OT-509 Medical and Social Conditions

Nurture

 Prenatal

Perinatal

Teratogen

Neurotoxicants

 Low Birth Weight

Etiology

Prematurity

Risks

Prenatal risk

Perinatal risks

Environmental risks

effects of neurotoxicants

low birth weight

Physical and Behavioral Characteristics of the Premature Infant

Three Levels of Prevention

Lead

Alcohol

mercury

tobacco smoke

illicit drugs

Pesticides

Polychlorinated Biphenyls (PCB)

zika virus

Fetal Alcohol Spectrum Disorder (FASD)

A group of conditions with a range of physical, mental, behavioral and learning effects with lifelong implications

Fetal Alcohol Spectrum Disorders

1.Fetal Alcohol Syndrome (FAS)

2.Alcohol-Related Neurodevelopmental Disorder (ARND) 

3.Partial Fetal Alcohol Syndrome (pFAS) 

FAS Signs at birth

1.Low birth weight

2.Height and weight below 10^th percentile for age and race

3.Cranio-facial characteristics

4.Lower IQ

5.Hypotonia

6.Emotional and behavioral problems

7.Poor coordination

8.Difficulty with attention

9.Poor memory, reasoning, and judgement

Treatment for FAS

▪Coordination of multiple services

▪Neonatal Intensive Care

▪Early Intervention

▪Sensory Processing

▪Fine and Gross Motor Skills

▪Classroom Participation

▪Social Skills

Neonatal Abstinence Syndrome

•A group of problems that occur in a newborn who was exposed to addictive illegal or prescription drugs while in the mother's womb.

•This often manifests by CNS irritability, autonomic overreactivity, and GI tract dysfunction.

NAS - Common Substances

•Prescription Drugs – Vicodin, Oxycodone, Morphine, Percocet, Fentanyl, Methadone or Codeine

Preterm vs. Term Newborns NAS

•Withdrawal is less extensive in preterm newborns

•Hallmark Sign of NAS

is Hyper-irritability

Signs of NAS

•Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone

•Fussiness, excessive crying or having a high-pitched cry

•Poor feeding or sucking or slow weight gain

•Breathing problems, including breathing really fast

•Fever, sweating or blotchy skin

•Trouble sleeping and lots of yawning

•Diarrhea or throwing up

•Stuffy nose or sneezing

Symptoms of NAS

•Blotchy skin coloring (mottling)

•Diarrhea

•Excessive and high pitched crying

•Excessive sucking

•Fever

•Hyperactive reflexes

•Increased muscle tone

•Irritability

•Poor feeding

•Tachypnea

•Seizures

•Sleep problems

•Slow weight gain

•Stuffy nose, sneezing

•Sweating

•Trembling (tremors)

•Vomiting

Comorbidities/Long term effects of NAS

•Long-term mortality rate is extremely low

•Risk for SIDS is significantly higher among infants who are exposed to opiates.

•This increased risk is related to a complex interplay of factors; the compromised home environment associated with a mother who is drug addicted is an important variable.

•Impulsivity and attention problems

•Slightly lower IQ scores

•Memory and perceptual problems

Medical Treatment for NAS

•Methadone

•Morphine

•Suboxone

•Tylenol

Nonmedical treatment for NAS

Swaddling  Indications

•Comfort a colicky or fussy baby

•Position in midline, flexion and containment

Attachment Disorder

▪A psychiatric illness can develop in young children who have problems in emotional attachments to others

▪Occurs as early as the first birthday

▪severe colic and/or feeding difficulties, failure to gain weight, detached and unresponsive behavior, difficulty being comforted, preoccupied and/or defiant behavior, inhibition or hesitancy in social interactions, being too close with strangers

Reactive Attachment Disorder (RAD)

▪Trauma and stressor related condition caused by social neglect and maltreatment

▪poor language acquisition, impaired cognitive development, Contributes to behavioral dysfunction

Trauma

a serious injury or shock to the body, as from violence or an accident

Complex trauma

chronic exposure to multiple traumatic incidents that occur within a relational system, often in early childhood, which impact on development and self-awareness

Alexithymia

the impaired capacity to describe emotions or bodily states, is a persistent sign of affect dysregulation.

Dissociation

a loss in the ability to process and integrate information and experiences.

parentification

absent parents so a sibling assumes the role

Pre attachment stage

(Birth to ~6 weeks)

• Definition: The infant shows no preference for any specific caregiver.

  • Behavior: Responds positively to anyone or anything that elicits a reaction

Indiscriminate attachment

(~6 weeks to ~7 months)

• Definition: The infant prefers people to objects but does not yet show a strong preference for one person

  Simply Psychology.

  • Behavior: Will accept care from strangers, though may show more engagement with familiar people.

Discriminate attachment

(~7–9 months)

• Definition: The infant develops a clear preference for a particular caregiver(s)

  Simply Psychology+1.

• Behavior: Shows distress when separated from that person, seeks comfort from them, and avoids or is wary of strangers.

multiple attachments

(~10 months onward)

• Definition: The child forms secure bonds with several caregivers — e.g., parents, grandparents, siblings, or other responsive adults

  Simply Psychology+1.

• Behavior: Stranger anxiety may weaken; the child can interact positively with multiple people while maintaining the strongest bond with the primary caregiver.

attachment disorder

▪Most children have severe challenges with early relationships

▪May have been physically or emotionally abused or neglected

▪Physical, social, and emotional problems last a lifetime

attachment disorder symptoms

▪severe colic and/or feeding difficulties

▪failure to gain weight

▪detached and unresponsive behavior

▪difficulty being comforted

▪preoccupied and/or defiant behavior

▪Inhibition or hesitancy in social interactions

▪being too close with strangers

etiology of reactive attachment disorder

▪Trauma and stressor related condition caused by social neglect and maltreatment

4 major types of maltreatment

▪Physical abuse

▪Neglect

▪Sexual abuse

▪Emotional abuse

signs of physical abuse

▪Sudden changes in behavior

▪Has not received help for physical or medical problems

▪Is always watchful

▪Is overly complaint, passive or withdrawn

▪Discloses maltreatment

▪Seems scared, anxious, depressed, withdrawn or aggressive

▪Unexplained injuries

signs of neglect

▪Is frequently absent from school

▪Begs or steals food or money

▪Lacks needed medical care (including immunizations), dental care, or glasses

▪Is consistently dirty and has severe body odor

▪Lacks sufficient clothing for the weather

▪States that there is no one at home to provide care

signs of sexual abuse

▪Has difficulty walking or sitting

▪Experiences bleeding, bruising, or swelling in their private parts

▪Suddenly refuses to go to school

▪Reports nightmares or bedwetting

▪Experiences a sudden change in appetite

signs of emotional maltreatment

▪Shows extremes in behavior

▪Is either inappropriately adult or inappropriately infantile

▪Is delayed in physical or emotional development

▪Shows signs of depression or suicidal thoughts

▪Reports an inability to develop emotional bonds with others

protective factors

▪Having Resilient parents

▪Building attachment and nurturing relationships

▪Building social connections

▪Meeting basic needs

▪Learning about parenting and how children grow

▪Building social and emotional skills

adverse childhoos experiences

▪Serious childhood Traumas that result in toxic stress that can harm a child’s brain

▪Prevents the child from learning, playing in a healthy way with other children and can result in long term health problems