GROWTH AND DEVELOPMENT
GROWTH DEVELOPMENT MATURATION DEVELOPMENTAL TASK CRITICAL PERIODS FACTORS INFLUENCING G & D HEREDITY – Genes Sex – Race & nationait! – Intei"ence Le#e – ENVIRONMENT P$e%nata – Post%nata – PRINCIPLES Lie%on" '$ocess O$(e$! se)*ence & (i$ectiona In*ence( +! acto$s In(i#i(*ai,e( T-e$e a$e s'*$ts o "$o.t P$e(icta+e sta"es a$e 'asse( t-$o*" Lea$ne( +! '$actice P$i/iti#e $eexes /*st (isa''ea$ 0e-a#io$ is t-e /ost sensiti#e & co/'$e-ensi#e Pa! S!ste/s (o not (e#eo' at t-e sa/e ti/e T-e$e is a ti/e o$ e#e$!t-in"
THEORIES OF GROWTH & DEVELOPMENT Ps!c-osocia De#1t acc to E$ic2son & Ps!c-osex*a De#1t acc to 3$e*( AGE ERICKSON FREUD TRUST VS INFANCY ORAL MISTRUST AUTONOMY VS TODDLER ANAL SHAME & DOU0T INITIATIVE INITIATIVE VS PRE-SCHOOL PHALLIC4OEDIPAL GUILT INDUSTRY VS SCHOOL AGE LATENCY IN3ERIORITY IDENTITY VS ROLE ADOLESCENT GENITAL DI33USION INTIMACY VS YOUNG ADULT ISOLATION GENERATIVITY VS MIDDLE AGE STAGNATION INTEGRITY VS OLDER ADULT DESPAIR
Mo$a De#1t acc to Ko-+e$" & Tince PRE% Sta"e 5 % 5%6 !4o CONVENTIONAL % C-i( (oes $i"-t to "ain 'a$ent1s LEVEL a''$o#a Sta"e 7 % 6%8 !4o % P*nis-/ent%o+e(ience Sta"e 6 % 9%: !4o % Inst$*/enta -e(onis/ an( conc$ete
Sta"e 8
Sta"e 9
POST% CONVENTIONAL LEVEL
Sta" Sta"ee <
$eci'$ocit! % :%75 !4o % O$ientation to inte$'e$sona $eations o /*t*ait! % 75 75%76 !4 !4o % Maintenance o socia o$(e$; ixe( $*es & a*t-o$ities % O#e$ O#e$ 76 !4o % Socia cont$act; *tiita$ian % 3oo.s stan(a$(s o societ!
Sta"e Sta"e <0 % Hi"-e$ Hi"-e$ a. & conscie conscience nce o$ientat o$ientation ion Sta"e Sta"e =
% Uni#e$ Uni#e$sa sa et-i et-ica ca '$in '$inci' ci'ee o$ient o$ientati ation on % 3oo.s inte$nationa stan(a$( o con(*ct
Co"niti#e De#1t acc to Pia"et SENSORIMOTOR - 5%6 Y4O - Reexes *se( to inte$act .4 en#i$on/ent - Lea$nin" is +! t$ia an( e$$o$ - So.! +eco/e a.a$e t-at o+>ects -a#e 'e$/anence PRE%OPERATIONAL4PRECONCEPTUAL - 8%: !4o - Use o an"*a"e - T-in2s o se - Una+e to *n(e$stan( conc$ete $eations-i' INTUITIVE - <%: !4o - Ma"ica t-in2in" - E"ocent$ic - Cente$in" CONCRETE OPERATIONS - ?%76 Y4O - In(*cti#e $easonin" - Conse$#ation - Re#e$si+iit! 3ORMAL OPERATIONS - 78%7= !4o - Int$os'ection - De(*cti#e $easonin"
S'i$it*a De#1t acc to 3o.e$1s Sta"e I % inanc! % P$i/a ait% E/+o(ies t$*st +et.een inants & 'a$ents Sta Sta"e II % Ea$ Ea$! ! c-i c-i((-oo -oo( @8% @8%:: !4 !4o % Int*iti#e%P$o>ecti#e ait% 3o$/ation o on" astin" i/a"es & eein"s Sta" Sta"ee III III % C-i( C-i(-o -oo( o( & +e! +e!on on(( @:!4 @:!4o% o%a( a(o oes esce cenc nce e % M!t-ic%Lite$a 3ait% 0eies a$e (e$i#e( $o/ t-e 'e$s'ecti#es o ot-e$s Sta Sta"e IV % A(o A(oe esc scen entt & +e +e!on( !on( % S!nt-etic con#entiona ait% Pe$son1s ex'e$ience exten(s +e!on( -is i//e(iate ci$ce
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CARE OF THE ILL CHILD
NORMAL CHARACTERISTICS OF A NEONATE
Co//on ReactionsB 7 Anxiet! 6 G*it 8 Re"$ession 9 Co#e$in"%*' < A""$ A""$es essi sion on4P 4Pas assi si#i #it! t!
1.
ANTH ANTHRO ROPO POME METR TRIC IC MEAS MEASUR UREM EMEN ENTS TS @0ODY MEASUREMENTS A. WEIGHT AND LENGTH A/e$icans % <8 c/ @ 67 inc-es % :: +s 3ii'inos % 9:< <6 c/ @<5 c/ o$ 7F 65 inc-es % =< +s o$ 8555 "$a/s
AGE GROUP IN3ANTS & TODDLERS
CONCERN Anxiet! Consistenc!
