MARTERNAL HEALTHCARE 27 NURSING CARE OF THE
CHILD BORN WITH A PHYSICAL OR DEVELOPMENTAL
DIFFERENCE STUDY GUIDE 2026
Birth defects affect one in every 33 babies, about 3% (CDC, 2021a). They are a leading cause of
death among infants, accounting for about 20% (CDC, 2021a). If you are a nurse in maternal–
child or pediatric nursing, you will undoubtedly be caring for and interacting with parents who
have a child with a physical or developmental difference. The cause and/or prevention of some
defects are known, and some have no identifiable cause. Taking folic acid during pregnancy can
decrease the risk of neural tube defects (NTDs). Avoiding tobacco, alcohol, and certain
medications can lower the risk of fetal alcohol syndrome and oral defects like cleft palate and lip.
Birthing parents who are obese or have diabetes have an increased risk of birth defects, including
cardiac defects. When a newborn is born with an apparent physical or developmental difference,
nurses play a major role in supporting and educating the parents to promote bonding. With some
newborns, their congenital disorder may be corrected with surgery, and they will have no long-
term sequela. With other newborns, the congenital disorders may require long-term care even
with surgical correction. This chapter covers physical disorders of the skeletal, gastrointestinal,
and neurologic systems that are apparent at birth or recognized soon after. Congenital disorders
of the cardiovascular system are addressed in Chapter 41. Birth defects remain a major public
health concern and financial burden. The newborn metabolic screening test is performed in
newborns in the United States and identifies many congenital conditions shortly after birth
(Fabie et al., 2019). The goal of newborn metabolic screening is the diagnosis of treatable
disorders early enough to provide an intervention that will improve their outcome (Fabie et al.,
2019). Some congenital and/or developmental conditions are diagnosed via sonogram, in utero or
after birth upon physical exam. Box 27.1 shows Healthy People 2030 goals related to decreasing
the number of newborns born with congenital anomalies.
Nursing Process Overview FOR CARE OF A NEWBORN WITH A PHYSICAL OR
DEVELOPMENTAL CHALLENGE ASSESSMENT
The nursing assessment of a newborn with a physical or developmental difference focuses on
determining the infant’s immediate physiologic needs required to transition in utero to birth.
Supporting the parents’ immediate emotional needs to promote bonding is an important aspect of
this transition. Along with assigning the newborn’s APGAR score at 1 and 5 minutes after birth,
the following eight primary needs of newborns should be assessed for in all newborns to identify
any newborn’s physical and developmental differences: Adequate respiration Extrauterine
circulation Body temperature stabilization Blood sugar stabilization Prevention of infection An
infant–parent bond Adequate stimulation Ability to take in adequate nutrients Ability to achieve
waste elimination Anomalies that affect a newborn’s appearance may have the most immediate
effect on the parents’ ability to establish a positive bond with their child. It is important, however,
not to jump to conclusions about the parents’ response. An assessment of the family’s verbal and
nonverbal responses may reveal that parents are prepared and able to meet this infant’s special
needs. The parents’ adjustment may be affected by their prior knowledge of their child’s physical
or developmental difference. Prenatal care has advanced to assist obstetricians/providers identify
many fetal physical conditions prenatally via ultrasound or serum testing (i.e., amniocentesis).
Parents may be informed of the diagnosis or condition prior to birth, which also allows for any
necessary life-supportive medical measures to be on standby at the time of birth. However,
,sometimes the birth of an infant with a physical or developmental difference or condition will be
unexpected and parents will need time, assurance, education, and support following the birth of
their child.
NURSING DIAGNOSIS
Many nursing diagnoses established for children with a physical or developmental difference
address the effect of the disorder on body function, including the child’s primary needs and the
family’s coping ability (Farrell & Krahn, 2014). Examples of possible diagnoses include:
Malnutrition risk related to inability to take in adequate nutrition secondary to a physical
challenge Altered physical mobility related to congenital anomaly Altered parenting risk related
to the birth of child with a congenital anomaly Anticipatory grieving (parental) related to loss of
the idea of a healthy child
OUTCOME IDENTIFICATION AND PLANNING
Nurses play an important role in providing immediate care to high-risk newborns at birth as well
as stabilizing them until the pediatric team arrives to assume care or transport the newborn to a
high-risk nursery. Consideration of the family’s resources, both emotional and financial, is an
important aspect of medical and nursing care and for planning and coordinating discharge care,
such as for pediatric palliative care services (see Chapter 56). It is important to consider both the
short- and long-term needs of the newborn and how these needs may affect the family.
