Wednesday, May 30, 2012

Early Childhood: Biosocial Milestones

After baby makes it through her first two years and officially becomes a toddler, everything is different. Between the ages of 2 and 6, baby grows from a chubby, toddling thing into a much more mature being whose body and brain is practically adult compared to just a few years before.

Baby's BMI at age 5 is lower than any other time in her life. Her chubby belly, round face and short limbs are replaced by a slim frame at she lengthens out and grows muscle. She suddenly looks much more like a gymnast than the infant she was. Every year between the ages of 2 and 6, your healthy baby should gain nearly 5 pounds and grow about 3 inches. By age 6 she is approximately 46 inches tall, weighs 46 pounds, and her legs are about half of her height - meaning she has adult-like body proportions.

While in the past undernutrition was a serious problem, these days the issue is becoming overnutrition. A study in New York City showed that as family income falls, the proportion of overweight children grows, showing that eating habits are a definite cause of obesity. Many times, this is because the grandparents (and sometimes parents) have known and seen the dangers of malnutrition first-hand, and overfeed the children to avoid those problems. Heart disease and diabetes are spreading as these overweight children become overweight adults with overweight health problems. An article from a medical journal in England suggests that because of these eating habits, "U.S. children could become the first generation in more than a century to have shorter life spans than their parents..."

A grim prediction. Based on how little weight gain takes place between ages 2 and 6 compared to the fast growth of infancy, baby's appetite will decrease dramatically. Especially because based on current trends, she will spend much less time outdoors exercising as you or your parents did. The last thing you should do is threaten her until she eats more, and you definitely shouldn't reward overeating with a dessert. This only worsens the problem.

You should be feeding baby a healthy, balanced diet with a variety of foods. Flesh it out with fruits and veggies instead of cereals that claim to fulfill her dietary requirements. She will get the vitamins and minerals she needs without the sugary breakfast cereal.

Too much sugar and too little fiber make for a terrible combination - tooth decay, now the most common disease among children in developed nations. Early tooth decay not only hurts her baby teeth, but can cause malformation in her jaw and harm adult teeth waiting to grow in later on. You should start brushing her teeth at age 2 and have her first dental visit around age 3, and your dentist can tell her overall health by the state of her teeth. Bad teeth mean bad health, even malnutrition or overnutrition.

By now, you may have noticed that baby likes her things done a certain way. Veggies can't touch potatoes, meat can't touch jell-o, and if anything goes wrong on her plate, it gets sent back to whoever prepared it. She may have one particular pair of boots she insists on wearing every day, and she probably has a bedtime ritual with a story, song or both that she absolutely cannot live (or sleep) without. This is called the "just right" phenomenon. In an older child, this could be considered OCD, but between the ages of 2 and 6 it is perfectly normal. Age 3 will generally be the worst for this phenomenon, and by age 5 you should see a serious decline in her habits. By age 6 it should have almost completely faded away.

The best way to deal with her "just right" tendencies is to be patient. She will eventually start some rational thinking and the obsessions will fade. If she insists on junk food, make healthy snacks available until she is willing to eat almost anything. If she won't let up on the story at bedtime, it's probably easier to read a short one and get it over with than start her into an ugly temper tantrum.

Her brain is truly doing some amazing things in these years. By age 5 her brain will be about 90% of it's adult weight and myelination is occurring throughout these years. This is the process of coating the axons with myelin, a fatty substance that speeds up signals between the neurons, just like oiling the wheels on an old wagon to get it running smoothly again. Social and language understanding start improving in leaps and bounds, baby is becoming more coordinated all the time, and she can suddenly have several thoughts in rapid succession.

The hemispheres of baby's brain are working together more closely as the corpus callosum - nerves that bind the right and left hemispheres of the brain - grows in thickness, coordinating her brain while each side begins specializing in different things baby must do - this is called lateralization. She will suddenly favor one hand, one foot, one ear, and even one part of the brain. Lateralization is completely dependent on the maturation of the corpus callosum. Without coordination there is no lateralization.

