The Life Cycle Flashcards
What % births are by C-section?
What’s premature birth?
What’s very premature birth?
1) 32%
2) <32 wks
APGAR used to predict likelihood of immediate survival. what does APGAR stand for
A-apperance (color) P-pulse G-grimace (reflex irritability) A-activity (muscle tone) R-respiration
Compare developed countries to US in terms of mortality rates
US has high rate of premature births so high infant mortality rate compared to other developed countries. No free prenatal care. Low income–> premature birth and high mortality. Prematurity from increased maternal age.
Postpartum Reactions
Baby blues; oxytocin-dopamine interactions associated with maternal-infant bond; major depression in up to 10% of mothers w/in 1 month of birth and can persist up to 1 yr. Postpartum Psychosis = .1%
Spheres of development are motor, social, verbal/cognitive. How do these develop?
From cephalad to caudad and central to peripheral. From self to others, from understanding to expressing (comprehension prior to speech)
Chess and Thomas theory
Temperament (endogenous differences at birth); traits include activity level, reactivity to stimuli, cyclic behavior patterns, reactions to people, mood, distractibility, attention span
Erik Erikson theory
critical periods of social goals (ex trust vs mistrust—>needs to be achieved by a specific age)
Jean Piaget theory
Cognitive or learning capabilities of a child at each age
Margaret Mahler
separation-individuation in enjoying relationships in adult life
Freud
parts of the body in which pleasure is derived
Infancy to 18 month mile marks
attachment, social smile @12wks, stranger anxiety @9months, separation anxiety late in 1st yr (comes with realization of object permanence–>that object still exists even if not visible)
Order of events between babies sitting/walking
sitting without support, standing with assistance, hands and knees crawling, walking with assistance, standing alone, walking alone
Importance of Attachment
Spitz–>observations in orphanages; Psychoimmunology (children w/out attachment are more prone to infections)–>thus family members encouraged to spend time w/children when hospitalized; As a result, formation of foster families. No compelling evidence that child care separations cause long term consequences
Infant Reflexes
1) Rooting reflex = touch cheek turn toward nipple
2) Palmar Grasp reflex = grip any object put in palm
3) Moro reflex = limbs extend when child startles
4) Babinski reflex = dorsiflexion of toes when sole of foot is stroked (disappears after 1yr)
Toddler Years: 18 months-3yrs
Rapprochement: moves away but quickly returns for comfort; Age 2 “No!”, parallel play (next to, not reciprocal); cooperative play by 4yrs; Milestones at 3 yrs: spend a few hrs away from mother in care of another adult, autonomy, bowel/bladder function (4/5yrs), Gender Identity by 3 yrs (understand if male/female)
Preschool: 3-6 yrs
Sibling rivalry, regression, increased vocab (2-4 yrs) including bathroom words, active fantasy life (imaginary friends) but know that imaginary friends aren’t real. Cooperative play at 4yrs. Strong fear of bodily injury (not a good time for elective procedures). Curiosity about bodies (playing doctor)
Milestones at 6 yrs
Development of child’s conscience (Superego); Sense of morality (right v wrong), empathy, lying is wrong, understand finality of death (and associated fears of losing loved ones)
Autism Spectrum Disorders
Do not acquire verbal/social skills at the expected age; no reciprocity, restricted range of interests, clumsiness, seen than dizygotic), assoc w/tuberous sclerosis and Fragile X Syndrome, approx 25% develop seizures
Rett’s Disorder/Childhood Disintegrative Disorder
Rett’s = 4yrs of normal functioning, hand wringing, breathing probs, intellectual impairment, ataxia motor and social declines, Xlinked; Childhood Disintegrative: 2-10 yrs of normal development followed by diminished functioning
School Age and Adolescence (7-11yrs)
psychosexual issues are dormant, Erikson’s industry vs inferiority (development of skills/hard work can lead to lifelong sense of competence), capacity for logical thought (reason, math), Piaget’s concrete operations (objects have more than one property, concept of conservation), learning problems identified
Play and Peer Relationships
relationships w/adults who are not primary caregiver, same sex peer relationships, not fitting in, latency of sexuality (identify w/parent of same sex), morality (rule conscious “what’s fair” – by 12, more flexible), more complex motor tasks (team sports), deal better w/illness/hospitalization, by age 9 UNIVERSALITY of death (I can die too), acting out as a defense mechanism, peer rejection
Adolescence: 11-20 yrs
early (11-14), middle (15-17), late (18-20); independence/autonomy/personal decision making; brain changes: myelination (inc white matter to gray matter volume), frontal and parietal lobes, pruning of up to 50% of synaptic connections, decline in glucose/O2 metabolism
Early Adolescence
Puberty is physical indicator of adolescence (girls 10.5yrs, boys 11.5); first period 11-14yrs; first ejaculation 12-15yrs; complete by 13.5-15yrs; tanner staging (puberty), early adolescence tends to be more obedient (older teens more likely oppose adults)
Middle Adolescence
by age 15: body image/popularity; preference to spend time w/friends (not family); risk taking behavior; education about obvious short-term benefits (re:physical appearance, popularity); autonomy/need for privacy: less likely to comply w/medical advice