REXNS P$otest Des'ai$ Denia 3antasies @ /a"ica t-in2e$s
PRE% SCHOOL
Se'a$ation M*tiation Rit*as
SCHOOL AGE
Sc-oo He'essness
P-o+ia
ADOL ADOLES ESCE CENT NT
De'e De'en( n(en ence ce 0o(! I/a"e He'essness
Denia .it-($a.a An"e$
TOOLS Roo/%in CCG Pa$ent s*+ Pa! T-e$a'! % (os 0an(%ai(s A#oi( te$/s G$o*' 'a! Honest! In#o#e/ent In(e'en(ence P$i#ac! E(*cation
TOYS / PLAY C-$onoo"ic4De#eo'/enta C-$onoo"ic4De#eo'/ent a a"e o Ca'acit! o T-e$a'e*tic '*$'ose o Saet! o PREPARING THE CHILD FOR DIAGNOSTIC PROCEDURES EMPATHY o TRUST o EPLAIN IN SIMPLE; CLEAR TERMS o LET CHILD EPRESS HIMSEL3 o EPLAIN IN ADVANCE WHAT THE CHILD WOULD 3EEL o PAIN - It is whatever the experiencing person says it is; existing when the person says it does. PAIN ASSESSMENT IN CHILDREN Q - )*estion t-e c-i( U - *se 'ain $atin" scae E - e#a*ate +e-a#io$ an( '-!sica c-an"es S - sec*$e 'a$ent1s in#o#e/ent T - ta2e ca*se o t-e 'ain into acco*nt
Ne.+o$n oses < 75 o$ = F o -is +o(! .ei"-t (*$in" t-e i$st e. (a!s o ie (*e toB a .it-($a.a o o -o$/ones -o$/ones + #oi(in" an( 'assin" o*t o stoo c i/ite( inta2e .i $e"ain .ei"-t in 75 79 (a!s o a"e ate$ on; -e .i +e "ainin" 7 +4/ont- o$ t-e 7 st = /ont-s o ie t-*sB 6x = /os 8x 7 !ea$ 9x 6 !ea$s
HEAD CIRCUMFERENCE CIRCUMFERENCE %88 8< c/ o$ 78 79inc-es % /eas*$e( at t-e .i(est 'a$t; .-ic- i s t-e occi'ito% $onta (ia/ete$; ocate( ac$oss t-e cente$ o t-e o$e-ea( an( /ost '$o/inent 'o$tion o t-e 'oste$io$ occi'*t % inc$eases +! <5 at one !ea$ CHEST CIRCUMFERENCE CIRCUMFERENCE % 87 88 c/ o$ 76 78 inc-es % *s*a! /eas*$es a+o*t 6c/ ess t-an t-e HC % ta'e /eas*$e 'ace( at t-e e#e o t-e ni''e ABDOMINAL CIRCUMFERENCE % sa/e as CC CC % /eas*$e( at e#e o */+iic*s % /*st +e c!in($ica in s-a'e an( '$ot$*(e si"-t! 2. VITAL SIGNS %TPR a$e a.a!s o+taine( %0P not $o*tine! assesse( *ness t-e$e is a 'otentia o$ ca$(iac; +ee(in" o$ $ena '$o+e/s A. TEMPERATURE % 8=< 8: C o$ F:: F? 3 In t-e 'ast; it is ta2en 'e$ $ect*/ to ocate ana o'enin"J t-*s $*in" o*t i/'e$o$ate an*s To(a!; To(a!; it is "ene$a! acce'te( t-at 'assa"e o /econi*/ is eno*"- to in(icate 'atent an*s %T-*s; ta2en 'e$ axia o$ 8 /in*tes o$ .it- t-e *se o eect$onic t-e$/o/ete$ 'e$ axia; ta2en o$ 7 * /in*te %S-o*( +e ta2en ate$ PR 4 RR -a#e +een ta2en a$ea(! %I ta2en 'e$ $ect*/B Inse$t 7< c/ o$ 8 /ins L*+$icate i$st
B.RESPIRATION % 85 =5 +$eat-s 'e$ /in*te % Va$ies .it- state o ae$tnessJ a$e s-ao.; i$$e"*a$ an( a+(o/ina in nat*$e
2
%Wit- 'e$io(s o a'nea astin" o$ < 7< secon(s T-*s; co*nt RR o$ 7 * /in*te % I =5 'ace te/'o$a$i! on NPO +eca*se o (an"e$ o as'i$ation
C.HEART RATE % 3*ct*ates +et.een 765 7?5 +eats4/in*te % In*ence( +! t-e N01s acti#it!J i$$e"*a$ % Ta2en +et.een +et.een et ni''e ine an( ste$n*/ o$ 7 /in % In a(*ts *n(e$ t-e ni''e; /i(%ca#ic*a$ ine; 9%< t- ICS D. BLOOD PRESSURE %Hi"- i//e(iate! ate$ +i$t- an( as to a /ini/*/ .it-in 8 -o*$s ate$ +i$t- %=:497 //H" ?5495 %0! Do''e$ (e#ice '$ee$$e(
%Ot-e$.iseB o$(ina$! 0P a''a$at*s can +e *se(; -o.e#e$B c* s-o*( +eB At +i$t- to 7 !$ 7 7 c* 6 to ? !$s 8 c* ? to 76 !$s 9 c*
con"enita -ea$t (isease; 0*e 0a+!
% to test test o$ t$*e c!anosis o$ ac$oc!anosis; $*+ t-e soe o t-e oot t$*e c!anosis (oes not t*$n 'in2 ac$oc!anosis t*$ns 'in2J .i (isa''ea$ .-en +a+! c$ies =Harl"#ui! =Harl"#ui! si$! % a''ea$s $e( on (e'en(ent si(e an( 'ae on *''e$ si(e in an inant !in" on -is si(e % t$ansient '-eno/enon 4 no cinica si"niicance % c-an"e o 'osition .i c-an"e t-e coo$ : P%ysiolo$i &au!'i" or N"o!atal %y("r)iliru)i!"mia % %y("r)iliru)i!"mia % a''ea$s in <5 o a ne.+o$ns as a no$/a '$ocess o t-e +$ea2(o.n o R0C inant1s s2in an( sce$a +eco/es !eo.is- in coo$
3* te$/ a''ea$s ate$ 69; +eco/es (einite +et 6 : (a!sJ (isa''ea$s ate$ : t- (a! P$e te$/ a''ea$s ate$ 7?; +eco/es (einite +et 8 75 (a!sJ (isa''ea$s ate$ t-e F t- 75t- (a!
