Week 2: Normal Infant Development 0-6

What is it like for an infant in the womb?

The mother's placenta helps the baby "breathe" while it is growing in the womb.

Oxygen and carbon dioxide flow through the blood in the placenta. Most of it goes to the heart and flows through the baby's body.

How does a newborn feel at birth?

At birth, the baby's lungs are filled with fluid. They are not inflated.

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The baby takes the first breath within about 10 seconds after delivery. This breath sounds like a gasp, as the newborn's central nervous system reacts to the sudden change in temperature and environment.

Once the baby takes the first breath, what changes occur in the infant’ lungs and circulatory system?

• Increased oxygen in the lungs causes a decrease in blood flow resistance to the lungs.

• Blood flow resistance of the baby's blood vessels also increases.

• Fluid drains or is absorbed from the respiratory system.

• The lungs inflate and begin working on their own, moving oxygen into the bloodstream and removing carbon dioxide by breathing out (exhalation).

At rest, the full-tern newborn infant is in a _______ position.

flexed

What is the flexed position that full-term newborn infants do?

physiological flexion

What is **physiological flexion**?

Recoil of flexed limbs when extended. Provides stability for early posture and random movements

What determines the amount of flexion?

The amount flexion is individual and depends on the size of the baby, the size of the mother’s uterus, and
the baby’s passive tone.

Posture is more flexed in ____ (belly) and less flexed in ____(back).

prone

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supine

How would you describe **motor patterns** of a newborn?

Random! Continuation of movements that occurred in utero. (vary from individuals to individual)

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Can be jerky, and have tremors (these movements are just practice for the baby)

What are the six types of motor patterns in newborns?

1- Progression movements

2- Symmetrical movements

3- Startle:

4- Asymmetrical tonic neck reflex (ATNR):

5- Facial movements:

6- Isolated movements:

What are **Progression movements**?

rhythmic alternating flexion-extension movements of the limbs
(upper and/or lower- can be one, or two, or three, or all four).

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With these movements the head does not move. These movements are similar to the swimming movements a fetus demonstrates in utero.

What are **Symmetrical movements**?

Total body movements. These movements occur more slowly than progressive movements.

What are **Startle**?

Quick, brief movements of the head, trunk, and limbs into flexion

With startle movements the hands are closed.

What are **Asymmetrical tonic neck reflex (ATNR)**?

When the baby turns its head to one side, the arm and leg of the other side flex.

What are **Facial movements**?

Movements that involve grimaces, eyelid opening and closing, smiles, sucking, and tongue movements.

What are **Isolated movements**?

random and spontaneous movements of the wrists and fingers; extension and abduction of the toes.

The newborn’s oral cavity is very _____

However, the structures within the oral cavity and the overall space it occupies is ____

small

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big

Newborns & 1-2 Months: Why are the buccals/sucking pads/cheeks needed?

for suckling and sucking activities

Newborns & 1-2 Months: Why are the lips (labial)/Orbicularis Oris needed?

to protrude the lips, round the lips, and close the lips

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This muscle assists in constricting the lips around the nipple for suckling.

Newborns & 1-2 Months: As the infant suckles, the muscles “work” and become more ____. These muscles also provide _____for further development of jaw and tongue movements.

active

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stability

Think about the premature baby or baby with any condition that cannot suck after birth. They are fed by nasal gastric tube (NGT) or oral gastric tube (OGT) or gastrostomy tube (GTT).

If the baby cannot suckle and “work” these muscles and these muscles provide stability for further development, what happens to baby’s feeding abilities?

They lose the ability to suck because never never developed the ability to (if you don’t use it, you’ll lose it)

The _______ portion of the tongue plays an important role in assisting the __________ phase of feeding and swallowing.

posterior

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pharyngeal

Where is the laryngopharynx?

It extends from the hyoid bone down to the openings of the larynx and the esophagus.

What do the muscles that attaches to the hyoid bone and larynx allow the phraynx to do?

1. feeding, swallowing


2. sound production
3. airway flow/development
4. head and neck control.

What muscles assist in the elevating the hyoid bone and larynx?

suprahyoid muscles

What do the suprahyoid muscles do?

elevate and depress the hyoid bone and larynx

mandibular depression

are part of the extrinsic muscles of the tongue ad the stylohyoid which connects the hyoid bone to the base of the skull.

What muscles assist in depressing the hyoid bone and larynx?

infrahyoid muscles

What do the infrahyoid muscles do?

depress the hyoid bone and larynx

attach the hyoid bone to the sternum, clavicles, scapulae, ribs, and thyroid

Think about the baby who has hypotonia, torticollis, skull deformity, respiratory disorder (and therefore ribcage involvement), cardiac disorder (and therefore sternum and ribcage involvement)

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What happens to their swallowing?

