Presented by;

J. Bhuvaneshwari
V. Deepa
J. Juhin
IIIrd Year B.Sc(N)
C.S.I JACON.
 Growth means an increase in the size
of an organism or part of an organism, usually
as a result of an increase in the number of
cells. Growth of an organism may stop at
maturity, as in the case of humans and other
mammals, or it may continue throughout life.
 A gradual change and expansion;
advancement from lower to more advanced
stages of complexity; the emerging and
expanding of the individuals capacities
through growth, maturation and learning.
 The period from birth to 28 days of
life is called neonatal period and the infant in
this period is termed as neonate or newborn
baby.
Rooting reflex:-
When the cheek or corner of the mouth
is stroked, the infant’s head should turn
towards the stimulus and the mouth should
open.
Sucking reflex:-
When touching or stroking the
lips, the mouth opens and sucking
movements begin.
Swallowing reflex:-
The passage of food from the posterior
aspect of mouth to the stomach.
Gagging reflex:-
When the posterior pharynx is
stimulated with food, there is an immediate
return of undigested food.
Extrution:-
When substance placed on anterior
portion of the tongue, it’ll be expelled out.
Blinking reflex:-
Protection of eye by rapid eye lid closure
when the eyes are exposed to bright light.
Doll’s Eye reflex:-
When you are showing an object to a
newborn, normally eyes don’t move but the
head turns to the right or left side towards
the object.
Pupillary reflex:-
Pupil contracts when bright light shines,
it persists throughout life.
Sneeze reflex:-
Nasal passage respond spontaneously to
irritation or obstruction, persists throughout
life.
Glabellar reflex:-
Tapping briskly on glabella(bridge of
nose) cause eyes to close tightly.
Yawn reflex:-
Infant has spontaneous response to
decreased oxygen by increasing amount of
inspired air, persists throughout life.
Cough reflex:-
Irritation of mucous membranes of
larynx or tracheonchial tree causes coughing,
persists throughout the life; Usually present
after 1st day of birth.
Babinski reflex:-
Stroking outer soul of food upward from
heel and across ball of foot to hyperextend
and hallux to dorsiflex.
Tonic neck reflex:-
Turning the head quickly to one side while
the baby is supine, arm and legs on the side
the head is turned towards extent, arm and
legs on the opposite side.
Perez reflex:-
While baby is prone on firm surface and
thumb is passed along spine, defecation and
urination may occur; disappears by 4-6
months.
Galat reflex:-
While baby is prone on firm surface
and thumb is passed along spine, defecation
and urination may occur; disappears by 4-6
months.
Palmar grasp:-
When the objects are place in the
palm of newborn, it grasps the object.
Plantar grasp:-
When objects touch the soul of the foot
at the base of the toes, toes grasps around
very small object.
Dancing or Stepping reflex:-
Hold newborn in a vertical position
with the feet touching a flat firm surface,
there will be a rapid alternating flexion and
extention of the legs.
Placing reflex:-
When baby is held
upright under arms and
dorsal side of foot, it
briskly places against hard
objects such as table, leg
lifts as if foot is stepping on
the table, the age of
disappearance varies.
Moro reflex:-
The newborn head is suddenly allowed to
drop backward an inch, there will be
symmetric abduction and extension of the
arms and legs with flanning of fingers.
Ankle reflex:-
Briskly dorsi flexing foot while supporting
knee in partially flexed position results in 1-2
oscillating movements, eventually no beats
should be felt.
 Love and affection
 Human contact
 Sensory stimulation
 Sucking
 Breast feeding 2-3 hours
 Maintain body temperature
 Hygienic needs
 Prevention of injury/aspiration
 Prevention of infection and injury
 Provision of optimal nutrition
 Watch for danger signs of newborn like hypothermia,
hypoglycemia, jaundice, apnea, etc.
Mile stones:
▪ 1st month : Social smile
▪ 2nd month : Cooos/ Vocalize
▪ 3rd month : Head control
▪ 4th month : Hand control
▪ 5th month : Turns over
▪ 6th month : Sits alone
▪ 7th month : Crawl
▪ 8th month : Creeping
▪ 9th month : Stands with support
▪ 10th month : Walks with support
▪ 11th month : Stands alone
▪ 12th month : Walks alone
Reflexes:
 Primitive reflexes present and strong
 Doll’s eye reflex and dance reflex fading
 Obligatory nose breathing (most infants)
Gross motor:
 Assumes flexed position with pelvis high but knees not under
abdomen when prone.
 Can turn head side to side when prone.
 In sitting position, back is uniformly rounded with absence of
head control.
Fine motor:
 Grasp reflex strong
 Hand clenches on contact with rattle
