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Psychosocial Development During the First Three Years


THE BIRTH PROCESS

Guidepost 1: What happens during each of the four stages of childbirth?

  • Birth normally occurs after a preparatory period of parturition and consists of four stages: (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.
  • Electronic fetal monitoring is widely used (and may be overused) during labor and delivery. It is intended to detect signs of fetal distress, especially in high-risk births.

Guidepost 2: What alternative methods and settings of delivery are available today?

  • About 23 percent of births in the United States are by cesarean delivery--an unnecessarily high rate, according to critics.
  • Natural or prepared childbirth 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. The presence of a doula can provide physical benefits as well as emotional support.
THE NEWBORN BABY

Guidepost 3: How do newborn infants adjust to life outside the womb?

  • The neonatal period is a time of transition from intrauterine to extrauterine life. During the first few days, the neonate loses weight and then regains it; the lanugo (prenatal hair) falls off and the protective coating of vernix caseosa dries up. The fontanels (soft spots) in the skull close within the first 18 months.
  • At birth, the circulatory, respiratory, gastrointestinal, and temperature regulation systems become independent of the mother's. If a newborn cannot start breathing within about 5 minutes, brain injury may occur.
  • Newborns have a strong sucking reflex and secrete meconium from the intestinal tract. They are commonly subject to neonatal jaundice, due to immaturity of the liver.
  • A newborn's state of arousal is governed by periodic cycles of wakefulness, sleep, and activity, which seem to be inborn. Sleep takes up the major, but a diminishing, amount of a neonate's time. Newborns' activity levels show stability and may be early indicators of temperament. Parents' responsiveness to babies' states and activity levels is an important influence on development.
SURVIVAL AND HEALTH

Guidepost 4: How can we tell whether a new baby is healthy and is developing normally?

  • At 1 minute and 5 minutes after birth, a neonate's Apgar score can indicate how well he or she is adjusting to extrauterine life. The Brazelton Neonatal Behavioral Assessment Scale can assess responses to the environment and predict future development.
  • Neonatal screening is done for certain rare conditions, such as PKU and congenital hypothyroidism.

Guidepost 5: What complications of childbirth can endanger newborn babies' adjustment or even their lives?

  • A small minority of infants suffer lasting effects of birth trauma. Other complications include low birthweight and postmature birth.
  • Low-birthweight babies may be either preterm (premature) or small-for-date (small-for-gestational age). Low birthweight is a major factor in infant mortality and can cause long-term physical and cognitive problems. Very-low-birthweight babies have a less promising prognosis than those who weigh more.

Guidepost 6: How can we enhance babies' chances of survival and health?

  • A supportive postnatal environment and other protective factors often can improve the outcome for babies suffering from birth complications.
  • Although infant mortality has diminished, it is still disturbingly high for African American babies, who are more likely to have low birthweight.
  • Sudden infant death syndrome (SIDS) is the leading cause of death of U.S, infants after the first month. Major risk factors include exposure to smoke and, prenatally, to caffeine, and sleeping in the prone position.
  • Vaccine-preventable diseases have declined as rates of immunization have improved, but many preschoolers are not fully protected.
EARLY PHYSICAL DEVELOPMENT

Guidepost 7: What influences the growth of body and brain?

  • Normal physical growth and sensory and motor development proceed according to the cephalocaudal and proximodistal principles.
  • A child's body grows most dramatically during the first year of life; growth proceeds at a rapid but diminishing rate throughout the first 3 years.
  • Breastfeeding offers many health advantages and sensory and cognitive benefits, but only about two-thirds of mothers begin breastfeeding.
  • Obese babies are not at special risk of becoming obese adults, unless they have obese parents. However, too much fat and cholesterol intake may lead to eventual cardiac problems.
  • Sleep patterns change dramatically; by the second half of the first year, babies do most of their sleeping at night. Cultural customs affect sleep patterns.
  • The central nervous system controls sensorimotor activity. Lateralization enables each hemisphere of the brain to specialize in different functions.
  • The brain grows most rapidly during the months before and immediately after birth as neurons migrate to their assigned locations, form synaptic connections, and undergo integration and differentiation. Cell death and myelination improve the efficiency of the nervous system.
  • Reflex behaviors--primitive, locomotor, and postural--are indications of neurological status. Most early reflexes drop out during the first year as voluntary, cortical control develops.
  • Especially during the early period of rapid growth, environmental experience can influence brain development positively or negatively.

Guidepost 8: When do the senses develop?

  • Sensory capacities, present from birth and even in the womb, develop rapidly in the first months of life. Very young infants show pronounced abilities to discriminate between stimuli.
  • 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. Peripheral vision, color perception, acuteness of focus, binocular vision, and the ability to follow a moving object with the eyes all develop within the first few months.

Guidepost 9: What are some early milestones in motor development, and what are some influences on it?

  • Motor skills develop in a certain sequence, which may depend largely on maturation but also on context, experience, and motivation. Simple skills combine into increasingly complex systems.
  • Self-locomotion seems to be a "setting event," bringing about changes in all domains of development.
  • Perception is intimately related to motor development. Depth perception and haptic perception develop in the first half of the first year.
  • According to Eleanor and James Gibson's theory of ecological perception, awareness of affordances affects infants' and toddlers' ability to get around.
  • Environmental factors, including cultural practices, may influence the pace of early motor development.










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