Prenatal Period to 1 year
Chapter 6
What are the two main factors
that influence growth and
development?
A.
B.
C.
D.
Stress and Family
Environment and Stress
Environment and Heredity
Heredity and Gender
Heredity: Zygote formation
• Sperm & ovum
– 23 chromosomes 
– Zygote
• Gender
– X & Y Chromosomes
• Ovum
– Always X
• Sperm
– X or Y
Dominant & Recessive Genes
Dominant
• Capable of expressing traits
over other genes
Recessive
• Traits only appear if they
exist in pairs
Recessive disorders
• >700 recessive gene
diseases
– Sickle-cell disease
– Tay-Sachs disease
– Hemophilia
Environment
• “From the moment life begins, the
environment begins to exercise its
influence on the newly formed
entity.”
For you personally, when does life
begin?
A.
B.
C.
D.
E.
Conception
Implantation
When there is a heart beat
When the fetus is viable if it was born
When the baby is born
Healthy Pregnancy
• Rest
• Exercise
– Continue
What is the best form of exercise for a
pregnant women?
A.
B.
C.
D.
E.
Bicycling
Walking
Swimming
Jogging
Kick-boxing
Teratogens
• Tobacco
– Low birth rates
– Growth restrictions
Teratogens
• Alcohol
– *1st trimester
– Fetal Alcohol Syndrome
(FAS)
– Miscarriages
– Growth restriction
– CNS damage
Teratogens
• Bacteria, protozoan,
viruses
– Rubella
• Toxoplasmosis
– Parasite
– Eat well-cooked meat
Ova to Fetus
• Ovaries
– Ova (pl)
– Ovum (sing)
•
•
•
•
•
•
•
Ovulation
Sperm
Conception/ Fertilization
Zygote
Implantation
Embryo
Fetus
What is the estimated length of
human pregnancy?
A.
B.
C.
D.
E.
28 weeks
38 weeks
40 weeks
42 weeks
48 weeks
Stages of Labor & Delivery
• Stage 1
– Dilation
• Dilation
• Effacement
• Stage 2
– Expulsion
• After-brith
– placenta
Fetal membranes
•
•
•
•
Amniotic sac
Amniotic fluid
Placenta
Umbilical cord
– 2 arteries
– 1 vein
Neonate
• 1st breath
• Apgar score
– 1 minute
– 5 minutes
APGAR
•
•
•
•
•
Activity
Pulse
Grimace
Appearance
Respiration
• activity and muscle
tone
• pulse
• grimace response /
reflex irritability")
• Appearance / skin
coloration
• respiration
What is the highest score a neonate
can get on a Apgar score?
A.
B.
C.
D.
E.
2
3
10
12
15
Head & Skull
• Head ¼ of total body
length
• Ave circumference
– 13-14 inch
– 33-35.5 cm
– 1 inch > chest
Skull
• 6 bones
–
–
–
–
1 occipital
1 frontal
2 parietal
2 temporal
• Separated by cartilage
– Sutures
• Fontanels
– Anterior
– Posterior
Which fontanel is smaller?
A. Anterior
B. Posterior
When does the posterior fontanel
“close” by?
A.
B.
C.
D.
E.
2 months
4 months
6 months
8 months
12 months or more
When does the anterior fontanel
usually “close” by?
A.
B.
C.
D.
E.
6 months
12 months
18 months
2 years
3 years
What is the normal lengths of a fullterm neonate?
A.
B.
C.
D.
E.
12 inches
18 inches
20 inches
24 inches
36 inches
How much does a normal infant grow
in the first year?
A. ½ inch a month
B. 1 inch a month
C. 1 ½ inch a month
D. 2 inch a month
E. 2 ½ inch a month
Normal Physiological Weigh Loss. How
much weight on average does a
neonate loss in the first few days of
life?
A.
B.
C.
D.
5-10 % of birth weight
15-20% of birth weight
25 – 30% of birth weight
There is no such thing as normal physiological
weight loss in a neonate
Skin
• Thin & pale
• Acrocyanosis
• Pigmentation
Mongolian Spot
• Usually fads by…
– Age 4 years
• 6 month old
Lanugo
Vernix Cascosa
Milia
Physiological Jaundice
Genitals
• Breasts
– Swollen
Genitals
• Scrotum
– Lg & edematous
What is the medical term for
undescended testicles?
• No – this is not multiple choice! Turn to your
neighbor and tell them the answer.
Cryptorchidism
• Undescended testicle/s
Cryptorchidism
• The testes develop in the
abdominal cavity in early
fetal life. By 14 to 17
weeks of intrauterine life
they migrate to an
opening in the body wall
known as the inguinal
canal. After 28 weeks
they pass through the
canal and by 35 to 40
weeks reach the scrotum.
• Undescended testicles
are fairly common in
premature infants. They
occur in about 3 - 4% of
full-term infants. In
most cases the testicles
descend by the time the
child is 9 months old.
• Increased risk of
– Testicular cancer
– Infertility
Genital
• Urethra
• Circumcisions
Pseudomenstruation
• Blood-tinged vaginal
discharge
Face
• Eyes swollen
• Eye treatment
– Erythromycin
– Silver nitrate
When do baby teeth start to come in?
