Early Intervention

Question 1

0 months/Newborn/Post Term

Answer 1

• The mother’s placenta helps the baby “breathe” while it is growing in the womb
• Oxygen and carbon dioxide flow through the blood in the placenta. Most of it goes to the heart and flows through the baby’s body.
• At birth, the baby’s lungs are filled with fluid. They are not inflated
• Baby takes the first breath within about 10 seconds after delivery
• Sounds like a gasp as the newborn’s central nervous system reacts to the sudden change in temperature and environment

Question 2

Baby’s First Breath

Answer 2

A number of changes occur in the infant’s lungs and
circulatory system:
- Increased oxygen in the lungs causes a decrease in
blood flow resistance to the lungs.
- Blood flow resistance of the baby’s blood vessels
also increases.

• Fluid drains
• Fluid is absorbed from the respiratory system.
• The lungs inflate and begin working on their own:
• moving oxygen into the bloodstream (inhalation)
• removing carbon dioxide by breathing out
  (exhalation)

Question 3

Motor Patterns of the Newborn

Answer 3

Physiological Flexion
* At rest, the full-term newborn infant is in a flexed position
* Recoil of flexed limbs when extended
* Provides stability for early posture and random movements)

Amount of flexion is:
* Individual
* Depends on the size of the baby, the size of the
mother’s uterus, and the baby’s passive tone.

Posture is:
* More flexed in prone (belly)
* Less flexed in supine (back)

Question 4

Newborn’s Movements

Answer 4

• Movements are random
• Movements are a continuation of movements
  that occurred in utero.
• Movements are individualized
• Movements vary with position and arousal:
  Increase when baby is crying, hungry, or cold
  Decrease when tired, sleeping
• Movements can be jerky
• Movements can be tremulous
• Movements are “practice” for baby to begin active movements

***Six types of Movements !!

Question 5

1- Progression movements

Answer 5

• Rhythmic alternating flexion-extension movements of the limbs
  Involves the upper and or lower limbs
  Can be one, or two, or three, or all four limbs
• The head does not move
• Movements are like in-utero swimming

Question 6

2- Symmetrical movements

Answer 6

• Total body movements
• Occur more slowly than progressive movements

Question 7

3- Startle

Answer 7

• Quick, brief movements of the head, trunk, and limbs into flexion
• Some babies move into extension and then quickly into flexion
• The hands are closed

Question 8

Asymmetrical tonic neck reflex (ATNR)

Answer 8

• Head turns to one side
• Arm and leg of opposite side flex

Question 9

5- Facial movements

Answer 9

Grimaces, Smiles, Eyelids, Sucking, Tongue

Question 10

6- Isolated movements

Answer 10

• Wrists and fingers: Random, Spontaneous
• Toes: Extension and abduction

Question 11

Oral-Motor Patterns of the Newborn:

Answer 11

• Oral cavity is very small
• Intra-oral structures are large
• The tongue is huge in comparison with the rest of the oral cavity
• The tongue fills the oral cavity
• The base of the tongue lies in the pharynx
• As baby suckles, these muscles “work”
• As they work, they become more active
• As the become more active, they will directly affect the movements of the cheeks and lips
• These muscles also provide stability for further development of jaw and tongue movements.
• Think about the premature baby or baby with any condition that cannot suck after birth
• They are fed by nasal gastric tube (NGT) or oral gastric tube (OGT) or gastrostomy tube (GTT)
• If the baby cannot suckle and “work” these muscles, and these muscles provide stability for further development, what happens to baby’s feeding abilities??**

Question 12

Newborn’s Face

Answer 12

• Tissue, muscles, skin provide stability
• The buccals/sucking pads/cheeks needed for suckling and sucking activities.