Reflexes:
 Posterior fontanel closed
 Crawling reflex disappears
Gross motor:
 Less head lag when pulled to sitting position
 Can maintain head in same plane
 When prone, can lift head almost 45 degrees
Fine motor:
 Hands often open
 Grasp reflex fading
Reflexes:
 Primitive reflexes fading
Gross motor:
 Able to hold head more erect when sitting.
 Assumes symmetric body positioning
 When held in standing position, able to hear slight
fraction of weight on legs.
Fine motor:
 Actively holds rattle but will not reach for it.
 Grasp reflex absent
 Pulls at blankets and clothes
Reflexes:
 Drolling begins
 Moro, tonic neck and rooting reflexes have disappears
Gross motor:
 Has almost no head lag when pulled to sitting position
 Balances head well in sitting position
 Rolls from back to side
 Able to sit erect if propped up
Fine motor:
 Inspects and plays with hands; pulls clothing or blanket over face in play
 Tries to reach objects with hand but overshoots
 Grasp object with both hands
 Play with rattle placed in hand, shakes it but cannot pick it up if dropped.
 Can carry objects to mouth
Physical:
 Beginning signs of tooth eruption
 Birth weight doubles
Gross motor:
 Able to sit for longer periods when back is well supported back
straight
 When sitting, able to hold head erect and steady
 Can turn over from abdomen to back
 When supine, pulls feet to mouth.
Fine motor:
 Able to grasp objects voluntarily
 Uses palmar grasp, bidextrous approach
 Plays with toes
 Takes object directly to mouth
 Holds one cube while regarding a second one
Physical:
 Growth rate may begin to decline
 Weight gain of 90-150 g weekly for next 6 months.
 Height gain of 1.25 cm monthly for next 6 months
 Teething may begin with eruption of two lower central incisors.
 Chewing and biting may occur
Gross motor:
 When prone, can lift chest and upper abdomen off surface, bearing weight on hands
 Sits in high chair with back straight
 Rolls from back to abdomen
 When held in standing position, bears almost all of weight
Fine motor:
 Resecures a dropped object
 Drops one cube when another is given
 Grasps and manipulates small objects
 Holds bottle
 Grasps feet and pulls to mouth
Physical:
 Eruption of upper central incisors
Gross motor:
 Sits, leaning forward on both hands
 When prone, bears weight on one hand
 Sits erect momentarily
 Bears full weight on feet
 When held in standing position, bounces actively
Fine motor:
 Transfers object from one hand to another
 Has unidextrous approach and grasp
 Holds two cubes more than momentarily
 Bangs cubes on table
Physical:
 Parachute reflex appears
 Begins to show regular patterns in bladder and bowel
elimination
Fine motor:
 Sits steadily unsupported
 Adjusts posture to reach an object
 May stand by holding a furniture
Gross motor:
 Retains two cubes while regarding third cube
 Rings bell purposely
 Releases objects at will
 Reaches persistently for toys out of reach
Physical:
 Eruption of upper lateral incisor may begin
Fine motor:
 Creeps on hands and knees
 Sits steadily on floor for prolonged time (10 minutes)
 Pulls self to standing position and holds a furniture
 Recovers balance when leaning forward but cannot do so
when leaning sideways.
Gross motor:
 Grasp third cube
 Compares two cubes by bringing them together
 Preference for use of dominant hand now evident
Reflexes:
 Labyrinth- righting reflex is strongest when infant is in
prone or supine position; is able to raise hand
Gross motor:
 Can change from prone to sitting position
 Stands while holding onto furniture, sits by falling down
 Recovers balance easily while sitting
 While standing lifts one foot to take a step
Fine motor:
 Crude release of an object beginning
 Grasps bell by handle
Physical:
 Eruption of lower lateral incisor may begin
 Gross motor:
 When sitting, pivots to reach toward back to pickup an
object.
 Cruises or walks holding unto furniture or with both hands
held
Fine motor:
 Explores objects more thoroughly
 Has neat pincher grasp
 Drops object deliberately for it to be picked up
 Puts one object after another into a container
Physical:
 Birth weight tripled
 Birth length increased by 50%
 Dentition: has 6-8 deciduous teeth
 Anterior fontanel almost closed
 Babinski reflex disappears
 Landau reflex fading
 Lumbar curve develops, lordosis evident during walking
Gross motor:
 May attempt to stand momentarily, may attempt first step alone
 Can sit down from standing position without help
Fine motor:
 Releases cube in cup
 Attempts to build two block tower but fails
 Tries to insert a pellet into a narrow necked bottle but fails
 Can turn pages, many at a time.
Psychosocial (Erick Erickson)

