NRS 434 Describe the developmental markers a nurse should assess for a 9-month-old female infant
NRS 434 Describe the developmental markers a nurse should assess for a 9-month-old female infant
Developmental milestones are a set of goals or markers that a child is expected to achieve during maturation. They are categorized into 5 domains: gross motor, fine motor, language, cognitive, and social-emotional and behavioral. Understanding and identifying the developmental milestones can help the provider more adeptly recognize delayed development, facilitating earlier interventions and improving outcomes (Boehning, A.P, et al, 2023). At 9 months the child should be able to do perform the following: Fine motor skills: bangs on table, transfers object from one hand to the and self feeds. Gross motor skills: crawls, sits without support, able to get into sitting position, pulls self to standing position, stands while holding onto a support and males stepping movements, Language: yes, no, mama, dada, imitates sounds, cognitive development: object permanence is often learned by playing peekaboo (Falkner, A, 2022) and social-emotional and behavioral: development of stranger anxiety is manifested by crying when unfamiliar people approach the child. It is linked to infants’ developmental task of distinguishing the familiar and unfamiliar.
Given the scenario with this 9 month-old infant female the weight, height and head circumference are below the 50th percentile on the CDC growth chart represents the possibility of the premature birth or severe failure to thrive. A 9 month-old infants average weight is 9 pounds 2 ounces, height 27 1/2 inches and head circumference should measure 43 centimeters (Brusie, C, 2020). Surveillance and screenings are part of every well-child care visit. These developmental assessments are performed according to an age-appropriate milestone checklist. The purpose of these assessments allows the provider the necessary information to closely monitor a child at risk or with developmental delays. It important that the provider adjusts assessments according to the child’s chronological age and gestational age for comparison. One example, is if a child was born at 30 weeks gestation and went in for a 9-month-old well-child visit the child would be behind approximately 10 weeks on milestones due to premature birth. If there are delays noted in an exam, it is important to schedule routine follow ups to assist in early child interventions. Some interventions could include physical therapy, occupational therapy and speech therapy. The earlier delays are identified the better the prognosis for the child.
If I was the clients nurse I would start off with a detailed H&P on mother and her pregnancy, pre-existing conditions, substance abuse, complications during pregnancy or preterm delivery. In addition, I would ask for the mother about the clients nutritional intake, living environment and current situation, housing, family support or assistance, is mom employed etcetera because these could be key factors that are affecting the growth and development of the infant. After gathering this information I would be able to make a nursing diagnosis for this client to best assist their current needs. Information I could offer the mother are nutritional information for the childs age, milestones appropriate for age, age appropriate toys, household safety and hazards, sleeping safety to prevent SIDS and discuss possible referral to agencies in the community if child fails to meet future developmental milestones for early intervention to prevent further delay.
Boehning, A. P., Misirliyan, S. S., & Shah, M. (2023, March 16). Development milestones – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557518/
Brusie, C. (n.d.). 9-month-old Baby: Development, milestones & growth. BabyCenter. (2021, Sep 21). https://www.babycenter.com/baby/month-by-month/9-month-old-baby-milestones-and-development_713
Falkner, A. (2022). 1. Health assessment of the infant. In S. Z. Green (Ed.), Health Assessment: Foundations for effective practice (second, pp. 9–19). essay, Grand Canyon University. Retrieved June 9, 2023,.
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Screening tools, such as the Denver Developmental Screening Test II, Infant Development Inventory, or Bayley Infant Neurodevelopmental Screener, are useful for assessment of language development as well as gross and fine motor skills and psychosocial development (Mackrides & Ryherd, 2011; Vitrikas, Savard, & Bucaj, 2017). If an infant shows developmental delays on screening, the nurse should pursue this with the infant’s primary practitioner or other referral sources such as early intervention services. Early intervention services are coordinated services aimed toward early identification, evaluation, and intervention for infants and young children who have developmental delays or medical conditions that could result in disabilities or delays. Rapid changes occur in infancy, which result in the development of growth and skills known as milestones (see Table 1.1). Parents often ask how fast the infant should be growing and if enough weight gain is occurring. On average, birthweight generally doubles by 6 months and triples by 12 months, with an additional 10 to 12 inches of growth in length (Mayo Clinic, n.d.b).
