MATERNAL & CHILD NURSING BIRTH WEIGHT

(PEDIA) ➔ N: 2, 500 - 3,500 g (5.5 lbs - 5.5 lbs / 2.5 - 3.5 kg)

OUTLINE: ➭ 6 mos x 2
I. NORMAL PEDIA ➭ 1 yr x 3
a. Growth and Development ➭ 2 1⁄2 x 4
b. Milestone
★ E.g. (if NB wt: 8 lbs, then 6 mos = 16 lbs, 1 yr = 24 lbs)
➭ Milestone (for 12 mos)
➭ Gross Motor;Fine Motor;Language ★ give breastmilk (has protein) to achieve normal wt.
c. Stages of Growth and Development
d. Psychoanalytic ➔ > 3, 500 g (Macrosomia → Cause: GDM)
e. Psychosocial Stages ● ↑ sugar → placenta → baby becomes big
f. Piaget’s Cognitive Development
g. Fear/Anxiety ● Interventions: Blood Sugar (to check for hypoglycemia) ; Heel
Prick Test
II. ABNORMAL PEDIA
a. Brain Disorders ★ A V A = In infants, the arteries are the one who carries
➭ Meningitis oxygenated blood (BRIGHT RED), while the vein carries
➭ Hydrocephalus
deoxygenated blood (DARK RED).
➭ Neural Tube Defect (NTD)
➭ Down’s Syndrome / Trisomy 21 ➔ < 2, 500 g (Microsomia → Cause: Smoking)
b. Hemolytic Diseases
➭ RH Incompatibility
➭ Hemophilia BIRTH LENGTH
➭ Sickle Cell Anemia ➔ N: 45 - 55 cm
➭ Phenylketonuria
c. Cardiac Disorders Formula: 18” - 21” x 2.54 =cm
➭ Patent Ductus Arteriosus
➭ Cyanotic Heart Defect ➭ 1st 6 mos: ⬆ 1”/month
➭ Tetralogy of Fallot ➭ 1st yr: + 50%
➭ Transposition of Great Vein
d. Lungs Disorders ● Dec 2023 = 18’’
➭ Cystic Fibrosis ● J = 19’’
e. GIT Disorders
➭ Cleft Lip / Cleft Palate ● F = 20’’
➭ Hypertrophic Pyloric Stenosis ● M = 21’’
➭ Celiac Disease
● by Dec 2024 (18’’ + 9” = 27”)
➭ Intussusception
➭ Hirschsprung Disease ★ What is needed to increase our height?
➭ Wills Tumor ○ Sleep (growth hormone is released by brain
before puberty during sleep)
NORMAL PEDIA ➔ Head Circumference: 33 - 35 cm
(Growth & Development) ● if > 35 cm (Macrocephaly → Cause: Hydrocephalus)
GROWTH ● if < 33 cm (Microcephaly → Cause: Down Syndrome ; prone to
➔ changes in size (wt & ht) mental retardation)
➔ Quantitative changes : Measurable ➔ Chest Circumference: 31 - 33 cm
➔ Parameters: ● if nipple are more than 2 (Supernumerary Nipples)
◆ Weight: Most Sensitive (mas big and boy) ➔ Abd. Circumference: 31 - 33 cm
◆ Height: Linear Growth (mas malaki ang boy)
 DEVELOPMENT
neat/fine pincer
➔ maturation / skills bouncing grasp
7 9
➔ changes in skills : UNIQUE (inaabot ang paa sa bibig) (choking; risk for
aspiration)
➔ Qualitative changes : Measurable
◆ we have assessment tools (MMDST)
throw (all fingers are
➔ Parameters: 8 sit without support 12 used & controlled:
◆ Gross Motor ex:throwing ball)

● walking ; sitting ; standing-up

crawling can draw vertical &
◆ Fine (Finger) Motor 9 (if in bed = risk for fall; if in crib = allow to 2 yrs old
horizontal
● writing ; pinching crawl)

◆ Language
Separation Anxiety
● saying “mama” (start 6 mos, at peak 10 mos)
◆ Social - iiyak once umalis
➔ Milestone: Benchmark of the child’s achievement. - 3 times before it gets
managed (thru the mgt)