2. HEAD TO TOE ASSESSMENT I. GENERAL APPEARANCE % "ene$a! exe( 'ost*$e II. SKIN P$e te$/ t-in; t$ans*cent; $*((! s2inJ .it- easi! seen#eins an( #en*es es' o#e$ t-e a+(o/en
Te$/ t-ic2; 'in2is-; /otte( +eca*se o te/'e$at*$e c-an"es @C*tis Ma$/o$ata Post te$/ t-ic2; 'a$c-/ent%i2e .it- 'eein" an( c$ac2in"J e. +oo( #esses o#e$ t-e a+(o/en
A. COLOR VARIATIONS VARIATIONSB 7 Gray 7 Gray % in(icati#e o inection 6 Pallor % *s*a! as a $es*t o ane/ia; t-at is (*e to t-e oo.in"B i excessi#e +oo( oss t-e ti/e t-e co$( .as c*t ii ina(e)*ate o. o +oo( $o/ co$( into inant +i$tiii eta/ate$na t$ans*sion i# o. i$on sto$es (*e to /ate$na n*t$ition (*$in" '$e"nanc! # ot-e$sB inco/'ati+iit!; +ee(in"
8 Cutis Marmorata 9 Aroya!osis 9 Aroya!osis % % +*is- (iscoo$ation (i scoo$ation o t-e -an(s an( eet (*e to 'oo$ 'e$i'-e$a ci$c*ation an( #aso/oto$ insta+iit! < Cya!osis < Cya!osis % % /a! in(icate (isease state % o+se$#e( in c$!in" 4)*iet state a c!anotic .-en )*iet an( "$o.s 'in2 .-en c$ies ateectasis + .it- no$/a coo$ .-en )*iet t-en c!anotic .-en c$!in"
%I occ*$s ess t-an 69 ate$ +i$t-J co*( +e (*e to R-4A0O o$ +oo( inco/'ati+iit! $eaction; con"enita en,!/e (eicienc!; ($*" in(*ce( -e/o!tic ane/ia %In eta (a!s; nee(s -i"-e$ e#es o R0C; H"+; Hct o$ s*icient ox!"enation Ate$ +i$t-; t-e nee( no on"e$ a$ises since *n"s a$e *nctionin"; (est$*ction o excess R0Cs
%Se$*/ *ncon>*"ate( +ii$*+in (oes not excee( 76/"4755cc A+o#e 65/"4755cc; .i c$oss t-e +oo( +$ain +a$$ie$ inte$e$e .it- c-e/ica s!nt-esis o +$ain 'e$/anent 'e$/anent ce (a/a"e an( an( 'ossi+e /enta $eta$(ation; e'ie's!; ce$e+$a 'as! KERNICTERUS
?OTHERS* ?OTHERS* LANUGO ine (o.n! -ai$; co//on on '$e%te$/s VERNI CASEOSA .-itis-; c-ees!; o(o$ess s*+stances co#e$in" t-e s2in; *s*a! on o(s o t-e s2in; /o$e in * te$/ It '$otects s2in 4 '$e#ents -eat oss 3ORCEP MARKS ci$c*a$ o$ inea$ cont*sion /atc-in" t-e $i/ o t-e +a(e o o$ce's on inant1s c-ee2s It (isa''ea$s i n 6 8 (a!s MILIA .-itis-; 'in'oint 'a'*es on t-e nose4c-in4c-ee2s It (isa''ea$s as ea$! as 6 o$ 8 9 .2s NEVI @ STORK0ITES $e( s'ots o*n( at t-e +ac2 o t-e nec2 an( a+o#e e!ei(s MONGOLIAN SPOTS "$a!is- +*e 'atc- at t-e o.e$ +ac2 $o/ t-e acc*/*ation o 'i"/ent ces; /eanoc!tes It (isa''ea$s +! sc-oo a"e ERYTHEMA TOICUM NEONATORUM NEONATORUM ne.+o$n $as- Pin2; 'o'*a$ $as- a''ea$in" a o#e$ t-e +o(! .it-in 69 % 9? ate$ +i$t- It (isa''ea$s .it-in a e. (a!sJ no t$eat/ent nee(e(
3
DESUAMATION DESUAMATION ($! 'eein" o t-e s2in 'a$tic*a$! on t-e 'a/ an( soes; /o$e in 'ost te$/s HEMANGIOMAS #asc*a$ t*/o$ o t-e s2in i ne#*s a//e*s ii st$a.+e$$! -e/an"io/a iii ca#e$no*s -e/an"io/a
III.HEAD % '$o'o$tionate! a$"eJ o tota en"t% c$ani*/ is a$"e an( ace $eati#e! s/a % -as ? +on! 'ates; c onnecte( +! s*t*$e ines G$o.t- o t-ese +ones aon" t-e si(es ca*ses ca*ses t-e -ea( to in si,e
%3ontanes a$e o'enin" at 'oints o *nion o s2* +ones i Ante$io$ is (ia/on( s-a'e(; coses 76 7? /os iiPoste$io$ is t$ian"*a$ in s-a'e(; coses 6 8 /ont-s s-o*( +e et as a sot s'ot;at an( i$/ Q%+*"es .-en c$ies; co*"-s;+*t; .-en '$oon"e( an( tense; /a! in(icate ICP; -!($oce'-a*s; s*+(*$a -e/ato/a % s*n2en an( (e'$esse( /a! in(icate (e-!($ation
VARIATIONS IN THE HEAD: 7 MOLDING as!//et$ic a(>*st/ent in t-e s-a'e o t-e -ea( to it t-e ce$#ix (*$in" (ei#e$!
6 CAPUT SUCCEDANEUM s.ein" o$ e(e/a o t-e '$esentin" 'o$tion o t-e sca'J *s*a! t-e occi'*t a$eaJ (isa''ea$s ate$ t-e 8$( (a!J no t$eat/ent nee(e(
8 CEPHALHEMATOMA CEPHALHEMATOMA coection o +oo( +et.een 'e$ioste*/ o t-e s2* +one an( +one itse Ca*se( +! $*'t*$e o a +oo( #esse (*$in" (ei#e$! Wi ta2e a .ee2 o$ a+so$'tion 9 CRANIOTA0ES ocai,e( sotenin" o c$ania +onesJ can +e in(ente( +! '$ess*$e Mo$e co//on in i$st +o$n inants (*e to '$ess*$e o eta s2* a"ainst /ot-e$1s 'e#ic +one No t$eat/ent nee(e( No$/a in ne.+o$nJ +*t; 'at-oo"ic in o(e$ c-i($en
EYES % "$a! o$ +*e at +i$t-J (o not ass*/e no$/a coo$ ti 8/os % s-o*( +e cea$; no $e(ness; no '*$*ent (isc-a$"es
-N!"#$ %'(')*: iSU0CONUNCTIVAL iSU0CONUNCTIVAL HEMORRHAGE (*e to '$ess*$e (*$in" (ei#e$! ca*sin" $*'t*$e o s/a ca'ia$iesJ no t$eat/ent iiEDEMA O3 EYELIDS o$ 6 8 (a!s ti 2i(ne!s a$e a+e to exc$ete *$ine eicient! iii PSEUDOSTRA0ISMUS OR TRANSIENT STRA0ISMUS c$oss%e!e( i# DOLL1S DOLL1S e!es e!es (o not oo. /o#e/ent o t-e -ea( Pe$sists o$ 75 (a!s; t-en (isa''ea$
EARS % s-o*( +e in ine .it- t-e o*te$ cant-*s o t-e e!es % ea$s set o.e$ a$e o*n( in t-ose .it- c-$o/oso/a a+e$$ations i2e t$iso/! 7? an( .it- /enta $eta$(ation NOSE % a''ea$s a$"e o$ -is ace % s-o*( +e 'atent; .it- t-in; .-ite /*coi( nasa (isc-a$"e
