Chapter 3 Flashcards
Neonatal phase
Period between birth and when the baby is 4 weeks old
* Development during neonatal phase advanced and significant from a psychological
point of view
General Appearance at Birth
Typical Appearance:
o Swollen, purple face
o Broad, flat nose
o Swollen eyelids and eyebrow ridges
o Skew-looking ears
Comparison: Often compared to a defeated boxer.
Reassurance: These features are normal and temporary, especially important for first-
time parents to understand.
Body Proportions
Head Size:
Limbs:
o Takes up ¼ of total body length in new-borns (vs ⅛ in adults).
o Neck muscles are underdeveloped and cannot support the head.
o Arms and legs appear short relative to the body.
o Hands and feet are exceptionally small.
Common Physical Conditions
Jaundice:
o Skin has a yellowish tint.
o Caused by a physiologically immature liver.
o Usually resolves within 10–14 days
Weight
Average Birth Weight: Between 2.5 kg and 4.5 kg
o Most common: Around 3.5 kg.
o Girls weigh about 120g less than boys.
o Firstborns tend to weigh less than later-born siblings.
Factors Affecting Weight:
o Malnutrition can lead to lower birth weights.
Weight Changes Post-Birth:
o May lose up to 10% in the first few days due to:
Fluid loss
Poor food intake
Poor digestion
o Regain begins by day 5, with original birth weight usually restored by day 10–
14.
Length
Average Length: Between 45 cm and 56 cm.
o Boys tend to be slightly taller than girls.
Influencing Factors:
o Size of parents
o Race
o Sex
o Mother’s nutrition during pregnancy
Heart Rate
Crying: Up to 170 beats per minute
Resting: Can drop to 80–90 beats per minute
Healthy Range: 120–150 beats per minute
Assessing the newborn
Apgar scale: Quantitative evaluation of certain critical physical characteristics of
newborn babies. Designed by Dr Virginia Apgar.
* Applied twice (1 minute after birth and 5 minutes after birth)
* Assess 5 aspects: Appearance (colour), pulse (heart rate), grimace (reflex irritability),
activity (muscle tone), respiration (breathing)
* Score of 0, 1, or 2 is given for each of above = total score out of 10
* Low scores indicate that a baby needs immediate medical care
* A slightly low score is common in babies born prematurely, after a high-risk
pregnancy, through a Caesarean section, and after a complicated labour and delivery
* Prolonged low Apgar scores (i.e., at 5- and 10-minute assessments) may be associated
with a greater risk of neonatal death and with neurological disabilities
* Risk factors for low Apgar scores include abnormalities of gestational length (i.e.,
either preterm or post term births) or congenital malformations, as well as the
availability and quality of health care, and the health, demographic, and
socioeconomic characteristics of the parents
Scores
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Neonatal Adjustments After Birth
Although the neonatal stage is the shortest of all life stages, it involves critical and rapid
adjustments to ensure the transition from the intrauterine environment to independent life.
These adjustments occur across multiple bodily systems:
Blood Circulation
Prenatal: The foetus relies on the mother for blood purification via the placenta.
Postnatal: With the first breath and cutting of the umbilical cord, the neonate’s heart
begins to function independently, sending blood to the lungs for oxygenation.
Respiration
Prenatal: Oxygen and carbon dioxide are exchanged through the umbilical cord.
Postnatal: The neonate must breathe independently. Breathing may be hindered by
mucus or amniotic fluid but is usually resolved with suctioning.
Traditional methods like smacking the baby are no longer used; gentle rubbing helps
stimulate breathing.
A delay in breathing can lead to anoxia, potentially causing brain damage.
Digestion and Elimination
Feeding: The neonate must take over feeding and digestion once the umbilical cord is
cut.
o Sucking and swallowing reflexes are present but take time to develop into
effective feeding.
Feeding schedules vary (2–4 hour intervals), and hunger cycles are not yet
established.
Excretion:
o The first stool is a dark green substance (meconium) passed within the first
few days.
o Urination occurs frequently (up to 18 times in 24 hours).
Body Temperature Regulation
Prenatal: Temperature is regulated by the mother’s body (~38°C).
Postnatal: The neonate must adapt to cooler ambient temperatures (~22°C).
o Initially, body temperature is unstable due to the lack of fat insulation.
o Over the first weeks, neonates develop a fat layer to help retain body heat.
o Sweat glands begin functioning around one month of age.
Nervous System and Reflexes
The neonate’s brain is about 25% the size of an adult brain; the cerebral cortex is still
underdeveloped.