Supportive family members can be a critical asset to parental adjustment. Providing nursing
support as part of an interdisciplinary team, including social workers, therapists, nutritionists,
medical specialists, and other community resources can also help with parental adjustment. Refer
parents to helpful websites and other resources when appropriate (see Chapter 20).
IMPLEMENTATION
Nursing interventions for a newborn with a physical difference include immediate life-
sustaining measures such as providing oxygen or adequate intake of nutrients when a disorder
prevents the infant from establishing respirations or sucking. Encouraging skin-to-skin contact
and interacting with the newborn promotes infant–parent bonding. Educating the parents about
procedures the infant may undergo lessens the parental anxiety and enhances self-esteem. Parents
experience the same stages of grief as those whose child has died at birth: denial, anger,
bargaining, depression, and adjustment (see Chapter 56). It is important for the nurse to provide
positive role modeling when caring for the emotional and physical needs of the newborn; it helps
the parents adjust to parenting a child born with a physical or developmental difference.
OUTCOME EVALUATION
Outcome evaluation should focus on establishing expected outcomes for the child’s physical and
developmental health needs as well as the family’s coping ability for the current and future
health of the child. This includes addressing family concerns and providing resources to support
the family during and after discharge. Examples of expected outcomes may include: Parent
describes positive features of child within 1 to 2 weeks of diagnosis. Parents state they are
comfortable with enteral feeding by 1 month. Child is ambulatory with walker or wheelchair by
2 years of age.
Care at Birth of the Newborn Who Has Physical or Developmental Differences
The pediatric provider or neonatologist typically provides the parents with medical information
regarding the health status of their newborn, in addition to any prenatal information they may
have received from the obstetric team. This information, as well as time to ask questions, should
be provided to the parents as quickly and accurately as possible. The nurse can provide support
to the family by keeping them informed of their newborn’s health status and facilitating their
, interaction with the healthcare team. It is distressing for parents, who expect to hold their
newborn immediately after birth, to watch their newborn undergo a medical evaluation and
intervention while physically separated from their newborn (Box 27.2).
When the parents are with their newborn, the nurse can begin by describing the newborn’s
physical condition, related to the diagnosis, to the parents. Medical equipment and its purpose
should be explained to parents. Provide parents with the opportunity to ask questions and interact
with their newborn. Comments by the nurse related to normal newborn observations can assist
the parents in relating to their newborn. A typical explanation to parents of a newborn with a
neural tube disorder might be, “When your doctor placed your baby on your abdomen, you might
have noticed that your baby’s spinal cord isn’t completely formed; this is called a meningocele. I
will bring the baby’s isolette over to you. Notice how bright-eyed and alert the baby is for just
being born.” Referring to the newborn by their name is helpful to personalize the interaction.
Physical and Developmental Disorders of the Skeletal System
Either genetic or environmental factors can compromise fetal physical growth to such an extent
that they result in skeletal disorders in the newborn.
ABSENT OR MALFORMED EXTREMITIES
Congenital skeletal disorders can result from reasons such as idiopathic congenital, maternal
drug or alcohol ingestion, maternal malnutrition, teratogenic medications, and/or virus invasion
or amniotic band formation in utero. Teratogenic medications are medications taken prior to
pregnancy or during pregnancy that may produce a congenital malformation. The U.S. Food and
Drug Administration developed a system that determines the teratogenic risk of drugs based on
research. Categories are A, B, C, D, and X. Category A medications have failed to demonstrate a
risk. Category B medications are used routinely and are safe. Category C medications have
revealed adverse effects on the fetus. Category D medications report positive evidence of adverse
risks. Category X medications have demonstrated fetal abnormalities and/or there is positive
evidence of human fetal risk. In most instances, however, the cause of the anomaly is unknown.
Children born without an extremity or with a malformed extremity can be fitted with a prosthesis
early in life, at about 6 months, so that the infant can learn to stand at the normal time or handle
and explore objects readily. However, it may be adventitious to allow the child to grow and learn
to use their altered body or limb without a prosthesis. Introducing a prosthesis early in life may
prevent a child from adjusting to a missing extremity, such as learning to write with their feet or
sliding across the floor rather than walking. Often, parents and therapists will teach children in
therapy to function both with and without a prosthesis. Children are resilient and can become so
proficient at these adjustments that later in life they may not see any advantage to using a
prosthesis. Those affected by a skeletal anomaly can choose to use a prosthesis as an adult or not.
Depending on the condition, in some children, there is a potential for better function if the
malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a
difficult decision for parents, as it is irreversible. They need reassurance that the malformed
fingers will not become normal over time. They need to understand that a well-fitted prosthesis
will enable their child to have functional use of the extremity (Fig. 27.1).
