Reflexes in the Newborn

1. Reflexes in the Newborn The tools that babies come equipped with

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.t., parachute reflex

3. 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.

5. Rooting Reflex (above pic) Newborn Babinski reflex on right; normal non-newborn response on left

6. 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.

7. The Sucking Reflex (this will often immediately follow the rooting reflex as baby searches for something to suck on)

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. Reflexive smiling…4 days old

10. Social Smiling: Zach 8 weeks

11. Sleep “Sleeping like a baby…” Is it all it’s cracked up to be?

12. 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.

13. 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

14. Where should 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

15. 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

16. 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)

17. 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.

18. 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!

19. 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.

20. 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.

21. 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)

22. 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.

23. 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.

24. 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.

25. Sleep Problems in Infants • Nighttime waking is the most common problem. • 20-30% have a hard time going to sleep at night and have nighttime waking problems. • Infant waking at 1 year predict sleep problems at 4 years and are consistently linked to parents interacting with their babies at night (e.g., going in to comfort them when they hear them wake up). • Solution—”sleep train” your child, starting around age 4 months. Let them cry it out (within reason). Known as the Ferber method.

26. Crying and Colic You’ll want to cry right along with the infant.

27. 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.

28. 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.

29. Zach after 4 hours of crying

30. Rejected 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

31. 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).

32. 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.

33. 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.

34. Feeding the Baby It may be natural, but it’s not as easy as you think.

35. Feeding the baby • Breast milk has been the standard for all of human history. • With the advent of formula, breast-feeding declined from the 1940s to 1970s, when over 75% of American children were formula-fed. • Today, about 2/3 of American women leave the hospital breastfeeding, but the figure drops to 30% still breast-feeding 6 months later. • Breast-feeding is more common in higher SES.

36. Advantages of breast milk • Contains at least 100 ingredients not found in formula. • Composition of breast milk changes throughout the day to meet baby’s specific needs; also changes as baby matures • More easily digested than formula; baby has less stomach upset. • Has correct balance of sodium, fat, and protein to put less strain on baby’s kidneys • Baby absorbs calcium better with breast milk.

37. Advantages cont. • Less risk of allergy to breast milk than to formula, although baby can be sensitive to something Mom has eaten. • Constipation almost never occurs in the baby who is breastfed. • Babies get essential antibodies that will bolster immune system. Get sick less often. • Breastfeeding may prevent obesity in children and adults. • Breast milk is free, convenient, and offers Mom some protection against breast cancer before menopause.

38. Do moms who breastfeed lose weight faster? • Mothers who breastfeed must take in an extra 500 calories a day to compensate for calories lost during breastfeeding. • Theoretically, breastfeeding Moms should lose weight faster, and it’s always been said to be true. • New research suggests that breastfeeding moms lose LESS weight initially than bottle-feeding moms do, but 8 years later, they are thinner than their bottle-feeding counterparts.

39. Is breastfeeding a form of birth control? • Often women who breast-feed don’t ovulate (and thus do not have a period). • Some women use breastfeeding as birth control, but this is unreliable. • You MAY ovulate while breastfeeding and could get pregnant without meaning to. • Breast-feeding moms can take a “mini-pill,” which is a specific version of birth control pills. It’s progestin-only, which won’t harm the baby.

40. So why would anyone bottle-feed? • Breast-feeding is hard work and has some disadvantages to the mother. • It’s not easy to learn to breastfeed. It can be painful, too. • Nursing moms often have to nurse “around the clock.” Baby eats every 1 ½ hours or so instead of every 3-4 hours like formula-fed babies do. • Mom is solely responsible for feeding—can’t get help from others unless she pumps.

41. More deterrents to breastfeeding • Mother must watch her diet and medication use just as she did while pregnant. Less freedom for her. • It’s draining and exhausting, which can lead to postpartum depression. • Interferes with sex in several ways: 1) no sex drive; 2) no vaginal lubrication; 3) breasts leak milk during sex • Nipples can become sore and cracked. Mom runs danger of developing mastitis.

42. Advantages of formula • Baby isn’t hungry as often; can go longer between feedings • Other people can feed the baby, leaving Mom free to do other things. • You can gauge exactly how much baby eats and don’t have to worry about whether he’s getting enough. • No dietary or medication restrictions; no sexual interference.

43. Are there IQ differences? • Some studies cite a difference of 7 IQ points between bottle-fed and breastfed children (breastfed children having higher IQ) • At least 3 longitudinal studies since 1999 have disputed this finding and have found no differences in intelligence, emotional stability, or attachment to the mother between breastfed and bottle-fed children. • It’s hard to say conclusively without experimental studies.

44. Bottom line • Breast milk is clearly better for the baby, and the baby likes the taste of breast milk better, too. • Breast-feeding is not easier for the mom. • If you choose to feed the baby formula, h/she will still be getting excellent nutrition and won’t suffer any damage. • Feeding is NOT the primary ingredient to having a happy, healthy baby.

45. Starting solids • Pediatricians recommend starting solids (“baby food”) between ages of 4-6 months, depending on baby’s weight and how easily he can swallow food. • Whether you start with fruits or vegetables is a matter of debate. Start one food and wait for 2-3 days to see if baby has an allergic reaction. Also introduce cereal. • Add meats last.

46. Starting solids takes some getting used to. Some babies don’t like it. This is Drew’s first bite of solid food (rice cereal) at age 4 months.

47. Obesity in infancy • New studies are focusing on the dangers of obesity in infancy because, contrary to what was thought only a few years ago, it may predict adult obesity. • Most babies thin out during toddlerhood and the preschool years as growth slows and become more active, but some remain obese. • Some researchers believe that weight setpoint is set in the first year of life, though. • Bottle-fed babies are 2 ½ times more likely to become obese than breastfed babies, although some studies refute this finding.

48. Malnutrition • 40-60% of world’s children are malnourished. • Marasmus—a wasted condition caused by a diet low in all nutrients. Appears in first year of life because Mother is too malnourished to produce healthy breast milk. Baby starves and is in danger of dying.

49. Height & Weight Changes • At birth, the typical baby is 7.5 lbs. and 20 inches long. • First year of life: babies grow 10-12 inches and triple their body weight. • By age 2 for girls & 2.5 for boys, toddlers are roughly half as tall as they will be as adults. • 2-year-olds still have proportionately larger heads than adults do because toddlers have nearly full-sized adult brains to go with their small bodies. (Cephalocaudal trend of development)

50. Child with marasmus