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Page 1: Physical Activity Developmental Chapters - Bright Futures: A

Physical ActivityDevelopmental Chapters

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Infancy0

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INFANCY

19

The first year of life is marked by dramatic

changes in the amount and type of phys-

ical activity displayed. Infants spend the

first days of life sleeping and eating.

However, 1 year later, when they become toddlers,

they usually are crawling and probably have taken a

few independent steps.

Motor skill development begins with the invol-

untary reflexes that ensure the newborn infant’s

survival. Over the next few months, these reflexes

disappear as the infant slowly gains voluntary con-

trol over body movements. With increasing control

comes more physical activity. Sitting up, rolling

over, crawling, standing, and eventually walking

expand the infant’s level of physical activity.

Motor skill development, like other aspects of

the infant’s development, is an individual process.

Infants usually acquire motor skills in the same

order, but the rate at which they acquire them is

individual. For example, some infants walk as early

as 9 months, whereas others do not walk until after

their first birthday.

The way infants are held and handled, the toys

they play with, and their environment all influence

their motor skill development. Parents can influ-

ence the quality of the infant’s movements by pro-

viding a stimulating environment. Physical activity

should be promoted from the time infants are born.

Motor skills do not just appear. Motor skills, like

cognitive skills, flourish when the infant is exposed

to a stimulating environment. Physical activity

opportunities and nurturing of motor skill develop-

ment during the first year of life establish the foun-

dation for physical activity behaviors.

Growth and PhysicalDevelopment

Immediately after birth, infants lose approxi-

mately 6 percent of their body weight because of

fluid loss and some breakdown of tissue. Infants

usually regain their birthweight by 10 to 14 days

after birth, and thereafter weight gain proceeds at a

slower rate. Typically, infants’ birthweight doubles

by 4 to 6 months and triples by age 1. On average,

infants gain 5 to 7 oz per week in the first 4 to 6

months and 3 to 5 oz per week from 6 to 18

months. Infants usually increase in length by 50

percent in the first year, but the rate of increase

slows down during the second half of the year.

From birth to 6 months, infants gain approximately

1 inch per month, and from 6 to 12 months of age,

they gain about a 1/2 inch per month.

These enormous changes make it difficult for

infants to control their rapidly growing bodies. In

addition, the head and trunk constitute about 70

percent of infants’ body length and most of its

mass, making it difficult for them to achieve

upright postures or any form of locomotion. How-

ever, this large mass offers infants weight-training

opportunities. As infants roll over, crawl to get a

favorite toy, or walk along furniture, their head and

trunk may be difficult to control, but they benefit

from the physical challenge by increasing motor

control and muscle development.

Muscles are not well developed at birth; there-

fore, most of the first year of life involves building

muscle mass. Infants need arm muscles to pick up

objects. They need leg muscles to crawl, stand, and

INFANCY • 0–11 MONTHS

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eventually walk. They need their head and trunk

muscles to control these two large body parts. And

they need arm and leg muscles to move their trunks.

Neural development in infants involves the

connection of 200 billion neurons, the conducting

cells of the nervous system. Stimulation is critical to

neural development. Without stimulation (e.g.,

visual, auditory, tactile), these cells die. With stimu-

lation, these cells create elaborate networks that

promote sensory and motor skill development.

Stimulation can be provided in many ways (e.g., by

hanging a mobile over the infant’s crib, which may

motivate the infant to reach, or by placing a toy

just out of reach, which may motivate the infant to

roll over).

Healthy LifestylesInfants’ vitality and successful development

depend on good nutrition during the first year of

life. Full-term infants who are fed on demand usual-

ly consume the amount they need to grow well. But

feeding infants is much more complex than simply

offering food when they are hungry, and it serves

purposes far beyond supporting their physical

growth. Feeding provides opportunities for emo-

tional bonding between the parent and infant.

Infants improve their hand-eye coordination and

fine motor skills as they begin to feed themselves.

In addition to interaction during feeding times,

infants need play time to explore objects, engage in

activities that stimulate their senses, and experience

movement and action.

Building PartnershipsPartnerships among health professionals, fami-

lies, and communities are essential for ensuring that

families receive guidance on physical activity during

infancy. Health professionals can have a tremendous

impact on decisions about physi-

cal activity as they inform families

about the importance of physical

activity for motor skill develop-

ment. They provide an opportuni-

ty for families to discuss, reflect

on, and decide which options best

suit their circumstances. Health

professionals also identify and

contact community resources that

help families.

The community may also

need to help families by provid-

ing programs that

• Encourage families to

promote physical activity in

infants.