Question 13

Newborn’s Lips

Answer 13

Orbicularis Oris:
* Sphincter like muscle of the lips
* Protrude the lips
* Round the lips
* Close the lips
* Assists in constricting the lips around the nipple for suckling

Question 14

Newborn’s Upper Airway

Answer 14

The pharynx and upper airway—–Suspend from the base of the skull. Muscles that attach to the hyoid bone and the larynx allow the pharynx to play a very important role in feeding swallowing AND sound production, airway flow/development AND head and neck control.

The suprahyoid muscles that assist in elevating the hyoid bone and larynx (and when these elevate what happens???) also include muscles that assist with mandibular depression (down) AND are part of the extrinsic muscles of the tongue AND the stylohyoid which connects the hyoid bone to the base of the skull.

The infrahyoid muscles- assist in depressing the hyoid bone and larynx. They also attach the hyoid bone to the sternum, clavicles, scapulae, ribs, and thyroid.

**The hyoid bone attaches to the base of the tongue and ribcage!!

Question 15

Importance of the hyoid bone

Answer 15

• The hyoid bone is directly attached to the mandible, tongue, larynx, shoulder girdle/scapulae, and rib cage
• It directly contributes to the movements of the oral, pharyngeal, and laryngeal areas.
• It also contributes to the alignment of the head, neck, shoulder girdle, and rib cage.
• It moves (Elevates and depresses) with the tongue and the larynx for swallowing
• It actively participates in respiration

Question 16

Tongue

Answer 16

• You must remember the tongue is considered an oral structure but the influences it has on the pharynx are clinically significant
• The bulk mass of the body of the tongue the attachment of its extrinsic muscles and its movements during functional activities impact the position and alignment of the larynx.

Question 17

The newborn’s rib cage and diaphragm

Answer 17

• The diaphragm of the newborn is positioned higher in the thoracic cavity at rest. This allows for more efficiency. The diaphragm is the primary muscle of inspiration used by the newborn.
• At birth, the ribs and the sternum are primarily cartilaginous structures– why?– To give these structures more flexibility and to make the ribs and sternum less susceptible to forces placed on them by surrounding musculature and activity
• The Diaphragm consists of muscles and tendons, and is surrounded by tissue. It forms the floor of the thoracic cavity and separates the thorax from the abdominal cavities. The diaphragm is dome shaped when relaxed. When the diaphragm is contracted on inspiration, it flattens, the abdominal wall is pushed outward, and the lower ribs are pulled up and out resulting in rib flaring AKA rib expansion. This is typical and normal in the newborn

Question 18

Feeding Process of the Newborn

Answer 18

• The rooting response.
• When the side of the cheeks and lips are touched (tactile input/tactile stimulation), the baby’s head ALONG with the tongue, lips, and jaw, move toward that side
• The tongue, Jaw, cheeks, and lips work together as a unit for the baby to breastfeed or bottle drink
• The tongue remains within the oral cavity , cups AKA grooves around the nipple, and moves up and down with the jaw
• The lips surround the nipple, rounded AKA flanged, but do not hold on to the nipple with the lips yet. The tongue licks at the nipple. This is called the total pattern of sucking. (This is different from active sucking of the infant which develops later.
• As the newborn begins to work against gravity and develop head extension, the movements of the oral cavity start to change. The tongue of the newborn move rhythmically with the jaw in an anterior- posterior direction or pattern.
• This active pattern is referred to as suckling.

Question 19

Flanged

Answer 19

Lips are rounded and outward when breastfeeding.

Question 20

Sound and phonation development of the newborn

Answer 20

• Sounds such as crying or vowel like sounds are produced upon exhalation
• Most of the sounds produced by the newborn are produced with general body movements
• As the infant moves, sounds are generated from the vocal folds and the larynx
• Short duration of sounds such as clicking noises are also produced
• The cries and vowel like sounds are nasal in quality
• The newborn does not drool! Minimal saliva production

