1. 1 © 2009 by the McGraw-Hill Companies, Inc Birth and Physical Development During the First Three Years Chapter 4

2. 2 Did You Know… In 1900, only 5% of expectant mothers in the US gave birth in hospitals, as compared to 90% today? Baby boy’s deliveries are more likely to involve complications than baby girls? At about 30% of all births, the cesarean rate in the US are the highest in the world? In the industrialized world, smoking during pregnancy is the leading cause of low birth weight? Worldwide, about 8 million infants die before their first birthday? Cultural practices such as how much freedom babies have to move around can affect at what age they begin to walk? © 2009 by the McGraw-Hill Companies, Inc

3. 3 Research in Action: Shaken Baby Syndrome A form of maltreatment of children under two years of age 20% of babies with head trauma die within a few days Usually a result of caregiver frustration and stress

4. 4 Guideposts for Study How has childbirth changed in developed countries? How does labor begin, what happens during each of the three stages, and what alternative methods of delivery are available How do newborn infants adjust to life outside the womb, and how can we tell if a new baby is developing normally? What complications of childbirth can endanger newborn babies, and what are the prospects for infants with complicated births? © 2009 by the McGraw-Hill Companies, Inc

5. 5 Guideposts for Study What factors affect babies’ chances of survival and health? What influences growth, and how do the brain and the senses develop? What are the early milestones in motor development, and what are some influences on motor development? © 2009 by the McGraw-Hill Companies, Inc

6. 6 Generations of Childbirth Customs Pre 20 th Century: – Birthing was a modest ‘female only’ ritual The woman, assisted by female relatives or neighbors, gave birth in her bed or perhaps the stable – Use of midwives was predominant Midwives had no formal training, she offered “advice, massages, potions, etc After the baby emerged the midwife would cut the umbilical cord. A peasant mother would be back at work within a few hours or death. More affluent mothers could take several weeks off. © 2009 by the McGraw-Hill Companies, Inc

7. 7 – Death rates high for mother and baby Mothers and babies had a high chance of death – In 17 th and 18 th century France women had a 1 in 10 chance of death during childbirth – 1 out 4 babies died in first year Modern Generations:  Dramatic reductions in death rate due to: – Antibiotics – Prenatal care © 2009 by the McGraw-Hill Companies, Inc

8. 8 ‘Humanizing’ Childbirth: A Social Trend Home births have brought back intimacy of event Birthing centers & hospital – Soft lights – Father or partner as coach – Baby stays in room – What are your thoughts about at home births? © 2009 by the McGraw-Hill Companies, Inc

9. 9 Birth Process Parturition – brings on labor – Begins 2 weeks before delivery – Uterine contractions – Cervix becomes flexible – Stimulated by rising estrogen levels © 2009 by the McGraw-Hill Companies, Inc

10. 10 3 Stages of Vaginal Childbirth © 2009 by the McGraw-Hill Companies, Inc

11. 11 Stages of Childbirth First: Longest, typically 12-14 hours for first child, cervix dilates – Cervix is dilated by regular and increasing uterine contractions 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 © 2009 by the McGraw-Hill Companies, Inc

12. 12 Cesarean Delivery Surgically removing baby from uterus through abdomen Almost 30% of all USA births Often used when labor progresses slowly Changing preferences among women and some physicians Cesarean Sections amongst women who are not at risk and with no previous c-section have doubled between 1991 and 2003. Common with:  First and/or large babies  Older moms  Mothers with previous C-sections © 2009 by the McGraw-Hill Companies, Inc

13. 13 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 – Mother learns to substitute other responses for feelings of pain © 2009 by the McGraw-Hill Companies, Inc

14. 14 Medicated Deliveries Local or regional anesthesia – Blocks pain receptors in brain Relaxing analgesic Approximately 60% of women choose pain relief during labor © 2009 by the McGraw-Hill Companies, Inc

15. 15 Size and Appearance of the Newborn Average neonate is: o 20 inches long o 7.5 pounds Fontanels – soft plates of head Lanugo – fuzzy prenatal hair Vernix caseosa – oily protection against infection © 2009 by the McGraw-Hill Companies, Inc

