Stages of Child Development and Newboern Screening

The fetal circulatory system uses two right to left shunts, which are small passages that
direct blood that needs to be oxygenated. The purpose of these shunts is to bypass
certain body parts in particular, the lungs and liver that are not fully developed while
the fetus is still in the womb. The shunts that bypass the lungs are called the foramen
ovale, which moves blood from the right atrium of the heart to the left atrium, and the
ductus arteriosus, which moves blood from the pulmonary artery to the aorta.

Oxygen and nutrients from the mother's blood are transferred across the placenta to
the fetus. The enriched blood flows through the umbilical cord to the liver and splits into
three branches. The blood then reaches the inferior vena cava, a major vein connected
to the heart. Most of this blood is sent through the ductus venosus, also a shunt that
passes highly oxygenated blood through the liver to the inferior vena cava and then to
the right atrium of the heart. A small amount of this blood goes directly to the liver to
give it the oxygen and nutrients it needs.
Waste products from the fetal blood are transferred back across the placenta to the
mother's blood.

Inside the fetal heart:

 Blood enters the right atrium, the chamber on the upper right side of the heart.
When the blood enters the right atrium, most of it flows through the foramen
ovale into the left atrium.

 Blood then passes into the left ventricle (lower chamber of the heart) and then to
the aorta, (the large artery coming from the heart).

 From the aorta, blood is sent to the heart muscle itself in addition to the brain.
After circulating there, the blood returns to the right atrium of the heart through
the superior vena cava. About two thirds of the blood will pass through the
foramen ovale as described above, but the remaining one third will pass into the
right ventricle, toward the lungs.

 In the fetus, the placenta does the work of breathing instead of the lungs. As a
result, only a small amount of the blood continues on to the lungs. Most of this
blood is bypassed or shunted away from the lungs through the ductus arteriosus
to the aorta. Most of the circulation to the lower body is supplied by blood
passing through the ductus arteriosus.

 This blood then enters the umbilical arteries and flows into the placenta. In the
placenta, carbon dioxide and waste products are released into the mother's
circulatory system, and oxygen and nutrients from the mother's blood are
released into the fetus' blood.

At birth, the umbilical cord is clamped and the baby no longer receives oxygen and
nutrients from the mother. With the first breaths of life, the lungs begin to expand. As
the lungs expand, the alveoli in the lungs are cleared of fluid. An increase in the baby's
blood pressure and a significant reduction in the pulmonary pressures reduces the need
for the ductus arteriosus to shunt blood. These changes promote the closure of the
shunt. These changes increase the pressure in the left atrium of the heart, which
decrease the pressure in the right atrium. The shift in pressure stimulates the foramen
ovale to close.

The closure of the ductus arteriosus and foramen ovale completes the transition of fetal
circulation to newborn circulation.
 List of the Growth and Development Theory

1.) Freud’s Psychosexual Development Theory

 Was based on his therapy with troubled adults.
 He emphasized that a child's personality is formed by the ways which his
parents managed his sexual and aggressive drives.

Stages and Age Characteristics

Stage I Oral Center of pleasure: Mouth (major source of gratification and

exploration)
o-1½
Primary need: Security Major conflict: Weaning
yr. old
Stage II Anal Source of pleasure : Anus & Bladder ( sensual satisfaction &
self-control)
1½ to 3
yrs. old Major conflict : Toilet training

Stage III Phallic Center of pleasure: Child’s genital (masturbation)

4 to 6 Major conflict: Oedipus & Electra Complex

years old

Stage IV Latency Energy directed to physical& intellectual activities

6 years Sexual impulses repressed

old to
Relationship between peers of same sex
puberty

Stage V Genital Energy directed towards full sexual maturity, function and
development of skills to cope with the environment.
Puberty
onwards

Erikson’s Stages of Psychosexual Development

Stage & Central Positive Negative Resolution Virtue

Age Task Resolution

Infancy Trust Learn to trust Mistrust, withdrawal Hope

estrangement
Birth-18 Vs.
(indifferent)
mos.
Mistrust
 Early Autonomy -Self- control -Compulsive, self- Will
Childhood vs. Shame without loss of self restraint or
and doubt esteem compliance.
1½- 3 yrs.
old -Ability of -Willfulness
cooperate& (deliberate) and
express oneself defiance.

