Reply 1

9-month old development markers

Based on the CDC (2020), a 9-month-old baby should be able to do at least these things listed below as examples:

Social and Emotional – May be afraid of strangers and attached with those familiar to them

Language/Communication – Understands “no” and makes different sounds that seem like “mama” or “dada”

Cognitive – plays peek-a-boo, can hold cereal between pointer finger and thumb

Physical Development – sits by themselves without support, crawls

Recommendations with EBP

There are so many assessments that would need to be made to ensure the baby is growing properly. If the baby’s birth weight, height, and head circumference were in the 5th percentile when born and developing on schedule, then the baby may just be small. If on the other hand, the infant was born in the 60% percentile and is now in the 20% for weight, that would be of concern. If that were the case, I would go over the infant’s daily intake and feeding schedule; also assessing if the mother is breastfeeding. If she is breastfeeding, it would be important to recommend foods that are nutritious for the baby and ensuring she is feeding often enough and producing enough milk. Not eating enough or the right foods could delay the baby’s growth and by 9 months, the infant should be eating baby foods and if drinking juice it should be 100% fruit juice (Green, 2018). If the mother was unable to produce enough milk, refer her to an appropriate formula and even information to have food supplement if the family is unable to afford. The WIC program is helpful to provide healthy choices. Based on the American Academy of Pediatrics (AAP) (n.d.) suggests that babies at age 9 months eat less fruits and vegetables because the baby can start feeding themselves and snack on non-nutritive snacks (baby cookies, etc.) instead of fruits and vegetables. “After 9 months, offer 2-3 healthy and nutritious snacks per day” consisting of fruits and vegetables (AAP, n.d.). I would also provide information and websites to access for more information.

References

• American Academy of Pediatrics (AAP). (n.d.) Infant food and feeding. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx
• Centers for Disease Control and Prevention (CDC). (2020). Important milestones: Your baby by nine months. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html
• Green, S.Z. (2018). Health assessment: Foundations for effective practice.Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/
• Reply 2

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.

Developmental markers are physical, communicational, emotional, and cognitive. ( Centers for Disease Control and Prevention, 2020) Physical markers such as height, weight, and head circumference are measurements of development. Average weight of a 9-month-old girl should be between 18-19 lbs., height should be around 27-28 inches, and head circumference around 44cm. ( Centers for Disease Control and Prevention, 2020) Other physical markers include the 9 month old being able to complete tasks such as crawling, sitting without support, pulling self to standing, stands while holding a support, and making stepping motions. (Green, 2018) Understanding of the word no, makes sounds such as mama and dada, copying sounds, and using fingers to point, are typical communication for a 9 month old. ( Centers for Disease Control and Prevention, 2020) Emotional markers include being afraid of strangers, being clingy to familiar adults, and having favorite toys. ( Centers for Disease Control and Prevention, 2020) A 9 month old with normal development in cognition will watch the path of falling items, looks for others when they hide, plays peek-a-boo, puts things in mouth, moves things from one hand to the other smoothly, and is able to pick up small items between thumb and index finger. ( Centers for Disease Control and Prevention, 2020) Another developmental marker is assessing dental health and the impact of teething.

Discuss the recommendations you would give the mother. Explain why these recommendations are based on evidence-based practice.

Recommendations to the mother would depend on the answers to the other developmental questions. Assessment of nutritional intake would be key in understanding why the child is lacking in weight. A thorough evaluation of the patient’s history and overall health would be needed to make appropriate recommendations. With the information provided this patient could be referred to the WIC program for assistance with access to food if that is an issue for the patient. Another recommendation would be to start the child on solid foods if they have not started them already. “First solid should be a single-grain iron-fortified baby cereal, such as rice with breastmilk, formula, or water via spoon.” (Green, 2018) By the age or 8 months on the child can eat small pieces of more solid type foods such as crackers, noodles, cooked vegetables, and more. (Green, 2018) If the child is teething and that is causing a lack of interest in food. The nurse can suggest items to ease the child’s teething pain such as a frozen teething ring or cool soft foods. Ensuring proper diet and care for the child are very important to maintain overall health and wellness.

References

Centers for Disease Control and Prevention. (2020, June 9). Retrieved from CDC 24/7: Saving Lives, Protecting People: https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html

Green, S. Z. (2018). Grand Canyon University. Retrieved from Health Assessment Foundations for Effective Practice: https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/1