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201 | may occur with other high risk behaviors. Students who carry weapons, smoke, and drink alcohol are at higher risk for engag ing in bullying. Negative parenting behavior is related to a moderately increased risk of becoming a bullyvictim (youth who are both perpe trators and targets) and small to moderate effects on bei... |
202 | functioning, poor grades in school, and poverty in the community. Family risk factors include early childbearing, low parental attach ment and involvement, authoritarian or permissive parenting styles (see Chapter 20), and poverty. There is more school violence in areas with higher crime rates and more street gangs, wh... |
203 | experiences and asks whom the child has spoken to about the problem and whether that has helped. Finally, it guides the practitioner through emphasizing the usefulness of talking about social problems and discusses how the physician can assist the patient. Children who are aggressive, overly confident, lacking in empat... |
204 | Many schools have established cyberbullying policies and are increas ingly involved with teaching youth about guidelines for appropriate online interactions and monitoring for cyberbullying problems. As of 2016, 23 states included cyberbullying in their state antibullying laws, and 48 states included electronic harassm... |
205 | of Violence Exposure on Children 105 Fig. 15.1 contd Downloaded for mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. 106 Part I u The Fi... |
206 | their children, including playing video games with them, watching movies together, and co viewing social media content. Parents can then assess these games and shows in regard to what they are teaching about communi cation and interactions with others. Parents should feel empowered to place restrictions on games or sho... |
207 | of polio or cholera and the increased virulence of tuberculosis have been associated with conflict affected regions and large population displacements. The COVID 19 pandemic that began in 2020 has worsened the existing situation, with widespread disruption of health and educational services provided by domestic healthc... |
208 | OF WAR Children do not have the physical or intellectual capabilities to defend themselves. It is easier for adults to victimize children than other adults. Older childrens curiosity, desire for adventure, and imperfect assessment of risk often lead them to participate in dan gerous behavior. Younger children, because ... |
209 | 20, 2024. For personal use only. No other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. 108 Part I u The Field of Pediatrics tactics that can include guerrilla, paramilitary, and terrorist activi ties, while the stronger side often resorts to the disproportionate use of force. Low intensit... |
210 | stress disorder (PTSD; see Chapter 38). The true incidence is difficult to assess because of the heterogeneous nature of war, degree of exposure to violence, and methodologic challenges related to the precise characterization of PTSD. Risk factors for having a more serious psychologic response to a violent event includ... |
211 | school performance Sleep disturbances Flashbacks Emotional numbness Antisocial behavior Substance abuse Revenge fantasies Suicidal ideation Withdrawal Downloaded for mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No oth... |
212 | resuscitation equipment suitable for children needs to be stockpiled. The signs of biologic infection, chemical intoxication, or radiation injury are dif ferent for children, and pediatricians and emergency personnel need to be aware of these differences (see Chapters 758 and 763). Surveys of pediatricians and other he... |
213 | complaints. Even when the triggering event is neither temporally nor physically proximate, it should not dissuade the pediatrician from making an appropriate referral to mental health professionals who are expert in childhood stress disorders. Medical professional standards demand that the physician treat all patients ... |
214 | but the International Labour Organization estimates that approximately 3.3 million children and adolescents across the globe experienced forced labor in 2021, of whom approximately 1.7 million were subjected to commercial sexual exploitation. In a global study of officially identified trafficked persons, the United Nat... |
215 | adolescents may have preexisting chronic medi cal conditions that have been inadequately treated before or during the exploitation (e.g., diabetes, seizure disorder, asthma). Individu als who are trafficked may also seek medical care for their children. Many of the same factors that prevent children and adolescents fro... |
216 | be reactions to trauma and should be met with a sensitive, nonjudgmental, empathic response by the pro vider. Physical safety of the patient and staff are critical, and protocols should be in place to address security issues that may arise if the trafficker is on the premises. Psychologic safety of the patient may be f... |
217 | remote or acute inflicted injury (suspicious burns, bruising, signs of strangulation, fractures, closed head injury, thoracoabdominal trauma) Evidence of preventable work injury, toxic exposure, overuse injury, or untreated injury Malnutrition with or without dehydration Poor dentition andor dental trauma Late presenta... |
