Human Behavior and the Social Environment I Part VI Chapter 10 Physical Development in Infancy & Toddlerhood

PART VI DEVELOPMENT IN Learning Objectives I Explore and connect Psychosocial , Cognitive , and Psychosexual Development I Explore and connect another Theory , Approach , or Perspective to work in critical thinking skills for client assessments I Explore important aspects of a persons experience and ability to justify why they are important Development in Infancy 341

Vignette Misty arrived at 28 weeks gestation , right at months into the pregnancy . She spent several weeks in the neonatal unit but showed positive growth in development during this time . Her mother , Pam , was able to spend time with Misty daily but Photo by Sharon on was not allowed to hold or touch her very often in the beginning due to needs for respiratory support . Pam held her as often as she could to provide comfort , cherishing the increased time each day brought but also worried about how the limited physical contact would affect their bond . The hospital has reported Pam will be able to take Misty home in a few days and she is meeting with the Social Worker to plan for discharge . The Social Worker has provided support for the family with connection to resources for developmental supports and plans for a home visit to follow up in a few weeks . The Social Worker arrives for the follow up appointment and Pam reports taking care of Misty is so much harder than I ever thought . She didn seem to cry this much when we were at the hospital and she wont stay asleep longer than an hour at a time , its just so much and I do know how to help her or make her feel better . Pam reports she has taken Misty to the doctor two times due to her concerns and was told they were not able to find any physical issues with Misty . Pam reported I just feel so helpless , the doctors were any help , they just told me I needed to give it some more time and she would eventually settle but I just not sure , it doesnt seem to be settling , it seems like its just getting worse . Pam also reports I been reading a lot of stuff online too about premature babies and attachment and its really scaring me because there are so many stories about how some babies really struggle with development and then all the stuff about 342 Development in Infancy

poor attachment and all the stuff that happens if a baby doesnt have a good attachment , it just all so scary . The Social Worker takes notes on areas of concern Pam reports with Misty and then explored use of the resources Pam had been given at discharge . Pam looks down and reports No , I havent called any of them . Its just been so crazy and hard with Misty that I havent even thought about them . The Social Worker reflects how hard it must be trying to manage a new baby and battle so many concerns related to the baby health and . The Social Worker discusses working to set a schedule and increasing some of the structure for their day to see if this may help provide some supports for both Pam and Misty . Pam reports being open to anything that will help and schedules to meet with the Social Worker the following week . Pam shares nothing has changed when the Social Worker arrives for their next meeting . The Social Worker allows Pam to share continued struggles with trying to comfort Misty and continued feelings of failure when nothing works . She states , I just dont understand . Is it me ?

Is something wrong with her ?

I just dont understand and dont know what to do . I tried all the stuff we talked about for a couple of days , but it didnt seem to work so I stopped . The Social Worker acknowledges how hard change can be and then explores options to make a referral for assessments in areas of Occupational and Mental Health supports , discussing while the pediatrician reports nothing is physically wrong with Misty , there may be some sensory issues presenting that would need a specific assessment by an Occupational Therapist . The Social Worker also discussed how Misty premature arrival can be felt as a trauma by both Misty and Pam and benefits of exploring this with a Mental Health provider for supports . Pam states I willing to try anything at this point . Send me to as many places you think would help . The Social Worker arrives for a follow up visit approximately weeks after referrals were made . Pam arrives at the door smiling . The Social Worker recognizes this and comments on the difference from their last visit . Pam states It still been rough but better . We have started Occupational Therapy for some sensory issues that were Development in Infancy 343

found when we went for our assessment . We ve also started seeing a therapist that focuses on work with parents and infants and its been life changing for me to have a better understanding of how our experiences have impacted us both , as well as learning some coping skills for when feeling overwhelmed . We ve also been doing some attachment work and starting to feel more connected to Misty and can tell she feeling it too . We have a long way to go but I don so hopeless anymore , I know well get there . Critical Thinking . What stage of Theory of Cognitive Development is the client currently in ?