[Sense of trust Vs Mistrust]

Trust – Firm believing the reliability, truth or

ability of someone or something
Mistrust – Lack of trust or confidence; distrust.
Complete dependence on care giver
Psycho sexual (Freud)

[Oral stage] – This is the first social and sexual

stage of an infant’s development, during
which the infant focuses on satisfying hunger.
This is satisfied by chewing, sucking and
biting.
Spiritual development: (Fowler)

[Undifferentiated] – Feeling of trust, warmth

and security from the foundation of the later
development of faith.
Intellectual development: (Jean Piaget)

[Sensory motor] (0-2 years)

Stimuli are recognized, absorbed and
incorporated into existing action.
Moral development: (Kohlberg)

[Pre-conventional morality stage] (0-2 years)

 Unable to understand good or bad
 The good is what I like and want
Language/ Speech development:

Receptive language:
 Responds to human voices

Expressive language:
 Cries when hungry or uncomfortable
 6 – 8 words at one year
Play: (New Hall)

[Solitary play]Alone; without companions;

done without assistance or accompaniment
Infants can play alone for longer periods.
 Need for sucking and safety
 Play and sensory stimulation
 Need for warmth
 Discipline leading to self control
 Developmental self esteem
 Meeting the nutritional need.
1 YEAR:
Gross motor:
▪ Walks without help
▪ Creeps upstairs
▪ Kneels without support
▪ Cannot throw ball without falling
▪ Runs clumsily
▪ Falls often
Fine motor:
▪ Constantly casting objects to floor
▪ Builds tower of two cubes
▪ Holds two cubes in one hand
▪ Releases a pellet in an narrow-necked bottle
▪ Scribbles spontaneously
▪ Uses cup well but often rotates spoon before it
Physical development:
 Head circumference: 49- 50 cm
 Chest circumference exceeds head circumference
 Usual weight gain of 1.8 – 2.7 kg per year
 Usual height gain of 10 – 12.5 cm per year
 Primary dentition of 16 teeth
 Beginning of daytime bowel and bladder control
Gross motor:
 Goes up and down stairs alone with two feet on each step
 Picks up object without falling
 Kicks ball forward without over balancing
Fine motor:
 Builds tower of 6 or 7 cubes
 Aligns two or more cubes like a train
 Turns pages of book one at a time
 In drawing, imitates vertical and circular strokes
 Unscrews lid
 Turns door knob
 Able to remember and imitate some actions and gestures
Physical development:
 Birth weight quadrupled
 Primary dentition (20 teeth) completed
 May have daytime bladder control
Gross motor:
 Jumps with both feet
 Jumps form chair or step
 Stands on one foot momentarily
 Takes a few steps on tiptoe
Fine motor:
 Builds tower of eight cubes
 Adds chimney blocks to train of block
 Good hand-finger coordination; holds crayon with fingers rather than fist
 In drawing, imitates vertical and horizontal strokes; makes two or more
strokes for cross; draws circle.
Psycho social (Erick Erickson)

[Autonomy Vs Shame]

Autonomy – The right of a person, an

organization, region etc.
Shame – The unpleasant feeling of guilt and
embarrassment that you get when you have
done stupid or morally wrong.
Psycho sexual (Freud)

[Anal stage] – Obtain pleasure from the feeling

of a distended bladder, from masses of feaces
in the rectum and from release of content
from those organs.
Spiritual development (Fowler)

[Intuitive projective] – Imitates religious

behavior such as bowing the head in prayer,
but does not understand the meaning.
Intellectual development (Jean Piaget)

 Preoperational (2 to 7 years)
 Pre-conceptional phase (2 to 4 years)
 Beginning of mental representation of events
and differentiates past and present.
Moral development (Kohl berg)

[Pre conventional morality stage]

Birth to 2 yrs – The good is what the child like

and wants
2 to 3 yrs – Child is punished for doing
something, its wrong; if not punished it must
be right.
Language/ Speech development

 1 year – 6 to 8 words
 2 years – 300 words
 3 years – 900 words
Play (New Hall)