A.
B.
C.
D.
E.
2 months
4 months
6 months
8 months
12 months
Deciduous teeth
Which teeth normally erupt first?
A. Two lower central
incisors
B. Two upper central
incisors
C. Two lower lateral
incisors
D. Two upper lateral
incisors
By age 12 months the baby will have 68 teeth
Abdomen
• Neonate
– Lg and flabby
• Umbilical cord
–
–
–
–
Cut
Clamped
Falls off
No tub bathing until…
Abdomen
• Digestion
– Simple carbs
• Stomach can hole
– Neonate
• 1-3 oz
– 12 months
• 10 – 12 oz
Why do you have to “burp” the
neonate?
• Cardiac sphincter
Bowel movement
Stool
Feces
• Meconium
– Duration
• 1-2 days
– Characteristics
• Green-black
• Tarry
• Odorless
Bowel movement, Stool or Feces
Formula Fed
• Pasty yellow or tan
• Odor
Breastfed
• Mustard seed color
• Sweet odor
Extremities
•
•
•
•
Short
Flexed
Finger/sole prints
Nurses
– ROM
– Gluteal folds
Gluteal fold assymetry
Neurological Characteristics
• Newborns
–
–
–
–
Reflexes
Posture
Movement
Muscle tone
Protective reflexes
•
•
•
•
Blinking
Sneezing
Swallowing
gag
Moro / Startle Reflex
• Sudden movement
Extension & Adduction
of extremities
• Disappears
– 3-4 months
Tonic Neck Reflex
• Turn head to one side
 extend arm and leg
on that side
• Disappears
– 5 months
Rooting reflex
• Stroke cheek  enfant
turns toward that side
and open mouth
• Disappears
– 4-6 months
Sucking Reflex
• Sucking movement
when anything touches
their lips
• Diminishes
– 6 months
Babinski
• When sole is stroked 
hyper-extened & fan
out toes & big toe turns
up
• Disappears
– 3 months
Palmar grasp
• Grasp anything placed
in hand
• Appears
– 6 wks
• Disappears
– 3 months
Spinal Bifida
Vision
• Newborn
– Primative
– Nystagmus
• 4 months
– Binocular vision
• 6 months
– 20/100
– Depth perception
Hearing
• 6 wks
– Recognize mom and turn
to respond
• 1 year
– ID sounds and source
Touch
• Birth
– Face
– Hands and soles
• 1 yr
– Withdrawal
– Recognize source
Vital Signs - Newborn
• Temp
– Initially low
– Stabilized
• 97.7 -99.5
• Axillary
• Pulse
– 120 – 160 / min
– Apical
• BP
– 64 / 40
• Resp
– 30 – 60 / min
– Irregular
– apnea
Motor Development
• Neonate
– Purposeless
– uncoordinated
Gross motor skills
• 2 months
– Control head
• 4 months
– Sit with support
– Roll belly to back
• 6 months
– Roll both ways
• 8 months
– Sits alone
• 10 months
– Laying to sitting
– Creep
• 11 months
– Pulls self up
• 12 months
– walks
Fine motor skills
• Neonate
– Grasp reflex
• 5 months
– Purposeful reaching
• 6 months
– Hold bottle
• 7 months
– Hand preference
– Pincer grasp
• 9
– Cup
– Spoon
• 12 months
– Scribble
– Tower – two blocks
Psychosocial Development: What
theorist are we going to discuss?
A.
B.
C.
D.
E.
Freud
Erikson
Paiget
Kohlberg
Maslow
What stage of psychosocial
development is a neonate?
A. Autonomy
B. Trust
C. Initiative
D. Industry
E. Identity
Parent-child relationship
Attachment
Engrossment
Parent guidance / discipline
• 0-6 months
– Distraction
• 6-12 months
– More direct discipline
Cognitive development: Who’s theory
are we going to be applying?
A. Freud
B. Erikson
C. Paiget
D. Kohlberg
E. Maslow
What stage of cognitive development
is an infant?
A. Preoperational
B. Concrete operational
C. Sensorimotor
D. Formal operational
Moral Development
• Neonate
– No conscience
– !00% ID
Communication: What “name” or
word to baby’s say first (usually)
A. MaMa
B. DaDa
Communication
• Birth
– Crying
• 8 months
– Dada
• 2 months
• 10 months
– Smile
– Coo
– Mama
• 4-6 months
– Babbling
• 12 months
– 4-6 words
Nutrition
Sleep & Rest
Play
Safety: Aspiration
• Avoid small objects
• Age aprop toys
Baby harm
•
•
•
•
Sharp objects
Heavy objects
Animals
Shaken baby syndrome
Burns
•
•
•
•
Check water temps
Smoke detectors
Handles of pans in
Cover electrical outlets
Drowning
• Bathtub never alone
Falls
• Mattress lowest
position
– firm
• Infant seat with
restraint
• Infant seat on the
ground
• Safe gaits
– Slide
– Not accordion
Poisoning
•
•
•
•
•
Lead paint
Plants
Safety locks
Medicine
CO monitor
MVA
• Read facing car seat
• 12 months