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• Teach families about physical and motor skill

development during infancy.

• Give infants the opportunity to be physically

active.

In addition, communities can provide (1) afford-

able, skilled child care providers who promote physi-

cal activity in infants, (2) safe environments for

indoor and outdoor physical activity, and (3) sup-

port for families of infants with special health care

needs.

Strengths, and Issues andConcerns

During health supervision visits, health profes-

sionals should emphasize the physical activity

strengths of the infant, family, and community

(Table 1) and address any physical activity issues

and concerns (Table 2).

INFANCY • 0–11 MONTHS

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Infant■ Enjoys playing with parents, sib-

lings, grandparents, and others

■ Enjoys physical activity (e.g.,movement, play)

■ Enjoys playing with objects andtoys

■ Is curious and explores environ-ment through a variety of physi-cal activities

■ Moves in new ways when chal-lenged with interesting activities

Family■ Spends time playing with the

infant

■ Encourages the infant to moveand explore

■ Provides a stimulating environ-ment that promotes play andphysical activity

■ Participates in physical activitythemselves

Community■ Encourages families to promote

play and physical activity intheir infants

■ Provides programs that teachfamilies about physical andmotor skill development

■ Provides programs that giveinfants the opportunity to bephysically active

■ Provides affordable, skilled childcare providers who promotephysical activity in infants

■ Provides safe environments forindoor and outdoor physicalactivity

■ Provides support for families ofinfants with special health careneeds

Table 1. Physical Activity Strengths During Infancy

Table 2. Physical Activity Issues and Concerns During Infancy

Infant■ Was born prematurely

■ Experiences developmentaldelays

■ Experiences discomfort withphysical activity

■ Has health problems

Family■ Lacks knowledge of physical

and motor skill development

■ Has health problems that affectthe amount of time spent withthe infant

■ Has a work schedule or othercommitments that reduce theamount of time spent with theinfant

Community■ Lacks programs that promote

physical activity in infants

■ Lacks affordable, skilled childcare providers who promotephysical activity in infants

■ Does not provide support forfamilies of infants with specialhealth care needs

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An infant’s level of physical activity should be

assessed as part of health supervision visits. (For

more information on health supervision, see Bright

Futures: Guidelines for Health Supervision of Infants,

Children, and Adolescents, listed under Suggested

Reading in this chapter.)

Health professionals can begin by gathering

information about the infant’s level of physical

activity. This can be accomplished by selectively

asking key interview questions listed in this chap-

ter, which provide a useful starting point for identi-

fying physical activity issues and concerns.

Health professionals can then use this chapter’s

screening and assessment guidelines, and counsel-

ing guidelines, to provide families with anticipatory

guidance. Interview questions, screening and assess-

ment, and counseling should be used as appropriate

and will vary from visit to visit, infant to infant,

and family to family.

Desired outcomes for the infant, and the role of

the family, are identified to assist health profession-

als in promoting physical activity.

Interview QuestionsThe following questions are intended to be

used selectively to gather information, to address

the family’s issues and concerns, and to build

partnerships.

Do you have any concerns about Julia’s

development?

How often do you play with her?

Do both you and your spouse play with

Alexander?

What are some physical activities you do with

him?

How often during the day is Julia in an open

environment, such as on the living room floor?

How do you carry her?

Is Alexander distressed when you gently bounce

him or swing him around?

Is he interested in his environment? What are his

favorite toys? Do toys motivate him to move?

INFANCY PHYSICAL ACTIVITY SUPERVISION

INFANCY • 0–11 MONTHS

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Is Julia interested in objects, toys, and people

around her?

What are some of her achievements?

Are you comfortable with Alexander’s increasing

independence? Do you encourage him to be

independent?

Are you pleased he can stand by himself? Are you

worried that he might hurt himself?

When Alexander is awake, how much time does

he spend in an infant safety seat or swing, on

the floor, on your lap, or in someone’s arms?

How does Julia’s development compare to that of

your other children when they were this age?

Do you have any questions?

Screening and Assessment■ Measure the infant’s length, weight, and head

circumference, and plot these on a standard

growth chart (see Tool H: CDC Growth Charts).

Deviation from the expected growth pattern (e.g.,

a major change in growth percentiles on the

chart) should be evaluated. This may be normal

or may indicate a problem (e.g., difficulties with

eating).

■ Examine the infant for other medical problems

that may interfere with motor skill development.

■ Determine whether the infant has a history of ear

infections.

■ Determine whether the infant has a heart

murmur.

