CHD 2200 CHD 2220
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This 8 page Class Notes was uploaded by klj15 on Wednesday September 14, 2016. The Class Notes belongs to CHD 2220 at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months taught by DR. MONTFORD in Spring 2016. Since its upload, it has received 2 views. For similar materials see Child Growth and Development in Economcs at 1 MDSS-SGSLM-Langley AFB Advanced Education in General Dentistry 12 Months.
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Date Created: 09/14/16
CHD 2220 Chapter 3: Prenatal Development -Birth rate trends (sizes of families changing) -Prenatal development -Teratogens (FASD, smoking, thalidomide, drugs, mercury) -Nutrition/Exercise during pregnancy -Folic Acid and Spina Bifida -Emotional Stress -Preparing for parenthood (models, prenatal relationship) 1. Motivations for Parenthood -Western industrialized nations family size has decreased (average is 1-2 children) due to want for a career. Birth order and spacing are unrelated to children’s intelligence. Low SES mothers have greater number of births and accounts for children’s lower intelligence test scores. -Older parents are better equipped financially and emotionally to rear children, but mothers in late 30-40s are associated with increased risks of chromosomal and genetically influenced disorders 2. Prenatal Development -The prenatal period (266 days or 38 weeks) can be divided into 3 periods: 1. Germinal Period (period of zygote)- takes place in the first 2 weeks after conception. It’s the fertilization and formation of the zygote through implantation of the blastocyst (embryo develops from this) in the uterine lining. Other structures form from the blastocyst such as the placenta (permits food and oxygen), umbilical cord (delivers blood and rids wastes), and amniotic sac. 2. Period of the Embryo- takes place 2-8 weeks after conception, and the foundations for all body structures are laid down. Major organs and major body systems develop rapidly. The nervous system develops the fastest, forming neural tube, which swells to form the brain. At the end of the period the embryo responds to touch and can move. This is a critical period and the body is most vulnerable to destructive influences in the environment. a. Ectoderm- (upper layer) becomes the outer layer of skin, nails, teeth, sensory organs, and nervous system b. Endoderm- (lower layer) digestive system, liver, pancreas, salivary glands, and respiratory system c. Mesoderm- (middle layer) inner layer of skin, muscles, skeleton, and excretory and circulatory system. i. All give rise to all parts of the body 3. Period of the Fetus- 9 weeks until the end of pregnancy, the growing and finishing phase. Dramatic increase in body size and completion of physical structures. The appearance of bone cells at 8 weeks signals fetal stage. Quickening, baby’s nd movements are felt by mother. At trd end of 2 trimester (6 months) most of the brain’s neurons are in place. In 3 trimester (6-9 months) between 22-26 weeks, the fetus reaches age of viability; the age when an infant would have a good chance of survival if born early, but may need help to breathe. Also, infant gains 3lbs and grows 7 inches. New sensory and behavioral capacities emerge like fetal activity. Boys tend to be more active in the womb. At the end they are able to distinguish different voices and language and musical sounds; hearing is last to develop. 2. Prenatal Environmental Influences Teratogens are any environmental agent that causes damage during the prenatal period and capable of causing birth defects, especially during the period of the embryo. Their impact depends on the dosage, time of exposure (age), genetic susceptibility, and any other negative influences (poor nutrition, lack of health care, etc). Males are more likely to be affected than female babies o Prescription and nonprescription drugs Aspirin Thalidomide given for morning sickness caused deformities and low intellectual development Cocaine, heroin, methadone cause prematurity, low birth weight, physical defects, and breathing difficulties o Alcohol- Fetal Alcohol Spectrum Disorder (FASD): 2 ounces a day taken in early pregnancy is related FAS features. Even when provided with enriched diets, babies fail to catch up in physical size and mental impairment is permanent. Children are given 3 diagnoses based on severity: Fetal Alcohol Syndrome- slow physical growth, facial abnormalities (short eyelid openings, widely spaced eyes, thin lip, small head), brain injury, and some others Partial Fetal Alcohol Syndrome- 2 of the 3 facial abnormalities & brain injury Alcohol Related Neurodevelopment Disorder (ARND)- typical physical growth, lack of facial abnormalities, mental functioning impaired o Tobacco- infants often born underweight and have attention, learning, and behavior problems in early childhood o Lead, radiation, chemical pollutants, mercury, PCBs- leads to physical malformations and severe brain damage o Rubella-an infectious maternal disease that causes abnormalities, intellectual disabilities, prematurity, and low birth weight. Often called German measles. o Syphilis/HIV- a maternal disease that can be passed during delivery. Physical malformations, miscarriage, intellectual disability, brain damage, or early death. Maternal Diet- the mother needs a gradual increase in calories; the poorer the diet the greater the loss in brain weight, birth weight, and damage to other organs for the baby. Mother should gain between 25-35 lbs for best pregnancy outcomes. Pattern is st usually 2-4.5 lbs in the 1 trimester then 1 lb per week in the last 2 trimesters. Folic Acid (vitamin/mineral) is important in the diet in order to decrease the chance of the baby having spina bifida (neural tube defect; tube does not close all the way causing spine and nerve damage). Age- mothers over 40 face the risk of miscarriage and babies with chromosomal defects, along with other complications. Adolescent girls who tend