Prenatal Influences, Birth, and Neonatal Development PDF

Chapter 3 -- Prenatal influences, birth and neonatal development ================================================================ Prenatal environmental influences --------------------------------- - 50% of congenital abnormalities are unknown - External factors that have a negative impact on...

Chapter 3 -- Prenatal influences, birth and neonatal development ================================================================ Prenatal environmental influences --------------------------------- - 50% of congenital abnormalities are unknown - External factors that have a negative impact on the development on an unborn child is known as teratogen - Teratogens influence dependent on: - Time of exposure - Genetic vulnerability - Degree/intensity - Each teratogen unique effects on unborn - Damage not always evident at birth Environmental factors that could negatively affect development -------------------------------------------------------------- - Age of the parents - Nutrition of the mother - Radiation - Infectious disease during pregnancy - Using medication of drugs - Emotional state of the mother Age of the parents ------------------ - Between 20 and 35 is a healthy age group - Teenage moms especially at risk (especially younger than 15) - Over 35 first time mothers and previous mothers older than 40 have longer more difficult birth processes - Over 35 good physical, nutritional and psychological condition is helpful - Paternal age also important (general guideline -- younger than 40 more healthy babies) Nutrition of mother ------------------- - The nutrition of the mother is important because the unborn child is completely dependant on the mother. - Malnutrition - Is the lack of proper nutrition. This means that the mother is taking in too little food or the diet is unbalanced (too little protein and vitamins). - The most common abnormalities linked to malnutrition of the mother are the risk of a stillbirth, low birth weight of the baby, premature births, deformities, delayed growth, and death in the 1st year). - The South African Health Systems Trust reported that if we eliminate malnutrition, there would be a 10--15 point increase in the populations IQ. - Overnutrition - Is the result of eating excessive amounts of calorie-rich foods that usually leads to maternal overweight and obesity Radiation --------- - WWII - Physical deformities, heart diseases and stillbirths, various systemic diseases (e.g. leukemia and physical deformities) - X-rays and other radiation can adversely influence a vulnerable unborn (especially between 10 days and 10 weeks) - The reason for the above is that cells that are in the process of division and differentiation are more susceptible than 'adult' cells Infectious disease during pregnancy ----------------------------------- - Most cases, the unborn baby is not affected by the illness the mother has because viruses and bacteria cannot enter the placenta - However, in some cases they do manage to get into the placenta - Diseases that may be transmitted to the baby include: - Rubella - AIDS - Syphilis - Genital herpes Medication and drugs -------------------- - Golden rule - do not take prescription drugs - Fetal tobacco syndrome - Fetal alcohol syndrome (FAS) (exact dangerous boundary not clearly known) - Illicit drugs (heroin, morphine) Emotional state of the mother ----------------------------- - Release of adrenaline and noradrenaline - Stress empirically linked with variety of prenatal difficulties (spontaneous abortions, premature birth, low birth weight & difficulties during delivery) - Influence of anxiety -- research shows a possible link between ADHD and anxiety. Natural birth ------------- - From dilation (going into labour) to birth - First birth usually longer - 3 stages: - cervix dilates - baby emerges - afterbirth - 3 types of procedures to reduce pain during child birth: - Narcotics and tranquiliser - Epidural - Spinal block - In many sub-Saharan African areas the use of traditional and herbal medication is also used Caesarean --------- - Usually recommended with complications or when labour fails to progress (breech baby, head too big) - Rates in SA approximately 75% - Justified, but: - Infant mortality rate higher - Chances of complications for mother higher - Hospitalisation longer - No effect on mother-baby interactions or psychosocial functioning of infants Childbirth complications ------------------------ - The most common complications are: - Anoxia (also known as asphyxia and hypoxia) - Low birth weight - Premature birth Neonatal phase (birth to 4 weeks) --------------------------------- - Physical appearance - Assessment - Adjustment to basic life processes - Perception - Sleep and dreaming - Feeding - Learning Physical appearance ------------------- - Physical appearance not always very attractive - Head size about one quarter of body length - Proportions (legs and hands seem too short) - Weight: usually between 2.5 -- 4.5kg - Length: 45 -- 56cm - Heart Rate (HR): 80-170 depending on whether at rest or crying Assessment of newborn --------------------- - Apgar Scale (Virginia Apgar, 1953) - 1min after birth and again at 5 min after birth - Body colour (Appearance) - Heartbeat (Pulse) - Reflex irritability (Grimace) - Muscle Tone (Activity) - Breathing (Respiration) Adjustment to basic life processes ---------------------------------- - Blood Circulation (blood forced to lungs for the first time) - Respiration (starts automatically) - Digestion (takes over gradually and initially no established hunger cycle) - Temperature Regulation - Nervous system - Immunity Adjustment to basic life processes (nervous system) --------------------------------------------------- - Reflexes play central role in survival of neonate - Between 20 and 100 reflexes have been described in literature - Babinski reflex - If