1. Growth and Development
AHMAD AYDI

2. 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.

3. APGAR SCORING CHART
Category 1 2
Heart rate
Absent
Slow (less than 100 beats/min)
More than 100 beats/min
Respiratory effort
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

5. Weight: Average birth weight: 2700–4000 grams
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.

8. 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.

11. 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.

13. 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.

14. —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.

16. —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.

17. 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.

18. 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

19. 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.

21. 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

22. Neurological
Assessment of reflexes is an essential component of the neurological assessment, along with assessment of posture, muscle tone, head control, and movement

23. Reflexes
Gag in response to stimulation of posterior pharynx by food or tube; causes infant to gag; reflex persists for life

24. Moro in response to sudden loud noise; infant extends then flexes arms and fingers; decreases at 3–4 months, disappears at 6 months

25. 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

27. 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

28. 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

29. Grasp reflexes: palmar grasp and plantar grasp
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.

31. 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

32. 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)

33. Sensory
Focus on objects 8–10 inches away and can perceive forms
Preference for human face apparent
Auditory systems function at birth

34. Cognitive Development
Newborn learns to turn to the nipple
Learns that crying results in parents' response

35. Psychosocial Development
Interactions during routine care between newborn and parent lay foundation for deep attachment