early child dev assign
4.1 What Are Prenatal and Neonatal Stages of Development?
When considering the importance of child development, it is common to think of contexts that begin during infancy and continue through toddlerhood, including nutrition, learning, and building relationships. However, a child’s developmental journey truly begins at conception. Chapter 2 explored the importance of genetics and experiences during the time before birth. The period from conception through birth is called the prenatal stage. During this time, the mother and her support team are ultimately responsible for providing the child with everything needed to grow physically and mentally. They are equally as responsible for protecting the child from harm during this period. The prenatal period is crucial for preparing the child for exposure to the outside world.
The next developmental stage in this journey begins immediately after birth and continues through the first 4 weeks of life. This is called the neonatal stage. Babies are especially vulnerable during this time period. Every detail about how they eat, sleep, and interact with other people can have huge implications for their future development. These implications are important for early childhood caregivers to recognize, regardless of the age at which the child begins receiving care.
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4.2 Prenatal Development
What occurs from conception to birth is a complex and intricate process. In discussing this process, we focus first on how conception occurs, the distinction between gestational age and fetal age, and the phases of prenatal development.
Conception
Each month in the female body, an egg is released from the ovary as part of the reproductive cycle. The process of releasing the egg, or ovum, is called ovulation. Ovulation typically occurs halfway through a woman’s menstrual cycle, approximately 14 days after menstruation begins. After ovulation, the ovum travels down the fallopian tube toward the uterus (see Figure 4.1). On a typical month, the ovum continues its journey to the uterus alone and is flushed out along with the uterine lining in the menstruation process. However, if the woman has recently had intercourse, or has intercourse after the ovum is released and before it is flushed out of the body, the process can potentially be altered. The male reproductive cell, called the sperm, is designed to penetrate the wall of the recently released ovum. If a sperm successfully penetrates the ovum wall, it results in fertilization. Sperm can live in the female body for roughly 3–5 days, and a released ovum is viable for fertilization for anywhere from 24 to 48 hours after it is released. This means that every month there is a small, but significant, window of time in which a woman can become pregnant. Even if intercourse occurs days before ovulation takes place, fertilization is still possible.
Figure 4.1: Female reproductive system
An ovum is released by the ovary and fertilized in the fallopian tube. After completing the journey through the fallopian tube and into the uterus, the fertilized egg implants in the uterine wall, where it will begin to grow.
Once fertilized, the egg is called a zygote. However, fertilization alone does not mark the beginning of a pregnancy, only the start of a new process. The zygote begins to multiply cells rapidly while continuing to travel down the fallopian tube toward the uterus. The traveling ball of cells is called a blastocyst. Once the blastocyst reaches the uterus it should attach itself to the thick uterine wall and begin to burrow into the lining. If achieved, this step is called implantation. If implantation is successful, it triggers the body to begin producing human chorionic gonadotropin, or hCG (this is the same hormone that home pregnancy tests detect). Production of hCG signals the body not to shed the uterine lining this month, but instead to switch into pregnancy mode.
Following successful implementation, a woman typically recognizes her missed period and soon after discovers that she is pregnant. In addition to a missed period, a number of symptoms indicate that a woman is pregnant. Early pregnancy symptoms include the following (Womenshealth.gov, 2010a):
Sore, heavy breasts
Nausea, vomiting, or just the feeling of needing to vomit (commonly referred to as “morning sickness,” although the sensation can occur at any time of the day)
Darkening and/or widening of the area around the nipples
Mood swings
Sensitivity to smells
Aversion to food (sometimes even favorite foods) or cravings
Fatigue
Frequent urination
Headaches
Cramping
Backaches
Bloating and/or constipation
Dizziness and/or fainting
Spotting (sometimes as a result of implantation, called implantation bleeding)
Keep in mind that every pregnancy is as unique as the mother carrying the child and as the child who is developing. Some women may experience very few or all of these symptoms, and symptoms may come and go throughout the pregnancy. Early symptoms from a woman’s first pregnancy may also differ greatly from her experiences in subsequent ones.
Gestational Age Versus Fetal Age
Women are advised to visit a doctor as soon as they suspect they are pregnant; the doctor can confirm the pregnancy and provide the woman with a wellness check. Some medical testing may be needed as well as confirmation that the expectant mother’s immunizations are up-to-date (Womenshealth.gov, 2010a).
The doctor will want to know how far the pregnancy has already progressed. Because women discover their pregnancies in different ways, and at different times during the course of their pregnancies, calculating the progression of the pregnancy is not always easy. Most doctors calculate the age starting with the first date of the woman’s last menstrual period. This method is used to calculate the gestational age. For example, if Amanda’s last menstrual period began on January 16 and her doctor confirmed her pregnancy on March 22, the gestational age would be 9 weeks and 2 days. This is the most common method used by doctors and expectant mothers to calculate the progression of the pregnancy because it does not rely on knowing the exact date of conception. When speaking in terms of gestational age, an average full-term pregnancy is 40 weeks.
A more accurate method for calculating the progression of a pregnancy assumes that the exact date of fertilization is known, and begins from that date. The exact age of a growing embryo or fetus is called fetal age. In some cases, especially with alternate methods of conception such as in vitro fertilization, this type of calculation is possible. If Amanda’s last menstrual period began on January 16, but Amanda underwent a successful in vitro fertilization procedure on February 4, then her doctor would know that the fetal age on March 22 is 6 weeks and 4 days. Because this method does not account for the 2 weeks following the last menstrual period, prior to fertilization, fetal age is usually approximately 2 weeks less than gestational age.
Phases of Prenatal Development
The development of the fetus during prenatal development can be separated into certain phases. Commonly, the phases that occur during a woman’s pregnancy are discussed as trimesters, which segment the pregnancy into three phases. However, an alternative way of discussing the phases of a pregnancy is based on what is occurring in fetal development. These are called the germinal, embryonic, and fetal phases.
Trimesters
A typical, healthy pregnancy lasting 40 weeks consists of three phases referred to as trimesters. Trimesters are the most commonly discussed breakdown of phases in a pregnancy. Trimesters are three approximately equal segments of time during pregnancy. This is a useful grouping of time periods, typically referred to by gestational age, because each trimester seems to hold its own distinctive symptoms, risks, and developmental progression. The first trimester (weeks 1–12) begins the development of all of the major organs (including the sex organs), the spinal cord, the placenta, and the umbilical cord. At the end of the first trimester, the nerves and muscles begin functioning and the eyelids close over the eyes. The second trimester (weeks 13–28) progresses through the formation of the skeleton and skin. More physical detail develops, including fingernails, eyelashes, eyebrows, fingerprints, and a covering of fine hairs all over the body. By the end of the second trimester, the baby can swallow, hear, and sleep. In the beginning few weeks of the third trimester (weeks 29–40), the baby moves around quite a bit and works to store important nutrients and body fat. As the third trimester comes to a close, the baby may reposition with its head down to prepare for birth (Womenshealth.gov, 2010a). See Table 4.1 for a more detailed description of these core fetal developments during each trimester (by gestational age).
Table 4.1: The developing fetus by trimester
First trimester (weeks 1–12)
At 4 weeks:
The baby’s brain and spinal cord have begun to form.
The heart begins to form.
Arm and leg buds appear. The baby is now an embryo and one-twenty-fifth-inch long.
At 8 weeks:
All major organs and external body structures have begun to form.
The baby’s heart beats with a regular rhythm.
The arms and legs grow longer, and fingers and toes have begun to form.
The sex organs begin to form.
The eyes have moved forward on the face and eyelids have formed.
The umbilical cord is clearly visible.
At the end of 8 weeks, the baby is a fetus and looks more like a human. The baby is nearly 1 inch long and weighs less than one-eighth ounce.
At 12 weeks:
The nerves and muscles begin to work together. The baby can make a fist.
The external sex organs show if the baby is a boy or girl. A woman who has an ultrasound in the second trimester or later might be able to find out the baby’s sex.
Eyelids close to protect the developing eyes. They will not open again until the 28th week.
Head growth has slowed, and the baby is much longer. Now, at about 3 inches long, the baby weighs almost an ounce.
Second trimester (weeks 13–28)
At 16 weeks:
Muscle tissue and bone continue to form, creating a more complete skeleton.
Skin begins to form. One can nearly see through it.
Meconium (mih-KOH-nee-uhm) develops in the baby’s intestinal tract. This will be the baby’s first bowel movement.
The baby makes sucking motions with the mouth (sucking reflex).
The baby reaches a length of about 4–5 inches and weighs almost 3 ounces.
At 20 weeks:
The baby is more active. The mother might feel slight fluttering.
The baby is covered by fine, downy hair called lanugo (luh-NOO-goh) and a waxy coating called vernix. This protects the forming skin underneath.
Eyebrows, eyelashes, fingernails, and toenails have formed. The baby can even scratch itself.
The baby can hear and swallow.
Now halfway through the pregnancy, the baby is about 6 inches long and weighs about 9 ounces.
At 24 weeks:
Bone marrow begins to make blood cells.
Taste buds form on the baby’s tongue.
Footprints and fingerprints have formed.
Real hair begins to grow on the baby’s head.
The lungs are formed, but do not work.
The hand and startle reflex develop.
The baby sleeps and wakes regularly.
If the baby is a boy, his testicles begin to move from the abdomen into the scrotum. If the baby is a girl, her uterus and ovaries are in place, and a lifetime supply of eggs have formed in the ovaries.
The baby stores fat and has gained quite a bit of weight. Now at about 12 inches long, the baby weighs about 1.5 pounds.
Third trimester (weeks 29–40)
At 32 weeks:
The baby’s bones are fully formed, but still soft.
The baby’s kicks and jabs are forceful.
The eyes can open and close and sense changes in light.
Lungs are not fully formed, but practice “breathing” movements occur.
The baby’s body begins to store vital minerals, such as iron and calcium.
Lanugo begins to fall off. The baby is gaining weight quickly, about a half-pound a week. Now, the baby is about 15–17 inches long and weighs about 4–4.5 pounds.
At 36 weeks:
The protective waxy coating called vernix gets thicker.
Body fat increases. The baby is getting bigger and bigger and has less space to move around. Movements are less forceful, but the mother will feel stretches and wiggles.
The baby is about 16–19 inches long and weighs about 6–6.5 pounds.
Weeks 37–40:
By the end of 37 weeks, the baby is considered full term. The baby’s organs are ready to function on their own.
As the mother nears her due date, the baby may turn into a head-down position for birth. Most babies “present” head down.
At birth, the average full-term baby weighs somewhere between 6 pounds 2 ounces and 9 pounds 2 ounces and is 19–21 inches long. Most full-term babies fall within these ranges. But healthy babies come in many different sizes.
Source: Womenshealth.gov. (2010a). Stages of pregnancy. Retrieved from http://womenshealth.gov/pregnancy/you-are-pregnant /stages-of-pregnancy.html.
Science Photo Library/SuperStock
Germinal, Embryonic, and Fetal Phases
An alternative breakdown of the phases of pregnancy gives more weight to the importance of the type of development taking place and less to the amount of time that passes in each phase. See Figure 4.2 for more detail on these phases. The following time frames for each phase are given in fetal age:
The germinal phase consists of the first 14 days (2 weeks) following fertilization. As discussed previously, this period of time follows the zygote through many repetitions of cell multiplication resulting in a blastocyst, migration of the blastocyst into the uterus, and implantation of the blastocyst in the uterine wall.
The Life of the Embryo
The first three months of pregnancy are called "embryonic life" and start in the fallopian tubes. Watch the stages of embryo growth and its transformation into a small fetus. For the rest of the pregnancy, the fetus will grow considerably, becoming 10 times larger and almost 1,000 times heavier.
Critical Thinking Questions
Why might it be important for a women to lead a healthy lifestyle before conception?
What would happen if the fertilized egg did not attach?
Upon implantation of the blastocyst, the embryonic phase begins (weeks 3–8), and the placenta starts to develop. The placenta, which connects the growing embryo to the uterine wall by means of the umbilical cord, provides for the absorption of nutrients and oxygen as well as the removal of waste from the intrauterine environment. The placenta also filters out harmful substances that can negatively affect the growing baby. The placenta will continue to grow throughout the pregnancy. The embryonic phase also marks the beginning of the development of the baby’s spinal cord, brain, heart, and other organs.
The fetal phase (weeks 9–38) includes the complete development of the eyes, head, arms, legs, neck, toes, fingers, fingernails, and bones. The baby’s genitals also form during this stage and are visible for the identification of the baby’s sex by ultrasound by the 14th week.
