Childs Growth Development and Geriatry System

Medical Faculty
Muslim University of Indonesia Makassar, April 28 rd, 2016
1st MODULE REPORT

Child Growth and Development Disorder

TUTOR :

dr. Nevi Sulfita

GROUP 14:

Lailatul Faizah 110 213 0005

Nurfi Resni Fitra Ramda 110 213 0016
H. Ahmad Frenrengi R 110 213 0025
M Lutfi Syahadatin Irwan 110 213 0026
Nurfatriani 110 213 0038
Yuni Susantri 110 213 0052
Wahyuni Sartika Dewi.S 110 213 0062
St. Giranti Adilia Gunadi 110 213 0074
Rahmawati S 110 213 0087
Annisa Rachma Muliani 110 213 0096
Fadhilah Rufaidah 110 213 0116

MEDICAL FACULTY
MUSLIM UNIVERSITY OF INDONESIA
2016
A. Scenario
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.

B. Difficult Word
- 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).

C. Key words
- 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.

D. Questions
1. Whats the characteristic of normal baby?
2. What the babys can do normally according to scenario?
3. How is the interpretation of babys growth and development?
4. How to calculate the babys nutrition status?
5. Whats factor can be affect to growth and development?
6. Whats the requirement for fototheraphy?
7. When the immunization should give to the normal baby?
8. Whats the connection between immunization with the babys condition?
9. Why the baby refuse to drink bottle feeding and the correlation between jaundice
to baby's growth and development?
10. How the treatment for the baby and education for the mother?
11. How about the Islamic perspective?

E. Answer
1. Whats the characteristic of normal baby?
Answer :

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.
 a. KMS CHART
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.
 b. CDC CHART
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.

A
B

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 : normal1,2

2. What the babys can do normally according to scenario?

Gross Motoric Development

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.

Fine Motoric Development

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 mature with finger 11 months

Release things 12 months

An 11 months baby can pincer grasp mature with finger.

Languange Development

React to the sound 2 weeks

Cooing 2 months

Looking for the sound source 2 months

Laughing and crying with reason 4 months

Babbling 6 months
Dadada Mamama (not specific) 9 months

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.2,3

3. How is the interpretation of babys growth and development?

Physical growth includes attainment of full height and appropriate weight and an
increase in size of all organs (except lymphatic tissue, which decreases in size). Growth
from birth to adolescence occurs in 2 distinct phases. The 1st phase (from birth to about
age 1 to 2 yr) is one of rapid growth, although the rate of growth decreases over that
period. In the 2nd phase (from about 2 yr to the onset of puberty), growth occurs in
relatively constant annual increments. Puberty is the process of physical maturation from
child to adult. Adolescence defines an age group; puberty occurs during adolescence. At
puberty, a 2nd growth spurt occurs, affecting boys and girls slightly differently. All growth
parameters can be charted on standard growth curves available from the Centers for
Disease Control and Prevention (see www.cdc.gov/growthcharts/ ).

Length

Length is measured in children too young to stand; height is measured once the
child can stand. In general, length in normal-term infants increases about 30% by 5
mo and > 50% by 12 mo; infants grow 25 cm during the 1st yr; and height at 5 yr is
about double birth length. In most boys, half the adult height is attained by about age
2; in most girls, height at 19 mo is about half the adult height.

Rate of change in height (height velocity) is a more sensitive measure of growth

than time-specific height measures. In general, healthy term infants and children grow
about 2.5 cm/mo between birth and 6 mo, 1.3 cm/mo from 7 to 12 mo, and about 7.6
cm/yr between 12 mo and 10 yr. Before 12 mo, height velocity varies and is due in
part to perinatal factors (eg, prematurity). After 12 mo, height is mostly genetically
determined, and height velocity stays nearly confstant until puberty; a childs height
relative to peers tends to remain the same. Some small-for-gestational-age infants tend
 to be shorter throughout life than infants whose size is appropriate for their gestational
age. Boys and girls show little difference in height and growth rate during infancy and
childhood.

Extremities grow faster than the trunk, leading to a gradual change in relative
proportions; the crown-to-pubis/pubis-to-heel ratio is 1.7 at birth, 1.5 at 12 mo, 1.2 at
5 yr, and 1.0 after 7 yr.

