Birth and Physical Development during the First Three Years

  Birth and Physical Development during the First Three Years

  CHAPTER 4 Learning Outcomes

  4.1 Specify how childbirth has childbirth has changed in developed countries

  4.2 Describe the birth process

  4.3 Describe the adjustment of a healthy newborn and the techniques for assessing its health

  4.4 Explain potential complications of childbirth and the prospects for infants with complicated births

  

4.5 Identify the factors affecting infants’ chances for survival

and health

  

4.6 Discuss the patterns of physical growth and development

in infancy

  4.7 Describe infants’ motor development

  Childbirth and Culture: How Birthing Has Changed

   Pre 20th Century: _

  Birthing was a modest “female only” ritual _ Use of midwives was predominant _

Death rates high for mother and baby

_

One out of four babies died in first year



  Modern Generations: _

Dramatic reductions in death rate due to:

_ Antibiotics _ Prenatal care

  “Humanizing” Childbirth: A Social Trend

   Home births have brought back intimacy of event

   Birthing centers and hospitals

  

  Soft lights

  

  Father or partner as coach

  

  Baby stays in room

  Birth Process

   Parturition – brings on labor

   Two weeks before delivery

   Uterine contractions

   Cervix becomes flexible

   Stimulated by rising estrogen levels

  Three Stages of Vaginal Childbirth Stages of Childbirth

   First: Longest, typically 12–14 hours

  for first child, cervix dilates

   Second: 1–2 hours, contractions

  stronger and closer together, baby’s head moves through birth canal; Stage 2 ends with baby emerging from mother’s body

   Third: 10–60 minutes, placenta and

  umbilical cord expelled from mother

  Fetal Monitoring

  

  Electronic monitoring can track the fetus’s heart rate during delivery

  

  Used in 89% of live births in the U.S. in 2004

  

  Sometimes can have false positive rate indicating the fetus is in trouble when they are not

  Cesarean Delivery

  

Cesarean delivery: Surgically removing baby from

_ uterus through abdomen Over 30% of all U.S. births _ Often used when labor progresses slowly _ Changing preferences among women and some

  _ physicians Common with: _{ First and/or large babies}  Older moms _{ Mothers with previous C-sections}

  Unmedicated Delivery

   Natural Childbirth _{ Mother receives training in fitness, breathing and } relaxation Traditional cultures - Use of doula _{ Experienced helper provides emotional support to } mother Prepared Childbirth _{ Lamaze}  _{of pain Mother learns to substitute other responses for feelings}

  Medicated Deliveries

   Local or regional anesthesia

   Blocks pain receptors in brain

   Relaxing analgesic

   Approximately 60% of women choose pain relief during labor

  Size and Appearance of the Newborn

  

  Average neonate is:

  

  20 inches long

   _ 7.5 pounds _ Fontanels – soft plates of head _ Lanugo – fuzzy prenatal hair Vernix caseosa – oily protection against infection

  Body Systems of the Newborn

   Breathing: Anoxia or hypoxia can lead to birth _ trauma Meconium _{ Stringy waste in fetal intestinal tract}

   Neonatal Jaundice _{ Yellowing of skin and eyeballs}  _{Caused by immaturity of the liver  Half of all babies experience}  _{Usually baby does not need treatment}

  Assessments: Apgar Scale

  Sign

  1

  2 Appearance ^{Blue and pale Body pink,} _{limbs blue} ^{All pink} Pulse ^{Absent Slow (< 100) Rapid} Grimace

^{None Grimace Coughing and} _crying Activity ^{Limp Weak Strong} Respiration ^{Absent Irregular, slow Good, crying} Assessments: Brazelton NBAS

   Tests responses to physical and social environment

  

  Motor organization

  

  Reflexes

  

  Attention and interactive capacity

  

  CNS instability

  Neonatal Screening Tests

   Help detect correctable disorders

  

  PKU

  

  Galactosemia

  

  Hypothyroidism

  Infant Arousal States _{Regular Sleep Closed Regular, slow None} State Eyes Breathing Movement Irregular Sleep Closed Irregular Twitching _{Open or} Drowsiness _closed ^{Irregular Some activity} Alert Inactivity Open Even Quiet _{Wakeful and Crying} Open Irregular Much activity Childbirth Complications

   Birth trauma

   Postmaturity

   Prematurity

   Low birth weight

  Low Birthweight  _ Weighing less than 5 ½ lbs.

  Very low birth weight - less than 3 ½ _ lbs.

  15.5% of all births, most in _ developing countries Prematurity and low birth weight are the second-leading cause of infant death, after birth defects Maternal Traits That Increase Risk of Low Birth Weight

   Underage or overage

   Uneducated and poor

   Poor nutrition

   Smoking and drinking

   Stress

   Infections and high blood pressure

  Immediate Treatment for Prematurity

   Intravenous feeding

   Surfactant

   Isolette – controlled environment, like an incubator

   Kangaroo care

  Long-Term Outcomes of Low Birth Weight

   Greater risk of:

  

  Neurological and cognitive impairment

  

  Lower academic achievement

  

  Social, behavioral, and attention problems

  Postmaturity & Stillbirth

   Postmature: 42 weeks or more

  

Stillbirth: Death of fetus at or

after 20th week of gestation

  Reduction may be due to fetal monitoring Ambiguous loss

  Death during Infancy

  

  Primary causes worldwide: _{ } Preterm delivery _ Sepsis or pneumonia Asphyxiation at birth

  

  Birth defects are leading cause in the U.S.