Are they meeting expectations of this stage ?

Examples ?

Are they demonstrating any delays in this stage ?

Examples ?

What stage of Theory of Psychosocial Development are they currently in ?

Are they meeting the goals of this stage ?

Examples ?

Are they demonstrating any struggles with their goals in this stage ?

Examples ?

What theory , approach , or perspective from previous Dimensions ( PIE , Sociocultural , or Social Change ) would you use to assess this client ?

Why ?

What do you feel are the most important aspects ( physical development , attachment , sexual development , etc ) to consider for this client ?

Why ?

344 Development in Infancy References , 2019 ) Dimensions of human behavior ( Sixth edition ) Sage Publications , Development in Infancy 345 Chapter 10 Physical Development in Infancy Summarize overall physical growth during infancy . Describe the growth in the brain during infancy . Explain infant sleep . Identify newborn . Compare gross and fine motor skills . Contrast the development of the senses in newborns . Describe the habituation procedure . Explain the merits of breastfeeding and when to introduce more solid foods . Discuss the nutritional concerns of marasmus and . Overall Physical Growth The average newborn in the United States weighs about pounds Chapter 10 Physical Development in Infancy 347

( between and 10 pounds ) and is about 20 inches in length . For the first few days of life , infants typically lose about percent of their body weight as they eliminate waste and get used to feeding . This often goes unnoticed by most parents but can be cause for concern for those who have a smaller infant . This weight loss is temporary , however , and is followed by a rapid period of growth . By the time an infant is months old , it usually doubles in weight and by one year has tripled the birth weight . By age , the weight has quadrupled , so we can expect that a should weigh between 20 and 40 pounds . The average length at one year is about inches and at two years it is around inches ( 2007 ) Body Proportions Another dramatic physical change that takes place in the first several years of life is the change in body proportions . The head initially makes up about 50 percent of our entire length when we are developing in the womb . At birth , the head makes up about 25 percent of our length , and by age 25 it comprises about 20 percent our length . 11 ' alt . i ' in . 348 Chapter 10 Physical Development in Infancy

The Brain in the First Two Years Some of the most dramatic physical change that occurs during this period is in the brain . We are born with most of the brain cells that we will ever have that is , about 85 billion neurons whose function is to store and transmit information ( 1997 ) While most of the brain neurons are present at birth , they are not fully mature . During the next several years dendrites , or branching extensions that collect information from other neurons , will undergo a period of exuberance . Because of this proliferation of dendrites , by age two a single neuron might have thousands of dendrites . or the formation of connections between neurons , continues from the prenatal period forming thousands of new connections during infancy and . This period of rapid neural growth is referred to as synaptic blooming . The blooming period of neural growth is then followed by a period of synaptic pruning , where neural connections are reduced thereby making those that are used much stronger . It is thought that pruning Chapter 10 Physical Development in Infancy 349

causes the brain to function more efficiently , allowing for mastery of more complex skills ( 2011 ) The experience will shape which of these connections are maintained and which of these are lost . Ultimately , about 40 percent of these connections will be lost ( Webb , Monk , and Nelson , 2001 ) Blooming occurs during the first few years of life , and pruning continues through childhood and into adolescence in various areas of the brain . Another major change occurring in the central nervous system is the development of myelin , a coating of fatty tissues around the axon of the neuron ( 2014 ) Myelin helps insulate the nerve cell and speed the rate of transmission of impulses from one cell to another . This enhances the building of neural pathways and improves coordination and control of movement and thought processes . The development of myelin continues into adolescence but is most dramatic during the first several years of life . The infants brain grows very fast . At birth , the brain is about 250 grams ( half a pound ) and by one year it is already 750 grams ( Eliot , 1999 ) Comparing to adult size , the newborn brain is approximately 33 of adult size at birth , and in just 90 days , it is already at 55 of adult size ( Holland et , 2014 ) Most of the neural activity is occurring in the cortex or the thin outer covering of the brain involved in voluntary activity and thinking . The cortex is divided into two hemispheres , and each hemisphere is divided into four lobes , each separated by folds known as fissures . If we look at the cortex starting at the front of the brain and moving over the top ( see Figure ) we see first the frontal lobe ( behind the forehead ) which is responsible primarily for thinking , planning , memory , and judgment . Following the frontal lobe is the parietal lobe , which extends from the middle to the back of the skull and which is responsible primarily for processing information about touch . Next is the occipital lobe , at the very back of the skull , which processes visual information . Finally , in front of the occipital lobe , between the ears , is the temporal lobe , which is responsible for hearing and language ( 2015 ) 350 Chapter 10 Physical Development in Infancy