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4.3 A Healthy Pregnancy Lifestyle
Healthy development of a child begins at conception. As the fetus grows and develops senses, organs, and brain function, the mother’s lifestyle controls the quality of development in all of the important areas. As discussed in previous chapters, child development consists of critical periods when progress can be crucially hindered or helped. Critical periods of development also occur as a fetus matures. However, it is not possible to pinpoint exactly when these critical periods will occur because all pregnancies and developmental timelines are slightly different. For this reason, it is important for women to make smart choices throughout their entire pregnancies. Proper nutrition, rest, exercise, and avoidance of harmful substances are the first and most important lines of defense for a healthy start to a child’s life.
Poor eating habits, exposure to harmful substances during pregnancy, and lack of sufficient activity and rest can lead to low birth weight, prematurity, and babies who are small for gestational age (Kaiser & Allen, 2008). Children born in these contexts may have certain problems that caregivers need to be aware of when caring for them. These characteristics and behaviors can include delays and disorders in any one or all of the developmental domains in neurological functioning (Aylward, 2005). Resultant behaviors include learning difficulties, hyperactivity, attention problems, poor executive functioning (see Chapter 2), and others.
Nutrition
During pregnancy, it is essential for a woman to receive proper nutrition in order to support the growing fetus’s development. When identifying nutritional needs, one must consider what a woman should eat, as well as what she should avoid.
What to Eat
Just as children, teens, and adults need a well-balanced diet to stay healthy, a fetus needs a variety of nutrients to develop properly. A mother’s body is also doing a considerable amount of extra work during pregnancy, and pregnant women need the right kinds of nutrition to sustain energy and avoid illness. A diet rich in vitamins, proteins, and other nutrients is recommended. Pregnant women are encouraged to eat foods across the major food groups to ensure that all of the necessary nutrients are obtained (visit this website for more information). Natural and fresh foods typically offer more nutrition than processed boxed or canned foods. A variety of fruits and vegetables is also important to diversify the types of nutrients and allow them to work together to be absorbed into the woman’s body. Eating a rainbow of different-colored fruits and vegetables is an easy way to ensure that a woman is getting the nutritional variety that a growing fetus needs.
Pregnant women need more specific types of nutrients because of their importance in aiding fetal development and protecting against birth defects. Women are encouraged to take prenatal vitamins to help ensure that the proper nutrients are absorbed daily. Pregnant women specifically need iron, calcium, vitamins A and B12, and folic acid. Folic acid is an especially important nutrient during pregnancy. Diets low in folic acid have been linked to preterm delivery, low birth weight, neural tube defects, and slow fetal growth (Scholl & Johnson, 2000). Table 4.2 describes these five important nutrients for pregnancy and how much a pregnant woman should consume daily.
Table 4.2: Nutrients and pregnancy (daily dose)
Nutrient
Daily Requirements During Pregnancy
Folic acid
400–800 micrograms (mcg) (0.4 to 0.8 milligrams [mg]) in the early stages of pregnancy, which is why all women who are capable of pregnancy should take a daily multivitamin that contains 400–800 mcg of folic acid. Pregnant women should continue taking folic acid throughout pregnancy.
Iron
27 mg
Calcium
1,000 mg; 1,300 mg if 18 or younger
Vitamin A
770 mcg; 750 mcg if 18 or younger
Vitamin B12
2.6 mcg
Source: Womenshealth.gov. (2010b). Pregnancy: Staying healthy and safe. Retrieved from http://womenshealth.gov/pregnancy /you-are-pregnant/staying-healthy-safe.cfm.
What to Avoid
Just as eating the right foods is critical to proper growth of the fetus, avoiding the wrong foods is equally as important (see Table 4.3). Some foods that do not pose a threat to a well-developed adult digestive and immune system can be extremely harmful to a vulnerable fetus. Many unpasteurized cheeses, dairy products, and juices, and deli-styles meats, including hot dogs, may contain harmful bacteria and should be avoided (U.S. Food and Drug Administration, 2013). Some fish contain high levels of mercury and should be eaten only in small quantities, or not at all. Food preparation is also very important. Making sure that food is cooked thoroughly and that cold food has been refrigerated properly is essential in keeping food safe.
Table 4.3: Food safety in pregnancy
Don’t Eat These Foods
Why
What to Do
Soft CHEESES made from unpasteurized milk, including Brie, feta, Camembert, Roquefort, queso blanco, and queso fresco
May contain E. coli or Listeria.
Eat hard cheeses, such as cheddar or Swiss. Or, check the label and make sure that the cheese is made from pasteurized milk.
Raw COOKIE DOUGH or CAKE BATTER
May contain Salmonella.
Bake the cookies and cake. Don’t lick the spoon!
Certain kinds of FISH, such as shark, swordfish, king mackerel, and tilefish (golden or white snapper)
Contains high levels of mercury.
Eat up to 12 ounces a week of fish and shellfish that are lower in mercury, such as shrimp, salmon, pollock, and catfish. Limit consumption of albacore tuna to 6 ounces per week.
Raw or undercooked FISH (sushi)
May contain parasites or bacteria.
Cook fish to 1458 F.
Unpasteurized JUICE or cider (including fresh squeezed)
May contain E. coli.
Drink pasteurized juice. Bring unpasteurized juice or cider to a rolling boil and boil for at least 1 minute before drinking.
Unpasteurized MILK
May contain bacteria such as Campylobacter, E. coli, Listeria, or Salmonella.
Drink pasteurized milk.
SALADS made in a store, such as ham salad, chicken salad, and seafood salad
May contain Listeria.
Make salads at home, following the food safety basics: clean, separate, cook, and chill.
Raw SHELLFISH, such as oysters and clams
May contain Vibrio bacteria.
Cook shellfish to 1458 F.
Raw or undercooked SPROUTS, such as alfalfa, clover, mung bean, and radish
May contain E. coli or Salmonella.
Cook sprouts thoroughly.
Be Careful with These Foods
Why
What to Do
Hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry
May contain Listeria.
Even if the label says that the meat is precooked, reheat the meat to steaming hot or 1658 F before eating.
Eggs and pasteurized egg products
Undercooked eggs may contain Salmonella.
Cook eggs until yolks are firm. Cook casseroles and other dishes containing eggs or egg products to 1608 F.
Eggnog
Homemade eggnog may contain uncooked eggs, which may contain Salmonella.
Make eggnog with a pasteurized egg product or buy pasteurized eggnog. When you make eggnog or other egg-fortified beverages, cook to 1608F.
Fish
May contain parasites or bacteria.
Cook fish to 1458 F.
Ice cream
Homemade ice cream may contain uncooked eggs, which may contain Salmonella.
Make ice cream with a pasteurized egg product; add the eggs to the amount of liquid called for in the recipe, and then heat the mixture thoroughly.
Meat: beef, veal, lamb, and pork (including ground meat)
Undercooked meat may contain E. coli.
Cook beef, veal, and lamb steaks and roasts to 1458 F. Cook pork to 1608 F. Cook all ground meats to 1608 F.
Meat spreads or pate
Unpasteurized refrigerated meat spreads or pate may contain Listeria.
Eat canned versions, which are safe.
Poultry and stuffing (including ground poultry)
Undercooked meat may contain bacteria such as Campylobacter or Salmonella.
Cook poultry to 1658 F. If the poultry is stuffed, cook the stuffing to 1658 F. Better yet, cook the stuffing separately.
Smoked seafood
Refrigerated versions are not safe, unless they have been cooked to 1658 F.
Eat canned versions, which are safe, or cook to 1658 F.
Source: Foodsafety.gov. (n.d.). Checklist of foods to avoid during pregnancy. Retrieved from http://www.foodsafety.gov/poisoning /risk/pregnant/chklist_pregnancy.html.
Highly processed foods, fried food, and other foods that are high in unhealthy fats and refined sugars are unhealthy for a growing baby and pregnant mother. In many cases, unhealthy foods like these can exacerbate unpleasant pregnancy symptoms for the mother, causing undue stress on the baby. They also provide calories without proper nutrition.
Teratogens
Other substances besides unhealthy foods and bacteria can be extremely harmful for a developing fetus, especially in brain development. Harmful substances that may cause adverse effects during prenatal development are called teratogens. Exposure to teratogens before or soon after birth can have extremely negative effects on the developing brain or on other developing areas of the embryo and fetus (see Figure 4.2). Brain development during the prenatal period is crucial for later years in a child’s life. The brain is the center of the nervous system, and it develops over time, beginning before birth in the mother’s womb and continuing into young adulthood. Although brain development is not completed until adulthood, the immature brain is much more susceptible to negative exposures than is the adult brain. This happens because the brain of a fetus or an infant has not yet developed the barrier of protective cells that is part of the mature brain. These cells keep toxic chemicals from entering the bloodstream and having negative effects on brain tissues. Many factors can have an effect on the fetal brain, but the intensity of that effect depends on the type of factor (positive or negative), dose, duration, and timing of interaction.
Figure 4.2: Sensitivity to teratogens during periods of prenatal development
During fetal development, the degree of sensitivity to teratogens and the physical components most susceptible are dependent on the timing of exposure.
Source: Moore, K. L., & Persaud, T. V. N. (2008). Before we are born: Essentials of embryology and birth defects (7th ed., p. 313). Philadelphia: Saunders Elsevier
For example, toxic substances can weaken the brain’s structure in a way that creates permanent and lifelong damage, with consequences on academic achievements and physical and mental health. This poisonous effect is called neurotoxicity because it affects brain structures of the neural circuits and neurons. Illnesses such as rubella occurring during the prenatal period can have the same effect. The National Scientific Council on the Developing Child (2006) divides harmful chemical substances into three categories: environmental chemicals such as lead and mercury; recreational drugs such as alcohol, nicotine, and cocaine; and prescription medications such as anticonvulsants and some drugs used for treatment of severe acne. Table 4.4 distinguishes scientific facts about toxins in the prenatal environment from long-held misperceptions of science on this topic.
Note, in particular, that smoking during pregnancy exposes the fetus to the harmful substance nicotine. This exposure to nicotine affects both the structural development of the brain and the way the developing brain functions (National Scientific Council on the Developing Child, 2006). Additionally, when a pregnant mother smokes, a decreased amount of oxygen reaches the fetus, which reduces fetal growth and can lead to low birth weight (Centers for Disease Control and Prevention, 2013; National Scientific Council on the Developing Child, 2006). Smoking can also cause certain complications during a woman’s pregnancy, can lead to a premature birth, and has been associated with certain birth defects (Centers for Disease Control and Prevention, 2013).
Similarly, the harmful effects of fetal exposure to alcohol during the pregnancy (and particularly higher levels of exposure) can lead to a number of problems that are characterized collectively as fetal alcohol syndrome (FAS). Features of FAS have been identified as reduced growth (both before and after birth), facial features characteristic of the syndrome (including a thin upper lip, the lack of a vertical groove between the lip and nose, and a smaller length from one corner of the eye to the other), and abnormalities within the central nervous system leading to delays in development and often significant impairment in the cognitive development domain (O’Leary, 2004). These features can differ based on race and ethnicity and can present differently over time; however, the cognitive delays and impairments have been shown to persist across developmental stages (O’Leary, 2004).
Table 4.4: Popular misperceptions of science: toxins and prenatal development
Popular beliefs about which chemical substances are more or less toxic to the developing embryo, fetus, infant, and child are most commonly related to their relative abundance and legal status in society. In this context, it is essential that we distinguish scientific facts from widespread misperceptions.
Myth:
Illegal recreational drugs have the most damaging impact on brain development and function for the growing fetus.
Fact:
Although illegal recreational drugs and alcohol are both damaging to the developing fetus, extensive research indicates that alcohol, while legal, is one of the most dangerous neurotoxins that can affect the brain during the period between conception and birth.
Myth:
The adverse impact of toxic substances on the developing architecture of the brain is an all-or-none phenomenon.
Fact:
Neurotoxins can produce a range of outcomes, from mild to severe impairment, which often lead to confusing conclusions about the linkage between exposure to a specific substance and its consequences.
Myth:
The absence of cognitive or behavioral problems in childhood indicates that an early exposure to a neurotoxin had no adverse effect on brain development.
Fact:
Studies in both animals and humans have demonstrated that some substances cause damage to the brain that is manifested in the delayed onset of learning problems, attention deficits, and changes in emotional regulation, which can have long-term consequences into the teenage and adult years.
Myth:
The determination of a dangerous level of exposure to a potentially neurotoxic substance is a straightforward scientific question.
Fact:
The determination of a dangerous level of exposure to a potentially neurotoxic substance can present a complicated challenge because the developing brain of a young child is typically more susceptible to damage than the mature brain of an adult, and the immature nervous system of an embryo or fetus is even more vulnerable to toxic exposures than is that of an infant. Therefore, there is no credible way to determine a safe level of exposure to a potentially toxic substance without explicit research that differentiates its impact on adults from the greater likelihood of its adverse influences on the developing brain during pregnancy and early childhood.
Myth:
Vaccines containing thimerosal (which has been added as a preservative) are linked to the development of autism in susceptible children.