Late Initiative -Leans to become -Lack of self- Purpose

childhood vs. guilt assertive confidence.

3-5 years - Ability to Pessimism, fear of

old. evaluate one’s wrongdoing, over-
own behavior control &over
restriction.

School Age Industry -Leans to create, -Loss of hope, sense Competency

vs. develop & of being mediocre.
6-12 years
Inferiority manipulate.
old - Withdraw from
-Develop sense of school and peers
competence& relationship.
perseverance.

Adolescence Identity -Coherent sense of -Feelings of Fidelity

vs. role self. confusion,
12-18 yrs.
confusion indecisiveness, and
old -Plans to actualize
possible anti-social
one’s abilities.
behavior.

Brazelton Neonatal Behavior Assessment Scale

Reflex Purpose Eliciting the Chacteristics Time of Abnormal Response
reflex Response Disappeara
nce
Blink To protect Shining a strong -Blinking of Difficult if not impossible
Reflex the eye from light coming the eye to elicit if infant has
any object. near it by rapid Flashlight or ophthalmic disability.
eyelid closure. otoscope light
on an eye
-A sudden
movement
toward the
eye.
Rooting “Search Brushing the Infant’s turns Disappears Difficult if not impossible
Reflex Reflex” helps check or head toward after 6 to elicit after infant has
baby to find stroking or stimulus and weeks of been fed. If weak absent
breast or touching near open his life but may consider prematurity or
bottle to the corner of the mouth to persist up neurologic defect.
begin mouth follow and to 1 year.
feeding root (attempt
Help to suck) in the
newborn to direction of
find food. stroking.
Sucking Helps in find Touching the Baby makes a Slowly Difficult if not impossible
Reflex food. newborns lips sucking replaces by to elicit after infant has
Have a hand- Touching the motion voluntary been fed. If weak,absent,
to- mouth roof of the sucking consider prematurity or
reflex goes baby’s mouth. around 2 neurologic defect.
with rooting
 and sucking months of
on fingers or age
hands.

Swallow- Helps food Putting food of The baby If weak or absent consider
ing that reaches the baby’s shallows the prematurity or neurologic
Reflex the posterior tongue. food. defect.
portion of
the tongue to
be
automaticall
y swallowed
Extrusion This is the Putting any Baby spits out Disappear Tongue protruding
Reflex protective substance on the the substance at about 4 without stimulation may
reflex that anterior of the months of indicate Down syndrome.
prevents the tongue. age
swallowing Tongue
of inedible protrudes when
substances touched with
finger or object
Palmar Also called “ Stroking the Baby will Grasp reflec When absent may due to
Grasp Darwinian palm of the close his disappear prematurity and
Reflex Reflex” baby’s hand fingers in a about 6 depressed from drugs.
To grasp grasp weeks to 3
object months age.
May strong
in
 Insurance premature
against baby
falling
Enables the
baby to
grasp to the
mother.
Step(Wal “Walking or Elicited baby’s Sudden head Disappear Indicate injury, paralysis
k)-in- Dance held in a vertical movement 3-4 months especially to brachial
Place Reflex” position with baby will plexus
Reflex their feet abduct and
touching own extend. Asymmetric response
cry possible injury,clavicular
Accurate or humerus
method of Embrace possible mental
eliciting the retardation.
reflex is hold
newborn in a
supine position
and allow their
heads to drop
backward about
1 inch(allowing
the baby’s head
to fall back
unsupported).
Babinski -Reflex to -Sole of the foot Fans out toes, Disappears Present after 1 year
Reflex insure stroke. and twist foot after the suspected neurological
against in. 3rd month involvement or disability.
falling.

