Topic 1 DQ 2: DESCRIBE THE DEVELOPMENTAL MARKERS A NURSE SHOULD ACCESS FOR A 9-MONTH-OLD INFANT

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.

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According to the CDC (2020) a 9-month-old baby should be able to do a few things that is important and will indicate how the baby progress for her age. Social and Emotional: Baby may be afraid of strangers and attached with those familiar with them. Language/Communication: Understands “no” and make different sounds that seems like “mama”, Cognitive: plays peek-a-boo, can hold cereal between pointer finger and thumb. Physical development: sits by themselves without support, crawls. (Green, 2018) These are` some of the developmental markers for a 9-month-old baby.

Various assessments are done to ensure that the baby is on the right track developmental wise. It is important for parents to be part of the assessments so they can understand what to look for. Before any recommendations can be given to the mother, assessment will be done in order to give appropriate information. I would talk to the mother and enquire about the baby’s feed regiment. I would also have to know if the mother was breast feeding. We will discuss feeding schedules and if the mother was breast feeding. It is important to know if she produces enough milk to satisfy the baby and how often. Once all the information is collected, we can recommend food that is nutritious for the baby, draw up a schedule to ensure that the baby eat, and drink as scheduled.

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References

Center for Disease Control and Prevention

(CDC). (2020). Important milestone: Your baby by nine months. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestone/milestone-9mo.html

Green,S.Z. (2018). Health assessment: Foundation for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundation-for-effective-practice/v1.1/

• JL

James Lokko

replied toValencia Classen

Jan 28, 2022, 11:20 PM

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Replies to Valencia Classen

Hello Valencia, it is true that feeding program of the baby are among the factors that ne must consider. For the case of breastfeeding mothers, we must understand the amount of milk the mother was producing since its fundamental in the development process of the child. I am impressed you have discussed an important factor that most people don’t think s impotant, especially with the diverse family set up that we have today.

Thank you. When babies or children present with underweight the first thing that comes to mind is feeding although they maybe underlying medical conditions,it is important to rule out those. For the breastfeeding mothers to be able to produce breast milk they should take themselves balanced meals , be well hydrated and have they their minds relaxed. Stress affects milk production so education on that should be given.

There are important milestones parents are looking forward to seeing their babies are practically able to do. Nine months is significant developmental milestones for babies. It is recommended by the American Academy of Pediatrics that children be screened for general development using standardized validated tools at 9,18, and 30 months and for autism at 18 and 24 months (Centers for Disease Control and Prevention (CDC), 2021). In the scenario with the baby girl length 68.5 cm, weight 6.75 Kg, and head circumference 43 cm. According to Medical News Today, the baby presents some developmental delay and underweight. At nine months a baby must have an average length of 70.1 cm and weigh 8.2 Kg. Weight plays an important role; it is one indicator of good nutrition and physical development.

When assessing a 9-month-old baby, the nurse must focus on important physical and mental developmental markers. Physically at nine months, the baby can crawl, reach out for objects while sitting, pull self to standing position, walk while holding to couch, chairs, feed self with fingers, and throw and shake objects (Medline Plus, 2021). At nine months, cognitively/mentally, the baby can show separation anxiety where she will start crying when the mother drops her off at the daycare, able to articulate words such as “mama” or “baba”, plays “peek-a-boo”, understands “no” (Misirliyan & Huynh, 2021).

Multiple factors can affect an infant nutritional and development status. Therefore, I will assess the household socioeconomic position by asking questions to the mother relevant to her status, on how she feeds the baby, environmental factors (presence of lead, drinking water, hygiene practices (Adhikari et al, 2017). Depending on her answers, I will make recommendations. First, if there is food scarcity, I will assist her to find available resources in the community such as WIC program and others. Second, I will educate the mother on how and what to feed by allowing finger foods while still breastfeeding. Third, I will recommend the mother to utilizing healthy diet with fruit, vegetables, meat to promote healthy growth.

References:

 Adhikari, D., Khatri, R.B., Paudel, Y. R., & Poudyal, A.K. (2017). Factors associated with underweight among under-five children in Eastern Nepal: Community-based cross-sectional study. Frontiers in Public Health. https://doi.org.10.3389/fpubh.2017.00350

 Medical News Today (n.d). What is the average baby weight by month? www.medicalnewstoday.com/article/325630

 Medline Plus (2021). Developmental milestones record – 9 months. US National Library of Medicine. www.medlineplus.gov/ency/article/002009.htm

 Misirliyan, S.S., & Huynh, A.P. (2021). Development milestones. Stat Pearls. www.ncbi.nlm.nih.gov/books/NBK557518/

Nine-month old infant currently in the 25^th percentile for head and height circumference with only 5^th percentile when it comes to the weight of the infant showcases that the baby is currently underweight and the infants body is not proportionate when it comes to the comparison of their circumference and height (Stein‐Zamir, Volovik, Rishpon, & Sabi, 2008). The developmental markers when it comes to the assessment of the infant includes banging table objects, the feeding of self-finger foods by the infant, sitting without support, crawling and pulling oneself to the standing position (Bondas, 2006). These markers will be generally used to describe the development of the 9 months old child.