They can’t swallow

Importance of the hyoid bone: What is the hyoid bone directly attached to?

mandible, tongue, larynx, shoulder girdle/scapulae, and rib cage.

Importance of the hyoid bone: What areas does the hyoid bone directly contribute movement to?

Oral, pharyngeal, and laryngeal area

Importance of the hyoid bone: The hyoid bone contributes to the alignment of the what body parts?

the head, neck, shoulder girdle, and rib cage.

Importance of the hyoid bone: The hyoid bone elevates and depresses what two parts for swallowing?

tongue and larynx

Importance of the hyoid bone: True/False The hyoid bone actively participates in respiration.

True

Importance of the hyoid bone: How does hyoid bone assists in maintaining the pharyngeal airway?

elevating and depressing to clear residual secretion

Think about the baby who has a condition where the structures are undeveloped (prematurity ) or

have hypotonia, cardiac condition, diaphragmatic hernia, respiratory distress, pulmonary stenosis, bronchopulmonary dysplasia, C.P. etc. etc. etc.).

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What happens to their swallowing and respiration?

They can’t swallow and they have difficulty breathing

What kind of structure is the tongue?

oral structure!! (but it influences the pharynx significantly)

What impacts the position and alignment of the larynx?

The body of the tongue, its extrinsic muscles, and its movements

The diaphragm of the newborn is positioned _______ in the thoracic cavity at rest. This allows for more efficiency.

higher

Newborns & 1-2 Months: What is the primary muscle of inspiration used by newborns?

the diaphragm

Newborns: & 1-2 Months: Why are the ribs and the sternum are primarily cartilaginous structures at birth?

To give these structures
more flexibility and to make the ribs and sternum less susceptible to forces placed on them by surrounding
musculature and activity.

Newborns & 1-2 Months: The diaphragm consists of ____ and __, and is surrounded by _____

muscles, tendons, tissue

Newborns & 1-2 Months: Describe the diaphragm (where it is and its shape).

It forms the floor of the
thoracic cavity and separates the thorax from the abdominal cavities.

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The diaphragm is dome shaped when
relaxed.

Newborns & 1-2 Months: What is rib flaring/rib expansion?

When the diaphragm is contracted on inspiration, it flattens, the abdominal wall is pushed outward, and the lower ribs are pulled up and out. (normal in newborns!)

Newborns & 1-2 Months: What is the rooting response?

When the side of the cheeks and lips are touched (tactile input/tactile stimulation), the baby’s head (and tongue, lips, and jaw) move toward that side

Newborns & 1-2 Months: What does the tongue do during the feeding process?

The tongue cups/grooves around the nipple and moves up and down, front and back, with the jaw.

Newborns: What is total pattern of sucking?

The lips surround the nipple, rounded/flanged, but do not hold on to the nipple with the lips yet.

Newborns & 1-2 Months: What is active pattern of suckling?

The active pattern of the newborn’s tongue moving rhythmically with the jaw in a pattern. New born has head extension and movement of oral cavity.

Newborns: Which comes first, total pattern of sucking or active pattern of suckling?

total pattern of sucking

Newborns & 1-2 Months: How are sounds such as crying or vowel like sounds produced and what body parts are used?

Sounds are produced upon exhalation with general body movements from the vocal folds and larynx.

Newborns: The cries and vowel like sounds are ______ in quality

nasal

Newborns: Newborns’ vision may be sensitive to ____ at first. Eye movements may be __ and ______.

light

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random, disorganized

Newborns: When does the baby begin to visually fixate using one eye at a time?

Within the first week of life.

Newborns: What type of object can newborns see better, moving or stationary ones?

Moving objects are seen better than stationary ones, as stationary objects blend into the background and disappear.

Newborns: Do newborns' eyes move with their head?

Yes, they do

Newborns: When does a newborn begin to look at the feeder while breast or bottle-feeding?

Within the first few weeks of life.

Newborns: At what distance does a baby see best?

Baby sees best when the object is 8-15 inches away.

1-2 Months: What are the characteristics of random movements in 1-2 month old babies?

Random movements continue to occur but are less reflexive and more coordinated.

1-2 Months: What happens to the head and neck in 1-2 month old babies?

The head and neck begin to dissociate from the neck and elongate downward.

1-2 Months: What happens to physiological flexion in 1-2 month old babies?

Physiological flexion begins to diminish.

1-2 Months: At what age can a 1-2 month old baby be held more upright on an adult shoulder?

During the second month.

1-2 Months: What can a 1-2 month old baby do in terms of holding its head upright?

