The Beginning of Life: Pregnancy Through Preschool

د.وليد عزيز العميدي
المرحله الثالثه
The Beginning of Life: Pregnancy Through Preschool
I. CHILDBIRTH AND THE POSTPARTUM PERIOD
A. Birth rate and cesarean birth
1. About 4 million children are born each year in the United States; 23% of all births are by cesarean section.
2. The number of cesarean births declined from 1989 to 1996, partly in response to increasing evidence that women often undergo unnecessary surgical procedures. Since 1996 the rate has been rising and is now as high as it was in 1989.
B. Premature birth
1. Premature births and very premature births are defined as those following a gestation of less than 37 and 32 completed weeks, respectively.
2. Premature birth puts a child at greater risk for dying in the first year of life and for emotional, behavioral, and learning problems; physical disability; and mental retardation.
3. Premature births, which are associated with low income, maternal illness or malnutrition, and young maternal age, occur in 6% of births to white women and 13% of births to African American women.
4. The Apgar score (named for Dr. Virginia Apgar but useful as a mnemonic): A—appearance (color), P—pulse (heartbeat),G—grimace (reflex irritability), A—activity (muscle tone), R—(respiration) measures physical functioning in premature and
full-term newborns (Table 1-1) and can be used to predict the likelihood of immediate survival.












The infant is evaluated 1 minute and 5 (or 10) minutes after birth. Each of the five measures can have a score of 0, 1, or 2 (highestscore = 10). Score > 7 = no imminent survival threat; score < 4 = imminent survival threat.



D. Postpartum maternal reactions
1. Baby blues
a. Many women experience a normal emotional reaction called "baby blues" or "postpartum blues" lasting up to 2 weeks after childbirth.
b. This reaction results from psychological factors (e.g., the emotional stress of childbirth, the feelings of added responsibility), as well as physiological factors (e.g., changes in hormone levels, fatigue).
c. Treatment involves emotional support from the physician as well as practical suggestions for child care.
2. Major depression and brief psychotic disorder with postpartum onset (postpartum psychosis) are more serious reactions than postpartum blues and are treated with anti-depressant and antipsychotic medications



Women who have experienced these reaction once are at risk for having them after subsequent deliveries.
II. INFANCY: BIRTH TO 15 MONTHS
A. Bonding of the parent to the infant
1. Bonding between the caregiver and the infant is enhanced by physical contact between the two.
2. Bonding may be adversely affected if:
a. The child is of low birth weight or ill, leading to separation from the mother after delivery.
b. There are problems in the mother-father relationship.
3. Women who take classes preparing them for childbirth have shorter labors, fewer medical complications, less need for medication, and closer initial interactions with their infants.
B. Attachment of the infant to the parent
1. The principal psychological task of infancy is the formation of an intimate attachment to the primary caregiver, usually the mother.
2. Toward the end of the first year of life, separation from the primary caregiver leads to initial loud protests from the infant (normal "separation anxiety").
3. With continued absence of the mother, the infant is at risk for depression.
a. Infants may experience depression even when they are living with their mothers if the mother is physically and emotionally distant and insensitive to their needs.
b. Depressed infants may exhibit "failure to thrive," which includes poor physical growth and poor health, and is potentially life threatening.
c. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) term for disturbances in otherwise normal children owing to grossly pathological care is reactive attachment disorder of infancy or early childhood, inhibited and disinhibited type.
1. Inhibited type: Children are withdrawn and unresponsive.
2. Disinhibited type: Children approach and attach indiscriminately to strangers as though the strangers were familiar to them.
C. Studies of attachment
1. Harry Harlow demonstrated that infant monkeys reared in relative isolation by surrogate artificial mothers do not develop normal mating, maternal, and social behaviors as adults.
a. Males may be more affected than females by such isolation.
b. Young monkeys raised in isolation for less than 6 months can be rehabilitated by playing with normal young monkeys.
2. René Spitz documented that children without proper mothering (e.g., those in orphanages) show severe developmental retardation, poor health, and higher death rates ("hospitalism") in spite of adequate physical care.
3. Partly because of such findings, the foster care system was established for young children in the United States who do not have adequate home situations. Foster families are those who have been approved and funded by the state of residence to take care of a child in their homes.