There are other developmental markers for the 9 to 12 months old baby as well which include drinking via a cup, pointing at the different objects and formation of a sitting position all by itself, standing without help and walking alongside the furniture. Nurse should additionally assess for the ability of the baby to laugh, babble and blow bubbles. Tools for usage in developmental screening include Denver Developmental Screening Test for assessment of language development and motor development. Pamphlets or online resources like http://wwww.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html can be provided for parent to understand more about child development.

References:

Bondas, T. (2006). Paths to nursing leadership. Journal of Nursing Management, 14(5), 332–339.

Stein‐Zamir, C., Volovik, I., Rishpon, S., & Sabi, R. (2008). Developmental dysplasia of the hip: Risk markers, clinical screening and outcome. Pediatrics International, 50(3), 341–345.

     When assessing a nine month old child, there are many milestone markers that need to be assessed. This child in particular is below average in size therefore it is important to pay close attention to developmental milestones to ensure the infant is growing properly. Regarding fine motor skills, watching for body motions such as transferring objects from one hand to the other, banging objects, feeding self with fingers, crawling, and sitting unsupported. Gross motor skills that should be assessed include stepping motions, cruising, and scribbling with crayons. A thorough assessment should include making notes on nutritional status, alertness, and behaviors such as stranger anxiety and responding to verbal commands (GCU, 2018).

      The mother of this infant should be encouraged to continue routine checkups to monitor the growth and development of the infant. Studies have shown that incorporating both developmental monitoring and developmental screening can detect issues in children at an early age to provide for early intervention strategies and reduce long term effects or complications of issues. It has been shown that “early intervention receipt prevalence was higher for children receiving both developmental monitoring and screening” (Barger, B. et al. 2018). Continuous, routine monitoring of developmental milestones is important in tracking an infants growth progress. Educating parents on the developmental markers of infants at every stage in development is crucial in ensuring early detection of any issues that could arrive.

 Resources

Grand Canyon University (Ed). (2018). Health assessment: Foundations for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/

 Barger, B., Rice, C., Wolf, R., & Roach, A. (2018). Better together: Developmental screening and monitoring best identify children who need early intervention. Disability and Health Journal, 11(3), 420–426. https://doi-org.lopes.idm.oclc.org/10.1016/j.dhjo.2018.01.002

There are important milestones parents are looking forward to seeing their babies are practically able to do. Nine months is significant developmental milestones for babies. It is recommended by the American Academy of Pediatrics that children be screened for general development using standardized validated tools at 9,18, and 30 months and for autism at 18 and 24 months (Centers for Disease Control and Prevention (CDC), 2021). In the scenario with the baby girl length 68.5 cm, weight 6.75 Kg, and head circumference 43 cm. According to Medical News Today, the baby presents some developmental delay and underweight. At nine months a baby must have an average length of 70.1 cm and weigh 8.2 Kg. Weight plays an important role; it is one indicator of good nutrition and physical development.

When assessing a 9-month-old baby, the nurse must focus on important physical and mental developmental markers. Physically at nine months, the baby can crawl, reach out for objects while sitting, pull self to standing position, walk while holding to couch, chairs, feed self with fingers, and throw and shake objects (Medline Plus, 2021). At nine months, cognitively/mentally, the baby can show separation anxiety where she will start crying when the mother drops her off at the daycare, able to articulate words such as “mama” or “baba”, plays “peek-a-boo”, understands “no” (Misirliyan & Huynh, 2021). Multiple factors can affect an infant nutritional and development status.

Therefore, I will assess the household socioeconomic position by asking questions to the mother relevant to her status, on how she feeds the baby, environmental factors (presence of lead, drinking water, hygiene practices (Adhikari et al, 2017). Depending on her answers, I will make recommendations. First, if there is food scarcity, I will assist her to find available resources in the community such as WIC program and others. Second, I will educate the mother on how and what to feed by allowing finger foods while still breastfeeding. Third, I will recommend the mother to utilizing healthy diet with fruit, vegetables, meat to promote healthy growth