MILESTONE Protest, Despair, Denial

stand (Phases of
can draw circle &
MONTHS
GROSS MOTOR
MONTHS
FINE MOTOR 10 with Abandonment) 3 yrs old
(cephalocaudal) (proximodistal) - Protest: crying; outburst curve
support
- If Toddler: Temper
Sleep: supine tantrums
Awake: supine - Despair: playing again
- SIDS (Sudden Infant Death Syndrome) (don’t cry anymore)
= common cx of death (placed in prone) - Denial: ignore; hindi
papansinin ng baby yung
Sleep: Supine 0 - 2: closed fist / mother pag-uwi.
0-1 Awake: Prone arm movements
- to strengthen the upper time (belly 0-3 3 mos: can open but can draw 4 sides
time) cruising
can’t control 11 (2 kamay hawak ni mom)
4 yrs old shapes
(palmar reflex) (square, rectangle)
head lag
(shaken baby syndrome: brain rub in the skull
→ ⬆ ICP d/t hematoma) 12 stand without support ; but,
can draw shapes
walk with support
with pointed
2 lift head 5 yrs old
corners
15 walk without support (triangle, diamond, stars)
close & open
4 lift head & lift chest 5 (hold: rattle)
3 yrs old run; tribike 6 yrs old can draw all shapes
roll over Stranger Anxiety
Palmar Grasp
5 (risk for
(starts at 5-6 mos)
6: can hold object
fall) (using pads of pointer
7 finger and thumb)
7: crude pincer
sit with support
6 grasp (transferring object
from one to another)
 TODDLER (autonomy vs. doubt)
MONTHS LANGUAGE ➔ 1 - 3 years old
➔ RITUALISTIC (they have security objects)
First Language: Cry
Loud Cry: Normal ◆ pag nawala ang kanilang security obj. (ex. teddy bear), lumalabas ang
High Pitched Cry: Abnormal (⬆ ICP → Cause: Hydrocephalus) “temper tantrums”
0 ◆ Temper Tantrums:
Acute Hearing:
- 1st sense to be develop (even in the womb, it can hear) ● X Language
- Best Mgt: Talk to the Baby ● Act - out
● Best Mgt: 1.) SAFETY ! (provide helmet / pillow) ;
cry 2.) Ignore: TO STOP THE TANTRUMS
(open mouth cry)
1-2 ➔ EGO-CENTRIC (self-centered)
crying & tear: if without, sx of DHN. ◆ “Parallel Play”
S ● promote physical development (walk/talk)
O cooing / bubbling ● e.g., throwing balls, push pull toys, walkie talkie
U
➔ NEGATIVISM (favorite word: NO)
N cooing:
- opening mouth (producing sound) ● Best Mgt: Provide choices / options (autonomy)
D
3 S - why? the baby can see that the mother is opening) ➔ TOILETING (18 mos)
◆ Maturation of sphincters
bubbling:
- naglalaway; parang may sinasabi
◆ Developed first:
- why? in preparation to talk (saliva if needed to talk) 1. Bowel
2. Bladder (am first, pm last)
vowel sounds ◆ Toothbrushing (30 mos = 2 ½ yrs old)
4 (not a word yet“A, E, I, O, U” ; O (favorite vowel to say))
● Complete (30 mos) : Milk Teeth (20 molar teeth)
5 consonant sounds ● Loosen : 6 - 7 years old
○ First eruption → 6 mos (lower central incisors)
mmmmm cry ○ Second eruption → 7 mos (upper central incisors)
7 (closed mouth) ○ Third eruption → 9 mos (upper lateral incisors)
● Best fruit to eat if hindi nagtoothbrush: PEAR
2 words
9 (mama/dada) ○ if asthmatic → APPLE
PRE-SCHOOLER
W 4 or more words ➔ 4 - 6 years old (3+ - 6 yrs old)
12 (mama, dada, + 2 new words)
O ➔ MAGICAL THINKING (they have “imaginary friend”)
R ➔ IMITATIVE BEHAVIOR (role play)
2 yrs old D 50 words
➔ SHARE: “COOPERATIVE PLAY” (associative)
S
3 yrs old 100 words ◆ promote creativity (toy: coloring books, clay, lego)
➔ WHY ? Questions (200 - 300 words)
4 yrs old 200 - 300 words
 STAGES OF GROWTH & DEVELOPMENT PSYCHOSEXUAL THEORY (by: Sigmund Freud)
★ ORAL phase: infancy (0-18 mos)
○ communicate thru CRY → hunger, discomfort, pain ; SUCK → feeding
AGE BRACKET FREUD ERICKSON PIAGET KOHLBERG
(O-A-Pha-La-Ge) (T-A-Ini-Ind-Id) (2S-P-C-F) (3PR-C-Po)
○ Fixation (persistence of trait / magiging ugali paglaki)
■ ↓ Fed = Sarcastic
Trust vs. 🗹 “masakit magsalita”
B-18m Infant Oral
Mistrust 🗹 gum chewing, nail biting, pen biting,
(2 brackets)
