Baby Development PDF
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This document discusses the features of a newborn baby, including weight, length, skin characteristics, and reflexes. It also covers the development of the nervous system and senses. It explores vital signs, such as temperature, heart rate, and respiratory rate.
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المحاضرة االولى The new born baby Definition:- A newborn refers to an infant in the first 28 days after birth; the term applies to Premature infants, Post mature infants, and Full term infants. The features of new born baby: A. Weight :- In developed countries, the average birth weight of...
المحاضرة االولى The new born baby Definition:- A newborn refers to an infant in the first 28 days after birth; the term applies to Premature infants, Post mature infants, and Full term infants. The features of new born baby: A. Weight :- In developed countries, the average birth weight of a full-term newborn is approximately 3.4 kg and is typically in the range of 2.7-4.6 kg. Over the first 5-7 days following birth, the body weight of a term neonate decreases by 3-7%, and is largely a result of the resorption and urination of the fluid that initially fills the lungs, in addition to a delay of often a few days before breastfeeding becomes effective. After the first week, healthy term neonates should gain 10-20 grams/day. B. Length: - The length of new born baby range from (35.6- 60 cm). The average (50Cm) male new born baby is taller than female new born baby. C. The skin: -it is usually dark pink covered with few lanugo hairs Lanugo hair: - it is a fine, immature hair covered the body of new born baby especially the premature baby and some dark hair baby it is usually disappear in the first week of life. Infants may be born with full heads of hair; others, particularly Caucasian infants, may have very fine hair or may even be bald. Amongst fair-skinned parents, this fine hair may be blonde, even if the parents are not. The scalp may also be temporarily bruised or swollen, especially in hairless newborns, and the area around the eyes may be puffy. Vernix caseosa :- soft white creamy layer covered the skin of the premature baby disappear by terms. Mongolian spots: - transient dark blue to black pigment seen over the lower back, buttock, in 90 % of the black, Indian, and oriental babies disappear in (1-2 years) of life. Hemangioma: - transient pink macule in the back of the neck, eyelids, forehead. Milia:- pin head whitish spot seen on the nose ,chin disappear in first (1-2 week ) of life. D. Head: - Head circumference (HC) is (33 - 37 cm), 35 cm. there are two fontanels: - 1) Anterior fontanel: - it is a bony gap in the skull result from incomplete fusion of 2 frontals & 2 parietal bones, it is diamond in shape, measured (2.5 × 2.5 cm) closed in (15-18 month) of life causes of delay in closure in rickets , causes of bulging in crying , hydrocephalus. 2) Posterior fontanel :- it is a bony gap in the skull result from incomplete fusion of 2 occipitals & 2 parietal bones, it is a tiangulre in shape, measured (0.5 cm) in width, closed in (6-8 week) of life. E. Chest :- chest circumference (CC) is ( 30 - 35 cm ) , it is like a bell. (CC) is equally or less than the (HC). F. Muscles: - it is fine and small , but have full strength. G. The nervous system (N.S) The brain of the NBB is immature so that the reaction of the NBB to the external stimuli is by a reflex called primitive reflexes (PR) the presence of these PR indicate that the (N.S) was normal or (health). The primitive reflexes are i. Motor PR include: - Moro reflex or (startle R) grasping, stepping, knee jerk, planter reflexes. ii. Primitive reflexes related to the feeding include: - Rooting, sucking, swallowing reflexes. iii. Protective reflexes include: - sneezing, coughing Blinking, yawing, gagging reflexes. i. Primitive reflexes related to Motor 1. Moro reflex (startle R) :- when the NBB exposed to a high voice or sudden change of his position the baby will extend and abduct both arms and legs then flexion and adduction of both. 2. Grasping R:- when the index finger is placed across the palm will cause flexion and grasping of the fingers. 3. Stepping R when the baby is hold upright and the foot placed over affirm surface ,the other leg will flexed in the hip and knee in a stepping movement. ii. Primitive reflexes related to the feeding 1. Rooting R :- Is done by touching the check of the NBB he will turn his head toward the stimulus. 