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Prenatal Development and Birth Ira Kantrowitz-Gordon, PhD, CNM, ARNP Learning Objectives • Provide an overview of prenatal development, pregnancy, and birth • Understand social and psychological cultural contexts of pregnancy and fetal development Maternal Health U.S How are we doing? • We are not doing too well o 18/100,000 women die every year when pregnant § this statistic is increasing o highest in African American women • Preterm Birth: Global/Local o Local: 10-15% § We have the same value as sub Saharan Africa for preterm births § Again highest numbers for African American women • Unintended Pregnancy o 50% planned o 31% mistimed o 19% unwanted o Make more money > pregnancy that you are intended to have o More prevalent for unwanted/mistimed pregnancies in southern states Environmental Context • Exposures and Birth Defects o Embyotic development happens really fast! § Within the first 8 weeks the majority of the bodies organs have started to form • Early Prenatal Care Too Late? o A person does not get prenatal care till the fetal period (9ish weeks) Risks Related to Exposures • Most common exposures come from legal substances • Teratogenicity o Timing: § Earlier can be worse o Dose- threshold o Chronicity of exposure o Metabolism- § Genetically determined • Tobacco, ETOH, Cocaine o Each inhale of the cigarette affects the baby § Each inhale is a hit to the baby • Environmental toxins o Pesticides, heavy metals, industrial bi-products • Diagnostic testing o X-rays, radiopaque dyes o Causes exposure Medications Exposure Risks • Case studies are the only ethical way we can study these drugs and there effects Prescription • Accutane • Contraceptives o No negative effects on the child due to the similarities in hormones types and quantities • Anti-epileptics • Opiates o Babies can get addicted and can go through withdrawal when born Over the counter • Ibuprofen o Increases the risk of blastocyst implantation failing (sometimes) o Increase heart trouble • Pseudoephedrine o Increase blood pressure… Fetal Development Blastocyst § Fertilized egg rapidly divides § Overall no growth in size § Forms ball of cells § Implantation complete about 12 days after fertilization • Has an inner cell mass and cavity inside the trophoblast o The inner cell is what becomes the actual fetus • Implantation takes about 12 days Embryonic Stage • 2 to 8 Weeks after Conception • Neural tube develops. • Forms foundations of all body organs and systems • Many organs and systems begin to function. Fetal Stage • End of Week 8 until Birth • Growth from 1/4 ounce and 1 inch to 7 pounds and 20 inches in length • Refinement of all organ systems o Allows for a bit of outside functioning of the child • Neuronal proliferation o Axons are sent out throughout the body • Viable at Week 24; full-term at Week 39 o Able to stay alive • Early fetal development • Blastocyst to fetus PRENATAL BEHAVIOR/ BIRTH OUTCOME • Fetuses can differentiate between familiar and novel stimuli by 32 to 33 weeks. • Newborns can remember prenatal stimuli and react accordingly. o Reading a book to the belly at night o Causes a physiological calming when read the book after the baby is born • Very active fetuses tend to be active children o Can be labeled “hyperactive” later on in life Maternal Health • Why preconception health matters o This could bring up the idea that overall the health of women in the US is not the most important this would help explain the high birth mortality Chronic Illnesses • Examples o Diabetes (pre-gestational) § 1 in 4 o Epilepsy § Some of the medication are the causes o Lupus § Cause still births • Effects o Illness on pregnancy/fetus o Pregnancy on illness § Have to take in to account the health of the mother and the illnesses she has Pre-gestational diabetes Age • First pregnancies are occurring later—average age is now 25.1 years. • Women over 35 have higher risks for pregnancy complications. • Teenage mothers have higher risks during and after birth. • US rate 26.5 births/1000 women 15-19 (CDC) Obesity and Birth Outcomes • Gestational Hypertension, Diabetes • Macrosomia, shoulder dystocia • Cesarean birth • NICU admission • Stillbirth • Dose dependent effect Pre-pregnancy BMI Dutch Hunger Winter 1944-1945 • The Germans starved the Dutch population in the winter • Average calorie intake o 500-1000 kcal/day • Were able to follow the people who were born in those periods o Depending on the trimester that the baby was in when starved would show different levels of long term affects Developmental Programming • Recent research has suggested the influence of early life stress on the pathophysiology of depression later in life • Longitudinal study of anxiety in pregnancy and effects on offspring in 86 mothers; 68 children followed through age 14-15 o Antenatal exposure to maternal anxiety at 12–22 weeks pregnancy was in both sexes associated with a high, flattened cortisol day-time profile o This altered cortisol response was associated with depression in female adolescents • Optimal health of women in pregnancy and afterwards makes sense for women and children. Stress and Mental Health Rubin’s Developmental Tasks (hierarchy of needs) • Ensuring a safe passage through pregnancy and childbirth • Ensuring acceptance of child by significant persons in her family • Binding in to her unborn child • Learning to give herself (after birth) • Bonding with the baby