Childbirth, Newborn, and Infancy Notes

I. Birth

A. Four Stages of Childbirth

• First Stage:
  • A series of stronger and stronger contractions dilates the cervix, which is the opening to the mother's womb.
• Second Stage:
  • The baby's head moves down the birth canal and emerges from the vagina.
• Third Stage:
  • The placenta and umbilical cord are expelled from the womb, and the cord is cut.

B. Methods of Delivery

• Medicated Delivery
• Natural and Prepared Childbirth:
  • Natural childbirth:
    • A method of childbirth that seeks to prevent pain by eliminating the mother's fear through education about the physiology of reproduction and training in breathing and relaxation during delivery.
  • Prepared childbirth:
    • A method of childbirth that uses instruction, breathing exercises, and social support to induce controlled
• Cesarean Delivery:
  • Delivery of a baby by surgical removal from the uterus.
• Electronic Fetal Monitoring

C. Settings for Childbirth

• Hospitals
• At Home
• Birthing Centers

II. The Newborn/Neonatal Period

• Neonatal Period:
  • The first four weeks of life, a time of transition from intrauterine dependency to independent existence.
• Neonate:
  • A newborn baby, up to 4 weeks old.

A. Size and Appearance

B. Body Systems

• Circulatory System

• Respiratory System

• Gastrointestinal System

• Temperature Regulation

• Anoxia:

  • Lack of oxygen, which may cause brain damage.

• Meconium:

  • Fetal waste matter, excreted during the first few days after birth.

• Neonatal jaundice:

  • A condition in many newborn babies caused by the immaturity of the liver, evidenced by a yellowish appearance.

III. Influences on Growth of Body and Brain

• Normal physical growth and sensory and motor development proceed according to the cephalocaudal and proximodistal principle.
• A child's body grows most dramatically during the first year of life.
• Breastfeeding offers many health advantages and sensory and cognitive benefits.
• Sleep patterns change dramatically; by the second half of the first year, babies do most of their sleeping at night.

IV. Medical and Behavioral Screening

• Immediate Medical Assessment: The Apgar Scale
• Neonatal Screening for Medical Conditions
• Assessing Responses: The Brazelton Scale

A. The Apgar Scale

• The Apgar Scale is a standard measurement of a newborn's condition, assessing appearance, pulse, grimace, activity, and respiration.
• How the Apgar score works:
  • A: Activity/muscle tone
    • 0 points: limp or floppy
    • 1 point: limbs flexed
    • 2 points: active movement
  • P: Pulse/heart rate
    • 0 points: absent
    • 1 point: less than 100 beats per minute
    • 2 points: greater than 100 beats per minute
  • G: Grimace (response to stimulation, such as suctioning the baby's nose)
    • 0 points: absent
    • 1 point: facial movement/grimace with stimulation
    • 2 points: cough or sneeze, cry, and withdrawal of foot with stimulation
  • A: Appearance (color)
    • 0 points: blue, bluish-gray, or pale all over
    • 1 point: body pink but extremities blue
    • 2 points: pink all over
  • R: Respiration/breathing
    • 0 points: absent
    • 1 point: irregular, weak crying
    • 2 points: good, strong cry

B. Neonatal Screening for Medical Conditions (Newborn Screening)

• Early detection and management of several congenital disorders.
• These conditions, if left untreated, can lead to mental retardation or even death.
• 3 Parts:
  • Blood spot screening, which determines if a baby might have one of many serious conditions
  • Pulse oximetry screening, which determines if a newborn might have certain heart conditions
  • Hearing screening, which determines if a newborn might be deaf or hard of hearing

C. Brazelton Neonatal Assessment Scale

• Neurological and behavioral test to measure neonate's responses to the environment.

V. Infancy

• From the Latin word "infans" - without speech.
• From birth to age two, as a time of beginnings.
• Infancy is when personality, social attachments, thinking, and language first take shape.