Learning to use a hand prosthesis takes weeks to months, and it also involves therapy, from a
pediatric occupational or physical therapist. It helps if parents can think of interesting activities
CHILD BORN WITH A PHYSICAL OR DEVELOPMENTAL
DIFFERENCE STUDY GUIDE 2026
Birth defects affect one in every 33 babies, about 3% (CDC, 2021a). They are a leading cause of
death among infants, accounting for about 20% (CDC, 2021a). If you are a nurse in maternal–
child or pediatric nursing, you will undoubtedly be caring for and interacting with parents who
have a child with a physical or developmental difference. The cause and/or prevention of some
defects are known, and some have no identifiable cause. Taking folic acid during pregnancy can
decrease the risk of neural tube defects (NTDs). Avoiding tobacco, alcohol, and certain
medications can lower the risk of fetal alcohol syndrome and oral defects like cleft palate and lip.
Birthing parents who are obese or have diabetes have an increased risk of birth defects, including
cardiac defects. When a newborn is born with an apparent physical or developmental difference,
nurses play a major role in supporting and educating the parents to promote bonding. With some
newborns, their congenital disorder may be corrected with surgery, and they will have no long-
term sequela. With other newborns, the congenital disorders may require long-term care even
with surgical correction. This chapter covers physical disorders of the skeletal, gastrointestinal,
and neurologic systems that are apparent at birth or recognized soon after. Congenital disorders
of the cardiovascular system are addressed in Chapter 41. Birth defects remain a major public
health concern and financial burden. The newborn metabolic screening test is performed in
newborns in the United States and identifies many congenital conditions shortly after birth
(Fabie et al., 2019). The goal of newborn metabolic screening is the diagnosis of treatable
disorders early enough to provide an intervention that will improve their outcome (Fabie et al.,
2019). Some congenital and/or developmental conditions are diagnosed via sonogram, in utero or
after birth upon physical exam. Box 27.1 shows Healthy People 2030 goals related to decreasing
the number of newborns born with congenital anomalies.
Nursing Process Overview FOR CARE OF A NEWBORN WITH A PHYSICAL OR
DEVELOPMENTAL CHALLENGE ASSESSMENT
The nursing assessment of a newborn with a physical or developmental difference focuses on
determining the infant’s immediate physiologic needs required to transition in utero to birth.
Supporting the parents’ immediate emotional needs to promote bonding is an important aspect of
this transition. Along with assigning the newborn’s APGAR score at 1 and 5 minutes after birth,
the following eight primary needs of newborns should be assessed for in all newborns to identify
any newborn’s physical and developmental differences: Adequate respiration Extrauterine
circulation Body temperature stabilization Blood sugar stabilization Prevention of infection An
infant–parent bond Adequate stimulation Ability to take in adequate nutrients Ability to achieve
waste elimination Anomalies that affect a newborn’s appearance may have the most immediate
effect on the parents’ ability to establish a positive bond with their child. It is important, however,
not to jump to conclusions about the parents’ response. An assessment of the family’s verbal and
nonverbal responses may reveal that parents are prepared and able to meet this infant’s special
needs. The parents’ adjustment may be affected by their prior knowledge of their child’s physical
or developmental difference. Prenatal care has advanced to assist obstetricians/providers identify
many fetal physical conditions prenatally via ultrasound or serum testing (i.e., amniocentesis).
Parents may be informed of the diagnosis or condition prior to birth, which also allows for any
necessary life-supportive medical measures to be on standby at the time of birth. However,
,sometimes the birth of an infant with a physical or developmental difference or condition will be
unexpected and parents will need time, assurance, education, and support following the birth of
their child.
NURSING DIAGNOSIS
Many nursing diagnoses established for children with a physical or developmental difference
address the effect of the disorder on body function, including the child’s primary needs and the
family’s coping ability (Farrell & Krahn, 2014). Examples of possible diagnoses include:
Malnutrition risk related to inability to take in adequate nutrition secondary to a physical
challenge Altered physical mobility related to congenital anomaly Altered parenting risk related
to the birth of child with a congenital anomaly Anticipatory grieving (parental) related to loss of
the idea of a healthy child
OUTCOME IDENTIFICATION AND PLANNING
Nurses play an important role in providing immediate care to high-risk newborns at birth as well
as stabilizing them until the pediatric team arrives to assume care or transport the newborn to a
high-risk nursery. Consideration of the family’s resources, both emotional and financial, is an
important aspect of medical and nursing care and for planning and coordinating discharge care,
such as for pediatric palliative care services (see Chapter 56). It is important to consider both the
short- and long-term needs of the newborn and how these needs may affect the family.
Supportive family members can be a critical asset to parental adjustment. Providing nursing
support as part of an interdisciplinary team, including social workers, therapists, nutritionists,
medical specialists, and other community resources can also help with parental adjustment. Refer
parents to helpful websites and other resources when appropriate (see Chapter 20).