i ' a an . a . um . um . in man . Although the brain grows rapidly during infancy , specific brain regions do not mature at the same rate . Primary motor areas develop earlier than primary sensory areas , and the prefrontal cortex , that is located behind the forehead , is the least developed ( 2015 ) As the prefrontal cortex matures , the child is increasingly able to regulate or control emotions , to plan activities , strategize , and have better judgment . This is not fully accomplished in infancy and but continues throughout childhood , adolescence , and adulthood . Lateralization is the process in which functions become localized primarily on one side of the brain . For example , in most adults the left hemisphere is more active than the right during language production , while the reverse pattern is observed during tasks involving abilities ( Springer , 1993 ) This process develops over time , however , structural between the hemispheres have been reported even in fetuses ( Chi , 81 Gilles , 1997 et , 2011 ) and infants ( et , 2009 ) Lastly , refers to the brains ability to change , both physically and chemically , to enhance its adaptability to Chapter 10 Physical Development in Infancy 351

environmental change and compensate for an injury . The control of some specific bodily functions , such as movement , vision , and hearing , is performed in specified areas of the cortex , and if these areas are damaged , the individual will likely lose the ability to perform the corresponding function . The brains neurons have a remarkable capacity to reorganize and extend themselves to carry out these particular functions in response to the needs of the organism , and to repair any damage . As a result , the brain constantly creates new neural communication routes and existing ones . Both environmental experiences , such as stimulation and events within a person body , such as hormones and genes , affect the brains plasticity . So too does age . Adult brains demonstrate , but they are influenced less extensively than those of infants ( 1989 , 2011 ) Infant Sleep A newborn typically sleeps approximately hours per period . This is usually sleep in that the infant is accumulating the hours over several sleep periods throughout the day ( 2005 ) The infant is averaging 15 hours per period by one month , and 14 hours by months . By the time children turn two , they are averaging closer to 10 hours per 24 hours . Additionally , the average newborn will spend close to 50 of the sleep time in the Rapid Eye Movement ( REM ) phase , which decreases to 25 to 30 in childhood . 352 Chapter 10 Physical Development in Infancy

Sudden Unexpected Infant Deaths ( SUID ) Each year in the United States , there are about Sudden Unexpected Infant Deaths ( SUID ) These deaths occur among infants less than and have no immediately obvious cause ( 2019 ) The three commonly reported types of SUID are Sudden Infant Death Syndrome ( is when the death of a healthy infant occurs suddenly and unexpectedly , and medical and forensic investigation ( including an autopsy ) are inconclusive . is the leading cause of death in Figure 75 infants to 12 months old , and approximately infants died of in 2017 ( 2019 ) Because is diagnosed when no other cause of death can be determined , possible causes of are regularly researched . One leading hypothesis suggests that infants who die from have abnormalities in the area of the brainstem responsible for regulating breathing ( 2005 ) Unknown Cause The sudden death of an infant less than one year of age that can not be explained because a thorough investigation was not conducted , and the cause of death could Chapter 10 Physical Development in Infancy 353