16. 16 Body Systems of the Newborn Breathing: Anoxia (lack of oxygen) or hypoxia (low oxygen supply) can lead to birth trauma – Typically occurs when baby is not breathing correctly right after delivery Meconium  Stringy waste in fetal intestinal tract, which is secreted during the first few days of birth Neonatal Jaundice – Yellowing of skin and eyeballs – Caused by immaturity of the liver – Half of all babies experience – Usually baby does not need treatment © 2009 by the McGraw-Hill Companies, Inc

17. 17 Assessments: Apgar Scale Used to Assess Babies One Minute After Delivery Sign012 Appearance Blue & Pale Body Pink, Limbs Blue All Pink Pulse AbsentSlow (<100)Rapid Grimace NoneGrimace Coughing & Crying Activity LimpWeakStrong Respiration AbsentIrregular, slowGood, Crying © 2009 by the McGraw-Hill Companies, Inc

18. 18 Assessments: Brazelton NBAS Tests responses to physical and social environment – Motor organization – Reflexes – Attention and interactive capacity – CNS instability © 2009 by the McGraw-Hill Companies, Inc

19. 19 Neonatal Screening Tests Help detect correctable disorders – PKU: enzyme disorder that leads to retardation unless fed a special diet for the first 3 to 6 weeks of life – Hypothyroidism © 2009 by the McGraw-Hill Companies, Inc

20. 20 Infant Arousal States StateEyesBreathingMovement Regular SleepClosedRegular, slowNone Irregular SleepClosedIrregularTwitching Drowsiness Open or closed IrregularSome activity Alert InactivityOpenEvenQuiet Wakeful and Crying OpenIrregularMuch activity © 2009 by the McGraw-Hill Companies, Inc

21. 21 Childbirth Complications Birth trauma Postmaturity – Not going into labor 42 or more weeks after gestation – These babies may not get enough blood supply towards the end of gestation – Can lead to brain damage or death Prematurity – Preterm birth is involved in nearly half of neurological birth defects, such as cerebral palsy, and more than 1/3rd of infant deaths. Low birthweight – Prematurity & low birth weight together are the second leading cause of death in infancy in the US © 2009 by the McGraw-Hill Companies, Inc

22. 22 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 2 nd leading cause of infant death, after birth defects © 2009 by the McGraw-Hill Companies, Inc

23. 23 Maternal Traits That Increase Risk of Low Birthweight Underage or over-age Uneducated and poor Poor nutrition Smoking and drinking Stress Infections and high blood pressure © 2009 by the McGraw-Hill Companies, Inc

24. 24 Immediate Treatment for Prematurity Intravenous feeding Isolette – controlled environment, like an incubator Kangaroo care © 2009 by the McGraw-Hill Companies, Inc

25. 25 Long-term Outcomes of Low Birthweight Greater risk of: – Neurological and cognitive impairment – Lower academic achievement – Social, behavioral, and attention problems © 2009 by the McGraw-Hill Companies, Inc

26. 26 Postmaturity & Stillbirth Postmature: 42 weeks or more Stilbirth: Death of fetus at or after 20 th week of gestation Reduction may be due to fetal monitoring © 2009 by the McGraw-Hill Companies, Inc

27. 27 Overcoming Birth Complications Higher family SES Quality early environment Educational day care Educating parents about children’s health © 2009 by the McGraw-Hill Companies, Inc

28. 28 Protective Factors for Development Individual traits – Sociability – Intelligence  At least one supportive adult in child’s life Child has a ‘sense of meaning’ Rewarded at school or work © 2009 by the McGraw-Hill Companies, Inc

29. 29 Death During Infancy © 2009 by the McGraw-Hill Companies, Inc

30. 30 Death During Infancy Primary causes worldwide: – Preterm delivery – 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 © 2009 by the McGraw-Hill Companies, Inc

31. 31 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 © 2009 by the McGraw-Hill Companies, Inc

