1. Gestational and Child Assessment
Jennifer Coleman, MSN
Theories and Concepts II

2. Gestational Assessment
Physical characteristics of the newborn
Reflexes
Physical exam
Brazelton Neonatal Behavioral Assessment Scale
New Ballard Scale by Ballard, Novack and Driver

3. Pre-term Newborns Preterm is born before 37 weeks
7% of all pregnancies (higher in blacks & LSE)
LBW = 5% of infants <2500g (5#8oz) - ~36 weeks
VLBW <1500g (3#5oz) - ~32 weeks

4. Post-term Newborn Post-term is born after 42 weeks
Mean wt. of full-term infant~3200g (7lbs)
Weight does not necessarily correlate to GA
SGA <10% of appropriate weight for GA
LGA >90% of appropriate weight for GA

6. Newborn (Primitive) reflexes
Onset Gone
Moro 28w m
Palmar grasp w m
Rooting/Sucking 28w m (12m suck)
Stepping w w
Tonic neck 35w m
*see pages 700 and 707 – 711 in London

7. Physical Exam of Newborn
Infant easily stimulated by noise, touch, temperature changes or other environmental stimuli
Always keep infant warm
Inspection, auscultation, palpation, percussion order (warm stethoscope and hands)

8. Brazelton Neonatal Behavioral Assessment Scale
Workshop training program required to administered-RN use parts of tool to assess infants and increase parental understanding
Habituation
Orientation
Motor performance
Range of state
Regulation of state
Autonomic regulation
Reflexes

9. Ballard Scale Neuromuscular Maturity Physical Maturity Posture -Skin
Square window -Lanugo
Arm recoil -Plantar surface
Popliteal angle -Breast
Scarf sign -Eye/ear
Heel to ear -Genitals (M/F)

10. Posture 0 to 4 Arms & legs extended
Slight-moderate flexion of hips/knees
Moderate-strong flexion of hips/knees
Legs flexed & abducted, arms slightly flexed
Full flexion arms & legs

11. Square Window -1 to 4 >90 degrees 90 degrees 60 degrees 45 degrees

12. Arm Recoil 0 to 4 Extended 180 degrees or random movements
Minimal flexion degrees
Small amount flexion, degrees
Moderate flexion, degrees
Brisk return to full flexion, <90 degrees

13. Popliteal Angle -1 to 5
Thigh held in knee chest position and leg is gently extended from behind the ankle. Measure the angle behind the knee.
180 degrees
160 degrees
140 degrees
120 degrees
100 degrees
90 degrees
<90 degrees

14. Scarf Sign -1 to 1 Elbow reaches/nears level of opposite shoulder
Elbow crosses opposite anterior axillary line
Elbow reaches opposite anterior axillary line

15. Scarf Sign 2 to 4 Elbow at midline Elbow does not reach midline
Elbow does not cross proximate axillary line

16. Heel to Ear -1 to 4
Pull foot to ear without force

17. Physical Maturity Skin (-1 to 5) Lanugo (-1 to 4)
Plantar (Sole) Creases (-2 to 4)
< 36 weeks: 1-2 transverse creases on anterior 1/3 of sole
by 40 weeks: complex criss-crossing of creases over entire sole

18. Physical Maturity Breast (-1 to 4) Eye/Ear (-2 to 4)
<34 weeks: not generally palpable
at 36weeks: diameter does not usually exceed 3mm
Eye/Ear (-2 to 4)
appears mainly after 36 weeks
Genitals M/F (-1 to 4)
<36 weeks: few anterior, inferior scrotal rugae
40 weeks: rugae cover entire scrotum

19. Maturity Rating (20-44 weeks)
TS GA TS GA TS GA

20. Child Assessment
Denver II or DDST-R (Revised Denver Developmental Screening Test)
Personal-social
Fine motor-adaptive
Language
Gross motor
see Appendix H in Pillitteri

21. Description of Denver II
Not an IQ test, not diagnostic, not predictive
Designed for apparently well children Birth-6yrs
Start with low items and work up
Need 3 items completely below age line
Need every item that age line intersects

22. Calculate Child’s Age Current date minus birth date
Work right to left (days, months, years)
To borrow
Take 30 days from one month
Take 12 months from one year

23. Practice Calculations
Example 1 Year Month Day
Current date
(2007) (0+12 =12) (15+30=45)
Birth date
Age of child y m d

24. Practice Calculations 2
Example 2 Year Month Day
Current date
Birth date
Age of child

25. Answer
2 years
6 months
29 days

26. Adjusting for Prematurity
Example 3 Year Month Day
Current date
Birth date
Age of child
6 weeks of premature
Adjusted age of child m d

28. Personal-Social
Getting along with people
Caring for personal needs

29. Fine motor-Adaptive Hand-eye coordination
Manipulation of small objects
Problem-solving

30. Language
Hearing
Understanding
Using language

31. Overall large muscle movement
Gross Motor
Sitting
Walking
Jumping
Overall large muscle movement

32. Interpretation of test results
Normal
No delays with max of one caution
Suspect
Two or more cautions &/or one or more delays
Rescreen 1-2 weeks
Untestable
Refusal on one item on or completely to left of age line in 75-90% area