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chamber that receives oxygen deoxygenated blood from the body; The end of systemic circulation
A baby can score a maximum of 10 points.
suspected Down’s syndrome, if the mother has given birth to a previous child with a heart malformation or of the mother herself has had congenital heart disease, maternal infections such as rubella, fetal exposure to
medications, drugs or alcohol or even, in some cases, if the mother has certain antibodies in her bloodstream that are known to increase the risk of heart
problems in the fetus.
Beginning of the 20th century, 16% of babies born in the US died before first birthday. deaths were thought result of improper infant feeding. “infant holocaust” and gave rise to two professions: pediatrics and food science. Europeans came up with the first commercial infant formulas, Americans were ready to embrace them. The new generation of pediatricians was ready to prescribe them and the formula manufacturers began to convince both pediatricians and the mothers who listened to them that formula was not just a substitute for breast milk but was in fact superior to it.
vitamin K, which needs to be given by injection within 6 hours of life and that’s to prevent hemorrhagic disease of the newborn. Newborns are relatively deficient in vit K for three reasons: 1. vit K doesn’t pass through the placenta very well; 2. Breast milk is relatively low in vit K; 3. the newborn hasn’t yet developed the gut flora (gastro-intestinal bacteria) that is usually responsible for the production of vit K. The second missing piece is vitamin D which needs to be given orally to all exclusively breastfed babies in North America daily to prevent rickets.
There is no upper limit to breastfeeding - no age at which women are advised to stop breastfeeding their babies as long as the mother and child are in mutual agreement that the breastfeeding should continue.
One of the major challenges to breastfeeding is public perception – societal pressure, a culture in which we see breasts as sexual – at all times.
The public’s perception of breastfeeding as inappropriate or just plain gross has played a huge part in the failure of breastfeeding to make a real comeback in our society. And this is one of the reasons why we see the numbers that we do.
But the key here is this, if a new mother does not receive adequate support from health professionals, the
immediate family including the father, and then society, it is much less likely that she will be successful at breastfeeding her baby. Later on issues like returning to work can also interfere with the continuation of breastfeeding. We’re getting there, but some say we’re getting there too slowly.
The first twelve months of a baby’s life are an important time for sleep development. Sleeping babies
alternate between periods of REM and NREM sleep and during the first 12 months, their sleeping patternschange so that they spend progressively more time in NREM sleep and less time in REM sleep.
characterized by bursts of rapid eye movements, intense EEG activity, (similar to EEG activityin the awake state) and dreaming
NREM sleep is divided into four stages. Stage one is considered to be the transitional stage between sleep and wakefulness, stage two is considered to mark the onset of true sleep – the baby exhibits decreased eye movements, decreased muscle tone and deceleration of
HR and resp rates. In this stage the child is able to move freely and reposition themselves in bed. Stage
3 and 4 are collectively called delta, deep or slow-wave sleep. This kind of sleep first develops in theinfant at about 2 months of age.
As in stage 2 sleep, muscle tone, HR and RR remain low, but the
difference is that as a baby enters this slow-wave sleep, it becomes increasingly difficult for the babyto wake herself up. If babies are awakened in this phase, they will appear to be confused and disoriented.
Nobody knows for sure.
Research in the 80’s 90’s began to suggest that babies who died of SIDS had some sort of a brain stem defect that increased their risk of being unable to arouse themselves from slow-wave sleep and they suffocated because basically, they were in too deep of a sleep to respond to the chemical signals in the body telling them to breathe.
SIDS babies have low serotonin levels
show lower amounts of the brain chemical serotonin, says a study. Levels of serotonin, which regulate a baby's sleep, heart rate and breathing, were 26 percent lower in the brainstems of babies who died of SIDS than in those of babies who died of other causes, the study says. low level of serotonin may be the "fundamental abnormality" in babies who die from SIDS. In the brainstem, serotonin acts as an alarm system, waking up a baby when breathing is disrupted. Babies without it can be unaware that they are not breathing enough oxygen, causing them to die in their sleep
1950’s to the late 1980’s official recommendations in countries where solitary sleeping was practiced (in Europe, North America and Australia) had been to place babies to sleep on their stomachs. In 1987, the Netherlands was the first to launch a campaign, advising parents to place their infants on their backs to sleep (supine), in an attempt to reduce the rate of SIDS. This was followed by infant supine position campaigns in the United Kingdom, New Zealand, and Australia in 1991, the U.S. in 1992, and Canada in 1993.
The original recommendations allowed side-sleeping but in 1996, the AAP further refined its sleep
position recommendation by stating that infants should only be placed to sleep in the supine position and not
in the prone or lateral positions.
SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004
"A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of
it is just code shifting”. Despite this question of whether or not the magnitude of the decrease in SIDS cases is true, the general consensus has been that putting a baby to sleep on their backs does reduce the risk of SIDS
because it means that the baby is spending less of the night in deep sleep.
inverse correlation between the incidence of SIDS and the practice of co-sleeping. You might be surprised to hear this, but co-sleeping is numerically, the most common sleeping practice for babies around the world. Surveys of today’s infant sleeping practices tell us that approximately 2 thirds of the world’s cultures practice mother-infant co-sleeping on the same sleeping surface and the fraction is even higher if the definition of co-sleeping is extended to include sleeping in the same room as the parent(s).
Mechanism #1: Co-sleeping mothers AND THEIR BABIES spend less time in slow-wave sleep
overall, both the mother and child who co-slept tended to sleep more lightly
through the night – they spent less time in slow-wave (NREM) sleep, BUT they spent more total
time asleep than the separate-sleeping pairs.
Mechanism #2: Co-sleeping mothers become “sensitized” to their newborns
Mothers and babies who routinely slept together experienced a synchronization of their sleeping patterns. Their brief awakenings tended to happen at the same times and these findings supported the hypothesis that routinely bed-sharing mothers do not habituate to the presence of their babies but become more sensitized to their behavior. The findings also suggested that the mothers are more likely to detect a prolonged pause in breathing and rouse their infants, even if they’re not aware that they’re doing it.
Mechanism #3: Co-sleeping facilitates breastfeeding, a known protective factor against SIDS
Bedsharing has been shown to facilitate breastfeeding and breastfeeding is a known preventative factor for SIDS. And while routinely bedsharing mother fed their infants more frequently through the night, on average they received more sleep than the solitary-sleeping breast feeding mothers. Altogether, these documented differences between the bedsharing and solitary sleep environments suggest some explanations for why SIDS is lowest in countries with the highest rates of co-sleeping.
Culture has a huge influence on child and infant sleep practices AND on the definition of “sleep problems”
In many Western families, a child who repeatedly cries at night when she’s
separated from her parents has a sleep problem – because most parents in our
culture expect children to sleep by themselves.
In many Eastern cultures, a child who cries at night when she’s separated from
her parents is a normal child – a smart normal child, because children are not
expected to be able to sleep alone.
In the American culture, we value independence and personal space or privacy so highly that we try to train our children to be self-reliant and to display their
independence by sleeping alone. In Japan, where co-sleeping is the most prevalent practice, interdependence and group harmony are the most highly regarded values that the Japanese parents describe when they’re asked what they want to instill in their children.
Richard Schweder, a cultural psychologist from the University of Chicago did a fascinating study in which he concluded that the decision of who sleeps by whom is guided by three concerns:
He looked at two groups, American and Japanese parents and asked them, if you had a
house with three rooms and you had a father a mother, two daughters aged 3
and 14 and three sons aged 8, 11 and 15, what would the ideal sleepingarrangements be?
Almost all of the American parents chose the sleeping arrangement
above, where the father and mother shared one room, the daughters were in one room
and the sons were in another room. In contrast, the Japanese parents were split
between the two arrangements above.
1999 from the U.S. Consumer Product
Safety Commission that showed 515 cases of accidental infant deaths occurred
in an adult bed over an 8-year period between 1990 and 1997. That's about 65
deaths per year.
Bronfenbrenner’s diagram circles
Education of the parents: Many parents (specifically, many mothers) haven’t had access to education about nutritious foods, so they don’t really know how important adequate nutrition is and what the long-term consequences of malnutrition are.
2) If we move out a layer to the Local Social Fabric, we have things like the Health service delivery
– does a child have access to a doctor to receive a vitamin A supplement, a hugely cost-effective intervention in reducing child mortality in the developing world. We’ll look a bit more at that story as well and how that discovery was made.
For the price of one missile, a school full of hungry children could eat lunch every day for 5 years
Throughout the 1990's more than 100 million children died from illness and starvation. Those 100 million deaths could have been prevented for the same cost as what the world spends on its military in two days.
Worldwide, half of the children who die before 5 years of age, die from under-nutrition
42.5% of children under five years of age in India are
The cycle of malnutrition, specifically among the women of rural India perpetuates the cycle of malnutrition and poverty for all rural Indians.
Low birth weight babies and child malnutrition are the main causes of sickness and undeniably, they reduce the lifetime achievement capacity of any given child. When a child does not get enough to eat, not only does their health suffer because they are less resistant to disease, but their development – their ability to learn and thrive and become productive members of their communities – is severely compromised.
And the current state of affairs for women and girl children in India is a direct result of the cultural beliefs about girl vs boy children, which results in the mistreatment and the disempowerment of women throughout their lives.
Kwashiorkor is a form of childhood malnutrition that was thought for may years to be due to a deficiency in protein, even if total caloric intake was okay. Now there’s some evidence That, in addition to a deficiency in protein, deficiencies in micronutrients and antioxidants may also play an important role in this disease process.
don’t appear to be wasting away – in contrast, the disease is most often characterized by a swollen child with a large, distended belly.
The disease was first defined in a 1935 Lancet article by a pediatrician called Cicely Williams. It was taken from the Kwa language of Ghana and translates literally into “first-second”.