A+'!"#$B % non%'atent; +oo(! nasa (isc-a$"e; CHOANAL ATRESIA MOUTH % s-o*( o'en e#en! .-en -e c$ies; ton"*e a''ea$s a$"e % i one si(e /o#es /o$e t-an t-e ot-e$B CRANIAL NERVE INURY
VARIATIONB iEPSTEIN PEARLS .-itis-%!eo. acc*/*ation o e'it-eia ces on -a$( 'aate; (isa''ea$s in a .ee2
A+'!"#$B iTHRUSH @ Can(i(a inection o$ Moniiasis .-itis-4 "$a!is'atc-es a''ea$in" on ton"*e an( si(es o c-ee2s Ac)*i$e( t-$o*"- 'assa"e into t-e +i$t- cana iiCLE3T LIP 4 PALATE iiiPROTRUDING TONGUE i#DROOLING # INA0ILITY TO PASS NGT NECK %s-o$t an( c-*++! @ t-ic2 s*$$o*n(e( +! s2in o(s .it- tonic nec2 $eex A+'!"#$: i NUCHAL RIGIDITY iiCONGENITAL TORTICOLIS $i"i(it! o nec2 (*e to in>*$! to ste$nocei(o/astoi( /*sces (*$in" +i$tIV.CHEST %ca#ices s-o*( +e st$ai"-t an( s!//et$ica %a''ea$s s/a since -ea( is a$"eJ +*t; 6 !$s; CC is "$eate$ "$eate$ t-an HC %+$east en"o$"e/ent +ot- o$ /ae an( e/ae; (*e to /ot-e$1s -o$/one %occasiona!; +$east sec$etes t-in .ate$! *i(B Witc-1s /i2 @(*e to actatin" -o$/one $o/ /ot-e$ -A+'!"#$: i 3*nne c-est (e'$esse( (e'$esse( ste$n*/ ii Pi"eon c-est a+no$/a '$o/inence o ste$n*/ iii As!//et$ic c-est ex'ansion LUNGS % 85 =5 +$eat-s 'e$ /in*teJ c-ie! a+(o/ina % A+no$/aB a'nea /o$e t-an 65 secs; (!s'nea; $ate a+o#e =54/in; "$*ntin"; see%sa. $es'i$ation 4
VI. HEART %755 765 +eats 4 /in*te %+et.een et ni''e an( ste$n*/J 8 9 t- ICS %A+no$/aB Ca$(io/e"a!; /*$/*$s; 'e$sistent c!anosis VII. ABDOMEN % c!in($ica i n s-a'eJ i#e$; s'een; 2i(ne!s a$e 'a'a+e % a s*n2en a''ea$ance /a! in(icate /issin" a+(o/ina contents
UMBILICAL CORD a''ea$s as a .-ite "eatino*s st$*ct*$e (*$in" t-e i$st -o*$ C-ec2 o$ AVA QAte$ t-e i$st -o*$ +e"ins to ($!; s-$in2 an( +eco/e (iscoo$e( Q6 8 $( (a! t*$ns +ac2 Q= 75t- (a! so*"-s o; s-o*( -a#e no +ee(in" at site VIII. ANO GENITAL AREA FEMALE % #*#a /a! +e s.oen (*e to /ate$na -o$/ones % *$inates .it-in 69 -o*$s
V#!#,'B PSEUDOMENSTRUATION +oo( tin"e( (isc-a$"e
A+'!"#$B i ena$"e( cito$is .it- *$et-$a /eat*s at ti' ii no #a"ina o'enin" iiieca (isc-a$"e 'e$ #a"ina o'enin" i#no *$ination
A+'!"#$B i S'ina +ii(a @ S'ina -e$nia ii I/'e$o$ate an*s iii No /econi*/ .it-in 8= -o*$s X. EXTREMITIES % a$/s 4 e"s a''ea$ s-o$t; -an(s '*/'; ist cenc-e(; in"e$nais a$e sot; s/oot- an( on" % ten in"e$s an( toes % * $an"e o /otion % nai +e(s 'in2 .it- t$ansient c!anosis
%c$eases in ante$io$ 648 o t-e soe %s!//et$ica ext$e/ities %+iate$a /*sce tone 4 +$ac-ia '*se
V#!#,'* B i We++in" @ S!n(act!! ii Ext$a toes an( in"e$s @ Po!(act!! M#! A+'!"#$,: iPe$sistent c!anosis o nai +e(sJ $act*$esJ (isocations iiS-o$t a$/s @ Ac-on($o'astic (.a$is/ iiiC*+oot @ Tai'es (eo$/it! i#A+sence o ext$e/ities @A/eia #S-o$t ext$e/ities; .-e$ein -an(s an( eet a''ea$ to a(-e$e to t-e +o(! @P-oco/eia
MALE %*$et-$a o'enin" at t-e ti' o t-e 'enisJ testes 'a'a+e at eacsc$ot*/ %sc$ot*/ *s*a! a$"e; e(e/ato*s; %(ee'! 'i"/ente( %SMEGMA @ t-ic2; c-ees!; o(o$ie$o*s sec$etions *n(e$ t-e '$e'*ce %*$inates .it-in 69 -o*$s
V#!#,'* B i U$et-$a o'enin" co#e$e( +! '$e'*ce iiIna+iit! to $et$act t-e o$es2in @ PHIMOSIS iiiE$ection o$ PRIAPISM i#Testes 'a'a+e at t-e in"*ina cana
%A+'!"#$B i H!'os'a(ia % *$et-$a o'enin" *n(e$ t-e 'enis ii E'is'a(ia *$et-$a o'enin" (o$s*/ o 'enis iii C$!'toc-i(is/ i# In"*ina -e$nia
IX.BACK / RECTUM BACK s'ine intactJ a''ea$s at in t-e */+a$ 4 sac$a a$eas % no o'enin"s; /ass o$ '$o/inent c*$#es RECTUM 'atent ana o'enin"J 'assa"e o /econi*/ .it-in 69 5
NEONATES DEVELOPMENTAL TASKS: 1. BIOLOGIC TASKS - esta+is-in" an( /aintainin" $es'i$ation - ci$c*ato$! c-an"es - $e"*ation o +o(! te/'e$at*$e - in"estin"; $etainin" an( (i"estin" n*t$ients - ei/ination o .aste - $e"*ation o .ei"-t 2. BEHAVIORAL TASKS - esta+is-in" a $e"*ate( +e-a#io$a te/'o in(e'en(ent o t-e /ot-e$ - '$ocessin"; sto$in"; an( o$"ani,in" /*ti'e sti/*i - esta+is-in" a $eations-i' .it- ca$e"i#e$s an( t-e en#i$on/ent TRANSITION PERIOD 1. FIRST PERIOD OF REACTIVITY A3IRST STAGE asts *' to 85 /in*tes ate$ +i$t0 SECOND STAGE asts 6 9 -o*$s 2. SECOND PERIOD OF REACTIVITY +et.een t-e 9 t- ?t-o*$ ate$ +i$tPRINCIPLES OF IMMEDIATE CARE I. AIRWAY PATENCY /ost c$itica a(>*st/ent a ne.+o$n /*st /a2e at +i$tTECHNIUES , "#',#' 0#,', #!#: .i'e o nose an( an( /o*t- .it- ste$ie "a*,e "a*,e s*ctionin" .it- t-e *se o o $*++e$ +*+ s!$in"e o$ s*ction cat-ete$ 'ositionin" i i NSD .it-o*t '$o+e/ TRENDELEN0URG ii,!#3"#,4 ($5! 3LAT .it- -ea( t*$ne( to.a$(s t-e si(es ,6!*B /i2in" t-e t$ac-ea +! st$o2in" t-e nec2 in t-e (i$ection o t-e /o*t sti/*atin" t-e ne.+o$n to c$!
