Child Development From Infancy to Adolescence. Laura E. Levine
Infant states. Infants continually move through a series of states that allow them to regulate the amount of stimulation that they receive. Can you see how this is an adaptive way for an infant to meet his or her needs for rest, stimulation, and physical care?
Photo courtesy of Ted Ketai
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Most newborns experience a period of quiet alertness shortly after they are born. Their eyes are open and they are attentive to what is going on around them, but their bodies are very still and their breathing is regular. This is a wonderful opportunity for new parents to begin the process of bonding with their infant. This initial period of quiet alertness is usually followed by a state of quiet sleep. Newborns typically sleep 16 to 18 hours each day (Hanrahan, 2006). About half this time is spent in REM (rapid eye movement) sleep, which is when dreams occur, and half is spent in regular sleep, which ranges from drowsiness in which the eyes open and close to a deeper sleep in which the infant is quiet and doesn’t move. Because infants’ stomachs are so small, they wake up to eat about every 3 or 4 hours throughout the day and the night (Hanrahan, 2006).
Although sharing a family bed is a common practice in many cultures around the world, co-sleeping has been a controversial topic in the United States (Sobralske & Gruber, 2009). The American Academy of Pediatrics ([AAP], 2011c) is critical of this practice because of its relationship with sudden infant death syndrome (SIDS) and other sleep-related causes of infant death. The AAP recommends that infants sleep in the same room as their parents for at least 6 months and ideally up to a year, but that they sleep on a separate surface with a firm mattress with no soft bedding (Task Force on Sudden Infant Death Syndrome, 2016).
The last state on the continuum is crying, which is how infants signal that they need something, although they also may cry for no discernible reason. The amount of time spent crying and fussing is high during the first 6 weeks of life, with an average of about 2 hours a day, but drops significantly to a little over one hour a day by 10 to 12 weeks after birth (Wolke, Bilgin, & Samara, 2017).
Even at this young age, there are individual differences in how regular infants are in their behavior. Some have regular and predictable schedules and are easy to calm when they are upset, but others are more variable in their schedule and more difficult to soothe. Some infants smoothly transition from one state to another, and others move rapidly or unexpectedly between states. Some signal what they need in a way that is clear and easy for parents to interpret so they can promptly respond, and others are much more difficult for new parents to “read.” We discuss these temperamental differences in Chapter 7, but over the early weeks, parents come to know the unique characteristics of their newborn, and in most cases, parents and newborns are able to get in sync with each other so things go relatively smoothly. That doesn’t mean, however, that there won’t be plenty of nights with too little sleep for the new parents and times when they worry about how well they and their new baby are doing.
Risks to the Newborn’s Health and Well-Being
A number of factors can place a newborn at risk, but being born prematurely or at a low birth weight are significant ones. Saying that an infant is premature or preterm are both ways of saying that the infant was born before a gestational age of 37 weeks (U.S. National Library of Medicine, 2017c). Babies born at full term weighing less than 5 pounds, 8 ounces are considered low birth weight. Babies who are smaller in size than normal for their gestational age are considered small for gestational age. This is an indication that something has restricted physical growth in the prenatal environment. Table 4.3 shows the criteria for identifying different levels of prematurity and low birth weight.
Premature or preterm birth: A birth that occurs before a gestational age of 37 weeks.
Low birth weight: A full-term infant who weighs less than 5 pounds, 8 ounces.
Small for gestational age: Babies who are smaller in size than normal for their gestational age.
Table 4.3
This table shows the criteria used to determine levels of prematurity and low birth weight. Although at times it is important to know how early an infant arrived and at other times it is important to know the infant’s birth weight, these two conditions usually co-occur. Infants who are born early (or preterm) will almost always have a less than normal birth weight.
Sources: Iannelli (2017); Mayo Clinic Staff (2017c).
In 2015, one in every 10 infants born in the United States was a preterm infant (CDC, 2016m). Although the number of preterm births declined between 2007 and 2014, data for 2014 and 2015 have shown a slight increase. Because premature infants are at risk for a number of neurological and development problems, any increase is a cause for concern.
The underlying causes of premature births are complex and not always well understood (CDC, 2016m), but several factors increase the risk. A lack of prenatal care for women who do not have health insurance plays a role in 20% of premature births (March of Dimes, 2013) and the unhealthy maternal behaviors that we have already discussed, such as smoking, drinking, or using drugs while pregnant, are responsible for some premature and low birth weight births. Both the youngest and the oldest mothers also are at increased risk, as are African American mothers (CDC, 2016m). The increase in the number of multiple births in recent years is another factor, because multiples are more likely to be born prematurely. Finally, stress during the pregnancy increases the risk. Over half of women who gave birth to a premature infant identified stress as a contributing factor (Lilliecreutz, Larén, Gunilla, Josefsson, & Sydsjö, 2016).
We have made great strides in recent years in our ability to care for babies born prematurely. Medical technology helps ensure not only their survival but also their healthy development. The modern neonatal intensive care unit (NICU) has roots that reach back more than 100 years. Read Journey of Research: From Child Hatchery to Modern NICU to understand the progress that has been made.
Journey of Research: From Child Hatchery to Modern NICU
One of the first attempts to improve the survival rates of premature infants was an incubator developed by obstetrician Étienne Stéphane Tarnier in the 1880s (Sammons & Lewis, 1985). It consisted of a wooden box with sawdust-filled walls. The box was divided into two compartments. Half of the bottom compartment was left open to allow for circulation of air, and the other half held stone bottles filled with hot water to control the temperature. As the air circulated into the upper compartment, which contained the infant, it passed over a wet sponge to pick up moisture. A chimney in the top compartment allowed the air to pass over the infant and exit into the room (Neonatology on the Web, 2007).
In 1896, Martin A. Couney supervised a display of incubators containing six premature infants at the Berlin World’s Fair, in an exhibit named “Kinderbrutanstalt” or “child hatchery.” The exhibit was such a commercial success (yes, people were willing to pay admission to see these wonders) that Couney repeated it at other expositions around the world until the 1940s (Snow, 1981). The doctor himself did not profit from the admission charges, but rather used the money to cover the cost of the intensive nursing care he provided for the infants. The care was so good that Courney claimed that 6,500 of the 8,000 infants survived, including one as small as 1.5 pounds (Snow, 1981).
By the 1940s, the care of premature infants increasingly moved into the hands of medical specialists, and neonatology was recognized as a medical specialty that deals with newborn infants. Because physicians at that time believed parents were the source of dangerous infections and that premature infants could easily be overstimulated, parents were routinely excluded from the nursery. This practice continued until the early 1970s (Davis, Mohay, & Edwards, 2003), when parents became an important part of the team that cares for a premature infant.
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