Weight

Weight follows a similar pattern. Normal-term neonates generally lose 5 to 8% of

birth weight in the days after delivery but regain their birth weight within 2 wk. They
then gain 14 to 28 g/day until 3 mo, then 4000 g between 3 and 12 mo, doubling their
birth weight by 5 mo, tripling it by 12 mo, and almost quadrupling it by 2 yr. Between
age 2 yr and puberty, weight increases 2 kg/yr. The recent epidemic of childhood
obesity has involved markedly greater weight gain, even among very young children.
In general, boys are heavier and taller than girls when growth is complete because
boys have a longer prepubertal growth period, increased peak velocity during the
pubertal growth spurt, and a longer adolescent growth spurt.

Head Circumference

Head circumference reflects brain size and is routinely measured up to 2 yr. At birth,
the brain is 25% of adult size, and head circumference averages 35 cm. Head
circumference increases an average 1 cm/mo during the 1st yr; growth is more rapid
in the 1st 8 mo, and by 12 mo, the brain has completed half its postnatal growth and is
75% of adult size. Head circumference increases 3.5 cm over the next 2 yr; the brain
is 80% of adult size by age 3 yr and 90% by age 7 yr.

Developmental milestones record - 4 months

PHYSICAL AND MOTOR SKILLS

The typical 4-month-old baby Have almost no head droop while

should: in a sitting position
Slow in weight gain to about 20 Be able to sit straight if propped up
grams (almost two thirds of an Raise head 90 degrees when placed
ounce) per day on stomach
Weigh 2 times more than their Be able to roll from front to back
birth weight Hold and let go of an object
 Play with a rattle when it's placed
in their hands, but won't be able to
pick it up if dropped
Be able to grasp a rattle with both
hands
SENSORY AND COGNITIVE SKILLS
A 4-month-old baby is expected to:
Have well-established close vision
Increase eye contact with parents
and others
Have beginning hand-eye
coordination
Be able to coo
Developmental milestones record - 9 months
All children develop a little differently. If you are concerned about your child's
development, talk to your child's health care provider.
PHYSICAL CHARACTERISTICS AND MOTOR SKILLS
A 9-month-old has usually reached the following milestones:
Gains weight at a slower rate,
about 15 grams (half an ounce) per
day, 1 pound per month
Increases in length by 1.5
centimeters (a little over one-half
inch) per month
Bowel and bladder become more
regular
Puts hands forward when the head
is pointed to the ground (parachute
reflex) to protect self from falling
SENSORY AND COGNITIVE SKILLS
The 9-month-old typically:
Babbles
Be able to place objects in the
mouth
Sleep 9 to 10 hours at night with 2
naps during the day (total of 14 to
16 hours per day)
Be able to laugh out loud
Anticipate feeding when able to see
a bottle (if bottle-fed)
Begin to show memory
Demand attention by fussing
Recognize parent's voice or touch
Is able to crawl
Sits for long periods
Pulls self to standing position
Reaches for objects while sitting
Bangs objects together
Can grasp objects between the tip
of the thumb and index finger
Feeds self with fingers
Throws or shakes objects
Has separation anxiety and may
cling to parents
 Is developing depth perception
Understands that objects continue
to exist, even when they are not
seen (object constancy)
Responds to simple commands
Responds to name
Developmental milestones record - 12 months
PHYSICAL AND MOTOR SKILLS
A 12-month-old child is expected
