1. This child is extremely behind in growth, but a nurse should still assess the development according to the age of the patient. A 9-month-old should be assessed by their age rather than their size. The nurse should assess the child’s ability to eat finger foods on their own, they should be able to sit up without support, and griping small objects. “Developmental milestones are specific skill attainments occurring in a predictable sequence over time, reflecting the interaction of the child’s developing neurological system with the environment. Skills can be grouped in sectors of development: gross motor, fine motor (including self-care), communication (speech, language and nonverbal), cognitive and social-emotional” (Evidence-based milestone ages as a framework for developmental surveillance, 2012). In addition, cognitive and communication assessment is also priority. “Communication and social skills involve the ability to interact with others. A 9-month-old female infant should be able to babble and make cooing sounds. She should also be able to respond to her own name and follow simple commands” (Denis, 2022). Some recommendations should include monitoring the child’s nutritional intake if the child is underweight. Other recommendations could be to babble back and forth with your baby and repeat words over and over again.
Denis, (. (2022, November 3). Developmental markers a nurse should assess for a 9-month-old female infant. Nursing Experts. https://nursingexperts.org/describe-the-developmental-markers-a-nurse-should-assess-for-a-9-month-old-female-infant-6/
2. A nurse should assess three major developmental markers in a 9-month-old female infant. First, the nurse should assess the infant’s sensory abilities by observing how the child handles objects (Gudritz, 2016). For example, does she try to taste and hold objects? Does she try to put the objects in her mouth? Can she turn or lift a variety of objects? Second, the nurse should assess the infant’s movement regarding whether she can do it independently (Gudritz, 2016). The nurse should assess whether the infant can sit on her own and in a controlled manner, whether she can crawl, whether she pick objects and turn her head to follow moving objects. Third, the nurse should assess the infant’s cognitive and emotional abilities (Gudritz, 2016). The nurse should observe whether the infant tries to mimic other people’s words, whether she becomes alert when her name is called, whether she can communicate with hands, produce sounds, and understand gestures.
The infant has nutritional issues based on the information given in the scenario. She weighs less than what 95% of infants her age should weigh. She has a shorter height than 75% of the stature of infants her age. She also has a smaller head than 75% of infants her age. Generally, the female infant is underweight, has a short stature, and might have slow brain development, suggesting nutritional needs. Recommendations to the mother include (a) giving the baby more meat and dairy products supplements and (b) adding an egg diet to the child’s daily meals. High-quality evidence shows that dairy products such as milk and meat help 5-12 months infants add weight and gain height (Tang et al., 2018). Evidence also shows that eggs help improve the weight and height of 6-9 months infants (Iannotti et al., 2017).
Gudritz, L. (2016), September 13). 9-month-old baby: Developmental milestones and guidelines. https://www.healthline.com/health/parenting/9-month-old-baby-milestones
3. Developmental markers refer to specific skills or abilities that children should achieve at certain ages. For a 9-months old female child, nurses should assess if she can sit without support, show separation anxiety, crawl or scoot on her belly, imitate sounds and gestures, babble and attempt words and respond to familiar voices or faces.
The scenario provided has detailed the baby’s physical growth and percentile according to the CDC growth chart. The child is at the 5th percentile for weight 6.7kg, meaning she weighs less than 95% of other girls in the same age group (Hendrickson & Pitt, 2022). Correspondingly, she is 68.5 cm long, which translates to 25% according to the CDC growth chart. This indicates that she is shorter than 75% of other infant girls of the same age. Her head circumference is also smaller than that of other infant girls of her age. All these may indicate failure to thrive. As a nurse, I would recommend the parents schedule an appointment with a pediatrician for further evaluation. Other possible referrals would include seeing a nutritionist or a developmental pediatrician.
All the aforementioned recommendations are based on evidence-based practice. This is because developmental milestones and failure to thrive are based on guidelines established by various organizations within the USA (Lezo, Baldini & Asteggiano, 2020). Such organizations include the American Academy of Pediatrics and the Center for Disease Control and Prevention. Referring children to specialists due to failure to thrive enable them to receive appropriate care and support to reach their full potential.
Hendrickson, M. A., & Pitt, M. B. (2022). Interpreting Weight, Height, and Body Mass Index Percentiles in the US Centers for Disease Control and Prevention Growth Charts—Reply. JAMA pediatrics, 176(4), 425-425.