Late Adolescence
Identity crisis (define/refine place in world); role confusion (difficulty forming identity/finding place in world); some develop abstraction (hypothetical and formal reasoning ie calculus and formal operations)
Teenage Sexuality and Pregnancy
Daily masturbation; homosexual experiences (may or may not be initial expression of homosexual orientation); first sex @16yrs; first marriage @23yrs; sex before marriage is the norm; <50% teens use contraceptive; in 2000, 15-19yrolds had highest rates of gonorrhea for women; chlamydia more common in teen women
Teenage pregnancy/sexuality continued
Emtional/social factors predisposing: depression, poor school achievement, divorced parents (1/3 American girls get preg before 20)
Pregnancy
Ethical and legal to provide minors with sex counseling and contraception w/out parental knowledge or consent and treatment for strs, drug and alcohol abuse; Roe v Wade (1st trimester abortions legal in every state); 2nd trimester by state
Problems Affecting Development
Mental Retardation (Down Syndrome/Fragile X); Down’s Syndrome: single palmar transverse crease, protruding tongue, flat facies, hypotonia, epicanthal folds, small ears, thick neck, premature aging and Alzheimer’s
FXS: males more severely effected, delayed cognitive function, hyperactive, hand flapping, hyperextensible joints, large ears, elongated face, poostpubertal enlargement of testes
Intellectual Impairment
Metabolic factors (infection–>rubella, toxoplasmosis, maternal substance abuse); Autism (seizures, hearing, visual problems), normal IQ of 70–>15 point ranges mild/moderate/severe
Other Disorders
Phonological: leaves out or misplaces speech sounds “ca for cat”
Articulation: lisping (motor speech problems)
Tourette’s: often w/OCD/ADHD/dopamine due dysfunctional regulation of dopamine in caudate nucleus)
Separation Anxiety (school phobia maybe from stressful life event/anxious family)
Selective Mutism (speak in some social situations but not in others)
Challenges of Early/Middle Adulthood
periods of life change (midlife crises), regression (become more adolescent?)
Demographic/Trends
Married men live longer and are healthier, cost of raising child to 18 yrs = $200,000 and after 18 even more than $200,000 depending on college
Divorce Factors
~50% marriages end up in divorce; factors: short courtship, teenage premarital pregnancy, absence of family support, prior divorce in family, differences in religion/socio$$ background, serious illness in one of their children
Single Parent Families
highest in African American families, inc risk of physical/mental illness, child at higher risk for school failure, depression, drug abuse, suicide, criminal activity and divorce; fast growing are single mothers/educated/professional choosing to bear or adopt on their own
Child Custody
Sole custody: parent w/whom child lives, has legal responsibility for and makes decisions about care. Other parent contributes $$ and visits on schedule
Joint custody: child spends part of time living w/each parent
Split Custody: each parent has custody of at least 1 child in the family
When to tell about adoption
at earliest possible age, told all that is known about biological parents, decreases chance of other person telling
Early Adulthood (20-40 years)
Age 30: one’s role in society is defined, physical development at peak, individual is independent; Age 30 transition: love and work/intimacy vs isolation; Freud: love and gratifying work; women change paths returning to work of becoming homemakers; adopt parental values
Middle Adulthood (40-65 years)
sandwich generation (responsible for both older and younger relatives); Generativity vs Stagnation (more life behind then ahead–>midlife crisis; Climacterium (the physiological changes–> men dec muscle strength/sexual performance; women menopause, vasomotor instability); use of estrogen replacement therapy for sleep but increased breast and uterine cancer risk
Old Age: 65 years and older
> 65 years is senior citizen; social security and medicare eligibility
The Losses of Aging
MOST adjust well: freedom from responsibilities of work/childrearing; Ego integrity vs Despair: pride in accomplishments or wasted life.
Independence vs care by others in old age
most live independently or in assisted living w/private rooms but get help w/meals, shopping and housework; only 5% elderly in nursing homes
Cognitive Function in Elderly
over 85yrs–> >50% w/cognitive impairment (Alzheimer’s most common); dementia in <10%
Neurological Changes of Aging
decreased cerebral blood flow, brain weight, amyloid plaque formation, intelligence the same, decreased NT availability, more sensitive to side effects
Psychosocial changes of aging
Abuse by caretakers of elders – adult protective services not mandates (yet) unlike child protective services
Stages of Dying
Elizabeth Kubler-Ross: Denial, Anger, Bargaining, Depression, Acceptance <>
Bereavement (normal vs complicated)
Both have: initial shock/denial/sadness/crying. Normal grid subsides over 1 to 2 yrs. Abnormal grief persist and involve suicidal thinking/hallucinations; note illusions may be normal in grief reactions; some hallucinations may be OK depending on culture/religion
Role of Physician in Death and Dying
make aware dx and px; reassure that intense response to news is expected; follow bereaved family members bc of increased risk of morbidity/mortality; resist emotional attachment
