SHOW ME YOUR SKILLS, BABY! Newborn Assessment Janelle Myers, OTRL - - PowerPoint PPT Presentation

SHOW ME YOUR SKILLS, BABY!

Newborn Assessment

Janelle Myers, OTRL 2016

OBJECTIVES

• Identify typical development patterns
• Identify atypical development patterns and indications for referral to early intervention

services

• Common deficits
• Subtle deficits
• Affect of preterm birth on development
• Learn about assessment tools for infants less than 4 months old

NEWBORN ASSESSMENT

• Start with information gathering
• VERY important development happens

well before birth

• What systems have possibly been

affected

PRENATAL AND BIRTH HISTORY

• Prenatal care and prenatal events
• Mother’s history
• Birth events
• Type of delivery
• Percentiles of height, weight and length
• APGARS

APGAR

• initial physical assessment performed by delivery room staff

Score of 0 Score of 1 Score of 2 Optimal Score Color blue or pale all over blue at extremities body pink (acrocyanosis) no cyanosis body and extremities pink 2 Heart Rate absent < 100 beats per minute > 100 beats per minute 2 Activity no response to stimulation grimace on suction or aggressive stimulation cry on stimulation 2 Muscle Tone none some flexion flexed arms and legs that resist extension 2 Breathing absent weak, irregular, gasping strong, lusty cry 2

TYPICAL DEVELOPMENT

• A good knowledge of typical development is important
• Helps to identify variances
• Typical development is the blueprint for therapy
• Design therapy approaches according to stage of development not age
• Nature’s building blocks

TYPICAL NEWBORN DEVELOPMENT

• Reflexes that should be present – extensor thrust, flexion withdrawal, ATNR, plantar and palmar

grasp, head righting, Moro, head lag, rooting, sucking

• Motor - physiologic flexion is very important for postural stability, head turning on surface, smooth

movement, very minimal isolated motor movements

TYPICAL NEWBORN DEVELOPMENT

• Feeding is based on reflexive activity:

rooting and sucking, gag is also present for protection

• State- smooth and predictable state

transitions, brief social interactions, strong robust, cyclical cry

ONE TO TWO MONTHS

• Reflexes – All still present have not

integrated yet

• Motor –
• relatively hypotonic due to decreased

physiologic flexion and increased muscle elongation

• Limited anti-gravity control
• hip and knee extension, lifts head in

prone 45 degrees, rotation of head, using trunk against surface for stability, begins asymmetrical flexion

ONE TO TWO MONTHS

• State- increased periods of awake state,

able to attend visually with tracking skills from periphery to midline, regards hand in ATNR

• Feeding - Suck Swallow Breath

coordination should be fully established

• Tightly fisted hands at birth begin to open

up

ATYPICAL DEVELOPMENT

• Orthopedic
• Club foot
• Surgical and treatment specialists for correction @ U of M (734) 936-5780 (ortho department)
• Shoulder Dystocia / Brachial Plexus Injury
• Acute phase – Pediatric Brachial Plexus Program @ U of M (734)936-5017
• Cleft lip / palate
• Syndromes
• Plagiocephaly

ATYPICAL DEVELOPMENT CONTINUED

• Plagiocephaly and Torticollis

ATYPICAL DEVELOPMENT

• Hypotonia
• Quality of Movement

• 41 weeks 1 day
• 44 weeks at time of video
• APGARS 9, 9
• Pneumonia
• Meconium Aspiration
• PPHN (persistent pulmonary

hypertension of the newborn)

ATYPICAL DEVELOPMENT

• Rigidity (especially among babies of neonatal abstinence syndrome or neurologic

disorders)

• Poor tolerance for touch and movement- touch is a primal source for comfort and

security.

RIGIDITY

• Born at 31 weeks
• Twin A
• APGARS 7, 9
• Intubated
• 9 weeks old at video (39 weeks 6 days)
• Poor feeding
• Often fussy and irritable

Retraction & elevation of shoulders Sensitive to touch

Extension of extremities Poor smooth movements

PREEMIE VS FULLTERM

• Corrected age consideration until 2 years old
• Weakness in trunk / central hypotonia
• Preferences for extension
• Sensory processing difficulties
• All or None movements:
• “my baby likes to stand”
• How are they rolling?
• Butt up or down in prone?

ASSESSMENT

• Stress Cues and Behavioral State from

NIDCAP (Newborn Individualized Care and Assessment Plan)

• Autonomic System
• Motor
• State
• Attention

ASSESSMENTS

• Hammersmith Neurological Assessment of the

Preterm and Full- Tem Newborn Infant

• Suitable for repeat examinations
• To detect deviations in neurological signs
• Administer in less than 15 minutes

SCORING

ASSESSMENTS CONTINUED

• TIMP – Test of Infant Motor Performance
• 34 weeks postconceptual age and 4 months post term

ASSESSMENTS CONTINUED

• Bayley Scales of Infant Development
• 1 – 42 months
• 30 – 90 minutes to administer

INTERVENTION

• Massage
• Trigger point release
• Sensorimotor inputs
• Therapeutic handling
• Calming supports

Treatment

Before After

Before After

WHY EARLY INTERVENTION?

• Identification of deficits before milestones

are missed!

• A certain level of readiness is necessary

for the acquisition of motor skill

REFERENCES

• Vergara, E. R. & Bigsby, R.(2004) Developmental & Therapeutic Interventions in the NICU. Paul H. Brooks Publishing Co.
• Brazelton, T. B. (2006) Touchpoints Birth to 3. Second Edition. Da Capo Press
• Payne, V.G. & Isaacs, L. D. (2011) Human Motor Development: A Lifespan Approach. Eigth Edition. Mayfield Publishing

Company

• Dubowitz, L., Dubowitz, V., & Mercuri, E. (1999) The Neurological Assessment of the Preterm & Full- Term Newborn Infant.

Second Edition. Cambridge University Press

• Als, H. (1982). Toward a snyactive theory of development: promise for the assessment and support of infant individuality.

Infant Mental Health Journal, 3, 229-243.

• Alexander, R. Boehme, R. & Cupps, B. (1993) Normal Development of Functional Motor Skills: The First Year of Life. Tucson,
• Arizona. Therapy Skill Builders.
• Ayers, A.J. (2005) Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Western Psychological

Services.

JANELLE MYERS, OTRL JMYERS@CHS-MI.COM