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Development
Lecture 1 Development
129
Physiology
Undergraduate 3
09/19/2012

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Term
What is the FDA Definition of a Newborn?
Definition
Birth to 1 Month
Term
What is the FDA definition of an Infant?
Definition
1 month to 2 years
Term
What is the FDA definition of a child
Definition
2-12 years
Term
What is the FDA definition of an adolescent?
Definition
12-21 yeas
Term
What percentage of infants are born normal? And does this mean their visual system will be normal?
Definition
98% and No
Term
What pre-natal factors may affect the development of the visual system?
Definition
Mom's age, Ionizing radiation, Chemical agents, infectious diseases, and Nutrition
Term
Older mom's predispose babys to what?
Definition
Developmental delays and teratogenic conditions
Term
Ionizing radiation may predispose children to what?
Definition
subtle to sever teratogenic effects
Term
Chemical agents may predispose children to what?
Definition
Ex: pesticides, alcohol, drugs, tobacco
May be teratogenic or cause defects in intrauterine deveopment. Presiposes low birth weight and premature delivery
Term
Infectious diseases in mother predispose children to what?
Definition
May be teratogenic. May be predisposed to visual manifestations and complications.
Viral and Venereal diseases are most common
Term
Poor nutrition in the mother predisposes her child to what?
Definition
Low birth weight, and inhibited normal growth
Term
Expected length of pregnancy?
Definition
37+ weeks (37-40)
Term
What is considered premature?
Definition
Less than 36 weeks
Term
What is the survival rate of a baby born at 24 weeks?
Definition
50%--predisposes the baby to developmental delays and ocular findings
Term
Complications due to premature delivery depend on what factors?
Definition
Birth weight and time in ICU
Term
What is the expected birth weight? length?
Definition
7.5 lbs 3400g
18"
Term
What is considered a low birth weight?
Definition
2500-1500g (5.5-3.3lbs)
Term
What is considered a very low birth weight?
Definition
2.21-3.4lbs
Term
What is considered an extremely low birth weight?
Definition
less than 2.2lbs
Term
Category A drugs
Definition
Safe, well controlled. Little to no risk for the fetus

Ex: prenatal vitamins, thyroid hormones (levothyroxine) and nystatin vaginal cream
Term
Category B Drugs
Definition
Most common in pregnant women.
No risk in animals, no adequate study in humans
or
Little risk in animals, but not confirmed in humans

Ex: the anticoagulant Levanox
Term
Category C Drugs
Definition
60% of all meds

Animal studies reveal adverse effects but no controlled studies have been confirmed in pregnant women. or studies in women and animals are not available
Term
Category D Drugs
Definition
Shows to be an associaiton with birth defects, but potential benefits might outweigh the cost (life threatening)
Term
Category X Drugs
Definition
Contraindicated. Clear association to fetal abnormalities and risks.

Ex. Alcohol
Term
Other than Category A-X, what is the other way to classify drugs?
Definition
According to placental transfer
Term
High Placental transfer of a drug means what?
Definition
Drug crosses the placenta rapily. May not be teratogenic, but can heavily tax the fetal metabolic and excretory systems

