Consider the following patient scenario:
A mother comes in with 9-month-old girl. The infant is 68.5cm in length (25th percentile per CDC growth chart), weighs 6.75kg (5th percentile per CDC growth chart), and has a head circumference of 43cm (25th percentile per CDC growth chart).
Describe the developmental markers a nurse should assess for a 9-month-old female infant. Discuss the recommendations you would give the mother. Explain why these recommendations are based on evidence-based practice.
There are different developmental milestones a child should achieve at every stage in life, although there might be some delays at some stages. A 9-month old girl with a 68.5 cm length, 6.75 kg weight, and a 43 cm head circumference is considered minimally underweight per the Center for Disease Prevention and Control (CDC, 2017) standard but not something to worry about. Nurses should assess the baby and recommend that the mother should report to the hospital (pediatricians) if the child is not able to perform some physical and neurological functions, which are as follows: crawl forward or backwards, feeds self, pulls up to stand, uses simple gestures like bye bye, sits without support for a short time, responds to sounds and calls, says small letter words like mama, drinks from a cup, copies others while playing; and many more (GCU, 2018). Evidence has shown that a 9-month old child should be able to achieve all this, but if deviated, further assessment should be conducted physically and neurologically. If a child is not able to attain such a goal at nine months, it means there might be autism or other congenital abnormalities causing the delay in the child’s developmental milestone. Some socioeconomic factors might cause some developmental delays, which are sometimes not easily detectable during assessment NRS-434 Topic 1 DQ 2.
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References
Center on the Developing Child. (2013). Early childhood mental health (InBrief). Retrieved from https://developingchild.harvard.edu/resources/inbrief-early-childhood-mental-health/.
Grand Canyon University (Ed. 2018). Health Assessment: Foundation for Effective Practice. Retrieved from: https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/2.
Office of Disease Prevention and Health Promotion. (2017). Early and middle childhood. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/early-and-middle-childhood.
NRS-434 Topic 1 DQ 2 SAMPLE 2
A mother comes into my care with a 9-month-old
daughter and this RN assess the patient for developmental milestones as well as
the vital signs. These milestones fall into different categories such as
social/emotional, language/communication, cognitive as well as movement/physical
development milestones.
The patient’s weight is of concern. She weighs less than ninety-five percent of other babies her age. Her length is in the twenty fifth percentile meaning she is not as long as seventy five percent of other babies. This should be taken into consideration of her weight but does not completely account for low weight.
In assessing social/emotional milestone the RN will look for the infant’s ability to recognize parents/caregivers. The child should be able to notice when her name is called. When the mother leaves the room the 9-month-old should notice and display behaviors such as looking or reaching around for mom or cries. The girl can display physical signs of emotion like happy, sad, angry, or surprised. The baby is shy, clingy, or fearful of strangers. When peek a boo is played, she smiles and laughs.
The language/communication milestones at this age are simple. The infant makes a lot of different like “mamama” or “babababa”. The baby girl holds her arms up to communicate that she wants to be picked up.
There are important cognitive milestones to be assessed as well. If the baby girl drops something, or it is out of sight, she looks around for the object. The infant at this age is banging things together to make sounds. Showing that they understand what is making the sound and how it is made.
This infant girl has physical/movement milestone that need assessing. The baby can sit up on her own. When sitting up she can hold her position by herself. She can pass an item from one hand to the other. Makes a tool out of the hands by raking food towards her.
There are other important assessment questions to ask mom on this visit. Does the baby have any skills that she no longer performs? Was the baby premature or have any special healthcare concerns? Does the baby girl do or not do anything that causes concern? Was the baby premature?
There are specific areas of concern that I would discuss with the mother. The foremost issue I would address is the infant’s weight. This does not correlate with healthy baby growth charts put out by the CDC and WHO. The infant nutritional needs in the first year of life are high due to the rapid growth. I would recommend that mom follow the guidelines set forth by the CDC for nutritional goals for 9 moth old infants. The child needs nutritionally dense foods. Sweets are to be avoided especially high fructose corn syrup. The baby has a small stomach at this age so she will need frequent feedings. Snacks are to be implemented at nine months and should be nutritionally sound. Not meeting the nutritional needs leads to higher incidence of developmental delay, and chronic diseases (Grand Canyon University (ed), 2018). I would recommend that the mom follow the CDC guidelines on milestone markers and relate any issues or discrepancies to the pediatrician.
References
Grand Canyon University (ed). (2018). Health assessment: Foundations for effective practice.https://doi.org/https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/
Important Milestones: Your Baby By Nine Months. (2022, August 9). CDC. Retrieved September 9, 2022, from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html
NRS-434 Topic 1 DQ 2 SAMPLE 3
Physical, verbal, emotional, and intellectual milestones are used to assess a person’s
level of development. A female newborn that is 9 months old should have a length of
between 68.5 and 71 centimeters and a head circumference of around 44 millimeters. Having
said that, the information provided suggests that the youngster has a very low body mass
index (Growth Charts – Clinical Growth Charts, 2019). Crawling, sitting independently,
pulling herself to standing, standing with help, and making gestures that resembled walking
were some of the other physical milestones accomplished by the nine-month-old. Aversion to
unfamiliar people, a need to be near loved ones, and a preference for certain types of toys are
all examples of emotional signals.
The responses to the questions on the mother’s child’s growth play a significant role in
the formulation of the recommendations for the mother. Examining the eating routines of the
child is necessary in order to have a better understanding of why the youngster is underweight.
It is beneficial to examine the pattern of the baby’s eating and to ascertain whether the
mother is breastfeeding. If the woman plans to breastfeed her child, it is very important to
offer nutritional meals for the infant and to monitor the mother to ensure that she is feeding
her child often enough and that she is producing an acceptable amount of milk.
The process of making decisions based on evidence, on the other hand, takes into
consideration the specifics of each circumstance. The clinical condition provides the
foundation for any necessary alterations to the recommendations that are based on the facts.
As a direct result of this, judgments that are founded on evidence have the duty to take into
account the perspectives of both patients and specialists in the field (Frolek Clark &
Schlabach, 2013). In order to provide direction that is supported by evidence, studies on the
characteristics of children of that age have been analyzed.
References.
Frolek Clark, G. J., & Schlabach, T. L. (2013). Systematic Review of Occupational Therapy
Interventions to Improve Cognitive Development in Children Ages Birth–5 Years.
The American Journal of Occupational Therapy, 67(4), 425–430.
https://doi.org/10.5014/ajot.2013.006163
Growth Charts—Clinical Growth Charts. (2019, January 11).
https://www.cdc.gov/growthcharts/clinical_charts.htm NRS-434 Topic 1 DQ 2