II. PROVIDE OPTIMUM TEMPERATURE FOUR PROCESSES OF HEAT LOSS: 7 CONVECTION o. o -eat $o/ t-e +o(! s*$ace s*$ace to cooe$ a/+ient ai$ 6 RADIATION oss o -eat -eat $o/ t-e +o(! s*$ace to cooe$ soi( s*$aces not in (i$ect contact +*t in $eati#e '$oxi/it! to eac- ot-e$ 8 EVAPORATION EVAPORATION oss o -eat t-at occ*$s occ*$s .-en a i)*i( is con#e$te( to a #a'o$ 9 CONDUCTION oss o -eat $o/ $o/ t-e +o(! +o(! s*$ace to cooe$ cooe$ s*$aces in (i$ect contact POSSIBLE WAYS WAYS TO PRODUCE HEAT: HEAT: 7 S-i#e$in" 6 Meta+ois/ o +$o.n at 8 G*coneo"enesis HOW TO PROVIDE WARMTH: 7 D$!; ne.+o$n1s s2in 6 W$a'; *sin" sot +an2et
8 Use o '$e -eate( +assinet o$ c $i+; $a(iant .a$/e$; ($o' i"-t o$ oo$ a/'
III. INITIAL ASSESSMENT OF CONDITION APGAR SCORING .as (e#eo'e( +! D$Vi$"inia D$Vi$"inia A'"a$ in 7F<6 7F<6 (one on t-e 7st /in*te; /in*te; < an( 75 /in*tes /in*tes ate$ +ase( on < 'a$a/ete$s; 'a$a/ete$s; $an2e( in o$(e$ o i/'o$tance i/'o$tance
A. HEART RATE 'a'ating the pulsation of the cord istenin" to to -ea$t+eat -ea$t+eat .it- a stet hoscope between the left nipple an( ste$n*/ 8 9 t- ICS o$ =5 secs
B. RESPIRATORY EFFORT a c$!in" +a+! is a +$eat-in" +a+! C. MUSCLE TONE D. REFLEX IRRITABILITY teste( t-$o*"- a "ente sa' on ootJ 'assin" cat-ete$ t-$* nose
E.
COLORQ ac$oc!anosis
IV. PROPER IDENTIFICATION % t-$o*"- oot'$ints an( na/e ta" 4 +$aceet % (one +eo$e ea#in" t-e (ei#e$! $oo/; to '$e#ent s.itc-in" o +a+ies % (one +eo$e co$( is c*t V. PREVENTION OF INFECTION AND IN7URY A. ASEPTIC TECHNIUE 7 CORD CARE No$/a = 1 vein and 2 arteries ( AVA ) A+no$/a 6 A & 6 V Mon"ooi( CAREB a ase'sis s-o*( +e o+se$#e( % '$esent ca$e nee(s no ($essin" ate$ co$( -as +een ca/'e( o$ i"ate( an( c*t I et ex'ose(; .i ($! +eca*se .ate$ is ost an( se'a$ates se'a$ates /o$e )*ic2! t-an .-en co#e$e( + $e)*ent! ins'ect o$ bleeding c co$( is ca/'e( 6
B. PROPHYLAXIS 1. EYE @ C$e(e1s '$o'-!axis 6
to '$e#ent O'-t-a/ia Neonato$*/ o$ "ono$$-ea con>*ncti#itis *se oB a si#e$ nit$ate 7 + o'-t-a/ic oint/ents i2e te$$a/!cin; tet$ac!cine
TECHNIUE: % inne$ to o*te$ cant-*s .-ie ex'o sing the lower conjunctival conjunctival sac % s-ould be delayed for 1 2 hours % /i"-t inte$e$e .it- t-e /ate$na an( inant +on(in" which should be sta+is-e( as soon as 'ossi+e ate$ +i$t- 2.HYPOPROTHROMBINEMIA 0!06$#8* '$esc$i+e( .it- sin"e (ose 7 / 457/ o P-!tona(ione so*tion @A)*a/e'-!ton 'e$ IM; #ast*s ate$ais A)*a/e'-!ton; a Vit K .ate$ so*+e '$e'a$ation acts as '$e#enti#e /eas*$e a"ainst neonata -e/o$$-a"ic (isease %/ost ne.+o$ns a$e +o$n with prolonged coagulation or '$ot-$o/+in ti/e (*e to boo( e#es o Vit K %VitK is necessa$! o$ t-e o$/ation o cottin" acto$s VII; I & ; .-ic- a$e s!nt-esi,e( t-$o*"t-$o*"- t-e action o intestina o$a VI. MOTHER 9 CHILD BONDING an eecti#e +on( +et.een /ot-e$ an( an( inant t-at is s'eciic to t-e/ $o/ .-ic- +ot- "ain sec*$it! i$st socia $eations-i' $eations-i' o$ t-e inant $esea$c- s-o.s /ot-e$ an( an( c-i( nee( ti/e i//e(iate! i//e(iate! ate$ +i$t- @a sensiti#e 'e$io( .-en inant is a.a2e; nee( 'a$enta contact o$ o'ti/a (e#eo'/ent inte$e$ences $o/ +on(in"B sic2ness; caesa$ian caesa$ian section; (iic*t a+o$
VII. NUTRITION P3!0**B a 0on(in" + In#o*tion c 0$east ee(in" sti/*ation % 0otte ee(in" is 'ost'one( *nti s*c2i n" an( s.ao.in" a$e .e coo$(inate(; to '$e#ent 'ossi+e as'i$ation % Once ee(in" is sta$te(; "i#e ste$ie .ate$ initia!; to c-ec2 o$ coo$(ination o s*c2in"; s.ao.in" an( '$esence o "a" $eex % O+se$#e t-e neonate1s $eaction; i t-e$e see/s to +e #ioent $eaction eicite( .-en s.ao.in"; sto' t-e ee(in" % 0$eastee(in" inants a$e +$o*"-t to t-ei$ /ot-e$s as soon as 'ossi+e an( a$e e( on (e/an( +asis % 0otte%e( +a+ies a$e "i#en $o*tine ee(in" o 6 8 o, 4 9 -o*$s
VII. BAPTISM OF INFANT I t-e$e is a '$o+a+iit! t-at t-e inant is in i//inent (an"e$ an( /a! not i#e; )*estion o +a'tis/ s-o*( +e consi(e$e( i a/i! is Ro/an Cat-oic Is an essentia (*t!; /eans /eans a "$eat (ea to t-e a/i! a/i! S-o*( +e $e'o$te( to t-e a/i! ate$ ate$