Fact:
Extensive and repeated studies by highly reputable scientific groups have failed to confirm the claim that there is a link between vaccines containing thimerosal and the development of autism in susceptible children.
Source: National Scientific Council on the Developing Child. Early Exposure to Toxic Substances Damages Brain Architecture. Copyright © 2006 National Scientific Council on the Developing Child and the Center on the Developing Child. Reprinted by permission.
Activity and Rest
Just as staying fit and active is an important part of any healthy lifestyle, it is also a fundamental ingredient in the recipe for a healthy pregnancy. Daily physical activity helps to improve blood flow through the body, improves mood, builds stronger muscles and bones, improves immune health, aids in digestion (which is not at its best during pregnancy), and even combats stress and improves sleep (HealthyFamilies BC, 2013a). The growing baby benefits from all of these perks, too. It is best practice for expectant mothers to talk to their doctors before starting any new exercise routine, but medical professionals agree that women who exercise regularly before becoming pregnant can continue their normal exercise routines into pregnancy as long as it does not cause injury or cause them to feel fatigued. Note, however, that with some high-risk pregnancies, doctors may recommend limiting, or even ceasing, activity as a precaution.
Rest is equally important for the healthy development of the fetus (National Sleep Foundation, 2013b). With pregnant bodies working overtime to manufacture a perfectly healthy baby in 38 short weeks, it is no wonder that ample rest is crucial for a successful outcome. When the body shuts down in rest, it rejuvenates energy sources and allows a mother’s body to concentrate on the growing fetus. It also helps to regulate the bodies’ systems and counteracts the effects of daily stress on the body.
Figure 4.3: Components of weight gain in pregnancy
Only a fraction of a woman’s weight gain in pregnancy is due to the growing baby. Fluids and other supplies stored in the breasts and uterus account for the majority of extra weight.
Weight Gain
Gaining weight is an inevitable and important component of pregnancy. However, the concept of “eating for two” is outdated and misleading. A pregnant mother needs only an additional 300 calories per day to properly nourish the growing baby. A woman in the normal weight range entering into pregnancy is expected to gain approximately 30 pounds throughout the pregnancy. Of course, this weight isn’t all contained in the baby. Other components in the intrauterine environment, fluids, and even extra blood contribute to the overall weight gain during pregnancy. Women who are overweight or obese need to gain slightly less, and women who are underweight should gain slightly more (HealthyFamilies BC, 2013b). Figure 4.3 shows where weight is gained in a women’s body during a healthy pregnancy.
Pregnancy Complications
Even with appropriate attention to the mother’s health prior to and during pregnancy, complications are possible. Understanding these complications is the best way to prevent them or to recognize symptoms early enough to receive proper treatment. Although there are many possible complications during pregnancy, some of the most common include gestational diabetes, a baby being small for gestational age, and various infections.
Gestational diabetes is glucose intolerance that presents for the first time during pregnancy. Its symptoms can mimic typical pregnancy symptoms, such as hunger and fatigue, or it may present with no symptoms at all. Therefore, it is difficult to diagnose without testing for sugar levels in the blood. Gestational diabetes can be controlled with diet, exercise, and even insulin injections. Untreated, gestational diabetes can result in a large baby with added delivery complications, babies with low blood sugar, or even fetal death; it may also cause later complications for the mother after pregnancy (American Diabetes Association, 2004).
Babies who do not grow at the rate they should for their age during the prenatal period are considered small for gestational age, or SGA. SGA babies have a higher risk of complications during the first 4 weeks of life. Later in life, those who were small for gestational age as babies may experience diabetes, cardiovascular disease, and hypertension (Karlberg & Albertsson-Wikland, 1995). Strauss (2000) found that although individuals who were SGA at birth had decreased academic and professional achievement, they did not present with long-term deficits in the social-emotional realm, based on employment, marriage, and life satisfaction.
Infections may occur during pregnancy from a variety of causes. Some infections may be identified from discolored or odorous discharge, burning or itching, muscle aches, or diarrhea or other flu-like symptoms. Some infections during pregnancy can be dangerous, resulting in miscarriage, preterm birth, or low birth weight (Schieve, Handler, Hershow, Persky, & Davis, 1994). Practicing safe sex, a healthy diet, good personal hygiene, and an overall healthy lifestyle are the best ways to prevent infections.
Tips on Recognizing Prenatal Depression
Prenatal depression can have many adverse effects on a developing baby. Learn to recognize the following signs and symptoms of prenatal depression in pregnant woman:
Dramatic increase or decrease in typical eating patterns
Disturbed sleeping patterns
Difficulty concentrating
Extreme mood swings
Excessive crying
Easily angered or agitated
Feelings of emptiness or worthlessness
Unjustified feelings of guilt
Lack of interest in previously enjoyed activities
Withdrawn behavior, especially from friends and family
Incessant anxiety or worrying
Severe lethargy
Frequent headaches or other body aches and pain
4.4 Genetics
Every child has a unique genetic code that influences the child’s appearance, behavior, preferences, special talents, and any physical or mental limitations. No two children, or adults, throughout history have ever been the same. The encoded instructions for creating all of the cells in our body are carried on sections of our DNA called genes (genes were also discussed in Chapter 2). A collection of many genes make up long DNA molecules, which are packaged tightly into chromosomes (see Figure 4.4). Every cell in the human body, with the exception of sperm and ovum cells, houses 46 chromosomes (23 pairs) in the control center of the cell called the nucleus. Sperm and ovum cells contain only 23 chromosomes each. In the Conception section, we discussed the process of the sperm and ovum joining to create new life. When this occurs, the sperm brings its 23 chromosomes and the ovum brings its 23 chromosomes. Combined, they form 23 sets of chromosomes, or 46 chromosomes in total. The complete set of all genes in a child is called the structural genome. Each child’s genome contains approximately 23,000 genes.
Figure 4.4: Cells, chromosomes, and DNA
A collection of many genes make up DNA molecules, which are packaged tightly into chromosomes. A cell’s nucleus contains these chromosomes.
One very important pair of chromosomes determines the baby’s gender. Every female carries two X chromosomes, making an XX chromosome pair. Every male carries one X and one Y chromosome, making an XY chromosome pair. Because an ovum carries only one of its chromosomal pair, it has no choice but to carry an X, every time. However, each sperm may carry either an X chromosome or a Y chromosome. If an X-carrying sperm fertilizes the X-carrying ovum, the result is an XX chromosome pair . . . it’s a girl. Alternatively, if the ovum is fertilized by a sperm carrying a Y chromosome, the result is an XY pair, or a baby boy. Consider the irony of the often-told story of King Henry VIII, who executed his wives because they did not produce a male heir. The gender was determined by him all along!
Sometimes the process of manufacturing, pairing, or replicating chromosomes does not occur as it should. When an irregularity occurs in a set of chromosomes, it is known as a chromosome abnormality. The National Human Genome Research Institute (2011) categorizes chromosome abnormalities into two groups, numerical abnormalities and structural abnormalities. Numerical abnormalities are the result of missing a chromosome from a pair or having more than two chromosomes present in a pair. For example, Down syndrome occurs when an individual has three copies of the 21st chromosome. Children with Down syndrome may have physical and mental limitations within a wide range of abilities. Early intervention is highly recommended to lessen the impact of these limitations. If a female is born with only one X chromosome, she is diagnosed with Turner syndrome. Females with Turner syndrome may have a variety of symptoms that involve atypical growth and atypical physical sexual characteristics. However, with medical care and monitoring by a doctor, most children with Turner syndrome lead a normal life. Klinefelter syndrome is the presence of more than one X chromosome with a Y chromosome in a male baby. Babies born with this syndrome have an atypical hormone level and may be affected in their physical and cognitive development. Yet, many males with this syndrome live normal lives and discover they have it only during or after puberty. Medical treatments are available.
Structural abnormalities occur when the chromosome takes on an atypical form. There are five possible structural abnormalities. They include missing or deleted parts of chromosomes, extra genetic material, parts of a chromosome or complete chromosomes exchanging places, genetic material that is inverted, and rings or parts of a chromosome that fall off (National Human Genome Research Institute, 2011). The most common examples of these abnormalities include Cri du Chat syndrome and Pallister Killian syndrome, both of which often include a variety and range of physical and mental disabilities.
A set of a child’s gene codes is called a genotype. The observable characteristic that is physically shown as a result of the genotype is called the phenotype. However, genotypes and their phenotypes are not the only elements at play in determining how a person looks, thinks, and acts. The epigenome controls the unique expression of the gene. The epigenome is made up of chemical compounds that mark the genome with proteins and enzymes in a way that turns genes “on” and “off.” The epigenome is the link between the genome and the environment (National Human Genome Research Institute, 2011). The epigenome is built over time and is influenced by experiences, relationships, nutrition, physical activity, drugs and medications, and toxins in the environment. Epigenomes can temporarily or permanently modify genes and thus influence brain structures, which in turn influences the child’s behavior. This can happen in a fetus and be passed on to later generations. For example, recurring, highly stressful experiences can cause epigenetic changes that have been observed to cause persistent stress responses (National Scientific Council on the Developing Child, 2010). Persistent stress responses have been associated with detrimental changes in brain structure and function, and thus can have a detrimental effect on a child’s growth and development (National Scientific Council on the Developing Child, 2010). By contrast, positive, supportive relationships can leave marks that switch on positive genetic potential. This recently discovered biological activity of epigenetics explains why early experiences can have long-term impacts and why siblings, even twins, may achieve more or less in school and behave very differently from each other (National Scientific Council on the Developing Child, 2010).
At Issue: Genetic Testing
Parents who are at particularly high risk of carrying genetic diseases, due to family history or ethnicity, are able to undergo genetic testing prior to or during pregnancy. Two of the most common tests are chorionic villus sampling (CVS), in which a piece of the placenta is taken, and amniocentesis, in which amniotic fluid is drawn. These tests can reveal if the baby inherited a genetic condition, including cystic fibrosis or Down syndrome. When a particularly severe disease is identified, parents may elect to terminate the pregnancy.
The ethics of genetic testing for these reasons has long been the subject of debate. Professionals and parents in favor of genetic testing argue the importance of preventing a lifetime of suffering and hardship for the whole family. Those opposed to genetic testing in general argue that genetic testing may not remain in the realm of identifying disease, but eventually could be used on a large scale to preselect traits like gender and hair color, or even traits for intelligence, athleticism, or musical talent, among other characteristics. Do the benefits of genetic testing outweigh the potential risks of the tests being abused for frivolous uses? Is it ethical to undergo genetic testing to identify the inheritance of a disease?
4.5 The Birth Process
The labor and delivery process does not have an easily recognizable onset. In fact, the birth process may occur differently for every woman. It is a gradual process that typically begins around 38–40 weeks of pregnancy. The baby’s brain releases certain hormones, including oxytocin and cortisone, which signal the mother’s body to prepare for labor and delivery. As early as 2 weeks before delivery, the mother may notice that she’s carrying the baby lower. This is because the baby has repositioned so that the head is nestled at the opening of the birth canal. A woman may notice bloody discharge as a result of the mucus plug dislodging from the opening of the cervix, and she may experience leaking amniotic fluid, commonly referred to as “water breaking” (American Pregnancy Association, 2007).
There are three commonly recognized stages of the birth process, followed by a recovery stage. The first stage, referred to as active labor, is the longest stage in the process (see Figure 4.5). Active labor usually lasts 12 hours or more for a woman birthing her first child, and a significantly shorter period of time for subsequent births (Mayo Clinic Staff, 2013). During this stage, the cervix softens and opens, or dilates, in preparation for transporting the baby through the birth canal. Typically the cervix is dilated about 2.5 centimeters at the beginning phase of labor. Throughout active labor the woman will experience painful contractions of the uterine muscles. Contractions during this phase will be intermittent and will occur more frequently toward the completion of this stage. When the cervix is dilated approximately 10 centimeters, the second stage begins.
Figure 4.5: Stage one: active labor
During active labor the cervix, at the opening of the uterus, proceeds from no dilation (before labor begins) through full dilation at 10 centimeters.
The second stage can last anywhere from 30 minutes to almost 3 hours, but is typically longer for the first birth. This stage begins with a fully dilated cervix and ends with the birth of the baby. During this stage the contractions become much more painful and frequent. The woman may experience a feeling of pressure, the need to defecate, and a desire to push along with the contractions. In a typical vaginal birth, the baby will emerge head-first.
The third and final stage lasts only minutes. During this stage the placenta detaches from the uterine wall and is carried out through the birth canal. The baby no longer needs the placenta for nutrients and oxygen, so the umbilical cord attaching the baby to the placenta is cut. In most settings, after the birth process is complete, the mother’s vital signs will be monitored to ensure that she recovers appropriately. In particular, her blood pressure and pulse, as well as bleeding, are monitored. This is called the recovery stage.