Reflexes are crucial for survival and indicate neurological health.
Common neonatal reflexes
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Neonatal Smiles:
Once believed to be reflexive, neonatal smiles now appear to resemble social smiles
(Meltzoff et al., 2017).
Babies may move cheeks and brows before smiling, showing attention to caregivers.
Smiling becomes a way to influence caregivers’ responses (
Immunity
Prenatal: Babies receive antibodies from the mother via the placenta.
Postnatal: These antibodies provide short-term protection, but immunity wanes over
time.
Immunisation is essential to support the infant’s developing immune system.
Immunisation Schedule in South Africa (Mediclinic, 2021):
At birth: Polio and Tuberculosis
6 weeks: Hepatitis
9 months: Measles
Challenges:
Many live far from clinics and lack transport (Axsel, 2015).
Limited awareness of immunisation schedules among parents.
Malnutrition increases vulnerability to disease.
In 2017/18, immunisation coverage was 77%, below the 87% target (Dlamini, 2019).
In some rural areas, only 50% of babies are fully immunised by 3 months.
Vision
Basic capacity: Neonates are born with a functional but underdeveloped visual system
(Lally et al., 2019).
In the womb: There is no visual stimulation, so vision is limited at birth.
At birth:
o Can blink in bright light and track moving lights/disks.
o Even foetuses respond to bright light through the mother’s stomach (Johnson
et al., 2015).
Visual acuity:
o About 20–40 times poorer than adults.
o Can focus only at a distance of 20–25 cm – the typical distance from baby to
caregiver’s face (Stanford Children’s Health, 2021).
o Eye muscles are underdeveloped → inability to focus on objects at various
distances → vision is generally blurry.
Facial recognition:
o Neonates prefer human faces over abstract patterns
o Can recognise their mother’s face as early as within the first week (Cronin et
al., 2016).
o Multisensory integration: Facial recognition improves with the smell of the
mother (Leleu et al., 2019).
Colour vision:
o Born seeing in black, white, and shades of grey.
o Red is the first colour seen (~2–3 months).
o Full colour vision develops around 4–5 years.
Hearing
At birth: The auditory system is immature (Brennan, 2017).
o The auditory canal still contains amniotic fluid, making sounds faint until
absorbed.
Transition: From sound conducted through water (in utero) to air (after birth).
Prenatal hearing: By the 18th week of pregnancy, foetuses respond to sound (Mayo
Clinic, 2021).
Discrimination:
o Can distinguish mother’s voice from others within hours after birth.
o Prefer high-pitched sounds (e.g., mother’s voice) to low-pitched ones (e.g.,
father’s voice) (Stanford Children’s Health, 2021).
Sound localisation: Neonates can turn toward sounds, indicating coordination of
auditory and visual space
Smell
Can detect and differentiate odours:
o Pleasant smells stimulate sucking.
o Unpleasant smells cause facial grimacing and head turning.
Able to identify mother’s breast by smell, and may reject if the breast has a strong,
unfamiliar scent.
Taste
Though not very sensitive, neonates can distinguish between sweet, bitter, and sour
tastes (Mennella et al., 2015).
Show a preference for sweet tastes:
o Sweet tastes → increased sucking.
o Bitter/sour → aversive reactions.
Taste preferences influenced by:
o Hunger
o Individual differences
o Flavours in mother’s milk, which introduce familiar cultural foods.
Pain
Previously believed that neonates couldn’t feel pain – now proven false.
Pain experience is similar to adults (Goksan, 2018).
Common painful procedures include:
o Circumcision, surgery, blood collection, and diagnostics
Pain management often inadequate, which can:
o Lead to poor neurodevelopmental outcomes (Walker, 2019)
o Result in hypersensitivity to pain, cell damage, and chronic pain issues
Assessment tools:
o Pain scales for newborns
o Physiological signs: Changes in heart rate, respiratory rate, blood pressure
o Behavioural signs: High-pitched/prolonged crying, large motor movements
Sleep and dreaming
Between 16 and 18 hours of sleep a day
o Awake and quiet for 2-3 hours per day
o Awake and active for 1 or 2 hours a day
o Cry and fidget between 1 to 4 hours a day
* Half of sleeping time in REM sleep (associated with dreaming)
o REM sleep is characterised by muscle twitches, called myoclonic twitching,
and occurs more in infants than in adults. This represents a form of motor
exploration that helps infants to build motor interactions and lays a foundation
for complex, automatic, and goal-directed movements when awake
o Function in the normal maturation of developing baby’s central nervous
system
o Prepares baby to cope with stimulation from the outside world