VI. Characteristics of Infancy/Babyhood

• Babyhood is the true foundation age.
  • Many behavior patterns, attitudes, and emotional expressions are established, and it is a critical period in setting the pattern for personal and emotional adjustments.
• Babyhood is an age of rapid growth and development:
  • They grow physically and psychologically.
  • Change in height and weight.
  • Can develop interests and attitudes.
• There’s the development of body control:
  • Sitting, standing, walking.
• Increased independence and individuality:
  • Begins to do things itself.
  • Rebellion against being treated as a baby.
  • A protest comes in the form of angry outbursts and crying when independence is denied.
• Period of creativity, sex role, and socialization for adjustment in future life.
• The ability to recognize and respond to people and objects in the environment grows.
• The baby is able to understand many things and communicate its needs and wants.

VII. Areas of Development

1. Motor Development
2. Cognitive Development
3. Emotional Development
4. Language Development
5. Moral-Spiritual Development

VIII. Motor Development

A. Principles of Development

• Cephalocaudal Law:
  • A progressive development of the skills and abilities which starts in our head and ends in our feet, going through the trunk in a vertical and descendant direction.
• Proximodistal Law:
  • A progressive development of the skills and abilities from the center of the body towards the members going through the shoulders, elbow, wrist, to end with the fingers.

B. Reflexes

• Infants are born with a surprising number of unlearned (innate) reflexes, that is, unlearned responses to stimuli.
  1. The Moro reflex is an outstretching of the arms and legs in response to a loud noise or sudden change in the environment. The infant's body tenses; arms are extended and then drawn inward as if embracing.
  2. The Babinski reflex is an outward projection of the big toe and fanning of the others when the sole of the foot is touched.
  3. The sucking reflex occurs when an object touches the lips.
  4. The rooting reflex is the turning of an infant's head toward a stimulus such as a breast or hand.
  5. The grasping reflex is the vigorous grasping of an object that touches the palm.
  6. The plantar reflex is the curling under of the toes when the ball of the foot is touched. Physicians sometimes use these reflexes to assess the rate of development. Gradually, learned responses replace the reflex actions as an infant becomes more responsive to the environment.

C. Motor Milestones

• 1-2 months:
  • Tonic-neck reflexes predominate. The head is turned far to the side, can roll partly to side.
• 3 months:
  • Is able to turn to prone position.
• 4 months:
  • Turns from prone to supine position.
• 5 months:
  • Turns back to supine from prone.
• 6-7 months:
  • Rolls form stomach to stomach.
• 8 months:
  • Can alternate from prone to sitting position and vice versa; can crawl.
• 9 months:
  • Can pull themselves up by holding onto something.
• 10-11 months:
  • Sits with good control.
  • Can pivot around.
  • Can walk while holding someone's hands.
• 12 months:
  • Walks even when only one hand is held.
• 15 months:
  • Can push a chair around, climb and get down from it.
• 18 months:
  • Runs but falls sometimes; can climb stairs by creeping.
• 21 months:
  • Can squat while playing; can climb up stairs by assuming an upright position.
• 24 months:
  • Can walk backwards and on toes.
  • Can run without falling; can climb stairs with both feet on tread before stepping.

IX. Cognitive Development

A. Intelligent Behavior

B. Approaches to Studying Cognitive Development

• Behaviorist Approach:
  • Concerned with basic mechanics of learning.
  • Concerned with how behavior changes in response to experience.
• Psychometric Approach:
  • Measures quantitative differences in abilities that make up intelligence by using tests that indicate or predict these abilities.
• Information-Processing Approach:
  • Focuses on perception, learning, memory, and problem-solving.
• Cognitive Neuroscience Approach:
  • Examines the hardware of the central nervous system and identifies what brain structures are involved in specific aspects of cognition.
• Social-contextual approach:
  • Examines the effects of the environmental aspects of the learning process, particularly the role of parents and other caregivers.
• Piagetian Approach:
  • Describes qualitative stages in cognitive functioning.