In some cases, the birth process does not proceed as expected and complications arise. Many medical interventions are now available to help a mother through many of these common complications. For example, if a vaginal birth is not possible because of a small birth canal, improper positioning of the baby, labor that is not progressing, or other medical problems, the mother may have to undergo a surgical removal of the baby through the abdomen (U.S. National Library of Medicine, Medline Plus, 2013a). This surgery is called a cesarean section, or C-section. C-sections have become much more common in the United States in recent years (Martin, Hamilton, Ventura, Osterman, & Mathews, 2013). Although the rate remained stable from 2010 to 2011 (and decreased by one-tenth of a percent from 2009 to 2010), the rate of C-sections in the United States increased by close to 60 percent between 1996 and 2009. In addition, based on certain characteristics of a vaginal delivery, an episiotomy, or an incision made in the tissue between the vaginal opening and the anus may be needed; however, this procedure is no longer routinely recommended as it had been previously, based on problems with maternal recovery.
If a baby is able to be delivered vaginally, but needs some assistance on the way out, doctors may use forceps placed on the baby’s head or a vacuum device to help gently move the baby through the birth canal. In addition, many medications are now available to mothers to help ease the pain of labor. The most common pain medication given during labor is epidural anesthesia. This medication is inserted into the back, near the spine, and serves to block pain to the lower region of the body.
These stages describe the process of a typical birth, but the process may vary greatly among different women, including the presence and severity of symptoms, length of each stage, and levels of pain. Even the same mother may experience differences in the birth process with different children. In the vignettes that follow, three mothers give their accounts:
I went into labor and was admitted to the hospital. I slept for hours, waking occasionally because of the contractions. Then the contractions stopped, so they induced me but I didn’t want the epidural. The induction without an epidural caused horrendous pain. It was not worth trying to do without the pain medication. Once I got the epidural, I couldn’t feel anything and it was smooth sailing! I’m currently pregnant and passed my due date. I’m scheduled to be induced in 1 week.—Crysta
My son was almost 2 weeks past his due date. I had planned his birth at a local birthing center with a midwife and doula. I went for a checkup and was told he was totally fine, but in order for me to have him at the birthing center (versus the hospital), I would have to go into labor the next day. Fortunately, I began enough contractions within the time limit to go to the birthing center. I laid in the Jacuzzi the majority of the time with soft music playing, was able to eat food (English muffin with peanut butter, fruit, water) for energy, and my support system was around me. There were no complications, and no medication. The contractions were painful, but I just breathed through it, and focused. I went into labor at about 10:00 p.m., and 3-1/2 hours later, he was here, at 1:30 a.m. . . . 3 hours of “hard labor” with 30 minutes of pushing.—Medina
With my first child, I woke up at 2:00 a.m. in labor and 3 weeks before my due date. Once at the hospital they gave me an epidural. I started pushing at 5:00 a.m., and I gave birth at 7:00 a.m. Only 5 hours of labor. My second was faster and 4 weeks early. My contractions started at 6:00 a.m., and we left for the hospital 30 minutes later. I gave birth at 7:05 a.m. in the hospital waiting room.—Julie
4.6 The Neonatal Period
© Michael Blackburn/iStock/Thinkstock
The first 4 weeks (or 28 days) of life are referred to as the neonatal period, beginning immediately after birth.
The neonatal period begins immediately after birth and lasts for the first 4 weeks of life. This is another critical time in the development of a child, and the most vulnerable in the lifetime of a human. During this time, a child learns how to survive outside of the womb for the first time, transitioning from its protection and resources.
An average newborn weighs 7–7.5 pounds and is approximately 20 inches in length. Even for newborns at a healthy size, the first few minutes are crucial to survival and sometimes require intervention. To gauge a newborn’s health status, a test is given at 1 minute after birth and 5 minutes after birth. This test, called the Apgar scale, assesses the baby’s breathing, heart rate, muscle tone, reflexes, and skin color (Apgar, 1953). Table 4.5 describes the scoring process for the Apgar scale.
Table 4.5: Apgar scale scoring
Category
0
1
2
Breathing effort
Not breathing
Slow or irregular
Cries well
Heart rate
No heartbeat
Less than 100 beats per minute
Greater than 100 beats per minute
Muscle tone
Loose and floppy
Some muscle tone
Active motion
Grimace/reflex
No reaction
Grimacing
Grimacing, plus cough, sneeze, or cry
Skin color
Pale blue
Body is pink, extremities are blue
Entire body is pink
Source: Adapted from U.S. National Library of Medicine, Medline Plus. (2013b). APGAR. Retrieved from http://www.nlm.nih.gov /medlineplus/ency/article/003402.htm.
Most healthy babies will receive an Apgar score of between 7 and 9. Any score under 7 requires medical attention for the child. However, a low score at 1 minute after birth will typically increase by the 5-minute time point (Apgar, 1953).
Sensory Abilities and Reflexes
© Philippa Banks/iStock/Thinkstock
Placing a finger on the open palm of an infant will elicit the grasping reflex.
A newborn’s sensory abilities and natural reflexes set the stage for the critical physical and cognitive developments to follow like building blocks. Sight, hearing, smell, touch, and taste are all natural senses that should begin to function within minutes after birth. Almost immediately an infant shows a preference for looking at human faces, and other stimuli with face-like characteristics, more than any other stimuli (Johnson, Dziurawiec, Hadyn, & Morton, 1991). In fact, newborns show a preference for their mother’s face and their mother’s smell over any other faces or scents (Mills & Melhuish, 1974; Pascalis, de Schonen, Morton, Deruelle, & Fabre-Grenet, 1995; Porter & Winberg, 1999). A newborn’s sense of hearing is very sophisticated. Newborns are able to distinguish variations in a sound’s frequency, duration, and volume, and can even separate vowel sounds (Huotilainen, 2010).
Observation of a newborn’s reactions to certain senses at work is a good way to gauge healthy development during this period. A natural response to an external stimulus is called a reflex. A variety of reflexes can be observed in newborns. Table 4.6 describes the stimuli for some of these reflexes and the appropriate responses that can be observed if the senses are developing properly.
Table 4.6: Neonatal reflexes
Reflex
Stimulus
Response
Moro (startle) reflex
A loud sound or a sudden movement imitating a fall
The newborn’s extremities extend quickly and the head jerks back and then the newborn pulls the extremities back in, often gasping in air and crying out.
Rooting reflex
Gently stroking the cheek or area near the mouth
The newborn turns toward and searches for the object.
Sucking reflex
Placing an object (usually a nipple or fingertip) gently in the newborn’s mouth
The newborn sucks rhythmically.
Babinski (step) reflex
Lightly touching the bottom of the foot to a flat, hard surface
The newborn’s feet move in a stepping or walking motion.
Tonic neck reflex
Turning the head of a newborn who is lying on his or her back to one side
The arm on the same side as the newborn’s turned head straightens and stretches away from the body. The opposite arm is pulled into the body, fist clenched.
Grasp reflex
Placing a finger on the newborn’s open palm
The newborn’s hand will close tightly around the object or finger.
Truncal incurvation
Stroking or tapping along the spine while the newborn is lying on his or her stomach
The newborn’s hips twitch in the direction of the sensation.
Source: Adapted from U.S. National Library of Medicine, Medline Plus. (2013c). Infant reflexes. Retrieved from http://www.nlm .nih.gov/medlineplus/ency/article/003292.htm.
All of these reflexes should be observable in the neonatal period following birth but will fade at various stages during the first year. Some additional reflexes seen in infancy actually last into adulthood, such as sneezing, blinking, and gagging.
The work of T. Berry Brazelton was greatly influential for establishing the perspective that newborns, even hours old, are competent and organized in their behavior, with a unique personality from the beginning (Nugent, 2013). He developed the Neonatal Behavioral Assessment Scale (Brazelton, 1973), an assessment tool to examine a newborn’s individual differences, strengths, and difficulties (Nugent, 2013). By observing the newborn’s behavioral responses through reflexes and interactions, professionals can identify the child’s neurological status and unique functioning (Nugent, 2013). This assessment tool has shown individual differences in neonatal behavior to be influenced by prenatal and birth circumstances (such as prematurity or fetal drug exposure), as well as by cultural environments (Nugent, 2013). Today, Brazelton’s contributions continue to influence the perceptions and perspectives of child development (Brandt, 2013).
Feeding and Sleeping
Newborns need to be fed around the clock, which means as many as 8–12 times a day or every 2–3 hours (Mayo Clinic Staff, 2012b). However, all babies eat differently, in different amounts, and on different schedules. What they do have in common is that they all show obvious interest in eating and sucking. Poor sucking, no interest, or inadequate weight gain are reasons to call the doctor. Sucking that is ineffective or a baby who cannot latch on to a nipple can lead to problems such as poor weight gain. Prematurity, labor and delivery mediations, and poor health conditions at birth may cause a newborn to be unable to suck and remove milk from the breast or a bottle (Robert Wood Johnson University Hospital, n.d.). See Table 4.7 for signs of ineffective sucking.
Table 4.7: Signs of ineffective sucking
The baby may be sucking ineffectively if he or she regularly:
Prompts the mother to breastfeed fewer than 8 times, or more than 14 times, within a 24-hour day.
Resists, pushes away from, or recurrently latches on and off during a breastfeeding.
Falls asleep within the first several minutes of feeding, or does not awaken on his or her own to prompt feedings.
Fails to suck consistently during the first 7–10 minutes of feeding, or does not act satisfied after feeding for 45 minutes or more.
Remains latched on to the same breast for more than 30–40 minutes.
Resists milk by alternate feeding methods.
Acts as if he or she has gas, produces frothy, green stools after the first week, or produces fewer than 3 stools within a 24-hour day during the first week.
Soaks through fewer than 6 diapers within a 24-hour day after the first week.
Source: Adapted from Robert Wood Johnson University Hospital. (n.d.). Ineffective latch-on or sucking. Retrieved from http://www.rwjuh.edu/health_information/centers_pregnancy_diffltch.html.
© Getty Images/Jupiterimages/Photos.com/Thinkstock
Newborns must be fed around the clock every 2–3 hours, both night and day.
If the baby has difficulties in sucking during feedings, the mother should consult the child’s pediatrician to receive personalized information and suggestions based on the unique circumstances of that mother and child. Burping the baby after feedings can eliminate some of the air the baby may swallow while feeding, which can decrease a baby’s gas and spitting up. Babies should be content between feedings and have several wet diapers and bowel movements a day. Whether babies are breast-fed or bottle-fed formula makes little difference in these feeding and elimination behaviors. Chapter 5 provides additional information regarding feeding (including breast-feeding and bottle-feeding), diaper changing, and other infant care.
Newborn sleep is different from that of an older infant. Newborns wake up frequently during the night and are expected to wake for feedings every few hours. They also fluctuate between deep sleep and active sleep but with irregular patterns. According to the National Sleep Foundation (2013a), newborns sleep 10–18 hours a day, in a restless sleep, with only 1–3 hours spent awake at a time. Too little sleep for a newborn may result in poor development and deficient physical growth. Sudden infant death syndrome (SIDS) and other issues regarding sleep are described in Chapter 5.
Bonding
Neonates and parents, usually the mother, generally experience attachment and intense emotions. This experience is called bonding. Some professionals believe bonding continues the intense feelings of devotion and attachment that often are evident during pregnancy. Yet in the 1980s it was thought to emerge primarily during the sensitive period beginning immediately after birth during the recovery stage (Klaus & Kennell, 1983). Later studies found that bonding can start later and even develop over time for many parents.
Bonding is a natural and complicated emotion. It is the feeling of strong affection and tenderness for the baby and generally results from performing everyday activities like touching, talking to, and gazing at the infant, and by providing care routines like feeding, changing, and cuddling the baby. The neonate is stimulated to bond by hormones that are released during labor and by the sound and smells of the mother. Bonding can be hampered by postpartum maternal depression, parental substance abuse (see Chapter 2), and even by the removal of a neonate from the parents for care in the neonatal unit of the hospital. Parents with an infant in the neonatal unit have been found to experience depression, stress, and anxiety (Obeidat, Bond, & Callister, 2009), which can make bonding with the baby more challenging. However, bonding is a process that grows and changes over time, as parents become more comfortable and confident caring for the baby, as well as with appropriate care of the parents’ unique needs. The timing and characteristics of bonding are unique to each mother and baby, and can occur at different times and in different ways. Any concerns about the bonding process should be discussed with the child’s doctor, in order to gain personalized information and care for both mother and child.
Summary and Resources
A child’s optimal development depends on an understanding of how important it is—before, during, and immediately after birth—to avoid harmful substances and behaviors and promote those that lead to healthy, happy children. This understanding starts with the parents’ health as early as the time of conception and through the prenatal phase. For example, it is important that the mother receive proper nutrition, avoid harmful substances, and get healthy levels of activity and rest. The embryo and fetus develop in several phases, and exposure to negative substances and experiences can affect growth at any time during a pregnancy.
