PBL TUMBUH KEMBANG DAN GERIATRI Group 15 Modul 1

GROUP 14
GROUP 14:
Lailatul Faizah Yuni Susantri

110 213 0005 110 213 0052
Nurfi Resni Fitra Ramda Wahyuni Sartika Dewi.S
110 213 0016 110 213 0062
H. Ahmad Frenrengi R St. Giranti Adilia Gunadi
110 213 0025 110 213 0074
M Lutfi Syahadatin Irwan Rahmawati S
110 213 0026 110 213 0087
Nurfatriani Annisa Rachma Muliani
110 213 0038 110 213 0096
Fadhilah Rufaidah
110 213 0116
Mrs. Asni Brought her boy to community health care on 15th April
2016 to have regular checkup. The identity was born on March 23,
2015 referenced by Doctor. Gestation age week 32, births weight
1800 gram, body length 46 cm, head circumference 28cm,
immediately crying, incubator care, and have yellow skin (K4),
according to his mother , also have phototheraphy care
On physical examination, weight 7100 gram (3 consecutive months
ago 6300 grams, 6700 grams, 6900 grams, respectively) based on
KMS data, body length 70cm, head circumference 36cm,. while the
child is still breastfeed, milk porridge since the age of 6 months, the
refined pulp porridge, fruit and refused to drink bottle-feeding.
The development sits with handle, rambling, papapapapa,
mamamama, waving hands, imitating sound.
The child is playing with baby walker, tricycle, playing tennis ball and
rattles. History of immunization was DPT, Hep B, Hib, Polio 1x period
at 2 times.
Phototheraphy: is the most common treatment fo reducing high
bilirubin levels that cause jaundice in a newborn
Immunization : is the process by which an individual's immune

system becomes fortified against an agent (known as
the immunogen).
A boy was born on March 23, 2015
Mrs. Asni Brought her boy to community health care on 15th April
2016
Gestation age week 32
births weight 1800 gram
body length 46 cm
head circumference 28cm
immediately crying
incubator care
have yellow skin (K4) also have phototheraphy care.
On physical examination, weight 7100 gram (3 consecutive months
ago 6300 grams, 6700 grams, 6900 grams, respectively)
KMS data : body length 70cm, head circumference 36cm
Milk porridge since the age of 6 months, the refined pulp
porridge, fruit and refused to drink bottle-feeding.
The development sits with handle, rambling, papapapapa,
mamamama, waving hands, imitating sound.
The child is playing with baby walker, tricycle, playing tennis
ball and rattles.
History of immunization was DPT, Hep B, Hib, Polio 1x period at
2 times.
Weight : 7100 gram
( 3 consecutive months
ago 6300 gram, 6700 gram, 6900
gram respectively)
Babys weight gain occurred in 4
quarters :
Quarters I : 700 1000
gram/month
Quarters II : 500 6000
gram/month
Quarters III : 350 450
gram/month
Quarters IV : 250 350
gram/month
After we made a calculation :
The babys age is 11
months, so the babys weight gain :
6950 7850 gram until the day
arrived. The babys weight is normal.
Length : 70 cm
Babys length grow occurred in
4 quarters :
Quarters I : 2,8 4,4
cm / month
Quarters II : 1,9 2,6
cm / month
Quarters III : 1,3 1,6
cm / month
Quarters IV : 1,2 1,3
cm /month
After we made a calculation :
The babys age is 11
months, so the babys length
grow : 63,8 74,4 cm until the
day arrived. The babys length
is normal.
Head circumference : 36 cm
HC = 2cm/months
HC = 1 cm/months
HC =0,5 cm/monts
honestly, the babys head is grow. But unfortunately the babys head cant turn into
normal category. Based on this two chart ( chart a and b), we can see the babys head
circumference is very small. Under the normal line. It means the babys turn into
microchepaly.
- The babys still breast-feeding : normal ( until 2 years )
- Since 6 months the babys eat pulp porridge, fruit : normal (since 6 months)
- Refused to drink bottled-feeding : abnormal (the babys should drink bottled-feeding
since 10 months)
The development :
- Sits with handle : late-development (cause in 11 months the babys should stand up
by him self and walk)
- Rambling : normal
- Papapapa : normal
- Mamamama : normal
- Waving hands : normal
- Imitating sound : normal
Referensi :
- Diktat kuliah. Dr.dr.Martira Maddeppungeng, Sp.A (K).2016
- Prof. Soetjiningsih, Dr., Sp.A(K). TUMBUH KEMBANG ANAK. Ed.2. Jakarta. EGC. 2015.
Supine from the prone position 3.5 months
Prone from supine position 4.5 months