[Parallel play] – A form of play in which a very

young child plays independently in the
presence of another child or children.
 Negativism – Doing opposite thing
 Temper tantrum – Roll on floor, shouting,
asking aloud, holding breath.
 Ritualistic behavior – Particular activity is
performed in particular manner only.
 Ambivalence – Demonstrating love and hatred
toward same person at same time.
 Curiosity – Interested to know more on things.
 Dawdling – Slowness in doing works.
 Ego centric – Thinks that everything belongs to
them.
 Love and security
 Security blanket – toys/ articles of parents.
 Toilet training
 Development of self esteem
 Dental care
 Setting of limits
 Encouragement for independence
 Feeding, dressing, toileting and Grooming
3 YEARS:
Gross motor:
 Rides tricycle
 Jumps off bottom step
 Stands on one foot for few seconds
 Goes upstairs using alternate feet; may still come down using both feet on
step.
 Broad jumps
 May turn to dance, but balance may not be adequate
Fine motor:
 Builds tower of 9-10 cubes
 Builds bridge with three cubes
 Adeptly places small pellets in narrow-necked bottle
 In drawing, copies a circle imitates a cross, names what has been drawn;
cannot draw stick figure but may make circle with facial features.
Gross motor:
 Skips and hops on one foot
 Catches ball reliably
 Throws ball overhead
 Walks down stairs with alternate footing.
Fine motor:
 Uses scissors successfully to cut out picture following
outline
 Can lace shoes but may not be able to tie bow
 In drawing, copies a square, traces a cross and diamond,
adds three parts to stick figure.

Gross motor:
 Skips and hops on alternate feet
 Throws and catches ball well
 Jumps rope
 Skates with good balance
 Walks backward with heel to toe
 Jumps form height of 12 inches and lands on toes
 Balances on alternate feet with eyes closed
Fine motor:
 Ties shoelaces
 Uses scissors, simple tools, or pencil very well
 In drawing, copies a diamond and triangle; adds seven to nine parts to
stick figure; prints few letters, numbers or words, such as first name.
Psychosocial (Erick Erickson)

[Sense of initiative Vs Guilt]

Initiative – An introductory act or step; leading

action.
Guilt – A feeling of responsibility or remorse for
some offense, crime, wrong
Independent and trust worthy, they are ready to
find out what they can do.
Psycho sexual (Freud)

[Phallic stage]

Oedipus complex – Boys desire their mothers

while experiencing an increased hostility
towards their fathers.
Electra complex – Girls want their fathers and
find their mothers in their way.
Spiritual development (Fowler)

[Intuitive projective]
Imitates religious behavior such as bowing
the head in prayer, but does not understand
the meaning.
Intellectual development (Jean Piaget)
[Intuitive phase] (4-7 yrs)
Children can repeat the event in play that occurred many
hours or day before.
Unable to accomplish true inductive or deductive reasoning.
Believes that all objects in the environment are there to
satisfy the human needs.
Oral development:
[Pre conventional morality] – Strictly for the purpose of self
interest that to avoid punishment and to have favors
turned.
Language/ Speech development:
 3 years – 900 words
 4 years – 1500 words
 5 years – 2100 words
Play (New Hall)

[Co-operative play] – Children begins to

exchange ideas with other children and
gradually interact in play activities.
 Selfishness
 Hurting others
 Destructiveness
 Enuresis
 Encopresis
 Bad language
 Masturbation
 Sibling rivalry
 Love and security
 Independence
 Managing the bed time problems
 Discipline leading to self-control
 Meeting the nutritional needs
 Accident prevention
 Respect individuality of children
 Potential and mastery of self-control
 Provide a sense of initiation
 Toileting, napping, health practices
 Play indoor & outdoor games.
6 YEARS:
Motor changes:
 Central mandibular incisor erupt
 Loses first tooth
 Gradual increase in dexterity
 Often returns to finger feeding
 Likes to draw, print, color
 Vision reaches maturity
Mental changes:
 Develops concept of numbers
 Can count 13 rupees
 Knows whether it is morning or afternoon
 Defines common objects such as fork,spoon and chair in terms of their use
 Obeys 3 commands in succession
 Knows right and left hands
 Says which is pretty and which is ugly as a series of drawings of faces
 Attends first grade
Motor changes:
 Maxillary central incisors and lateral mandibular incisors erupt
 More cautions approaches to new performances
 Repeats performance to master them
 Jaws begins to expand to accommodate permanent teeth
Mental changes:
 Notices the certain items are missing from pictures
 Can copy a diamond
 Repeats three numbers backward
 Develops concept of time; uses clock for practical purposes
 Attends second grade
 More mechanical in reading; often does not stop at the end of a
sentence; skips words such as “it”, “the” and “he”.
Motor effects:
 Lateral incisors and mandibular cupids’ erupt
 Movement fluid; often graceful and poised
 Always on the go; jumps, chases, skips.
Mental effects:
 Gives similarities and differences between two things from memory
 Counts backward from 20 to 1; understands concept of reversibility
 Repeats days of the week and months in order; knows the data
 Describes common objects in detail, not merely in their use
 Makes change out of a quarter
 Attends third grade
 Reads more; may plan to wake up early just to read.
Motor effects:
 Increased smoothness and speed in fine motor control; uses
cursive writing
 Dresses self completely
 Hard to quiet down after recess
 More limber; bones grow faster than ligaments
Mental effects:
 Reads classic books; but also enjoys comics
 More aware of time; can be relied on to get to school on time
 Can grasp concept of parts and whole
 Attends fourth grade
 Classifies objects by more than one quality
 Produces simple paintings and drawings
Motor effects:
 Posture is more similar to an adult
 Reminder of teeth will erupt and tend toward full
development.
 Perform tricks on bicycle – races, participate in sports.
Mental effects:
 Writes brief stories
 Attends fifth grade
 Writes occasional short letters to friends or relatives
on own initiative.
Motor effects:
 Will overcome lordosis
 Dresses neatly
 Likely to overdo
Mental effects:
 Uses telephone for practical purposes
 Writes good inspirational stories
 Attends sixth grade
 Knows right and wrong
Motor effects:
Girls:-
Pubescent changes may begin to appear; body lines
soften and round out.
Boys:-
Slow growth in height and rapid weight gain; may
become obese in this period
Mental effects:
 Responds to magazine, radio or other advertising
 Reads for practical information or own enjoyment
 Attends seventh grade
Psychosocial development (Erick Erickson)
[Sense of industry Vs Inferiority]
Industry- The people who are involved in
providing a service.
Inferiority- A state of feeling less important.
Engage in task in real world
Highly motivate in purposeful activity, Eg: include
them in planning menu. Encourage the child to
identify his potentials.
Psycho sexual (Freud)

