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.
Describe the developmental markers a nurse should assess for a 9-month-old female infant.
The first step is to observe the child’s engagement in different activities. It is important to see if she likes social games, making sounds and noises, playing with toys, etc. Another way of assessing developmental markers for a 9-month-old female infant involves testing her motor skills (Rattana-Umpa et al., 2021). Test to see if she is crawling, grasping objects, and moving her arms and legs. One of the most important developmental markers a nurse should assess for a 9-month-old female infant is her speech. Test to see if she can say two or three words, or even make some sounds (Rattana-Umpa et al., 2021). Lastly, observe the child interacting with others. Observe if she is in eye contact when playing with another person and whether she seems interested in what the other person has to offer.
At 9 months, a child should be able to grasp objects, and she should show interest in toys. When a child is first born, it does not usually surprise a mother much if a child does not kick or make noises. After all, the child is only a few days old (Rattana-Umpa et al., 2021). However, when at 9 months the child has still been not kicking or making noises many mothers begin to get worried that something might be wrong with their baby.
When a child is born, the mother should be attentive to the child’s development to know if there are any developmental markers she sees that indicate the child might need some extra attention. The mother should be attentive to testing each of the known developmental markers (Premkumar et al., 2019). If there is a sign that she might need some extra attention such as she is not sucking properly or her head circumference did not increase, then she needs to consult a pediatrician immediately.
Discuss the recommendations you would give the mother.
A 9-month-old baby’s height and weight are always an important part of the medical evaluation. The CDC guidelines provide a useful tool to help determine whether growth may be abnormal. Although the baby has not yet reached a percentile, this information should allow you to determine if further tests might be needed (Centers for Disease Control and Prevention & National Center for Health Statistics, 2019). Most importantly, height and weight are good indicators of general health status and developmental delay, so it is crucial for your assessment.
The first thing the nurse should do is review the mother’s prenatal and postnatal history to determine if any abnormalities or events have occurred that may have affected the child’s feeding and growth. For example, a baby that has had a bout of diarrhea, pneumonia, dehydration, or any significant illness during this time may have suffered from poor feeding habits and slow weight gain.
When you examine your patient you should note if she’s in pain or uncomfortable. This is particularly important with a younger child. You should note whether the child is putting on weight appropriately, or if it appears that she is losing weight. All of this information will assist you in determining if additional tests are needed or if treatment is needed.
There are also other tests you can conduct during your assessment to determine a baby’s status. If you notice that the baby is jaundiced it may be a sign of a liver problem. To test for jaundice, the mother can be asked to remove the child’s shirt and observe for any yellowing on the skin (jaundice will generally appear on her face, neck, or chest). If she does not have any signs of jaundice you can test for it by using a special light to illuminate the baby’s skin. The light will cause the yellow pigments to absorb more light, which turns them dark.
The normal color for a baby’s skin is pink, so if you see dark spots in the light you can tell that the pigments are absorbed. Further testing may be needed to determine if there is some underlying problem with the liver. Additionally, other tests may be performed to determine if there are any problems with the blood, such as a vitamin B12 deficiency or anemia.
The infant’s general health status and developmental level are determined by age, weight, and head circumference. In general, a normal 9-month-old female infant is 25th percentile for height, 5th percentile for weight, and 25th percentile for head circumference. The baby’s diet is also important in the growth chart. There are numerous importance of breastmilk to a baby. Babies that are breastfed have a higher growth curve, especially if given iron-fortified cereals. Babies will also have different growth curves depending on their race. Caucasian babies generally have a greater growth curve compared to African American babies.
Explain why these recommendations are based on evidence-based practice.
The recommendations above are based on primary literature that is used as evidence to support the recommendations. The growth chart itself is based on a study done of over 2,700 infants in Scotland and published in the “British Journal of Pediatrics”. The information found in the growth chart is not specific enough to be used for clinical practice but does provide an understanding of normal growth ranges for the baby’s age and sex.
The growth chart explains where a baby falls in each percentile. This size is then compared with other babies of their age and sex worldwide to determine their status. Physicians must understand the growth chart, because it may be useful to provide pediatricians with a reference before they diagnose children (Wei et al., 2020). The growth chart uses measurements of weight and length at three times different times during infancy, for each month of the first year and last year. The average weight gain of a healthy baby is about 10 to 11 grams per day. The actual weight gain is determined by more than just how fast the baby gains weight, however.
A child’s intake of breast milk or formula feedings also has an impact on the amount of weight gain. So if a baby is being fed with bottles and you are seeing less than 10–11 grams per day, then you need to investigate further. The growth chart may be useful for pediatricians to determine whether the child has certain problems that might be health problems (Wei et al., 2020). Some examples of how it can be helpful are if a pediatrician wants to make sure that a child’s weight gain is adequate, or if they want to know if there are health issues related to poor growth.
If a child is not gaining enough weight, then it could be caused by health or dietary problems. The growth chart shows that the child is below their normal range, and if it continues to drop the pediatrician will know that there could be a problem (Wei et al., 2020). The growth chart may be used by parents to determine whether there are any problems with the baby’s weight or health.
The CDC Growth Charts help determine whether a baby is gaining too little or too much weight and also in determining what causes a baby to gain too much weight. If a child is above their expected weight by more than two standard deviations (SD), then a child may be at risk. This means that there is an increased chance for growth problems, learning problems, and behavioral problems. These children are on average about 2 to 3 SDs above their expected weight than the national average. In these cases, it may be necessary to consider the possibility of unhealthy habits like overfeeding or underfeeding or the presence of other health issues outside the scope of this growth chart such as diabetes or anemia.
References
Centers for Disease Control and Prevention, & National Center for Health Statistics. (2019). CDC growth charts: United States. May 30, 2000. https://t2sc.me/userfiles/14640612098.pdf
Premkumar, S., Venkatramanan, P., Dhivyalakshmi, J., & Gayathri, T. (2019). Comparison of nutrition status as assessed by revised IAP 2015 growth charts and CDC 2000 growth charts in lower socioeconomic class school children. The Indian Journal of Pediatrics, 86(12), 1136-1138. https://link.springer.com/article/10.1007/s12098-019-03036-w
Rattana-Umpa, N., Tanwatthanakul, J., & Santiboon, T. T. (2021). Associated indicator factors among inappropriate malfunctions’ development for the 9-month-old-baby. https://www.pediatricshealthjournal.com/articles/japch-aid1038.pdf
Wei, R., Ogden, C. L., Parsons, V. L., Freedman, D. S., & Hales, C. M. (2020). A method for calculating BMI z-scores and percentiles above the 95th percentile of the CDC growth charts. Annals of Human Biology, 47(6), 514-521. https://www.tandfonline.com/doi/abs/10.1080/03014460.2020.1808065