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Difficulty: Very hardDevelopmental Stages and Transitions

A pediatric nurse is evaluating the developmental progress of a 12-month-old infant who was born prematurely at 32 weeks of gestation. Based on the infant's adjusted age, which set of assessment findings should the nurse identify as the expected developmental baseline for this client?

  1. The infant pulls to a standing position, cruises along furniture, and uses a crude pincer grasp.Answer
  2. B
    The infant stands independently for several seconds, uses a mature pincer grasp, and places a block into a cup.
  3. C
    The infant sits unsupported without assistance, creeps on the abdomen, and uses a raking grasp to pick up small objects.
  4. D
    The infant walks independently across the room, creeps up the stairs, and scribbles spontaneously with a crayon.

Answer

The infant pulls to a standing position, cruises along furniture, and uses a crude pincer grasp.
For infants born prematurely, developmental milestones must be evaluated using the adjusted age rather than the chronological age until the child is approximately 2 years old. The calculation for adjusted age is the chronological age minus the weeks of prematurity. In this scenario, the infant has a chronological age of 12 months (52 weeks). Because the infant was born at 32 weeks gestation, they are 8 weeks (or 2 months) premature based on a standard 40-week term. Subtracting the 2 months of prematurity from the 12-month chronological age yields an adjusted age of 10 months. Expected developmental milestones for a 10-month-old infant include pulling to a standing position, cruising along furniture, and developing a crude pincer grasp.

Step-by-Step Solution

1
Determine the infant's chronological age based on the assessment data.
The infant's chronological age is 12 months.
Chronological age is the time elapsed since birth and serves as the starting point for calculating adjusted age in premature infants.
2
Calculate the degree of prematurity by subtracting the gestational age at birth from a standard full term.
The infant was born at 32 weeks. 40 weeks−32 weeks=8 weeks40\ weeks - 32\ weeks = 8\ weeks (which is equivalent to 2 months premature).
A full-term gestation is considered 40 weeks. The difference determines how much time needs to be subtracted to accommodate for missed in-utero development.
3
Calculate the adjusted age by subtracting the prematurity time from the chronological age.
12 months−2 months=10 months12\ months - 2\ months = 10\ months adjusted age.
Developmental milestones for infants born prematurely should be assessed based on their adjusted age until they reach 2 to 2.5 years of age.
4
Correlate the adjusted age with the expected developmental milestones.
A 10-month-old is expected to pull to a stand, cruise holding onto furniture, and use a crude pincer grasp.
Applying the correct physiological and motor milestones to the adjusted age prevents falsely identifying a normal premature child as developmentally delayed.

Key Concept

Adjusted Age Milestone Assessment
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Topics

Developmental Stages and Transitions

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