218 | depression, and suicidality are very high among individuals experiencing human traf ficking, and questioning may highlight the need for emergency care or nonurgent referrals. It also provides an opportunity for anticipatory guidance aimed at harm reduction: a discussion of condom use, STIs, HIVAIDS, and substance use m... |
219 | in a protocol. Emergency contraception and other methods of birth control (especially long acting reversible contraception) should be discussed with the patient as feasible. Many individuals who have been trafficked (and children of trafficked adults) have experienced nutritional deprivation, lack of immuniza tions, an... |
220 | period raise the risks of tuberculosis, scabies, and diarrheal illnesses. Toxic levels of lead or chemicals may be present, and vitaminmineral deficiencies should be considered. A developmental or educational assessment is important, given the high likelihood of poor primary care in the past and possible harsh living c... |
221 | ability to respond. A multidisciplinary team approach is needed to ensure the child is provided with necessary food, shelter, crisis management, language interpretation, immigration assis tance, mental health and medical care, educational needs, and other services. Such a team may include local victim service providers... |
222 | victims from varied cultures; there is a limited evidence base for the effectiveness of behavioral health therapy for children experiencing trafficking. However, in the United States, therapies with an evidence base for child sexual assaultabuse are often adapted for use. HPV, Human papillomavirus; HIV PrEP: human immu... |
223 | potential for serious harm increases. Acts of serious violence (e.g., throwing a hard object, slapping an infants face) should be seen as abusive even if no injury ensues; significant potential harm exists. Although some PCPs think that hitting is acceptable under limited conditions, almost all prefer more constructive... |
224 | suffer physi cal punishment andor psychologic violence at the hands of parents. In addition, as many as 1 in 5 women and 1 in 13 men report having been sexually abused as a child. Less international research has been done on child neglect. Nevertheless, neglect too is clearly a global prob lem. For example, a large stu... |
225 | biases concerning minoritized and low income families. In contrast, protective factors, such as family supports or a par ents concern for their child, may buffer risk factors and protect children from maltreatment. Deliberately identifying and incorpo rating protective factors is vital to intervening effectively. One c... |
226 | specific for identifying abuse. In nonmobile infants, bruises are considered a sentinel injury because of the low likelihood of noninflicted injury. Bruises are the most common injury to be missed or misdiagnosed among children who later present with fatal or near fatal injuries. Other sentinel injuries include orophar... |
227 | rubbed on the skin, causing petechiae or purpura. Cupping is another approach, popular in the Middle East. A heated glass is applied to the skin, often on the back. As it cools, a vacuum forms, leading to perfectly circular bruises. The context here is important, and such circumstances should not be considered abusive ... |
228 | a burn was inflicted depends on the history, burn pattern, and the childs capabilities. A delay in seeking healthcare may result from the burn initially appearing minor, before blistering or becoming infected. This circumstance may represent reasonable behavior and should not be automatically deemed neglectful. A scene... |
229 | associated with noninflicted fractures include family history of recurrent fractures after minor trauma, abnormally shaped cra nium, dentinogenesis imperfecta, blue sclera, impaired hearing, craniotabes, ligamentous laxity, bowed legs, hernia, and translucent skin. Subperiosteal new bone formation is a nonspecific find... |
230 | in infants include arteriovenous malforma tions, coagulopathies, birth trauma, tumor, and infections (see Table 17.2). Glutaric aciduria type 1 can present with intracranial bleeding and should be considered. When AHT is suspected, possible injuries elsewhereespecially skeletal and abdominalshould be ruled out. Retinal... |
231 | Coining Spooning SKELETAL LESIONS Osteogenesis imperfecta Obstetric trauma Caffey disease Rickets (not just low 25 hydroxy vitamin D levels) Hyper IgE syndrome Recurrent multifocal osteomyelitis Skeletal dysplasias HEAD TRAUMA Birth trauma Hemophilia Factor XIII deficiency Vitamin K deficiency (malabsorption) Cobalamin... |
232 | and symp toms may evolve slowly. Delayed perforation may occur days after the injury; bowel strictures or a pancreatic pseudocyst can develop weeks or months later. PCPs should consider screening for occult abdomi nal trauma when other evidence of physical abuse exists. Screening should include liver and pancreatic enz... |
233 | AP (dorsoventral) view of each foot Images are checked by a radiologist before the patient leaves. Poorly positioned or otherwise suboptimal images should be repeated. Lateral views are added for positive or equivocal findings in the extremities. Coned views of positive or equivocal findings (i.e., at ends of long bone... |