The infant begins to lift its head off of the shoulder to hold it upright momentarily.

1-2 Months: What can a 1-2 month old baby do in prone position?

In prone position, the 1-2 month old can lift its head to shoulder level.

1-2 Months: What happens to the movements of arms and legs in supine position for a 1-2 month old baby?

The arms and legs move randomly but are not as jerky.

1-2 Months: What happens to the range of arm movements in a 1-2 month old baby?

The arms move in wide ranges.

1-2 Months: What assists in expanding the chest of a 1-2 month old baby?

The infant's own movements and gravity assist with expanding the chest.

1-2 Months: What happens when a finger is placed into a 1-2 month old baby's hand?

The baby will grasp the finger, but does not yet know that it is holding a finger.

1-2 Months: What is the nature of grasping in a 1-2 month old baby?

The grasping is reflexive and involuntary.

1-2 Months: When is physiological flexion lost by?

2 months

1-2 Months: True/False The head is lifted more actively

True

1-2 Months: What happens to movements (body, prone, supine)? Is this good?

Movements become more organized and asymmetrical (in a good way!)

1-2 Months: How does the routing response benefit the infant?

It provides practice for the infant and a good experience for oral sensory and tactile stimulation.

1-2 Months:

What is the rhythmical, coordinated, non- nutritive experiences that help the infant to calm and quiet as the body is organized?

suckling

1-2 Months: How does sound production and voicing change?

Still sound nasally but now more voicing is evident.

1-2 Months: Sounds are produced in relation to the infant’s ___________.

body movements

1-2 Months: How do cries change?

cries are longer and vary in pitch

1-2 Months: True or False Cries begin to sound different depending on “state” (hungry, uncomfortable, pain, tired)

True

1-2 Months: At what distance does a baby see best?

Baby sees best when the object is 10-20 inches away

1-2 Months: What patterns are interesting to the 1 month old?

Black and white patterns

1-2 Months: Do 2-month olds use one eye at a time or both eyes simultaneously?

both eyes stimultaneously

1-2 Months: How is the baby’s tracking?

It is better

3-5 months: What is the improvement seen in an infant's head control at 3 months?

At 3 months, when held upright, the infant maintains its head in a vertical position, indicating an improvement in head control.

3-5 months: What happens to the primitive reflexes of infants at 3-5 months post-term?

the primitive reflexes begin to diminish and become integrated with the baby's movement patterns.

3-5 months: What functional position can the infant take?

the prone position becomes a functional position for the infant, as they can bear weight on their forearms, lift their head and shoulder girdle upward.

3-5 months: What is the stretching and elongation of the neck, trunk, and shoulder girdle important?

the development of postural stability and movement against gravity.

3-5 months: What is the significance of the infant's ability to explore objects with their mouth at 3-5 months?

The infant's ability to explore objects with their mouth at 3-5 months is a normal part of their developmental exploration process.

3-5 months: True/False Weight shifting occurs

true

3-5 months:What changes are there to the baby’s motor movements?

they can reach and grab dangling objects and bring things to their mouth

3-5 months: What happens to the salivary glands?

Drooling begins! Salivary glands begin to produce more saliva.

4-5 months old: True/False Significant changes in oral-motor development occur in 4-5 month olds.

True

4-5 months old: What happens to the face, tongue, and mandible?

It begins to elongate and enlargen.

4-5 months old: What happens to the hyoid bone?

The hyoid bone descends to an inferior position below the body of the mandible.

4-5 months old:

As __ control of the infant develops, the structures of the shoulder girdle, upper rib cage, larynx, tongue, and mandible directly impacts the alignment and function of the ___ bone.

postural

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hyoid

4-5 months old: What does the hyoid bone influence?

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* the development of controlled head movements
* neck elongation
* shoulder girdle activity
* rib cage movements

4-5 months old: New _________ movements occur

antigravity

4-5 months old: The baby is placed in a supported “____” sit which pulls the sternum, ribs, and rib cage down.

ring

4-5 months old: Rolling from ____ to ___ begins

supine to prone/prone to supine

4-5 months old: What does the baby begin to use to stabilize itself?

Its mouth!

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it may use the lips, jaw, and tongue to reinforce stability at the neck, head, shoulder girdle, and upper trunk.

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(the baby learns to coordinate the oral and pharyngeal mechanisms with the body movements.)

4-5 months old: What patterns begin to change? How?

the infant’s suckling patterns begin to change.

* The lips begin to actively hold on to the nipple more
* The tongue cups around the nipple more
* The tongue moves with greater up-down movements.

4-5 months old: Instead of suckling, what is developed instead?

Sucking! (mature movements and patterns)