Magnet Test for When there is Baby pushes Absent when the spinal
Reflex spinal cord pressure at the back against cord is damage or weak.
integrity. sole of the foot the pressure.
Crossed Test for When the sole of Causes the Absent when the spinal
extension spinal cord foot is foot to rise cord is damage or weak.
reflex integrity. stimulated by a and the other
sharp object foot extend
Truck Test for While in prone Causes flexion Disappear Absent when the spinal
Incurva- spinal cord position and the of the trunk after 1 cord is damage or weak.
tion integrity. paravertebral and swing his month
reflex area is pelvis toward
stimulated the touch.
Landau Test for While prone Exhibit some After 9-10
reflex muscle tone position and the muscle tone months
and present trunk is being
by 6 – 9 supported
months. underneath a Injury of muscles may
hand. hurt the baby.
Deep Tests are Patellar reflex Boney hard Injury or paralysis of the
tendon used to tapping patellar surface. area result no movements.
reflex determine tendon that will
the integrity make
of the spinal movements.
cord nerve
L2 and
peripheral
nervous
system,
Patellar
reflex.
Placing Test sensory Touch anterior Make quick Difficult to compensate
reflex and motor surface against lifting motion neonatal with neurologic
neurons the hard surface as it starting to (sensory and motor)
functions to gain support. make a step. disability.
Patellar Test sensory When an object The toes grasp Disappear Difficult to compensate
grasp and motor touches the sole in the same by 8 – 9 neonatal with neurologic
reflex neurons of a newborn’s manner as months in disability.
functions. foot at the base fingers do preparation
of toes or its with the palm. for walking
fingers.
Tonic Called a When a baby's The arm and 6 to 7 Difficult to compensate
neck boxer or head is turned to the leg on the months. neonatal with neurologic
reflex fencing one side, the side to which disability.
reflex arm on that side the head turns
Coordination stretches out and extend, and
of arm, leg, the opposite arm the opposite
 head and bends up at the arm and leg
neck. elbow contract.

Moro Test for A startle reflex In response to Disappear Difficult to compensate

reflex neurological because it the sound, the by 4 – 5 neonatal with neurologic
integrity usually occurs baby throws months) disability.
(jarring crib, when a baby is back his or her
loud voice) startled by a head, extends
loud sound or out the arms
movement. and legs, cries,
then pulls the
arms and legs
back in. A
baby's own
cry can startle
him or her and
trigger this
reflex.

III. Tools in Newborn Assessment

1. Apgar Scoring:
In 1953, Virgenia Apgar introduced a simple systematic assessment of
intrapartum stress and neurologic depression at birth.
  The Apgar score is a simple assessment of how a baby is doing at birth, which
helps determine whether your newborn is ready to meet the world without
additional medical assistance. Your practitioner will do this quick evaluation one
minute and five minutes after your baby is born.
 This score – developed in 1952 by anesthesiologist Virginia Apgar and now used
in modern hospitals worldwide – rates a baby's appearance, pulse,
responsiveness, muscle activity, and breathing with a number from 0 to 2 (2
being the strongest rating). The five numbers are then totaled.
 It's easy to remember what's being tested by thinking of the letters in the name
"Apgar": Activity, Pulse, Grimace, Appearance, and Respiration. Here's how each
is used to assess a baby's condition at birth:
Appearance (color)
0 The baby's whole body is completely bluish-gray or pale
1 Good color in body with bluish hands or feet
2 Good color all over

Respiration (breathing)
0 Not breathing
1 Weak cry; may sound like whimpering, slow or irregular breathing
2 Good, strong cry; normal rate and effort of breathing

The one-minute Apgar score

 The first Apgar score helps your practitioner decide whether your baby needs
immediate medical help. If your baby scores between 7 and 10, it usually means
he's in good shape and doesn't need more than routine post-delivery care.
 Baby scores between 4 and 6, he may need some help breathing. This could mean
something as simple as suctioning his nostrils or massaging him, or it could
mean giving him oxygen.
  If your baby scores 3 or less, he may need immediate lifesaving measures – a full-
fledged resuscitation. Keep in mind that a low score at one minute doesn't mean
that your baby won't be just fine eventually. Babies born prematurely or
delivered by cesarean section, for example, sometimes have lower-than-normal
scores, especially at one minute.
 The five-minute Apgar score
The second score helps your practitioner see how your baby is progressing and whether
he has responded to any initial medical intervention. A score of 7 to 10 is still
considered normal at this point. If your baby scores 6 or less at the five-minute mark, he
may need medical help and your practitioner will determine what steps need to be

taken.