Postpartum

Refer to handout for information on the feelings experienced during the postpartum period, The Baby Blues, Postpartum Depression, Postpartum Psychosis, and Bonding with Baby

Attachment After noticing in the 1940s that children in orphanages, despite being well fed, displayed slower mental development as well as withdrawn and listless behaviour, several scientists decided to conduct experiments on attachment, believing that the cause was was a lack of a loving relationship

Attachment Harry Harlowe In 1966 he studied rhesus monkeys to see what would happen if they were separated from their mother at an early age. Some monkeys were given a wire monkey with a bottle attached to feed them as well as a cloth monkey with no bottle Others were simply given the wire monkey with the bottle

Attachment The monkeys feed from the wire monkey when hungry but spend the majority of their time cuddled up with the cloth monkey for comfort and security when frightened Monkeys who did not have a cloth monkey failed to grow even though nourishment was provided Harlowe’s studies showed the importance of touch and contact for the survival and growth of infants

Attachment Rene Spitz In the 1940s Rene observed children living in isolated cribs in a hospital and children living with their mothers in prison Read the article provided “Attachment: Rene Spitz” Children require physical contact, comfort and love for healthy development – beginning from day 1

Attachment Mary Ainsworth Children develop different types of attachment to their parents based on their experiences and interactions in the first year of life Attachment: use of a preferred person as a secure base from which to explore A caregiver provides a secure base if he/she is able to: Detect the infant’s signal Correctly interpret the signal Make an appropriate and timely response

Attachment 3 types of attachments can form Secure: infants are comfortable with the parent and seek comfort upon his/her return and are easily consoled Anxious Avoidant: infants turn away from parents upon their return and avoid touch Anxious Ambivalent: infants showed resistance, anger or hostility when the parent returned and were difficult to console The best way to foster a secure attachment with infants is to respond consistently to their needs. They then begin to realize that they can trust their caregiver. These bonds are lifelong.

Neonatal Assessments The APGAR Rating Scale This scale refers to the initial physical check that a newborn is rated on to determine their health Refer to your handout for the chart

Neonatal Assessments Neonatal Behavioural Assessment Scale (NBAS) Comprehensive evaluation Conducted from birth-2 months Includes 28 behavioural items and 18 reflexes Checks 4 Functioning Systems Autonomic: the newborn’s ability to control body functions such as breathing and temperature regulation Motor: the newborn’s ability to control body movements and activity level State: the newborn’s ability to maintain a state (staying alert or staying asleep) Social: the newborn’s ability to interact with people

Neonatal Assessments NBAS Harm associated with teratogens produces lower scores Can predict later development

Reflexes Unlearned responses that are triggered by a specific form of stimulation What are some reflexes that you can think of? Refer to your handouts for the chart of infant reflexes

Newborn States Alert Inactivity: The baby is calm and attentive, with eyes open; the baby looks as if he is deliberately inspecting his environment Waking Activity: The baby’s eyes are open, but they seem unfocused; the baby moves her arms or legs in bursts of uncoordinated motion Crying: The baby cries vigorously, usually accompanying this with agitated but uncoordinated motion Sleeping: The baby’s eyes are closed and the baby drifts back and forth from periods of regular breathing and stillness to periods of irregular breathing and gentle arm and leg motion

Newborn States Crying Newborns spend 2-3 hours each day crying or on the verge of crying Babies have different cries for different reasons Basic Cry: starts softly, then gradually becomes more intense and usually occurs when a baby is hungry or tired Mad Cry: more intense version of of a basic cry Pain Cry: begins with a sudden, long shriek, followed by a long pause and gasping crying

Newborn States Crying Tricks: lift the baby to the shoulder and walk or gently rock the baby, sing lullabies, pat the baby’s back, give the baby a pacifier, take a drive in the car seat, swaddling etc. When/how should you respond to your child’s crying? Why?

Newborn States Sleeping Newborns sleep hours They have a nap cycle every 4 hours 1 hour awake (moving between crying, alert inactivity and waking activity) 3 hours asleep As the baby gets older her/she starts to adjust to day/night sleep routine (at 3-4 months the baby sleeps through the night) Exposure to afternoon daylight helps babies sleep at night and entrain the sleep-wake cycle

Newborn States States of Sleep Rapid Eye Movement Sleep (REM) Half of a newborn’s sleep is in this state Body is active (move arms and legs, grimace, eyes move under lids) Heart rate and breathing is more rapid Becomes less frequent as the child gets older: 25% by 1 st birthday. Regular for adults is 20% Purpose? Older children and adults dream (brain activity is the same as wakefulness) Stimulates the brain that helps foster growth in the nervous system

Newborn States States of Sleep Non-REM sleep Heart rate, breathing and brain activity are steady Lie quietly without twitching

SIDS Sudden Infant Death Syndrome A health baby dies suddenly for no apparent reason 1 in 1400 Canadian babies die from SIDS More vulnerable if: Born prematurely or with a low birth weight Parents smoke Baby sleeps on stomach Born during the winter (overheated from too many blankets and heavy sleepwear) Less able to handle physiological stress

Meeting the Needs of Infants Clothing Need clothing to keep them warm and comfortable Indoor, outdoor, daytime, and nightime Undershirts, sleepers, socks, bibs, diapers Diapers are needed everyday for up to 3 years – you can use cloth diapers, disposable diapers or a combination

Meeting the Needs of Infants Feeding Two main options are breast-feeding and bottle feeding Both breast milk and formula can be fed by bottle Read through breast feeding handout Colostrum: the fluid secreted by the mother’s breasts right after birth – it easy to digest and it rich in antibodies to protect against disease Formula is needed by women who can not breast feed, who have HIV, smoke, or take prescription drugs Formula is harder to digest and does not contain the quality of nutrients or the antibodies of breast milk but is as close as possible To create a close bond during bottle feeding hold the infant closely through the duration of the feeding Burping: air trapped in the stomach can be painful. Lift the baby to your shoulder and gently rub or pat the back (a receiving blanket will protect your clothing)

Meeting the Needs of Infants Safety and Security Babies need care and supervision around the clock Before moving children can pull things down on themselves or propel themselves with arm and leg movements Once they start to move around you may need to Childproof All equipment should adhere to the required standards Sleepwear must be flameproof No dangling ribbons or ties Etc.

Meeting the Needs of Infants Health and Hygiene Need to be bathed and kept clean, dry, and comfortably warm Objects that go in their mouths need to be sterilized until immune systems kick in (6 months) Doctor check ups and immunizations Indications of illness: fever, loss of appetite, runny nose, listlessness, crying Need to sleep, rest and exercise Establish a routine and play and communicate with them

Meeting the Needs of Infants Love and Affection Babies respond to touch, smile and voice Respond to their needs quickly and consistently Holding them, kissing them, rocking them, smiling and talking to them and carrying them close to the body helps to fuel their growth and development

Questions Answer the following: Describe parental behaviors that would promote mistrust in an infant. What advice would you give to a parent who has to leave his/her child at daycare on how to foster a secure attachment? What are the different functions of reflexes? Why do you think that newborns spend half or their sleep time in REM sleep? What would you recommend to a couple that is worried about SIDS? Describe some potential household hazards that would need to be childproofed.