Arteriosus → Descending aorta →
Extremities/Body (Mix of oxy and deoxy blood) → Umbilical artery (deoxy) → Placenta → Mom