1© 2009 by the McGraw-Hill Companies, Inc

Birth and Physical Development

During the First Three Years

Chapter 4

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Did You Know…

In 1900, only 5% of expectant mothers in the US gave birth in hospitals, as compared to 90% today?

Baby boy’s deliveries are more likely to involve complications than baby girls?

At about 30% of all births, the cesarean rate in the US are the highest in the world?

In the industrialized world, smoking during pregnancy is the leading cause of low birth weight?

Worldwide, about 8 million infants die before their first birthday? Cultural practices such as how much freedom babies have to

move around can affect at what age they begin to walk?

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3 © 2009 by the McGraw-Hill Companies, Inc

Research in Action: Shaken Baby Syndrome

A form of maltreatment of children under two years of age

20% of babies with head trauma die within a few days

Usually a result of caregiver frustration and stress

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Guideposts for Study

How has childbirth changed in developed countries? How does labor begin, what happens during each of

the three stages, and what alternative methods of delivery are available

How do newborn infants adjust to life outside the womb, and how can we tell if a new baby is developing normally?

What complications of childbirth can endanger newborn babies, and what are the prospects for infants with complicated births?

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Guideposts for Study

What factors affect babies’ chances of survival and health?

What influences growth, and how do the brain and the senses develop?

What are the early milestones in motor development, and what are some influences on motor development?

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Generations of Childbirth Customs

Pre 20th Century:– Birthing was a modest ‘female only’ ritual

The woman, assisted by female relatives or neighbors, gave birth in her bed or perhaps the stable

– Use of midwives was predominant Midwives had no formal training, she offered “advice,

massages, potions, etc After the baby emerged the midwife would cut the

umbilical cord. A peasant mother would be back at work within a few

hours or death. More affluent mothers could take several weeks off.

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– Death rates high for mother and baby Mothers and babies had a high chance of death

– In 17th and 18th century France women had a 1 in 10 chance of death during childbirth

– 1 out 4 babies died in first year

Modern Generations: Dramatic reductions in death rate due to:– Antibiotics– Prenatal care

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‘Humanizing’ Childbirth: A Social Trend

Home births have brought back intimacy of event

Birthing centers & hospital– Soft lights– Father or partner as coach– Baby stays in room– What are your thoughts about at home births?

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Birth Process

Parturition – brings on labor– Begins 2 weeks before delivery– Uterine contractions– Cervix becomes flexible– Stimulated by rising estrogen levels

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3 Stages of Vaginal Childbirth

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Stages of Childbirth

First: Longest, typically 12-14 hours for first child, cervix dilates– Cervix is dilated by regular and increasing uterine

contractions Second: 1-2 hours, contractions stronger and

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

Third: 10-60 minutes, placenta and umbilical cord expelled from mother

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Cesarean Delivery

Surgically removing baby from uterus through abdomen Almost 30% of all USA births Often used when labor progresses slowly Changing preferences among women and some physicians Cesarean Sections amongst women who are not at risk and

with no previous c-section have doubled between 1991 and 2003.

Common with: First and/or large babies Older moms Mothers with previous C-sections

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Unmedicated Delivery

Natural Childbirth� Mother receives training in fitness, breathing and

relaxation

Traditional cultures - Use of ‘doula’ � Experienced helper provides emotional support to mother

Prepared Childbirth– Lamaze– Mother learns to substitute other responses for feelings

of pain

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Medicated Deliveries

Local or regional anesthesia– Blocks pain receptors in brain

Relaxing analgesic

Approximately 60% of women choose pain relief during labor

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Size and Appearanceof the Newborn

Average neonate is: o 20 inches longo 7.5 pounds

Fontanels – soft plates of head Lanugo – fuzzy prenatal hair Vernix caseosa – oily protection

against infection

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Body Systems of the Newborn

Breathing: Anoxia (lack of oxygen) or hypoxia (low oxygen supply) can lead to birth trauma

– Typically occurs when baby is not breathing correctly right after delivery Meconium

Stringy waste in fetal intestinal tract, which is secreted during the first few days of birth

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

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Assessments: Apgar ScaleUsed to Assess Babies One Minute After Delivery

Sign 0 1 2

Appearance Blue & PaleBody Pink, Limbs Blue

All Pink

Pulse Absent Slow (<100) Rapid

Grimace None GrimaceCoughing &

Crying

Activity Limp Weak Strong

Respiration Absent Irregular, slow Good, Crying

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Assessments: Brazelton NBAS

Tests responses to physical and social environment– Motor organization– Reflexes– Attention and interactive capacity– CNS instability

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Neonatal Screening Tests

Help detect correctable disorders– PKU: enzyme disorder that leads to

retardation unless fed a special diet for the first 3 to 6 weeks of life

– Hypothyroidism

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Infant Arousal States

State Eyes Breathing Movement

Regular Sleep Closed Regular, slow None

Irregular Sleep Closed Irregular Twitching

DrowsinessOpen or closed

Irregular Some activity

Alert Inactivity Open Even Quiet

Wakeful and Crying

Open Irregular Much activity

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Childbirth Complications

Birth trauma Postmaturity

– Not going into labor 42 or more weeks after gestation– These babies may not get enough blood supply towards the end of gestation– Can lead to brain damage or death

Prematurity– Preterm birth is involved in nearly half of neurological birth defects, such as

cerebral palsy, and more than 1/3rd of infant deaths.