[Latent phase]

 Associate with same sex

 Peers ignore the opposite sex
Spiritual development (Fowler)

[Mythical literal faith]

 Follows the rituals practiced in the family/society

 Believes others, differentiate their thinking
Intellectual development (Jean Piaget)

[Concrete operational stage]

 Able to understand, read and write

 Developing problem solving abilities
 Asks questions
Language/ speech development:

20,000 – 30,000 words

Play (Newhall)
[Competitive play]
Girls:
 Cooking
 Grooming
 Teaching
Boys:
 Kites
 Cycling
 Team sports
 Truancy
 Fear of darkness (night mares)
 School phobia
 Stealing
 Nail biting, Teeth grinding
 Tics
 Hurting others
 Nutrition
 Dental hygiene
 Exercise
 Sex education
 Accident prevention
 Love and security
 Immunization
 Parental guidance
13 YEARS:
Reproductive organ development:
Male:
 Prostate begins functioning
 Penis begins to lengthen
Female:
 Internal and external organs continue growing
 Pubic hair becomes darker, coarser and curlier
Cognitive development:
 Adolescent learn to think new ways to understand
complex ideas.
 The peer group usually consists of non-romantic
friendship.
Reproductive organ development:
Male:
 Pubic hair grows
 May experience wet dreams, spontaneous erections,
ejaculations.
 Growth sprut may begin.
Female:
 Underarm hair growth
 Onset of menstruation
 Pregnancy is now possible
Cognitive development:
 Mind has great ability to acquire and utilize knowledge.
 Members of the peer group often try to act alike, dress alike,
have secret codes & participate in same activities.
Reproductive organ development:
Male:
 Rapid growth of the penis, especially enlargement
occurring about 1 year after testis begin to grow.
 Testes color deepens.
Female:
 Underpants maybe wet at times with a clear mucus; Flow
is often behavior in teen years and will continue naturally
with sexual arousal.
Cognitive development:
 Categories thought into usable forms.
 Imaginative thinking develops
 The peer group expands to include romantic friendships.
Reproductive organ development:
Male:
 Under arm hair
 Mustache begins as a fine hair starting at outside lip edges
about 2 years after pubic hair starts to grow
 Voice change begins.
Female:
 Most of the growth sprut complete (Ht)
Cognitive development:
 They learn selectively
 They have better memory
 Often feel the need to establish their sexual identity by
becoming comfortable with their body and sexual feelings.
Reproductive organ development:
Male:
 Average age that sperm matures and cause pregnancy
 Majority of the growth sprut complete (Ht)
Female:
 Acne
 Voice deepens, although not much as males.
Cognitive development:
 Problem solving skill gets improved.
 Learn to express and receive intimate or sexual advances
Reproductive organ development:
Male:
 Chest and shoulders fill out
 Facial and body hair becomes heavier
 Acne
Female:
 Full height achieved
Cognitive development:
 Able to think in logical way
 Able to sound judgment and develop abstract
thinking.
Psychosocial (Erick Erickson)
Early- [Identity Vs Role confusion]
Identity - Wrong person
Role confusion- Confusion in their own role
Who am I?
Intense loyalty to peer group
Begins to separate from parents