■ Assess the symmetry of the infant’s arms and

legs.

■ Assess the infant’s muscle tone in the arms and

legs (i.e., resistance to joint extension).

■ Assess the infant’s motor skill development. The

Bayley Scales of Infant Development are often

used for this purpose (Table 3).1

CounselingHealth professionals can use the following

information to provide anticipatory guidance to

families. Anticipatory guidance provides informa-

tion on the infant’s physical status and on what to

expect as the infant enters the next developmental

period, and fosters the promotion of physical

activity.

General■ Encourage parents to attend classes to learn

about promoting physical activity during infan-

cy. Suggest that they participate in parent-infant

play groups.

■ Infants need the opportunity to move. Encourage

parents to provide objects and toys and to play

games to encourage their infants to move and do

things for themselves.

■ Gently turning, rolling, bouncing, and swaying

infants are excellent ways to increase their mus-

cle strength and to help them develop important

connections between the brain and muscles.

■ Tell parents that rough-and-tumble activities are

not appropriate for infants. Infants usually signal

their distress (e.g., by crying) if the physical activ-

ity is too vigorous, overwhelming, or disconcert-

ing. Parents should pay attention to these signals

and stop the physical activity if needed.

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■ Encourage parents to ask the child care provider

how much time the infant spends moving

around (i.e., not sitting in an infant safety seat or

sleeping).

Physical Development■ Infants need physical activity from the time they

are born. Encourage parents to nurture their

infants’ motor skill development and to promote

physical activity.

■ Infants need to develop head and trunk control.

When infants are 3 months old, parents can

encourage this control by (1) placing the infant

on their laps, facing them; (2) holding the

infant’s hands and encouraging the infant to

stand; and (3) pulling the infant up into a stand-

ing position. When the infant is pulled up, the

infant should stand with the parent’s support. If

the infant can hold the upright posture, the par-

ent can gently sway the infant side to side.

Safety■ Infants need a safe environment for physical

activity.

INFANCY • 0–11 MONTHS

Table 3. Motor Skill Development During Infancy

Mean

1.6 months

2.3 months

3.5 months

5.3 months

5.4 months

6.4 months

8.1 months

8.8 months

11 months

11.7 months

Motor Skill

Holds head erect and steady

Sits with support

Lifts head, shoulders, and forearms while lying down

Sits momentarily without support

Reaches with one hand

Rolls over from back to front

Crawls and pulls on objects to achieve upright position

Walks with handholds (“cruises”)

Stands momentarily without support

Walks independently

Age Range

0.7–4 months

1–5 months

2–4.5 months

4–8 months

4–8 months

4–10 months

5–12 months

6–12 months

9–16 months

9–16 months

Source: Adapted from Bayley.1

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Educational/Attitudinal■ Enjoys moving

■ Enjoys playing with parents, sib-lings, grandparents, and others

Behavioral■ Achieves motor skills milestones

at an appropriate age

■ Plays with objects and toys andexplores the environment

Health/Physical Status■ Develops the strength and pos-

tural control to walk

■ Develops the fine motor skillsneeded to pick up objects, toys,and food and manipulate themwith both hands

Educational/Attitudinal■ Understands the importance of

physical activity (e.g., move-ment, play)

■ Recognizes developmentallyappropriate motor skills

Behavioral■ Plays with the infant

■ Promotes physical activity in theinfant

Health/Physical Status■ Recognizes delays in motor skill

development

26

Infant

Family

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Table 4. Desired Outcomes for the Infant, and the Role of the Family

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INFANCY • 0–11 MONTHS

References1. Bayley N. 1969. Manual for the Bayley Scales of Infant

Development. New York, NY: The Psychological Corp.

Suggested ReadingAmerican Academy of Pediatrics, Committee on Injury

and Poison Prevention. 1995. Injuries associated withinfant walkers. Pediatrics 95(5):778–780.

American Academy of Pediatrics, Committee on SportsMedicine and Fitness and Committee on Injury andPoison Prevention. 2000. Swimming programs forinfants and toddlers. Pediatrics 105(4):868–870.

Association of State and Territorial Directors of HealthPromotion and Public Health Education. 1997. Howto Promote Physical Activity in Your Community (2nded.). Washington, DC: Association of State and Terri-torial Directors of Health Promotion and PublicHealth Education.

Bly L. 1994. Motor Skills Acquisition in the First Year. NewYork, NY: Academic Press.

Bornstein M, Lamb ME. 1992. Development in Infancy: AnIntroduction. New York, NY: McGraw-Hill.

