What Does a Healthy Child Mean - Essay Example

THE HEALTHY CHILD Introduction It is well known that first few years of human being are most important years of life. Each child is different and may learn and grow at a different rate. However, if a child cannot do many of the skills listed for his or her age group, one should consult the paediatrician (National Network for Child Care - NNCC. Powell, J. and Smith, C.A., 1994). They also differ in the ways they interact with and respond to their environment as well as play, affection, and other factors. Understanding stages of rapid growth rate correctly at this crucial stage would allow parents and caregivers to help and give much needed attention to all these children at the right stage. Physical Development - Motor Skills Various development stages include bone thickness, weight, size of limbs, motor (gross and fine), hearing, vision, reflexes, facial expressions and perceptual development. Growth is rapid during the first few years of life. As each physical change occurs, the child gains new abilities. During the first year, physical development mainly involves the infant coordinating motor skills. Infants since birth have certain reflexes or motor skills. Blinking eye is one such reflex. The presence of reflexes at birth is an indication of normal brain and nerve development. When normal reflexes are not present or if the reflexes continue past the time they should disappear, brain or nerve damage is suspected. The rooting reflex causes infants to face toward anything that brushes their faces while survival reflex helps them to find food such as a nipple. For example, the Moro reflex or "startle response" occurs when a newborn is startled by a noise or sudden movement. The child moves his arms suddenly and starts crying. The Palmar grasp reflex is observed when the infant's palm is touched and when a rattle or another object is placed across the palm. The infant's hands will grip tightly. The Stepping or walking reflex can also be observed in normal full term babies. When the infant is held so that the feet are flat on a surface, the infant will lift one foot after another in a stepping motion. Given below is an expected pattern of systematic development of motor skills in an infant during first year of growth. (Source: Understanding Growth and Development Patterns of Infants by Novella J. Ruffin, June 2001) Motor Behaviour Growth Sequence (Source: Sensory-Motor Integration and Learning, Rosemary BoonM.A. (Psych) Age Motor Behaviour Hand-eye Coordination 1 Month Preference to lying on back Looks at object held directly in field of vision Grasps reflexively if object is placed in hand Eyes begin to coordinate 2-3 Months When lying on stomach, can lift head to 45 degrees and extend legs Follows object visually within a limited range Looks at object but can only grasp by reflex 4 Months Can roll from back to side When lying on stomach, can lift head to 90degrees. Arms and legs are able to extend Is able to sit propped about for around 10-15 minutes Follows objects with eyes through 180 degrees May touch or grasp an object when presented with it Brings any object grasped to mouth 5-6 Months Rolls from back to stomach Will often 'bounce' when held in standing position Can grasp small block using palmar grasp - there is little use of thumb and forefingers Cannot pick up tiny objects, but may scratch at them Sometimes holds own bottle with one or two hands 7-8 Months Can lift feet to mouth when lying on back Able to sit erect for a few minutes Able to grasp a small block and may transfer it from hand to hand 9-10 Months Creeps on hands and knees Can sit indefinitely Able to pull self to standing position and 'cruise' along table etc. Often able to sit form the standing position Pokes at objects with forefinger Able to play 'pat-a-cake' May uncover a toy they have seen hidden 11 Months Actively pulls self to feet and 'cruises' along table Will often stand momentarily without support Able to walk if hand is held and may take a few tentative steps alone Begins to use the pincer grasp on smaller objects and uses thumb opposition on larger May try to stack blocks 12 Months Able to get up and walk unaided - may take several steps alone Creeps up stairs on hands and knees May be able to squat or stoop without losing balance Able to throw a ball May help to turn the pages of a book Able to stack blocks Able to find toys hidden under things Enjoys putting objects into containers and taking them out again Most physical changes involving motor changes including running, hopping, writing etc. cover 2 main areas of development. Gross motor (large muscle) development refers to improvement of skills and control of the large muscles of the legs, arms, back and shoulders which are used in walking, sitting, running, jumping, climbing, and riding a bike. Fine motor (small muscle) development refers to use of the small muscles of the fingers and hands for activities such as grasping objects, holding, cutting, drawing, buttoning, or writing. Children must have manual or fine motor (hand) control to hold a pencil or crayon in order for them to write, draw, or color. Infants have the fine motor ability to scribble with a crayon by about 16 to 18 months of age when they have a holding grip (all fingers together like a cup). By the end of the second year, infants can make simple vertical and horizontal figures. By two years of age, the child shows a preference for one hand; however, hand dominance can occur much later at around four years of age. By the age of four, children have developed considerable mastery of a variety of grips, so that they can wrap their fingers around the pencil. Bimanual control is also involved in fine motor development, which enables a child to use both hands to perform a task, such as holding a paper and cutting with scissors, and catching a large ball. (Source: Understanding Growth and Development Patterns of Infants by Novella J. Ruffin, June 2001) Vision, hearing and perception also develop early in life and have contributory effect on appropriate reflex-motor, cognitive