Fetal concentration is close to maternal concentration (at equilbrium)
Term
Limited placental transfer
Definition
fetal plasma concentrations are lower than maternal
Term
Excess placental transfer
Definition
fetal plasma concentations of drugs are higher than the mother
Term
What is the placental transfer of Antibiotics?
Definition
Penicillins have a high placental transfer
Cephalosporins and Aminoglycosides have a limited transfer
Term
What is the placental transfer of Antiparasitics?
Definition
High
Term
What is the placental transfer of Antivirals?
Definition
High
Term
What is the placental transfer of Anticonvulsants?
Definition
High
Term
What is the placental transfer of Benzodiazepines (anxiolytics and seditives?)
Definition
In Excess
Term
What is the placental transfer of psychotropics?
Definition
High
Term
What is the placental transfer of Digitalis
Definition
High
Term
What is the placental transfer of beta blockers?
Definition
High
Term
What is the placental transfer of Antiarrhythmic
Definition
High
Term
What is the placental transfer of General Anethetics
Definition
High
Term
What is the placental transfer of Analgesics?
Definition
High
Term
What is the placental transfer of NSAIDS
Definition
High
Term
What is the placental transfer of Anti ulcer
Definition
High
Term
What is the placental transfer of Xanthins
Definition
High (like in coffee)
Term
The birthing process starts with what?
Definition
The first contraction
Term
How long does the birthing process last?
Definition
Can last hours/days/weeks/months
Term
Labor starts with what?
Definition
Back pain and water breaking
Term
What is the length of an average labor?
Definition
15 hours. 1st time and male babies may take longer
Term
What are the 3 stages of labor?
Definition
Dilation
Expulsion
Placental
Term
Stages in Dilation during labor
Definition
At onset: 2-4cm
Dilation takes 2-20hrs
Contractions initially are every 15-20 mins
At the end they are every 30 seconds
Must dilate to 10cm to reach expulsion
Term
What does the apgar score provide?
Definition
And assesment of viability
Term
When is the apgar taken?
Definition
at 1 and 5 mins after birth
Term
What is a normal apgar score
Definition
7+
Term
What apgar score is of concern?
Definition
5 or less
Term
What percentage of newborns score 7+ on the apgar?
Definition
90%
Term
What 5 categories does the apgar evaluate?
Definition
Heartrate
Respiratory effect
Muscle tone
Reflex
Circulation
Term
What is the ranking for heartrate on the apgar?
Definition
0 absent
1 less than 100bpm
2 more than 200bpm
Term
What is the ranking for repiratory effect on the apgar?
Definition
0 absent
1 irregular
2 regular
Term
What is the ranking for muscle tone on the apgar?
Definition
0 limp
1 flexon of extremeties
2 well flexed
Term
What is the ranking for the reflex on the apgar?
Definition
0 none
1 some motion/grimace
2 cry cough or sneeze
Term
What is the ranking for the circulation on the apgar?
Definition
0 pale or blue
1 pink with blue extemeties
2 pink
Term
What is the last stage of the birthing process?
Definition
Placental: brief stage of expulsion of the umbilical cord and placenta
Term
What are post natal factors that may affect visual development?
Definition
Oxygen deprivation
Malnutrition
Environmental imbalance
meds during breastfeeding
Poisoning/chemical exposure
Illness
Accidents
Term
What affect does oxygen deprevation have on an infant
Definition
sever and non reversible damage
Term
How does malnutrition affect an infant?
Definition
Affects overall growth and development
Includes food allergies and feeding disorders
Term
How does an environmental imbalance affect a newborn?
Definition
Affects physical and emotional growth
Term
What is the accepted guidline for growth?
Definition
Weight
Term
How does weight change in an infant?
Definition
Doubles @ 5 months
Triples by first year
and Quadruples by 30 months
Term
How does height change in an infant?
Definition
20% gain by 3 months
50% gain by 1st year
Term
What proportion of each comprise an infant? (muscle organs and nervous system)
Definition
20% muscle, 15% organs, 15% nervous system
Term
Whta proportion of each comprise an adult? Muscle, organs and nervous system
Definition
45% muscle, 10% organs, 3% nervous system
Term
Ocular motor responses are integration of what?
Definition
visual system and motor function
Term
Delays in gross or fine motor skills may predispose a child to what? and may indicate what?
Definition
Predisposed to accommodative and sensory integrative anomalies