2. Sucking reflexes 3. Swallowing reflexes Both motor reflexes and the reflexes related to the feeding disappears by 4-6 month of age. iii. Protective reflexes 1. Sneezing and coughing R when foreign body in the upper respiratory tract the NBB will sneeze or cough in order to discharge this foreign body. 2. Blinking R when foreign body near his eyelid or high light he will try to close his eyes. 3. Gagging R when there is a large amount of milk in his mouth and he cannot swallow he will try to discharge it out. H. Senses The NBB has many sensation like touch, sight, hearing, taste, smell senses 1. Touch sense :- it is well developed in NBB especially in lips, tongue, ear, cheek so can feel these external stimuli to the skin like light touch, pressure, change in temperature. 2. Sight sense :- close his eyes to the light. 3. Hearing sense :- we can test the hearing by doing moro reflex or by a bell from a short distance. 4. Taste sense :- it is more developed than the sense of sight and hearing, the NBB like sweat liquid, refuse bitter. 5. Smell sense :- he has a good smell to his mother milk so can reach the breast of his mother I. Vital signs The vital signs include the: - 1. Temperature : The temp of the NBB is unpredictable so he has sudden fall in the temp. immediately after birth then start to increase and his temp. is affected with the temp of the room and bed. Normal body temperature (36-37.70c). measured initially per rectum later on measured axillaries’. 2. Heart rate : Normal heart rate of the NBB is (120-160) beats/mint, it increase with crying. 3. Respiratory rate: Normal respiratory rate is (30-60) beats/mint we can monitor respiration by movement of the muscle of the chest and abdomen. المحاضرة الثانية The premature baby Definition :- live born baby age from (28-37week)gestation. ❖ Features included :- i. Somatic Features A) wt (1- 2.5 Kg ) B ) length (35- 45 cm ) C) Head circumference less than full term (35cm) but appear larger in proportion to the small body. - Small upper & lower limbs ,fingers,( nail& very thin). -Little sub cutaneneous fat so the skin is wrinkled. - Small face so the eye appear projected ii. Physiological Feature 1.Weak or poor body temperature control. 2.Difficulty in breathing (R.D.S). 3.Cyanosis,apnea, more than in full term. 4. Immature immune system ( more infection). 5. Immature hematopoiesis( more infection). 6. Vitamin D deficiency more affection with rickets. 7. Immature liver so deficiency of money enzymes. 8. Immature kidney so Premature baby is liable to fluid over load. 9. Retrolental fibroplasia ( fibrosis in retina). 10.Weak sucking & swallowing Causes of Premature baby A. Fetal causes include:- 1.Abnormal lie 2. Congenital abnormality 3.Twin pregnancy B. Maternal causes include:- 1.Under nutrition. 2.External trauma. 3-Bleeding in pregnancy. 4-Medical diseases (heart, renal ,diabetes mellitus). 5. Infectious diseases (urinary tract infection.) 6. Rh incompatibility between mother & father. 7.Smoking & alcohol. Nursing care of premature baby :- A. NC in delivery room. B. NC in incubator. A. Care in the delivery room include: - 1-Establishment and maintenance of respiration:- the first and most important care given to the NBB after birth is to a- Clean the mouth and the nose from the mucous, blood and amniotic-fluid so that the airway is open. b-The first respiration starts with the first crying so if this not occur in the first 30 second after the birth, so that the risks of asphyxia increase. c-If there is excessive secretion so can be drained with a sucker to prevent aspiration. The head of the NBB put little down and the foot should be elevated to encourage the drainage of secretion. or the NBB put in aside position also to encourage the drainage. 2- Improve the body temperature by: - a. Remove the excess vernix, mucous, blood, amniotic fluid and dry the NBB body. b. Wrap the NBB in a heated blanket and exposed only to measure birth weight. 3- Care of the umbilical cord :- a. Aseptic media is used to prevent cord infection like septicemia or tetanus and take care of bleeding from the cord. b. Clamp the cord with 2 sterile artery forceps 2.5 cm from the umbilicus and the second one is applied 5cm from the umbilicus. c. Cut the cord between the 2 forceps with sterile scissors. d. In case of Rh negative mother Clamp the cord in distance more than 3 cm e. Treat the cord at least once/day with 70% alcohol swab. Place the diaper below the cord to avoid irritation. 4- Care of the eye :- The eyelid and surrounding skin should be cleaned carefully with a sterile cotton which may be moisten with sterile water ,in some hospitals they use 1% silver nitrate eye drop as 2 drops in each eye as prophylaxis for gonorrhea. 5- Skin care :- a. clean the face, head, body of the baby from blood ,mucous with a piece of cotton cloth (towel ). b. don’t remove the vernix caseosa c. to prevent prolonged exposure of the baby body exposed only the part of the body which want to clean & dry & covered immediately to keep this part warm then put on the cloths ( soft & comfortable ) & covered with blanket. NC in delivery room. 1. Airway should be open by suction of secretions. 