States of Arousal in Newborns

1. States of Arousal in Newborns • Regular sleep—8 to 9 hours • Irregular sleep—8-9 hours • Drowsiness—varies • Quiet alertness—2 to 3 hours • Waking activity and crying—1 to 4 hours • **Quiet alertness is the most variable and fleeting. Time spent in each state depends on temperament.

2. Early human reflexes • There are 27 major innate reflexes • Controlled by lower brain centers • Play an important part in stimulating early development of CNS and muscles • Primitive reflexes—e.g., sucking, rooting for nipple, Moro reflex, grasping—related to need for survival and protection • Postural reflexes—reactions to changes in position/balance—e.g., parachute reflex

3. Moro reflex • Baby extends legs, arms, and fingers when dropped a few inches; throws head back and arches the back. Shows same pattern when startled.

4. Tonic neck reflex • Infant lies in a fencing position (one arm extended, one flexed while lying awake on back.

5. Rooting reflex • Stroke cheek near corner of mouth, and the head turns toward source of stimulation (trying to locate nipple)

6. When reflexes disappear • Most early reflexes disappear in 6 months to a year after birth. • Protective reflexes (sneezing, blinking, yawning, shivering, pupillary reflex) remain. • Disappearance of unneeded reflexes on schedule is a sign that motor pathways in cortex have been partially myelinated, enabling a shift to voluntary behavior. • Doctors assess neurological function by seeing if reflexes disappear when they’re supposed to.

7. Sucking reflex • Two purposes—babies get nourishment, and they get enjoyment out of sucking • Even fetuses show sucking reflex • Non-nutritive sucking—85% of babies do it (suck on pacifier, fist, etc.) • As many as 40% of children suck their thumbs after they’ve started school. • Sucking behavior is also used to gauge a baby’s attention or interest in people, things, or noises.

8. Smiling • Helps ensure an infant’s survival by making the adult feel tenderness toward him/her. • Two types of smiling—reflexive & social. • Reflexive smiling—first month of life; child smiles for no apparent reason, usually during sleep (doesn’t appear in alert state) • Social smiling—appears somewhere around 2 months of age (some say as early as 3 weeks); baby smiles in response to a face

9. Zach showing a reflexive smile at a few days old

10. Another reflexive smile—nephew Josh—3 days old

11. Early social smile—Zach at 8 weeks

12. REM sleep in infants • Infants spend 50% of total sleep time in REM sleep • By age 3-5 years, it declines to 20%…the same amount an adult has • It’s thought that REM sleep is vital to baby’s development—helps stimulate the CNS. • REM sleep is disturbed in infants who are brain-damaged or have severe birth trauma. • Poorly sleeping babies are likely to be behaviorally disorganized & have problems learning. Trouble with interactional synchrony

13. Where should your baby sleep? • Attachment parenting proponents insist baby should sleep in “family bed” until h/she decides to sleep in own bed. • Called “co-sleeping” • Opponents believe child should learn to fall asleep in own bed; baby must be taught to put self to sleep

14. Problems with the family bed • Increased sleep disorders in children (sleep problems found in 35-50% of co-sleepers), compared to 7-15% of those who sleep alone • Dental problems—co-sleeping babies continually feed during the night, which causes cavities

15. Problems…cont. • Developmental problems—Controversial topic; some theorists believe that child can’t develop independent sense of self when co-sleeping • Peer problems—school-age cosleeping child could be made fun of • Marital problems—cosleeping creates difficulties for parents attempting intimacy • Safety problems—the biggest issue; sharing bed greatly increases chances of child dying during night (by smothering)

16. SIDS—Sudden Infant Death Syndrome • Leading cause of death in US of infants between ages of 1 month and 1 year (2-3 per 1000 children die of SIDS in US every year) • SIDS especially prevalent in Australia & New Zealand; low in Japan and Sweden. Reasons unknown. • With SIDS, babies simply stop breathing during naps or nighttime sleep, and they die.