Sitting with help 5.5 months
Sitting without help 6 months
Creeping 6.5 months
Sitting with their own 7.5 months
Crawling 7.5 months
Standing 8 months
Moving 9 months
Walking 12 months
Running 14 months
=> An 11 months baby can moving their body and start to walking
1. Slide Dr. dr. Martira Mddeppungeng, Sp.A(K). Pediatric Rehabilitation. April 20th 2016.
2. Ilmu Kesehatan Anak Nelson. 2011. Saunders Elsevier.
Fixation of sight Neonatal
Follow things from midline 2 months
Detect small things 5 months
Open the palms 3 months
Unite the palms 4 months
Moving things 5 months
Grab unilateral 6 months
Pincer grasp matur 9 months
Pincer grasp matur with finger 11 months
Release things 12 months
=> An 11 months baby can pincer grasp mature with finger
React to the sound 2 weeks
Cooing 2 months
Looking for the sound source 2 months
Laughing and crying with 4 months
reason
Babbling 6 months
Dadada Mamama (not 9 months
specific)
Saying 2 syllable word 9 months
Mama papa (specific) 12 months
Saying 1 or 2 other words 12 months
=> An 11 months baby can saying 2 syllable word and calling their
parents specifically.
3. How is the interpretation of babys
growth and development?
Physical growth of normal infant
Weight : the infant gains :

- Birth to 4 months kg /month
- 5 to 8 months kg / month
- 9 to 12 months kg /month
The infant will double his birth weight by 4-5 months and
triple it by 10-12 months of age
http://www.merckmanuals.com/professional/pediatrics/growth-and-development/physical-growth-of-infants-and-children [updated on
April,24.2016]
Length increases about 3 cm /month during the 1st 3
months of age,
then it increases 2 cm /month at age of 4-6 months,
Then, at 7 12 months, it increases 1 cm per month
http://www.merckmanuals.com/professional/pediatrics/growth-and-development/physical-growth-of-infants-and-children [updated
on April,24.2016]
Head circumference
It increases about 2 cm /month during the 1st 3 months,

Then, cm/month during the 2nd 9 months of age.
Posterior fontanel closes by 6-8 w of age.
Anterior fontanel closes by 12-18 months of age.
on April,24.2016]
Chest circumference
By the end of the 1st year, it will be equal to head

