1. INFANT ASSESSMENT
PRESENTED TO : MRS. RINKY MASIH
SENIOR NURSING TUTOR
DMCH, CON, MALAKPUR
PRESENTED BY : BHAWNA GOYAL
ROLL NO. 18
BSC (N) 4TH 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
To 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.
To 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
beginning as child may not cooperate due to strangers' anxiety
While interacting with mothers send maximum time on observation of child for
social responsiveness, alertness, concentration, interest and distractibility
Keep recording vocal responses I terms of frequency and quality of the vocalizations
Go ahead and interact with child
Vision and hearing must be assessed in the beginning
Perform the developmental assessment before the systemic examination
Offer toys, pellets, cubes or form board to asses the skill as per the age
appropriately
Perform annoying maneuvers at the end such as assessing reflexes, head
circumference, ventral suspension, pull to sit another maneuvers.
8. ARTICLES FOR ASSESSING GROWTH
AND DEVELOPMENT
A Red ring (diameter 6.5 cm) tied to a string
Nine red cubes (1" side)
Paper pellets
Spoon
Cup with handle
A book with thick pages
Picture book
Red pencil
Doll and mirror
Paper
NOTE : Always carry a list of key milestones with normal age of
their achievement.
9.
10. 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
11. 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 general physical assessment and look particularly for
dysmorphism , stigmata of intrauterine infections and signs of
hypothyroidism, assess physical growth and head
circumference, and then perfume developmental assessment .
13. 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.
14. 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.
15.
16. 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
17. 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 first 3 months it indicates
hydrocephalus
18. 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.
21. 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
22. GROSS MOTOR DEVELOPEMENT
It is related with large movements such as
crawling ,standing and walking
Gross motor assessment sis performed :
1.Supine and pull to sit
2.Ventral suspension
3.Prone position
4.Siting
5.Standing and walking
23. 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
24. 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
25. 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
26. 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
27. 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
28. 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
29. 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.
30. 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.
31. 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
32. 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”
33. 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”.
34. 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)
35. 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.
37. 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
38. 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
39. 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.
40. 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.
DQ =DEVELOPMENT AGE x 100
CHRONOLOGICAL AGE
41. 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 .
42. 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.