not be determined . In 2017 , 1300 infants died from unknown causes ( 2019 ) Accidental Suffocation and Strangulation in Bed Reasons for accidental suffocation include Suffocation by soft bedding , another person rolling on top of or against the infant while sleeping , an infant being wedged between two objects such as a mattress and wall , and strangulation such as when an infant head and neck become caught between crib railings . In 2017 , 900 infants died from accidental suffocation and strangulation . The combined SUID death rate declined considerably following the release of the American Academy of Pediatrics safe sleep recommendations in 1992 , which advocated that infants be placed for sleep on their backs ( position ) These recommendations were followed by a major Back to Sleep Campaign in 1994 . However , accidental suffocation and strangulation in bed mortality rates remained unchanged until the late . In 1998 death rates from accidental suffocation and strangulation in bed 354 Chapter 10 Physical Development in Infancy

actually started to increase , and they reached the highest rate at deaths per live births in 2017 ( 2019 ) LI . Infant hy ( Chapter 10 Physical Development in Infancy 355 , and Moon ( 2014 ) analyzed a total of 8207 deaths from 24 states during that were contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System , a database of death reports from state child death review teams . The results indicated that younger victims ( months ) were more likely to die by and sleeping in an adult a person . A higher percentage of older victims ( months to 364 days ) rolled into objects in the sleep environment and changed position from to prone . Carpenter et al . 2013 ) compared infants who died of with a matched control and found that infants younger than three months old who slept in bed with a parent were five times more likely to die of compared to babies who slept separately from the parents but were still in the same room . They concluded that , even when the parents do not smoke or take alcohol or drugs , increases the risk of . However , when combined with parental smoking and maternal alcohol consumption drug use , risks associated with greatly increased . The two studies discussed above were based on American statistics . What about the rest of the world ?

occurs in many cultures , primarily because of a more collectivist perspective that encourages a close bond and interdependent relationship ( Goldsmith , 1992 ) In countries where is common , however , Figure Source 77 parents and infants typically sleep on floor mats and other hard surfaces which minimize the suffocation that can occur with bedding ( Nelson , 2000 ) From to Voluntary Movements Table Some Common Infant 356 Chapter 10 Physical Development in Infancy

III load than an am An ( cu ! out IN . Guru up mun Newborns are equipped with a number of reflexes ( see Table ) which are involuntary movements in response to stimulation . Some of the more common , such as the sucking reflex and rooting reflex , are important to feeding . The grasping and stepping reflexes are eventually replaced by more voluntary behaviors . Within the first few months of life these disappear , while other reflexes , such as the , swallowing , sneezing , gagging , and withdrawal stay with us as they continue to serve Chapter 10 Physical Development in Infancy 357

important functions . Reflexes offer pediatricians insight into the maturation and health of the nervous system . Reflexes that persist longer than they should and can impede normal development ( Berne , 2006 ) In preterm infants and those with neurological , some of these reflexes may be absent at birth . Once present , they may persist longer than in a neurologically healthy infant ( Glass Aly , 2012 ) Motor Development Motor development occurs in an orderly sequence as infants move from reflexive reactions ( sucking and rooting ) to more advanced motor functioning . As mentioned during the prenatal section , development occurs according to the Cephalocaudal ( from head to tail ) and ( from the midline outward ) principles . For instance , babies first learn to hold their heads up , then to sit with assistance , then to sit unassisted , followed later by crawling , pulling up , cruising or walking while holding on to something , and then unassisted walking ( 1989 ) As motor skills develop , there are certain developmental milestones that young children should achieve . For each milestone , there is an average age , as well as a range of ages in which the milestone should be reached . An example of a developmental milestone is a baby holding up its head . Babies on average are able to hold up their head at weeks old , and 90 of babies achieve this between weeks and months old . On average , most babies sit alone at months old . Sitting involves both coordination and muscle strength , and 90 of babies achieve this milestone between and months old . If the child is displaying delays on several milestones , that is reason for concern , and the parent or caregiver should discuss this with the child pediatrician . Developmental delays can be identified and addressed through early intervention . 358 Chapter 10 Physical Development in Infancy