circumference.
Physiological growth of infants:-

Pulse 110-150 b/min
Resp 35 10 c/min
Breath through nose.
Blood pressure 80/50 20/10 mmHg
on April,24.2016]
At 2 months At 3 months, the infant can
Hold head erects in mid-position. Hold head erects and steady.
Turn from side back Open or close hand loosely.
Hold object put in hand
on April,24.2016]
Head Control
At 4 months, the infant can At 5 months, the infant can:
Sit with adequate support.
Roll over from front to back. Balance head well when
sitting.
Hold head erect and steady
while in sitting position. Site with slight support.
Pull feet up to mouth when
Bring hands together in supine.
midline and plays with
Grasp objects with whole
fingers. hand (Rt. or Lt.).
Grasp objects with both Hold one object while looking
hands. at another
on April,24.2016]
At 6 months, the infant can At 7 months, the infant can
Sit alone briefly. Sit alone.
Turn completely over ( Hold cup.
abdomen to abdomen ). Imitate simple acts of others
Lift chest and upper
abdomen when prone.
Hold own bottle.
on April,24.2016]
At 8 months, the infant can At 9 months, the infant can
Site alone steadily. Rise to sitting position alone.
Drink from cup with Crawl (i.e., pull body while in
assistance. prone position).
Eat finger food that can be Hold one bottle with good
held in one hand hand-mouth coordination
on April,24.2016]
At 10 months, the infant can: At 11 months , the infant can:
Creep well (use hands and Walk holding on furniture.
legs). Stand erect with minimal
Walk but with help. support
Bring the hands together.
on April,24.2016]
Stand-alone for variable length of time.
Site down from standing position alone.
Walk in few steps with help or alone (hands held at shoulder
height for balance).
Pick up small bits of food and transfers them to his mouth
9 month old: crawl
10 month old: creep
1 year: stand independently from a crawl &
creep position
13 month old: walk and toddle quickly
15 month old: can run
on April,24.2016]
His emotions are instable, where it is rapidly changes from
crying to laughter.
His affection for or love family members appears.
By 10 months, he expresses several beginning recognizable
emotions, such as anger, sadness, pleasure, jealousy, anxiety and
affection.
By 12 months of age, these emotions are clearly distinguishable.
on April,24.2016]
Age : 11 months
Weight (W) : 7100 gr = 7,1 kg
Body Length (BL) : 70 cm = 0,7 m
Calculate :
Body Mass Index (BMI):
()
Formula: BMI =
()
7,1
=
0,7 0,7
= 14,49
Reference: Keputusan Menteri Kesehatan Republik Indonesia Nomor : 1995/MENKES/SK/XII/2010 tentang Standar Antropometri
Penilaian Status Gizi Anak
Nutritional status category Threshold
Index
(Z-Score)
Severe malnutrition < -3 SD
Weight for age (W/A) Mild malnutrition -2 SD
0-60 months Normal > -2 SD until 2 SD
Over nutrition > 2 SD
Index
(Z-Score)
Very shorty < -3 SD
Body lenght for age (BL/A) Shorty -2 SD
Tall > 2 SD
Index
(Z-Score)
Very skinny < -3 SD
Body mass index for age skinny -2 SD
(BMI/A)
Obesity > 2 SD
Index
(Z-Score)
Very skinny < -3 SD
Weight for body length skinny -2 SD
(W/BL)
Obesity > 2 SD
Factors affecting growth and development Genetics
A. Ethnicity
B. Birthweight
C. Prematurity
D. Hormones
E. Nutritional
F. Environment
Risnes, K.R., et al., Birthweight and mortality in adulthood: a systematic review and meta-analysis. International Journal of Epidemiology, 2011.
http://www.education.vic.gov.au/Documents/childhood/professionals/support/factorsaffgrowth.pdf (diakses tanggal 26 april 2016)
Table 1. Phototherapy indication is based on total serum
bilirubin
Age (day) Healthy term infants Infants with risk factors*
mg/dl umol/dL mg/dl Umol/dL
1 Yellow seen on any body part
2 15 260 13 220
3 18 310 16 270
>4 20 340 17 290
*) Risk factors terdiri dari little baby (<2500 gram), premature

(<37 weeks), hemolysis, sepsis
Source: Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011

Tabel 2. Phototherapy indication is based on low birth weight
infants
Weight (gram) Levels bilirubin (mg/dL)
< 1000 Phototherapy start in the 24 jam first
1000 -1500 7-9
1500-2000 10-12
2000-2500 13-15
Source: Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011

Ikatan Dokter Anak Indonesia, 2014
1. Vaccines hepatitis B. It is best given within 12 hours after birth and
was preceded giving an injection of vitamin K1. Babies born to
mothers positive for HBsAg, hepatitis B vaccine and hepatitis B
immunoglobulin (HBIG) at different extremities.
2. Polio vaccine. At birth or when the baby is discharged should be
given the oral polio vaccine(OPV-0). Furthermore, for the polio-1, 2-
polio, polio-3 and can be given polio vaccine booster OPV or IPV,
but you should at least get one dose of IPV vaccine.
3. BCG vaccine. BCG vaccine is recommended before 3 months, optimal
age of two months. If given after 3 months of age, needs to be done
tuberculin test.
4. DTP vaccine. The first DTP vaccine is given as early as 6 weeks of
age. can be given DTwP or DTaP or in combination with other
vaccines. For children over 7 years Td vaccine is given, dibooster
every 10 years.
5. Measles vaccine. The second measles vaccine should not be given at
age 24 months, when the MMR already given at 15 months.
6. Pneumococcal vaccine (PCV). When given at the age of 7-12 months, given PCV
2 times with intervals of 2 months; at the age of over 1 year is given one time, but
both need booster first time at the age of more than 12 months or a minimum of 2
months after the last dose. On children aged over 2 years of PCV given sufficient
one.
7. Rotavirus vaccine. Monovalent rotavirus vaccine given 2 times, pentavalent