Later- [Intimacy Vs Isolation]

Intimacy – Having close personal relationship with someone.
Isolation – Separate from others.
Develops intimacy with self and persons of both sexes.
Psycho sexual (Freud)

[Genital stage] – Masturbation and sexual

fantasies are common
Spiritual development (Fowler)

[Conventional faith]
Personal and social values evolved to support
their identity to explore religious affiliation.
Intellectual development (Jean Piaget)

[Formal operational stage]

Thinking is oriented to things and events that
they can observe directly.
Moral development (Kohl berg)

[Post conventional stage]

Able to differentiate from right and wrong.
Language/ Speech development:

Continuous to learn new concepts.

Play (Newhall)

[Social play]
 Sports
 Parties
 Telephone conversations
 Watching TV
 Computer game
 Risk for parenting and family maladjustment
 Risk for intentional and unintentional injuries
 Dietary habits
 Sexual and emotional abuse
 Risk for depression and suicide
 Learning and school problem
 Hero worship, teenage pregnancy
 Self care- supervision of health problem
 Disease detection and treatment (Self breast
examination and Testicular examination)
 Sex education
 Prevention of anemia
 Accident prevention
 Dental hygiene
 Trusting and productive relationship
CENTRAL NERVOUS SYSTEM DEFECTS:
 Anencephaly
 Hydrocephalus
 Spina bifida
 Microcephaly
 Anencephaly is a lethal anomaly due
to the absence of;
▪ The membrane ossifying bones of the cranial vault and
consequently the skull and scalp.
▪ The cerebral hemispheres, underlying the above
structures.
Diagnosis:
 Clinical features – Polyhydramnios and abdominal
palpation
 Investigations – Raised plasma and amniotic fluid,
α-fetoprotein levels and ultra sound features.
Management:
 Elective abortion
 Vaginal delivery: There is an increased incidence
of face presentation and shoulder dystocia.
 Hydrocephalus is an excessive of
cerebrospinal fluid within the ventricles and
the subarachnoid space.
This is common among;
 Congenital cerebral malformations, Eg: Arnold- Chiari malformation
 Congenital fetal infections, Eg: Toxoplasmosis, cytomegalovirus.
 Intrauterine-intracranial hemorrhage
 Obstruction of aqueduct of Sylvius, which may be due to
 Toxoplasmosis
 Cytomegalovirus
 intracranial tumors
 intracerebral hemorrhage.
 Chromosomal abnormalities:
 triploidy
 trisomy 18
 trisomy 21
 X-linked trait.
Surgical management:
 Choroid plexectomy
 Surgical shunts
 Ventriculostomy
 Spina bifida is a
defect in the spine resulting
from failure of the two halves
of the vertebral arch to fuse.
The posterior ossification
centers of the spine, at the
level of the defect are widely
spaced. The vertebral segment
appears in U-shape. The defect
may by visualized on
longitudinal scanning. There is
restricted motility of lower
limbs.
Surgical management:
 Surgical closure
 Vesicostomy
 Augumentation Enterocystoplasty
 Laminectomy
 Microcephaly is an abnormally small
head. Diagnosis depends on biometry:
Occipto-frontal diameter(OFD) and BFD are
reduced. The main complication is Mental
retardation.
Classification:
Acyanotic
▪ Patent ductus arteriosus (PDA)
▪ Ventricular septal defect (VSD)
▪ Atrial septal defect (ASD)
▪ Atrio ventricular canal (AVC)
Cyanotic defects
▪ Tetralogy of Fallot (TOF)
▪ Transposition of great arteries (TGA)
▪ Tricuspid atresia (TA)
▪ Hypoplastic left heart syndrome
Patent Ductus Arteriosus (PDA)
 The ductus arteriosus connects the pulmonary