C. Piaget's Sensorimotor Stage

• Six Substages of Piaget's Sensorimotor Stage of Cognitive Development:

  1. Use of reflexes (birth to 1 month):
     • Infants exercise their inborn reflexes and gain some control over them.
     • They do not coordinate information from their senses.
     • They do not grasp an object they are looking at.
  2. Primary circular reactions (1 to 4 months):
     • Infants repeat pleasurable behavior that first occurs by chance.
     • Activities focus on the infant's body rather than the effects of the behavior on the environment.
     • Infants make first acquired adaptations; that is, they suck different objects differently.
     • They begin to coordinate sensory information and grasp objects.
  3. Secondary circular reactions (4 to 8 months):
     • Infants become more interested in the environment; they repeat actions that bring interesting results and prolong interesting experience.
     • Actions are intentional but not initially goal-directed.
  4. Coordination of secondary schemes (8 to 12 months):
     • Behavior is more deliberate and purposeful as infants coordinate previously learned schemes and use previously learned behaviors to attain their goals, and they can anticipate events.
  5. Tertiary circular reactions (12 to 18 months):
     • Toddlers show curiosity and experimentation; they purposefully vary their actions to see results.
     • They actively explore their world to determine what is novel about an object, event, or situation.
     • They try out new activities and use trial and error in solving problems.
     • Actions get one pleasing result, leading the baby to perform similar actions to get similar results.
  6. Mental combinations (18 to 24 months):
     • Mental representation of events.
     • Symbolic thought enables toddlers to begin to think about events and anticipate their consequences without always resorting to action.
     • Toddlers begin to demonstrate insight.
     • They can use symbols such as gestures and words and can pretend.

D. Key Developments of the Sensorimotor Stage

• Imitation:
  • Invisible imitation develops around 9 months; deferred imitation begins after the development of mental representations in the sixth substage (18-24 months).
• Object permanence:
  • Understanding that a person or object still exists when out of sight, develops gradually between the third and sixth substages.
• Symbolic development:
  • Depends on representational thinking, which develops in the sixth substage.
  • Representational ability is the capacity to store mental images or symbols of objects and events.
• Categorization:
  • Depends on representational thinking, which develops during the sixth substage.
• Causality:
  • Develops slowly between 4-6 months and 1 year, based on an infant's discovery, first of effects of own actions and then of effects of outside forces.
• Number:
  • Depends on the use of symbols, which begins in the sixth substage (18-24 months).

X. Language Development

• The first language of a child is crying, expressing hunger, pain, anger, fear, etc.
• Then "cooing" (yawning, guttural sounds, growls, etc.) followed by babbling (“da”, “na”, “ma”).
• Then syllable-word languages:
  • Usually, the last syllable is said.
  • "Ma" for mama, "di" for daddy, "tay" for tatay.
• At around one year, they can say a word, usually mama.

A. Theories of Language Development

• Noam Chomsky:
  • Proposed that there are deep structures and surface structures in every sentence, regardless of the language. This is the reason why you can form sentences with similar meaning using a theoretically infinite combination of words.
  • Developed the theory of universal grammar, asserting that the human brain contains a mechanism for language acquisition, meaning that our languages share the same deeper structures despite the largely superficial surface structures.
  • This is why it's possible for anyone to learn a foreign language, regardless of the complexity of its grammatical structure or script.
• B.F Skinner:
  • Theorized that language acquisition is dictated by our environment and the positive or negative reinforcement we receive from it.
  • Parents, for example, enforce correct usage of a word in children with positive facial or verbal reactions.
  • Introduced the concept of functions to words, as well as meanings.
• Jean Piaget:
  • Asserted that children would only be able to fully grasp some concepts within specific developmental stages, due to the fact that certain sections of the brain would only further develop at certain ages.
  • For example, since the sensorimotor area develops first during the first two years of a child's life, children focus on their immediate surroundings, experimenting with the things around them by playing with them, biting them, or throwing them.
  • Throughout this stage, they'll take things apart, put things back together, and explore the concept of things existing in and out of sight. By the end of it all, they'll be able to visualize things that aren't there in front of them, which is arguably the most crucial part of this stage when it comes to language and communication.