rotavirus vaccine given 3 times. Monovalent rotavirus vaccine first dose given 6-14
weeks of age, 2nd dose given at intervals of at least 4 weeks. Monovalent
rotavirus vaccine should finish given before the age of 16 weeks and does not
exceed the age of 24 weeks. rotavirus vaccine pentavalent: 1st dose given 6-14
weeks of age, dosing interval of the 2nd and 3rd, 4-10 weeks; 3rd dose given at
age less than 32 weeks (minimum interval of 4 weeks).
8. Varicella vaccine. Varicella vaccine may be given after the age of 12 months, the
best on age before entering elementary school. If given the age over 12 years,
need 2 doses with a minimum interval of 4 weeks.
9. Influenza vaccine. The influenza vaccine given at least 6 months, repeated every
year. For the first immunization (primary immunization) in children aged less than 9
years given twice with a minimum interval of 4 weeks. For children 6 - <36
months, a dose of 0.25 mL.
10. Vaccine human papilloma virus (HPV). HPV vaccine can be given from the age
of 10 years. Vaccine HPV bivalent given three times at intervals of 0, 1, 6 months;
HPV vaccine is tetravalent with 0,2,6-month intervals.
Figure 1. Recommended immunization schedule for persons aged 0 through 18 years United
States, 2016.
immunizations must be immunization already
obtained obtained
0-7 days Hep B 0 DPT
1 mounth BCG, Polio 1 Hep B
2 mounth DPT-Hep B 1- HiB
Hib 1-Polio 2 Polio
3 mounth DPT-Hep B 2-
Hib 2-Polio 3
4 mount DPT-Hep B 3-
Polio 4
9 mounth Campak
http://www.cdc.gov/vaccines/hcp/acip-recs/index.html.[updated on April,26.2016]
Incomplete Gross motor The
Immunization Impaired disorders Development
Boy (1 year) growth sits with
(polio) (in teh
scenario) handle
http://www.cdc.gov/vaccines/hcp/acip-recs/index.html.[updated on April,26.2016]
Answer :
The baby refuse to drink bottle feeding because it was used by

breastfeeding and the baby is usually assumed as a breastfeeding
mother's smell.
(Reference : Suririnah, dr. 2009. Buku Pintar Merawat Bayi 0-12 Bulan. Jakarta: PT. Gramedia Pustaka Utama)
Babies with low birth weight is one of the
complications of jaundice. Pathological within the first
24 hours of life.
Picture 1. The division of jaundice by Kramer

(Reference : Suririnah, dr. 2009. Buku Pintar Merawat Bayi 0-12 Bulan. Jakarta: PT. Gramedia Pustaka Utama)
The Correlation Between Jaundice To Babys
Growth And Development
At a certain degree, it will be toxic bilirubin and tissue
damage. These properties allow the pathologic effects on
cells bilirubin if the brain had been able to penetrate the
blood brain barrier. This disorder occurs in the brain called
kernicterus or biliary encephalopathy is generally
considered that abnormalities in the central nervous system
that may be incurred.
(Reference : Thor WR Hansen, MD, PhD, MHA, FAAP Professor. March 04, 2016. Neonatal Jaundice. [Online].
(http://emedicine.medscape.com/article/974786-overview#a4 accessed on April 25, 2016.
Treatment for developmental disorders based on the scenario
that Is by giving stimulation or exercise
Stimulation or exercise that is given is:

1. Sensory: tactile, auditory, visual, smell, taste
2. Motor: gross motor, fine
3. Cognitive, intelligence, creativity
4. Helping yourself
5. The communication-language
6. socio-emotional
7. independence
Soetjiningsih. 2015.Tumbuh Kembang Anak Edisi 2. Jakarta:EGC hal 172-173, 208-209, 235
1. Screening of developmental disorders of children
It is recommended the use of a screening instrument for early detection of
abnormalities of the child's development. Example: Danver II, CHAT
(Checklist for Autism in Toddlers) for autism, ELMS for language disorders
2. Evaluate the child's speech and language to determine whether a child's
ability to speak
3. got enough breast milk
4. nutritious foods
5. The appropriate immunizations recommended
6. supervised careful not to fall
7. keep an eye on the child's head circumference (2 cm every first 3 months, 1
cm every 3 months of the second, and 0.5 cm every 6 months)
8. Communication and the warmth of the child-parent interaction should be
maintained
9. Caregivers should be healthy and well-trained, if the child was forced cared
for others because of working mothers
Soetjiningsih. 2015.Tumbuh Kembang Anak Edisi 2. Jakarta:EGC hal 172-173, 208-209, 235
The parents duty in the first time of their baby birth, those are :
- Hearing azan for the right ear and iqomat for the left ear in
case of giving first penetration to the child's hearing about
tayyibah (divine) or sentence appeal of the Almighty, and also
the teaching of Islamic Shariah in their first existing of the
world. Tayyibah sentence also keep the nature of the
temptation from the Satan / devil.
- Shaving the hair on the seventh day
- Holding Aqiqah Day
- Giving a good name

Meaning:
The mother should give breastfeeding to their children for two years
long, especially for those who want to complete it. And the fathers
duty is to give food and clothes to the mother in a good way. People
are not burdened except of their capibilities. For a mother, dont be
feel miserable by her children and a father by her children, and the
heir is also in the same cases. If both of them want to care (before 2
years) in the willingness and deliberation, there is no sin for them.
And if you want your children to breastfed by others, you have no sin
if you give payment as its worth. Keep full believe in Allah and for
sure Allah is know all what you have done.
: :

:
.
Meaning:
"Anas Said; As the Prophet said ; On the seventh day of birth,
children should be slaughtered the goat for aqiqah, given name, and
shaved the hair. Then, in the age of 6 years, they should be educated
in well-manner. After nine years, their bed should be separated.
When they are 13 years old, they give punishment of leaving prayer.
After the age of 16 years, they are married by their parents (for the
girl by her father) in which her father shakes her hands and said ; I
have educated you, taught, and married you. I ask the Lord to keep
me away from your punishment and defamition in the world and the
hereafter.
GROUP 14

PBL TUMBUH KEMBANG DAN GERIATRI Group 15 Modul 1

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

PBL TUMBUH KEMBANG DAN GERIATRI Group 15 Modul 1

Încărcat de

Drepturi de autor:

Formate disponibile

GROUP 14

Lailatul Faizah Yuni Susantri

Immunization : is the process by which an individual's immune

Prone from supine position 4.5 months

Physical growth of normal infant

Weight : the infant gains :

then it increases 2 cm /month at age of 4-6 months,

Then, at 7 12 months, it increases 1 cm per month

It increases about 2 cm /month during the 1st 3 months,

By the end of the 1st year, it will be equal to head

Physiological growth of infants:-

13 month old: walk and toddle quickly

15 month old: can run

mg/dl umol/dL mg/dl Umol/dL

1 Yellow seen on any body part

>4 20 340 17 290

*) Risk factors terdiri dari little baby (<2500 gram), premature

Source: Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011

< 1000 Phototherapy start in the 24 jam first

1000 -1500 7-9

Source: Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011

7. Rotavirus vaccine. Monovalent rotavirus vaccine given 2 times, pentavalent

The baby refuse to drink bottle feeding because it was used by

Picture 1. The division of jaundice by Kramer

Stimulation or exercise that is given is:

S-ar putea să vă placă și