Figure Motor Skills refer to our ability to move our bodies and manipulate objects . Fine motor skills focus on the muscles in our fingers , toes , and eyes , and enable coordination of small actions ( grasping a toy , writing with a pencil , and using a spoon ) Newborns can not grasp objects voluntarily but do wave their arms toward objects of interest . At about months of age , the infant is able to reach for an object , first with both arms and within a few weeks , with only one arm . At this age grasping an object involves the use of the fingers and palm , but no thumbs . This is known as the Palmer Grasp . The use of the thumb comes at about months of age when the infant is able to grasp an object using the forefinger and thumb . Now the infant uses a Pincer Grasp , and this ability greatly enhances the ability to control and manipulate an object and infants take great delight in this newfound ability . They may spend hours picking up small objects from the floor and placing them in containers . By Chapter 10 Physical Development in Infancy 359

months , an infant can also watch a moving object , reach for it as it approaches , and grab it . Gross motor skills focus on large muscle groups that control our head , torso , arms and legs and involve larger movements ( balancing , running , and jumping ) These skills begin to develop first . Examples include moving to bring the chin up when lying on the stomach , moving the chest up , and rocking back and forth on hands and knees . But it also includes exploring an object with one feet as many babies do as early as weeks of age if seated in a carrier or other device that frees the hips . This may be easier than reaching for an object with the hands , which requires much more practice ( Berk , 2007 ) Sometimes an infant will try to move toward an object while crawling and surprisingly move backward because of the greater amount of strength in the arms than in the legs . Sensory Capacities Throughout much of history , the newborn was considered a passive , disorganized being who possessed minimal abilities . William James , an early psychologist , had described the newborns world as a blooming , buzzing confusion , 1985 ) However , current research techniques have demonstrated just how developed the newborn is with especially organized sensory and perceptual abilities . Vision The womb is a dark environment void of visual stimulation . Consequently , vision is one of the most poorly developed senses at birth , and time is needed to build those neural pathways between the eyes and the brain ( American Association , 2019 ) Newborns typically can not see further than to 10 inches away from their faces ( 2019 ) An old vision is 300 . This means an object 20 feet away from an infant has the same clarity as an object 300 feet away from an adult with normal vision . 360 Chapter 10 Physical Development in Infancy

By visual acuity has sharpened to , which would allow them the see the letter at the top of a standard eye chart ( 2016 ) As a result , the world looks blurry to young infants ( Johnson , 2015 ) Why is visual acuity so poor in the infant ?

The fovea , which is the central field of vision in the retina and allows us to see sharp detail , is not fully developed at birth , and does not start to reach adult levels of development until 15 months ( Li Ding , 2017 ) Even by 45 months some of the sensory neurons ( cones ) of the fovea are still not fully grown . Can babies see color ?

Young infants can perceive color , but the colors need to be very pure forms of basic colors , such as vivid red or green rather than weaker pastel shades . Most studies report that babies can see the full spectrum of colors by five months of age ( 2019 ) Newborn infants prefer and orient to stimuli more than they do other patterned stimuli ( 2005 ) They also prefer images of faces that are upright and not scrambled ( Chien , 2011 ) Infants also quickly learn to distinguish the face of their mother from faces of other women ( Morton , De , 2001 ) When viewing a person face , olds fixate on the outer edges of the face rather than the eyes , nose , or mouth , and olds gaze more at the inner features , especially the eyes ( 1978 ) Researchers have examined the development of attention and tracking in the visual system and have found the following for young infants have difficulty disengaging their attention and can spend several minutes fixedly gazing at a stimulus ( Johnson , 2015 ) 1981 ) found that when tracking an object visually , the eye movements of newborns and olds are not smooth Chapter 10 Physical Development in Infancy 361

