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Chapter 4
PS3313

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CHAPTER 4

 DEVELOPMENT DURING THE FIRST THREE YEARS

 

WHAT ARE THE FOUR STAGES OF CHILDBIRTH?

 

(1) Dilation of the cervix

 

(2) Descent and emergence of the baby

 

(3) Expulsion of the umbilical cord and the placenta

 

(4) Contraction of the uterus and recovery of the mother

 

During each of theses stages a process called electronic fetal monitoring is widely used (and may overused) during labor and delivery. It is intended to detect signs of fetal distress, especially in high-risk births.

 

WHAT ALTERNATIVE METHODS OF DELIVERY ARE AVAILABLE TODAY?

 

Cesarean Delivery  Almost 21 percent of births in the United States are by Cesarean Delivery.  Critics claim that many cesareans births carry special risks to mother and baby most are not necessary.

 

Natural Childbirth This process can minimize the need for pain-killing drugs and maximize parents active involvement.

 

Modern epidurals can give effective pain relief with smaller doses of medication than in the past.

 

Delivery at home or in birth centers, and attendance by midwives, are alternatives to physician-attended hospital delivery for women with normal, low-risk pregnancies who want to involve family members and make the experience more intimate and personal. 

 

HOW DO NEWBORNS ADJUST TO LIFE OUTSIDE THE WOMB?

 

 

An average newborn in the United States is about 20 inches long and weighs about 7 pounds.

 

 

The first four weeks of life, called the neonatal period, is a time of transition from intra-uterine to extra-uterine life. During the first few days, the neonate (newborn) loses weight and then regains it. 

 

 

At birth, the circulatory, respiratory, gastrointestinal, and temperature systems become independent of the mother’s. If a newborn cannot start breathing within about 5 minutes, brain injury due to anoxia (lack of oxygen) may occur. Spank  

 

Neonatal Juandice: A yellowing of the eyeballs and skin caused by immaturity of the Liver.  (Fairly common in newborns and not considered dangerous).

 

 

WHAT COMMPLICATIONS OF CHILDBIRTH CAN ENDANGER NEWBORNS

 

 

Birth trauma (difficult delivery)

Low birth-weight

Post-mature (Pre-term or Premees)

Although the infant mortality rate in the United States has improved, it is still disturbingly high, especially for African American babies.  Birth defects are a primary cause of death in the first year, for black infants, low birth weight is the leading cause.

 

 

                    LOW BIRTHWEIGHT      VERY LOW BIRTHWEIGHT      INFANT MORTALITY RATE

                          LESS THAN             LESS THAN                            PER 1,000

                           5.5 POUNDS             3.3 POUNDS                                                                   

 

 

BLACKS              13.0                          3.06                                          14.1                                                                                                                       

 

WHITES                6.6                          1.13                                            5.7                                                        

 

HISPANICS          6.4                           1.14                                            5.6                                                     

 

 

See Table 4.3 page 119 (Birth weight, Mortality and Race)

 

In your opinion, what might accounts for the above differences?

 

 

 

 

 

 

POSSIBLE FACTORS AS LISTED IN THE TEXT INCLUDE:

 

 

BEING UNDER AGE 17 OR OVER AGE 40

POOR

UNMARRIED

UNDEREDUCATED

MEDICAL (Hypertension)

POOR NUTRITION

INADEQUATE PRENATAL CARE

SMOKING

USE OF ALCOHOL, DRUGS, OR EXPOSURE TO STRESS

Sudden infant death syndrome (SIDS) is the third leading cause of death in infants in the United States.  Exposure to smoke and sleeping in the prone position are major risk factors.

 

Because we know the first few minutes, days, and weeks are crucial for development in infants, it is important to have tests to detect as soon as possible any problems that might need special attention.

 

TWO TESTS THAT ASSESS IMMEDIATE HEALTH CONDITION OF INFANTS ARE

 

*   Apgar Scale  (see Table 4.3 page 117 text)

*   Neonatal Behavioral Assessment Scale

 

Apgar Scale is a test that is administered 1 minute after delivery and 5 minutes after birth to assess babies appearance, pulse, grimace, activity and respiration.

 

Brazelton Neonatal Behavioral Assessment Scale (NBAS) is a Neurological and behavioral test to measure neonate’s response to the physical and social environment.

 

 

PHYSICAL DEVELOPMENT

(FIRST THREE YEARS)

 

A child’s body grows most dramatically during the first year of life; growth proceeds at a rapid but diminishing rate throughout the child’s first 3 years.

GROWTH

 

Children grow faster during the first 3 years of life than at any other time.  At 5 months a baby’s weight usually has doubled since birth.

 

The brain grows most rapidly during the months before and immediately after birth as neurons migrate to their assigned locations, from synaptic connections, and undergo the process of integration and differentiation.

 

Growth occurs from the top down.  The head which is largest at birth becomes proportionately smaller as the child grow in height, See Figure 4.3 page 126 text.

 

 

 

INFLUENCES ON GROWTH

 

 

The genes an infant inherits have a strong influence on growth determining whether one is  tall, short, stocky or thin.

 

These genetic influences interact with environmental factors such as nutrition and living conditions.  Example:

 

Japanese American children are taller and weight more than Japanese children of the same age born in Japan

(probably because of diet)

EARLY SENSORY CAPACITIES

 

 

Touch seems to be the first sense to develop and mature.  Newborns are sensitive to pain.  Smell, taste, and hearing also begin to develop in the womb.

 

Vision is the least well developed sense at birth.

 

Environmental factors, including cultural practices, may affect the pace of early motor development.

 

 

 

NEWBORN’S SENSORY CAPACITIES

(WHAT CAN NEWBORNS  DO?)

 

 

VISION       HEARING       SMELL       TASTE       TOUCH

Focus and See               Can Coordinate Listening     Can tell the difference    Can tell the                This sense is present

Contrast in lst week      and looking at birth               difference between         difference between     when the Fetus is in          

                                                                                     certain odors which       Sweet, Bitter, Sour      the Womb.

Prefer bright moving                                                    Is indicated by a            Salty solutions                                           

objects                                                                         change in respiration                                                                           

                                                                                                                                                                                                    

Look at Mothers        Turns head toward                                                                                                                                                                                                                                                                 

face longer than        sounds they hear                                                                                                                                                                                                                                                           

other objects               

 

 

By the time small children can run, jump, and play with toys requiring sophisticated coordination, they are very different from, the neonates we described at the beginning of this chapter.

 

 

A final thought before we close this chapter centers around Breast Feeding and the role it may or may not play in Physical Development.

 

 

BREAST FEEDING AND ITS BENEFITS

 

 

Research show that breast feeding offers many benefits (helps immune system, assist in mother child bonding, etc.).  However, the quality of the relationship between parents and infant maybe more important than the feeding method in promoting healthy development.  (About 25% of women breast feed in 19971).  However, now that the results are out concerning the benefits of breast feeding, about 70% of new mothers breast feed at least for the first 4 to 6 months.

 

 

DID YOU BREAST FEED?  WHY OR WHY NOT?

 

 

 

 

In this chapter we have discussed the Physical Development during the first three years.

 

The Cognitive changes that have taken place between birth and 3 years are equally dramatic, as we will discuss next week in Chapter 5

 

 

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