May indicate refractive conditions or binocular anomalies
Term
What is at the apex of the sensory integrative pyramid and what is at the base?
Definition
Apex: Vision
Base: gross motor skills
Term
Gross Motor skills by age
Definition
4-5mts: Roll over
5-8mts: sit witout support
7mts: lift head and creep
8-10mts: crawl
9-10mts: stand up and walk with furnature
11 mts: stand up alone and walk with adult help
12mts: Walk alone
15mts: kneel, stand up and throw things
24mts: jump, tiptoe, walk up and down stairs
36mts: accelerate, turn and stop
3.5 yo: alternate steps
4 yo: balance on beam and climb trees
Term
Fine Motor skills by age
Definition
6 mts: put things in mouth
12mts: pincer grasp
15mts: 2 cube tower
24mts: pick up book, flip pages, 7 block tower
36 mts: feed with spoon, 10 block tower
3-4years: manipulate writing instrument
5yo: cut with sissors
Term
Development of grasping by age
Definition
0-4mts: reflex
6mts: grab objects at will
8mts: grab and release objects at will
1 yo: pincer grasp
Term
Stages of visual motor integration by age (drawings)
Definition
2 yo- vertical line
2.5yo-horizontal line
2y 9mths- circle
2y10months- copy verticle line
3 years-copy horizontal line and circle
4.1-cross
4.4 oblique line (right to left)
4.6 square
4.7 oblique line (left to right)
4.11 oblique cross
5.3 triangle
5.6 open square and a circle
5.9 asterick
8.1 diamond
10.11 oblique diamond
Term
Who's theories on cognitive development do we follow?
Definition
Piaget
Term
What are Piaget's 4 periods of cognitive developement?
Definition
Sensorimotor
Preoperational
concrete operations
formal operations

**Each stage must be mastered to go to the next stage
Term
Sensory Motor period (Piaget)
Definition
0-2 years old
Thinking is associated to immediat sensory and moter behavior
Interaction with the object is necessary otherwise the object doesn't exist
Intellectual development is based on assimilation and storage of info
Storing might be most important for recall
Additional information of same object requires extraction
Term
6 stages of the Sensory Motor period (Piaget)
Definition
Stage 1: Reflex activity 0-1 month. Cannot distinguish self from surroundings

Stage 2: Primary circular reaction 1-4 months. Hand mouth coordination, anticipates simple events

Stage 3: Secondary circular reaction. 4-10 months. Imitation, hand eye coordination and increased manipulation of objects

Stage 4: Coordinating secondary schemas: 10-12mts,. Anticipates events at specific times, learned response in different situations

Stage 5: tertiary circular reaction. 12-18mts; Learns from trial and error, uses objects to explore surroundsing

Stage 6: symbolic representation. 18-24mts. Imitate in absens of model, imagination starts to show. Imagination used to represent objects, start to solve problems which indicated "thought" and memory
Term
Preoperational Period (Piaget)
Definition
2-7 years old
Suses symbols to represent objects and events. Language and writing

Cannot conceive changes from one state to another
Classifies objects and ideas into categories
Develops understanding of space, time and quantity
No concept of conservation of mass
Term
Concrete operations period (Piaget)
Definition
7-11 years old
Can understand sequence of events and how objects change.
Later int he stage, can reverse this thinking
Shows understanding of conservation of mass
Can detach self in order to understand someone else's point of view: DECENTRATION
Term
Formal Operations Period (Piaget)
Definition
11-never
75% reach this stage
Not reaching it doesn't mean mental deficiency
Abstract thought is manifest
Thinks about objects, but also thinks about thoughts
Considers several alternaties to solve a problem
Deals with ideas contraty to fact, metaphor or symbols of symbols (codes)
Term
What is essential for the initial stages of language development?
Definition
Hearing
Term
When does a child begin to pay attention to sound?
Definition
4mts
Term
When does a child begin to start babbling?
Definition
6mts
First attempts of verbal communication have very little ptich variation
Term
When does a child begin to show understandin of emotion and pitch variations?
Definition
7 months
Term
When does a child begin to use simple words?
Definition
12 months.
1 word sentences: holoprasic speech
Attempts to control environment and actions
Recognizes own name and common activities
Single words are used correctly
Shows understanding of what is being told
Term
When does a child begin to recognize objects by memory and say them?
Definition
13-15mts
Term
When does a child begin to follow simple instructions?
Definition
15-18mts
Term
How many words should a 21 month old know?
Definition
50
Term
When should duophrasic speech be reached?
Definition
Two word sentences
18-24mts
Term
When does a child begin to start constructing longer sentences?
Definition
24months
Term
When does a child begin to use 3-5 word sentences and have a 900 word vocab?
Definition
3 years old
Term
When is speech intelligible to other and can narrate a story and have a 1500 word vocab?
Definition
5 years old
Term
When is language fluent to understand? Elaborate conversations and when should a child want to learn to read and write?
Definition
7 years old
Term
Why is emotional development important?
Definition
Social integration
development of trust
self worth
Term
When does a child develop attachments?
Definition
6 months.
Before this, the child will accept anyone
Term
What happens to kids who don't develop attachments?
Definition
they have social adaptation problems and motor/cogitive developmental delays
Term
When does anxiety, specifically toward strangers develop?
Definition
7-8 months
Term
When is attachement optimal, which may lead to separation anxiety?
Definition
7-10months
Term
When does a child have loose attachments and may be more receptive to strangers?
Definition
12 months
Term
When does a child start to show temper tantrums, fear, and potty training?
Definition
24 months
Term
When does a child increase their socialization, develop self esteem, and imitate parental behavior?
Definition
3-4 years old