Just as a pregnant mother needs proper care, a newborn also needs proper care. The level of care needed will be based largely on whether the birth proceeded without issue, or whether complications arose. It is crucially important that the parents be prepared for the birth and know where to access supports afterward. Recognizing typical newborn characteristics immediately after birth and over the first 4 weeks of life is critical, to ensure that healthy growth and development are occurring. The neonatal period may be perhaps the most vulnerable period of a child’s life, and identifying complications early allows the newborn to receive necessary care as quickly as possible.
Key Terms and Concepts
active labor
amniocentesis
Apgar scale
blastocyst
bonding
cesarean section
chorionic villus sampling (CVS)
chromosome abnormality
chromosomes
embryonic phase
epidural anesthesia
epigenome
fertilization
fetal age
fetal phase
genes
genome
genotype
germinal phase
gestational age
implantation
neonatal
neurotoxicity
nucleus
ovulation
phenotype
placenta
prenatal
reflex
small for gestational age
sperm
teratogen
trimesters
zygote
Discussion Questions
Why is it important to understand the stages of prenatal development?
What are some lifestyle changes a mother may need to make when she learns that she is pregnant?
Is it more appropriate to refer to stages of prenatal development by trimesters or by germinal, embryotic, and fetal phases? Why?
Why might a chaotic home environment be harmful to a baby’s prenatal development?
What types of birthing methods do you know of that aim to reduce the amount of stress the baby encounters upon birth? Do you agree with these methods?
What might you suspect if a newborn does not want to be fed regularly? Should you seek medical help?
Can bonding still occur between parents and adoptive children? Please describe.
Web Resources
Womenshealth.gov
www.womenshealth.gov
This website offers information on all areas of women’s and girls’ health.
HealthyFamilies BC
www.healthyfamiliesbc.ca
This website offers to families resources on issues related to pregnancy through the first 3 years of life.
Foodsafety.gov
www.foodsafety.gov
This website provides information on food safety in the United States, including food recalls, food poisoning, tips for eating safely, and additional resources.
National Human Genome Research Institute
www.genome.gov
This website offers information about genetic health, research, and other issues in genetics.
MedlinePlus
www.nlm.nih.gov/medlineplus
This U.S.-government-sponsored resource offers information on a variety of health topics for all ages.
5.2 Physical Growth and Brain Development in Infancy
An infant’s physical growth is quite impressive, and shows a wide range of what is considered “normal.” An infant’s physical growth is a composite of three measurements: weight, height (or length), and head circumference. Each of these measures is discussed in this section. In addition, because so much brain growth and development takes place during this period, that topic is addressed here as well.
Weight
As noted in Chapter 4, the typical neonate weighs 7–7.5 pounds at birth. Most newborns lose weight in the first few days after birth. An average weight loss is about 5 percent of the infant’s birth weight. But after this loss, the typical infant gains about 5–7 ounces every week in the first month, doubles birth weight by 5 months, and typically triples birth weight by the first birthday (Hoecker, 2011). As pointed out in one of the early books on infant development, Infants, if this growth rate continued at the same rate as it does in the first 6 months, a 10 year old would be 100 feet tall and weigh about 240,000 tons (McCall, 1979). This certainly puts an infant’s early growth rate into perspective.
Infant weight gain is generally monitored regularly through well-child or pediatric visits. Clinical charts for infants are published in various forms. The U.S. Centers for Disease Control and Prevention (CDC) provides a commonly used set of 10 charts (5 for boys and 5 for girls), with the 5th, 10th, 25th, 50th, 75th, 90th, and 95th smoothed percentile lines shown on all charts, and the 85th percentile line shown for body-mass-index-for-age and weight-for-stature (see Figure 5.1). These charts are available in English, Spanish, and French and cover not only weight but also head circumference.
Figure 5.1: Clinical charts, birth–36 months
Clinical charts can be used to monitor infants’ weight gain. The U.S. Centers for Disease Control and Prevention publishes a series of such charts. The child’s age and sex determine which version of the chart should be used.
Source: Adapted from Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., Wei, R., Curtin, L. R., Roche A. F., Johnson, C. L. (2002).. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital and Health Statistics 11(246).
Failure to thrive refers to infants whose weight or rate of weight gain is significantly lower than that of other infants, at times presenting with diminished growth after typical growth patterns had been observed previously (MedlinePlus, 2011). Failure to thrive can be due to a medical problem or the result of environmental issues such as abuse or neglect, poverty, poor eating habits, or parents’ lack of understanding about proper infant nutrition. Often, however, the cause of failure to thrive cannot be specifically identified. Children who are characterized by failure to thrive may show delays in their milestone skill development, and severe and prolonged failure to thrive may have long-term effects on a child’s developmental growth. However, if a cause can be determined and/or treatment can be provided quickly, a child’s developmental growth may not be severely affected (MedlinePlus, 2011).
Length
Along with weight, measurement of an infant’s length is needed to assess physical growth at this stage. Recumbent length is a measure of an infant’s physical growth (analogous to the height of older children and adults), and refers to the length of the infant while lying down. The CDC and the American Academy of Pediatrics recommend the use of the 2006 World Health Organization (WHO) international growth charts to monitor growth in children in the United States under age 24 months (WHO, n.d.). Growth curves are graphed by these growth charts from birth to age 2, by gender. (For one example of a growth chart, see Figure 5.2.)
Figure 5.2: Length-for-age and height-for-age, for boys, birth–5 years
This chart is a standard growth chart showing that the precise point where an infant lies on the chart is not as important as the overall trend of growth.
Source: WHO Child Growth Standards (2014). Length/height-for-age: Birth to 5 years. Retrieved from http://www.who.int/childgrowth/standards/cht _lhfa_boys_p_0_5.pdf?ua=1.
There are general patterns that are considered typical for an infant’s growth. If an infant is determined to be far off the pattern for several routine pediatrician visits, a red flag should be raised to identify the cause and to decide whether an intervention is needed. For instance, extreme chronic malnutrition may produce stunted growth in children. The term stunted growth is generally used for children who fall below the 5th percentile of the reference population in height for age. This is where culture comes into play. The reference population for Asian children is different than that for children from the United States. Stunting is commonly found where poverty is extreme (including in the United States), with the conditions of poverty affecting how children are fed. Children below the poverty threshold experience stunting at much higher rates (7–13 percent) than do those living above the poverty threshold (4–5 percent), as shown in Figure 5.3 (Lewit & Kerrebrock, 1997).
Figure 5.3: Stunting and the effects of poverty
Depending on age, children living below the official federal poverty threshold varied widely in the percentage falling in the range of stunting, whereas children in families over the poverty threshold have a much lower percentage of stunting.
Source: Lewit, E. M., & Kerrebrock, N. (1997). Population-based growth stunting. The Future of Children, 7(2), 149–156.
Important relationships have been identified between the number of years of malnutrition early in life and lower scores on tests of cognitive development (Korenman, Miller, & Sjaastad, 1995). However, research over the past three decades has shown that good nutrition after age 2 years can restore cognitive development (Brown & Pollitt, 1996; Bryan, Osendarp, Hughes, Calvaresi, Baghurst, & van Klinken, 2004).
Head Circumference
The third measurement of physical growth in infants is that of head circumference. Head circumference is indicative of brain volume and is measured by a tape around the forehead. An unusually shaped head is common immediately after birth due to the birthing process through the birth canal, but it lasts only hours or a few days. The infant head is large in proportion to the rest of the infant’s body, usually about one-fourth the size of the infant’s body length (Gairdner & Pearson, 1971). The skull also may appear large for the face and has parts that are soft because the bones have not fused yet. These soft spots are known as fontanels. The anterior fontanel can be found at the front top part of the head, a smaller one (the posterior fontanel) can be found at the back of the head, and smaller soft areas also may be found in other areas of the skull (Children’s Hospital of Wisconsin, 2013). The anterior fontanel is the one generally referred to when identifying the soft spot. The posterior fontanel will close within the first few months, while the anterior fontanel will close at around 2 years (Children’s Hospital of Wisconsin, 2013). The American Academy of Pediatrics (2013d) describes fontanels as being fairly durable but cautions against applying extreme pressure anywhere on a newborn, including the fontanels.
Brain Development
The architecture of an infant’s brain is constructed from genetic information, with successive brain development shaped largely by experiences. During early gestation, brain cells called neurons are developing by the millions. These neurons then travel to sites determined by genetics and form the layers of the brain. Neurons cluster together by the function they perform. The clusters are connected to each other through a system of synapses, which are gaps between the clusters of neurons through which messages are sent.
All functioning, whether sensory or cognitive, is determined by this connecting of neurons. At the end of neurons are chemical messengers, such as adrenaline and serotonin, called neurotransmitters. Neurotransmitters activate areas of the brain at different times so that it can produce thoughts, emotions, and behaviors. The critical connections of groups of neurons are strengthened and become denser by being used, and are eliminated by not being used. The elimination of these unneeded connections or synapses is called pruning (Webb, Monk, & Nelson, 2001).
Before birth and into early infancy, the less complex parts of the brain are developed. These parts include the brain stem and the midbrain, which control bodily functions such as breathing, blood pressure, heart rate, and sleeping. Over the rest of the first year and through the next 2 years, the more complex parts of the brain in the limbic system are shaped and developed (see Figure 5.4).
Figure 5.4: The limbic system
This lateral view of an adult brain illustrates the prefrontal cortex, amygdala (emotions), and hippocampus (memory).
The limbic system is responsible for processing experiences and developing controls for emotions. Not until adolescence are the prefrontal cortex and the rest of the cortical areas that control abstract thinking and executive functioning (see Chapter 2) fully developed. Therefore, early experiences teach the brain how to react and also continue to influence development of the brain through adolescence. It is quite clear that early childhood caregivers have a huge influence in shaping the brain and, hence, the child’s future abilities and behaviors.
Although a critical amount of brain development occurs early and is influenced immensely by experiences, for young children who have difficult beginnings, researchers have identified the brain’s ability to change, and its ability to change in a positive way. As described in Chapter 1, the brain’s natural ability to change is called plasticity. Researchers have found that in the early stages of brain development there is a great deal of plasticity. Plasticity can compensate for areas in the brain that have been damaged or did not develop typically. Because of this plasticity, experiences in the early years have a substantial influence on the brain’s development and functioning. Although negative experiences can have a detrimental influence on brain development in early childhood, later experiences also have a significant influence because of plasticity, which means that care from responsive and nurturing caregivers can compensate for earlier problems.
A group of infants to consider when examining brain development are those born prematurely. With every additional week of gestation, the fetus’s brain is more developed. Risks to fetuses born prematurely include future problems with language, learning, coordination, and behavior (e.g., attention-deficit/hyperactivity disorder); the more premature the birth, the greater the risks (Black et al., 2008). In addition, extremely premature infants may have brain hemorrhages, which can cause a variety of deficits in cognitive and motor functioning (Shonkoff & Phillips, 2000).
5.3 Motor Development in Infancy
Infants are born with protective reflexes in the motor domain. Most reflexes disappear within the first year, but some play a protective function for survival and remain throughout life. Reflexes specific to the period of infancy are identified in Table 4.5 of Chapter 4. These reflexes will be observed following birth but fade over the first year of life. Reflexes that serve a protective function during infancy and that remain throughout life include the gag reflex, which protects an infant from choking while sucking and drinking; the blink reflex, which protects the infant’s eyes from foreign particles; and the shiver reflex, which signals to caregivers that the infant is experiencing uncomfortable temperatures (Muller et al., 2013). Although sucking is considered a reflex at birth, it becomes voluntary at about 2 months and becomes permanent. In coordination with the suck reflex, the swallowing reflex is established at birth. Voluntary swallowing develops sometime in the middle of the first year in time for solid foods to be introduced into the infant’s diet.
© 2009 Daniel MacDonald/www.dmacphoto.com/Flickr Select/Getty Images
The Moro reflex can be a response to a loud noise or sudden loss of support. It includes rapid extension of arms followed by bringing them back to midline.
Other infant reflexes disappear within the first year as maturation of the central nervous system allows voluntary movements to take their place (Zafeiriou, 2004). The palmar grasp reflex is produced by putting pressure on an infant’s palm. The fingers will curl and grasp the pressure-producing object. This reflex weakens in the third month and disappears by the end of the first year. The stepping reflex is observed immediately after birth in full-term infants and disappears at around 2 months. It is elicited when the child is held upright with toes touching a surface and reciprocal “walking” movements of the legs are observed. This pattern of movement is a precursor to independent walking later in life (Bradley, 2003).