SELECTED CONDITIONS OF THE NEWBORN HYPOGLYCEMIA o. +oo( s*"a$ Q CHO sto$es a$e o.; "*cose is t-e /ain so*$ce o t-e ene$"! o$ t-e i$st 9%= -o*$s P$e/at*$it!; P$e/at*$it!; 'ost /at*$it!; ina(e)*ate inta2e; st$esses @co( st$ess; (iic*t +i$t- Q Wi a $a'i(! t-en sta+ii,eB $o/ <5 to =5 /"4( to =5 :5 /"4( SXB >itte$!; a'nea; tense; +*"in" ontanes a+sent MORO $eex T8B 7 ORAL GLUCOSE 6 Kee' .a$/ 8 Monito$ t-e VS 9 A(/iniste$ o$(e$e( 75%6< IV "*cose "*cose HYPOPROTHROMBINEMIA NEONATAL BLEEDING DISORDER; ANEMIA WEIGHT LOSS PHYSIOLOGIC 7AUNDICE OR HYPERBILIRUBINEMIA T!#,"',: 7 ea$! ee(in"% to s'ee( 'assa"e o eces t-*s '$e#entin" $ea+so$'tion o +ii$*+in in t-e +o.es 6 '-otot-e$a'!% ex'os*$e to i"-t to initiate /at*$ation o i#e$ en,!/es DESUAMATION H0#,,* B HBV; 5#44' #("'*,!#,' < = >* < 1? >* <1@ >* N+!' S4!'') ,*, %! (*#** Q ea$! sc$eenin" an( (etection o "enetic (iso$(e$s s*c- as '-en!2eton*$ia @PKU; -!'ot-!$oi(is/; "aactose/ia; an( sic2e ce Q e(*cate t-e 'a$ents on t-e i/'o$tance o sc$eenin" an( to coect a''$o'$iate s'eci/ens at t-e $eco//en(e( ti/e @ate$ 69 -o*$s o a"e U'5!*#$ N+!' 6#!') *4!'') Q sc$eens a ne.+o$n inants +eo$e +eo$e (isc-a$"e o$ -ea$in" oss +! a*(ito$! +$ainste/ $es'onse o$ e#o2e( oto%aco*stic e/issions B#$$#!( S4#$ A****"', % G*,#,'#$ A); Q an a++$e#iate( #e$sion o D*+o.it, D*+o.it, scae Q /eas*$es "estationa "estationa a"e 65%96 .ee2s Q assesses = exte$na '-!sica an( = ne*$o/*sc*a$ ne*$o/*sc*a$ si"ns
DAILY CARE OF THE NEWBORN BATHING Q -!"iene an( exceent ti/e ti/e o$ o+se$#ation o t-e neonate neonate Q 'e$o$/e( ate$ ate$ VS -a#e +een +een sta+ii,e( Q in#o#e t-e 'a$ents 'a$ents in t-e ca$e o t-e c-i( Q '$ese$#e s2in1s aci( /ante /ante Q .it-in an -o*$ ate$ (ei#e$! (ei#e$! to $e/o#e t-e #e$nix caseosa 7
Q t-en ONCE A DAY; DAY; +eo$e ee(in" in AM
M#,!#$*: 7 +at- .ate$% 8:%8? C o$ F?%755 3; .a$/ to t-e e+o. $oo/ te/'e$at*$e% 69 C o$ :< 3 6 oi 8 soa'% /i(; no -exac-o$o'-ene 9 +asin; .as- cot- to.e; co/+; cean (ia'e$4cot-es T46'3*: % ceanest to t-e t-e /ost soie( a$ea a$ea % .as- -ai$ (ai! % eac- 'a$t s-o*( +e .as-e( .as-e( an( $inse( .e % inc*(e co$( ca$e CORD CARE Q c*t t-e OS t-en 'ace on t-e +ase o t-e co$( Q a''! +eta(ine 8x $o/ t-e +ase Q ca/' co$( 7 inc- $o/ t-e +ase Q c*t t-e co$( 7 c/ $o/ t-e ca/' Q a''! +eta(ine 8x o$ t-e st*/' st*/' Q .$a' t-e co$( .it- OS t-en 'o*$ :5 aco-o Q $e/o#e t-e t-e OS Q (ai! co$( ca$e .it- et-! aco-o aco-o Q (ia'e$s a$e 'ace( +eo. t-e t-e co$( to '$e#ent i$$itation Q a#e$a"e co$( se'a$ation ti/e ti/e 75 to 79 (a!s CLOTHING Q cotton; si/'e; co/o$ta+e; co/o$ta+e; not $est$icti#e; i"-t coo$e( /ate$ias Q no sna's t-at /a! +e acci(enta! $e/o#e( an( s.ao.e( s.ao.e( Q a''$o'$iate to t-e 2in( o .eat-e$ .eat-e$ SLEEP PATTERN Q see's /ost o t-e ti/eJ .a2es *' o$ t-e '-!sioo"ic nee( nee( Q a#e$a"es 7=%65 -o*$sJ 9 -o*$s at a ti/e SKIN CARE % /etic*o*s s2in ca$eJ ot-e$.ise /a! ea( to inection NUTRITIONAL ALLOWANCES 7 CALORIE Q *' to 6 /os o a"e765 cao$ies42" +o(! .t o$ <5%<< 2c4 + e#e$! 69 -o*$s o$ a(e)*ate a/o*nt o oo( o$ "$o.t-+e!on( 6 /os; (ec$eases 755 2ca42" o$ 9< 2ca4+4(a! a(*ts% 96 2ca42" o$ 6F5 2ca4+4(a! 2. CHON Q i$st 6 /os is 66 " 'e$ 2" +o(! .t Q co.s /i2 -as /o$e CHON @7= content t-an -*/an /i2 @7? Q +ot- contains an a/ino aci(;HISTIDINE; necessa$! o$ inant "$o.t+*t not necessa$! o$ a(*t "$o.tQ /ain '$otein content in co.1s /i2B CASEINJ -*/an /i2B LACTAL0UMINJ LACTAL0UMINJ -*/ans /i2 easie$ to +e (i"este( . CHO Q LACTOSE; a (isacc-a$i(e; t-e /ost easi! (i"este( ca$+o-!($ate Q I/'$o#es caci*/ a+so$'tion an( ai(s in nit$o"en $etention Q It '$o#i(es stoos in .-ic- "$a/ 'ositi#e /ic$oo$"anis/ '$e(o/inates Q A(e)*ate CHO e#es in o$/*a ao.s CHON to +e *se( in +*i(in" ne. ces Q co.1s /i2B 6FJ -*/an /i2B 8:
FATS Q -*/an /i2 -as 8x /o$e content t-an co.1s co.1s /i2 . FLUID Q nee(s s*icient *i( inta2e +eca*se $ate o /eta+ois/ /eta+ois/ is -i"- an( /eta+ois/ nee(s .ate$ Q N0 *ses 9<%<5 2ca42" in 69 -o*$s -o*$s o$ /eta+ois/ Q 85%8< o N01s *i( is ext$ace*a$ an( 2i(ne!1s i//at*$it! ca*ses ai*$e to *! concent$ate *$ine so a$"e a/o*nt o .ate$ is ost Q -as a$"e$ s*$ace o t-e +o(! in $eation to +o(! /ass; t-*s a$"e a/o*nt o .ate$ is ost (*$in" e#a'o$ation Q Re)*i$e/entB 7=5%655 /42" o$ 6<%8 o, 4+4 69 -o*$s
=. CALCIUM Q nee(e( o$ +one "$o.tQ -*/an /i2 -as -as /o$e /o$e t-an co.1s /i2 IRON Q /ate$na i$on s*''ie( to N0 is eno*"- to ast o$ 8 /os; /os; *nti -e sta$ts to '$o(*ce a(*t HG0