234 | are there? This is as important as identi fying problems. What treatment or services do the child and family need? What interventions have been tried and with what results? Knowing the nature of these interventions can be useful, especially from the par ents perspective. What is the prognosis? Is the family motivated t... |
235 | ease a parents anxiety. Parents are frequently concerned that they might lose their child. PCPs can cautiously reassure parents that CPS is responsible for helping children and families and that, in most instances, children remain with their parents. When CPS does not accept a referral or when it is not substantiated, ... |
236 | anticipatory guid ance helps with positive parenting (see Chapter 20), diminishing the risk of maltreatment. Hospital based programs that educate parents about caring for a crying infant and the risks of shaking may help pre vent AHT. Screening for and addressing major psychosocial risk factors for maltreatment such as... |
237 | problems underpinning child maltreatment, such as poverty, parental stress, substance use, and limited child rearing resources, require policies and programs that enhance families abilities to care for their children at least adequately. Examples in the United States include Medicaid, the Supplemental Nutrition Assista... |
238 | uncommon and behavioral findings are often nonspecific, a more reliable means of identifying sexual abuse is through a childs history. Some children provide a clear, spontaneous description of abuse to a trusted adult. Other children provide less clear histories, such as not wanting to visit a partic ular persons home ... |
239 | alcohol, or run away from home. Therefore sexual abuse should usually be considered when addressing a wide variety of child behavior and mental health problems. Physical signs of sexual abuse are uncommon and are seen in only about 5 of children who undergo medical examination, usually soon after the abuse occurred. Th... |
240 | asked whether there are other children in the home, school, or childcare who may have been exposed to the alleged offender; this information should be shared with CPS, as these children may benefit from a precautionary interview or exam at the local child advocacy center (CAC). Parents who have expe rienced sexual abus... |
241 | child friendly setting and by professionals skilled in this field. Because emergency depart ments may not have a child abuse expert and can be busy, noisy, and lacking in privacy, examination at an alternative location such as a CAC or outpatient clinic is preferable, when possible. If the exam is not urgent, it is bes... |
242 | abuse. Several genital findings may raise concern about abuse but often have alternative explana tions. For example, genital redness in a prepubertal child is usually caused by nonspecific vulvovaginitis, diaper dermatitis, or infection with a nonsexually transmitted organism such as staphylococcus or Abuse suspected R... |
243 | other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. Chapter 17 u Abused and Neglected Children 125 are amenable. The PCP may decline to do an exam if the teen refuses a chaperone. The female genital exam is done with the child in the frog leg supine position or the adolescent in the lithot... |
244 | little risk for pelvic inflammatory disease. Testing for Trichomonas vaginalis is by culture, NAAT, or wet mount. Wet mount requires the presence of vaginal secretions, view ing must be immediate for optimal results, and sensitivity is only Labia minora Urethral opening Hymen Moundbump on hymen Fossa navicularis Poster... |
245 | tests are common. NAAT tests for Trichomonas should only be performed using FDA approved prod ucts. Positive tests should be confirmed using the same sample or a repeat collection. Point of care tests for Trichomonas, done at the PCPs office, have not been validated for prepubertal children and should not be used. Obta... |
246 | of sexual abuse. There is some evidence to indicate that chlamydia in chil dren up to 3 years of age may be perinatally acquired. Chlamydia in children older than 3 years is diagnostic of contact with infected genital secretions almost always because of abuse. HIV is diagnostic for sexual abuse if other means of transm... |
247 | use only. No other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. Chapter 17 u Abused and Neglected Children 127 Recommendations for Children and Families At the conclusion of the medical evaluation, the PCP should let the child and parent know that the child is physically healthy but shoul... |
248 | can include information about statu tory rape and electronic dissemination of sexual photos, along with their risks. Finally, PCPs can encourage open communication between parents and children; children need to hear that their parent is there to protect them and will not be angry with them if they hear something bad. I... |
249 | internet provides other parents with easy access to medical information. A convincing seizure history may be offered, as a normal electroencephalogram cannot fully rule out the possibility of a seizure disorder. Even after extensive testing fails to lead to a diagnosis or treatment proves inef fective, clinicians may t... |
250 | par ent may report that another physician diagnosed seizures, and the myth may be perpetuated if there is no effort to confirm the original diagnosis. Alternatively, seizures may be induced by toxins, medi cations (e.g., insulin), water, or salt. Clinicians need to be familiar with the substances available to families ... |