2. Keep Premature baby warm to prevent cold injury. 3. Care of umbilical cord ,skin, eye. 4. Gentle movement of Premature baby. 5. Prevention from injury. 6. Prevention from infection. B. NC in incubator include : put Premature baby in incubator which was prepared for him befor with a- Warm incubator Premature baby need to be warm so incubator temperature should be (31.2-35.2) in order to keep Premature baby(35.5 -36.5) temperature b- Oxygen with humidity with concentration of 30-40 % & not than 40% & humidity 55%. Not ♥ O2 concentration not more than 40% to prevent retrolental fibroplasia. ♥ Ways of giving oxygen 1- by incubator 2- nasal tube. 3- mask. المحاضرة الثالثة Premature baby feeding Premature baby has weak sucking & swallowing. Small stomach. Decrease ability for fat absorption Incomplete digestion of any food Premature baby need 110-150 kcal/kg /day , protein5gm/kg/day, more cho & less fat than full term Vitamin D &C & iron add to feed First feed is 5%-10% gloucose water as 5ml then increase gradually Breast milk is the ideal ,if Premature baby has weak sucking &swallowing so given by spoon ❖ Ways of feeding:- 1) Bottle or breast in (good sucking &swallowing). Use clean bottle, small and fine teat with suitable pole, warm formula, few amount & frequently in sitting or semi sitting position Duration of feeding 10-15 minute ¬ more than 20 minute Gas discharge in between & in the end of feeding Nursing notes record during feeding Amount of feeding Appearance of cyanosis, distress, vomiting in feeding 2) Small spoon in (poor sucking & good swallowing). Be sure baby has good swallowing 3) drug drip in (poor sucking & good swallowing). 4) Naso gastric tube (gavages) in (week sucking &swallowing). Appearance of cyanosis, distress in the three ways. Giving drugs to premature baby In premature intensive care unit some drugs should be prepared like epinephrine, vitamin K. Prevention from infection 1. Wash the hand with water & soap. 2. Wear gown, mask, cap ,clean& sterile shoes. 3. Don’t wear ring or jewel 4. Wash the hand with water & soap in between the patient to prevent cross infection. 5. If medical staff infected with influenza prevent from entrance to the ward. 6. Prevent foreigner person from entrance to premature intensive care unit 7. Take care of premature baby cleaning. 8. Isolation of premature baby with diarrhoea, meningitis. 9. prepare specialized room to prepare milk & baby feeding. Handling of premature baby Take care of handling because has large head in proportion to small body, head put in hand & body between lower arm chest nurse chest Monitoring the premature baby Nursing care & nurse has an important role & should have a good practice in take care of premature baby the important points recorded are Color, respiration, movement, sucking & swallowing, feeding, crying, cyanosis, vomiting, bowel motion. المحاضرة الرابعة The Growth and development of the child Growth The changes that occur in all the body include an increase in his body length, weight and the internal organ size. Which lead to increase in his total size. The growth measure unites are kilogram (kg), meters. Development It is a series of regular changes in behaviours and skills, this result from increase in the function of different parts and organs of the body. Stages of growth and development There is a positive relationship between growth and development, there is some variation from one person to another. The stages are: - 1. From pregnancy to delivery Embryo and fetus 2. 1-28 days of life New born baby 3. I month - I year Infant 4. 1-3 year Toddler 5. 3-6 year Preschool 6. 6-12 year School 7. 12-18 year Puberty and adolescence From fertilization of the ovum to the end of third month called First trimester From the end of third month to the end of 6 month called Second trimester From the end of 6 month to the end of 9 month called Third trimester Rapid growth of the body of fetus In sec. Trimester There in increase in subcutaneous fat mass and muscle bulk. In 3 rd trimester 1) Infant (oral stage). This period is from (1 month - 12 months). In this period the infant depend completely on feeding in nutrition so is called the characterized by rapid increase in weight and size. - Somatic growth and development 1. Weight :in the first 6mth, wt inc. by 150-200 gm/wk in the sec 6mth, wt inc. by 90-150 gm/wk So the wt in 6 mth was double his birth wt (6)kg in l yr was triple his birth wt (9.5-10)kg 2. Length: in the first 6 mth, leng. inc. By 2.5 cm/mth. in the sec. 6 mth, leng. inc By 1.5 cm/mth. So the length in: 6 mth = 65 cm. 1 yr = 72 cm. 3. Head circumference and chest circumference In (lyr) of age the chest circum. is more than Hc. so Hc is (51) cm and cc is (63cm). 