and affective development of a child. Any early deficiencies in these senses can have adverse effect on required development in these fields. Diet matters Observational studies in Egypt reported an association between mothers' diets and their infants' early behavior and development (32,33). Mothers who consumed diets high in animal products had infants who were more attentive shortly after birth, as measured on the Brazelton Neonatal Behavioral Assessment Scale, than infants of mothers who consumed diets low in animal products. At 6 mo, infants whose mothers consumed diets that were primarily plant based, and therefore low in bioavailable zinc, had lower motor scores on the Bayley Scales of Infant Development than infants whose mothers consumed animal-based diets. Motor development was also related to infant diarrhea and psychosocial factors such as household socioeconomic status. (The Evidence Linking Zinc Deficiency with Children's Cognitive and Motor Functioning by Maureen M. Black, 2003) Cognitive Development Cognitive development refers to the understanding part of development and develop skills reason (think), language, solving problems, and gain knowledge. Inquisitive nature begins to show its first steps here where a child wants to experiment, ask, learn and teste his knowledge for himself in different ways. Infants interact with the world through their senses (see, touch, hear, smell, and taste). Gradually infants show interest in light and movement, such as a toy above the crib. Infants also learn through communication. Their initial communication is through crying which develops into gestures and the stages of language such as babbling, then monosyllables such as "ba" and "da" and later to single words put together to make a meaningful sentence. You can observe that infants also communicate through their motor actions. It is very important that parents and other caregivers nurture and respond to the infant's actions, to hold, carry the infant, sing to the infant, play with the infant, and meet his needs in other responsive and nurturing ways. (2) As infants master new developments like creeping and crawling, they are no longer totally dependent on an adult to meet some of their needs. The task for adults, parents and other caregivers is to ensure that babies have a safe and clean environment in which they can move about and interact. (Source: Understanding Growth and Development Patterns of Infants by Novella J. Ruffin, June 2001) Principles of cognitive development provide us with a basis for understanding how to encourage exploration, thinking, and learning. Affective Development The expression of feelings about self, others, and things describe affective/emotional development. Learning to relate to others is social development. Emotional and social development are often described and grouped together because they are closely interrelated growth patterns. Feelings of trust, fear, confidence, pride, friendship, and humour are all part of social-emotional development. Other emotional traits are self concept and self esteem. Learning to trust and show affection to others is a part of social-emotional development. Temperament refers to the quality and degree or intensity of emotional reactions. Passivity, irritability, and activity are three factors that affect a child's temperament. Passivity refers to how actively involved a child is with his or her environment or surroundings. A passive infant withdraws from or is otherwise not engaged with a new person or event. An active infant does something in response to a new person or event. As caregivers, we need to nurture and give loving attention to all infants regardless of their temperament. We also need to adjust to the temperament of different children. Even very irritable infants can grow to be emotionally happy and well adjusted if caregivers are patient, responsive, and loving in their caregiving ways. Socially, young children and particularly infants tend to focus on the adults who are close to them and become bonded to a small group of people early in life - mainly the people who care for them. This forms the basis for attachment. Separation anxiety is another attachment behavior of infants. This is when a child shows distress by often crying when unhappy because a familiar caregiver (parent or other caregiver) is leaving. The first signs of separation anxiety appear at about six months of age. Children between the age of 9 and 18 months will usually have a lot of difficulty beginning a child care program. Parents can make the transition easier by bringing the child's favorite toy or blanket along. (Source: Understanding Growth and Development Patterns of Infants by Novella J. Ruffin, June 2001) Movement, Learning And The Brain The human body was designed to move, and it is our early experiences that lay the foundation of what follows. To truly store something mentally as a sensory motor event, some type of movement activity is required - either speaking out loud, writing or other physical action such as gesticulation. By putting it into 'muscular memory' it is more likely to be remembered than something simply thought about and not 'acted out'. Constant sensory input and processing are required throughout life as well as in the early stages to maintain active development of neural networks within the brain. These networks are constantly being structured by dendrite formation and pruning. Every new motor activity performed generates a burst of dendritic formation creating new connections within the brain. If these new connections are not reinforced, they are literally reabsorbed by the cell body. The brain is a judicious budgeter and will not expend more than it has to, only putting energy into what it actively uses. For example, a 2 year old child has a nasty infection on the upper eyelid, and because of it's location the doctor decides to put a patch over the whole eye for 2 weeks. During that time the synaptic connections from the right eye to the visual cortex will be reabsorbed by the cell body and right field vision will be permanently impaired9. Movement of light across the retina is a necessary stimulus for dendritic growth and reinforcement of those connections within the visual cortex. If any of such parts (leg, neck, head, arm, elbow, forearm, hand, fingers, thumb, eye, nose, face, lips, teeth and tongue). are immobilised, the synaptic connections controlling those parts are reabsorbed by the cell body and movement is compromised. Rigorous therapy and retraining to form new neural pathways will become necessary.