Even more reflexes disappear at around 4–5 months. One such reflex is the rooting reflex. This reflex occurs when an infant’s cheek is stroked lightly. The head turns in the direction of that cheek; the infant opens his or her mouth, and attempts to suck. The asymmetrical tonic neck reflex is sometimes referred to as the fencing position because the infant’s head turns to one side, while the arm and leg on that side extend and the limbs on the other side flex, making the infant look like a fencer (Clopton, 2000). The Moro reflex, also called the startle reflex, is a reaction to a startling stimulus such as a sudden loud noise. This stimulus causes the infant’s arms to extend and rapidly come back to midline while the fingers close and release in a grasping motion (Ronnqvist, 1995).
Newborns’ skills in the fine and gross motor domains are limited, as is seen in the uncoordinated movements of the legs and arms. However, their motor development follows two patterns that, once understood, make infant motor development seem very orderly and logical. These two patterns—cephalocaudal and proximodistal development—take motor development from the simple to the advanced.
Cephalocaudal development refers to how body growth and muscular control proceeds from top down or from the head to the legs. The infant smiles, gains head control, and is able to lift the upper trunk, in that order. This is followed by arm control, which comes before sitting up (which requires trunk or core control), followed by the gaining of strength and coordination in the legs.
Proximodistal development is motor development progressing from the center of the body to the extremities. The infant must first gain proximal stability in the musculature of the trunk before mastering more refined distal movements. An infant’s muscle strength follows the same pattern. In the first month, an infant attains good muscle strength in the upper body. Control of the upper trunk and shoulders will be followed by reaching, which is then followed by grasping or object manipulation. This pattern is also observed in the motor sequence of crawling: As core control improves, the child will begin to rock on all fours until proximal extremity strength is achieved, allowing progression of strength development to the limbs. Based on this proximodistal motor development, it makes sense that, depending on the progressive development of strength and stability of musculature, the infant smiles at 2 months, then lifts the shoulders and chest at 3 months. At 3–5 months, the infant is able to hold the head steady and can roll over, bear weight on legs, reach out for toys, and play with hands and feet.
Finally, the infant is able to sit independently at about 5 months and can creep, crawl, and cruise along furniture by the second half of the first year. Walking is a milestone that parents often anticipate with special joy. As with other motor milestones, the ability to walk varies in its precise age of onset, but it typically appears at approximately 12 months.
These cephalocaudal and proximodistal growth patterns explain why fine motor skills develop after many of the gross motor skills are achieved. Different from the innate palmar grasp reflex discussed previously, infants develop the voluntary motor skill of grasping objects with the palm, called the palmar grasp. This palmar grasp typically develops before the more advanced pincer grasp, in which infants use the index finger and thumb to pick up objects. At about 3 months, infants typically can bring their hands toward midline. Midline refers to the center of the body if a line were to be drawn from head to toe with left and right sides of the body equivalent. At about 6–9 months, infants are able to use this skill to transfer toys from one hand to the other. From 9 to 12 months, infants develop the ability to isolate the index finger to point and to push buttons, and many motor skills combine to enable infants to feed themselves finger foods at this time.
Tips on Promoting Motor Development in Infancy
Engage an infant in play.Present toys that stimulate the infant’s senses to encourage the infant to move eyes, head, and neck to see what you have. This can also encourage older infants to reach and grab for toys, promoting fine motor skills.
Without causing frustration, place a toy just out of the infant’s reach to encourage the development of skills used to move toward and grasp objects.
Use tummy time (occasionally placing a supervised infant on his or her stomach during awake time) to help strengthen muscles and improve motor skills. Provide interesting toys and interact with the infant during this activity.
Before an infant begins to stand and cruise, make sure furniture and items low to the floor are safe and stable for the infant to hold onto and walk around.
Allow an infant to self-feed (when ready) with finger foods. This helps the child to develop fine motor skills.
Source: Harding, S. (2013). Activities to encourage the motor development of a baby. Retrieved from http://www.livestrong .com/article/82666-activities-encourage-motor-development-baby/.
5.4 Cognitive Development in Infancy
Cognitive development in newborns and infants is interrelated with each of the other developmental domains. However, this cognitive development initially is based in the five senses of hearing, vision, touch, smell, and taste. Each of the senses is functional at birth and becomes refined in the first year (see Table 5.1).
Developmental Milestones: Infancy
During this time infants progress toward developmental milestones in areas of motor skills, cognition, communication, social emotional, and self-help.
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Critical Thinking Questions
How would you help support the development of an infant?
What do you think most influences infant development?
The infant is born with selective but good hearing. Many studies have demonstrated infants’ ability to discriminate among voices, especially responding to female voices with preference for the mother’s voice (Fernald, 1985). Within a few months, the infant can coordinate the behaviors of listening and looking, and turning voluntarily toward sounds. Infants also seem to enjoy musical sounds at this time.
Visually, newborns attend more readily to moving objects than to static ones. They are able to follow moving objects if the objects are close enough to see. Infants cannot yet distinguish all colors, but they are able to see and focus on black-and-white patterns. Acuity, or visual clarity, is weak in early infancy, and two-dimensional visual skills likewise are poor. However, acuity, visual tracking of a moving object in all directions, and depth perception improve in the first 6–8 months so that by the second half of the year vision is comparable to that of an adult. This means that infants recognize color and shapes and see at a distance.
Jean Piaget’s theory of cognitive development (see Chapter 3) identifies four main stages. In the first year of life, children are within what Piaget referred to as the sensorimotor stage. Object permanence is an important part of Piaget’s sensorimotor stage. Object permanence is the ability to know that objects exist even when they cannot be seen, heard, or touched. It is thought to be an important cognitive milestone that usually occurs after the age of 4 months. Object permanence is connected to the senses since the object first must be recognized through the senses, usually by vision. It is a significant milestone because it also signals that the infant is developing memory and some abstract thinking.
The sense of touch is also not very sophisticated at birth, but it is present. Newborns’ responses to touch often are by reflexes, but gradually they begin to discriminate between touch that is preferred and touch that is not. For instance, infants may like being patted on the back to fall asleep and may enjoy skin-to-skin cuddling. Mouthing is another way infants experience touch and exploration. This behavior begins in the first half of the year, but an infant needs more developed motor skills in order to bring an object, whether a toy or body part, to the mouth.
Researchers have found that neonates are able to discriminate between odors by looking in the direction of the more pleasant ones, with their favorite being their mothers’ (Cernoch & Porter, 1985). Taste is also somewhat selective. Most infants prefer sweet tastes to salty or tasteless ones.
Table 5.1: Senses in infancy
Sense
Characteristics
Hearing
Infants are born with selective but good hearing, as they have been shown to discriminate among voices.
Within a few months, infants can coordinate the behaviors of listening and looking, turning voluntarily toward sounds.
Vision
Newborns attend more readily to moving objects than to static ones.
Newborns can follow moving objects if the objects are close enough to see.
Infants cannot yet distinguish all colors, but they are able to see and focus on black-and-white patterns.
Acuity (visual clarity) is weak in early infancy.
Two-dimensional visual skills are poor in early infancy.
Acuity, visual tracking of a moving object in all directions, and depth perception improve in the first 6–8 months; by the second half of the year vision is comparable to that of adults.
Touch
The sense of touch is also not very sophisticated at birth, but it is present.
Often the newborn’s responses to touch are by reflexes, but gradually they begin to discriminate between touch that is preferred and touch that is not.
Smell
Neonates are able to discriminate between odors by looking in the direction of the more pleasant ones, with their favorite being their mothers’.
Taste
Most infants prefer sweet tastes to salty or tasteless ones.
Tips on Promoting Cognitive Development in Infancy
Provide infants with interesting toys and experiences.
Talk to infants. Respond to infants’ smiles and vocalizations.
Read and sing to infants.
Provide infants with adequate nutrition.
Provide infants with sensitive and responsive care.
PLAY!
Allow infants to touch and mouth objects that are safe. Infants learn through all of their senses.
Provide toys that stimulate all of an infant’s senses.
Follow an infant’s cues for the need for more or less stimulation.
A relatively recent debate among caregivers is the use of technology and media with infants. The American Academy of Pediatrics (2011a, 2011b), the National Association for the Education of the Young Child and the Fred Rogers Center for Early Learning and Children’s Media (2012), and the White House Task Force on Childhood Obesity (2010) discourage the use of screen media for children under 2 years of age in early childhood programs. However, there is agreement that some technology such as music and audio recordings, if used intentionally and in an age-appropriate manner, can enhance the quality of programs. Mixed messages about the use of technology for infants has much to do with the use of passive technology like television versus the use of interactive technology that, when combined with adult involvement such as modeling its use and partnering in play, can help build relationships, feed curiosity, and improve communication and social skills (Plowman & Stephen, 2005).
Media, Technology, and Early Childhood: Infants and Technology: A Lost Opportunity
Nancy cares for two infants, Louise and Carol (9 and 11 months old, respectively), in her home child care. Several times a day, she needs to prepare food, change bedding, and complete other chores related to their care. Nancy finds that leaving the infants in safe seats to watch television during these times keeps them quiet. In addition, when she returns to the room they are in, the quiet suggests to her that she can leave them in front of the television longer so that she can have some quiet reading time for herself.
Screen time for children under 2 years old is discouraged by experts in child development (National Association for the Education of the Young Child and the Fred Rogers Center for Early Learning and Children’s Media, 2012) for many reasons but especially because children under age 2 need direct adult interaction and relationship-building activities. Therefore, if Nancy changes her use of technology for the infants in her care from passive watching of television to interactive activities led by her, she can supplement Louise’s and Carol’s opportunities for improved development. For instance, Susie, another home child caregiver, folds her children’s laundry in the same room in which the children in her care are listening to soft music. She talks with the infants about what she is doing and sings with the music.
5.5 Communication Development in Infancy
Communication and language are key to social interactions, building relationships, and other critical skills later in life. In addition to being directly related to the social-emotional domain, it is difficult to separate communication skills from the cognitive domain since an infant’s communication is often seen as the vehicle by which cognition and intelligence are assessed. For example, if a baby cannot communicate with caregivers, the caregiver could not know what the baby understands, or develop a reciprocal relationship.
© R. Eko Bintoro/iStock/Thinkstock
Intentional communication occurs when infants use actions (like pointing) or vocalizations to influence a caregiver.
Communication is typically separated into two categories: receptive and expressive. Receptive communication skills are generally apparent sooner than are expressive skills. Receptive communication includes symbols like words, sounds, and gestures that an infant understands. Receptive communication skills are important for current and future learning; however, it is sometimes difficult to recognize if the infant is having challenges with these receptive skills. Expressive communication includes how infants express themselves and communicate to others. Expressive communication is an equally important component of communication, and it signals to caregivers that receptive skills are being used.
Infancy is a time when many communication skills are gained, but researchers also recognize that infants are born with many capabilities to communicate. For instance, infants communicate specific needs early (Owens, 2001). The earliest forms of infant communication are nonverbal or preverbal communication. The typical infant often begins communication with crying. The infant cries to signal the need for food, nurturance, and comfort, including the need for a diaper change. Generally in the first 3 months, infants also coo and use other similar sounds of pleasure as well as smiling to communicate contentment.
Infants also use early nonvocal communication through facial expressions, head turning, and reaching. They react to loud sounds, recognize familiar voices, and calm down to those voices if they are upset. In the next 3 months, infants pay attention to changes in voice tones and to music. They can follow sounds with their eyes and are aware of toys that make sounds. They express themselves with even more sounds than in the first 3 months by adding babbling and gurgling sounds. They begin to laugh out loud and babble in response to emotions like being excited (American Speech-Language-Hearing Association, 2013; National Institute on Deafness and Other Communication Disorders [NIDCD], 2010).
Babbling and First Words
Babbling emerges from 3-12 months as babies experiment with language sounds. Early language development is a maturation process. The average age for first words is 13.6 months.
Critical Thinking Questions
Discuss why a baby’s babbling sounds the same regardless of what language their parents speak?
Why is talking to a baby important for their language development? Describe this importance in your own words.
During the second half of the first year, infants imitate speech sounds and may say one or two simple words like “dada,” “up,” and “mama.” This stage in communication development is called the sound imitation period. One form of sound imitation is echolalia. Echolalia is when infants imitate sounds, not real words, they hear in their environments, including sounds from people. It occurs at around 9 months.
At about this same time, infants begin to attend more carefully when caregivers talk to them. Thus it becomes apparent through the infant’s communication skills that infants understand some words for common items like “milk” and “dog” and react to simple phrases like “come here.” The use of gestures to communicate desires, such as wanting to eat or wanting to be picked up, begin at 7–12 months of age (NIDCD, 2010). This is the beginning of intentional communication. Intentional communication is demonstrated when infants deliberately communicate by using either actions or vocalization to get something (Owens, 2001). The difference in this type of communication, as compared with other types, is in its use as the means to get a response from another. See Table 5.2 for distinctions among types of infant communication.