4. Vital signs a) HR : in lst month is 120-150 beat/mint 1year is 100-130 beat/mint b) RR : in lst month is 30-50 cycle./mint 1year is 20-40 Resp./mint c) Temp : body temp is affected by temp of room of the body and gradually there is self control on body temp and decrease the effect of the environment on his body temp. Teething The NBB born with out teeth. Ist tooth appear bet 6 - 9 mth of age, in first yr there is 8 tooth. sec. yr 16 tooth. Development include :- 1. (motor) - First mth : When put the baby on his abdomen Move his arms and his legs (Prone position) Can move his head to Rt and lt Can't elevate his head above his body - Sec-mth : when put the baby on his abdomen can move his head & shoulder from bed. - Third mth : 1.Try to reach the bright object but can't touch it. 2. Head control, start. 3. Grasp reflex disappear. - 4th mth : 1. Good head control 2. When put on his back (supine position) can move his body to each side. 3. Can raise his head and chest (in prone posit) - 6 mth : Can sit with support - 7 mth : Can sit without support; put his foot in his mouth - 9 mth : Start crawling; hold his feeding bottle in his hand - 10-11 mth : Can stand and walk few steps. With support - 12 mth : Can walk alone 2. (Psychological and social development of infant) At this stage the baby feel sense of trust which start naturally , this feeling may increase or decrease in the later stage of the life. And if this feeling is not present he will have a feeling of mistrust. So he is completely depend on his mother and so the Psychological development occur gradually as fallow - At ( 1 mth ) the infant smile with out stimulus , crying when feel hunger or irritable. - At ( 2 mth ) listen to voice and words. - ( 3 rd - 4 th mth ) smile with other and laugh with high voice ( 6 mth ) say BaBa , dada - ( 8 mth ) the baby become happy when saw a person who love him. - ( 10 mth) play with other , make by – by - ( 11 - 12 mth ) say 2 words added to baba or mama , become more social. Protection baby from : A. Protection and prevention from accidents and injures prevention from accidents and injuries that occur at home like : 1. Swallowing of foreign body in the mouth or put it in the nose. 2. Wound that result from playing with a sharp materials. 3. Burn with water or fire or electricity. 4. Crib death : The best way for protection from accidents is by use a special cage for playing , special chair with belt and special beds for infants. a) Hygiene and Bathing. b) It is very important which include change the diaper after each urination or defecation the area should be cleaned with water and soap. Daily bathing is important. c) Exposure to fresh air and sun light. d) Rest and sleeping for infant :- At first month the baby sleep 18 - 20 hr / day. The baby become irritable , awake or crying because of hunger , pain or his diaper is full with urine or feces which occur each 3 - 4 hr. At 3 mth of age the pattern of sleep change so the sleep become longer during the night as ( 6 hr ) then become ( 6 - 12 hr ) as he become older and awake at the day for playing. B. Protection from infectious disease by immunization. Age Vaccine Dose Rout First 24 hour Hepatitis B First IM ---------------- BCG Intradermal 73 hour ------- Poliomyelitis Zero Orally Hexavalent (DPT, Hemophilus influenza First IM B, Hepatitis B, IPV ) Pneumococcal polysaccharide First IM 2 month Rota virus First Orally Poliomyelitis First Orally Hexavalent (DPT, Hemophilus influenza Second IM B, Hepatitis B, IPV ) Pneumococcal polysaccharide Second IM 4 month Rota virus Second Orally Poliomyelitis Second Orally Hexavalent (DPT, Hemophilus influenza Third IM B, Hepatitis B, IPV ) 6 month Pneumococcal polysaccharide Third IM Rota virus Third Orally Poliomyelitis Third Orally ---------------- 9 month Measles + Vitamin A 100000 I.U ------- Sc 15 month Measles Mumps and Rubella (MMR) First Sc Pentavalent (DPT, Hib, IPV ) Booster 1 IM Poliomyelitis Booster 1 Orally 18 month ---------------- Vitamin A 200000 I.U Sc ------- Pentavalent (DPT, Hib, IPV ) Booster 2 IM Poliomyelitis Booster 2 Orally 4-6 year Measles Mumps and Rubella (MMR) Second Sc ---------------- Vitamin A 200000 I.U Sc ------- 1)Toddler This stage start from 1 - 3 yr of age. The growth and development :- a) Somatic :- - Weight and height → weight increase 2.3 kg / yr. length increase 7.5 cm / yr The difference between male and female is to little. - Vital signs → 1. Temperature is not affected by external condition like in premature baby and the infant. 2. Pulse rate : 90 - 100 beat / mint and more regular ( so it is decrease ). 3. Respiratory rate : 20 breath / mint ( so is decrease ). 