to:
Be 3 times their birth weight
Grow to a height of 50% over birth
length
Have a head circumference equal
to that of their chest
Have 1 to 8 teeth
Stand without holding on to
anything
SENSORY AND COGNITIVE DEVELOPMENT
The typical 12-month-old:
Begins pretend play (such as
pretending to drink from a cup)
Follows a fast moving object
Responds to their name
Can say momma, papa, and at least
1 or 2 other words
Understands simple commands
Tries to imitate animal sounds
Connects names with objects
Understands that objects continue
to exist, even when they can't be
seen
Participates in getting dressed
(raises arms)
Understands the meaning of "no"
Imitates speech sounds
May be afraid of being left alone
Plays interactive games, such as
peek-a-boo and pat-a-cake
Waves bye
Walk alone or when holding 1
hand
Sit down without help
Bang 2 blocks together
Turn through the pages of a book
by flipping many pages at a time
Pick up a small object using the tip
of their thumb and index finger
Sleep 8 to 10 hours a night and
take 1 to 2 naps during the day
Plays simple back and forth games
(ball game)
Points to objects with the index
finger
Waves bye
May develop attachment to a toy or
object
Experiences separation anxiety and
may cling to parents
May make brief journeys away
from parents to explore in familiar
settings
 Developmental milestones record - 18 months
PHYSICAL AND MOTOR SKILL MARKERS
The typical 18-month-old:
Has a closed soft spot on the front
of the head
Is growing at a slower rate and has
less of an appetite compared to the
months before
Is able to control the muscles used
to urinate and have bowel
movements, but may not be ready
to use the toilet
Runs stiffly and falls often
SENSORY AND COGNITIVE MARKERS
The typical 18-month-old:
Shows affection
Has separation anxiety
Listens to a story or looks at
pictures
Can say 10 or more words when
asked
Kisses parents with lips puckered
Identifies 1 or more parts of the
body
Developmental milestones record - 2 years
Physical and motor skill markers:
Able to turn a door knob
Can look through a book turning
one page at a time
Can build a tower of 6 to 7 cubes
Can kick a ball without losing
balance
Can pick up objects while standing,
without losing balance (This often
Is able to get onto small chairs
without help
Walks up stairs while holding on
with 1 hand
Can build a tower of 2 to 4 blocks
Can use a spoon and cup with help
to feed self
Imitates scribbling
Can turn 2 or 3 pages of a book at a
time
Understands and is able to point to
and identify common objects
Often imitates
Is able to take off some clothing
items, such as gloves, hats, and
socks
Begins to feel a sense of
ownership, identifying people and
objects by saying "my"
occurs by 15 months. It is a cause
for concern if not seen by 2 years.)
Can run with better coordination.
(May still have a wide stance.)
May be ready for toilet training
Should have the first 16 teeth (The
actual number of teeth can vary
widely.)
 At 24 months, will reach about half
final adult height
Sensory and cognitive markers:
Able to put on simple clothes
without help (The child is often
better at removing clothes than
putting them on.)
Able to communicate needs such as
thirst, hunger, need to go to the
bathroom. 4,5
Can organize phrases of 2 - 3
words
Can understand 2-step command
such as "give me the ball and then
get your shoes"
Has increased attention span
Vision is fully developed
Vocabulary has increased to about
50 - 300 words (Healthy children's
vocabulary can vary widely.)