Table 5.2: Types of infant communication
Type of Communication
Description
Approximate Age
Nonverbal/preverbal
Cries to signal needs, including the need for food, nurturance, and comfort.
Coos and uses other similar sounds of pleasure
Smiles to communicate contentment
Pays attention to music
Laughs
Understands basic sounds of native language
Obviously listens to words by turning and physically reacting
Birth–9 months
Simple words/intentional gestures
Waves, holds up arms to be picked up
Understands common words
Responds to simple requests
Imitates speech sounds
Has one or two words
9–12 months
Tips on Promoting Communication Development in Infancy
Be engaging when talking to infants; respond to their vocalizations.
Engage in joint attention. Point to objects and talk about what you and the infant see.
Describe to infants the objects they see, the activities in which they take part, and events that occur.
Use a variety of words and grammar.
Label objects and actions.
Let infants take part in interesting activities.
Read books (and read them over and over!).
Introduce and talk about new and interesting objects.
Involve infants in musical activities; sing nursery rhymes and children’s songs.
Use gestures or simple signs when talking.
Source: Gardner-Neblett, N., & Gallagher, K. C. (2013). More than baby talk: 10 ways to promote the language and communication skills of infants and toddlers. Chapel Hill: University of North Carolina, FPG Child Development Institute.
Figure 5.5: Three components necessary for first words and sentences
For infants to begin to use words and sentences, some language specialists believe that they must have a conceptual framework of their environment, which is made up of conceptual development, speech/signal decoding, and intentionality.
Source: From De Villiers, J. G., & De Villiers, P. A. (1999). Language development. In Developmental psychology: An advanced textbook (4th ed.). Copyright © 1999 Lawrence Erlbaum Associates, Inc. Reprinted by permission.
5.6 Social-Emotional Development in Infancy
Infant social-emotional development begins with the neonate’s bonding experience described in Chapter 4, as well as all social interactions and early relationships. Early behaviors that demonstrate that infants have emotions include laughing and smiling, showing anticipation and excitement (possibly through arms and legs flailing), and switching from quiet to alert states when paying attention to the environment.
The intense closeness an infant feels to the attachment figure is part of social-emotional development. The infant sends out signals that encourage relationships by mutual gazing, cooing, cuddling when held, and smiling. Some researchers say the grasp reflex is demonstrative of this innate desire, based on the infant’s strong grasp of a parent’s fingers, but there is no evidence for this interpretation.
According to attachment theory (see Chapter 3), attachment is the basis for social-emotional well-being, which is the basis for good future mental health. Attachment behaviors are observed in all healthy infants. These behaviors include clinging to a caregiver, crying when the attachment figure leaves the infant, and in later infancy, clinging and crying when a stranger approaches. In addition, infants use different strategies to seek out a familiar person or object, at first visually and later with locomotion, given that making eye contact and physical touching are also behaviors that promote relationships. Those individuals who most often become attachment figures are caregivers who are responsive to the infant’s cues and signals, are typically sensitive in their style of caregiving, and who are stable in the infant’s life (Ainsworth, 1979).
Tips on Fostering the Attachment Relationship
Be sensitive and responsive to children’s needs; be warm and affectionate.
Read and respond to the cues that children show.
Engage children by taking turns during interactions and when communicating.
Be physically and emotionally available when children explore the environment.
Provide comfort when children are distressed.
Enthusiastically follow a child’s lead during play, and provide help to support a child’s problem-solving skills.
Keep in mind that relationships can be built and strengthened at any time during the day.
Communicate to children that you will keep them safe.
Provide consistency in the care that children receive (including primary caregivers and child-care providers).
Maintain consistent caregiving, especially when a child’s environment changes (e.g., moving to a new home, transitioning to a new child-care classroom).
As a caregiver, locate any needed mental health support or other needed resources so that you can maintain warm and responsive interactions with the children in your care.
Source: Modified from Wittmer, D. (2011). Attachment: What works? Retrieved from http://csefel.vanderbilt.edu/briefs /wwb_24.pdf.
Attachment and relationship building have been described as having phases within the infancy stage (Ainsworth, 1982; Ainsworth, Blehar, Waters, & Wall, 1978). In phase 1, which is approximately the first 2 months of infancy, there is little discrimination among caregivers or objects. However, infant behaviors of crying, cuddling, and smiling promote caregivers’ interactions. In phase 2, during the next 4 months and sometimes much later, differentiation among caregivers becomes the typical behavior, with obvious preferences for familiar individuals. Beginning at about 6 or 7 months but by 2 years, the toddler is clearly attached to one or more figures (Lamb, Thompson, Gardner, & Charnov, 1985). See Table 5.3 for a more detailed look at the phases of attachment according to John Bowlby (1969). This forming of attachments early in life is believed to be important throughout life.
Table 5.3: Phases of attachment according to Bowlby (1969)
Phase
Approximate Age
Characteristics
Phase 1: Orientation and signals with limited discrimination of figure
Birth to 2 months (but may last up to 3 months or later)
Little discrimination among caregivers or objects.
Infant behavior of crying, cuddling, grasping, reaching, and smiling promotes caregivers’ interactions and proximity.
Phase 2: Orientation and signals directed toward one (or more) discriminated figure(s)
Following phase 1 until about 6 months of age or later
Differentiation among caregivers with obvious preferences for familiar individuals.
Continued friendly behavior toward others, but more distinctly toward the primary attachment figure than toward others.
Phase 3: Maintenance of proximity to a discriminated figure by means of locomotion as well as signals
Begins at 6–7 months and continues into the third year
Increasing discrimination in the way caregivers are treated.
Follows a preferred caregiver when she leaves; greets a preferred caregiver when she returns.
Uses preferred caregiver as a safe base in order to explore.
Other caregivers can be identified as secondary attachment figures.
Strangers are treated with increasing caution and become cause for alarm.
Some behavior becomes organized and goal-directed toward the primary attachment figure.
Proximity to attachment figure is beginning to be maintained.
Phase 4: Formation of a goal-directed partnership
Begins about the middle of the third year
The child gains insight into the primary attachment figure’s “feelings and motives” (p. 219).
A more complex relationship develops, which Bowlby refers to as a partnership.
Source: Bowlby, J. (1969). Attachment and loss. Vol. 1: Attachment. New York: Basic Books.
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Empathetic concern is demonstrated by infants’ attention to a crying peer.
Social-emotional characteristics that infants are considered to be born with include temperament and personality traits. Evidence indicates that temperament and personality traits are stable over time, but how a child expresses them later depends on early relationships, culture, and other environmental factors (Lamb, 1988; Shonkoff & Phillips, 2000). Emotions and their expressions are other characteristics in an infant’s early social-emotional development. These expressions of emotion are often related to the infant’s response to stress and are identified in the infant’s ability to self-control or regulate stress. Behaviors include crying, tantrums, rocking, and turning away. Controlling negative emotions early is viewed as the healthy interaction between reflex responses and cognitive abilities (Kopp, 1989).
Some child psychologists believe that the emotion of empathy, or the concern for others in distress, is vital in life. In the past, this experience was believed to develop sometime after the child’s second birthday, as developmentalists reasoned that younger children could not yet see themselves as separate from others, and thus could not feel empathy or concern for another individual (Hoffman, 2000). Infants were thought to experience emotional distress but not to have the ability to distinguish whether this distress was their own or another’s. This would cause infants to soothe themselves. Recent research finds this not to be the case. Empathic concern is shown to exist during the first year of life and is evident through infants’ social nature (Davidov, Zahn-Waxler, Roth-Hanania, & Knafo, 2013) and their behaviors of focusing attention on crying peers through gesturing or touching.
5.7 Attending to the Infant’s Basic Needs
The infancy period cannot be discussed without addressing the infant’s basic needs. This period of life is dominated by changes, questions, and concerns about how best to care for an infant. Close attention to an infant’s needs may offer many clues to the health and early development of that infant. Infants are born with many skills that their caregivers underestimate. However, infants need caregivers to meet their needs through attentive and responsive care during the first year of life. Infants change a great deal in these first 12 months, with appropriate care allowing for an infant’s developmental gains and the early stages of important skills in the self-help domain. The self-help domain becomes a prime focus during toddlerhood (see Chapter 6). For the first year, however, the focus is placed instead on the caregiver’s identifying how to best meet the infant’s needs.
For instance, after the neonatal period, an infant’s sleeping patterns make many parents think they will live the rest of their lives sleep deprived. Then a few months later the infant is sleeping peacefully for long stretches of time. Elimination initially is a constant clean-up task and every aspect of it is examined by the new parents, who see it as a window to internal health. Then patterns develop and consistency and frequency are possible to determine.
Next, feeding a newborn seems like a continuous activity because soon after one feeding it is time for the next. This leaves parents wondering if the infant ate enough, is eating enough, or will eat enough during the next feeding. Bathing and dressing are not as routine as sleeping, eliminating, and feeding because it seems that all newborns do is sleep, eliminate, and eat, so they are changed often with no bathing schedule. Infants sometimes get rashes or peeling skin even if hygiene is conducted with care and deliberation. In reality, each infant has unique patterns in these areas, but all have the same basic caregiving needs. The following subsections provide a glimpse into what can be expected or not expected in meeting infants’ basic needs.
Sleeping
Newborns and infants need a lot of sleep. As described in Chapter 4, neonates can sleep as much as 18 hours a day. This diminishes by about 4–6 months, when infants may sleep approximately 9–12 hours a night (waking several times for feeding) with several naps during the day lasting 30 minutes to 2 hours. They do not have regular sleep cycles until about 6 months. Helpful to sleeping through the night is “growing out” of nighttime feedings. Important for getting infants to sleep on their own is to develop consistent bedtime routines and to put them to bed when they are drowsy but not asleep (National Sleep Foundation, 2013).
Infants go through six states of consciousness through most days of their first month. Two are sleep states (see Table 5.4) and four are states of relative alertness. State 1 is deep sleep. The infant does not move while in this state. During more active, lighter sleep, considered to be state two, noise may awaken the infant. During state 2, rapid movements of the eyes while closed can be seen. Infants typically alternate between these two states. State 3 is when the infant starts to fall asleep. In state 4, the infant may be awake but generally will be quiet and inactive. State 5 is an alert and active state. State 6 is when the infant cries and seems upset (American Academy of Pediatrics, 2013c).
Table 5.4: Infant sleep states
Sleep State
Description
Non-REM sleep
Non-REM sleep is actually made up of 4 sleep stages. They are separate from one another because of the distinct brain wave patterns produced in each stage, and the infant may cycle through all of the stages many times while sleeping:
Stage 1: The infant is “dozing off.” This stage marks the beginning of the sleep cycle; it is the transition between wakefulness and sleep, when the infant’s eyes become droopy and start to close.
Stage 2: The infant is lightly sleeping and may still startle at noises.
Stages 3 and 4: The infant is falling into a deeper sleep and does not move or make sounds. After Stage 4 of non-REM sleep, the infant will transition back down to Stage 3, then to 2, and will then enter REM sleep. The infant may wake up and have trouble falling back to sleep while making these transitions.
Rapid eye movement (REM) sleep
During REM sleep, the brain is active and the eyes move back and forth rapidly, hence the name. REM is when dreaming occurs, and for infants this type of sleep comprises about 50% of their total sleep. Newborns and infants typically need about 16 hours of sleep per day, but as children age and grow into adulthood, they require less REM sleep and fewer hours of sleep in general.
Source: Adapted from Stanfordchildrens.org. (n.d.). Newborn-sleep patterns. Retrieved from http://www.stanfordchildrens .org/en/topic/default?id=newborn-sleep-patterns-90-P02632, and Nueroscience for kids—Sleep. (n.d.). Retrieved from https://faculty.washington.edu/chudler/sleep.html.
Purestock/Thinkstock
Recommendations to reduce the risk of sudden infant death syndrome include putting infants to sleep on their backs and using a firm mattress without loose bedding.
By the end of the first year, infants should have nights and days figured out so that longer sleep periods occur during the night. Sleep problems such as insufficient sleep and poor-quality sleep have been associated with impaired cognitive functioning and have been shown to be related to problems in attention, learning, memory, and later academic achievement (Hill, Hogan, & Karmiloff-Smith, 2007; Stores, 2007). Sleep problems are more common in toddlers and preschoolers than in newborns and infants.
During infancy there is the fear of sudden infant death syndrome, known as SIDS. SIDS is the sudden death, during sleep, of an infant who appeared to be healthy. A definitive explanation for an infant’s death cannot be identified in cases of SIDS. Typically the infant dies after having been put to bed. SIDS is the most common cause of death in the United States for infants ages 1–6 months (Nagler, 2002). SIDS prevention strategies include putting infants to sleep on their backs, using a firm mattress, having infants sleep in their own beds, and keeping loose bedding and toys out of the bed. A “back to sleep” campaign in the United States emphasizes the need to leave the infant lying face up when being put to bed. One of the possible explanations for SIDS is that these infants have problems with the part of the brain that controls breathing, and arousal from sleep does not occur (Mayo Clinic Staff, 2011a).