  

  Improvement in U.S. infant mortality rates likely due to SIDS awareness

  SIDS Sudden Infant Death Syndrome

   “Crib death” _ Sudden death of infant under 1 year of age _ Cause of death unexplained _ May have underlying biological defect (heart

  _ gene mutations)

May be associated with sleeping on stomach

  Deaths from Injuries

   90% of injury deaths in infancy due to:

  

  Suffocation

  

  Motor vehicle accidents

  

  Drowning

  

  Residential fires or burns

  Immunizations 

  

About 90% all children today are

vaccinated 

  Some regions are better vaccinated than others 

  No causal connection between vaccines and autism or other disorders

  Proportions of Physical Growth Growth: Height and Weight

  Nutrition: Breast Feeding

   Breast milk almost always the best food _

  More digestible _ Reduces allergic reactions _ Minimizes numerous infections _ May reduce risk of SIDS _ Better cognitive performance 

  Recommendation is babies exclusively breast-feed for 6 months

  Bottle Feeding

   Formula should be iron- _ fortified Necessary for women with _ infectious illnesses

Does NOT reduce emotional bonding between mother and baby Other Nutritional Concerns

  

  Solid food introduced second half of first year

  

  Malnutrition

  

  Overweight _{ } 6% of U.S. infants classified as overweight Parental obesity strong predictor

  Brain Growth

  Research in Action:

  Lessons from Neuroscience

  

  Brains develop over time

  

  Social environment is factor in brain development

  

  Brains are capable of change

  

  Complex, integrated dynamic organ

  

  Long term stress can be damaging

  Parts of Brain

   Cerebrum

  

Corpus callosum joins two halves

   Four lobes _

  Frontal _ Parietal _ Occipital _ Temporal

  Brain Cells 

  Neurons: Send and receive information

   Glia: Nourish and protect neurons

  

Neurotransmitters: Chemical

messengers

   Myelination: Fatty substance helps send faster signals

  Reflexes: Unlearned & Protective Behaviors

   Postural

   Reactions to changes in posture or balance

   Locomotor

   Resemble later-appearing voluntary movements

   Walking and swimming reflexes

  Research in Action:

  The Autism “Epidemic”

   Autism disorders are brain disorders characterized by a lack of normal social interactions, impaired communications, repetitive movements, and a highly restricted _ range of activities and interests _ Asperger syndrome _ Genetic factors _ Environmental factors Early interventions

  Role of Experience in Brain Development

   Postnatal brain is molded by development

   Plasticity

   Threats _{ } Sensory impoverishment

  Malnutrition 

  

Corrective experiences can relieve past

deprivations

  Early Human Reflexes 

  Moro 

  Darwinian 

  Tonic neck 

  Rooting 

  Babkin and Babinski 

  Walking and Swimming Early Senses of Touch & Pain

   Touch

  

  First sense to develop

  

  Rooting reflex

  

  Able to experience pain at birth Early Senses of Smell & Taste 

  Begins to develop in womb 

  Newborns prefer sweet tastes 

  Fluids and odors may be transmitted through amniotic fluid

  Nature vs. Nurture?

  

Odor preference requires experience

_

  6-day-olds prefer mother’s breast pad to another nursing mother’s 

  Certain tastes are innate _ Sweetened water calms crying newborns, whether full-term or premature

  Sense of Hearing

   Functional before birth

   3-day-olds can tell new speech sounds from ones they’ve already heard

  Sense of Sight 

  The sense least developed at birth 

  20/20 reached by about 6 months 

  Binocular vision (depth) develops around 4.5 months Milestones of Motor Development

  Age 90% of Children Skill Master Rolling over 5.4 months Grasping rattle 3.9 months Standing alone 13.7 months Walking well 14.9 months Building tower of cubes 20.6 months Copying circle 4 years Denver Developmental Screening Test

   Gross motor skills

   Fine motor skills

   “Average”

  

  Head control

  

  Hand control

  

  Locomotion Walk & Gibson: The Visual Cliff

   Do infants perceive depth?

   6-month-old babies would approach “ledge,” but avoided “drop”

   Demonstrated depth perception

  Thelen’s Dynamic Systems Theory

   Learning occurs through detecting the many features of an environment

   With experience, babies learn to gauge their environment

   Is that ball moving away from me?

   Is that ground too rough to walk on?

  Cultural Influences on Motor Development

   Depends on the pace of the culture

   African and West Indian cultures actively encourage early motor strength _

  Bouncing and stepping exercises 

  Other cultures discourage … _ Ache mothers pull infants to their laps when they crawl away