4. B. p : 85 / 60 mm Hg. - Teething :- the deciduous teeth completed at 3 yr of age which was 20. b) Motor development : The baby movement is increase, and feeling proud of himself when he has control of his urination and defecation process and personal hygiene ( cleaning ), he can take off his cloths, can raise upstairs, can pull his toys behind him. c) Social and psychological development : In this stage the baby is active , hyperkinetic , look for things , express his feeling and his needs by talking , crying is less , his appetite is decrease because he has more pleasure with playing , he has interest in colored picture in books. 2) The preschool age child : This stage start from 3 - 6 yr. characterized by playing and imagination. a)Somatic growth and development : - Weight and height : The wt increase by 1.8 - 2.7 kg / yr. The length increase by 7 cm / yr The increments in wt and ht is less than in the previous stages. The increase in the lower limb is more than in trunk. b)Motor development : The activity of the baby become more and rapid. can clean himself , can wear and underwear cloths , depend on himself in toilet. c ) Social development : This stage characterized by playing and imagination very talkative , can know full name , play with other, can make good social relationship , has money question try to know the answers , can learn song , can learn money numbers , day of weeks 3) The school age child : This stage start from 6 - 12 year. ( primary - school ) a) Somatic growth and development : - Weight and height : The wt increase by 2 kg/yr. The length increase by 5 cm/yr. at the end of this stage the girl has more increase in the height and wt than the boy. - The bone and muscle : The bone growth is more than muscle growth. - Teething : At 6 yr of age the deciduous teeth start to lose , and the permanent teeth start to appear , the first molar start to appear. The permanents teeth usually completed at 12 yr with out second and third molar. b ) social and psychological development and growth : - 6 yr → may be aggressive , change in his thought and behaviours. - 7 yr → may be love to be alone. - 8 yr → may be proud of himself ( can know reading and writing ) - 9 yr → start to learn ( to be sick ) in order not to go to school. - 11 yr → become an exited , not obey his parents. - 12 yr → become more stable in his behaviours and more happy. 4) Puberty and adolescence. This stage start from (10- 12 year in girls) &( 12-14 year in boys) till 18 year in both. a) Somatic growth and development : - Weight and height : Weight and height characterized by rapid growth. The wt become (43-45 kg)&the height become (151-160 cm). The length increase by 5 cm / yr. - The characteristic features of growth and development of both male & female in organs & system are un equal & not in the same time. - The important changes that occur in boys are ;- The appearance of hair in face, chest, limbs, under axilla pubic region. Changes in voice, spermatozoa start to develop. - The important changes that occur in girls are ;- Enlargement of breast , pelvis & hip ,menstrual period start to appear. - The average increase in height & weight in girls is more earlier than in boys till 16 years of age after that the average increase height & weight in boys is more than in girls & the end result the boys are more taller than girls. b ) social and psychological development and growth : The adolescent have 1. Felling of fear ,anxiety because of rapid changes in the body. 2. Take care of the body in the future. 3. Take more time to do the job or work so the parents should don't have a strong behaviours with them to finish theirworks. 4. Take care about way of speech with others to be greeting to him. 5. Felling of trust develop more & this feeling firstly develop in the infant stage. 6. Feeling of independence & autonomy. 7. Feeling of initiative. 8. Start to thinks about his future in learning , jobs social lives. المحاضرة الخامسة Factors that affect growth and development i. Genetic factors include: - A. The genetic features which transfer to the embryo from both parents. B. Other external factors affect the development of embryo include: 1) Infectious disease of the mother in pregnancy like rubella (German Measles) in first 3 months, disorders in endocrine gland function. 2) Exposure to radiation. 3) Placental disorder - placenta previa - abruption placenta 4) Nutrition of the pregnant woman. 