o Fetal presence, growth, and movements become more part of the woman’s “experiential self” o Begin the work of bonding and attachment when the fetus becomes real § Hearing the heartbeat § Quickening § Ultrasound o Interacting with fetus Perinatal Mood Disorders (get in the way with bonding) • 7.4 – 12.0% of pregnant women experience a depressive disorder nd rd o Higher in 2 & 3 trimester • Pregnancy not protective for most mood and anxiety disorders. o Relapse rate 26% when antidepressants continued o Relapse rate 68% when discontinued • Diagnosis often missed due to failure to screen or disclose o It is seen that you should be happy when you are pregnant o Is not screened for in doctor appointments Balancing Risks • Depression o Maternal burden of illness o Miscarriage o Preterm birth, low birth weight o Child behavioral and psychological abnormalities • Antidepressants (SSRIs) o Heart defects (rare) o Persistent pulmonary hypertension (rare) o Neonatal withdrawal syndrome § transient irritability: common Neonatal Withdrawal Syndrome (Depression) • Transient (1-2 weeks) neonatal symptoms in <30% of late third trimester exposure to antidepressants • Increased or decreased muscle tone, irritability, jitteriness, hypothermia, abnormal breathing pattern, tremor, feeding problems • Discontinuing medication prior to delivery may increase risk of maternal relapse Long-Term effects of Antidepressants • Most studies do not suggest negative effects on child neurodevelopment with SSRIs exposure during pregnancy or breastfeeding • Child cognitive and behavioral status often poorly assessed, and mixed samples in many studies • Hard to separate effects of treatment from effects of underlying illne s Prenatal Care • Types of providers: Obstetricians, nurse-midwives, family physicians, maternal-fetal medicine, genetics counselors, social workers, etc. • Individual care or group care (CenteringPregnancy) o Monthly group visit for 2ish hours § Allows for more time in sharing, making friends, longer health info talks • Early prenatal care (1 trimester) • The Midwifery Model of Care o Recognizes the woman as a unique individual in context of her family and community o Supports and protects the normal physiologic process of labor and birth o Establishes the woman as active partner in her own care § Make the mother be active in her plan care • Goals of Prenatal Care o Health, education, and prevention § Monitor fetal growth and well-being • The mother is the best for information and drawing conclusions o Early detection of disease (gestational diabetes, hypertension) o Prevent stillbirth and birth injury o Prevent maternal mortality o Measuring fundal height § Cm = weeks pregnant o Electronic Fetal Monitoring § Check the babies health and brain § Do low risk stress test o Ultrasound information § Fetal anatomy § Fetal growth § Cervical length § Fetal well-being § Placenta/amniotic fluid • Tests o Blood type o Infections o Diabetes testing o Blood pressure § Some conditions can not be cured § The cure is to get the baby out (induced labor) o Urine protein • Genetic Testing o Options (quad screen, nuchal translucency, CVS, amniocentesis, NIPT) o Why do any of these? § To detect health issues/ birth defects § Knowledge for both health care and parents § To determine if you want to continue the pregnancy o How does it impact developing relationship? • Diagnostic Tests o Both CVS and amniocentesis are tools for sampling fetal cells § Some capture cells fro the fetus that is sloughed off or take cells from the placenta o Cell-free DNA testing § Some of the babies cells will actually makes its way into the mothers blood stream § These cells can be detected Labor and Birth • Labor: An Overview • 1 Stage o Contractions which effect progressive dilation of the cervix nd • 2 Stage o Pushing baby through the vagina and birth of the baby • 3 Stage o Birth of the placenta and umbilical cord THE THREE STAGES OF LABOR • Open the pelvis o Lunging and squatting • Ease the back o Hands and knees o kneeling • Upright o Standing swaying • 2 stage positions o “Women should be encouraged to give birth in comfortable positions, which are usually upright.” (Cochrane Database 2004) o don’t lie down on your back…. • “Purple pushing” o Sustained valsalva bearing down efforts may slightly shorten second stage o Negative effects § De-oxygenation of the fetus § Damage to perineal/urinary/pelvic anatomy § Increased maternal fatigue, lactic acidosis • Physiologic pushing o The sounds help you push better!!!! • Spontaneous efforts • Two phases to 2 stage • Open glottis • Shorter pushes • Noise (grunting) • No counting Cesarean Deliveries • Why are Cesarean deliveries performed? o A life saving procedure o Happens a bit too much… • Why to do it o Fetal distress o Poor progress during labor (impatience, malposition, size) o Breech presentation o Severe maternal illness THE APGAR SCALE • The Evidence o 30 studies (n=1925) found that immediate mother and infant skin-to skin-contact: • Keeps the newborn warmer • Reduces infant crying in the first hour of life • Improves breastfeeding initiation and duration • Improves infant sleeping and maternal attachment behavior Skin-to-Skin • Skin-to-skin is not swaddling o Recommended for the first hour of life • Promotes heat transfer from mother to infant • Promotes bonding and breastfeeding • Increases newborn’s blood sugar Growth and Development Across the Lifespan: Infancy A note