to have poor health and environmental risks are associated with poverty and pregnancy complications Exercise that is regular and moderate/low impact during pregnancy contributes to maternal health, fetal cardiovascular functioning, and higher birth weight. Vigorous exercise results in lower birth weight Stress causes higher rate of miscarriage, infant respiratory and digestive issues, prematurity, behavior issues, anxiety, lower test scores, irritability, and low birth weight. When stressed, the body sends large amounts of blood to parts of the body related to defensive responses, which then sends less blood to the uterus; meaning the baby is deprived of oxygen and nutrients. To decrease emotional stress mothers need emotional support Rh Factor Incompatibility is when an Rh-positive fetus developing within an Rh- negative mother and the mother’s body begins to reject the baby. Can cause oxygen deprivation, brain and heart damage, and infant death. Only occurs to the first born due to the mother now having antibodies Prenatal Care is important for the health of the baby and the mother just in case of unexpected difficulties. Those who are young or poverty stricken are least likely to seek care. Low SES ethnic minority mothers and culturally sensitive health care practices, can lead to more health promoting behaviors. The U.S. has a high rate of infant mortality and this may be the reason. 3. Preparing for Parenthood Expectant parents usually rely on models of parenthood to build their own images of themselves as mothers and fathers. The couple’s relationship is also important; a troubled relationship usually worsens, and a good relationship usually strengthens. Paternal factors like exposure to lead, pesticides, and other chemicals may cause abnormal sperm count, lead to miscarriage, or diseases. Smoking during pregnancy can cause low birth weight from second hand smoke of the mother. CHD 2220 Chapter 4: Birth and The New Born Baby -Stages of Child Birth (transition, lighting, crowning) -Apgar -Natural & Prepared Child Birth (doula, C-section, induced labor) -Fetal Monitoring -Labor Medication -Preterm, Low Birth Weight, Small for Date (kangaroo care) -Reflexes -SIDS -Crying (common reasons) -Sensory Capacities (1 and last to develop) -Transition to Parenthood (gender roles, parent interventions) 1. Stages of Childbirth -Stage 1: The longest stage typically lasting 12 hrs for the first child (4-6 hrs for later children). Dilation and effacement of the cervix occur as uterine contractions increase in strength and frequency. This stage culminates in transition; a brief period in which contractions are at their peak and the cervix opens completely -Stage 2: typically lasting 1 hr for the first child (20 min for later births) is the delivery of the baby. The baby’s head begins to move into vaginal canal, crowning, and the baby emerges from the mother. -Stage 3: The afterbirth (birth of the placenta), lasting 5-30 minutes, the placenta is expelled. The Apgar Scale is used to assess the baby’s physical condition at birth. It’s used at 1 minute and 5 minutes after birth. Heart rate, respiratory effort, muscle tone, body color, and reflex irritability are evaluated on a score of 0-10. 7 or better means good condition, 4-6 needs help breathing, below 3 serious danger. 2. Approaches to Childbirth -Natural childbirth aims to reduce the pain mother’s feel by decreasing fear with education. -Prepared childbirth is similar to natural, but includes special breathing techniques, labor and delivery classes (Lamaze, Bradley), Emphasize education, relaxation, and support. Midwives are the norm in most of the world but only 8% of mothers in the U.S. have one. There are more positive outcomes for babies delivered by certified nurse midwives during a home delivery Doulas are trained lay attendants who provide emotional support for mothers before, during, and after labor. Improved outcomes such as shorter labors, higher rate of breastfeeding, and decreased need for instrument-assisted births and pain medication. 3. Medical Interventions -Fetal Monitoring is an instrument that tracks the baby’s heart rate during labor and it’s required in most hospitals. They are also linked to an increase in cesarean deliveries -Analgesic (relieve pain) and Anesthesia (used in 1 stage of labor to block sensation of consciousness) are medications used to control pain. These have been linked to prolong labor and cause irritability for newborns. -Instrument delivery using forceps or a vacuum extractor may be appropriate if the mother’s pushing does not move the infant through the birth canal in a reasonable period of time. Linked to cause serious complications -Induced Labor is scheduled only when continuing the pregnancy threatens the well being of the mother or baby. Oxytocin is a synthetic hormone used to stimulate contractions in order to break the amnion. -Cesarean Deliveries are also used in cases of medical emergency or serious maternal illness. For example, when the baby is in breech position (upside down, with feet coming out first) or if the baby is too large. The baby is removed from the mother through an incision made in the abdomen. It’s more dangerous than vaginal delivery due to higher infection rate, longer hospital stays, more expense, and stress. Scheduled c-sections are not recommended before 39 weeks. In the U.S. 31% of births are c-section. 