17. Risk factors for SIDS • More common in winter when babies suffer more respiratory infections • More common in males than females • Highest rates with babies 2-4 months of age • Putting a baby to sleep on stomach is a big risk factor—PUT BABY TO SLEEP ON ITS BACK!

18. More risk factors for SIDS • Babies who have history of apnea—brief periods when breathing stops—are more likely to die of SIDS • Racial differences: SIDS rates highest in Native Americans, then Blacks, then Whites, and finally, Asians. • SIDS rates are higher among the poor and among moms who didn’t get proper prenatal care. • Preterm or low-birth-weight babies are at higher risk, as are those who had low APGAR scores.

19. Smoking and SIDS • If women stopped smoking while pregnant, the SIDS rate would drop by 30%. • Babies who are exposed to smoke either prenatally or after birth (in the home) are 4 times more likely to die of SIDS.

20. Brain differences in SIDS babies • Brains of SIDS babies often show signs of delayed maturation. • Myelinization of neurons has progressed at a slower rate • May be that inadequate fat intake in last month of pregnancy or during infancy may contribute to the problem (link with dietary fat)

21. Pacifier use and SIDS • American Academy of Pediatrics issued a statement in October of 2005 advocating the use of pacifiers as a deterrent of SIDS. • Pacifier use has now been added to the SIDS prevention list.

22. Another SIDS hypothesis • Between 2-4 months, reflexes decline and are replaced by learned, voluntary responses. • Respiratory & muscular weaknesses may prevent some babies from acquiring voluntary behaviors that replace defensive reflexes. • Instead of waking up or shifting position, they simply give in to death.

23. Summary: Reducing risk factors • Do not smoke or allow baby to be exposed to any smoke. • Put baby on back to sleep. • Keep room fairly cool (68-72 degrees). • Don’t put blankets, stuffed animals, or pillows in crib. Make sure mattress is firm. • Eat well during pregnancy; don’t skimp on fat.

24. Crying • First way babies communicate with parents—signals distress • Usually cry because of physical needs, but they also cry when they hear other babies crying. • 80-90% of babies have crying spells of up to 1 hour per day that aren’t easily explained. • Crying time often corresponds with dinnertime and may be related to sensory overload.

25. Colic • A period of sustained, uncontrollable crying that differs from normal crying. • Crying must last for 2-3 hours at a time on a daily/almost-daily basis for at least 3 weeks to be considered colic. • Usually begins during the 2nd or 3rd week of life and lasts until about 3 months • Baby with colic is inconsolable and appears to be in pain. Acts hungry but can’t or won’t eat. • Eating and sleeping are upset by colic.

26. Reasons that have been REJECTED as causes of colic • Babies cry to exercise their lungs • They cry because of gastric discomfort triggered by food allergies or sensitivity • They cry because of parental inexperience • Colic is hereditary • Colic is more common in babies whose mothers had difficult pregnancies or deliveries

27. Possible theories still being debated • Crying is a normal manifestation of a baby’s physiological immaturity, and colic is just an extreme form of it. • Immature digestive tract may contract violently when gas is passed, causing pain. • Painful intestinal spasms occur because of progesterone withdrawal as maternal hormones in baby’s body drop off. • Immature nervous system hasn’t yet learned to inhibit unwanted behavior (crying).

28. Most plausible theory • Babies with colic lack a “calming reflex” that other babies are born with. • Can’t shut out sensory experiences. • During first month (when colic is relatively rare), newborns have a built-in blocking mechanism that allows them to shut out stimuli. Around the 1 month mark, the mechanism disappears, and they may have a hard time adjusting to the new sensations of life.

29. 5-step colic cure (“Cuddle Cure”—Harvey Karp) • Swaddle baby tightly so he can’t move. • Put baby on side or stomach • Shush baby (make loud hushing sounds in baby’s ear, preferably in rhythmic fashion) • Swing baby from side to side • Give baby something to suck on—finger or pacifier • These tips are known as the 5 S’s of the Cuddle Cure. • From The Happiest Baby on the Block by Harvey Karp.

30. Harvey Karp and a baby undergoing Cuddle cure