(2) The old adage "use it or lose it" is more true than most people think. There are strong links between the motor cortex and the reasoning parts of the frontal lobes. Most of our planning and thinking is object related initially. In planning to fulfill a conscious desire, the brain is occupied with neuronal activity. Movement stimulates increasing diversity of connections, which allows thoughts to spread beyond its original focus - we can 'think outside the square'. Movement then stimulates creativity. (Source: Understanding Growth and Development Patterns of Infants by Novella J. Ruffin, June 2001) Pre-term Birth Preterm birth is a risk factor for normal brain development. The germinal matrix is located subependymally beside the lateral ventricles, and it practically disappears before term age (Greisen, 1992). In preterm infants, during the functionally active phase of the germinal matrix, the highly vascularized area is prone to vascular insults because of impaired cerebral autoregulation and mechanical fragility of the vascular bed leading to ischemia and hemorrhage. These vascular insults may disturb the neural and especially the glial migration, and may be diagnosed later as periventricular leukomalasia or cysts, enlarged ventricular size, and reduced white and gray matter (Inder et al., 1999). Other causes for abnormal brain development include inflammation, hypoxia, reperfusion injury, or postnatal disorders such as cerebrovascular insults or nutritional deficiency (Amin, 2004; Folkerth, 2005; Lucas et al., 1998; Murphy et al., 2001; Raman et al., 2006; Vollmer et al., 2006). Pre term children have a definite difficulties in the initial years. The high rate of cognitive dysfunction in the neuropsychological test profile suggests an increased risk for learning difficulties that needs to be evaluated at a later age. In addition, the SGA infants still showed poorer growth at 5 years of age Extended followup should be the rule in outcome studies of ELBW infant cohorts to elucidate the impact of immaturity on school achievement and social behaviour later in life. (The Effect of Intrauterine Growth Restriction on Long Term Outcome in Very or Extremely Low Birth Weight Infants, Kaija Mikkola Academic dissertation 2007) Relationship between Sensory and Motor Skills Most of sensory input for humans is visual, and vision therefore plays a large part in the process of learning. A reflex called the vestibulo-occular reflex coordinates body movement with head and eye movement to provide a stable platform for vision by compensating with subtle muscle movements, or posture. Hearing of course plays an important part as well, and is very dependent upon movement. The ability to orient ourselves to a sound in our environment is critical for our survival. It is one of the first complex senses that we develop in the womb. After birth, at around 6 -9 months of age, the vestibular control of the neck muscles and the auditory system become linked to a neck righting reflex designed to coordinate head movement with sound. Many things can go wrong with the sense of hearing and balance. For example, continued ear infections during the critical periods of neuronal network formation will disrupt normal development. Without being able to hear properly, (certain frequencies may be 'blocked' due to the infection) we are unable to process and integrate that information. As a result, language, both written and spoken, may be delayed, the sense of balance disrupted or worse. With each ear infection crucial frequencies of sound are not integrated within the critical time frame of development. Developmental delay is proportionate to recovery time. For example, babies who are not taught to sit up, generally do so when developmentally ready after the 'creeping and crawling' stages of normal development. Those who are left on their backs for long periods of time may not learn to crawl and instead, will often become 'bottom shufflers', or will pull themselves up to stand and walk, thus missing the important sensory motor experiences of creeping and crawling. It is during creeping and crawling that lateralisation or the 'choice' of the dominant side - left or right, will take place. Excessive use of playpens, bouncers and walkers denies the child free explorative movement on the floor, and any surface which hinders movement (such as slippery tiled surfaces etc.) can be a hindrance to normal development. Early walking under 10 months and not preceded by crawling and creeping can herald future problems, especially if the child is already hyperactive. It takes 7-8 years of play and movement to provide a child with sensory motor intelligence that can serve as the foundation for intellectual, social, and personal development. Without early intervention, children with sensory integration difficulties seldom "grow out of it". (Source: Understanding Growth and Development Patterns of Infants by Novella J. Ruffin, June 2001) Landmarks of Motor Development (Source: Sensory-Motor Integration and Learning, Rosemary BoonM.A. (Psych) The following table represents a guide to landmarks in motor development. Since each and every individual is unique, and will develop according to their own developmental 'programmes' (usually genetically and environmentally based), this is just a guideline and if there is major difference in stages mentioned, professional help should be sought by the caregivers or parents. The normal newborn adopts the flexion posture and any deviations may be indicative of hypotonia for any number of reasons Asymmetry of movements up to 1 month of age may