XI. Psychosocial Development

XII. Emotional Development

• Emotions are subjective reactions to experience that are associated with physiological and behavioral changes.
• Crying:
  • Hunger cry, angry cry, pain cry, frustration cry.
• Self-conscious emotions:
  • Emotions such as embarrassment, empathy, and envy that depend on self-awareness.
• Self-awareness:
  • Realization that one's existence and functioning are separate from those of other people and things.
• Self-evaluative emotions:
  • Emotions such as pride, shame, and guilt that depend on both self-awareness and knowledge of socially accepted standards of behavior.
• Empathy:
  • Ability to put oneself in another person's place and feel what the other person feels.
• Social cognition:
  • The ability to understand that other people have mental states and gauge to their feelings and intentions.
• Egocentrism:
  • Piaget's term for the inability to consider another person's point of view; a characteristic of young children's thought.

A. Temperament

• Three Temperamental Patterns:
  • "Easy" children:
    • Children with a generally happy temperament, regular biological rhythms, and a readiness to accept new experiences.
  • "Difficult” children:
    • Children with irritable temperament, irregular biological rhythms, and intense emotional responses.
  • "Slow-to-warm-up" children:
    • Children whose temperament is generally mild but who are hesitant about accepting new experiences.

B. Earliest Social Experiences: The Child in the Family

• The Mother's Role
• The Father's Role
• How Parents Shape Gender

C. Object Relations Theory (Melanie Klein)

• Klein emphasizes the importance of 4-6 months after birth: the child's relation to the breast is considered to be a prototype for later relationships towards the infant's parents and other individuals.

XIII. Attachment Theory (Mary Ainsworth)

• Attachment theory was based on the behavior children exhibited when the caregiver does not provide the necessary care or is absent.

• The absence from the caregiver makes the child insecure; the lack of a stable mother or caregiver causes the child to experiences emotional effects.

• Ainsworth believed that the attachment between the caregiver formed a secure base for children to explore. In addition to, caregivers being sensitive to children signals of need and patterns. Forming these securements now makes for a successful adulthood.

• This lead to her procedure called "The Strange Situation Experiment." This experiment supported her theory by testing the amount of stress children displayed when a stranger was near. This lead to researches identifying four different attachment children have based on their securement with their caregiver.

• Mary Mainsworth – 4 attachment styles:

  • Secure Attachment:

    • This happens when a child is very attached to the mother. Their emotional and basic needs are being met by the mother.
    • As adults, those who are securely attached tend to have to trust, long-term relationships. Other key characteristics of securely attached individuals include having high self-esteem, enjoying intimate relationships, seeking out social support, and an ability to share feelings with other people

  • Anxious-Resistant Insecure Attachment:

    • This child becomes irritated when the stranger appears in the room, while the mother is still nearby. And when the mother leaves, the child cannot explore and continue play. He is very distressed.
    • However, when the mother comes back, the child acts resentful and upset to the mother, and he tries to move away from her.
    • As adults, this individual tends to have a sensitive nervous system, struggles communicating directly, and tends to 'act out' when triggered (make partner jealous)

  • Anxious-Avoidant Insecure Attachment:

    • This child seems careless. He doesn't show much emotion whether the mother is in the room or not. He doesn't want to be played with or held. He acts the same with the stranger as well.
    • As adults, they may have problems with intimacy, invest little emotion in social and romantic relationships, and be unable to share thoughts and feelings with others.

