Healthy physical development begins before birth. Pregnant women who receive emotional support and care, who have nutritious foods to eat and who abstain from smoking and using drugs or alcohol give their babies a healthy start. Mothers who are in good health and who are supported in their pregnancy are less likely to have low birth weight babies. Children who weigh more than 2, 500 grams at birth have fewer health problems than those who weigh less than this at birth.

During the first year, babies experience rapid gains in weight and height, mobility and coordination. By the time they are one year, babies have more than doubled their birth weight. They have developed many fine motor skills and their vision is as good as a teenager's. They can crawl and sometimes, walk.

The pace and order of this growth follows a biological timetable, but the development of specific functions is supported by parents who encourage and help their children add new skills to their growing list of physical accomplishments. Sensitive caregivers know when their children are ready to try something new. They encourage infants in their early attempts to master new skills and praise their achievements.

Improvements in coordination and mobility depend on growing muscles and bones, as well as changes taking place in the central nervous system. The neural pathways that send messages to control these actions are established and strengthened as each activity is learned and repeated.

Influences on the positive outcome: Physically healthy

		A healthy pregnancy
		Adequate nutrition
		Safe physical environment
		Early detection and treatment of developmental problems

Note: These influences are also listed in the drop-down box above. Please use this menu to navigate within this ppage.

A healthy pregnancy

Assuming no genetic problems, a healthy birth, including a healthy birth weight, is the result of:

the health of the expectant mother - where the pregnant women abstains from substances that are harmful to the fetus such as tobacco and alcohol, and her body has the necessary nutrients to ensure the baby’s health
good prenatal health care - where a mother’s weight gain can be monitored, she can be informed of any nutritional supplements needed, and she can be monitored for any other complications in the pregnancy (77, 82, 99, 119, 53)

"Birth weight is a key indicator of a healthy pregnancy and birth. What is commonly termed low birth weight consists of two over-lapping conditions: some babies are born to small (growth impaired), while others are born to soon (55). While most low birth weight babies now live because of improved neonatal care - many infants weighing as little as 750 grams are now surviving - the lower the birth weight, the greater the risk of preserving life at the cost of life-long health and development problems that may limit the child's ever leading a full and productive life, while greatly increasing the cost to the community for expensive and often insufficiently available health and remedial education care (Allen et al, 1993; 74). Low, and especially very low, birth weight babies are almost twice as likely to die at birth and, if they survive, within their first year. They have almost twice the risk of life-long disease and disability, including cerebral palsy, visual problems, attention deficit hyperactivity disorder, learning disabilities, and respiratory problems (Standing, 1992; McCormick et al, 1990). Children from the poorest neighbourhoods are 1.4 times as likely as those from the riches neighbourhoods to have low birth weight babies (77), but it is not clear how much of such babies' less severe but more common developmental delays are a result of disadvantaged environments in which low birth weight children are more likely to love and grow. Certainly a disadvantaged environment aggravates the cognitive and behavioural behavioural disabilities that originate in biological deficiencies (Watkins et al, 1987; Shiono et al, 1995)." (190)

"Biological factors that increase the risk of low or very low birth weight include extremes of maternal age (less than 20; over 45 years), multiple births, black race (independent of level of disadvantage: Paneth, 1995 b; Shiono et al, 1986), smoking, and poor maternal diet. At least some of the social class gradient follows from the fact that the poorest mothers are the heaviest smokers (Institute, 1985; Rush et al, 1983). Smoking which retards fetal growth, is the single largest modifiable risk factor contributing to low birth weight and infant mortality. Smoking during pregnancy, low maternal weight gain, and low pregnancy weight among them account for nearly two thirds of all growth retarded infants (102). Up to 20% of all low birth weight babies could be prevented by eliminating smoking in pregnancy (40). The abuse of alcohol and other drugs during pregnancy is also associated with low birth weight and preterm birth (Schneider et al, 1989; Rodgers, 1989; Standing, 1992)." (190)

"Other biological risks during this period include sources of fetal brain damage (e.g. Fetal Alcohol Syndrome), often resulting in hyperactivity, difficulties in impulse control, dysphoric mood and inability to be soothed. These symptoms frequently result from maternal drinking or drug- and especially alcohol and cocaine - abuse during pregnancy. Fetal brain damage increases the rates of attachment failure, academic failure, oppositional/defiant and antisocial behaviour, and psychiatric problems in adult life (Mannuzza et al, 1993)." (190)

"Social factors increasing the risk of low or very low birth weight include maternal isolation, the lack of psychological supports, and chronically high stress and/or the risk of abuse of the mother during pregnancy (Goodyer, 1990; 328, 33). Anything that combats isolation and counteracts the psychosocial stresses often associated with poverty also helps prepare for attachment, bonding and other precursors of resiliency in the neonatal period (96). Preterm delivery, which causes most low birth weight in the United States is, like fetal growth impairment, very much related to social class, and is a greater cause of infant mortality in developed nations than fetal growth impairment. Maternal smoking and nutrition - which are linked to fetal growth retardation - affect preterm delivery less than they do growth impairment. In summary, decreasing isolation, improving nutrition and lowering smoking, alcohol and drug use during pregnancy can cause a significant though modest increase in the number of healthy potentially resilient babies born to relaxed, prepared mothers." (190)