Sensory (3 brackets) thumbsucking
Autonomy
Motor Pre- ■ ↑ Fed = Substance Dependent
18m-3y Toddler Anal vs. Shame
Convention 🗹 smoking
& Doubt
al 🗹 alcoholism
Initiative Pre- 🗹 over-eating
3-6y Preschooler Phallic
vs. Guilt Operational
★ ANAL phase: toddlerhood (18 mos - 3 yrs old)
Industry
Concrete ○ Libido = sexual desire/drive (⬆ libido = ⬆ success)
6-12y Schooler Latency vs. Conventional
Operational ○ Toilet training (do not scold/punish the child during training)
Inferiority
○ Criteria for Readiness:
1. Talk, Walk, Sit & Stand (must observe these to know if the
Identity vs.
Formal Post- child is ready)
12-18y Adolescence Genitals Role Operational Conventional
Confusion 🗹 if present = anal sphincter starts to mature ; most
important (physiologic)
2. Obey simple commands
6 THEORIST (4 FAV): 🗹 getting sandals, closing the door
➔ SIGMUND FREUD (father of psychoanalysis) 3. Interest w/ Bathroom habits
◆ started studying growth & development 🗹 flushing toilet, playing w/ water (dapat bantayan
◆ dream interpretation ; free association habang naglalaro ng tubig sa CR → risk for aspiration
PSYCHOANALYTICAL (BY: Sigmund Freud) & infection)
★ ID: Principle Pleasure 4. Takes pride w/ accomplishment
○ peak in toddlerhood 🗹 calling the mother when they break a vase
○ “instinctual drive” ; desire/wants 🗹 must appreciate their achievement, don’t scold
○ makulit, pasaway (wag pagalitan/paluin yung bata → they can’t them.
understand) ○ Fixation:
★ EGO: Reality Principle ■ Anal Retentive : Parents (strict) → inc. super ego (child) →
○ form in school-age/schooler perfectionist , inorder, clean
○ “conscious self” ■ Anal Expulsive: Parents (Ignore ; Lenient) → inc. id (child)
○ “bad yan” ; very strict rules (wag pagalitan/paluin yung bata → not → disorganized & dirty
complete personality)
★ SUPEREGO: Conscience (Moral) Principle
○ form in adolescent
★ PHALLIC phase: pre-schooler (3 - 5/6 y.o) ➔ ERIC ERICKSON
○ Masturbation: holding the genitals (diff from adolescent) ◆ 1st theory to be believed (continued Freud's theory)
🗸 fondling, curiosity, explore ◆ Psychosocial
🗸 reason why masturbation is done ● Trust vs Mistrust (infancy)
🗹 curiosity: “Am I a Male/Female?” 🗸 trust: not reprimanding
🗹 done in private 🗸 mistrust: spanking
🗹 if in public: distract & divert 🗸 always follow your promises
○ child w/o undies playing in the rain → get
towel and cover → “May binili si mama ➔ JEAN PIAGET
para sa’yo” ◆ Cognitive (talino)
○ Sex Education: right time to teach sex ed ● Pre, Complete, Formal Operational
🗸 sexuality of the thoughts ● knowledge is important for survival
🗹 preschoolers are mostly abused.
🗹 must answer the qs = ⬆ level of knowledge PIAGET’S COGNITIVE DEVELOPMENT
○ Complexes: child attached to the parent of opposite sex ➢ Pre-School: Symbolic
🗸 OEDIPUS COMPLEX = boy → mother (father = rival) ; dev’t: ○ Ampalaya → mapait = (lahat ng gulay mapait ; “stereotyped”)
castration fear ➢ School-Age: Systematic
🗸 ELECTRA COMPLEX = girl → father (mother = rival) ; dev’t: ○ Gulay → many variants = (has idea of the sub concept)
penis envy ➢ Adolescent: Scientific
🗸 Fixation (if w/o father/mother image) ○ Gulay → many nutrients/fiber
🗹 F = envious
🗹 M = narcissistic ➔ LAWRENCE KOHLBERG
◆ Moral Conventional
★ LATENCY phase: schooler (6 - 12 y.o) ● Infant - Adolescent: don't know morality
○ discovering if male/female (difference of right from wrong)
○ homosexual Stage (boy-boy ; girl-girl) ● Toddler: “Bad” boy/girl → (negative)
○ ↓ sexual energy (focus: academic / school) 🗸 Best Mgt: ex. punching → “anak hindi pwedeng
○ able to relate with people ; connect with others ; form friends manuntok”, “ayaw ni mama na manuntok ka”
○ “Dorman” / “Suppressed” Fixation (don’t explain)
🗸 wala na yung fixation ● Preschoolers: “Why” qs (want to learn more)