It was taken from the Kwa language of Ghana and translates literally into “first-second”.
The name was used because people in Ghana noticed that this was a disease which
appeared in children when a new sibling was born and they were weaned from
breastfeeding. (ie: they went from being the first to the second). When this happened, these
children lost the protein they were getting in the breastmilk and this food was usually
replaced with foods that were high in starches and carbohydrates and relatively low in protein.
Under-nutrition à immune suppression (especially in infants who are not being breastfed)
Exposure to pathogens (ie: from unsafe water) à diarrheal disease à dehydration and death
1) aid – but is it sustainable and does it cause a state of perpetual dependence--community empowerment
2) programs that find ways to support positive change within the communities.
approximately 1 out of every three children in the United States is suffering from overweight or obesity. It’s currently estimated that one in three children born in the year 2000 will have diabetes in their lifetimes – a direct result of this obesity epidemic. If we continue along the current trajectory, some experts warn that this may well be the first generation of American children in modern history to face a shorter life expectancy that their parents. And this is preventable – it’s a direct result of the lifestyle choices that we as a society have chosen for our children.
So, 1935, the US Congress passed a law allowing surplus commodities to be distributed to public schools that served lunch and, in 1946, the US government launched the National School Lunch Act. – in which a Type A hot lunch (containing at
least 2 ounces of meat, a tablespoon of butter, two vegetables and half a pint of whole milk) became widely available to American children.
trained mother cats to eat banana or mashed potato. She then tested their kittens' food choice. When offered a normally preferred food (meat pellets) and an unusual food (banana or mashed potato), most of the kittens followed the example of their mother and ate the unusual food rather than the meat pellets. The kittens' preference for the unusual food persisted even when they were tested on their own. The kittens started to share their mother's food choices soon after weaning commenced (at about five weeks of age), and the effect was most marked towards the end of the weaning period (7-8 weeks).
In a large-scale survey of the eating behaviours of 2–6 year old British children, we found that parent-reported frequency of fruit and vegetable consumption was strongly inversely related to child food neophobia . This inverse relationship also held for meat and fish consumption, but not for starchy foods or for sweet or fatty snack foods .
-The culture of eating in the American home has changed as well. In 1950, the average American child ate three meals per day with at least two of those supervised by a parent.By 1990, the average American child ate at least 5 times a day and for many children, not one of those 5 eating times was a parent-controlled, sit-down event. Not one family meal. With the rise of the single-parent family and the two-income household,
Over the past few decades, portion sizes of everything from muffins to sandwiches have grown enormously. And while this isn’t the only culprit, there is no doubt that the large quantities of cheap food we’re surrounded by have not only distorted our perceptions of what a typical meal is supposed to look like, they’ve actually made us consume more.
Our goal should be to teach our children, mostly by example, to enjoy reasonable amounts of healthy food.
1 in every 10 to 15 children in the United States has been diagnosed with the disorder, and 1 in every 20 to 25 children in the United States is being treated for their ADHD with a stimulant medication. 1990’s--unprecedented rise in the number of children being diagnosed with ADHD and in the use of stimulant drugs in this population. record increase being treated with psychoactive medications triggered an intense public debate.
Or they can qualify by exhibiting six symptoms of hyperactivity and impulsivity. These are things like
-getting up from one’s seat when sitting is expected
-having difficulty waiting one’s turn.
CNS stimulants that are considered 1st line therapy and are currently being used in approximately 2.5 million US children – one in every 20-25 children in the US is taking a medication for their ADHD.
Not approved by FDA for use in very young children but are being prescribed off label to young children as young as 18 months.
One of the biggest factors fueling the debate on whether or not stimulants are being used appropriately in the United States is that stimulants are effective in helping individuals with or without ADHD. There is a reliable body of evidence suggesting that stimulant medications enhance most people’s ability to sustain their level of concentration, particularly when they are engaging in a task that they find difficult or boring (see citations below).
Pediatric psychiatric medicines overtook cardiovascular meds reach the top spot in spending for all drugs in all ages in 2003
In 2004, the US ADHD market generated $2.5 billion in drug revenues. The US produces and consumes 85%t of the world’s methylphenidate, according to the UN’ International Narcotics Control Board.American children using as much as 3x more psychiatric medication than children in the rest of the world combined.
ADHD and the stimulants used to treat it do not exist in a vacuum. Medical anthropologist Byron Good, calls this debate “social, psychological and cultural to the core,” Largely because of the powerful influence of public opinion and because of varying expectations of what is considered normal and abnormal behavior for children in our society.
Timimi says the result is that parents tend to criticize schools for lack of discipline, schools criticize parents for lack of discipline and in the end, more power goes to children who are too young to handle it. This has effectively led to a breakdown of a child’s relationship with authority.f
The tendency towards having these over-reactive receptors (to suffer from asthma) is associated with two other diseases. The three diseases run together so commonly in families that if one is present, a doctor (and a medical student when you start interviewing patients) must remember to ask about the other two.
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