indicate birth injuries, neurological or congenital problems and professional advice should be sought Feeding, chewing or sleeping difficulties. Sluggishness, preferring to just sit and is not interested in investigating the world about him Overactivity Is exceptionally upset by loud sounds Stiffens when handled Frequent tantrums Uncontrolled crying for long periods Doesn't cry when physically hurt Persistent head-banging or rocking (It is not abnormal for a young child to rock intermittently while on hands and knees) Any other worrying behavioural difficulties From 2-3 years of Age During this period of brain development, the limbic system undergoes refinement. By this time children are moving across freely and develop a reasonable vocabulary. At this time, language functions are becoming localised in either the right or left hemispheres of the brain. Without the integration that occurs in this second year of life, all subsequent development would be difficult. Sensory awareness of the body is developed through the sense of touch, and if the child does not integrate these sensations well may have difficulty in learning to do things, trouble playing with toys, negotiating zippers and the like. Climbing is an important step at this age as it truly takes a well developed sense of balance to climb. During this activity the senses of gravity and visual information are further integrated which is an important step toward development of visual perception. Picture books are enjoyed and the pages turned one at a time. Enjoyment of nursery rhymes and attempts to join in are made. The sense of selfhood is also developed at this time, and the word "no" is often used to express this newfound independence. Although at one moment they will assert their independence and in the next, they want to cling to their care givers to feel reassured that they are safe and secure in the world. The integration of sensations provide the foundations for good relations with other people. By the end of this stage of development they also show signs of empathy, sharing the joys and sorrows of others. Some things to watch for at this age are:- Tip-toe walking - if this is prolonged you should seek advice Inability to jump with both feet simultaneously without help Any indication your child is not hearing clearly, and signs of difficulty in understanding simple commands. Excessive (more than other children of his/her age) fumbling, clumsiness and dropping of things. Poor behaviour with other people may indicate an inability to deal with the integration of sensations Inability to control a pencil between the thumb and two fingers Inability to straddle and steer a tricycle pushing with the feet This period of the cycle of brain development signals logic elaboration. Such things as detail and linear processing, refinement of cognitive processes, and the elements of language, reading and writing skills development, the refinement and development of technique and linear math processing. It is also the period in which the corpus collosum (the bundle of fibres interconnecting the left and right hemispheres of the brain) are further developed and myelinated (reinforced by a myelin sheath around the axons of the dendritic connetions) to allow whole brain processing. By around the age of eight years, a child's sense of touch and proprioceptive abilities are on their way toward full development. He can tell almost exactly where on his body he is being touched. The sense of gravity and balance is usually well established. The child can balance on one leg and walk a narrow beam. The ability to plan and sequence a number of motor activities should be evident and these will continue to be refined and improved upon in the next few years. Language is usually spoken well enough to communicate ideas, needs and interests. A child who is able to regulate emotions is more likely to be able to utilize a problem-solving process that allows him or her to generate and focus on adaptive goals that will build and enhance a relationship (e.g., avoid conflict, not hurt others' feelings). Those who are less skilled may focus on more external and self-serving goals, which lead them to react in less adaptive ways that do not promote successful interaction (e.g., revenge, spite). (Overview of the Affective Domain, Amy M. Brett, Melissa L. Smith, Edward A. Price, & William G. Huitt 2003) Conclusion Children differ in physical, cognitive, social, and emotional growth patterns. Understanding rapid growth rate at this crucial stage would allow parents and caregivers to help and give much needed attention to all these children at the right stage. There is critical association between development of motor skills, cognitive skills and affective skills during initial growing years of a child's development which needs to be understood well by caregivers and parents. During the first year, physical development mainly involves the infant coordinating motor skills. The expression of feelings about self, others, and things describe affective/emotional development. Learning to relate to others is social development. Principles of cognitive development provide us with a basis for understanding how to encourage exploration, thinking, and learning. There are strong links between the motor cortex and the reasoning parts of the frontal lobes. Most of our planning and thinking is object related initially. In planning to fulfill a conscious desire, the brain is occupied with neuronal activity. It takes 7-8 years of play and movement to provide a child with sensory motor intelligence that can serve as the foundation for eventual intellectual, social, and personal development. Without early intervention, children with sensory integration difficulties seldom "grow out of it". Diets and pre-term stages of birth also have effect on motor, affective and cognitive development of a child which can be treated if identified at early stages. These aspects if closely monitored during the initial years would ensure that the child grows up in most optimum ways in all spheres of life and lives a content life. Read More