IMPLEMENTATION
Nursing interventions for a newborn with a physical difference include immediate life-
sustaining measures such as providing oxygen or adequate intake of nutrients when a disorder
prevents the infant from establishing respirations or sucking. Encouraging skin-to-skin contact
and interacting with the newborn promotes infant–parent bonding. Educating the parents about
procedures the infant may undergo lessens the parental anxiety and enhances self-esteem. Parents
experience the same stages of grief as those whose child has died at birth: denial, anger,
bargaining, depression, and adjustment (see Chapter 56). It is important for the nurse to provide
positive role modeling when caring for the emotional and physical needs of the newborn; it helps
the parents adjust to parenting a child born with a physical or developmental difference.
OUTCOME EVALUATION
Outcome evaluation should focus on establishing expected outcomes for the child’s physical and
developmental health needs as well as the family’s coping ability for the current and future
health of the child. This includes addressing family concerns and providing resources to support
the family during and after discharge. Examples of expected outcomes may include: Parent
describes positive features of child within 1 to 2 weeks of diagnosis. Parents state they are
comfortable with enteral feeding by 1 month. Child is ambulatory with walker or wheelchair by
2 years of age.
Care at Birth of the Newborn Who Has Physical or Developmental Differences
The pediatric provider or neonatologist typically provides the parents with medical information
regarding the health status of their newborn, in addition to any prenatal information they may
have received from the obstetric team. This information, as well as time to ask questions, should
be provided to the parents as quickly and accurately as possible. The nurse can provide support
to the family by keeping them informed of their newborn’s health status and facilitating their
, interaction with the healthcare team. It is distressing for parents, who expect to hold their
newborn immediately after birth, to watch their newborn undergo a medical evaluation and
intervention while physically separated from their newborn (Box 27.2).
When the parents are with their newborn, the nurse can begin by describing the newborn’s
physical condition, related to the diagnosis, to the parents. Medical equipment and its purpose
should be explained to parents. Provide parents with the opportunity to ask questions and interact
with their newborn. Comments by the nurse related to normal newborn observations can assist
the parents in relating to their newborn. A typical explanation to parents of a newborn with a
neural tube disorder might be, “When your doctor placed your baby on your abdomen, you might
have noticed that your baby’s spinal cord isn’t completely formed; this is called a meningocele. I
will bring the baby’s isolette over to you. Notice how bright-eyed and alert the baby is for just
being born.” Referring to the newborn by their name is helpful to personalize the interaction.
Physical and Developmental Disorders of the Skeletal System
Either genetic or environmental factors can compromise fetal physical growth to such an extent
that they result in skeletal disorders in the newborn.
ABSENT OR MALFORMED EXTREMITIES
Congenital skeletal disorders can result from reasons such as idiopathic congenital, maternal
drug or alcohol ingestion, maternal malnutrition, teratogenic medications, and/or virus invasion
or amniotic band formation in utero. Teratogenic medications are medications taken prior to
pregnancy or during pregnancy that may produce a congenital malformation. The U.S. Food and
Drug Administration developed a system that determines the teratogenic risk of drugs based on
research. Categories are A, B, C, D, and X. Category A medications have failed to demonstrate a
risk. Category B medications are used routinely and are safe. Category C medications have
revealed adverse effects on the fetus. Category D medications report positive evidence of adverse
risks. Category X medications have demonstrated fetal abnormalities and/or there is positive
evidence of human fetal risk. In most instances, however, the cause of the anomaly is unknown.
Children born without an extremity or with a malformed extremity can be fitted with a prosthesis
early in life, at about 6 months, so that the infant can learn to stand at the normal time or handle
and explore objects readily. However, it may be adventitious to allow the child to grow and learn
to use their altered body or limb without a prosthesis. Introducing a prosthesis early in life may
prevent a child from adjusting to a missing extremity, such as learning to write with their feet or
sliding across the floor rather than walking. Often, parents and therapists will teach children in
therapy to function both with and without a prosthesis. Children are resilient and can become so
proficient at these adjustments that later in life they may not see any advantage to using a
prosthesis. Those affected by a skeletal anomaly can choose to use a prosthesis as an adult or not.
Depending on the condition, in some children, there is a potential for better function if the
malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a
difficult decision for parents, as it is irreversible. They need reassurance that the malformed
fingers will not become normal over time. They need to understand that a well-fitted prosthesis
will enable their child to have functional use of the extremity (Fig. 27.1).
Learning to use a hand prosthesis takes weeks to months, and it also involves therapy, from a
pediatric occupational or physical therapist. It helps if parents can think of interesting activities