As baby's prefrontal cortex matures even further in early childhood, there are many benefits for baby and you that are worth noting. Her sleep becomes more regular, emotions are more responsive and nuanced, temper tantrums start to disappear and uncontrollable laughter or tears become less common. Even though baby is learning, she probably hasn't found the right balance yet. She has not yet figured out how to pay attention long enough for the learning they do in elementary school. She is a little impulsive, yet at the same can display perseveration - that is the tendency to stick to one thought, toy, action, etc. for a long time. If her favorite toy is lost or her favorite TV show doesn't come on when it should, a temper tantrum explodes and she cries uncontrollably, becoming stuck in that moment. Over time this will go away.

The limbic system in the brain works to advance expression and emotional regulation in early childhood. The amygdala, a small structure deep in the brain, increases in activity during early childhood. It registers positive and negative emotions and the increase in activity causes sudden terrors in baby. If she insists there is a monster in the closet, it doesn't help to explain that monsters don't exist. The better idea is to check the closet and send the monster away. Baby's fears will be nonsensical and you have to respond to them in a way that helps her. The hippocampus is the memory center of the brain and it can work with the amygdala to help the child remember her emotions. This of course can be good or bad. The hypothalamus, another major part of the limbic system, responds to the amygdala and the hippocampus to produce hormones that react to what's going on in baby's head.

By age 6, baby should be a pro when it comes to many of her motor skills. She should be able to write simple words, draw, paint, read, ride a bike, do a cartwheel, tie her own shoes, and catch a ball. The fine motor skills advance her education and her gross motor skills keep her active. Sadly, we live in an age where children living in urban areas have very little access to open spaces where they can run around and work on their gross motor skills. Added to that, violent neighborhoods only hurt the limbic system, adding to the irrational fears already held by young children. As fine motor skills develop, some children can get frustrated trying to accomplish tasks beyond their control. Girls are usually about 6 months ahead of boys in fine motor skills. Children love to express themselves and even if you have no idea what baby has drawn, she will be proud of it and adamant about what it is she drew. You should praise her for her skills to help her in development.

Children between the ages of 1 and 4 are accidentally injured five times more than children between the ages of 5 and 11. Immaturity in the prefrontal cortex makes for impulsive toddlers, and for preschoolers the injuries are most likely to involve poison, fire, choking, or drowning. For this reason, injury control is a huge part of public health. In 2005, only half as many 1- to 5-year-olds in the US were injured as in 1985. Public health measures taken to reduce the likelihood of accident on a large scale are called primary prevention. Secondary prevention is averting harm in a high-risk situation, such as pulling baby out of the way of a falling ladder. Tertiary prevention comes last, limiting the damage caused by an injury that has already taken place, such as rushing to the ER after baby takes a bad fall and breaks her leg.

The measures of prevention are not only present when it comes to accidents. They also come into play in cases of child maltreatment - that includes abuse and neglect of anyone under the age of 18. Primary prevention here involves laws taking a stand against abuse, secondary might be a teacher taking note of a bruise, and tertiary is separating a child from an abusive parents after the damage has been done. Reported maltreatment is when the authorities have been informed and substantiated maltreatment means the authorities have confirmed a report. The number of reported cases ranges between 2.7 and 3 million cases per year, and substantiated cases in 2005 were only 900,000. Every citizen is responsible for protecting children from abusive or neglectful situations.

Some children who have been maltreated may seem fearful, develop more slowly, and have trouble socializing with peers. If the child is startled easily, defensive, or confused between what's real and what's not, they are exhibiting signs of PTSD - post-traumatic stress disorder. Originally PTSD was discovered in combat veterans, but it is becoming evident in many maltreated children.

If a child is taken from his or her parents for maltreatment, they rely on the system to get them to a caregiver they can trust. Child-welfare authorities begin permanency planning - the effort to find a family who can care for the child until adulthood. Foster care is just one part of the system. The foster parents receive reimbursement for expenses incurred related to the child. Kinship care is like foster care, but the child is placed with a relative such as a grandparent is the caregiver. Even though there are many issues with foster care, children develop better in foster or kinship care than if they are left with their abusive families. Adoption is the goal - it means a permanent home for the child.

If baby is well taken care of, she will adjust fine out of her fears  and troubles. She should be sociable and pleasant as her brain continues to mature and her motor skills develop, giving her freedom to move around in the world she is only just beginning to discover.

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