on vocabulary • Neonates = newborn o 1 month • Infants: o 1 year (or so) § Usually only up to 1 years o Up to year 2 in our book • Development patterns: o Cephalocaudal (head to toe) § Babies in utero develop head to toe o Proximodistal (near to far) § Develop from the core out • Core = organs….real important Overview (reminder): Issues in developmental science • Nature vs. nurture vs. interaction • Continuity vs. discontinuity o Continuous: height o Discontinuous: puberty • Vulnerability vs. resilience • Parents want to do what’s best, but what is that? o Strict vs. lenient o Worry! Don’t worry! Worry! Don’t worry! Compared to animals: o Humans are very dependent at first o Physical growth & development slower o Cognitive & social: less is instinctive § A lot of learning is involved Implications for care of istants o Importance of the 1 two years: o Physically § Feeding them, body temp reg, cleaning them o Psychologically § Support fro the family o Neurologically § Providing stimulation for the brain o These categories are closely interconnected Infant mortality o Def: death within the first year of life o Important indicator of national health and social welfare o So basically the US is not good at all… o USA: o 1900: 100 deaths per 1000 live births o 2000: 7 o 2013: 6 § (Less than 5 in Washington State, one of the lowest in the country) o Improving but still higher in U.S. than in other industrialized countries § Leading causes in U.S. linked to congenital anomalies and low birth weight o Infant mortality - global o Infant mortality – US vs.OECD o Infant mortality in US: o Varies widely within U.S. population due to § Education § Poverty § Race/ethnicity **The link between poverty and infant mortality is complex** o Overall US rate: ~ 6/ 1,000 o Rate for African American women: 14/ 1,000 o US Caucasian women w/ college = 4 o US African American women w/ college = 10 o Infant mortality rates for immigrants lower than US o (Although poverty higher and prenatal care lower: ??) Group differences in infant mortality Early prenatal care and ethnicity Infant mortality - global o Neonatal: 40% of all deaths under 5 y/o are in 1 month of life o 3.3 million neonatal deaths (2009) § globally o Infant (<1 yr) = 70% of under 5 y/o deaths § ~ 6 million o 70% of these are in Africa or SE Asia o Leading (primary) causes: o Dehydration from diarrhea o Pneumonia & sepsis § Full body infection that can create a shock in the body o Malaria o Malnutrition is an underlying cause in about 50% SIDS o Leading cause of death in US in ages 1 month – 1 year o Def: An apparently healthy infant dies suddenly and unexpectedly § Diagnosis by exclusion o Primary causes: unclear- only diagnosed as SIDS if other causes of death have been ruled out. o Contributing factors: o Apnea spells? § Respiratory drive: if the baby does not recover from the lower breathing sleep cycle o Sleeping on stomach or sides, or fluffy bedding (AAP recommendation now = Back to Sleep) o More common in winter months § Viral infections § Overheating o Smoking § Exposure during pregnancy or second-hand § Increases SIDS rate 4 x o Myelinization lag? § Different structure/not fully developed o Brain stem abnormality? § in area of brain regulating respiration and arousal o NOT immunizations! SIDS prevention o Health and Wellness o Sleeping § Baby on back § Firm mattress § No loose bedding § Cool sleeping environment o Pacifier!! § Help with airway protection o Malnutrition-globally o Macro-nutrient malnutrition § Leading cause of death § Not enough calories § Contributing factor in ~ one-half of deaths for children under age of 5 worldwide o Marasmus- § Disease that results from severe starvation: insufficient calories § Weight <60% normal § Parasitic infections • Diarrhea • Loss ability to absorb nutrient through the gut § Severe neurological damage o Kwashiorkor: § Severe protein deficiency § Swollen bellies • Because proteins are the fluid regulators • Fluid build up in the abdomen o micro-nutrient § Deficiencies more common – iron, vitamin D § In industrialized countries Malnutrition – U.S. o In the US: “food insecurity” o 17 million households (~1/7) o 14 million children § 3.5 million children under age of 5 o Dramatic rise since 2006 o Poor quality food: o Excess fats, oils, sugar o Short on fruits & vegetables o Hunger & obesity can go together o Not eating the proper food o Bad quality Infant nutrition o Breast is best! o Recommendation: exclusive breastfeeding x 6 months o And the longer the better o Benefits – § Nutrition (better growth) § Immunity- fewer illnesses • Preterm babies may need fortification of breast milk o Need to make the formula super rich because the preterm babies cant drink a large quantity of milk • Moms who use drugs or certain medications shouldn’t breastfeed • Breast fed babies need supplementation with Vit D and maybe iron o The mom may be deficient o They are not transferred to the baby from the breast milk o Iron: mothers stop giving their baby milk through breast milk after 3-4 months o Solid food o Introduce gradually § Cautious of allergies and choking § Usually 1 at a time, mashed/ pureed o Best after 6 months, not before 4 months o Does not increase night-time sleeping o Signs of readiness § Holds head up well § Swallow saliva § Sits with support § Interested in what parents are eating Physical Changes in Infancy o Think about how much happens in 2 years! o Growth is a marker of health: o Weight o Length (height) § Length: Lying down § Height: standing • Gravity has an affect o Head circumference § Measured up till age 2 • Maybe longer if irregular o Head is disproportionately large (compared to later) Physical Growth o Growth is a measure of health o Average birth weight ~7.5 lbs o Normal newborn weight loss is 7-10% in the first few days § Decrease in fluid volume intake § Increase caloric use o Weighed naked o Back to birth weight by 2 weeks of age o Double birth weight by 5-6 months o One year (triple birth weight) o 10 – 12 inches of growth o Triple their birth weight o Two years o Toddlers reach half of their adult height by age 2 or 2 ½! Failure to Thrive o Children whose growth is significantly lower than others of their age and gender o Found from plotted values on the CDC and WOE charts and compared to averages (globally and nationally) o Multiple possible causes o Some medical o Some social o Some emotional o May require a team of professionals to figure it out Brain & nervous system o Parts of the brain o Medulla & midbrain: § Basic physiological functions • Heart, breathing, etc.. • Most fully developed at birth o Cerebellum § Motor coordination o Cortex § Perception, movement, thinking, language § Cortex develops most rapidly in first 2 years o Brain is 60% fat o No low fat diet o Will delay and hinder brain development Neurology - Important terms o Synapses: o Connections between neurons o Synaptic development o Synaptogenesis: occurs rapidly in cortex- quadrupling overall weight of brain by age 4 o Pruning: unnecessary pathways eliminated- use it or lose it o Eventually each muscle fiber is connected to ONE motor neuron § Synaptogenesis and pruning occurs throughout life, making the brain more EFFICIENT. o One year old brain has many more connections but functions less efficiently o One year old brain can bounce back from an insult o Malnutrition/head injury § there are more “back-up” connections o Plasticity: brain’s ability to change in response to experience Brain development o Infants need developmental stimulation to maximize development o “Use it or lose it” – a more intellectually challenging environment creates a more complex network of synapses o Myelin sheath forms around axons o Improves conductivity because it is smooth o Cephalocaudal – o Head control before rolling over o Reticular Formation o Helps you pay attention and not be distracted by unimportant information. o Myelination of RF begins in infancy but isn’t complete until about 25 y/o. Poverty and the brain o Substance abuse o Abuse, neglect, trauma o Exposure to toxins o Inadequate nutrition o Parental depression o Quality daily care TV – okay or not okay? o Some studies show excessive television in first 3 years linked o Reduced social interactions between infants and caregivers o As well as increased ADHD later o AAP recommends no TV for kids before age 2yo o Text suggests this might be a correlational and not a causative effect… Reflexes o Early ones – o Primitive: § Startle (Moro) § Babinski • Feet splay out when tickled o Tend to disappear in ~ 6-8 months § If they don’t disappear it may indicate a neurological problem… Adaptive Reflexes o Adaptive: sucking, tongue-thrust, withdrawal from pain o Suck and rooting reflex o Opening the mouth and turning head towards object States of consciousness; sleep/wake cycle o What newborns do: o Eat, sleep, cry o Gradual periods of increasing wakefulness § (2-3 hrs/day as neonates) o Sleep/ wake cycles: o Individual variation & temperament o Can be stressful for parents & caregivers o Not increased by solid food Reflexes and Behavioral States Five States of Sleep and Wakefulness o This cycle happens every 2 hours o Crying babies o Crying is normal & inevitable o Parental responses to crying? o Early responsiveness > earlier tapering? (stop crying sooner) o Colic: way different! § Intense crying, > 3 hours a day § Causes unclear § Usually disappears ~ 3-4 months Sensory Skills o Vision o Hearing o Smelling, tasting o Touch o Motion “Looking skills” o Visual acuity- what is 20/20? o At 20 feet, you can see what an average person can see at 20 feet o Tracking o Def: when an object is moving they can find it/follow the movement of it o Skillful by 6-10 weeks o Depth perception o Study: visual cliff o 3-6 months old babies have depth perception o In 1960 experiment 6 mo. olds would not crawl over the “cliff” o More recent research shows that even 3 month olds have some depth perception o How far away can newborns see clearly? § 8-10 inches (20/200 vision) • this distance is important for visual of parents faces o Is there any reason you can think of that this limited sight distance might be helpful to them then? Sensory Skills o Hearing o Adult voices heard well and some directional loud-sound location o Smelling and Tasting o Newborns react differently to each basic taste as early as birth. o Touch and Motion o Best developed of all the senses Motor development: muscles & coordination o Gross motor skills: o roll over, sit up, crawl o crawl, maybe only 20% of infants crawl o Fine motor skills: o Holding, picking up, stacking blocks o Notice the general sequence and progress o Development: o Getting the parts to work together o Need to practice (repetitive actions) § Experience influences motor development Developmental milestones Why? o CDC campaign: o “Learn the Signs. Act Early.” o Concerns? o Intellectual Disabilities