4. How to calculate the babys nutrition status?

Answer :

Nutritional Status

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

The standard weight for age (W/A)

Interpretation

Nutritional status Threshold

Index category
(Z-Score)

Severe malnutrition < -3 SD

Weight for age Mild malnutrition -2 SD

(W/A)

0-60 months Normal > -2 SD until 2 SD

Over nutrition > 2 SD

The standard body length for age (BL/A)

Interpretation

Nutritional status Threshold

Index category
(Z-Score)

Very shorty < -3 SD

Body lenght for age Shorty -2 SD

(BL/A)

0-60 months Normal > -2 SD until 2 SD

Tall > 2 SD

The standard weight for body length (W/BL)

Interpretation

Nutritional status Threshold

Index category
(Z-Score)

Very skinny < -3 SD

Body mass index skinny -2 SD

for age (BMI/A)
Normal > -2 SD until 2
0-60 months SD

Obesity > 2 SD

The standard body mass index for age (BMI/A)

Interpretation6

Nutritional status Threshold

Index category
(Z-Score)

Very skinny < -3 SD

Weight for body skinny -2 SD

length (W/BL)

0-60 months Normal > -2 SD until 2 SD

Obesity > 2 SD

5. Whats factor can be affect to growth and development?

Answer :

Factors affecting growth and development

A. Genetics
Parental size has a direct influence on a childs growth potential and their
predicted adult height; more so for height than weight. A child with short stature
may be of concern because of possible illness or poor nutrition, but for a short
child with short parents they are possibly genetically small. Extreme shortness
 may be due to a combination of genetic and non-genetic factors. Complex
calculations can be performed to predict the childs height potential based on their
parents heights. Calculate mid-parental height by adding both parents heights
together and dividing by two. Charts are available to determine the predicted
height based on mid-parental height. A child whose adjusted stature is still low
should be investigated further for illness or poor nutrition. It is normal that five
percent of all children will grow below the 5th centile on height for age charts and
be healthy.
B. Ethnicity
It was traditionally believed that different ethnic groups show different
patterns of growth; on average African-Caribbean groups are taller and heavier,
and Asian and Chinese groups are shorter and lighter when compared with
Caucasians. More recently, the Multicentre Growth Reference Study group
refuted this belief showing that variability in infant growth was greater within
population groups than between the different country groups.
C. Birthweight
Small birth size may be associated with increased risk of cardiovascular
diseases, suggesting that foetal under-nutrition may increase susceptibility to
diseases occurring later in life. Evidence from animal studies suggests that the
foetus may adapt to an adverse intrauterine environment by slowing down growth
and metabolism, whereas large birth size may predict increased risk of obesity,
diabetes and some cancers.
Birthweight is one of the most accessible and reliable indicators and
universally measured In general, lower birth weight is associated with higher risk
or morbidity. At a population level, groups with lower mean birthweight often
have higher infant mortality (eg infants of mothers who smoke, or of mothers
from lower socioeconomic background). Asthma, lower developmental outcomes
and hypertension have all been reported to be more common among small birth
weight infants.
A babys weight at birth is strongly associated with mortality risk during the
first year, and to a lesser extent, with developmental problems in childhood and
the risk of various diseases in adulthood, including cardiovascular disease and
some cancers according to a recent systematic review.
D. Prematurity
 A child born before 37 completed weeks gestation is considered preterm.
Weight is plotted on an appropriate intrauterine growth chart. In Victoria, these
charts are based on data from Kitchen and used until the expected birth date plus 2
weeks. Growth of premature infants is monitored by a paediatrician.
E. Hormones
Anomalies in circulating hormones such as growth hormone, insulin like
growth factor, testosterone, oestrogen, thyroid hormone, cortisol, insulin affect
birth weight and growth. For example, children who are large for gestational age
at birth following exposure to an intrauterine environment of either maternal
diabetes or maternal obesity are at increased risk of developing metabolic
syndrome. Given the increasing obesity prevalence, these findings have
implications for perpetuating the cycle of obesity, insulin resistance and their
consequences in subsequent generations
F. Nutritional
The direct impact of Inadequate nutrition including energy, protein and
micronutrients caused by illness, neglect, or food insecurity. Breastfed infants
have been long-recognised to have different growth in the first year of life
compared to non-breastfed babies. Significant difference between the growth rates
of formula and breast fed infants was first reported in the DARLING (US) study
showing that BF infants grow more quickly initially, for the first 3 -6 months, and
then more slowly over the next 6 9 months. At the end of 12 months, breastfed
infants were generally 0.5 0 6 kg lighter than formula fed infants. Data from
seven longitudinal studies of infant growth were pooled and this confirmed that
infants breast fed for at least 12 months grew more rapidly in the first 2 months
and less rapidly from 3 12 months. This provided the rationale for formation of a
working group to develop new standards.
G. Environment
General health and maternal age, parity, socio-economic status and substances
such as smoking affect birth weight and growth whilst infants born at high
altitudes are known to be smaller babies believed due to lower oxygen.7,8

6. Whats the requirement for fototheraphy?

 Table 1. Phototherapy indication is based on total serum bilirubin9
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

Tabel 2. Phototherapy indication is based on low birth weight infants9

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

7. When the immunization should give to the normal baby?

 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.
Hepatitis B vaccination can then use monovalent hepatitis B vaccine or vaccine
combination.
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.
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.
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.
Measles vaccine. The second measles vaccine should not be given at age 24
months, when the MMR already given at 15 months.
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.
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).
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.
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.
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.

Information: Since 2013, the Ministry of Health of Indonesia has formally adopted the
use of pentavalent vaccine. Pentavalent vaccine consists of a combination of several
vaccines are: Haemophilus influenza (Hib), DTP (Diphtheria, Tetanus, Pertussis),
Hepatitis B. The five antigens are given in a single injection, making it more efficient.10
8. Whats the connection between immunization with the babys condition?

