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1. INFANT ASSESSMENT PRESENTED TO : MRS. RINKY MASIH SENIOR NURSING TUTOR DMCH, CON, MALAKPUR PRESENTED BY : BHAWNA GOYAL ROLL NO. 18 BSC (N) 4 TH YEAR

2. INTRODUCTION It is the assessment of health of infant ( i.e. from 28 days to 1 year ) to know about the well being of baby, any growth and development delay and abnormality, teach the parent about child’s body and current status of health, as well as measures to ensure health in the future.

3. Objectives To know the well being of the baby. To note down any growth and development delay To assess the current health status of the baby. To educate parent about the infant care.

4. Purpose T o understand the physical and mental well being of the child. To detect disease in early stage. To determine the cause and effect of the disease. To teach child and parent. To measure the health in future. T o determine the nature of treatment or care needed for the child.

5. INFANT ASSESSMENT In infant assessment physical assessment Anthropometry assessment Growth And Development Reflex's Immunization Nutrition

6. POINTS TO REMEMBER Interacts with mother and do not try to touch and interact with child in the be ginning as child may not cooperate due to strangers' anxiety While interacting with mothers s end maximum time on observation of child for social responsiveness , alertness , concentration , interest and distractibility Keep recording vocal responses I terms of freq uency and quality of the vocalization s Go ahead and interact with child Vision and hearing must be assessed in the beginning Perform the development al assessment before the systemic examination Offer toys , pellets, cubes or form board to asses the skill as per the age appropriately Perform annoy ing maneuvers at the end such as assessing reflexes, head circumference, ve ntral suspension , pull to sit another maneuvers .

7. Articles for infants assessment

8. ARTICLES FOR ASSESSING GROWTH AND DEVELOPMENT A R ed ring (diameter 6.5 cm) tied to a string Nine red cubes (1" side) P aper pellets Spoon Cup with handle A book with thick pages P icture book Red pencil Doll and mirror Paper NOTE : Always carry a list of key milestones with normal age of their achievement.

9. Definitions GROWTH refers to the increase in size, or mass of tissue. It include of cells and increase in intraocular substance hypertrophies do not contribute to growth . DEVELOPMENT specifics maturation of functions which means progressive increase in skills and capacity of function.it is related with the maturation and myelination of nervous system

10. The assessment of growth and development of child requires experience and in depth knowledge . It is important to take a brief history and monitor vital signs before proceeding with the growth and development assessment. Ask for probable risk factors ,evaluation of rate of acquisition of skills and differentiation between delay and regression and keep observing the child activity while conversing with the mother.
These activities will help in formation of a gross impression about the development age. Perform a gen eral physical assessment and look particularly for dysmorphism , stigmata of intrauterine infection s and signs of hypothyroidism , assess physical growth and head circumference , and then perfume developmental assessment .

11. ANTHROPOMETRY MEASUREMENTS [plot all the parameters in WHO growth chart and specifics interpretation ]

12. WEIGHT : The Average birth weight of Indian newborn is 2. 5-3 kg. The weight doubles by 6 months, triples by one year . After plotting in charts mention whether normal weight for age/ underweight or severely underweight.

13. LENGTH : The length at birth 50 cm, at 3 months 60 cm, 9 months 70 cm, at one year 75 cm, at 2 years 90 cm, at 4 and half years 100 cm . A rough estimation formula to estimate increase in length is 2.5 cm/month for 1st 6 months of life, 1.2 cm/month for Next 6 months. This is a good indicator of chronic malnutrition . After plotting in chart mention whether normal height for age stunted or severely stunted or severely wasted.

14. Cont. Weight for height : This is a good indicator of acute malnutrition. After plotting in chart mention whether normal weight for height, wasted or severely wasted

15. Cont. HEAD CIRCUMFERANCE: At birth, head circumference is 33-35, increase by 2 cm per month up to 3 months, 1 cm/month for next 3 months and 0.5 cm/month for next 6 months. REMEMBER if it is increase >1cm/2 weeks in f irst 3 months it indicates hydrocephalus

16. Cont. CHEST CIRCUMFERENCE AT BIRTH, CHEST CIRCUMFERENCE IS 3 CM LESS THAN HEAD CIRCUMFERENCE The chest circumference is equal to head circumference at 1 year of age. Thereafter chest circumference exceeds the head circumference .