Strategies that contribute to a healthy pregnancy include those that:

ensure pregnant women has access to assessments for medical and psychological risks early in their pregnancies and on a continual basis
provide supports that promote good nutrition and encourage pregnant women to reduce or eliminate behaviours that negatively affect the health of the fetus, such as smoking, drinking alcohol, excessive strain and fatigue
provide psychosocial support for pregnant women

Families can ensure their infants receive the care and attention they require for healthy growth.

Give your babies lots of physical affection such as hugs and cuddles. Physical stimulation together with good nutrition also promotes healthy physical development.

Community groups that provide services to support physically healthy infant development include public health departments, family physicians and pediatricians, community clinics, hospitals and parent resource centres. There are also some groups which provide services to specific target groups, for example, breastfeeding support and home visiting programs.

Breastfeeding can be encouraged through family-friendly policies in hospitals, such as babies remaining with the mother 24 hours a day and breastfeeding on cue. Effective community support systems for mothers who want to breastfeed could include a local information, support telephone service, and breastfeeding support groups, for example, La Leche League.

Develop flexible parental leave policies. Going back to work is one of the main reasons mothers stop breastfeeding. Extended leave provisions with guaranteed job security, would allow some women to continue breastfeeding for the recommended six months.
Develop policies which would allow for flexible work hours. A 1988 national survey of households, with at least one child under 13, indicated that only one third of parents with major responsibility for child care wanted to work full-time. Fifty-three percent preferred part-time work and 13 percent preferred not to work at all. Opportunities for job-sharing or part-time work would reduce the pressure on family time and lead to more relaxed caregivers (233).

Provincial and federal governments are responsible for legislation related to:

length of parental leave to care for newborns
income support available which determines lengthy parental leave
tax policies (which currently favour families in which both parents work over families in which one parent stays home to care for children)
support for research to understand how environmental contaminants affect the fetus, lactating mothers and young children
monitoring the presence of environmental contaminants
regulations setting high standards for environmental pollution

Adequate nutrition

Rapid growth marks a child’s physical development in the first year of life. Good nutrition is vital. Both formula and breast milk contain the nutrients that young babies need for healthy growth. However, professionals recommend breast milk as the best option because, in addition to being less expensive, always sterile and readily available, it has a number of nutritional and immunological advantages including:

a more efficient nutritional balance that seems particularly suited to rapid brain development
protection against gastroenteritis, middle ear infection, upper respiratory diseases and Sudden Infant Death Syndrome (SIDS) (229).

Another aspect of good nutrition is ensuring a smooth transition to solid foods starting at about six months. Solid foods are introduced gradually to:

ensure the child has no allergies or intolerance to individual foods
ensure the digestive system is ready

Families can ensure their infants receive the care and attention they require for healthy growth.

Give your babies lots of physical affection such as hugs and cuddles. Physical stimulation together with good nutrition also promotes healthy physical development.

Breastfeeding can be encouraged through family-friendly policies in hospitals, such as babies remaining with the mother 24 hours a day and breastfeeding on cue. Effective community support systems for mothers who want to breastfeed could include a local information, support telephone service, and breastfeeding support groups, for example, La Leche League.

Develop flexible parental leave policies. Going back to work is one of the main reasons mothers stop breastfeeding. Extended leave provisions with guaranteed job security, would allow some women to continue breastfeeding for the recommended six months.
Develop policies which would allow for flexible work hours. A 1988 national survey of households, with at least one child under 13, indicated that only one third of parents with major responsibility for child care wanted to work full-time. Fifty-three percent preferred part-time work and 13 percent preferred not to work at all. Opportunities for job-sharing or part-time work would reduce the pressure on family time and lead to more relaxed caregivers (233).

Provincial and federal governments are responsible for legislation related to:

length of parental leave to care for newborns
income support available which determines lengthy parental leave
tax policies (which currently favour families in which both parents work over families in which one parent stays home to care for children)
support for research to understand how environmental contaminants affect the fetus, lactating mothers and young children
monitoring the presence of environmental contaminants
regulations setting high standards for environmental pollution.

Safe physical environment

While accidents become more common as children get older, prevention begins as soon as the child is born. Parents need to watch their children closely as they are rapidly acquiring new physical skills, and ensure their toys are safe and appropriate for their age.

Children are not simply "little adults" in terms of their experience of environmental contaminants.

Children:

behave differently than adults
are physiologically different from adults
have organs that are still developing

This means that children’s experiences of their environment and its impact on their bodies cannot be judged by adult standards.