5) Smoking and alcohol drinking 6) Drugs 7) External trauma 8) Rh incompatibility ii. Race , nation and sex factors iii. Environmental factors include A. Parent environment. B. Labour environment. C. External. D. Quality of nutrition E. Socio eco. Status F. Health G. Ordinal position in family H. Parent child relationship ⁂ Height - ESTROGEN responsible for increase in height in female - TESTOSTERONE responsible for the increase in height in male - Stoppage of height coincide with the eruption of the wisdom teeth PRINCIPLES OF GROWTH AND DEVELOPMENT - Growth and development is a continuous process (WOMB TO TOMB PRINCIPLE) begins from conception and ends with death - Not all parts of the body grows at the same time or at the same rate (ASSYCHRONOUS GROWTH) - Each child is unique - Growth and development occurs in a regular direction reflecting definite and predictable patterns or trends PATTERNS OF GROWTH AND DEVELOPMENT Renal & Digestive & Circulatory & Musculoskeletal ✔ childhood Brain & CNS & Neurologic Tissue ✔ Rapid growth and development of brain from1 - 2 years ✔ Malnutrition may result to Mild Mental Retardation Lymphatic System (Lymph Nodes) Grows rapidly during infancy and childhood ✔ Provide protection against infection Reproductive ✔ Grows rapidly during puberty RATES OF GROWTH AND DEVELOPMENT Fetal and Infancy ✔ Period of most rapid growth and development ✔ Prone to develop anaemia Toddler ✔ Period of slow growth and development Toddler and preschool ✔ Period of alternating rapid and slow growth and development School Aged ✔ Slower growth and development ✔ Least to develop anaemia Adolescent ✔ Period of rapid growth ✔ Secondary prone to anaemia المحاضرة السادسة Types of growth: A. Physical growth: Can be assessing through measurement of head circumference, thoracic diameter, weight, height and arm circumference. B. Physiological growth: This can be assessing through measurement of vital signs (temperature, pulse, respiration and blood pressure). Types of development: 1. Motor development: e.g. sitting, standing, running, usage of fine muscles. 2. Intellectual ( Cognitive) development e.g. Problem solving, reasoning, mental (cognitive) 3. Social development: e.g. Raising and training a child in the culture, self-concept, and friend-ship 4. Emotional development e.g. Love, fear The patterns of Growth and development: Cephalocoudul ( start from head to toes ): The infants achieve control of the head before they have control of the trunk and extremities. And they achieve control of their hands before they have control of their feet. Proximodistal ( start from near to far ): Refers to the development of motor skill from the center of the body to the peripheral. The limbs of the body develop before hands and feet, hands and feet develop before the fingers and toes. General to specific: The infant used whole hand as a unit before the fingers. And they will be to grasp object with all fingers before using the thumb. 1- Motor development Months Gross Motor Skills Fine Motor Skills 0-3 Months Smiles at the sound of voice and Holds small object in hand (without follows you with their eyes as you thumb tucked in hand) move around a room 4 Months Babbles, laughs, and tries to imitate Reaches for toy & Briefly holds toy sounds; holds head steady 6 Months Rolls from back to stomach and Follows objects with eyes in all stomach to back directions Moves objects from hand to hand 7 Months Responds to own name Transfers objects from one hand to Finds partially hidden objects the other 9 Months Sits without support, crawls, babbles Able to release an object voluntarily "mama" and "dada" 12 Months Walks with or without support Likes to explore, turn pages of Says at least one word cardboard books Enjoys imitating people 18 Months Walks independently, drinks from a Puts objects/toys in a container cup, says at least 15 words, points to body parts 2 Years Runs and jumps Uses both hands to play Speaks in two-word sentences Points at objects with index finger Follows simple instructions Can isolate index finger with other Begins make-believe play fingers closed 2- Cognitive development (Piaget) The best known theory regarding children thinking, intelligence enables individuals to make adaptations to the environment that increase the probability of survival; through their behavior individuals establish and maintain equilibrium with the environment. a- Sensorimotor (birth to 2 years) 1. Reflex activity through simple repetitive to imitative behavior. 2. Develop sense of cause and effect. 3. Primary problem solving through trial and error. b- Preoperational (2-7 years) The predominant characteristic of this stage of intellectual development is 1. Egocentrism that not mean selfishness but rather inability to put oneself in the place of another. 2. ↑ able to use language and symbols to represent objects in their environment. 3. Through imaginative play, questioning, and other interaction begin to elaborate concepts and to make simple association between ideas. c- Concrete operation (7-11 years) 1. The thought become ↑ logical and coherent. 