artery to the descending aorta during fetal life.
 PDA results when the ductus fails to close after
birth.
Surgical management:
 Thoracotomy
Ventricular septal defect (VSD)
 Defect in the septum separating the right and left
ventricles.
 Most common type of congenital heart disease
accounting for 21% of all cases.
Surgical management:
 Pulmonary Artery Banding (PAD)
 Cardiopulmonary Bypass
Atrial septal defect (ASD)
Atrial septal defect (ASD) is a
congenital heart defectin which blood flows
between the atria (upper chambers) of the
heart. Normally, the atria are separated by a
dividing wall, the interatrial septum.
Surgical management:
 Surgical closure
 Open heart surgery
Atrio ventricular canal (AVC)
The condition occurs when there's a
hole between the heart's chambers and
problems with the valves that regulate blood
flow in the heart. Sometimes called endocardial
cushion defect or atrioventricular
septal defect, atrioventricular canal defect is
present at birth.
Surgical management:
 Surgical closure
 Open heart surgery
Tetralogy of Fallot (TOF)
Tetralogy of fallot is a most common cyanotic
congenital heart disease. This condition is
characterized by the combination of four defects;
▪ Pulmonary stenosis
▪ Ventricular septal defect
▪ Overriding of the aorta
▪ Right ventriculat hypertrophy
Surgical management:
▪ Potts operation
▪ Modified Blalock- Taussig(BT) shunt
▪ Waterson’s operation
▪ Open heart surgery
Transposition of Great Arteries:
Transposition of great
arteries(TGA) occurs when the
pulmonary artery originates from the
left ventricle and the aorta originates
from the right ventricle. It is an
embrayologic defect caused by a
straight division of the bulbar trunk
without normal spiraling. It is the most
important cause of cyanosis at birth.
Surgical management:
▪ Beff’s operation
▪ Restelli’s operation
▪ Arterial switch operation
Tricuspid Atresia (TA):
Tricuspid atresia is a
form of congenital heart disease
whereby there is a complete absence
of the tricuspid valve. Therefore,
there is an absence of right
atrioventricular connection. This
leads to a hypoplastic (undersized) or
absent right ventricle.
Surgical management:
 Homograft
Hypoplastic Left heart
syndrome:
Hypoplastic left heart
syndrome (HLHS) is a rare
congenital heart defect in which
the left heart is severely
underdeveloped.
Surgical Correction:
 Nor wood correction
 Bidirectional Glenn shunt
 Tracheoesophageal fistula
 Omphalocele/ Umbilical hernia
 Gastroschesis
 Congenital megacolon (Hirschsprung disease)
 Scaphoid abdomen - Congenital diaphragmatic
hernia
 Tracheoesophageal fistula(TEF) is an
abnormal connection between trachea and
oesophagus. This is common among pre
mature and low birth weight babies.
Surgical management:
 Gastrostomy
 Cervical oesophagostomy
 Esophago gastroplasty
 A hernia in which abdominal organs
protrude into a baby’s umbilical cord.
Gastroschesis represents a congenital defect
characterized by a defect in the anterior
abdominal wall through which the abdominal
contents freely protrude.
 Hirschsprung’s disease is also called as
congenital aganglionic megacolon. It occurs due
to congenital absence of parasympathetic
ganglionic nerve cells, both in muscle layer or
submucosal layer of distal colon and rectum,
which results in extreme dilatation of the colon.
Surgical management:
 Swensen’s operation
 Duhamel’s operation
 Soave’s operation
 A condition in which the
anterior abdominal wall is sunken and
presents a concave rather than a convex
contour.

