Embryotic Period
- week 3-8
- cells differentiate to form CNS, major organs, muscles, ...
- During 3^rd week formation of neural tube
- During 4^th week heart can be detected and it is beating
- During 5^th week eyes can be detected
- 7^th - 8^th week, sex characteristics can be identified
- By end of 8^th week, has all the structures it will be born with
- teratogens will lead to structural deficits in the organs being formed at that point ... if teratogens

Fetal Period
- week 9-delivery
- refinement and further differentiation of cells and organs
- interconnections between organ systems
- visual/auditory senses are functional by the end of the 2^nd trimester

Age of Viability - point when fetus could survive on its out
 

Teratogens
-any disease, drug, or environmental agent that will harm the embryo/fetus

Maternal Diseases
- Rubella (German measles)
    - can lead to blindness, deafness, cardiac abnormalities, and MR
    - most dangerous during the 1^st trimester
    - blindness and cardiac problems when weeks 1-8
    - deafness when weeks 6-13
- Toxoplasmosis (parasite potentially in cat feces, undercooked meat)
    - brain damage and eye problems
    - can lead to miscarriage
- Urinary Tact Infections
    - miscarriage
    - low birth weight

Drugs
- Thalidomide (drug given to alleviate morning sickness)
    - physical deformities - arms, legs, ears
    - heart defects
- Aspirin
    - growth retardation & poor motor control
- Caffeine
    - low birth weight & miscarriage
- Diethylstilbestrol (DES) - given to prevent miscarriages
    - female kids (when reaching maturity) developed cervical cancer
    - female kids who become pregnant higher risk of miscarriage
- Nicotine
    - growth retardation & increased risk of miscarriage
- Alcohol (FAS/FAE)
    - small heads (decreased in volume and convolutions of the brain)
    - malformations of face, limbs, heart
    - hyperactivity, irritability, seizures
    - growth retardation
    - cognitive deficits
- Marijuana
    - tremors & sleep disturbances
- Cocaine
    - physical defects
    - increase fetal blood pressure
    - increased rate of miscarriage or premature birth
    - tremors, sleep disturbances, irritability, inattentive
    - later social deficits are noted
- Heroine
    - increased likelihood of miscarriage or premature birth
    - babies are born addicted and go through withdrawal
    - tremors, sleep disturbances, irritability, weak sucking, vomiting

Environmental Hazards
- Radiation
    - increased risk of child being still born
    - mental retardation
- Lead
    - increased miscarriage
    - deformities
    - mental retardation
    - low birth weight
    - increased risk if premature delivery
    - lowers fetal metabolism
- PCBs - (polychlorinated biphenyls)
    - eating contaminated fish from Lake Michigan
    - smaller
    - less responsive
    - cognitive deficits

Maternal Characteristics
- Diet
    - malnutrition
        - small and premature births
        - 1^st trimester - spinal cord damage
        - 3^rd trimester - small head size
        - cognitive deficits
        - increase risk of developing heart disease and diabetes
    - lack of folic acid
        - neural tube does not close properly
        - Spina Bifida

- Emotional Well being
    - severe or prolonged stress
    - low birth weight
    - premature delivery
    - complications with birth

- Age
    - younger than 20 and older than 35 there are increased risks

Birth Process
- Stages of Labor

Apgar
- assessed immediately following birth and at 5-10 min following birth
- scores below 4 - needs immediate medical care
- scores above 7 - good physical conditon

Brazelton
- test examines infant in their current state and attempts to elicit the best performance
- low scores indicate potential brain damage or neurological problems

Medication -

Alternative Approaches to Childbirth
- natural or prepared childbirth
    - Lamaze

- home births

- alternative birth centers
 

Birth Complications
Anoxia - oxygen deprivation

Breech position - feet or butt are born first

RH-factor -
if mom is RH- and baby is RH+ antibodies can be formed which deplete the oxygen from the blood on the baby and can cause deficits
typically not seen with 1^st child

preterm- more than 3 weeks before their due date

small-to-date - weight (and size) are smaller than what it should be for their given gestational age

respiratory distress syndrome -irregular breathing pattern
    - may stop breathing for periods of time
 

Social Environment
Mom -
first 6-12 hours as a sensitive period for bonding
Postpartum depression
- linked to hormonal changes and stress

Dad -
engrossment

Baby -
Survival and Primitive reflexes
Sleep/Wake Cycles
    Week 2-6 14-16 hours of sleep
    Week 13-28 sleep through night and require 2 naps
    Autostimulation Theory - if given a lot of stimulation when awake, babies will spend less time in REM sleep
                    Therefore REM sleep may simply be an attempt to provide stimulation.
    SIDS - sudden infant death syndrome

Crying

Brazelton

Neurological Items - 3 point scale (lo-med-hi) asymmetry/absence noted
    plantar grasp
    hand grasp
    ankle clonus
    Babinski reflex
    standing
    automatic walking
    crawling
    tonic neck reflex
    Moro reflex
    rooting reflex
    sucking reflex
    passive movements of both legs and arms

Behavioral Items - 9 point scale
                            - midpoint =expected behavior for 3 day old normal baby
    focus and follow an object
    reaction to auditory stimulus
    reaction to person
    reaction to a voice
    reaction to a person's face and voice
    degree of alertness
    motor maturity
    cuddliness
    consolability with intervention
    peak of excitement
    irritability
    amount of startles
    self-quieting activity
    hand-to-mouth facility
    number of smiles