FEEDING TYPES a +$eastee(in" + o$/*a ee(in" c /ixe( ee(in" B!#*,%(') Q H*/an /i2 is t-e '$ee$$e( o$/ o n*t$ition o$ t-e *%te$/ inant P6*$) % B!#*,%(') A. M$> *4!,' !%$8 ! 0!$#4,' !%$8 % tota e/'t!in" o t-e +$easts is t-e +est sti/**s to /o$e /i2 sec$etion B. M$> 4,' !%$8 ! $,(' !%$8 % $eaxe( an( sec*$e( /ate$na /ate$na eein" +est sti/*ates et(o.n et(o.n $eex P!!3*,: a '-!sioo"ic $ea(iness + a+sence o e/otiona st$ess c s*c2in" sti/*ates et (o.n $eex ( $est; exe$cise; (iet M#,!'#$ C',!#'(4#,' 7 na$cotic a((iction 6 acti#e PT0 8 ac*te conta"io*s (isease 9 ca$(iac (isease < cance$ = extensi#e s*$"e$! I'%#', C',!#'(4#,' 7 cet i' 6 cet 'aate E**',#$* % B!#*,%('): A. T *,#!,B Q $i"-t on t-e (ei#e$! ta+e PRIMARILY to '$o/ote '$o/ote +on(in" 8
Q 85 /in*tes ate$ +i$t- in no$/a s'ontaneo*s (ei#e$! Q 9 -o*$s ate$ CS B. D3!#,': Q < /in*tes4 +$east ate$ esta+is-/ent o ee(in" Q t-e i$st 75 /in*tes o$ NOURISHMENT Q t-e 6n( 75 /in*tes o$ SUCKING PLEASURE
CARE OF THE BREAST Q (ai! +at- to.e ($! Q cean +$a Q *se o n*$sin" 'a(s 'a(s Q no soa'in"J no aco-os on ni''es ADVANTAGES OF BREASTFEEDING M,6! Q '$o/otes +on(in" Q '$o/otes *te$ine *te$ine in#o*tion Q (ea!s e$tiit! @+*t not sae to *se *se as soe /eans o 3P Q econo/ica! sa#es ti/e; /one!; /one!; eo$t Q ess inci(ence o +$east cance$ B#+ Q contains anti+o(ies @I"A t-at '$otects N0 $o/ GI inections Q a.a!s a#aia+e in ste$ie o$/ X co$$ect te/'e$at*$e Q ess inci(ence o coic; consti'ation; (ia$$-ea; ae$"! Q its '$otein; LACTAL0UMIN; is eas! to (i"est Q contains TAURINE t-at en-ances +$ain (e#eo'/ent B. ARTIFICIAL FEEDING Q $eco//en(e( on! i +$eastee(in" is not 'ossi+e ADVANTAGES: 7 '$o#i(es an ate$nati#e to +$eastee(in" 6 /o$e acc*$ate assess/ent o inta2e 8 /a! /eet t-e nee(s o .o$2in" /ot-e$s 9 /a!+e in(icate( in cases o con"enita (eo$/ities; in+o$n e$$o$s o /eta+ois/; ae$"ies
MMED IATELY AVAILA0LE AVAILA0LE I% MMEDIATELY N% UTRITIOUS G%ASTROENTERITIS PREVENTED
COMMON SKIN DISORDERS A. DIAPER DERMATITIS 7 (#0! (!"#,,*% 'e$iana i$$itation (*e to acc*/*ation o /oist*$e; -eat; an( c-e/ica s*+stances 6 #""'# (!"#,,*% (i*se e$!t-e/a e$!t-e/a in t-e 'e$iana an( "*tea "*tea a$eas ca*se( +! +$ea2(o.n o *$ea in t-e *$ine to a//onia +! +acte$ia in t-e eces . ',!,!) /ace$ation o an! t.o s2in s*$aces in cose o''osition4 c-ain" o t-e s2in B. MILIARIA/ HEAT RASH/ PRICKLY HEAT % +*n"an"%a$a. % (*e to o#e$($essin"; o#e$($essin"; .a$/ .eat-e$ .eat-e$ C. SEBORRHEA DEMATITIS %c$a(e ca' % (*e to acc*/*ation o s.eat an( (i$t ca*sin" at; a(-e$ent an( "$eas! scaes .it- '$*$it*s an( c$*stin"J *s*a! in(icates a secon(a$! inection TREATMENTB TREATMENTB /ine$a oi; oint/ent o$ otion D. IMPETIGO % /ac*es; 'a'*es; '*st*es; c$*sts% inection ca*se( +! +acte$ia (*e to 'oo$ s2in ca$e; o#e$c$o.(in"; /an*t$ition E. BOILS/FURUNCLES BOILS/FURUNCLES % +acte$ia inection o -ai$ oices co//on co//on in t-e ace; nec2; axia; +*ttoc2s TREATMENTB TREATMENTB 'e$sona 'e$sona -!"ieneJ no s)*ee,in"J to'ica neo/!cin neo/!cin c$ea/J (iet -i"- in CHON; o. i n ats an( CHO F. ORAL MONILIASIS % o$a t-$*s-J *n"i inection o t-e /o*t% ca*se( +! Can(i(a a+icans % seen as .-ite 'atc-es on t-e ton"*e PREVENTIONB o$a -!"ieneJ ca$e o /ate$na ni''es TREATMENTB TREATMENTB /!costatin o$ n!statin o$a s.a+
FACTORS TO SUCCESS: 7 'aste*$i,ation o t-e /i2 6 sanitation in /i2 -an(in" 8 a(e)*ate ste$ii,ation; $e$i"e$ation; sto$a"e 9 to +e e)*a .it- /ot-e$1s /i2 in n*t$ientsB ADD s*"a$ to inc$ease ene$"! #a*e; DILUTE .it- .ate$ to $e(*ce /ine$as an( CHON concent$ation SPECIAL CONSIDERATIONS 7o+se$#e as'i$ation '$eca*tion 6-o( +otte in *'$i"-t 'osition so t-at t-e ni''e is a.a!s ie( .it/i2 8+*$' 9(e/an( ee(in" is '$ee$$e( t-an sc-e(*e( B% EST 3OR 0A0Y R% EDUCES ALLERGY E% MOTIONAL 0ONDING A% NTI0ODY PRESENT S% TOOL INO33ENSIVE T% EMPERATURE ALWAYS IDEAL F% RESH E% CONOMICAL E% ASY ONCE ESTA0LISHED D% IGESTED EASILY 9
CARE OF THE INFANT
M#,!'#$ #'( C6$( H#$,6 P!)!#"
ASSESSMENTB Wei"-t Gains 7<5%675 " 'e$ .ee2 Do*+es .ei"-t +! = /ont-s T$i'es 0W +! 76 /ont-s Hei"-t 3i$st = /ont-sB 7 inc-4/ont 6n( = /ont-sB <5 o 0L Moto$ (e#eo'/ent 3ine /oto$ G$oss /oto$ S'ecia senses Vision Hea$in" Lan"*a"e Pe$sona an( socia Pa!