251 | a child) can be valuable. In addition to helping clarify the diagnosis, video surveillance can identify a true medical problem. It is prudent to consult with risk management and hospital legal staff before ini tiating surveillance. Specimens should be carefully collected, with no opportunity for tampering with them. Si... |
252 | neglect and needs to be referred to CPS even when one is less than certain of the diagnosis; law enforcement may also need to be involved. CPS staff often lack knowledge of and experience with MCA and may need to be edu cated regarding this condition. Once the diagnosis of MCA is Downloaded for mohamed ahmed (dr.mms202... |
253 | able to change their behavior. Visit Elsevier eBooks at eBooks.Health.Elsevier.com for Bibliography. To improve the health of children, pediatricians often ask patients and caregivers to make behavioral changes. These may be lifestyle changes to manage a chronic condition (e.g., obesity, asthma), adherence with the rec... |
254 | make a change is made, four factors determine whether an intention leads to carrying out the behavior: knowledge and skills, environmental facilitators and constraints, salience of the behavior, and habits. The pediatrician can help ensure intent leads to behavior change by addressing these factors during the visit. In... |
255 | project to others. Interact with family in a partnering, supportive, respectful manner. Identify strengths. Reframe any negative images they foresee may happen with the behavior. I am sure your in laws will be so happy when your child is doing better in school. Am I a good parent if I give my child medications that aff... |
256 | Chapter 18 u Strategies for Health Behavior Change 131 TRANSTHEORETICAL MODEL OF HEALTH BEHAVIOR CHANGE It is difficult to counsel families to change a behavior when they may not agree there is a problem or when they are not ready to build an intention to change. The transtheoretical model of health behavior change pla... |
257 | know it can be hard to change a habit when you feel under pressure. It is totally up to you to decide if cutting back is right for you. Is it okay if I ask you about this during our next visit? Contemplation Beginning to consider making a change, but still feeling ambivalent about making a change. Identify ambivalence.... |
258 | Mental Health Priorities in Practice: Substance Use, American Academy of Pediatrics. https:www.aap.orgen usadvocacy and policyaap health initiativesMental HealthPagessubstance use.aspx. Downloaded for mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, ... |
259 | use reflective statements during telehealth visits so the family does see that you are listening to them. By the end of this step in the visit, all parties should feel reassured that their problems were heard and accurately described. The next step is to agree on the problem to be addressed during that visit. If the pa... |
260 | are saying. You no longer feel like doing things that made you happy in the past? Loyalty: Express support and commitment. You are free to talk to me about anything while we work through this. Permission: Ask permission to explore sensitive subjects. Offer advice. Partnership: Identify and overcome barriers. I would li... |
261 | situation. Developing a discrepancy between current behaviors (or treatment choices) and treatment goals motivates change and helps move the patient from the precontemplative stage to the contemplative stage or from the contemplative stage to preparation, as described in the transtheoretical model. Through MI the clini... |
262 | Emphasize hope. Weve managed difficult things before. Remember when Jacqueline kept getting admitted for her asthma when she was younger? We have come a long way since then, and Im sure we can manage this as well. Jacqueline is an adolescent female who has had asthma since she was an infant. Despite multiple hospitaliz... |
263 | you can cut back on soda? A 5. Why didnt you answer a 3? What would it take to bring it to a 7? Planning Focus on how to make the change, not why anymore. Be concrete. Maybe completely eliminating soda is too difficult right now. Do you want to think of a couple of times during the week where you can reward yourself wi... |
264 | change. The clinician should then respond by asking why the patient did not choose a lower number and should follow up by asking what it would take to bring it to a higher number. 4. The planning stage is similar to that described in the discussion of a common factors approach and occurs once a patient is in the prep a... |
265 | ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. 136 PART II Growth, Development, and Behavior The field of pediatrics is dedicated to optimizing the growth and development of each child. Pediatricians require know... |
266 | eventually leads to about 100 billion neurons in the adult brain. Each neuron develops on average 15,000 synapses by 3 years of age. Dur ing early childhood, synapses in frequently used pathways are preserved, whereas less used ones atrophy, a process termed pruning. Changes in the strength and number of synapses and r... |
267 | studies consistently show that heredity accounts for approxi mately 40 of the variance in IQ and in other personality traits, such as sociability and desire for novelty, whereas shared environment accounts for another 50. The negative effects on development of prenatal expo sure to teratogens, such as mercury and alcoh... |