17. GROWTH MONITORING CURVE CHART: FOR GIRLS

18. GROWTH MONITORING CURVE CHART: FOR BOYS

19. ASSESSMENT OF DEVELOPEMENT The developmental assessment is performed under five main areas: 1. Gross motor development 2. Fine motor skill development 3. Personal and social development and general understanding 4. Language 5. Vision and hearing

20. GROSS MOTOR DEVELOPEMENT It is related with large movements such as crawling ,standing and walking Gross motor assessment sis performed : Supine and pull to sit Ventral suspension Prone position Siting Standing and walking

21. GROSS MOTOR ASSESSMENT POSITION AGE IN WEEKS GROSS MOTOR MOVEMETNTS Supine and pull to sit : hold a neonate gently from the arms to the sitting position At birth Complete head lag 4 weeks Tries to hold neck momentarily and the curvature of back is prominent 12 weeks Hold neck in mid line and curvature of back is naot promiment 20 weeks Maintains head In mid line even if swayed form one side to other

22. Cont. POSITION AGE IN WEEKS GMM Ventral suspension: Lift a neonate in prone position and hold in the air while the chest and abdomen are supported Birth to 4 weeks Head flops 6 weeks Momentarily holds the head in horizontal plain 8 weeks Holds the headin horizontal plain for longer duration 12 weeks Hold the head above horizontal plain

23. Cont. POSITION AGE IN WEEKS GMM Prone position: Make a neonate to lie down on the prone position. At birth Turns head to one side 2 weeks Keep his knees flexed with high pelvis 4 weeks Momentarily lifts the chin 6 weeks Lies with flat on pelvis with extended hips 8 weeks Lifts the face at 45" but the shoulder remain on the bed

24. Cont. POSITION AGE IN WEEKS GMM 12 weeks Lifts the face at 45 degree with chin and shoulder off the couch and support the upper body with extended arms 4-6 months Roll over form back to side and then form back to abdomen, then abdomen to back 6 months Lifts the face or 90 degree with chin and shoulder off the couch and support the upper body with extended arms 8 months Crawls 10 months Creeps

25. Cont. POSITION AGE IN WEEKS GMM Sitting 5 months Sit with support 6-7 months Sit with the support of extended arms 8 months Sit without support 10-11 months Pivot to play around the toys Standing and walking 6 months Bear weight when made to stand

26. Cont. POSITION AGE IN WEEKS GMM 9 months Begins to stand holding on to furniture 10-11 months Cruise around the furniture 12-13 months Stand independently and can walk when held from one hand 13-15 months Walk independently 18 months Runs, crawl up and down the stairs, pull toy and wheel chair

27. Fine Motor assessment Fine Motor development is related with smaller movements. It is assessed under four main areas hand and eye coordination, hand and mouth coordination, dressing skills and advance hand skills.

28. POSITION AGE IN WEEKS Fine Motor assessment Hand and eye coordination 12-20 weeks Hand regard : observe hand intently 3-4 months Offer dangling ring and observe how infant reaches up to it, if uses both hand to reach this, is called as bidextrous reach 6 months Offer dangling ring and observe how infant reaches up to it , if uses both hand to reach this is called as unidextrous reach , offer a cube and see how infant hold it.he will use ulnar boarder to hold it. 6-7 months Offer a cube and look transfers of objects from one hand to other. 1 year Offer paper pellets the infant will try to hold it with thumb and index finger and will demonstrate mature grasp know as pincer grasp.