but saccadic , that is jerky movements . also found their eye movements lag behind the object motion . This means young infants do not anticipate the trajectory of the object . By two months of age , their eye movements are becoming smoother , but they still lag behind the motion of the object and will not achieve this until about three to four months of age ( Johnson , 2015 ) Newborns also orient more to the visual field toward the side of the head , than to the visual field on either side of the nose ( Lewis , 1979 ) By two to three months , stimuli in both fields are now equally attended to ( Johnson , 2015 ) Binocular vision , which requires input from both eyes , is evident around the third month and continues to develop during the first six months ( 2003 ) By six months infants can perceive depth perception in pictures as well ( Sen , 2001 ) Infants who have experience crawling and exploring will pay greater attention to visual cues of depth and modify their actions accordingly ( Berk , 2007 ) Hearing The infants sense of hearing is very keen at birth , and the ability to hear is evidenced as soon as the seventh month of prenatal development . Newborns prefer their mother voices over another female when speaking the same material ( Fifer , 1980 ) Additionally , they will register in utero specific information heard from their mothers voice . 362 Chapter 10 Physical Development in Infancy

Figure and Spence ( 1986 ) tested 16 infants ( average age of hours ) whose mothers had previously read to them prenatally . The mothers read several passages to their fetuses , including the first 28 paragraphs of the Cat in the Hat , beginning when they were months pregnant . The fetuses had been exposed to the stories an average of 67 times or hours . When the experimental infants were tested , the target stories ( previously heard ) were more reinforcing than the novel story as measured by their rate of sucking . However , for control infants , the target stories were not more reinforcing than the novel story indicating that the experimental infants had heard them before . An infant can distinguish between very similar sounds as early as one month after birth and can distinguish between a familiar and voice even earlier . Infants are especially sensitive to the frequencies of sounds in human speech and prefer the exaggeration of speech , which will be discussed later . Additionally , infants are innately ready to respond to the sounds of any language , but between six and nine months they show a preference for listening to their native language ( Cutler , Chapter 10 Physical Development in Infancy 363

, 1993 ) Their ability to distinguish the sounds that are not in the language around them diminishes rapidly ( et , 1995 ) Touch and Pain Immediately after birth , a newborn is sensitive to touch and temperature , and is also highly sensitive to pain , responding with crying and cardiovascular responses ( 2013 ) Newborns who are circumcised , which is the surgical removal of the foreskin of the penis , without anesthesia experience pain as demonstrated by increased blood pressure , increased heart rate , decreased oxygen in the blood , and a surge of stress hormones ( United States National Library of Medicine , 2016 ) Research has demonstrated that infants who were circumcised without anesthesia experienced more pain and fear during routine childhood vaccines . Fortunately , today many local pain killers are currently used during circumcision . Taste and Smell Studies of taste and smell demonstrate that babies respond with different facial expressions , suggesting that certain preferences are innate . Newborns can distinguish between sour , bitter , sweet , and salty flavors and show a preference for sweet flavors . Newborns also prefer the smell of their mothers . An infant only days old is significantly more likely to turn toward its own mother breast pad than to the breast pad of another baby mother ( Porter , Makin , Davis , 1992 ) and within hours of birth an infant also shows a preference for the face of its own mother ( 2001 , Sai , 1989 ) 364 Chapter 10 Physical Development in Infancy

Figure Infants seem to be born with the ability to perceive the world in an way that is , through stimulation from more than one sensory modality . For example , infants who sucked on a pacifier with either a smooth or textured surface preferred to look at a corresponding ( smooth or textured ) visual model of the pacifier . By months , infants can match lip movements with speech sounds and can match other audiovisual events . Sensory processes are certainly affected by the infant developing motor abilities ( Jacob , Chapin , 2014 ) Reaching , crawling , and other actions allow the infant to see , touch , and organize his or her experiences in new ways . How are Infants Tested Habituation procedures , that is measuring decreased responsiveness to a stimulus after repeated presentations , have increasingly been used to evaluate infants to study the development of perceptual and memory skills . 2005 ) describes a habituation procedure used when measuring the rate of the sucking reflex . Chapter 10 Physical Development in Infancy 365