Figure 1. Recommended immunization schedule for persons aged 0 through 18

years United States, 2016.

(FOR THOSE WHO FALL BEHIND OR START LATE, SEE THE CATCH-
UP SCHEDULE [FIGURE 2]).
These recommendations must be read with the footnotes that follow. For those who
fall behind or start late, provide catch-up vaccination at the earliest opportunity as
indicated by the green bars in Figure 1. To determine minimum intervals between
doses, see the catch-up schedule (Figure 2). School entry and adolescent vaccine age
groups are shaded.

1. Hepatitis B (HepB) vaccine. (Minimum age: birth) Routine vaccination:

At birth:
 Administer monovalent HepB vaccine to all newborns before hospital
discharge.
For infants born to hepatitis B surface antigen (HBsAg)-positive mothers,
administer HepB vaccine and 0.5 mL of hepatitis B immune globulin
(HBIG) within 12 hours of birth. These infants should be tested
for HBsAg and antibody to HBsAg (anti-HBs) at age 9 through 18 months
(preferably at the next wellchild visit) or 1 to 2 months after completion of
the HepB series if the series was delayed; CDC recently
recommended testing occur at age 9 through 12 months;
If mothers HBsAg status is unknown, within 12 hours of birth administer
HepB vaccine regardless of birth weight. For infants weighing less than
2,000 grams, administer HBIG in addition to HepB vaccine within
12 hours of birth. Determine mothers HBsAg status as soon as possible
and, if mother is HBsAg-positive, also administer HBIG for infants
weighing 2,000 grams or more as soon as possible, but no later than age
7 days.

Doses following the birth dose:

The second dose should be administered at age 1 or 2 months. Monovalent

HepB vaccine should be used for doses administered before age 6 weeks.
Infants who did not receive a birth dose should receive 3 doses of a HepB-
containing vaccine on a schedule of 0, 1 to 2 months, and 6 months
starting as soon as feasible. See Figure 2.
Administer the second dose 1 to 2 months after the fist dose (minimum
interval of 4 weeks), administer the third dose at least 8 weeks after the
second dose AND at least 16 weeks after the fist dose. The fial
(third or fourth) dose in the HepB vaccine series should be administered
no earlier than age 24 weeks.
Administration of a total of 4 doses of HepB vaccine is permitted when a
combination vaccine containing HepB is administered after the birth dose.

Catch-up vaccination:

Unvaccinated persons should complete a 3-dose series.

A 2-dose series (doses separated by at least 4 months) of adult formulation
Recombivax HB is licensed for use in children aged 11 through 15 years.
For other catch-up guidance, see Figure

2.Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV1 [Rotarix] and RV5
[RotaTeq])
Routine vaccination:
Administer a series of RV vaccine to all infants as follows:
1. If Rotarix is used, administer a 2-dose series at 2 and 4 months of age.
2. If RotaTeq is used, administer a 3-dose series at ages 2, 4, and 6 months.
 3. If any dose in the series was RotaTeq or vaccine product is unknown for any dose
in the series, a total of 3 doses of RV vaccine should be administered.

Catch-up vaccination:
The maximum age for the fist dose in the series is 14 weeks, 6 days;
vaccination should not be initiated for infants aged 15 weeks, 0 days or
older.
The maximum age for the fial dose in the series is 8 months, 0 days.
For other catch-up guidance, see Figure 2.

3.Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Minimum
age: 6 weeks.
Exception: DTaP-IPV [Kinrix, Quadracel]: 4 years)
Routine vaccination:
Administer a 5-dose series of DTaP vaccine at ages 2, 4, 6, 15 through 18
months, and 4 through 6 years. The fourth dose may be administered as early
as age 12 months, provided at least 6 months have elapsed since the third
dose.
Inadvertent administration of 4th DTaP dose early: If the fourth dose of
DTaP was administered at least 4 months, but less than 6 months, after the
third dose of DTaP, it need not be repeated.

Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine (contd)
Catch-up vaccination:
The fith dose of DTaP vaccine is not necessary if the fourth dose was
administered at age 4 years or older.
For other catch-up guidance.
4.Haemophilus inflenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks for
PRP-T [ACTHIB, DTaP-IPV/Hib (Pentacel) and Hib-MenCY (MenHibrix)], PRP-
OMP [PedvaxHIB or COMVAX], 12 months for PRP-T [Hiberix])
Routine vaccination:
Administer a 2- or 3-dose Hib vaccine primary series and a booster dose (dose
3 or 4 depending on vaccine used in primary series) at age 12 through 15
months to complete a full Hib vaccine series.
The primary series with ActHIB, MenHibrix, or Pentacel consists of 3 doses
and should be administered at 2, 4, and 6 months of age. The primary series
with PedvaxHib or COMVAX consists of 2 doses and should
be administered at 2 and 4 months of age; a dose at age 6 months is not
indicated
One booster dose (dose 3 or 4 depending on vaccine used in primary series)
of any Hib vaccine should be administered at age 12 through 15 months. An
exception is Hiberix vaccine. Hiberix should only be used
 for the booster (fial) dose in children aged 12 months through 4 years who
have received at least 1 prior dose of Hib-containing vaccine.
For recommendations on the use of MenHibrix in patients at increased risk for
meningococcal disease.

Catch-up vaccination:

If dose 1 was administered at ages 12 through 14 months, administer a second

(fial) dose at least 8 weeks after dose 1, regardless of Hib vaccine used in the
primary series.
If both doses were PRP-OMP (PedvaxHIB or COMVAX), and were
administered before the fist birthday, the third (and fial) dose should be
administered at age 12 through 59 months and at least 8 weeks after the
second dose.
If the fist dose was administered at age 7 through 11 months, administer the
second dose at least 4 weeks later and a third (and fial) dose at age 12 through
15 months or 8 weeks after second dose, whichever is later.
If fist dose is administered before the fist birthday and second dose
administered at younger than 15 months, a third (and fial) dose should be
administered 8 weeks later.
For unvaccinated children aged 15 months or older, administer only 1 dose.
For other catch-up guidance, see Figure 2. For catch-up guidance related to
MenHibrix, please see the meningococcal vaccine footnotes and also MMWR
February 28, 2014 / 63(RR01);1-13 Vaccination of persons with high-risk
conditions:
Children aged 12 through 59 months who are at increased risk for Hib disease,
including chemotherapy recipients and those with anatomic or functional
asplenia (including sickle cell disease), human
immunodefiiency virus (HIV ) infection, immunoglobulin defiiency, or early
component complement defiiency, who have received either no doses or only
1 dose of Hib vaccine before 12 months of age,
should receive 2 additional doses of Hib vaccine 8 weeks apart; children who
received 2 or more doses of Hib vaccine before 12 months of age should
receive 1 additional dose.
For patients younger than 5 years of age undergoing chemotherapy or
radiation treatment who received a Hib vaccine dose(s) within 14 days of
starting therapy or during therapy, repeat the dose(s) at least 3 months
following therapy completion.
Recipients of hematopoietic stem cell transplant (HSCT) should be
revaccinated with a 3-dose regimen of Hib vaccine starting 6 to 12 months
after successful transplant, regardless of vaccination history; doses should be
administered at least 4 weeks apart.
A single dose of any Hib-containing vaccine should be administered to
unimmunized* children and adolescents 15 months of age and older
 undergoing an elective splenectomy; if possible, vaccine should be
administered at least 14 days before procedure

5.Pneumococcal vaccines. (Minimum age: 6 weeks for PCV13, 2 years for PPSV23)
Routine vaccination with PCV13:
Administer a 4-dose series of PCV13 vaccine at ages 2, 4, and 6 months and at
age 12 through 15 months.
For children aged 14 through 59 months who have received an age-appropriate
series of 7-valent PCV (PCV7), administer a single supplemental dose of 13-
valent PCV (PCV13). Catch-up vaccination with PCV13:
Administer 1 dose of PCV13 to all healthy children aged 24 through 59 months
who are not completely vaccinated for their age.
For other catch-up guidance, see Figure 2.
Vaccination of persons with high-risk conditions with PCV13 and PPSV23:
All recommended PCV13 doses should be administered prior to PPSV23
vaccination if possible.
For children 2 through 5 years of age with any of the following conditions:
chronic heart disease (particularly cyanotic congenital heart disease and cardiac
failure); chronic lung disease (including asthma
if treated with high-dose oral corticosteroid therapy); diabetes mellitus;
cerebrospinal flid leak; cochlear implant; sickle cell disease and other
hemoglobinopathies; anatomic or functional asplenia; HIV infection;
chronic renal failure; nephrotic syndrome; diseases associated with treatment
with immunosuppressive drugs or radiation therapy, including malignant
neoplasms, leukemias, lymphomas, and Hodgkin disease;
solid organ transplantation; or congenital immunodefiiency:

