02.02 Growth & Development – Neonate

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Overview

  1. Major development goals of the neonate are:
    1. Adapting to life outside the womb
    2. Bonding with care givers
    3. Learning to feed

Nursing Points

General

  1. Neonates period = first 30 days of life

Assessment

  1. Physical changes
    1.  Growth
      1. May lose 10% of their birth weight
      2. Should regain this within the first 2 weeks of life
  2. Development
    1. Newborn reflexes are present
      1. See OB lesson on Newborn Physical Exam and Newborn Reflexes
    2. Not expected to have head or neck control
    3. Vision and hearing are intact
      1. Hearing screen performed after birth
      2. Can only see objects that are close up
  3. Cognitive
    1. Piaget- Sensorimotor stage
    2. Behavioral Stages
      1. Quiet sleep
      2. Active sleep
      3. Quiet alert
      4. Active alert
      5. Crying
  4. Psychosocial
    1. Erikson’s- Trust vs Mistrust
      1. Should bond with primary caregivers as needs are met
    2. Sleeps 15-20 hours per day
    3. Eats every 2-3hours per day

Therapeutic Management

  1. Patient interactions
    1. See OB lesson “Initial Care of the Newborn”
    2. Support parent child bonding
      1. Provide education on-
        1. Feeding
        2. Responding to babies cues
        3. Safe comfort measures for baby
          1. Swaddling, cudding, rocking, pacifiers
  2. Common issues
    1. Jaundice
    2. Weight loss and difficulty feeding
    3. Neonatal fever
    4. Reflux
    5. Diaper rash
    6. Thrush
    7. Constipation
    8. Congenital defects

Nursing Concepts

  1. Human Development
    1. Neonates are fully dependent and require complete care from caregivers
  2. Patient Centred Care
    1. Understanding development and growth of a neonate is important for providing nursing care that is age approprite.
  3. Safety
    1. Neonates are a high risk patient group.
    2. Educating parents on risks associated with neonates is an imporant part of illness and injury prevention.

Patient Education

  1. Educate parents on safe sleeping and SIDS prevention.
  2. Provide feeding support and education for parents.
  3. Educate parents on ways to prevent Abusive Head Trauma (Shaken Baby Syndrome).

Reference Links

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Video Transcript

Okay guys in this lesson we are going to talk about growth and development in the neonatal phase.  There are a couple other lessons you should check out to get a more complete picture of neonatal care and these are the OB lessons on how to complete a newborn physical exam and also the one on newborn reflexes.  Okay- let’s get started!

The neonatal phase is from birth to 30 days.  Some people may say birth to 28 days, but you get the idea.  Now one thing to consider here is if the baby was born prematurely or not.  The first 30 days of life are going to look extremely different for a baby born full term vs a baby born 8 weeks early. 

Either way though the major goals are the same- just the amount of medical support they will need will vary.  These babies need to learn to adapt to life outside the uterus- and the two most important things for that are learning to feed and bond with their caregivers. 

It’s a pretty high risk phase in terms of development because they are fully dependent and physiologically there are a lot of congenital defects and abnormalities that may not have been picked up on in during prenatal scans.  We’ll talk a little more about specific issues that may arise and you’ll see how your nursing care reflects these goals
First, let’s go through a few these 4 different categories and talk about important milestones and things you should be assessing for.  

Growth is a really important thing for us to keep an eye on during the neonatal phase.  Like I said, they are learning to feed first the first time and this isn’t always an easy thing for a baby to coordinate.  It can be stressful. So we feed to watch babies weights closely in the first month. It is expected that initially they will lose some weight- up to 10%, but they should regain this within the first 2 weeks of life. 

Some important developmental things to assess for are, newborn reflexes and hearing.  Remember to check out the OB lesson on newborn reflexes if you aren’t familiar with them.  In general though, the presence of these reflexes is a positive sign of a healthy neurological system.  Hearing screens are done after birth. Sometimes babies have fluid in their ears and may not pass straight away and have to be retested.   Vision for newborns is pretty undeveloped but they can see things up close so bonding occurs really nicely with feeding as the baby is being held up closely for face time.   We would not be expecting head and neck control at these phase – so they still need full support when being held. 

Cognitively, neonates are in the reflex stage of the sensorimotor phase.  This means they are fully learning through those primitive reflexes we talked about so sucking and feeding as well as any eye contact and comfort they are receiving.   There are some behavioural stages you can look for and being aware of these may help as you are planning nursing interventions or helping parents learn to care for their new baby.    These are the quiet asleep stage, active asleep stage, quiet alert stage, active alert stage, and crying stage- The best times to try and feed are the quiet alert and the active alert- these are also the best time for face to face time and tummy time.  The crying stage usually indicates the baby is over stimulated and ready to sleep or feed again. .

Psychosocially- the neonate is in the trust vs mistrust stage.  Again the most important things for this stage are feeding and bonding with their caregiver.  In terms of routine – neonates are likely to sleep 15-20 hours per day and will eat every 2-3 hours.   One thing to highlight here is that we aren’t just assessing the baby here, we are assessing the entire family.  So we may need to assess for how well the parents are coping and need to be thorough with our assessments for maternal depression and checking to see if parents have a supportive community. 

Your interactions with caregivers and the patient, if the patient isn’t acutely unwell, are likely to be centered on providing feeding support and also providing some education on topics like how to safely comfort the baby, how to recognize cues that the baby is hungry or tired and also how to make sure the baby is sleeping in a safe environment to reduce the risk of sudden infant death syndrome.   Some health issues or diagnoses that can be associated with this age group are jaundice, weight loss, reflux, thrush and congenital defects. 

Your priority nursing concepts when providing nursing care to a neonate are human development, patient centered care and safety. 

Okay- let’s recap the key points for this lesson on growth and development for the neonate.  The neonatal period is from birth to 30 days.   The primary goals for this stage are feeding, bonding and basically just adjusting to life outside the uterus.  A lot of what we are doing during this stage is providing support to parents.  This usually means providing education on topics like feeding, safe sleep and how to comfort the baby.  Common health issues to be aware of are jaundice, weight loss and congenital defects.  

That’s it for our lesson on growth and development for the neonatal phase.  Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!

 

Read more

  • Question 1 of 6

The nurse enters the clinic room and observes the mother of a 2-week-old holding a rattle in front of the neonate’s face. The neonate is looking at the rattle. The nurse recognizes that this neonate is in which of the following behavioral states?

  • Question 2 of 6

A mother of a 2-week-old baby calls the clinic concerned that her baby is having difficulty feeding. Which of the following statements by the mother does NOT cause concern?

  • Question 3 of 6

Which statement reflects a mother’s appropriate understanding of development goals for a neonate? Select all that apply.

  • Question 4 of 6

While teaching the parents of a newborn about care of their 3-day-old infant, the nurse tells the parents about how many wet and soiled diapers the infant should have each day, which would indicate that the client is getting enough to eat. Which information from the nurse is correct?

  • Question 5 of 6

The nurse is assessing a neonate born six weeks early who was brought to the clinic for a follow up visit by the mother. The nurse knows that the neonate stage is which of the following for a baby born 6 weeks early?

  • Question 6 of 6

The nurse is assessing a neonate at a 1-month well-check. Which of the following statements by the mother is most concerning to the nurse?