Researchers first measure the initial baseline rate of sucking to a pacifier equipped with that measure muscle contractions . Next , an auditory stimulus is presented , such as a human voice uttering a speech sound such as da . The rate of sucking will typically increase with the new sound , but then decrease to baseline levels as da is repeatedly presented , showing habituation . If the sound ma was then presented , the rate of sucking would again increase , demonstrating that the infant can discriminate between these two stimuli . Additionally , the speed or efficiency with which infants show habituation has been shown to predict outcomes in behaviors , such as language acquisition and verbal and nonverbal intelligence . Infants who show difficulty during habituation , or habituate at slower than normal rates , have been found to be at an increased risk for significant developmental delays . Infants with Down syndrome , infants , malnourished infants , and premature infants have all been studied . Researchers have found that at the age of 16 months , infants show rates of habituation comparable to newborn infants ( 2005 ) Nutrition Breast milk is considered the ideal diet for newborns . Colostrum , the first breast milk produced during pregnancy , and just after birth has been described as liquid gold ( United States Department of Health and Human Services ( 2011 ) It is very rich in nutrients and antibodies . Breast milk changes by the third to fifth day after birth , becoming much thinner , but containing just the right amount of fat , sugar , water , and proteins to support overall physical and neurological development . For most babies , breast milk is also easier to digest than formula . infants experience more diarrhea and upset stomachs . The absence of antibodies in 366 Chapter 10 Physical Development in Infancy

formula often results in a higher rate of ear infections and respiratory infections . Children who are breastfed have lower rates of childhood leukemia , asthma , obesity , type and diabetes , and a lower risk of . The recommends that mothers breastfeed their infants until at least months of age and that breast milk be used in the diet throughout the first year or two . Several recent studies have reported that it is not just babies that benefit from breastfeeding . Breastfeeding stimulates contractions in the uterus to help it regain its normal size , and women who breastfeed are more likely to space their pregnancies further apart . Mothers who breastfeed are at lower risk of developing breast cancer ( et , 2015 ) especially among racial and ethnic groups ( et , 2015 et , 2012 ) Women who breastfeed have lower rates of ovarian cancer ( Terry , Cramer , 2010 ) reduced risk for developing Type diabetes ( Schwarz et , 2010 , et , 2015 ) and rheumatoid arthritis ( 2004 ) In most studies these benefits have been seen in women who breastfeed longer than months . Chapter 10 Physical Development in Infancy 367

Current rates of breastfeeding indicate that of mothers have breastfed their infants at some point ( 2018 ) However , most mothers who breastfeed in the United States stop breastfeeding exclusively at about weeks , often in order to return to work outside the home ( 2011 ) Mothers can certainly continue to provide breast milk to their babies by expressing and freezing the milk to be bottle fed at a later time or by being available to their infants at feeding time . However , some mothers find that after the initial encouragement they receive in the hospital to breastfeed , the outside world is less supportive of such efforts . Some workplaces support breastfeeding mothers by providing flexible schedules and welcoming infants , but many do not . In addition , not all women may be able to breastfeed . Women with HIV are routinely discouraged from breastfeeding as the infection may pass to the infant . Similarly , women who are taking certain medications or undergoing radiation treatment may be told not to breastfeed ( 2011 ) Besides the nutritional benefits of breastfeeding , breast milk is free . Anyone who has priced formula recently can appreciate this added incentive to breastfeeding . Prices for a year worth of formula and feeding supplies can cost between and 3000 per year ( Los Angles County Department of Public Health , 2019 ) In addition to the formula , costs include bottles , nipples , and other supplies . 368 Chapter 10 Physical Development in Infancy

Figure . 875 PER YEAR PER YEAR Source One early argument given to promote the practice of breastfeeding was that it promoted bonding and healthy emotional development for infants . However , this does not seem to be the case . Breastfed and infants adjust equally well emotionally ( Ferguson . Woodward , 1999 ) This is good news for mothers who may be unable to breastfeed for a variety of reasons and for fathers who might feel left out . When to Introduce More Solid Foods Solid foods should not be introduced until the infant is ready . According to The University Cooperative Extension ( 2014 ) some things to look for include that the infant can sit up without needing support can hold its head up without wobbling shows interest in foods others are eating Chapter 10 Physical Development in Infancy 369