o Autism Spectrum Disorders o Vision & Hearing Loss o ADHD o Cerebral Palsy o Fetal Alcohol Spectrum Disorders o Positive Parenting Tips o Talk to your baby. o Read to your baby. o Sing to your baby. Play music. o When your baby makes sounds, respond. o Cuddle your baby. o Notice when baby is tired or alert, relaxed or fussy. o Take care of yourself! Child safety o Don’t shake the baby. Ever. o Face up to wake up! o Rear-facing car seats, in the back seat. o No smoking in the house. o Beware of small objects that could be choking hazards. o If it can go through a toilet paper tube, keep it away from the baby o Careful with hot liquids. o Get their shots! Vaccination schedule o Vaccines today o By age 2 children will receive 10 different vaccines, up to 28 doses of vaccine using the usual vaccine schedule (depending on age during flu season) o These vaccines will protect them from o Diphtheria o Pseudo membrane that makes its impossible for babies to swallow/eat o Tetanus o Polio o Pertussis (whooping cough) o HIB diseases (meningitis etc) o Rotavirus o Pneumococcal diseases (meningitis, pneumonia) o Measles o Mumps o German measles o Varicella (and secondary encephalitis) o Hepatitis B, Hep A o Influenza Healthcare during infancy? o “Well baby checks” o Monitoring progress o Baby and caregivers o Health of both baby and parents o Immunizations o Respiratory infections (7/year?) o Ear infections Developmental Theories: Cognitive (Chapter 5) o Piaget: cognitive-developmental o Vocabulary: o The baby will develop Schemes, assimilation, accommodation, equilibration o Object permanence o Imitation Piaget: Stages of Cognitive Development o Sensorimotor : o Birth – 18 months o Start to interact with the environment o Primitive reflexes (0-1 months) o Primary circular reactions (1-4 months) § Accidental motions o Secondary circularity motions (4-8 months) o Coordination of secondary schema (8-12) § Clear intentions and behaviors o Tertiary reactions (12-18) § Experimentation o Beginning of mental representation (18-24) § Development of symbols to objects and give them meaning o Preoperational Stage: o 18 months – 6 years o Start to represent the world symbolically o Concrete Operational Stage: o 6 – 12 years o Child starts to use rules such as conversations o Formal Operational Stage: o 12 + years o Start to think about the future Cognitive Theories: Jean Piaget o Scheme o Internal cognitive structure o Assimilation o Process of using schemes to make sense of experiences o Accommodation o Changing a scheme to incorporate new information o Equilibration o Balancing assimilation and accommodation Piaget: Object Permanence o The realization that objects still exist after disappearing from sight o 2 months: rudimentary expectations, shown by surprise when an object disappears o 6 – 8 months: looking for a missing object for a brief period of time o 8 – 12 months: reaching or searching for a toy that is completely hidden Perceptual Skills - Studying Perceptual Development o Preference Technique o Study how long the baby attends to a particular stimulus. o Habituation/ Dishabituation o Study loss of interest in a particular stimulus after repeated exposures. o Operant conditioning o Vary the stimulus and study the learned responses. o Cognitive Changes Spelke’s Alternative Approach o Assumption: Babies have inborn assumptions about objects and their movement. o Method: Violation of expectations method o Researchers move an object the opposite way from that which the infant comes to expect. Spelke’s Classic Study of Object Perception o Cognitive Changes Baillargeon’s Alternative Approach o Assumption: Knowledge about objects is not built in, but strategies for learning are innate. o Method: Study of object stability perception o Researchers stack smiling-face blocks in stable and unstable positions. Object Stability Perception o Learning, Categorizing, Remembering - Rovee-Collier o Variant of operant conditioning procedure o Babies as young as 3 months can remember specific objects and their own actions with those objects, for as long as a week o This suggests that young infants are more cognitively sophisticated than previously thought o These infants memories though were tied very specifically to this activity - as they get older they can generalize their learning o Rovee-Collier’s Study of Infant Memory Language development theories o Behaviorists: o Babbling is selectively reinforced- parents respond more to correct language o BF Skinner o Nativists: o We are ‘hard-wired for language’ o Following rules of language- overregulation “I breaked it” o ‘Language acquisition device’ o Innate language processor o Contains basic grammatical structure of all human language o Sounds are vowels and consonants o Interactionist o Generalized sets of tools o Use of tools; social interactions o Use of language to convey what’s already in their head Language development o Crying o Cooing o Babbling o “Holophrases” o word + gesture o Telegraphic speech – short 2-word sentences o Use of inflections to change meaning o Universal capability – at first o Gradually “tuning in” to sounds important to local language o Helped by songs, games, rhymes Infant-directed speech o Characteristics: o Speech in a higher pitch o Repetition, minor variations, slightly more elongated sentences o “Recasting” o Repeating the child’s sentence with corrected & modified structure o Easier for child to imitate a correct