Healthy physical development begins before birth. Pregnant women who receive emotional support and care, who eat well 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. Test

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 page.



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. Usually, low birth weight means that babies are born too small, too early or both (55). Most low birth weight babies now live because of improved neonatal care – many infants weighing as little as 750 grams are now surviving. However, 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 ever leading a full and productive life. The cost to the community for expensive and often insufficiently available health and remedial education care is also greatly increased. (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)

Mothers from the poorest neighbourhoods are 1.4 times as likely as those from the richest neighbourhoods to have low birth weight babies. (77) However, it is not clear how much of their less severe, but more common developmental delays, are a result of the disadvantaged environments in which these low birth weight children are more likely to grow up. Certainly a disadvantaged environment aggravates the cognitive and behavioural disabilities that originate in biological deficiencies. (Watkins et al, 1987; Shiono et al, 1995,)(190)

Different biological factors increase the risk of low or very low birth weight babies. These include:

  • the age of the mother (under 20 years; over 45 years)

  • if there are multiple births involved

  • if the mother smokes or does not eat properly during pregnancy.

The greater number of economically disadvantaged mothers who have low birth weight babies can at least be partially explained by 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 account for nearly two-thirds of all low birth weight babies. (102) Up to 20 percent of all low birth weight baby births 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, for example, Fetal Alcohol Syndrome. This often results in hyperactivity, difficulties in impulse control, dysphoric mood and the inability to be soothed. These symptoms frequently result from maternal drinking or drug abuse during pregnancy - especially through alcohol and cocaine use. Fetal brain damage increases the chances of a child not being able to form secure attachments, academic failure, behavioural problems, and psychiatric problems in adult life. (Mannuzza et al, 1993)(190)

Social factors can also increase the risk of low or very low birth weight. These include maternal isolation, 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. 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)

In Canada in 1990, 21,963 babies were born who weighed less than 2,500 grams. (77)

Strategies that contribute to a healthy pregnancy include those that:

  • ensure pregnant women have 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 initiatives that ensure a mother has good nutrition and social support have improved birth weight outcomes. Programs targeting lifestyle issues take advantage of a pregnant woman's interest in improving her lifestyle for both her own sake and that of her baby. In fact, many women quit smoking spontaneously during pregnancy but resume after the baby is born. (82)

Since prenatal medical care is freely available in Canada, it is assumed that most pregnant women receive the care they need. Community strategies tend to focus on women who may not seek medical attention until late in their pregnancy, and women who are known to be at high risk for a range of poor outcomes after the birth of the child. Commonly this includes teenage mothers, poor mothers, and mothers who speak languages other than English or French. However, while these may be the groups most at risk, in fact, most low birth weight babies are not born to women in high risk groups. (195) Population health strategies need to be combined with those for targeted populations.

Some examples of model programs that reduce low birth weight are:

More ways communities can help ensure a healthy pregnancy:

  • Regular medical care can be encouraged through access to well baby clinics that are well publicized and convenient for new families and by public health nurses calling families to check on new babies.

  • Make attempts to reach families who may not access regular services, or who may not be well prepared for their child. Outreach to new parents ensures they are connected to regular or specialized services in the community – through public health units, family resource centres, community clinics, for example Staying on Track. Mentoring programs are available for vulnerable families, for example, Canadian Mothercraft’s Birth Companion and Parent Companion Programs.

  • Institue homevisiting programs that involve regular visits to an infant’s home (often weekly) by a public health nurse or trained lay home visitor. The visiting lasts anywhere from a few months to several years and is intended to support all aspects of the child’s development and family functioning. Programs can include a focus on nutrition, substance abuse prevention, preparation for labour and delivery, early childhood development, parenting skills, enhancement of support networks and linkages with other services. Research has shown homevisiting can lead to more positive outcomes for children and families, provided there is a positive relationship between the visitor and the family, and the intensity of the intervention matches the needs. Homevisiting may be combined with other services such as child care, parenting groups or play groups. (41) Examples of programs using homevisitors are Hawaii Health Start (190) and Better Beginnings, Better Futures (149) and The Prenatal and Early infancy Project.

  • Adopt flexible parental leave policies to allow women to take prenatal leave for health reasons without decreasing the time they can take once their babies are born.

  • Allow women the option to work fewer hours prior to the birth to help decrease the level of stress they experience.


  • Develop research, legislation and regulations which influence the economic, social and physical environment in which families raise their children. Work has been done to identify substances that are harmful to the developing fetus and to identify essential nutrients to support the healthy growth of the fetus.

  • A brochure from the Spina Bifida and Hydrocephalus Association of Canada cites research that identifies the importance of folic acid prior to conception and in the earliest stage of pregnancy to help prevent neural tube defects. Most women need dietary supplementation to ensure they have adequate quantities. Additional information on folic acid and pregnancy is available from Health Canada.



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.


 

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 that provide services to specific target groups, for example, breastfeeding support and home visiting programs.

  • Encourage breastfeeding through family-friendly policies in hospitals, such as babies remaining with the mother 24 hours a day and breastfeeding on demand. 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 to one year.

  • Develop policies that 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 that determines length ofparental 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 five 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 near 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, because of 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.

  • 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.

  • Persuade local governments to stop pesticide use in public parks.

  • Provide public education and support healthy public policies around child-friendly standards related to issues such as smoking indoors.

  • 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.

  • Encourage safety in the home through public awareness campaigns that target parents' 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 developmental 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 baby’s 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 that piloted such a system is Staying on Track.

 

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