★ GENITALS phase: adolescence (12 - 18 y.o) FEAR / ANXIETY

○ already know if male/female ➢ Infant: Strangers Anxiety
○ heterosexual Stage (boy-girl) ○ can’t also be seen in toddler etc.
🗸 Mngt (Genital Exposed) ➢ Toddler: Separation Anxiety
🗹 Provide privacy ➢ Pre-School: Mutilation
🗹 Ignore the behavior (not the self) ○ takot masugatan
○ form attraction to opposite sex ➢ School-Age: School Phobia; Death
○ established sexual relationship ○ takot sa school/bully
○ established goals / dreams / ambitions ➢ Adolescence: Altered Body Image; Peer rejection
 ABNORMAL PEDIA ● Anterior fontanelle: close 12-18 mos (diamond)
BRAIN DISORDERS ○ 18 mos: great imitators
(MENINGITIS) ○ 30 mos: complete set of temporary teeth (milk teeth)
➔ Inflammation of the meninges (covering of the brain) ■ 20 molar teeth
➔ Cx: Viral or Bacterial or Fungal ★ set-up the first dental appointment
🗸 caused by a bacteria not a virus (child can’t brush own teeth yet)
➔ Causative Agent (Bacterial): (HSN) ■ 6 y/o: fall off of temporary teeth
● Haemophilus Influenzae ■ hindi agad natanggal → sungki
○ Acute Epiglottitis ■ Climb stairs one step at a time
○ Hib Vaccine (prevents complication = Meningitis) ○ 3 y/o: climb stairs with alteration
● Streptococcus Pneumoniae ● Posterior fontanelle: closes 2-3 mos (triangle)
○ Pneumonia
● Neisseria meningitidis MONRO - KELLIE HYPOTHESIS
○ Meningococcemia (star like rash, localized purpura) ➔ 3 THINGS IN THE CRANIAL VAULT (SKULL)
🗸 Uso sa Baguio (early 2000s) 1.) BRAIN VOLUME
🗸 Antibiotics as Prophylaxis (ciprofloxacin, 1 dose, 2.) CSF
500 mg) 3.) INTRACEREBRAL / INTRACRANIAL BLOOD
➔ Absolute contraindication: administration of vaccines to pt with bacterial
skin infections ● Any increase → compress the other two → ICP
(E.g. IMPETIGO) → bacterial invasion → meningitis ○ Increase 1 = Decrease 2 (need to adjust)
➔ What is the usual sequelae (complication) of Upper Respiratory Tract ○ Ex: Brain Inflammation = inc. I=intracranial Blood → dec. in CSF &
Infection? Meningitis volume
➔ Tooth decay → Pus in the brain → Paralysis
● Mgt: Craniotomy BRAINSTEM SIGNS (STROKE LIKE S/SX)
1. Difficulty Breathing
MANIFESTATIONS OF MENINGITIS 2. Chewing difficulty
● Usually abrupt onset 3. Blurring of vision
○ Fever 4. Weakness of the limbs
○ Chills
○ (Projectile) Vomiting MANIFESTATIONS OF MENINGITIS cont…
■ Forceful vomitus ○ Irritability (earliest sign of hypoxia/ hypoxemia)
■ Can reach 3-6 ft away ■ Children: Crying, irritability
○ Seizure ■ Adult: Confusion, lightheadedness
■ Cx: Firing of electrolytes ■ Elderly: ALOC/Confusion
○ High pitched crying and bulging fontanels in younger children ○ Nuchal rigidity
○ Bulging of fontanelle: to accommodate the pressure, ■ stiff neck, bumaba sa nerves ang inflammation, irritable rin
■ Adults: cannot accommodate, solid head / fused ang nerves
fontanelle already, results to brain herniation ○ Opisthotonic Position
■ Brain: when compressed → lose its function ■ exaggerated arching of the back
→ paralysis/numbness/loss of sensation ■ Position: side-lying ; Best position (sleeping): supine
DIAGNOSTIC TESTS OF MENINGITIS