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NEWBORN
PERIODS OF GROWTH
Prenatal 0-280 days AOG Neonatal 0-28 days Infancy Early Infancy Late Infancy 1-2 years 2-12 months 12-24 months Preschool 2-5 years old School age 6-10 years old Adolescent 10-19 ears old NEWBORN Marked physiologic transitions occur in all organ systems Parent’s role in the developmental status Prenatal factors Unplanned/unwanted pregnancy Childhood experience Prenatal risk factors for attachment Recent death of a loved one Previous loss of or serious illness in another child Prior removal of a child History of depression or serious mental illness History of infertility or pregnancy loss Troubled relationship with parents Financial stress or job loss Marital discord or poor relationship with the other parent Recent move or no community ties No friends or social network No good parenting model Experience of poor parenting Drug and/or alcohol abuse Extreme immaturity Social support Father and family members Peripartum and postpartum influences Labor Early skin-to-skin contact Mother-child interaction Infant-parent bonding Assessment of intrauterine growth BW, BL, HC AGA, SGA, LGA (+/-) intrauterine growth retardation Posture Flexion and adduction of the hips Flexion of the knees Arms are adducted and flexed at the elbow Fists are clenched with the thumb concealed by the fingers Interactional abilities
Alert, ready to interact and nurse soon after birth Nearsighted, fixed focal length of 8-12 inches Hearing is well-developed Initial period of interaction → 40 mins → somnolence behavioral states (brazelton) six states: o Quiet sleep: No movement, regular breathing o Active sleep: w/ eye movements, hypotonia, irregular breathing o Drowsy: eyes closed or half open, with slight activity o Alert: open eyes, alert with some movement o Fussy: awake w/ plenty of movement o Crying: fully awake and crying Determines an infant's muscle tone, spontaneous movement, EEG pattern, response to stimuli Neurodevelopmental exam is best done in states 3 or 4 Latching-on provides a opportunity to assess state Rooting, licking, sucking → reflects infant level of responsiveness First 24 hours - unstimulated crying is infrequent Modulation of arousal Adapt to extrauterine life - lungs, circulation, GIT Must become aroused to in response to stimulation Underarosued: not able to feed and interact Overaroused: sign of autonomic instability Mutual regulation
- Between mother and newborn infant
- Infants signal - hunger - letdown of milk or bottle
- Basis of psychologic relationship
- Social interaction - lay the foundation for cognitive and emotional development *THE FIRST YEAR 0-2 MONTHS Weights decreases 10% below BW during the first week
- Excretion of excess extravascular fluid, poor intake Regain or exceed BW by 2 weeks of age 30g (1oz)/day during the 1st^ month Limb movements: uncontrolled writhing, purposeless hand opening and closing Smiling is involuntary Eye gaze, head turning, sucking: demonstrates infants’ perception a cognition Crying peaks at 6 weeks of age – 3hr/day Visual, tactile, olfactory, auditory stimuli: support the development of cognition Habituate to the familiar
- Differentiate to similar patterns, colors
- Attend less to repeated stimuli Recognize facial expressions Development of basic trust (Erikson’s)
- Trusted adult: creates a condition for secure attachment Hunger – tension -crying – feeding – tension dissipates “on demand”, fixed schedule, parent’s convenience
- 2-6 MONTHS 3-4 months - 20g/day
o Orbit around their parents o Explore unfamiliar surroundings Emergence of attachment o Best assessed using “strange situations” o Child’s security of attachment is based on his or her response upon parent’s return Securely attached - go immediately to be picked up and return to play Not securely attached - resistant, angry Avoidant - do not protest Receptive language precedes expressive 12 months - first word (no, bye-bye, give me) 15 months - points to major body parts, uses 4-6 ords spontaneously (+) polysyllabic jargoning they are not upset that nobody seems to understand them *18-24 MONTHS Improvements in balance and agility Emergence of running and stair climbing Height and weight increase at a steady state End of sensorimotor period Object permanence firmly established at 18 months o Anticipate where an object will end up, even though it as not visible while it was moved Cause and effect are better understood Demonstrate flexibility in problem solving o Stick in reaching for toys Symbolic transformations in play are no longer to the child’s body (+) rapprochement at 18 months o Reaction to growing awareness of the possibility of separation o Usually end up in tantrums o They tend to use transitional objects Self-conscious awareness o E.g. toddlers fond of looking at the mirror, hand in broken toys for parents to fix Language - most dramatic developmental milestone at this age 18 months - 10-15 words 2 years old - > Combination of words to form sentences Understand 2 step commands Emergence of verbal language marks the end of sensorimotor period 15 months Walks alone, crawls up the stairs Makes tower of 3 cubes, inserts pellets in table Polysyllabic jargon
