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
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A healthy pregnancy
Assuming no genetic problems, a healthy birth, including a healthy birth weight, is the result of:
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 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)
Strategies that contribute to a healthy pregnancy include those that:
Families can ensure their infants receive the care and attention they require for healthy growth.
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:
Rapid growth marks a childs 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:
Another aspect of good nutrition is ensuring a smooth transition to solid foods starting at about six months. Solid foods are introduced gradually to:
Families can ensure their infants receive the care and attention they require for healthy growth.
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.
Provincial and federal governments are responsible for legislation related to:
Safe physical environment
Children are not simply "little adults" in terms of their experience of environmental contaminants. Children:
This means that childrens experiences of their environment and its impact on their bodies cannot be judged by adult standards.
Various studies suggest a need to be concerned about the impact of environmental contaminants on children:
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 Childrens Environmental Health identified seven areas of concern that require further study and information sharing in terms of policy and program solutions:
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 childrens exposure to other environmental threats.
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.
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
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.