you stroke the sole of the baby's foot, the toes spread out like a fan - Disappears between 6 and 12 months - Moro reflex - If you introduce a sudden intense stimulus like a loud noise, the baby stretches out arms and legs, brings arms back to the midline as if to self embrace - Disappears after about 4 months - Rooting reflex - If you stroke baby's cheek, baby's head will turn to the direction of the stimulus and begin to suck - Disappears after about 5 months - Sucking reflex - If you place your finger in the baby's mouth or on the baby's lip, baby will start sucking - Grasping reflex - If you touch the palm of the baby's hand, baby will grasp the object firmly - Disappears after about 4 months - Walking/ Stepping reflex - If you hold baby up vertically with his/her feet touching a horizontal surface, baby will make 'walking' movements - Disappears at 3 months - Swimming reflex - When baby is placed with his/her stomach under water, baby will make swimming movements Perception ---------- - Vision - Functional and complete at birth but not fully developed - Cannot distinguish well between colours (cells for colour perception not mature) - Hearing - Can distinguish mothers voice within hours after birth - Smell - Can perceive and distinguish - Taste - Can detect taste from their mother's milk - Pain - If not well managed may lead to permanent damage Other developments of neonatal phase ------------------------------------ - Sleeping and dreaming - Anywhere between 16-18 hours a day - Spend about 50% in REM sleep (adult is about 20%) - Feeding - Between 8 to 14 times a day - Intervals 1.5 and 5 hours - Ongoing debate on breastfeeding vs bottle feeding - Learning - Classical and operant conditioning - Imitation -- neonate can imitate particular facial expressions like sticking out their tongues and opening their mouths. 36 hours after birth, neonates can also imitate facial expressions e.g. sorrow, joy & surprise - Temperament - Some differences noticeable even before birth Infancy ------- - From neonatal phase until 2 years old - Areas of development: - Physical - Cognitive - Personality - Social - Physical development - Head grows more slowly than the rest of the body - Weight - Doubles every 4-5 months in first year - Slows down during second year - Height -- 72cm - Closure of fontanel - Teeth -- 6-8months WHO Neural Dev - Perceptual development - Depth perception (6-14 months) - Visual cliff - Babies between 44 and 115 days? - Visual constancy (18 weeks) - Visual acuity (adult like at 12 months) - Auditory perception (reasonably well developed at 6 months) - Intrasensory integration (about 5 months) - Cognitive development - At this point in an infant's life, the infant goes from 'mindlessly' grasping objects to actively using them in a constructive way, such as building towers - Piaget's theory - Believed children naturally try to make sense of their world - Children act like scientists in creating theories about their physical and social worlds - Theories tested by experience - If predicted event happens, theory grows stronger - Children go through 4 distinct stages of cognitive development, and each stage represents a fundamental change in how children understand and organise their environment - Each stage characterised by sophisticated type of reasoning - 6 substages of sensorimotor stage(reflexes, primary circular reaction, secondary circular reactions, coordination of secondary reactions, tertiary circular reactions and mental representation ) Piaget's 4 stages of cognitive development ------------------------------------------ - Sensorimotor stage - Birth -- 2 years - Understanding of world acquired through senses and movement - E.g. looking and grasping - Object permanence develops -- child begins to realise that physical object can exist even if not in view - Preoperational stage - 2 -- 6 years - Start to use language and symbols (e.g. Pictures and words) to represent ideas and objects - Animism (all lifeless objects have feelings/thoughts) and egocentric thinking develop - Concrete operational thought stage - 7 -- 11 years - Logical thinking develops, but applies to real, concrete objects - Abstract thinking is largely absent - Formal operational thought - 12 and older - Abstract thinking, speculates on hypothetical situations and reasons deductively about what may be possible The sensorimotor stage ---------------------- - Reflex stage - 0-1month - Reflexes to explore environment - Mainly responsive - Primary circular reaction stage - 1-4 months - Repetitive actions centred on own body - Secondary circular reaction stage - 4-8 months - Actions are now more focused on environment - Co-ordination of secondary themes stage - 8-12 months - Intentional actions to achieve goals - Tertiary circular reactions stage - 12-18 months - Infant begins to experiment to determine the effects of their actions - Symbolic representation via mental combinations stage - 18-24 months - Insight and creativity starts to develop Object permanence ----------------- - This is the understanding that objects (including people) continue to exist even when they cannot be seen anymore - Before 8 months: out of sight, out of mind - However, develop the ability to understand that an object under a blanket can be discovered Imitation --------- - Imitation: the ability to copy someone else's behaviour - This means that an infant can now form a mental image of someone's facial expression, for instance, and then copy it - 18-24 months (sub stage 6): deferred imitation -- can imitate a facial expression a day after seeing it Criticism of Piaget's viewpoint ------------------------------- - Research has found that infants develop object permanence as young as 4 months. - Imitation: have discovered that newborns can even imitate facial expressions - Also, deferred imitation starts much earlier and can last longer -- as much as 2 days