Posted: January 16th, 2023
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 Developmental Markers for a 9-month-old female infant.
This nine-month-old baby girl is probably sitting (with or without support), pulling herself up to standing, clapping her hands, and maybe even working on crawling and cruising. The average weight for a 9-month-old baby is 18.1 pounds for girls, and here she is around 14.88 lb and a close 2.75 lb but still lacks 3 lbs of body weight. According to the World Health Organization, the average length for girls is 27.6 inches. Here our baby girl is 70.104 cm and looks pretty good in that case. Also, the average head circumference for the baby girl is a little small but almost matches that prescribed by WHO (44 cm) (World Health Organization [WHO], 2018).
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The main developmental markers a nurse should access are: 1. movement (sitting, creeping, leaning etc), 2. sensory development ( truing pages, looking around etc), 3. emotions (pain, laughing, crying etc) , and 4. other physical activities (mimics facial expressions and gestures) (Bishop et al., 2018). Of course, height and weight can vary widely among healthy babies, but here there is a significant loss in weight. So a nurse should give a lot of recommendations for her mother to keep in mind. 30 ounces per 24 hours is the key. Developmental Markers for a 9-month-old female infant Evidence-based breastfeeding results insist on exclusive breastfeeding as far as possible. A baby who refuses to breastfeed is said to be on a “nursing strike.” If such a problem exists , we should find it. Additionally, we should educate parents about breastfeeding and feeding intervals. Another thing is sleep. Sleeping continues to be an important process for your little one at 9 months. Evidence-based research showed that they should drop from 3 to 2 naps a day. We can ask the parents about that. A nurse should check the physical activities , emotions, and reactions of the baby girl. Interacting or asking is the first step in EBP. We should try to talk and engage with the child to check their reactions and movements. We should find that all of their sensory organs are working properly . Additionally, nurses should give recommendations about vaccines too (Misirliyan & Huynh, 2022 ).
We can find that all the above steps we took are the steps included in EBP, like asking, gathering evidence, applying recommendations/interventions, acting, evaluating, and disseminating. The things we learn about baby care are the results of earlier evidence-based practice. So we should add our own contributions to it for further developments . So the final step is important in the future development of EBP in baby care. For example, the comprehensive milestone chart is evidence-based and can help parents learn what are appropriate and atypical behaviors based on the charts. The charts allow for developmental achievements within a range. The milestone ages quoted are based on the oldest age by which a skill should have been achieved, using the best evidence-based upper thresholds available. These charts help to alert a clinician or family when they should be concerned and get further evaluation Developmental Markers for a 9-month-old female infant.
Bishop, S. L., Farmer, C., Bal, V., Robinson, E. B., Willsey, A. J., Werling, D. M., Havdahl, K. A., Sanders, S. J., & Thurm, A. (2018). Identification of Developmental and Behavioral Markers Associated With Genetic Abnormalities in Autism Spectrum Disorder. The American journal of psychiatry, 174(6), 576–585. https://doi.org/10.1176/appi.ajp.2017.16101115
Misirliyan, S. S., & Huynh, A. P. (2022). Development Milestones. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32491450/
World Health Organization. (2018). Child growth standards: methods and development. https://www.who.int/childgrowth/standards/Technical_report.pdf?ua=1
Determining the correct growth of this 9-month-old infant is based on the Center for Disease control and prevention clinical growth chart. Clinical growth consists of a series of percentile curves that illustrate the distribution of selected body measurements in children (CDC, 2016) Developmental Markers for a 9-month-old female infant. This particular infant 68.5cm in length which means 75 percent of other infants is longer than she is. Her weight is concerning she weight 6.75kg (14.9 lbs.) at 9 months 95 percent of infants weight more than her. Head circumference is 43 cm which mean 75 percent of other infants have larger head circumference.
Developmental markers or milestones a nurse should assess in a 9-month-old infant physical development is sitting without support, crawling, ability to pull self-up to stand, stand while holding support, use fingers to rake food towards herself, and move things one hand to another. Cognitive development is looking for objects when dropped out of sight and bangs two things together. Communication milestone includes lifting arms to be picked up and making different sounds. Social and emotional milestone consist of shy, clingy, or fearful of strangers, show facial expression such as happy, sad, etc. Looks when name is called, react when parent leaves, smiles or laugh when playing peek-a-boo (CDC, 2016).
As a Nurse I would recommend following CDC nutrition guidelines and her local resource such as WIC (Women, infant, and children) a supplemental nutrition program. We would address weight, start with introducing foods one at a time like potato, pumpkin, sweet potato, peas, eggs, pureed meats, etc. which will help in weight gain. Continue with breastfeeding or baby formula until the infant reach 12 months. Length and height should correlate in some way but it also could mean that the birth mother and/or father could be shorter in height.
CD, C. (2010, September 9). Growth charts – who child growth standards. Centers for Disease Control and Prevention. Retrieved September 9, 2022, from https://www.cdc.gov/growthcharts/who_charts.htm
CD, C. (2021, December 1). Foods and drinks for 6 to 24 month olds. Centers for Disease Control and Prevention. Retrieved September 9, 2022, from https://www.cdc.gov/nutrition/InfantandToddlerNutrition/foods-and-drinks/index.html
According to the CDC, “milestones for the 9 month old,” how your child plays, learns, speaks, acts, and moves offers important clues about your child’s development, and wether they are meeting their minimal milestone markers. Developmental milestones are things most children, 75% or more, can do by a certain age. There are many evaluations that need to be performed in order to determine whether your child is or is not in their suggested milestone category. Although this child is not in the recommended growth percentile for her age, there are other considerations that should be assessed before determining if there is an issue with growth. If this 9 month old was premature at birth, or was born with low birth weight, it should not be assumed that she is not in her desired growth chart. The considerations of low birth weight and prematurity, should be assessed before developmental markers are deemed unmet. Other assessments that should be done are those of different milestones such as social, emotional, cognitive, language, communication, movement or physical developmental milestones. At the 9 month age mark, your child should be able to smile, or laugh when playing peek a boo, lifts arms up when wanting to be held, able to bang two objects together, look for objects that are dropped out of their sight, sit without support, looks when called by name, and other tasks that are within their milestone achievements. The CDC has several different handouts for different milestones, and other tasks, and achievements that can help parents along the way with milestone developments. It is important that the parents take note if they believe that their child is not reaching a certain milestone marker, and inform their child’s doctor at the earliest time possible Developmental Markers for a 9-month-old female infant.
Rosas-Blum, E. D., Granados, H. M., Mills, B. W., & Leiner, M. (2018). Comics as a Medium for Parent Health Education: Improving Understanding of Normal 9-Month-Old Developmental Milestones. Frontiers in pediatrics, 6, 203. https://doi.org/10.3389/fped.2018.00203
Centers for Disease Control and Prevention. (2022, August 9). Important milestones: Your baby by nine months. Centers for Disease Control and Prevention. Retrieved September 7, 2022, from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html Developmental Markers for a 9-month-old female infant
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