2. Able to classify, sort, order, and otherwise organize fact about the world to use in solve problem. d- Formal operation (11-15 years) 1. Formal operation thought is characteristic by adaptability and flexibility. 2. Adolescents can think in abstract terms, use abstract symbols, and draw logical conclusion from a set of observation. 3- Freud Psychosexual Stages of Development 4- Erik Erikson: (Psychosocial Development): 5- Emotional development 6- Teething development: The stages for tooth development are the same for each set. That our baby teeth start forming while we’re inside the womb. In fact, teeth start forming at around the 5–6-week mark! There are five stages teeth go through in the development process: A- Bud Stage: The bud stage is the first stage in teeth development. During this time, dental epithelium bud cells start to form a layer called the dental lamina. This takes place in upper and lower jaws, this layer will build the foundation of the tooth germ. It provides the soft tissue necessary for tooth formation. This stage is called the “bud” stage because it resembles the leaf buds on plants. B- Cap Stage: Cells begin to shape the outer layer of the tooth during the cap stage. This is called the cap stage as it forms the cap that rests above the tooth bud. This layer will eventually form the enamel that protects the tooth. The tooth bud below will form the two interior layers of the tooth called the dentin and the pulp. The dentin helps provide the primary structure for the enamel while the pulp provides nutrients to the tooth. During this stage, the dental follicle (a sac of cells that contain blood vessels and nerves) surrounds the enamel and dental papilla. We now have three essential elements of the tooth germ: the enamel, the papilla and the dental follicle. C- Bell Stage: As the cap begins to grow larger it forms a bell shape. During this stage, cells of the enamel organ change functions. They divide into four groups, inner enamel epithelium, outer enamel epithelium, stratum intermedium and stellate reticulum. These cells work together to develop the enamel layer of the tooth. This marks the end of the early bell stage, during the late bell stage (or the crown stage) the enamel epithelium folds and starts to create the crown, each tooth has its own unique shape depending on the type of tooth (molars, canines and incisors). D- Crown Stage and Root Formation: During the crown stage, the outer two layers of teeth start to form. Ameloblast and odontoblast cells help with the formation of enamel and dentin. The tooth also begins to harden and mineralize. tooth’s root forms at this stage, it comprises of three structures, the dental papilla, the dental follicle and cells known as Hertwig’s epithelial root sheath. E- Eruption Stage: The final stage is the eruption stage, once the tooth is formed it begins to move vertically, above the gum line. Depending on the type of tooth, eruption for infants begin at different times. Typically, baby teeth erupt at 6 months old and wisdom teeth only erupt when you are five years old. child’s mouth changes dramatically from the time their teeth start erupting to when their permanent adult teeth come in. During this process, Calgary dentist can monitor child’s growth and development, and identify and treat any problems that may arise. Regular visits to dentist throughout childhood will help child’s teeth grow strong and healthy with minimal problems. المحاضرة السابعة Feeding of Baby Breast milk has many advantages over formula such as 1. Requiring no mixing. 2. Being the correct temperature. 3. Requiring no sterilization 4. Being easily digested. 5. Having antibodies and immunoglobulin to many types of microorganisms, which are passed from mother to baby. 6. Being the correct temperature. 7. Being cost effective Family teaching: Colostrum: it is first immunization, explain to the mother that breast milk does not come in until the 2nd or 4th day, until the newborn gets nutrients from colostrum, a product the breast produces prior to milk. Breastfeeding: 1. breast may be firm but feel softer after nursing. 2. Nurse at least 10-15 minutes on each side. 3. To prevent nipple tenderness hold infant correctly , cradle hold , football or side-lying down. 4. Make sure the newborn lips are behind the nipple , encircling areola. 5. Release the suction before the newborn is removed from the breast by placing a finger in the side of the mouth and between the jaws. 6. After nursing express a little breast milk , massage into the nipples and areola, and allow to air dry. 7. Avoid using soap , alcohol or creams on breasts or nipples , Express droplets of breast milk and allow to air dry , especially for cracks and reddened areas on nipples , clean with water during showering or bathing. 8. Baby s urine should be light yellow with soft yellow stools. 