Nelsons Club

The First Year

Faye Angeli V. Lomocso

VCMC
PGI
 Platform for remarkable growth and
development
Trajectory for a childs life
Neural plasticity at its peak --- brains
ability to be shaped by experience
Total brain volume doubles
additional 15% over the 2nd yr.
1 month of age -- 36% of adult brain
volume
1 yr of age -- 72% (83% by 2 yr)
 Substantial learning of the basic tools of
language (phonology, word segmentation)
infant brain possesses a structural and
functional organization similar to that of
adults, suggesting that structural
neurologic processing of speech guide
infants to discover the properties of his or
her native language.
Continuum of Myelination of the cortex
begins at 7-8 mo gestation
importance of nutrition are critical such as
iron, cholesterol
 acquires new competences in all
developmental domains
All growth parameters should be
plotted using WHO charts which
show how children from birth through
72 mo should grow under optimal
circumstances
 AGE 0-2 MONTHS
In full-term infant, (+)myelination by the time
of birth in dorsal brainstem, cerebellar
peduncles, and posterior limb of the internal
capsule.
The cerebellar white matter acquires myelin
by 1 mo of age and is well myelinated by 3
mo of age.
The subcortical white matter of the parietal,
posterior frontal, temporal, and calcarine
cortex is partially myelinated by 3 mo of age.
 Physical Development
1st wk-- weight initially decrease 10% below
birthweight as a result of excess extravascular
fluid loss and limited nutritional intake.
Nutrition improves as colostrum is replaced by
higher-fat breast milk
learn to latch on and suck more efficiently, mothers
become more comfortable with feeding
2 wk of age-- Infants regain or exceed
birthweight
Should grow 30 g (1 oz)/per day during the 1st
mo
 AGE 0-2 months
the period of fastest postnatal growth
Arms are held to the sides
Limb movements consist largely of
uncontrolled writhing, with apparently
purposeless opening and closing of the
hands.
Smiling occurs involuntarily
preferential turning toward the mothers
voice is evidence of recognition memory
 Neurologic maturation accounts for
the consolidation of sleep into blocks
of 5 or 6 hr at night, with brief
awake, feeding periods.
 Cognitive Development
differentiate among patterns, colors, and
consonants.
can recognize facial expressions (smiles) as
similar, even when they appear on different
faces.
2 mo of age -- can discriminate rhythmic
patterns in native vs non-native language.
appear to seek stimuli actively, as though
satisfying an innate need to make sense of
the world.
integration of sensory inputs in the central
nervous system
 Caretaking activities provide visual,
tactile, olfactory, and auditory
stimuli;
support the development of cognition.
Infants habituate to the familiar,
attending less to repeated stimuli
and increasing their attention to
novel stimuli
 Emotional Development
consistent availability of a trusted
adult to meet the infants urgent
needs creates the conditions for
secure attachment.
Basic trust vs mistrust
Infants who are consistently picked
up and held in response to distress
cry less at 1 yr and show less-
aggressive behavior at 2 yr.
 Crying normally peaks at about 6 wk
of age
may cry up to 3 hr/day,
3 mo- decreases to 1 hr or less
Infants cry in response to the cry of
another infant
early sign of empathy development
 Crying/Fussiness
Excessive crying
longer than 3 hr/day, longer than 3 days/wk lasting
longer than 1 wk
Crying/fussiness persisting longer than 3-5 mo
associated with child abuse, behavioral problems,
decreased duration of breastfeeding and postnatal
depression
Most infants do not have gastroesophageal
reflux, lactose intolerance, or cow-milk protein
allergy.
Excessive crying may be an early manifestation
of migraines.
 teaching caregivers about precry cues and
responding to the signal for feeding in a calm
relaxed manner.
sensory overstimulation, creating a non-
distracting, calm environment
lack of sensory stimulation , motherinfant
skin-to-skin contact, and carrying the infant
If fed at parents convenience, neither
attention to infants hunger cues nor fixed
schedule, does not experience feeding as
pleasurable reduction of tension.
Infants with early dysregulation often show
increased irritability and physiologic instability
(spitting, diarrhea, poor weight gain) as well as
later behavioral problems.
AGE 2-6 months
 2-6 months
voluntary (social) smiles and
increasing eye contact mark a
change in the parentchild
relationship
heightening the parents sense of being
loved reciprocally
Between 3 and 4 mo of age, the rate
of growth slows to approximately 20
g/day
age 4 mo, birth weight is doubled.
 Disappearance of asymmetric tonic neck
reflex
examine objects in the midline and
manipulate them with both hands
A novel object may elicit reaching
Increasing control of truncal flexion
makes intentional rolling possible
can begin taking food from a spoon
Total sleep requirements are 14-16 hr/24
hr, with 9-10 hr concentrated at night
and 2 naps/day
Approximately 70% of infants sleep for a
6-8 hr stretch by age 6 mo
Cognitive Development
4 mo of age - hatching socially
During feeding, turns around, preferring to face
outward.
Explore their own bodies, staring at their
hands, vocalizing, blowing bubbles, and
touching their ears, cheeks, and genitals.
Infants learn that voluntary muscle movements
generate predictable tactile and visual
sensations.
represent an early stage in the understanding of
cause and effect
 Cognitive
Development
1st stage of personality development
emergence of a sense of self,
separate from the mother.
The proprioceptive feeling of holding
up the hand and wiggling the fingers
always accompanies the sight of the
fingers moving
self sensations are consistently linked
and reproducible at will
 Emotional Development and
Communication
Initiating games (singing, hand games) increases
social development.
face-to-face behavior reveals the infants ability to
share emotional states, the 1st step in communication
development
Infants who do not show this reciprocal language and
movements are at risk for autism spectrum disorders
Depressed parents, Infants spend less time in
coordinated movement and make fewer efforts to
reengage.
Rather than anger, they show sadness and a loss of
energy when the parents continue to be unavailable.
 AGE 6-12 MONTHS
Slower growth = 12g/day
By the 1st birthday
3x birth weight
50 % length
10 cm head circumference
The ability to sit unsupported (6-7 mo) and
to pivot while sitting (around 9-10 mo)
manipulate several objects at a time
Explore novel objects by the emergence of
a thumbfinger grasp (8-9 mo) and pincer
grasp by 12 mo. Voluntary release
emerges at 9 mo.
 8 mo - begin crawling and pulling to
stand around, followed by cruising.
some walk by 1 yr
Motor achievements correlate with
increasing myelinization and cerebellar
growth.
gross motor skills expand infants
exploratory range, opportunities for
learning and create new physical dangers
Tooth eruption occurs, usually starting
with the mandibular central incisors.
Cognitive Development (6-12 mo)