4. Birth Complications -Babies are born covered with vernix caseousa, a protective skin grease, to help baby stay warm -Anoxia, oxygen deprivation, is caused by squeezing of the umbilical cord during birth, placenta abruptio, and placenta previa. Causes brain damage, infant death, and cognitive/language development (still seen in middle school) for moderate anoxia -Low Birth Weight infant’s weigh less than 5.5 lbs. Major cause of neonatal and infant mortality along with wide range of developmental issues. Most common to poverty stricken mothers; chronic maternal stress among African American women is the leading cause of low birth weight babies. -Preterm infants are born 3 weeks or more before the pregnancy has reached its full term. So their weight is appropriate for time spent in the uterus. -Small For Date are babies whose birth weight is below normal when the length of pregnancy is considered. They weigh less than 90% of what a normal baby would weigh. Consequences of the above: -The earlier preterm babies are born the more likely they are to drop out of school, lower IQ score, and behavior problems -The earlier the birth and lower the birth weight, the more likely they are to have brain injuries -Problems don’t go away after they grow out of infancy; more likely to have problems in school and asthma. Even as adults, low birth weight babies are more likely to still live at home and be married -Interventions are provided for special infant stimulation in the intensive care nursery. Others teach parents how to care for and interact with their babies. Kangaroo Care: holding a preterm infant so that there is skin-to-skin contact. Can help newborns regulate their breathing and heart rate when they hear and feel their caregivers. Newborns have more positive moods when they are held like this Training Parents in Infant Care giving: teaches parents about infant characteristics and promote care giving skills. Linked to better parent-infant interactions, reduced infant crying, and improved sleep. 5. Precious Moments After Birth -Parents do not require close physical contact with the baby immediately after birth for bonding and effective parenting to occur. Early contact supports parents’ feelings of caring and affection. Hospital practices promote parent-infant closeness, such as rooming in. Bonding is a close connection, especially a physical bond between parents and their newborn in the period shortly after birth. Hospital policies seem to interfere due to drugs given to mothers making them too drowsy therefore having newborns taken to the nursery. 6. The Newborn Baby’s Capacities -Reflexes are the newborn baby’s most obvious organized pattern of behavior. Some have survival value, others help parents and infants establish gratifying interaction, and provide foundation for voluntary motor skills. Reflexes are built in reactions that are present at birth and fade out over the first 6-7 months of life. They help babies survive; babies hold their breath when put under water. -Newborns move in and out of Five States of Arousal, but they spend most of their time asleep. They spend about 18 hrs a day sleeping. Parents report the common issue of infant night waking due to excessive parental involvement in sleep related interactions, breast feeding, and sleeping with parents in their bed. Rapid Eye Movement Sleep (REM): newborns spend about 50% of their time in REM sleep, far more than they ever will again. REM provides young infants with stimulation essential for central nervous system development Non-Rapid-Eye-Movement Sleep (NREM): are disturbed cycles and signs of nervous system abnormalities, which may lead to sudden infant death syndrome (SIDS). SIDS: infant stops breathing and dies without apparent cause. The highest risk is at 2-4 months of age, low birth weight, siblings who have died with SIDS, lower SES, exposure to cigarette smoke, and soft bedding. Sleeping on the back and using a pacifier lowers the risks. -Crying shows strong feelings of discomfort to the parents. May indicate hunger, diaper is full, or need for soothing. Usually increases during the early weeks and peaks around week 6. -Sensory Capacities ALL well developed at birth: Touch- very sensitive to pain. Circumcision should require pain medication because st babies can feel it. 1 sense. Taste- the 2nd sense. They prefer sweet tastes and smells, and are oriented toward the odor of their own mother’s lactating breast and human milk. Preferences are developed through prenatal exposure to mother’s diet or breast milk continues through 1 year and possibly beyond. th Smell- prefer odor of mother’s milk and are able to differentiate odors. 4 sense Sound- able to distinguish variety of sound patterns and nearly all speech sounds. They are very responsive to human speech, high-pitched expressive voices, their own mother’s voice, and speech in the native language. Possibly the 3 sense because they can hear things in the last 2 months of pregnancy. Vision- the least developed of senses. Visual acuity is limited, but they can detect human faces and prefer their mother’s familiar face. They are attracted bright objects but limit their looking to single features and have difficulty discriminating colors. Able to see by age 1. Brazelton Neonatal Behavior Assessment Scale (NBAS)- most widely used instrument for assessing the behavior of newborn infants and helps understand individual and cultural differences in newborn behavior. It’s performed 24-36 hrs after birth. Able to see neurological development, reflexes, and reactions to people and objects. 7. The Transition to Parenthood -Gender roles of husband and wife become more traditional -Emotional and Psychological adjustments: Postpartum depression- a major depressive state that typically occurs 4 weeks after delivery, mother’s become so sad and have trouble coping with daily tasks. It affects how mothers interact with their babies; less healthy feeding and sleeping practices for the baby. More likely to have infants with colic; prolonged crying. A father’s support can play a role in whether the mother develops depression. They should take active roles for caring for the baby. They can also develop postpartum depression -The postpartum period, after childbirth, lasts for 6 weeks or until the mother’s body has completed its adjustments and returned to pre-pregnancy state. Involution (uterus returns to pre-pregnancy size) occurs 5-6 weeks after birth. -Physical Adjustments have to be made, like the loss of sleep. Primary caregiver can lose up to 700 hrs in the first year.
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