is still hungry after being breastfed or is able to move foods from the front to the back of the mouth is able to turn away when they have had enough For many infants who are to months of age , breast milk or formula can be supplemented with more solid foods . The first solid foods that are introduced are infant cereals mixed with breast milk or formula . Typically rice , oatmeal , and barley cereals are offered as a number of infants are sensitive to more cereals . Finger foods such as toast squares , cooked vegetable strips , or peeled soft fruit can be introduced by months . New foods should be introduced one at a time , and the new food should be fed for a few days in a row to allow the baby time to adjust to the new food . This also allows parents time to assess if the child has a food allergy . Foods that have multiple ingredients should be avoided until parents have assessed how the child responds to each ingredient separately . Foods that are sticky ( such as peanut butter or taffy ) cut into large chunks ( such as cheese and harder meats ) and firm and round ( such as hard candies , grapes , or cherry tomatoes ) should be avoided as they are a choking hazard . Honey and corn syrup should be avoided as these often contain botulism spores . In children under 12 months , this can lead to death ( University Cooperative Extension , 2014 ) Figure Global Considerations and Malnutrition Children in developing countries and countries experiencing the harsh conditions of war are at risk for two major types of malnutrition , also referred to as wasting . Infantile marasmus refers to starvation due to a lack of calories and protein . Children who do not receive adequate nutrition lose fat and muscle until their bodies 370 Chapter 10 Physical Development in Infancy

can no longer function . Babies who are breastfed are much less at risk of malnutrition than those who are . After weaning , children who have diets deficient in protein may experience known as the disease of the displaced child often occurring after another child has been born and taken over breastfeeding . This results in a loss of appetite and swelling of the abdomen as the body begins to break down the vital organs as a source of protein . Figure ( fut Duran and Around the world , the rates of wasting have been dropping . However , according to the World Health Organization and , in 2014 there were 50 million children under the age of five that experienced these forms of wasting , and 16 million were severely wasted ( 2015 ) This works out to child in every 13 children in the world suffers from some form of wasting , and the majority Chapter 10 Physical Development in Infancy 371

of these children live in Asia ( 343 million ) and Africa ( million ) Wasting can occur as a result of severe food shortages , regional diets that lack certain proteins and vitamins , or infectious diseases that inhibit appetite ( 1997 ) The consequences of wasting depend on how late in the progression of the disease parents and guardians seek medical treatment for their children . Unfortunately , in some cultures families do not seek treatment early , and as a result by the time a child is hospitalized the child often dies within the first three days after admission ( 1997 ) Several studies have reported term cognitive effects of early malnutrition ( Galler Ramsey , 1989 Galler , Ramsey , Salt Archer , 1987 , 1980 ) even when home environments were controlled ( Galler , Ramsey , Archer Salt , 1990 ) Lower IQ scores ( Galler et , 1987 ) poor attention ( Galler Ramsey , 1989 ) and behavioral issues in the classroom ( Galler et , 1990 ) have been reported in children with a history of serious malnutrition in the first few years of life . References , 1979 ) attachment . American Psychologist , 34 ( 10 ) Waters , Wall , 1978 ) Patterns of attachment . 1999 ) Differences in behavior between European and Japanese Americans Effect on competence evaluations . Journal of Psychology , 30 , American Association . 2019 ) Infant vision Birth to 24 months of age . Retrieved from 372 ) Chapter 10 Physical Development in Infancy

American Psychiatric Association . 2013 ) Diagnostic and statistical manual of mental disorders , edition ( Washington , Author . 1993 ) Vocabulary development A morphological analysis . of the Society for Research in Child Development , 58 10 ) 1981 ) Development of smooth pursuit in human infants . In Fisher , Monty , Eye movements Cognition and visual perception ( 51 ) 2003 ) Neurobiological models of normal and abnormal visual development . In de Johnson ( The cognitive neuroscience of development ( 71 ) Hove Psychology Press . 1987 . Object permanence in and infants . Developmental Psychology , 22 , Li , Wu , 2011 ) How do infants reason about physical events ?

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