Child Development From Infancy to Adolescence. Laura E. Levine
then, we have learned that touch and stimulation at a level that is appropriate for the capacity of the premature infant is beneficial, not harmful (Field, Diego, & Hernandez-Reif, 2010). For instance, neonatal massage therapy is associated with weight gain and passive movement of the limbs is associated with both weight gain and increased bone density (Field et al., 2010). While human touch promotes physical well-being in the infant, it also enhances the bond between the parent and the newborn, affirming for the mother the importance of her role in caregiving for her infant (Jefferies & Canadian Paediatric Society, Fetus and Newborn Committee, 2012). Today both parents are encouraged to participate in caring for their infant and to ask questions so they understand the complicated medical interventions that are sustaining their infant. They might even be encouraged to provide kangaroo care, in which the baby is placed in skin-to-skin contact with the parent’s bare chest and draped with a blanket. Low birth weight infants who receive kangaroo care are more likely to survive, have less likelihood of severe illness and infection, and have a shorter stay in the hospital. There also is evidence of improved cardiorespiratory functioning and temperature stability, sleep organization, and neurodevelopmental outcomes (Jefferies & Canadian Paediatric Society, 2012). Our technology has come a long way in its ability to save the lives of very young and fragile infants, but it has not replaced the need for sensitive human interaction.
Care of fragile preterm infants. Hospitals provide intensive medical care for premature infants by carefully controlling their environment and continually monitoring their bodily functions. However, even in this intensive medical environment, human touch is an important part of their care, so parents are encouraged to hold and touch their newborns.
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Premature infants cannot regulate their bodily functions in the same way full-term infants can, so the NICU is designed to monitor their functioning and compensate for what they cannot yet do for themselves. For instance, premature infants do not have a layer of body fat that helps them regulate body temperature and fluid loss, so incubators provide constant levels of heat and moisture. They may not yet have a sucking reflex or gag reflex, so they need special feeding procedures. Their immature central nervous system can be easily overwhelmed by stimuli, so the light level is kept low, noise is minimized, and the infants are handled slowly and gently (VanderBerg, 2007). Overall, the staff in the NICU need to be particularly sensitive toward infants who cannot signal what they need (Bowden, Greenberg, & Donaldson, 2000; VanderBerg, 2007).
Modern NICUs are very successful at saving even very small, fragile babies, but as birth weight goes down, the risk of complications goes up. This has created a dilemma for medical professionals who work with these tiny patients. Most NICUs provide intensive care to infants born at a gestational age of 25 weeks or more, but may provide it to infants at a gestational age of 23 or 24 weeks only with the agreement of the parents (Tyson, Nehal, Langer, Green, & Higgins, 2008). The question is whether there is a point at which a premature infant is so small and the chance of survival so low that the humane thing to do is provide comfort care rather than trying to save the life of the infant. Comfort care provides for the basic needs of the infant but stops short of heroic measures that might cause additional pain and suffering without being likely to prolong the infant’s life.
Despite our best efforts, prematurity and low birth weight account for one quarter of all neonatal deaths (March of Dimes, 2015b). Those infants who do survive demonstrate a wide range of developmental outcomes. Some go on to have few, if any, developmental problems and do not differ substantially from full-term infants, while others experience lifelong disabilities that can range from mild to very severe (Serenius et al., 2013). A consistent finding from numerous studies is that low birth weight and premature infants are at increased risk of cognitive impairment and academic failure as they grow up (Jepsen & Martin, 2006). They also can have sensory or motor impairments or be medically fragile, with those who are born the earliest being at greatest risk (Benzies, Magill-Evans, Hayden, & Ballantyne, 2013; Dombrowski, Noonan, & Martin, 2007). However, even among very premature infants born at 22 to 24 weeks of gestation, 20% show no neurodevelopmental impairment (Younge et al., 2017). Many factors—prenatal conditions, birth circumstances, number and quality of medical services utilized by the family, access to intervention services, and many more—come together to affect the quality of the outcome.
T/F #8
An infant who is born prematurely will have developmental problems and lag behind other children of the same age. False
To improve the chances of a good developmental outcome, comprehensive services should start early in development and be delivered consistently over a period of time. Providing psychosocial support and education for the mothers of premature infants results in better outcomes for the infants, but also helps reduce maternal anxiety and depression and increase the parent’s belief in her ability to cope with the situation (Benzies et al., 2013). However, even under the best of circumstances, caring for a premature infant places extraordinary demands on a parent, so parents need to stay motivated to use the services available to them and to follow through on the recommendations made by the professionals who work with their child. The way the parents view their infants and the expectations they have for them are crucial, so it is important that we help parents of premature infants understand that their infants can have good developmental outcomes so they can recognize and appreciate the progress their children make.
Check Your Understanding
Knowledge Questions
1 What is the newborn capable of doing at birth?
2 What are some risks to the newborn’s health and well-being?
3 What promotes optimal development in premature infants?
Critical Thinking
Use the information you now have about the challenges and cost of caring for a premature infant to make the most persuasive argument that you can for programs that could help reduce the number of infants who are born early.
The Transition to Parenthood
>> LQ 4.5 How do people experience the transition to parenthood?
Families come in many different forms today and there is a unique set of issues for each type. In this section we discuss how heterosexual couples may respond to the birth of their baby, but keep in mind that there may be unique issues for adoptive families, single-parent families, and other family configurations. The addition of a new family member affects the roles and functioning of all the individuals in the family, but here we look at the impact of the birth of a new baby on the mother and the father, and also on the couple. Becoming a parent affects all aspects of your life including your sense of identity, your relationships with your partner and others, and your career.
Becoming a Mother
In a society that idealizes mothers as being totally self-sacrificing, all-giving nurturers, women who struggle with the normal array of mixed feelings may have an added burden of guilt that they are not living up to this ideal if they are not ecstatic following the birth of their baby (Zamosky, 2011). It is a common misconception that after a baby is born, a new mother automatically follows her instincts and knows just what to do (Redshaw & Martin, 2011). In fact, many first-time mothers around the world must learn to be comfortable with breastfeeding, changing diapers, and soothing a crying baby. The way they were mothered as a child provides an unconscious model for most women of what a mother should be