Question 21

Newborn’s Vision

Answer 21

• The newborn can see
• They may be sensitive to light at first
• Eye movements may be random and disorganized.
• Within the first week, the baby begins to visually fixate using one eye at a time
• The newborn sees a moving object better that a stationary one (because the stationary object blends into the background and disappears
• The eyes of the newborn move with the head.
• Within the first few weeks of life, the newborn begins to look at the feeder while breast or bottle feeding. (Baby sees best when the object is 8-15 inches away)

Question 22

1-2 Months AKA 4-8 weeks Post-Term

Answer 22

• Random movements continue to occur but are less reflexive and more coordinated.
• The head and neck begin to dissociate from the neck (elongate downward)
• Physiological flexion begins to diminish. During the second month the baby can be held more upright on an adult shoulder the infant begins to lift its head off of the shoulder to hold it upright momentarily. Some babies do this at one month and some babies do this two months
• In prone, the 1-2 month old can lift its head to shoulder level
• In supine, the arms and legs move randomly but are not as jerky. The arms move in wide ranges
• The infant’s own movements and gravity assist with expanding the chest
• The baby will grasp a finger when it is placed into the baby’s hand. The baby does not yet know that it is holding a finger (although adults say “aww, he/she/it grabbed my finger!). The grasping is reflexive and involuntary

Question 23

1-2 months oral motor development

Answer 23

• The same as we discussed for the newborn
• Like the newborn, the one and two-month old infant suckles when the hand comes into contact with the mouth. This is part of the routing response
• This activity provides practice for the infant and a good experience for oral sensory and tactile stimulation.
• The infant practices suckling, swallowing, breathing coordination. These rhythmical, coordinated, non-nutritive suckling experiences help the infant to calm and quiet as the body is organized by the suckling activity
• Suckling is similar in the 1-2 month old as the newborn. One significant change is more head movements, greater head control, and dissociated movements of the head and shoulders.

Question 24

1-2 months rib cage development

Answer 24

• Similar to the newborn. However, there is greater mobility between the ribs and the spine- closer to the 8-week mark
• Physiological flexion is dissipating or lost by 2 months
• The head is lifted more actively. Movements in prone and supine become more asymmetrical (in a good way! Different from asymmetry we’ll talk about later)
• As these body movements become more organized and asymmetrical, the oral movements begin to change shape too.

Question 25

1-2 months phonation

Answer 25

• The rib cage is still rounded and high in position.
• Belly-breathing continues
• Rib flaring is still evident upon inhalation
• Sounds are produced in relation to the infant’s body movements. They sound nasal, with more voicing evident (more laryngeal involvement)
• Cries are longer and vary in pitch
• Cries begin to sound different depending on “state” (hungry, uncomfortable, pain, tired)

Question 26

1-2 months vision

Answer 26

• The 1- month old can fixate on an object briefly.
• The infant can see best when the object is 10-20 inches away.
• Black and white patterns are interesting to the 1 month old
• The 2-month old begins to use both eyes simultaneously, rather than one at a time
• The infant can track better

Question 27

3-5 Months AKA 12 weeks-16 weeks-20 weeks
Post-Term

Answer 27

• Baby’s head control is much improved.
• At 3 months, when held upright, the infant maintains its head in a vertical position
• Primitive reflexes begin to diminish and become integrated with the baby’s movement patterns.
• Baby is gaining postural stability as it moves against gravity
• Weight shifting occurs, upper and lower extremities are moved, and thoracic movements occur- Lateral and rotational movements
• Reciprocal kicking of the legs occurs often in the 3-5 month old infant.
• Prone becomes a functional position for the infant. It can bear weight on the forearms, lift the head and shoulder girdle upward.

The neck, trunk, and shoulder girdle are stretched and elongated. **This is important WHY???
- The 3-5 month old also has more ability to reach and grab a dangling object or an object that is held in front of it/her/him. At first, accidentally, and then with purpose
- The baby is also able to bring its hands to its mouth more frequently.
- Grasping an object in its hands usually ends up right in the mouth
- This is how the 3-5 month old explores the object- with its mouth

**Drooling begins around 3-months, as the salivary glands begin to produce more saliva