268 | and to poor adjustment to adversity. Lon gitudinal twin studies of adult personality indicate that changes in per sonality over time largely result from dissimilar environmental influences, whereas stability of temperament appears to result from genetic factors. The concept of temperament can help parents understand an... |
269 | role. Family systems theory recognizes that individuals within systems adopt implicit roles. Although birth order does not have long term effects on personality development, within families the members take on different roles. One child may be the troublemaker, whereas another is the negotiator and another is quiet. Ch... |
270 | case is not the prematurity, the undernutrition, or the mater nal depression, but the interaction of all these factors (Fig. 19.3). Conversely, children with biologic risk factors may nevertheless do Ecology Biology Health and development Policy and Program Levers for Innovation Primary health care Public health Childc... |
271 | is reduced. An estimate of developmental risk can begin with risk factors, such as low income, low literacy, and lack of neighborhood resources. Stress and anxiety in pregnancy are associated with cognitive, behav ioral, and emotional problems in the child. Early stress may have effects on aging mediated by shortening ... |
272 | brought about by these drives. Although Freudian ideas have been challenged, they opened the door to subsequent theories of development. Erikson recast Freuds stages in terms of the emerging personal ity (see Table 19.2). The childs sense of basic trust develops through the successful negotiation of infantile needs. As... |
273 | of age; (2) Piagets observa tions often lend themselves to quick replication in the office, with little special equipment; and (3) open ended questioning, based on Piagets work, can provide insights into childrens understanding of illness and hospitalization. However, other studies have found that even young children a... |
274 | behavioral theory are its simplicity, wide applicabil ity, and conduciveness to scientific verification. A behavioral approach lends itself to interventions for various common problems, such as temper tantrums, aggressive preschool behavior, and eating disorders, in which behaviors are broken down into discrete units. ... |
275 | 2 95.4 2 2.3 3 99.7 3 0.13 Table 19.3 Similar or Identical Elements Within Six Theories of Health Behavior CONCEPT GENERAL TENET OF ENGAGING IN THE BEHAVIOR IS LIKELY IF... HEALTH BELIEF MODEL THEORY OF REASONED ACTION THEORY OF PLANNED BEHAVIOR SOCIAL COGNITIVE THEORY TRANS THEORETICAL MODEL (STAGES OF CHANGE) SOCIAL ... |
276 | the observations lie; the mode is the value with the highest number of observations. Distributions are termed skewed if the mean, median, and mode are not the same number. The extent to which observed values cluster near the mean deter mines the width of the bell and can be described mathematically by the standard devi... |
277 | reading aloud to children, eating family meals, and participating in family outings, predicts an increased risk of develop mental delay in low income families. Interventions that increase par ents reading to children promote positive developmental outcomes such as early language and literacy development. The affective ... |
278 | can promote resilience and buffer adversity and turn potentially toxic stress responses into tolerable or positive responses. PARENTING STYLES Parenting practices are significantly influenced by culture, defined as a pattern of social norms, values, language, and behavior shared by a group of individuals. Approaches to... |
279 | behavior (e.g., anxious and moody behavior). Temperament traits are relatively stable, but how the child func tions is affected by the environment, especially by parenting and the goodness of fit between the parent and child. Children with difficult temperament characteristics respond more negatively to neglectful pare... |
280 | key components such as those in Table 20.1 will likely remain fundamental. PARENTING AS AN INTERVENTION The influence of parenting practices on child behavior, development, and overall adjustment has led to efforts to teach parenting as a method of primary prevention. The Video Interaction Project (VIP) uses a coaching... |
281 | All successful programs require parents to practice parenting skills during the program. Parents have been found to benefit from participation in parenting programs. Before their participation, parents experienced a loss of con trol, self blame, social isolation, and difficulty dealing with their childs emotional and b... |
282 | along with others Using good manners Promoting childrens cognitive or academic skills Fostering language and literacy development Promoting school readiness Adapted from U.S. Centers for Disease Control and Prevention: Parent training programs: insight for practitioners, Atlanta, CDC;2009. Downloaded for mohamed ahmed ... |
283 | and providing linkage to treatment services when appropriate. Parents want more information about child development, but parents of children with behavior problems often feel stigmatized and isolated. Practitioners are encouraged to be supportive and optimistic in their interactions with families and to develop a part ... |