1. Administer 1 dose of PCV13 if any incomplete schedule of 3 doses of

PCV (PCV7 and/or PCV13) were received previously.
2. Administer 2 doses of PCV13 at least 8 weeks apart if unvaccinated or
any incomplete schedule of fewer than 3 doses of PCV (PCV7 and/or
PCV13) were received previously.
3. Administer 1 supplemental dose of PCV13 if 4 doses of PCV7 or other
age-appropriate complete PCV7 series was received previously.
4. The minimum interval between doses of PCV (PCV7 or PCV13) is 8
weeks.
5. For children with no history of PPSV23 vaccination, administer PPSV23
at least 8 weeks after the most recent dose of PCV13.
For children aged 6 through 18 years who have cerebrospinal flid leak; cochlear
implant; sickle cell disease and other hemoglobinopathies; anatomic or
functional asplenia; congenital or acquired immunodefiiencies; HIV infection;
chronic renal failure; nephrotic syndrome; diseases associated
with treatment with immunosuppressive drugs or radiation therapy, including
malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized
malignancy; solid organ transplantation; or multiple myeloma:
 1. If neither PCV13 nor PPSV23 has been received previously, administer 1
dose of PCV13 now and 1 dose of PPSV23 at least 8 weeks later.
2. If PCV13 has been received previously but PPSV23 has not, administer 1
dose of PPSV23 at least 8 weeks after the most recent dose of PCV13.
3. If PPSV23 has been received but PCV13 has not, administer 1 dose of
PCV13 at least 8 weeks after the most recent dose of PPSV23.
For children aged 6 through 18 years with chronic heart disease (particularly
cyanotic congenital heart disease and cardiac failure), chronic lung disease
(including asthma if treated with high-dose oral corticosteroid therapy), diabetes
mellitus, alcoholism, or chronic liver disease, who have not received PPSV23,
administer 1 dose of PPSV23. If PCV13 has been received previously, then
PPSV23 should be administered at least 8 weeks after any prior PCV13 dose.
A single revaccination with PPSV23 should be administered 5 years after the
fist dose to children with sickle cell disease or other hemoglobinopathies;
anatomic or functional asplenia; congenital or acquired
immunodefiiencies; HIV infection; chronic renal failure; nephrotic syndrome;
diseases associated with treatment with immunosuppressive drugs or radiation
therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin
disease; generalized malignancy; solid organ transplantation; or
multiple myeloma.

6.Measles, mumps, and rubella (MMR) vaccine. (Minimum age: 12 months for
routine vaccination)
Routine vaccination:

Administer a 2-dose series of MMR vaccine at ages 12 through 15 months and 4

through 6 years. The second dose may be administered before age 4 years,
provided at least 4 weeks have elapsed since the fist dose.
Administer 1 dose of MMR vaccine to infants aged 6 through 11 months before
departure from the United States for international travel. These children should
be revaccinated with 2 doses of MMR vaccine, the fist
at age 12 through 15 months (12 months if the child remains in an area where
disease risk is high), and the second dose at least 4 weeks later.
Administer 2 doses of MMR vaccine to children aged 12 months and older
before departure from the United States for international travel. The fist dose
should be administered on or after age 12 months and
the second dose at least 4 weeks later.

Catch-up vaccination:
Ensure that all school-aged children and adolescents have had 2 doses of
MMR vaccine; the minimum interval between the 2 doses is 4 weeks.11
9. Why the baby refuse to drink bottle feeding and the correlation between jaundice to
baby's growth and development?