Low birthweight– Prematurity & low birth weight together are the second leading cause of death

in infancy in the US

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Low Birthweight

Weighing less than 5 ½ lbs. Very low birth weight - less than 3 ½ lbs. 15.5% of all births, most in developing

countries Prematurity and low birth weight are the 2nd

leading cause of infant death, after birth defects

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Maternal Traits That Increase Risk of Low Birthweight

Underage or over-ageUneducated and poorPoor nutritionSmoking and drinkingStress Infections and high blood pressure

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Immediate Treatment for Prematurity

Intravenous feeding Isolette – controlled environment,

like an incubator Kangaroo care

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Long-term Outcomes ofLow Birthweight

Greater risk of:– Neurological and cognitive impairment– Lower academic achievement– Social, behavioral, and attention problems

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Postmaturity & Stillbirth

Postmature: 42 weeks or moreStilbirth: Death of fetus at or after

20th week of gestationReduction may be due to fetal monitoring

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Overcoming Birth Complications

Higher family SESQuality early environmentEducational day careEducating parents about

children’s health

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Protective Factors for Development

Individual traits– Sociability– Intelligence �

At least one supportive adult in child’s life Child has a ‘sense of

meaning’Rewarded at school or work

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Death During Infancy

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Death During Infancy

Primary causes worldwide:– Preterm delivery– pneumonia– Asphyxiation at birth

Birth defects are leading cause in the U.S. Improvement in U.S. infant mortality rates

likely due to SIDS awareness

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SIDSSudden Infant Death Syndrome

‘Crib Death’ Sudden death of infant under 1 year of age Cause of death unexplained May have underlying biological defect

(heart gene mutations) May be associated with sleeping on

stomach

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Deaths from Injuries

90% of injury deaths in infancy due to:– Suffocation– Motor vehicle accidents– Drowning– Residential fires or burns

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Immunizations

About 90% all children today are vaccinated

Some regions are better vaccinated than others

No causal connection between vaccines and autism or other disorders

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Proportions of Physical Growth

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Growth: Height and Weight

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Nutrition: Breastfeeding

Breast milk almost always the best food– More digestible– Reduces allergic reactions– Minimizes numerous infections– May reduce risk of SIDS– Better cognitive performance

Recommendation is babies exclusively breastfeed for 6 months

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Bottle Feeding

Formula should be iron-fortified

Necessary for women with infectious illnesses

Does NOT reduce emotional bonding between mother and baby.

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Other Nutritional Concerns

Solid food introduced 2nd half of first year Malnutrition Overweight

6% of US infants classified as overweight Parental obesity strong predictor

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Brain Growth

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Parts of the Brain

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Brain Cells

Neurons: Send and receive information

Glia: Nourish and protect neuronsNeurotransmitters: Chemical

messengersMyelination: Fatty substance helps

send faster signals

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Role of Experiencein Brain Development

Postnatal brain is molded by development ‘Plasticity’ Threats

� Sensory impoverishment

�Malnutrition Corrective experiences can relieve past

deprivations

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Early Senses of Touch & Pain

Touch– First sense to develop– Rooting reflex– Able to experience

pain at birth

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Early Senses of Smell & Taste

Begins to develop in wombNewborns prefer sweet tastesFluids and odors may be transmitted

through amniotic fluid

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Nature v. Nurture?

Odor preference requires experience� Six-day-olds prefer mother’s breast pad to

another nursing mother’s

Certain tastes are innate� Sweetened water calms crying newborns,

whether full-term or premature

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Sense of Hearing

Functional before birthThree-day-olds can tell new

speech sounds from ones they’ve already heard

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Sense of Sight

The sense least developed at birth 20/20 reached by about 6 monthsBinocular vision (depth) develops

around 4.5 months

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Milestones of Motor Development

SkillAge 90% of Children

Master

Rolling over 5.4 months

Grasping rattle 3.9 months

Standing alone 13.7 months

Walking well 14.9 months

Building tower of cubes 20.6 months

Copying circle 4 years

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Walk & Gibson: The Visual Cliff

Do infants perceive depth?Six-month-old babies would

approach ‘ledge,’ but avoided ‘drop’

Demonstrated ‘depth perception’

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Thelen’s Dynamic Systems Theory

Learning occurs through detecting the many features of an environment

With experience, babies learn to gauge their environment– Is that ball moving away from me?– Is that ground too

rough to walk on?

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Cultural Influences on Motor Development

Depends on the pace of the culture African and West Indian cultures

actively encourage early motor strength� Bouncing and stepping exercises

Other cultures discourage…� Ache mothers pull infants

to their laps when they crawl away

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Research in Action: Autism

Brain disorder Lack of normal social interactions Impaired communication Repetitive movements Restricted range of activities and interests

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Early Signs of Autism

Very early signs:– No joyful gazing at parent or caregiver– No back and forth babbling between infant and caregiver– Not recognizing parent’s voice– Failure to make eye contact– Delayed onset of babbling (past 9 months)– No or few gestures (pointing, waving)– Repetitive movements with objects

Later Signs:– No single words by 16 months– No babbling, pointing or communication gestures by 1 year– No 2 word phrases by 2 years– No language skills at any age

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