29. Cont. POSITION AGE IN WEEKS Fine Motor assessment Hand to mouth coordination 0-1 year Puts everything into mouth 6 months Starts chewing 15 months Drinks from cup without spillage, tries to feed self with spoon but spills out everything 18 months Feeds self well with spoon Dressing skills ( learns in between 18 – 30 months) 1 year Pull off mittens , caps and socks

30. Personal And Social Development And General Understanding Skill Assessment POSITION AGE IN WEEKS USA Self development 1 month Intently watches his mother when talked 6-8 weeks Social smile 3 months Recognises mirror 6 months Smiles at mirror, imitates acts such as cough or tongue protrusion 7 months Stranger anxiety, inhibits to “no”

31. Cont. POSITION AGE IN WEEKS USA 9 months Waves “ bye- bye” , repeat any performance that evokes an appreciative response 1-2 years Asks for food, drink, toilet, pulls people to show toys stranger anxiety General understanding 1 year Understand simple phrases like “ where is papa”, “ where is your ball”.

32. Language: Assessment of Language Skills POSITION AGE IN WEEKS Language skills assessment Language 8-10 weeks Vocalize with vowel sounds “ah”, “uh” 3-4 months Squeals with delight and laughs loud 5 months “ah goo , gaga” 6 months Mono syllables ( ba , da, na ) 8-9 months Bisyllables ( mama, baba, dada)

33. Cont. POSITION AGE IN WEEKS Language skills assessment 9-10 months Imitate sounds derived from his native language 12 months Joint 2-3 words Vocabulary 12 months Say 2-3 words with meaning.

34. Vision And Hearing : Assessment of vision And Hearing

35. POSITION AGE IN WEEKS Vision And Hearing skills assessment Vision Birth Fixate on and follow a moving person Can see a dangling ring held at 8-10 inches at 45 degree 4 weeks Fixate on his mother as she talks Can see a dangling ring held at 8-10 inches at 90 degree 12 weeks Can see a dangling ring held at 8-10 inches at 90 degree 3-4 months Fixates intently on an object shown to him ( “ grasping with the eye”) it appears that the child wants to each for the object 4 months Well established binocular vision

36. Cont. POSITION AGE IN WEEKS Vision And Hearing skills assessment 6 months Adjust position according to location of object 1 year Follows rapidly moving objects Hearing Birth Responds to sounds by startle, blink, cry, quieting or change in ongoing activity 3-4 months Turns his head towards the source of sound 10 month Directly looks at the source of sound diagonally

37. EVALUATION OF DEVELOPMENT The development delay is seen in 10% of children. The speech impairment, hyperactivity and emotional disturbance are often not detected till the child is 3-4 years old and learning disabilities are not Picked up till the child starts schooling. Significant delays on screening are an indication for a detailed formal assessment of development status.

38. DEVELOPMENT QUOTIENT ( DQ) FOR ANY DEVELOPMENT SPHERE It is calculated as: DQ below 70% is taken as delay and warrants further detailed evaluation. In such case refer the child to psychologist for detailed assessment. Retardation can not be diagnosed on a single feature, therefore repeat examination is needed. Factors – recent illness, significant malnutrition, emotional deprivation, slow maturation. Sensory deficits, neuromuscular disorder should always be taken into account. Keep in mind the opportunities provided . Look for red flag signs and refer child for further evaluation os these signs are indicator of significant delay. D Q = DEVELOPMENT AGE x 100 CHRONOLOGICAL AGE

39. RED FLAGS SIGNS IN CHILD DEVELOPMENT No visual fixation or following by 2 months. No vocalization by 6 months Not standing alone by 16 months Not walking alone by 18 months No single words by 18 months Lack of imaginative play at 3 years Loss of comprehensive, single words or phrases at any age .

40. Documentation Documentation the findings as per domain . Under each domain specify any delay/ regression reported by primary care giver and mention the findings of your assessment. Calculate DQ and action taken, for example DQ is less than 70% , mention that the child was sent to psychologist for further evaluation.

41. Assessment of Reflex's

42. PROCEDURE: Types of Reflex's

43. Cont.

44. Palmar and plantar grasp. Galant reflex

45. IMMUNIZATION ASSESSMENT

46. NUTRITION ASSESSMENT Assess nutrition pattern in infant : Exclusive breastfeeding Weaning diet ( after six month) Begins liquids of 6 months Semiliquid at 8 months Solid at 12 months

47. HEALTH EDUCATION