Sheila wanted nothing more than for her family to get a restful night. She sensed the family’s exhaustion since Maggie had been born and now Maggie’s waking to feed frequently was stirring the entire family of five throughout the night. When Maggie woke at midnight for the first of her feedings, Sheila decided it would be easiest if she let Maggie return to sleep next to her so that she could respond quickly to her next request to feed. As Sheila next woke to the sun shining through the curtains, she knew immediately that something was wrong. Sheila could not wake Maggie. The doctors could give Sheila and her family no specific medical explanation for Maggie’s death. Sheila and her family were devastated by their loss. Sheila often went over and over in her head what could have happened. Before Maggie’s death, Sheila had read about the “back to sleep” campaign, but she had not heard that many infant deaths are now thought to be the result of accidental suffocation. She often thinks, “If only I had put Maggie back in her crib, would that have saved her?” Now that she knows more, she has taken on the task of informing others about what happened so that other families can reduce the risk of this heartbreaking loss. As Sheila talks about the night she lost Maggie, she urges parents to give their babies a clear and safe space to sleep.
Feeding and Eating
Infants need a lot of milk in the first few months. In the first two months, feedings may occur as often as every 2–4 hours for breast-fed babies and about every 3–4 hours for bottle-fed babies. Breast milk has several advantages over formula. The most important advantage is its immunity benefits. Breast milk has been shown to protect against illnesses common in childhood, as well as to protect against infections and allergies (Kidshealth.org, 2013; National Institute of Child Health and Human Development, 2012). Also, nutritional advantages have been identified for breast milk, and breast-feeding has been shown to lead to a decrease in the likelihood of type 1 diabetes and obesity later in life (National Institute of Child Health and Human Development, 2012). Not only does breast-feeding show advantages for an infant’s physical health, but it also provides for an infant’s emotional health, based on the mother-child interactions during breast-feeding and the skin contact that occurs (National Institute of Child Health and Human Development, 2012). Nevertheless, based on a mother’s comfort level, the timing of feedings, a mother’s diet, restrictions due to a mother’s medical conditions or medications, and the convenience and flexibility factor, bottle-feeding has its own advantages (Kidshealth.org, 2013). Every mother must make the decision to breast-feed or not depending on many personal circumstances, and it is important to support the mother in whatever decision she makes regarding the feeding method selected.
Infant Formulas
Infant formulas are food products designed to provide for the nutritional needs of infants under 1 year old. They include powders, concentrated liquids, or ready-to-use formulas, and vary in nutrients, calorie count, taste, ability to be digested, and cost.
Critical Thinking Questions
Consider three reasons why parents might choose to feed their infant formula rather than breastfeeding?
Why is it important to always feed an infant what their parents have selected for them to eat?
If bottle-feeding is chosen for the baby, commonly used infant formulas generally fall into three main categories: (a) cow’s milk based, (b) soy based, and (c) elemental. Elemental formulas are used for infants who cannot tolerate cow’s milk or soy and are made from amino acids, the components that combine to form protein. Formulas are offered in powder, concentrate, and ready-to-feed preparations. Caregivers should be aware of the importance of using iron-fortified infant formulas and should be cautioned against the use of microwave ovens to warm formula because it causes uneven heating and may burn the infant’s mouth or tongue. Also, bottles should never be propped or left with the infant without supervision. Propping may cause choking and aspiration (Kan & Sullivan, 2008).
Infants have small stomachs and need to be feed often. Breast milk is digested easily and quickly. Formula takes longer to digest. In either case, on-demand feeding should be considered. On-demand feeding is the feeding of babies when they cry or in some way give signals that they are hungry, like sucking their hands (Pryor & Pryor, n.d.). Decades ago, on-demand feeding was thought to lead to a spoiled child. However, Ainsworth and Bell (1969) found that infants fed on a schedule were less secure than infants fed on demand. At 4 months, the infant should show signs of anticipating feeding when the bottle or breast is in view. Monitoring of weight gain is a good indicator of whether or not the infant is eating enough.
As the infant gains weight, solid foods may be introduced as supplements to milk. This generally happens at about 4–6 months. Tongue coordination is necessary for solid foods, so this motor development may be a factor in timing the introduction of solid foods. These foods must be moved from the front of the mouth to the back to be swallowed. If the infant cannot do this yet, it may be too early for such foods. If the infant is ready, solid food feeding often begins with baby cereal that is mostly liquid and then gradually made thicker. Pureed foods can be added if the cereal feeding is successful. Later, generally in the second half of the year, self-feeding of finger foods comes when fine motor grasping skills begin to develop.
Erin had read many books and magazines about what to expect during the first year of life. Formed in her head was this “life itinerary” that laid out nicely the expectations and milestones for her daughter, Lucy. Erin was amazed initially at how the various stages that had been described seemed to fit with Lucy’s development. Erin joked that child development writers were almost clairvoyant as they could predict within a narrow window of time the next emergent activity or trait that Lucy would display. As time pressed on, Erin became no less amazed by how the predictions of these milestones continued, but she began to feel something was missing; namely, sleep. As outlined, Lucy’s feeding, sleeping, and diaper change patterns did become more predictable, but the endless cycle of attending to these needs meant months of little rest for Erin. While a book or magazine could sum up the process, Erin learned that it did not necessarily prepare her for the state of exhaustion she felt constantly or the roller coaster of emotions she felt: joy, anger, guilt, and insecurity. Years later and following the arrival of a second child, Erin now sees the first year differently. While it is a magical year in the tremendous development that occurs, Erin appreciates the bigger picture and understands that the impact on the entire family will ebb and flow. She knows that although this early period can be exhausting and demanding, it gets easier.
Elimination
Elimination patterns vary considerably from infant to infant. Most pediatricians will say that after about a week newborns should have between four and six wet diapers a day, but this is not a definite number. A newborn’s urine may be pinkish or red especially right after birth, but if this continues beyond a few days a pediatrician should be contacted.
Infants who are breast-fed have loose and frequent stools, often after every feeding. The stools of a breast-fed baby may be green, yellow, or black and a variety of consistencies depending on the mother’s diet. The stools of a formula-fed infant are generally pasty and firm, yellow to brown or green in color. Some infants may not have a bowel movement for several days, but if they go too long, about a week, or if there is a sudden change in the consistency of an infant’s stool it would be advisable to call the pediatrician. When infants eliminate stools, they may exhibit straining behaviors that resemble a child who is constipated. Infants may grunt, grimace, and turn red while pulling up their legs because of the effort to eliminate while lying down (Kan & Sullivan, 2008). This behavior is typical, and only unusual consistency of the stool should be cause for intervention. The frequency of elimination should decrease after about 6 weeks, and the variety and patterns of elimination should become more predictable.
Hygiene
Good hygiene practices carried out by caregivers during the first year of life help to keep an infant healthy and comfortable. It is important for caregivers to provide appropriate care and cleaning, based on an infant’s unique needs. If questions or concerns about this matter should arise, an infant’s pediatrician can be a trusted source of information for caregivers.
Infant Bathing
Newborns do not need daily bathing, and soap is not recommended when they do receive a bath. The use of soap may dry an infant’s skin and cause flaking. Plain water is recommended, but a mild cleanser with a neutral pH can be used (Kan & Sullivan, 2008). Hair can be washed with a mild shampoo or plain water also.
Even if all of the recommendations in infant bathing are followed, infants may develop scale-like rashes on their scalps and around the nose, behind the ears, and in the creases on the neck and armpits. The rash may appear yellow and crusty and is believed to be the normal buildup of skin oils (Canadian Paediatric Society, 2007). When this scale-like rash occurs only on the scalp, it is called cradle cap. It is considered to be a noninfectious dermatitis and is quite common in newborns. It is not thought to be uncomfortable for the infant and goes away gradually, disappearing slowly over a period of weeks or months. Unlike eczema or contact dermatitis, it is rarely uncomfortable or itchy and may not need special care.
The umbilical cord, however, does need special care in the postnatal period. Before birth the umbilical cord functions as the tubing that removes wastes and brings nourishment to the fetus from the placenta. The newborn’s connection to the placenta is separated at birth and a stump remains on the newborn’s stomach. The umbilical cord stump must be kept dry and clean, and whenever cleaning the area of the stump, hands must be clean, especially if diapers were handled. If the stump comes into contact with stool or urine, it should be cleaned with plain water and left exposed to air to dry or covered very loosely. The diaper should always be folded away from the area until the stump falls off and the site is healed. The umbilical cord stump usually falls off anywhere from 1 to 3 weeks after birth (Kan & Sullivan, 2008) and then the “belly button” is visible. Until then only sponge baths are recommended so that it is easier to keep the area dry for healing.
Infant Skin Care
Once again, plain water is best for washing an infant’s skin. Lotions and other lubricants are not necessary. Talcum powder of any sort should never be used because it can cause aspiration. The use of commercial wipes can be convenient and is fine if they are free of chemicals, alcohol, and fragrances. Diaper rashes may appear in spite of extreme care in cleansing. These rashes heal with simple zinc oxide. More difficult or resistant diaper rashes may need the attention of a health care professional (Kan & Sullivan, 2008).
Genitalia Care for Boys and Girls
Circumcision is the surgical removal of the skin covering the tip of the penis (Mayo Clinic Staff, 2012a). It is commonly done for newborn boys for religious reasons or family tradition, while some parents opt for the procedure for hygiene and health care reasons. For the male infant with an uncircumcised penis, pulling back of the foreskin is not necessary when bathing and plain water is once again recommended. If the penis was circumcised, it should be washed with warm water and gentle soap at every diaper change and lubricated with simple vitamin A & D ointments to prevent the skin from sticking to the diaper while it heals over a period of 1–2 weeks (Kan & Sullivan, 2008).
For female infants, the vaginal area should be washed gently with warm water by wiping from the front to the back. A white or bloody discharge is common in the early neonatal period as a result of the fetus’s absorption of maternal hormones.
Dressing
The question of how infants should be dressed is based not on style but rather on safety and health. Strings and loose decorative items on clothing are not appropriate for infants. Common sense should drive caregivers’ decisions regarding infant clothes. For instance, the temperature of the infant’s environment should be a major factor in deciding how much an infant should wear. Protection from sun in the summer and from cold in the winter is a key determinant of an infant’s clothing. Infants have delicate skin and should be shaded from direct sunlight. Babies should be monitored frequently for overheating. However, if the infant is in an air-conditioned environment, warmer clothes are necessary.
Healthy infants do not need to be dressed more warmly in the winter than the adults they are with. This rule is a handy guide in most cases unless the infant is premature or sick. Swaddling is an effective way to comfort an infant, but overdressing the infant may lead to hyperthermia and puts the infant at increased risk for SIDS if overheated during sleep (Mayo Clinic Staff, 2011b).
5.8 Developmental Red Flags and Where to Get Help
Red flags during infancy should be attended to immediately. As described in this chapter, infants develop quickly and profoundly in the first year. If there is a highly unusual pattern of development or a significant delay in expected progress, time is of the essence. For example, if certain reflexes do not disappear approximately within the typical timetable, it could be a sign of neurological problems. If an infant does not respond or pay attention to sounds or moving objects, the senses may not be functioning properly. If this is the case, progress in the cognitive, motor, social-emotional, and communication domains is likely to be affected. Also, if the infant loses skills rather than gains skills in the various domains, a red flag should be raised. For example, if a child had previously turned to look at an individual calling her name, and this no longer occurs, this could be cause for concern for both the sense of hearing and the infant’s social-emotional development. The child’s pediatrician is often the first professional contacted with any of these concerns. This physician may refer the infant to a developmental specialist or to another health care specialist. If the concern is minor, the specialist may recommend watchful waiting, or early intervention screening and assessment may be the route to take.
Developmental Milestones: Assessing Development in Infancy
Using observation of infants allows caregivers to identify how they are progressing developmentally in all developmental domains.
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Critical Thinking Questions
What do you see as the benefits of observing children in their natural environment?
What might it be an advantage to partner with parents?
The following red flags should be attended to by the end of the infant’s first 6 months:
Has poor muscle strength in lifting or controlling the head
Does not respond to noises or lights
Has inadequate weight gain
Has extremely tight or floppy muscles
Uses only one arm or one leg
Does not laugh
Red flags for infants ages 6 months to 1 year include the following:
Poor eye contact
Makes only a few sounds or none at all
Does not roll over or sit
Does not mouth objects
Does not have object permanence
Does not gesture or point to things
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