D. Characteristics of the infant
1. Reflexive behavior. At birth, the normal infant possesses simple reflexes such as the sucking reflex, startle reflex (Moro reflex), palmar grasp reflex, Babinski reflex, and rooting reflex. All of these reflexes disappear during the first year of life (Table 1-4).
2. Motor, social, verbal, and cognitive development (Table 1-5)
a. Although there is a reflexive smile present at birth, the social smile is one of the first markers of the infant s responsiveness to another individual.
b. Crying and withdrawing in the presence of an unfamiliar person (stranger anxiety) is normal and begins at about 7 months of age.
1. This behavior indicates that the infant has developed a specific attachment to the mother and is able to distinguish her from a stranger.
2. Infants exposed to many caregivers are less likely to show stranger anxiety than those exposed to few caregivers.
c. At about 1 year the child can maintain the mental image of an object without seeing it ("object permanence").






E. Theories of development
1. Chess and Thomas showed that there are endogenous differences in the temperaments of infants that remain quite stable for the first 25 years of life. These differences include such characteristics as reactivity to stimuli, responsiveness to people,and attention span.
a. Easy children are adaptable to change, show regular eating and sleeping patterns, and have a positive mood.
b. Difficult children show traits opposite to those of easy children.
c. Slow-to-warm-up children show traits of difficult children at first but then improve and adapt with increased contact with others.
2. Sigmund Freud described development in terms of the parts of the body from which the most pleasure is derived at each stage of development (e.g., the "oral stage" occurs during the first year of life).
3. Erik Erikson described development in terms of critical periods for the achievement of social goals; if a specific goal is not achieved at a specific age, the individual will have difficulty achieving the goal in the future. For example, in Erikson s stage of
basic trust versus mistrust, children must learn to trust others during the first year of life or they will have trouble forming close relationships as adults.
4. Jean Piaget described development in terms of learning capabilities of the child at each age.
5. Margaret Mahler described early development as a sequential process of separation of the child from the mother or primary caregiver.
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III. THE TODDLER YEARS: 15 MONTHS–2 1/2 YEARS
A. Attachment
1. The major theme of the second year of life is to separate from the mother or primary caregiver, a process that is complete by about age 3.
2. There is no compelling evidence that daily separation from working parents in a good day care setting has short- or longterm negative consequences for children. However, when compared to children who stay at home with their mothers, those that have been in day care show more aggressiveness.
B. Motor, social, verbal, and cognitive characteristics of the toddler
See Table 1-6.






IV. THE PRESCHOOL CHILD: 3–6 YEARS
A. Attachment
1. After reaching 3 years of age a child should be able to spend a few hours away from the mother in the care of others (e.g., in day care).
2. A child who cannot do this after age 3 is experiencing separation anxiety disorder (see Chapter 15).
3. Preschool children do not yet understand that death is permanent; they typically expect that a dead pet or relative will come back to life.
B. Characteristics
1. The child s vocabulary increases rapidly.
2. The birth of a sibling is likely to occur in the preschool years and sibling rivalry may occur.
3. Sibling rivalry or other life stress, such as moving or divorce, may result in a child s use of regression, a defense mechanism in which the child temporarily behaves in a "baby-like" way (e.g., starts wetting the bed again) (see Chapter 6). This is a normal reaction to life stress.
4. Children can distinguish fantasy from reality (e.g., they know that imaginary friends are not "real" people), although the line between them may still not be sharply drawn.
5. Preschool children are normally active and rarely sit still for long.
6. Other aspects of motor, social, verbal, and cognitive development of the preschool child can be found in Table 1-6.
C. Changes at 6 years of age
1. The child begins to understand that death is final and fears that his or her parents will die and leave. It is not until about age 9, however, that the child understands that he or she also can die.
2. At the end of the preschool years (about age 6), the child s conscience (the superego of Freud) and sense of morality begin to develop.
3. After age 6, children can put themselves in another person s place (empathy) and behave in a caring and sharing way toward others.
4. Morality and empathy increase further during the school-age years.