32. 32 Deaths from Injuries 90% of injury deaths in infancy due to: – Suffocation – Motor vehicle accidents – Drowning – Residential fires or burns © 2009 by the McGraw-Hill Companies, Inc

33. 33 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 © 2009 by the McGraw-Hill Companies, Inc

34. 34 Proportions of Physical Growth © 2009 by the McGraw-Hill Companies, Inc

35. 35 Growth: Height and Weight © 2009 by the McGraw-Hill Companies, Inc

36. 36 Nutrition: Breastfeeding 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 breastfeed for 6 months © 2009 by the McGraw-Hill Companies, Inc

37. 37 Bottle Feeding Formula should be iron- fortified Necessary for women with infectious illnesses Does NOT reduce emotional bonding between mother and baby. © 2009 by the McGraw-Hill Companies, Inc

38. 38 Other Nutritional Concerns Solid food introduced 2 nd half of first year Malnutrition Overweight  6% of US infants classified as overweight  Parental obesity strong predictor © 2009 by the McGraw-Hill Companies, Inc

39. 39 Brain Growth © 2009 by the McGraw-Hill Companies, Inc

40. 40 Parts of the Brain © 2009 by the McGraw-Hill Companies, Inc

41. 41 Brain Cells Neurons: Send and receive information Glia: Nourish and protect neurons Neurotransmitters: Chemical messengers Myelination: Fatty substance helps send faster signals © 2009 by the McGraw-Hill Companies, Inc

42. 42 Role of Experience in Brain Development Postnatal brain is molded by development ‘Plasticity’ Threats  Sensory impoverishment Malnutrition Corrective experiences can relieve past deprivations © 2009 by the McGraw-Hill Companies, Inc

43. 43 Early Senses of Touch & Pain Touch – First sense to develop – Rooting reflex – Able to experience pain at birth © 2009 by the McGraw-Hill Companies, Inc

44. 44 Early Senses of Smell & Taste Begins to develop in womb Newborns prefer sweet tastes Fluids and odors may be transmitted through amniotic fluid © 2009 by the McGraw-Hill Companies, Inc

45. 45 Nature v. Nurture? Odor preference requires experience  Six-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 © 2009 by the McGraw-Hill Companies, Inc

46. 46 Sense of Hearing Functional before birth Three-day-olds can tell new speech sounds from ones they’ve already heard © 2009 by the McGraw-Hill Companies, Inc

47. 47 Sense of Sight The sense least developed at birth 20/20 reached by about 6 months Binocular vision (depth) develops around 4.5 months © 2009 by the McGraw-Hill Companies, Inc

48. Milestones of Motor Development Skill Age 90% of Children Master Rolling over5.4 months Grasping rattle3.9 months Standing alone13.7 months Walking well14.9 months Building tower of cubes20.6 months Copying circle4 years © 2009 by the McGraw-Hill Companies, Inc 49

49. Walk & Gibson: The Visual Cliff Do infants perceive depth? Six-month-old babies would approach ‘ledge,’ but avoided ‘drop’ Demonstrated ‘depth perception’ © 2009 by the McGraw-Hill Companies, Inc

50. 50 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? © 2009 by the McGraw-Hill Companies, Inc

51. 51 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 © 2009 by the McGraw-Hill Companies, Inc

52. 52 Research in Action: Autism Brain disorder  Lack of normal social interactions  Impaired communication  Repetitive movements  Restricted range of activities and interests © 2009 by the McGraw-Hill Companies, Inc

53. 53 Early Signs of Autism Very early signs: – No joyful gazing at parent or caregiver – No back and forth babbling between infant and caregiver – Not recognizing parent’s voice – Failure to make eye contact – Delayed onset of babbling (past 9 months) – No or few gestures (pointing, waving) – Repetitive movements with objects Later Signs: – No single words by 16 months – No babbling, pointing or communication gestures by 1 year – No 2 word phrases by 2 years – No language skills at any age © 2009 by the McGraw-Hill Companies, Inc