  • Disorganized/Disoriented Attachment:

    • This child might be distressed when the mother leaves the room and be relieved when she comes back. However, the child may not want to be held or may show anger once the mother approaches. He might hit or rock.
    • Further research revealed that more than half of the mothers with a child who fell into this category had suffered a trauma immediately before the birth of the child and had developed depression because of that trauma.
    • As adults, they tend to fear close intimacy in relationships, fear showing vulnerability, express little or no empathy with others, have little or no understanding of personal boundaries, and express extreme range or anger in response to confrontation or threat.

• John Bowlby:

  • Defined attachment as a 'lasting psychological connectedness between human beings'. He proposed that attachment can be understood within an evolutionary context in that the caregiver provides safety and security for the infant. Attachment is adaptive as it enhances the infant's chance of survival

D. Stages of Attachment

• Preattachment Phase (Birth - 6 Weeks):
  • Baby's innate signals attract caregiver (Grasping, crying, smiling and gazing into the adult's eyes).
  • Caregivers remain close by when the baby responds positively.
  • The infants encourage the adults to remain close as the the closeness comforts them.
  • Babies recognize the mother's smell, voice and face.
  • They are not yet attached to the mother, they don't mind being left with unfamiliar adults.
  • They have No fear of strangers
• "Attachment in Making" Phase (6 Weeks - 6 to 8 Months):
  • Infant responds differently to familiar caregivers than to strangers. The baby would babble and smile more to the mother and quiets more quickly when the mother picks him.
  • The infant learns that her actions affect the behavior of those around
  • The begin to develop "Sense of Trust" where they expect that the caregiver will respond when signaled
  • The infant still does not protest when separated from the caregiver
• "Clear Cut" Attachment Phase (6-8 Months to 18 Months -2 Years):
  • The attachment to familiar caregivers becomes evident
  • Babies display "Separation Anxiety", where they become upset when an adult whom they have come to rely leaves
  • Although Separation anxiety increases between 6 -15 months of age its occurrence depends on infant temperament, context and adult behavior
  • The child would show distress when the mother leaves but if the caregiver is supportive and sensitive then this anxiety could be short-lived.
  • Also if the baby has not developed the concept of Piagetian object permanence they usually do not become anxious when the parent leaves
• Formation of Reciprocal Relationship (18 Months - 2 Years and on):
  • With rapid growth in representation and language by 2 years the toddler is able to understand some of the factors that influence parent's coming and going and to predict their return. Thus separation protests decline.
  • The child could negotiate with the caregiver, using requests and persuasion to alter her goals
  • With age the child depends less on the caregiver, more confidence that the caregiver will be accessible and responsive in times of need.

XIV. Freud's Psychosexual Stages

A. The Oral Stage (0-2 Years)

• In the first year, the ID is dominant; tension is reduced through satisfying basic needs and pleasure is gained through sucking and body stimulation.
• Any disturbance of this may result in a permanent fixation on the oral channel for gratification, for example smoking, overeating, thumb-sucking, pencil chewing.
• Certain personality traits may be related to such fixations such as impatience, passivity, greediness, dependence, preoccupation with issues of giving and taking.
• Primary Conflict:
  • Weaning. If a child is weaned too early or too late that can result in either too much or insufficient gratification of the id, resulting in an oral fixation.

XV. Erikson's Stages of Psychosocial Development

A. Stage 1: Trust vs. Mistrust (0-18 months)

• Crisis: Infants develop feelings of trust, or a lack of trust. If adults meet the needs of the baby (nourishment, attachment, attention), the baby develops trust. If adults are inconsistent providers or the baby experiences unpleasant interactions, it develops mistrust.

XVI. Moral-Spiritual Development

• At birth, they can't recognize those around them.
• By the 3rd month, the baby starts to respond to voices.
• They express joy in the presence of others by kicking, smiling, or crying.
• By the 6th month, they smile at familiar faces and show fear of strangers
• By the 15th month, shows interest in familiar people and wants to be with them.
• Likes to play with babies
• Takes things from them; and won't give it back.
• But as they grow older, they start to share and be nicer.