may also show frustration and inability to deal with the rules. Will manifest as physical aggression.
Term
When does a child develop self esteem from attributes, skills, and limitation?
Definition
5-7
Highly influenced by external factors
At later stages, self esteem is manifest through subjects behavior
Term
When may a child develop a nervous tic?
Definition
6-7 blinking, shoulder shrugs, yawning, throat clearing.
girls may develop closer to 6 an boys, 7 yo
Term
Obsessions are normal in what age group?
Definition
7-8
If present after 8, it is usually due to a phobia
Term
Hysteria
Definition
response to anxiety
Loss of control may be so extreme as where the subject may loose speech, hearing vision and motor skills
Term
Depression in a child is usually due to what?
Definition
Loss of pet or loved one.
Term
Which drug causes a teratogenic effect called phocomelia?
Definition
Thaildomide
Term
Major structural malformations of the fetus typically occur during what trimester?
Definition
1st
Term
What is the incidence of drug induced physical malformation in humans?
Definition
2-3%
Term
Certain drugs accumulate in the neonate, resulting in an exaggerated or prolonged response. What is this phenomenon called?
Definition
Neonatal abstinence syndrome
Term
When used by preggo women, which of the following causes small or gestational age neonates by decreasing the delivery of oxygen and nutrients?
Definition
Cigarette smoking
Term
Levothyroxine is what category?
Definition
A
Term
Which vitamin deficiency can lead to neural tub defects?
Definition
Folic Acid
Term
Pregnancy category C drugs are assigned to what percentage of drugs?
Definition
60%
Term
How much folic acid is contained in the otc prenatal vitamin?
Definition
400mcg
Term
When would pregnancy Category D drugs be used during pregnancy?
Definition
In life threatening situations or in diseases with no safer alternatives
Term
Which drug can cause a cleft palate?
Definition
Phenytoin
Term
List of drugs with known adverse fetal affects
Definition
Antimetabolites
Finasteride/dutasterid (avodart)
Isotrentinoin and retinoic acid
Warfarin
Misoprostol
Live vaccines (rubella)
Iodides
Androgens (and other hormones)
Thalidomides
Alcohol
Penicillamine (cuprimine)
Lithium
Tobacco
Antipelleptic Agents
Term
Risks of not breastfeeding
Definition
Increase in necrotizing enterocolitis for preterm infants

Increase in childhood obesity

Increase in materal breast cancer
Increased UTI in infants
Term
Technetium 99 will require a breastfeeding mother to do what?
Definition
interupt breastfeeding for 15-72 hours
Term
The hormone primarily responsible for mild ejection "let down" is what?
Definition
Oxytocin
Term
What is the condition where an infant should not breastfeed?
Definition
Galactosemia
Term
Considerations for choosing drug therapy in a nursing mother
Definition
Age of infant
experience with the drug in infants
relative concentration of the drug in breast milk
Potential long term effects on the infant
Term
When can a mother breast feed after general anesthesia?
Definition
When she is fully awake and able to care for herself
Term
What is the weight adjusted relative infant dose (RID) suggested as theoretically safe for an infant?
Definition
<10%
10-20% can be used with caution
Term
What drugs may reduce milk production?
Definition
Estrogen
Metoclopramide
cabergoline
Diuretics
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