Grand Canyon University (ED). Green, Sue. (2018). Health assessment: Foundations for effective practice. Grand Canyon University. https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/
I completely agree with you, Developmental screenings help to monitor how the infant grows and changes over time; heater the infant meets the developmental milestones in each are , such as; psychosocial, motor and behavioral. Parents and caregivers can monitor and track the development of the infant. The CDC has booklets, free online CEU courses and checklist, developmental test available online for caretakers to monitor the development of the infants. It is important for the parents also to maintain appointment with primary care physician to monitor the milestones and health of the infant. By assessing the infant developmental markers, it is easier to identified early if there is any potential developmental delay.
Developmental monitoring and screening | CDC. (n.d.). https://www.cdc.gov/ncbddd/childdevelopment/screening.html
I agree with you that all care for infants will first begin with the baby’s primary care provider. If there are any concerns regarding cognitive, motor, language or any other concern, parents should be educated on making sure that the child sees their primary. The primary provider will know what resources to give the parents as well as what other specialties of the interdisciplinary team will need to be recommended. Early intervention is the key so the sooner the child is seen and assessed, the better the outcome for the child. Thank you for mentioning the various screenings that providers will opt to perform on the child.
The importance of establishing primary care for your child
Thank you for posting this. I agree with you. Screenings will help mothers to see the babies develop and thus able to detect abnormalities mentally in an early stage. Parents should track their child’s growth in order to have comparisons. According to the CDC, these developmental milestones involve social, emotional, language, communication, cognitive, physical, and motor skills. The infant may show social or emotional milestones like being shy or fearful around strangers around this age (CDC, 2022).
CDC. (2022, December 6). Important milestones: Your baby will be by nine months. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html
Developmental markers or milestones are a necessity in health assessment. It helps parents and health practitioners to detect when a child may not be growing as expected as crosschecked against certain age-appropriate checklists, just as you already mentioned. However, one aspect of developmental milestones which is rarely talked about is the pressure parents face when their children do not ‘reach’ certain milestones as expected.
The internet and social media have further heightened the anxiety of parents especially with young and first time moms. People have access to a large amount of information (and misinformation) regarding the “standard developmental milestones” that children should reach as they progress from infants to toddlers to primary school children. Many parents have expressed that the stress caused by their child not reaching a milestone within the prescribed timeframe – or worse – missing a milestone altogether is quite enormous. Parents compare their children’s milestones with what is obtainable on the internet, with other children and sometimes comparing different children born to them.
Most of these concerns stem from the fact that there is a shared understanding of a “standardised” developmental milestone roadmap that each “normal” child follows. However, Todd Rose, a Harvard scholar points out that no child “sticks” to the average developmental roadmap, just as no human being ever conforms to the so-called “standard” behaviour or development identified in any social or psychological developmental metric. As a unique individual, each human being deviates from what is regarded as “standard behaviour” in multiple ways. He addresses the error in using the ‘average’ as a yardstick for measurement of what a normal developmental pathway should be. He recognises that there are obvious things during child development which should not be overlooked, but these will mostly be quite pronounced and hard to ignore. “However, this is not the same as seeing some deviation from developmental milestones as an indication of “abnormal” development”. For instance, Rose highlights research done by Karen Adolph on how infants progress from crawling to walking. In one study, following 28 infants, she discovered that among them they used no less than 23 different pathways from crawling to walking The point here is not that developmental milestones are useless, simply that they should not be seen as fixed, normative, single path roadmaps which every “normal” child should follow if they were to develop “properly”. Parents should know that every individual is different and that there are several possible ways in which children can progress through the different stages of development.
Liebenberg, L. (2020, November 2). The importance and limitations of developmental milestones. Crayonkidsacademy. https://www.crayonkids.co.za/post/the-importance-and-limitations-of-developmental-milestones
How would you go about obtaining comprehensive information about the mother’s pregnancy history, pre-existing conditions, substance abuse, complications, living environment, current housing situation, and other relevant factors that could potentially influence the infant’s growth and development? Additionally, how would you approach discussing these sensitive topics with the mother in a respectful and non-judgmental manner to ensure that accurate and necessary information is obtained? I’m a newer nurse, so this is a struggle for me.