discovered hands and learn to manipulate

objects
At first, everything is mouthed.
novel objects are picked up, inspected, passed from
hand to hand, banged, dropped, and then mouthed
Each action represents a nonverbal idea about what
things are for (Piagetian terms, a schema)
pleasure, persistence, and energy to tackle these
challenges = intrinsic drive or mastery motivation
by 9 mo - major milestone is object
permanence (constancy)
understanding that objects continue to exist, even
when not seen
 Emotional Development (6-12 mos)

stranger anxiety
Separations often become more difficult
Poor weight gain at this age reflects a struggle
between an infants emerging independence
and parents control of the feeding situation.
Use of the 2-spoon method of feeding (1 for the
child and 1 for the parent), finger foods, and a high
chair with tray table
Tantrums make their first appearance
drive for autonomy and mastery conflicts with
parental controls
 Communication
8 and 10 mo, babbling takes on a new
complexity, with multisyllabic sounds (ba-
da-ma)
Discriminate between languages. Infants in
bilingual homes learn the characteristics and
rules that govern 2 different languages.
The first true word (i.e., a sound used
consistently to refer to a specific object or
person) appears in concert with an infants
discovery of object permanence 9 months
Picture books now provide an ideal context
for verbal language acquisition.
 Implications for Parents and
Pediatricians
previously resolved issues of feeding and
sleeping reemerge.
at the 6 mo visit, reassurance as part of
developmental progress and not regression.
Infants wariness of strangers often
makes the 9 mo examination difficult
pediatrician initially, should avoid direct eye
contact with the child
Time spent talking with the parent and
introducing the child to a small, washable toy
Examination on the parents lap