grammatical form “recast” from her own sentences o Baby talk = infant-directed speech o Recent UW study reinforces that baby talk helps babies learn to talk more § Important that interactions are one-on-one § The quality of speech (baby talk) seems to be more important than the number of words used (quantity) Language development o Receptive language o ~100 words at 13 months o Expressive language o ‘Naming explosion’ o 16 mos – 50 words o 24 mos – 320 words Effects of caregivers on language development o Talking with children o Listening to children o Reading with children Bilingual children o Generally few if any learning problems o Advantages in meta-linguistic ability and concentration o May reach some language milestones a little later o Congruence between school language and home language may be an issue o Early childhood is easiest time to learn language Measuring intelligence in infancy What is intelligence? o Intelligence: Ability to take in information and use it to adapt to environment o Although each infant develops at a different pace, both genetic and environmental factors influence infant intelligence. Measuring infant intelligence o Bailey Scales of Infant Development o Measure sensory and motor skills o Help find babies with delays o Not necessarily a good indicator of later IQ o Fagan Test of Infant Intelligence o “Novelty preference” “visual recognition” o May be used to test intelligence in babies with delayed motor skills (eg CP) o Habituation in young babies MAY have a correlation with later intelligence – unclear evidence Social and Personality Development in Infancy Objectives • Compare theories of social and personality development • Analyze attachment • Understand personality, temperament, and self-concept • Evaluate the effects of nonparental care THEORIES OF SOCIAL AND PERSONALITY DEVELOPMENT Psychoanalytic Perspectives: Freud and Erikson • Freud: psychosexual stage related to infant attempts at needs satisfaction o Oral stage: infants derive satisfaction from the mouth o Fixation -- swearing, nail biting. o Symbiotic relationship between the mother and infant in which the two are joined together as if they are one. o Gratifying nursing period followed by a balanced weaning process infants develop sense of both attachment to and separation from the mother. • Erikson: psychosocial stage in which attending to infant needs and social development is important o Nursing and weaning are important but they are only two aspects of the overall social environment. o Responding to the infant’s other needs by talking to her, comforting her, and so on, was just as important. o Trust vs. mistrust: infant learns to trust the world around her or becomes cynical about the social environment’s ability to meet her needs consistently. ATTACHMENT Ethological Perspectives: John Bowlby o Attachment: deep and enduring emotional bond that connects one person to another across time and space o Strong emotional bond making is innate. o Bonds are maintained by instinctive behaviors that create and sustain proximity. Synchrony: o Def: mutual, interlocking pattern of behaviors between parent and child that results in a smooth “dance” of interaction. o Infants signaling their needs and parent’s response o Unlearned behavior that crosses cultural barriers o Real synchrony develops after much practice of responding to each other o Provides developmental benefits- Highly synchronous six- to eight-month- old infants o Have larger vocabularies at age two o Have higher intelligence scores at age three A Mother’s Bond with Her Infant o The bond is dependent on synchrony. o Mothers typically provide more routine caregiving than fathers do. o Mothers talk to and smile more at their babies. o When mothers observe or interact with their infants, their bodies release oxytocin, a hormone that is correlated with empathy and physical relaxation. A Father’s Bond with His Infant o The relationship depends on synchrony. o Fathers have same repertoire as mothers do (Talk to, touch, cuddle). o After the first few weeks, fathers begin to spend more time playing with the baby. o Watching and interacting with babies stimulates vasopressin in fathers, a hormone that is linked to arousal, aggression, and physical activity. o Culture may impact the interpretation of study results and the benefits of father involvement . Establishing Attachment: Bowlby’s Four Phases o Non-focused orienting and signaling (birth – 3mo): Uses an innate set of behavior patterns to signal needs, everyone in contact o Focus on one or more figures (3-6mo): Signals to fewer people o Secure base behavior (6-24mo): true attachment emerges, proximity seeking behaviors, most important person used as a safe base for explorations o Internal model (24mo -): an internal model of the attachment relationship allows children older than two to imagine how an anticipated action might affect the bonds that they share with the caregiver. by age 5, a child has clear internal models. Attachment Behaviors o Once clear attachment is established, related behavior begins appearing. o Stranger anxiety (6/8mo-12/16mo-then, decline): Cling to mother when strangers are present o Separation anxiety (6/8mo-12/16mo-then, decline): Infants cry and protest when separated from their mothers. Signals the formation of a true attachment. o Social referencing (10mo): Use cues from caregiver facial expressions and emotional tone of voice, helps to figure out