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. When the baby
looked nothing like the formula, try to express the milk and gave it through the bottle,
and gradually add milk formula to the baby bottle, until the baby is fully able to drink
formula. It takes time and patience to train it. If the baby still can not drink from the
bottle, give formula milk with a spoon.

Babies with low birth weight is one of the complications of jaundice.

Pathological within the first 24 hours of life is usually caused by excess production of
bilirubin, due to clearance of bilirubin slow rarely led to increased concentrations
above 10 mg / dl at this age. So, early neonatal jaundice is usually caused by
hemolytic disease.

Picture 1. The division of jaundice by Kramer

At a certain degree, it will be toxic bilirubin and tissue damage. The toxicity is
mainly found in indirect bilirubin that is poorly soluble in water but soluble in fat.
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 if the indirect bilirubin levels over 20 mg
/ dl. Ease of bilirubin through the blood-brain barrier turns not only depend on high
levels of bilirubin but it depends also on the state of the neonate's own. Indirect
bilirubin will be easy through the blood-brain barrier in infants if there are
circumstances immaturity, low birth weight, hypoxia, hypercarbia, hypoglycemia, and
central nervous system disorders that occur because of trauma or infection.12

10. How the treatment for the baby and education for the mother?
Treatment for developmental disorders based on the scenario that is by giving
stimulation or exercise.

38

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

The principle in providing stimulation:

1. Provide a positive emotional, such as love, affection and warmth (ASIH).

Democratic parenting is parenting that provides a positive environment to stimulate
development of the child

2. Providing nutritious food and health care

3. Provide stimulation in all aspects of development, but not all at once at the same
time, because it will confuse the child

4. Provide a conducive atmosphere, which creates a natural environment, relaxed and

fun, in an atmosphere play free from under pressure and punishment so that children
do not stress

5. Provide a gradual and continuous stimulation. Stimulation provided should not be

difficult or easy, but according to the level of child development / maturation of the
brain.

6. Giving freedom to children's active social interaction

7. Tools stimulation should be harmless, simple and easily modified. In addition,

should be varied so as not boring

Examples of plaything and development stimulated are:

1. Physical growth / gross motor skills: tricycles, balls, toys are being pulled and
pushed, rope

2. Motor Fine: pencils, ball, beam, candles

3. Intelligence / Cognitive: picture books, story books, puzzles, crayons

4. Language: picture books, story books, magazines, radio, tape, TV

5. Helping yourself: glass / plastic plates, spoons, clothes, shoes, socks

Education

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 mothers13

11. How about the Islamic perspective?

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

QS. Al-Baqarah ayat 233:



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.

Nabi saw in his words:

: :

: .

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.14

DAFTAR PUSTAKA
1. Prof. Soetjiningsih, Dr., Sp.A(K). Tumbuh Kembang Anak. Ed.2. Jakarta. EGC.
2015.
2. Diktat kuliah. Dr.dr.Martira Maddeppungeng, Sp.A (K).FK UMI. 2016
3. Ilmu Kesehatan Anak Nelson. 2011. Saunders Elsevier.
4. https://www.nlm.nih.gov/medlineplus/ency/article/002456.htm [updated on
April,24.2016]
5. http://www.merckmanuals.com/professional/pediatrics/growth-and-
development/physical-growth-of-infants-and-children [updated on April,24.2016]
6. Keputusan Menteri Kesehatan Republik Indonesia Nomor :
1995/MENKES/SK/XII/2010 tentang Standar Antropometri Penilaian Status Gizi
Anak.

7. Risnes, K.R., et al., Birthweight and mortality in adulthood: a systematic review

and meta-analysis. International Journal of Epidemiology, 2011.
8. http://www.education.vic.gov.au/Documents/childhood/professionals/support/fact
orsaffgrowth.pdf [updated on April,26.2016]
9. Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011
10. Ikatan Dokter Anak Indonesia, 2014
11. http://www.cdc.gov/vaccines/hcp/acip-recs/index.html.[updated on April,26.2016]
12. 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.
13. Soetjiningsih. 2015.Tumbuh Kembang Anak Edisi 2. Jakarta:EGC hal 172-173,
208-209, 235
14. Al-Quran dan Hadits