Particularly young children, breathe closer to the ground which has a higher concentration of small particles of dust, mist and heavy gases.
Children eat up to eight times as much as adults in proportion to their body weight which may mean greater exposure to food related toxins.
Children's organs are still developing. Small levels of particular compounds at sensitive developmental stages may have lifelong effects (151).

Various studies suggest a need to be concerned about the impact of environmental contaminants on children:

Two comparative studies of breast milk found Inuit women displayed levels of PCB’s that were 5 times higher than in the breast milk of women from southern Quebec (229).
Women who consumed fish contaminated with PCBs had children who exhibited small but significant neurodevelopmental effects including lower IQ and poorer reading comprehension (229).
Poor children are more likely to be exposed to multiple contaminants, including living in substandard housing and in neighbourhoods adjacent to transportation corridors and polluting industries. (324)

The effects of environmental tobacco smoke (ETS) on fetuses and young children can include complications of pregnancy and low birthweight, increased risk of sudden infant death syndrome and ear infections, reduced lung development, and increased severity of asthma and other respiratory illnesses. In 1995, at least 1.4 million Canadian children were exposed to ETS in their homes. The majority of these children lived with parents aged 25 to 44—the age group that smokes the greatest number of cigarettes daily. (325)

In recent years, the idea that chemicals may pose a threat to the developing reproductive systems of the fetus and young child has been identified as a major concern requiring further study. There is also growing scientific evidence that a variety of contaminants called "endocrine-disrupting chemicals" can exert health effects including reproductive disorders, cancer, neurological damage and behaviour and immune dysfunction, by their ability to alter the functions of hormones within the body. (326)

The 1997 Declaration of the Environment Leaders of the Eight on Children’s Environmental Health identified seven areas of concern that require further study and information sharing in terms of policy and program solutions:

increasing our understanding of the particular exposures and sensitivities of infants and children to environmental standards and exchanging information on relevant regulatory decisions
further reducing maternal and child exposure to lead
ensuring microbiological safe drinking water for all Canadian families
reducing air quality threats
reducing the exposure of pregnant women, children and youth to environmental tobacco smoke
reducing threats to children’s health from endocrine-disrupting chemicals
reducing the impact of global climate change on children’s health. (327)

Parents control many aspects of their home environment and also exercise some control over where their children spend time away from home. Parents can take steps to reduce their children’s exposure to other environmental threats.

Maintain a smoke-free home.
Keep your children away from environmental pollutants as much as possible, for example lawn pesticides and contaminated land-fill sites.
Join other parents and groups that advocate for healthier environments.
Recognize your babies’ physical skills are changing rapidly and situations which are safe one week are not safe the next as they learn to roll over, reach further and move around.
Parents can ensure all toys are safe, including being non-toxic, having no sharp edges or removable pieces and are not small enough to swallow.
Child-proof your house before your baby starts moving around. Make sure cleaning agents, medications and other potential hazards are out of reach; cover electrical outlets and place gates across stairwells.
Babies should always sleep on their sides or their backs - although the cause of Sudden Infant Death Syndrome (SIDS) is unknown, research suggests these positions reduce the chances of SIDS

Lactating women and their families can make informed choices about the foods that they eat.

Avoid or restrict the intake of wild game and fish from areas known to be contaminated.
Wash and peel all fruits and vegetables (229).

Community groups often provide leadership for promoting public awareness about environmental threats to children and advocating for change. They also promote awareness of healthy public policy and practice.

Community groups can persuade local governments to stop pesticide use in public parks.
Community groups can provide public education and support healthy public policies around child-friendly standards related to issues such as smoking indoors.
Community groups can demand action to deal with local environmental threats to children’s health. One example of this is the South Riverdale campaign to remove lead contaminated soil.
Safety in the home can be encouraged by public awareness campaigns that target parent’s attitudes towards providing safe environments for their children.

Governments are in the strongest position to ensure healthy environments for growing children, although their willingness to act on many issues is a function of public pressure. Through research, public education, regulations and legislation, governments can promote knowledge, education and action related to healthy physical environments for children. One example is the Great Lakes Health Effects Program.

Early detection and treatment of development problems

Regular preventive medical care is very important at this stage for the early identification and correction of any developmental problems. Some conditions, such as binocular vision problems, will result in a permanent deficit if they are not identified and dealt with at an early stage (53).

Mothers can breastfeed their babies.
Schedule regular check-ups with a family doctor or pediatrician to monitor your babies’ development.

Although the first years of life are extremely important developmentally for children, there is no public institution that has mandatory contact with children during this period and therefore no comprehensive, coherent system to monitor their development and identify and deal with physical or developmental problems in a timely manner.
Given the range of services and service providers, effective coordination is needed to ensure that the development of all children is tracked and monitored and that children and families that need additional supports are identified and referred to a supportive response system.
A system to track the development of all children during the early years and systematically screen them for health and developmental problems would provide for early identification of problems and the opportunity for taking action in a timely manner. An example of a project which piloted such a system is Staying on Track.

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