novel situations, helps to learn to regulate emotions Infant’s attachment to parents Characteristics of Attachment o Safe haven: children rely on their caregiver for comfort at times when they feel threatened, frightened or in danger o Secure base: caregiver gives a good and reliable foundation for children to explore world o Proximity maintenance: children aim to explore the world but still try to stay close to caregiver o Separation distress: children become unhappy and sorrowful when they become separated from their caregiver Secure and Insecure Attachments o Mary Ainsworth: the Strange Situation o Protocol: Series of eight episodes played in a laboratory, Children between 12 and 18 months o The reunion episodes provide the best assessment of attachment strength. o Secure, Insecure, Avoidant & Ambivalent Attachment in Mothers & Babies (3:38) Attachment Stability o Dependent on consistency of child’s life circumstances o Influenced by major upheavals o Internal models elaborated from year one until the age of four or five o 2 - 3 years: pattern of attachment is relevant to each specific relationship, quality of the relationship determines the child’s security with that specific adult. o 4 or 5 years: the internal models become more a property of the child, more generalized across relationships, more resistant to change. child tends to impose it upon new relationships, including relationships with teachers or peers. Caregiver Characteristics and Attachment o Essential to the formation of a secure attachment: o Emotional availability § Caregiver who is able and willing to form an emotional attachment o Contingent responsiveness § Caregivers who are sensitive to the child’s cues and respond appropriately § Still Face Experiment: Dr. Edward Tronick https://www.youtube.com/watch?v=apzXGEbZht0 o Infants of parents who display contingent responsiveness in the early months are more likely to be securely attached at age 12 months. Caregiver Characteristics and Attachment o Insecure/avoidant attachment § Mother rejects or regularly withdraws from her infant. § Mother is overly intrusive or overly stimulating. o Insecure/ambivalent attachment § The primary caregiver is inconsistently or unreliably available to the child. o Insecure/disorganized attachment § Likely when the child has been abused, or when the parent has unresolved childhood trauma Other Caregiver Characteristics Influencing Secure Attachment o Older mothers display more sensitive caregiving skills. o Higher education produces better attachments. o Married parents produce more secure attachments than cohabiting or single parents. o Psychiatric illness § Depressed mothers interact less. Children of depressed mothers are more likely to display aggression and social withdrawal in school. o Poverty is hard on attachment. Attachment Quality: Long-Term Consequences o The securely attached children are . . . o More sociable o More positive in relationships with friends o Less clingy and dependent on teachers o Less aggressive and disruptive o More emotionally mature o Continues into adolescence o More likely to be leaders o Have higher self-esteem o Foundation for future social relationships o Increased sociability throughout early, middle, and late adulthood o Influence on parenting behaviors CROSS-CULTURAL COMPARISONS OF ATTACHMENT Adoption and Development o Non-institutionalized children adopted before the age of six months are generally indistinguishable from non-adopted children in security of attachment, cognitive development, and social adjustment. o Children adopted at later ages, with histories of institutionalization and/or abuse and/or neglect, tend to have more cognitive and emotional problems. o Reactive attachment disorder may develop. o Parenting may be challenging. Attachment and Autism Disorders o Autism spectrum disorders (ASD) a group of disorders that impair an individual’s ability to understand and engage in the give-and-take of social relationships o Developmentalists once believed that ASD result from a disturbance in the attachment process caused by insensitive parenting. o Most infants with ASD, however, are securely attached to their caregivers. Three-category system o Level 1: o very limited or nonexistent language skills, stereotypic behaviors such as hand-flapping and rocking, severely limited range of interests, intellectual difficulties. o Level 2: o some degree of verbal communication, mild degrees of cognitive impairment, difficulty looking at situations from other people’s perspectives, utter repetitive words or phrases that are inappropriate for the situations. o Level 3: o age-appropriate language and cognitive skills, most are not diagnosed with Level 3 ASD until later in childhood. Autism spectrum disorders (ASD) o Develop mentalists now believe that ASDa are caused by a variety of interactive biological and environmental factors rather than the product of a flawed attachment process. o Treatments such as intensive social skills training and behavior modification for stereotypical behaviors can reduce the impact of ASD symptoms on children’s lives. o Treatments are most successful when they are implemented during the first 3 years after birth. PERSONALITY, TEMPERAMENT, AND SELF-CONCEPT o Temperament: basic behavioral and emotional inborn predispositions o Personality: stable patterns of responding to people and objects in the environment Dimensions of temperament o Thomas and Chess: o Easy children (40%) have regular sleeping and eating cycles, approach new events positively, and try new foods without much fuss. They are usually happy and adjust easily to change. o Difficult children (10%) have irregular sleeping and eating cycles, emotional negativity and irritability, and resistance to change. o Slow-to-warm-up children (15%) display few intense reactions and appear nonresponsive to unfamiliar people. Dimensions of temperament o 5 dimensions of temperament o Activity level: tendency to move often and vigorously o Approach/positive emotionality: tendency to move toward new experience o Inhibition and anxiety: tendency to respond with fear or withdrawal in new situations, precursor to shyness o Negative emotionality: tendency to respond with anger, fussing, loudness, or irritability or a low threshold of frustrations. o Effortful control/task persistence: ability to stay focused and to manage attention and effort Origins and Stability of Temperament o Heredity: Identical twins are more alike in temperament or personalities than fraternal twins are. o Long-Term Stability: Stable across long periods of time o Neurological processes: In shy infants, two hemispheres of the frontal lobes respond asymmetrically to stimuli. shyness is based on differing thresholds for arousal in the parts of the brain that control responses to uncertainty. Origins and Stability of Temperament o Environment: behavior shapes the brain. shy children may exhibit different neurological patterns than outgoing children because their exhibition of shy behavior contributes to the neural networks that developmental processes in the brain, such as pruning, allow to develop and those that are shut down due to lack of use. o Sandra Scarr: Niche-picking: the process of selecting experiences on the basis of temperament o Thomas and Chess: Goodness of fit: the degree to which an infant’s temperament is adaptable to his or her environment, and vice versa o Synchronous Relationships: Parental influence with children at temperamental extremes Understanding Infant Sense of Self o During the same months in which infants are developing an internal model of attachment and exploring their own unique temperament, they are also developing a unique sense of self. SELF-CONCEPT The Subjective Self o Awareness by the child that he is separate from others and endures over time o 8–12 mo, at the same time as object permanence The Objective Self o A toddler comes to understand that he is an object in the world. o The self has properties, such as gender, size, a name, and qualities like shyness or boldness, coordination or clumsiness. o 21 mo shows self-recognition in the mirror. o Same age that children name themselves, use “I,” “me,” and “mine” o Same time when the region of brain where temporal and parietal lobes mature The Emotional Self o 2-3mo: Babies learn to identify changes in emotional expression. o 5-7mo: Infants can “read” and respond to facial expressions. Respond to much wider variety of emotions and distinguish among happy, surprised, angry, interested, sad. o 1 yo: infants’ perception of others’ emotions help babies to anticipate others’ actions and guide their own behavior. EFFECTS OF NONPARENTAL CARE Overview o At least half of children under 12 months are cared for by someone else at least part time. o 1970: 18 % of U.S. married women with children under 6 were in the labor force. o Now: 64 % are in the workforce at least part-time. o Arrangements vary considerably. o Time in care varies. o Some children are in multiple care settings. o Younger children are less likely to receive nonparental care. NONPARENTAL CARE ARRANGEMENTS FOR CHILDREN UNDER 6 IN THE U.S Effects on physical and cognitive development o Physical: overweight early in life and when they reach school age o Cognitive: High-quality daycare has beneficial effects, especially for children from poor families. Several studies, however, point to possible negative effects of day-care experience on cognitive development. Effects on Social Development o Infant daycare has negative effects on attachment if started when the child is under one year of age. Heightened risk for insecure attachment. o Parents whose behaviors are associated with insecure attachment (e.g., poor sensitivity to the child’s needs) have children who are negatively affected by early daycare. o Early daycare entry is associated with greater risks for social problems in school-aged children. Research Challenges o Complex interaction among numerous variables in all care types o Nonparental care varies in quality and structure. o Maternal attitudes toward care arrangements vary. o The effects of multiple care settings can be difficult to separate. What’s Responsible? o Nonparental care may induce child stress, causing higher levels of cortisol. May affect the child’s brain development o Variations in ways stress-induced related to child age and temperament o Individual and gender differences interact with nonparental care. Boys are more insecurely attached to caregivers in nonparental care, but differences between children in parental and nonparental care are very small. CHOOSING A DAYCARE CENTER o Low teacher/child ratio (<2yo 1:4, 2-3yo 1:4-10) o Small group size (<1yo 6-8; 1-2yo 6-12; >3yo 15-20) o Clean, colorful space, adapted to child play o Daily plan o Sensitive caregivers o Knowledgeable caregivers
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