18 months Runs stiffly, sits on small chair, walks upstairs with one hand held Makes towers of 4 cubes, imitates vertical stroke Average of 10 words, names pictures, identifies body parts Feeds self, seeks help, kisses with pucker 24 months Runs well, walks up and down stairs one step at a time Tower of 7 cubes, imitates horizontal stroke 3 words together Handles spoon well 30 months (2.5 years) Goes up stairs with alternating feet Tower of 9 cubes imitates circular stroke Refers to self by “I,” knows full name 36 months (3 years) Rides tricycle, stand on one foot Tower of 10 cubes, copies a circle, imitates a cross Knows age and sex, counts 3 numbers 48 months (4 years) Hops on 1 foot, uses scissors to cut out pictures, climbs well Copies cross and square, draws a man with 2-4 parts Counts 4 pennies, tells a story 60 months (5 years) Skips Draws triangle from copy Names 4 colors, counts 10 pennies Dresses and undresses, domestic roleplaying *PRECHOOL YEARS PHYSICAL DEVELOPMENT 2 kg/year, 7 cm/year Weight in kg = age (in years) x2 + Height in cm = age (in years) x5 + Head in circumference - increase in ½ inch/year Abdomen flattens, body becomes leaner 11-13 hours of sleep/24 hours 3 years - 20/30 VA, 4 years - 20/20 VA Range of motor activities expands o Throwing, catching, and kicking balls, riding bicycles, climbing, dancing Toe walking - associated with developmental delays 3 years - handedness (attempts change hands preference → frustration) 2.5 years: emergence of bowel and bladder control : Daytime bladder precedes bowel control, girl precede boys Bed-wetting - normal - 4 years in girls, 5 years in boy *LANGUAGE DEVELOPMENT
Most rapid between 2-5 years old
Vocabulary - 50-100 words to >
Number of words in a sentence equals a child’s age
successful Social, emotional development → home, school, environment/community Popularity through possessions, personal attractiveness, accomplishments, social skills Social issue: family DEVELOPMENTAL DOMAINS
Does the child’s skills or behaviors differ significantly from his peers?
Does the child’s problem behavior occur frequently and persistently?
Has the child’s behavior occurred over a long period of time?
Motor skills
- Gross motor skills
● Dependent on brain maturity
● Weakest correlation to IQ
- Fine motor skills
Language skills
- Receptive language
- Expressive language
- Language delay is a part of most neuro-developmental problems
- Correlates IQ
Personal-social skills Cognitive/adaptive skills (development)
- Learn, understand, solve problems
- Verbal and non-verbal reasoning
- Meet daily living demands
Psychosocial development
- Personal: perform activities of daily living
- Social: interact, form and maintain relationships
BENEFITS OF EARLY IDENTIFICATION
Effect developmental change while the nervous system is still
malleable and responsive
Many causes of delay may be treated with satisfactory results
if detected early enough thus preventing further damage
Allows family members to feel that they are doing all they can
to assist the child Developmental screening ↓ Early recognition of developmental delay ↓ Early and appropriate intervention ↓ Help child achieve his OPTIMAL POTENTIALS RED FLAGS
● Motor delay
- Poor head control by 3 months
- Hands still fisted by 4 months
- Unable to hold objects by 7 months
- Does not sit independently by 10 months
- Cannot stand on 1 leg by 3 years
● Language delay
- Does not turn to sound by 6 months
- Does not babble or use gestures by 12 months
- No single word utterances by 16 months
- No 2-word phrases by 2 years
- No 3-word phrases by 3 years
● Psychosocial delay
- No social smile by 3 months
- Not laughing in playful situations by 6 months
- Hard to console, stiffens when approached by 1 year
- In constant motion, resists discipline
- Does not play with other children at 3 years
● Cognitive delay
- Not alert to mother at 2 months
- Not searching for dropped object at 9 months
- No object permanence at 18 months
- Does not categorize similarities at 2 years old
- Does not know full name at 3 years old
- Cannot count sequentially at 4 ½ years old
- Does not know letters or colors at 5 years old
- Does not know own birthday or address at 5 ½ years old
● School-age children
- Slow to remember facts
- Slow to learn new skills, relies heavily on memorization
- Poor coordination, unaware of physical surroundings and prone to accidents
- May be awkward and clumsy, and has trouble with fine motor skills
● Reading skills
- Slow in learning connection between letters and sounds
- Confuses basic words
- Makes consistent reading errors: letter reversals, letter inversion,
transpositions, word reversals, number reversals
- Repeats, omits, adds words
- Avoids reading allowed, does not like reading
- Uses finger to follow of print when reading