9. Burp baby between breasts and at the end of feeding. Complementary feeding ( weaning): Definition : complementary feeding may be defined as a process by which the infant gradually becomes accustomed to semi-solid and solid food as supplements to breastmilk. When should complementary feeding( weaning) start? It is recommended that complementary feeding \ weaning should start at the beginning of fifth month of age. Parent guideline : introducing solid food to infants : 1. begin with 1 or 2 teaspoons and gradually increase to a couple of tablespoons per feeding. 2. introduce only one new food at a time , usually at intervals of 4 to 7 days to allow for identification of food allergies. 3. introduction of other foods besides breast milk before the fifth month is dangerous because the baby s stomach and digestive system are not ready for it. 4. Delay in starting complementary feeds beyond the fifth month can cause malnutrition and will make the baby vulnerable to disease and infections. 5. Salt: unnecessary salt intake can overload the baby s kidneys and digestive system. 6. do not introduce foods by mixing them with formula in the bottle. 7. weaning food prepared at home using traditional foods items is always fresh and nutritious and costs less as compared to processed baby foods. 8. good hygiene, proper handling of food and feeding habits are very important during the weaning process. المحاضرة الثامنة Care of orphan Child who lost one parent or both so he is losing love & security. 1-establish of children for normal life [ physical , mental &social ]. 2-give name & identify the unknown origin. 3-prevent any differentiation between them to give them values in society. Services of orphan care 1-provide family atmosphere—2-school &follow up developmental state 3- provide feeding , clothes &health care 4-solving social problems 5-follow up after graduating. Characteristics of education directors 1-well trained & have experiences 2-intrrested in field 3-stading problems 4-can explain the child behaviors. المحاضرة التاسعة Growth & Development needs and problems according to child stage All children have basic needs for physical, emotional and spiritual aspects of growth. The age of the child determines the rate of physical, emotional and spiritual development. Needs are generally met in the following order from the base of the pyramid upward 1.Physiological 2.Safety 3.Love/Belonging 4.Esteem 5.Self-Actualization Physiological Needs – air/oxygen, water, food, rest, shelter, avoidance of pain. Safety & Security Needs – free from threat of physical & emotional harm, stability, job security, medical insurance. Love & Belonging – give and receive affection, interact with others, maintain a feeling of belonging, attain a place in a group Esteem Needs – self-respect, achievement, confidence, independence, freedom, mastery. Self-Actualization Needs: When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activate. Infant Age - Needs of infant 1. feeding 2. sucking 3. warmth 4. comfort 5. love and security 6. exercise 7. nourishment 8. fresh air and sun light 9. sensory stimulation 10. immunization Toddler age - Needs of Toddler 1. love and security 2. learning of the language 3. independence 4. control of body function 5. Toilet training 6. sleeping 7. nutrition 8. playing Toilet training Many parents are unsure about when to start toilet teaching. Not all kids are ready at the same age, so it's important to watch child for signs of readiness. Most children begin to show these signs between 18 and 24 months, although some may be ready earlier or later than that. And boys often start later and take longer to learn to use the potty than girls. Tips for Toilet Teaching Even before child is ready to try the potty, you can prepare little one by teaching about the process: 1- Use words to express the act of using the toilet ("pee," "poop," and "potty"). 2- Get a potty chair. 3- Trained the child on practice sitting. At first, child can sit on it clothed. Then, he or she can sit on the chair with a diaper. And when ready, the child can go to use the chair. 4- Establish a routine. 5- Sit the child on the potty chair within 15 to 30 minutes after meals this induced a bowel movement after eating (this is called the gastro-colic reflex). Preschool age - Preschool age needs of 1. love and security 2. playing 3. learning of the language 4. guidance 5. independence 6. learning 7. sex information (masturbation) Sleep problem Sleep is an important physiological process with profound impact on the body. Sleep is a basic human need that affects and affected by mental health. Humans spend about 1/3rd of their lives asleep State of rest, reduced voluntary body movement, decreased awareness of surroundings Normal Sleep Requirements for Children by Age Newborns (