U'(!-F5 C#! S!54* 7 0$ea 0$east ste ee( e(in in"" Ca/' Ca/'ai ai"n "n 6 P-ii P-ii'' ''in inee N*t N*t$it $ition ion P$o"$ P$o"$a/ a/ 8 Ex'an( Ex'an(e( e( P$o"$a P$o"$a/ / on I//*ni I//*ni,at ,ation ion 9 Inte"$ Inte"$ate ate(( Mana" Mana"e/e e/ent nt o C-i( C-i(-oo -oo(( Ines Inesss
AGE IN MONTHS
LANGUAGE
7
C$ies
6
Die$entia c$!in" Coos; "*$"e
8 9 < =
:
? F 75 77 76
S)*eas4a*"-s ao*( Coos; +a++e; c-*c2es La*"-s ao*( Vocai,es; ta2s; /oo( S)*eas; coos; #o.es .it- consonants I/itates so*n(s; /onos!a+ic .o$(s; se $eino$ce/ent Vo.e so*n(s; c-aine( s!a+es% mama+'a'a in(isc$i/inate! Consonants t+ ' an( an( , J c-aine( s!a+esJ e/otions Res'on(s to si/'e co//an(sJ Mama an( Mama an( Da'a -as Da'a -as /eanin"J 2no.s +!e% +!eJ sin"e .o$(s S'eec- so*n(s 8%< .o$(sJ 2no.s o+>ects +! na/eJ *n(e$stan(s si/'e co//an(s
S46(3$ % 4'*3$,#,' 7st !ea$ o ie @5%77 /ont-s /ont-s e#e$! /ont6n( !ea$ o ie @76%68 /ont-s e#e$! 6 /ont-s 8$( !ea$ o ie @69%8< /ont-s e#e$! 8 /ont-s 9t- !ea$ o ie @8=%9: /ont-s e#e$! = /ont-s
SENSORY 3ixates on /o#in" o+>ects @?% 75 inc-esJ )*iets%#oice 0inoc*a$ ixationJ sea$c-es to ocate a so*n(J t*$ns -ea( to so*n( at ea$ e#e Pe$i'-e$a #ision @7?5J t*$ns -ea(J coo$(ination 0e"ins e!e%-an( coo$(inationJ esta+is-e( +inoc*a$ #ision 3oo.s a ($o''e( o+>ectJ ocai,es so*n( +eo. ea$ A(>*sts 'ost*$eJ ocai,es so*n( a+o#e ea$J t*$n; *' o$ (o.n Res'on(s to o.n na/eJ ixates on s/a o+>ectsJ (e'tan( s'aceJ -ea( in an a$c-
Locai,es so*n( +! t*$nin" -ea( (ia"ona!
Disc$i/inates "eo/et$ic o$/sJ can oo. $a'i(! /o#in" o+>ectsJ so*n(s
B!#*,%('): T6 %!*, *,0 , !#*') # +!)6, 46$( S,#,*,4* ' B!#*,%(') B#*( ' ,6 2?? N#,'#$ D")!#064 H#$,6 S3!5 NDHS;: On! @ 0!4', o inants .e$e initiate( to +$eastee(in" .it-in an -o*$ ate$ +i$t- . 0!4', o inants *n(e$ six /ont-s o( .e$e exc*si#e! +$easte( On t-e a#e$a"e; inants a$e +$easte( exc*si#e! on! o$ $** ,6#' # "',6 0$eastee(in" a !o*n" c-i(; on t-e a#e$a"e; aste( o$ 1@ "',6* '$ P!",') B!#*,%(') La.s RA :=55B Roo/in"%In an( 0$eastee(in" Act o 7FF6 0$eastee(in" Wee2B A*"*st 7%: EO <7B Mi2 Co(e Heat- e(*cation A(#anta"es o +$eastee(in" Tec-ni)*e o +$eastee(in" R%$8* '5$5( ' +!#*,%(') P$oactin $eex Let(o.n $eex T46'3 T46'3 % +!#*,%(') • Position C$a(e Ho( @aso cae( Ma(onna o$ c$oss%c-est 'osition 3oot+a Ho( @aso cae( c*tc- 'osition Si(e%!in" 'osition Ho. to -e' +a+! atc- on to t-e +$east • 7 T-e /ot-e$ /ot-e$ -o(s -o(s -e$ -e$ +$ea +$east st in in a C%-o C%-o( ( 6 Sti/*a Sti/*ate te t-e +a+!1s +a+!1s $ootin $ootin"" $ee $eex x 8 W-en t-e +a+!s +a+!s /o*t/o*t- o'ens o'ens .i(e; '*t t-e ni''e ni''e an( as as /*c- o t-e a$eoa as 'ossi+e into -is /o*t- • Ho. to /a2e +a+! et "o o t-e +$east 7 P$ess P$ess (o.n (o.n on t-e t-e +$ea +$east st nea$ nea$ -is /o*t/o*t- 6 P* (o.n (o.n on on -is c-in an( an( inse$t inse$t a s/a in"e$ in"e$ in t-e co$ne$ co$ne$ o -is /o*t- T-is .i +$ea2 -is sea on t-e ni''e 8 T-en T-en $e/ $e/o# o#ee -i/ -i/ $o/ $o/ t-e t-e +$e +$eas ast t Si"ns t-at t-e +a+! -as atc-e( on '$o'e$! to t-e +$east 7 T-e T-e +a+! +a+!1s 1s /o* /o*tt- is is .i(e .i(e o'e o'en n 6 T-e +a+! +a+! an( an( t-e t-e /ot-e$ /ot-e$ a$e a$e in t*//! t*//! to to t*//! t*//! 'ositi 'osition on 10
8 9 < • •
M*cM*c- o t-e t-e /ot-e$1 /ot-e$1ss a$eoa a$eoa is insi( insi(ee t-e +a+! +a+!1s 1s /o*t/o*t- T-e /ot-e /ot-e$$ (oes (oes not not ee ee ni'' ni''ee 'ain 'ain T-e T-e +a+! +a+! is is $ea $eaxe xe(( an( an( -a' -a''! '!
3$e)*enc! o +$eastee(in" Si"ns o '$o'e$ +$eastee(in" tec-ni)*e
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