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.

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

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.

Tonic neck reflex

Infant lies in a fencing position (one arm extended, one flexed while lying awake on back.

Rooting reflex

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

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.

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.

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

Zach showing a reflexive smile at a few days old

Another reflexive smile—nephew Josh—3 days old

Early social smile—Zach at 8 weeks

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

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

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

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)

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.

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!

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.

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.

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)

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.

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.

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.

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.

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.

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

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).

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.

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.

Harvey Karp and a baby undergoing Cuddle cure