284 | time out space No talking No playing No lecturing No scolding No excuses from child Ignore protesting or promise to be good Time for both parent and child to calm down 4. End time out 5. Explain why there was a time out 6. Praise next positive behavior Time out duration rule is 1 minute per child age in years Adapted f... |
285 | lungs useless as organs of gas exchange. During the third trimester, weight triples and length doubles as body stores of protein, fat, iron, and calcium increase. NEUROLOGIC DEVELOPMENT During the third week, a neural plate appears on the ectodermal surface of the trilaminar embryo. Infolding produces a neural tube tha... |
286 | on their behavioral state, which can be characterized as quiet sleep, active sleep, or awake. Individual differences in the level of fetal activity are usually noted by mothers. Fetuses will preferentially turn to light patterns in the con figuration of the human face. Fetal movement is affected by maternal medications... |
287 | all clinically recognized pregnancies. The majority occur in the first trimester. Many spontaneous abor tions occur as a result of chromosomal abnormalities, most commonly aneuploidies. Teratogens associated with gross physical and mental abnormalities include various infectious agents (e.g., toxoplasmosis, rubella, sy... |
288 | mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. 148 Part II u Growth, Development, and Behavior on the part of the fetus presumably inc... |
289 | Velocity curves of the various components of human brain growth. Blue line, DNA; red line, brain weight; green line, cholesterol. From Brasel JA, Gruen RK. In Falkner F, Tanner JM, eds: Human Growth: a comprehensive treatise. New York: Plenum Press; 1986: pp 7895. See also Chapter 115. Regardless of gestational age, th... |
290 | that the fetus will survive until birth. For any potential fetal insult, the extent and nature of its effects are determined by characteristics of the host as well as the dose and timing of the exposure. Inherited differences in the metabolism of ethanol, timing of exposure, and the mothers diet may explain the variabi... |
291 | age, the newborn (neonatal) period begins at birth and includes the first month of life. During this time, marked physiologic transitions occur in all organ systems, and the infant learns to respond to many forms of external stimuli. Because infants thrive physically and psychologically only in the context of their soc... |
292 | its pro motion of bonding. Providing breastfeeding education for the parents during prenatal pediatric or obstetric care can increase maternal confi dence in breastfeeding after delivery, reduce stress during the newborn period, and promote increased breastfeeding rates and duration (see Chapter 61). Peripartum and Pos... |
293 | birthweight (2,500 g) rates with higher rates in low socioeconomic status (SES) groups and in minoritized populations. The infants response to being examined may be useful in assess ing its vigor, alertness, and tone. Observing how the parents handle their infant, their comfort, and affection is also important. The ord... |
294 | response to stimuli. In active sleep, an infant may show progres sively less reaction to a repeated heelstick (habituation), whereas in the drowsy state, the same stimulus may push a child into fussing or crying. Mutual Regulation Parents actively participate in an infants state regulation, alternately stimulating and ... |
295 | at all 6. Things have been getting on top of me Yes, most of the time I havent been able to cope at all Yes, sometimes I havent been coping as well as usual No, most of the time I have coped quite well No, I have been coping as well as ever 7. I have been so unhappy that I have had difficulty sleeping Yes, most of the ... |
296 | Hos pital) have been shown to significantly increase breastfeeding rates (see Chapter 115.3). After discharge, home visits by nurses and lactation counselors can reduce early feeding problems and iden tify emerging medical conditions in either mother or baby. Infants requiring transport to another hospital should be br... |
297 | relationships mature throughout the first year of life. Substantial learning of the basic tools of language (phonology, word segmentation) occurs during infancy. Speech processing in older individuals requires defined and precise neuronal networks; the infant brain possesses a struc tural and functional organization si... |
298 | um e in m m 3 24 1000000 750000 500000 250000 0 D 0 12 Age in months Subcortical and Brainstem V ol um e in m m 3 24 1500000 100000 50000 0 C 0 12 Age in months Cerebellum V ol um e in m m 3 24 1250000 1000000 750000 500000 250000 0 0 12 Age in months Total Brain Volume V ol um e in m m 3 24 Fig. 23.1 Scatterplots show... |
299 | availability of a trusted adult to meet the infants urgent needs creates the conditions for secure attachment. Basic trust vs mistrust, the first of Eriksons psychosocial stages (see Chapter 19), depends on attachment and reciprocal maternal bonding. Crying occurs in response to stimuli that may be obvious (a soiled di... |
300 | voluntarily. A novel object may elicit purposeful, although inefficient, reaching. The quality of spontaneous movements also changes, from larger (proximal) writhing to smaller, circular (distal) movements that have been described as fidgety. Abnormal or absent fidgety movements may constitute a risk factor for later n... |
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