Surgical management:
 Surgical repair
 Tracheoesophageal fistula
 Congenital atlectasis
 Congenital stridor
 Congenital cyanosis
 Atelectasis is a collap
se of lung tissue affectin
g part or all of one lung.
This condition prevents
normal oxygen absoptio
n to healthy tissues.
 Congenital larynge
al stridor is a noisy or
high-pitched sound
with breathing. It is
from an abnormally
formed voice box
(larynx). It is present
at birth (congenital).
 Cyanotic congenital heart disease
(CCHD) is a condition present at birth. CCHD
causes low levels of oxygen in the blood. A
common symptom is a bluish tint to the skin,
called cyanosis
 Hypospadiasis
 Epispadiasis
 Congenital Phimosis
 Undescended testes
 Congenital Hydrocele
 Inperforate anus
 Virilized female- Ambiguous genitalia
 A congenital in males in which the opening
of the urethra is on the underside of the
penis.
Surgical management:
 Meatotomy
 Chordee correction
 Advancement of prepuce
 Urethroplasty
 An epispadias is a rare type of
malformation of the penis in which the
urethra ends in an opening on the upper
aspect of the penis. It can also develop in
females when the urethra develops too far
anteriorly.
Surgical management:
 Elongation of urethral strip
 Chordee correction
 Bladder neck reconstruction
Phimosis is a condition in which the foreskin of
the penis cannot be pulled back past
the glans. A balloon-like swelling under the
foreskin may occur with urination.
Surgical management:
 Circumcision
An undescended testicle (cryptorchidism) is a
testicle that hasn't moved into its proper
position in the bag of skin hanging below the
penis (scrotum) before birth.
Surgical management:
 Orchiopexy
 Orchidopexy
 A hydrocele is a buildup
of watery fluid around one
or both testicles. It causes
the scrotum or groin area
to swell. A congenital
hydrocele is one that a
baby is born
with. Hydroceles can also
occur later in life for a
number of reasons.
Surgical management:
 Surgical repair
 An imperforate anus or anorectal
malformations are birth defects in which the
rectum is malformed.
Surigal management:
 Anoplasty
 Virilization is the biological development
of sex differences changes that make a male
body different from a female body.
 Club foot (Talipes)
 Congenital Hip dysplasia
 Marfan syndrome
 Club foot or talipes is a non traumatic
deformity of the foot. The foot is twisted out
of shape or position. The foot maybe
deformed in plantar flexion or dorsi flexion.
The foot maybe abducted and inverted.
Surgical management:
 Tenotomy
 Dysplasia of the hip means the
abnormal development of the proximal femur
and/or acetabulum. Left hip is commonly
affected, but bilateral involvement occurs in
more than 50% of cases. Girls are affected 8
times more than boys.
Surgical management:
 Osteotomy
 Marfan
syndrome (MFS) is a genetic
disorder of the connective
tissue. The degree to which
people are affected varies.
People with Marfan tend to
be tall, and thin, with long
arms, legs, fingers and toes.
They also typically have
flexible joints and scoliosis.
 Thalassemia
 Hemophilia
 Sickle cell anemia
 Congenital spherocytosis
 Thalassemia is a group of hereditary
hemolytic anemia characterized by reduction in
the synthesis of hemoglobin. It produces
hypochromic anemiadue to defective
hemoglobinization of RBCs, hemolysis and
ineffective erythropoiesis.
Management:
 Blood transfusion
 Splenectomy
 Bone marrow
transplantation
 Hemophilia is an inherited bleeding
disorder due to deficiency of plasma coagulation
factors. It is primarily found in males but
transmitted by female carriers.
Management:
 Replacement therapy
 Home treatment
 Gene therapy
 Orthotics
 Synovectomy
 Hereditary spherocytosis is a condition
that affects red blood cells. People with this
condition typically experience a shortage of
red blood cells (anemia), yellowing of the
eyes and skin (jaundice), and an enlarged
spleen (splenomegaly)
Management:
 Blood Transfusion
 Spleenectomy
 Cystic fibrosis
 Phenyl ketonuria (PKU)
 Cystic fibrosis(CF) is s fatal autosomal
recessive disease that manifests itself in multiple body
system. The name cystic fibrosis is derived from the
characteristic histological changes in pancreas. It is
also known as mucoviscidosis. This condition leads to
chronic obstructive pulmonary disease(COPD),
frequent lung disease, deficient pancreatic enzymes,
osteoporosis and abnormally high electrolyte
concentration in sweat.
Management:
 Genetic counseling
 Gene therapy
 Phenylketonuria (PKU)
is an inborn error of
metabolism that results in
decreased metabolism of
the amino
acidphenylalanine.
Untreated PKU can lead
to intellectual
disability, seizures,
behavioral problems,
and mental disorders.
 Congenital Hypothyroidism (Cretinism)
 Congenital hypopituitarism (Dwarfism)
 Congenital goiter
 Deficiency or low circulating
level of thyroid hormones result
in hypothyroidism. Congenital
hypothyroidism is also called as
cretinism. The harmone causes
decreased metabolism, growth
retardation and delayed physical
maturation.
Management:
 Replacement therapy with synthetic
levothyroxine
 Hypopituitarism is the decreased (hypo)
secretion of one or more of the
eight hormones normally produced by
the pituitary gland at the base of the brain.
 Goiter is the
enlargement of thyroid
gland. When the lateral
lobe of thyroid gland
becomes larger than the
terminal phalanx of child’s
thumb, then it is diagnosed
as thromegaly. Goiter may
develop due to high
production of TSH in
response to decreased
thyroxine level.
 Down’s syndrome (Trisomy 21)
 Patau’s syndrome (Trisomy 13)
 Down’s syndrome is
the most common
chromosomal disorder
and most common
identifiable cause of
mental retardation. It is
a condition associated
with variety of
congenital anomalies.
Management:
 No specific treatment
 Parental counseling
 Patau syndrome is
a syndrome caused by
a chromosomal abnormality, in
which some or all of the cells of
the body contain extra genetic
material from chromosome 13.
The extra genetic material
disrupts normal development,
causing multiple and complex
organ defects.
Management:
 No specific treatment
 Parental counseling
▪ Cleft lip/ palate
 The failure of the maxillary process to fuse
with nasal elevations on frontal prominence is
called cleft lip. The failure of masses of lateral
palatine process to meet and fuse together is
called cleft palate.
Surgicalmanagement:
 Palatoplasty (Cleft Palate)
 Surgical repair of lip (Cleft Lip)