Clark JE. 1994. Motor development. In RamachandranVS, ed., Encyclopedia of Human Behavior (pp. 245–255).San Diego, CA: Academic Press.

Field T. 1990. Infancy. Cambridge, MA: Harvard Universi-ty Press.

Green M, Palfrey JS, eds. 2000. Bright Futures: Guidelinesfor Health Supervision of Infants, Children, and Adoles-cents (2nd ed.). Arlington, VA: National Center forEducation in Maternal and Child Health.

Haywood KM. 1993. Life Span Motor Development (2nded.). Champaign, IL: Human Kinetics.

Shumway-Cook A, Woollacott M. 1995. Motor Control:Theory and Practical Applications. Baltimore, MD:Williams and Wilkins.

U.S. Department of Health and Human Services; U.S.Department of Education. 2000. Promoting BetterHealth for Young People Through Physical Activity andSports: A Report to the President from the Secretary ofHealth and Human Services and the Secretary of Educa-tion. Atlanta, GA: U.S. Department of Health andHuman Services.

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I’m Afraid Natalie Might Break!

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Natalie is Susan andJacob’s first baby. Theyare the first among their

friends to have a baby. They haveno family members living nearby.Susan brings Natalie in to see Dr.Fuentes for her 6-month healthsupervision visit, and the physi-cian notices that Susan handlesNatalie like a china doll. Natalieexhibits very little head andtrunk control. When placed onher stomach, she fusses and raisesher head only to see what’s infront of her. When a toy is placedin front of her, Natalie looks atthe toy but doesn’t reach for it.Dr. Fuentes determines thatNatalie’s height and weight arenormal. She is alert and happy.However, her motor skill devel-opment is lagging—most notice-ably in head and trunk control.

Dr. Fuentes asks Susan howshe and Jacob interact withNatalie. Susan admits that sheand Jacob are not very sure ofthemselves when it comes toholding and playing with Natalie.Susan discloses that she is afraidNatalie might “break” if she letsher move around too much. In

fact, Natalie spends most of theday in her infant seat or crib.

Dr. Fuentes asks Susan toshow her how she carries,undresses, and bathes Natalie.The demonstrations confirm thatSusan is gentle and extremelycareful—so much so that Natalieremains passive. With as muchgentleness as Susan exhibited, Dr.Fuentes picks up Natalie. Howev-er, Dr. Fuentes encourages Natalieto sit while he holds her firmlyunder the arms. Dr. Fuentes care-fully moves Natalie from side toside to show Susan how she canmove Natalie without hurtingher.

The secret, Dr. Fuentes says,is to encourage Natalie to moveindependently. “Natalie’s headand trunk are almost two-thirdsof her weight, and she has tolearn to control them. You andJacob need to give Natalie oppor-tunities to strengthen her mus-cles and her brain’s connectionsto the muscles, while offeringsupport if she needs it. Tonight,spend some time with Natalie sit-ting on your lap facing you; holdher gently but firmly, and let her

sway back and forth and side toside. Make it a game. Talk to herand encourage her. As long asyou are gentle but hold her firm-ly, she won’t break.”

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FREQUENTLY ASKED QUESTIONS ABOUT PHYSICAL ACTIVITY IN INFANCY

■ How can I encourage my baby to be physi-cally active?

Babies need physical activity from the time theyare born. Provide your baby with opportunitiesthat encourage her to move. Offer her a chal-lenge (for example, a toy just out of reach) andsee how she reacts. She will let you know if youpush her too much. When babies move, theirarms and legs often look jerky and uncoordinat-ed. Remember, your baby is learning a lot of newskills in her first year. When a baby’s brain andmuscles learn how to work together, her move-ments will get smoother.

■ What’s the best way to carry my baby?

Carry your baby in a way that makes him feelsecure and comfortable. Try to vary the position.For example, instead of always carrying yourbaby so that he faces backward, carry him so thathe faces forward, to give him the opportunity tolook in the direction you are going.

■ Should I use a walker to help my babylearn to walk?

Babies should never be placed in an infant walker(baby walker) because of the considerable risk ofinjury and even death. The risk of injury fromthe use of walkers is even greater in homes withstairs. Make sure your child care provider doesnot use walkers.

■ My baby’s head flops over to the sidewhen she is upright. Should I support herhead?

Yes, offer light but firm support. Try to offer lesssupport each time, so that eventually she will beable control her head herself.

■ My friend’s baby, who is the same age asmine, is sitting on his own, but my babycan’t do this yet. Should I be worried?

Babies develop at different rates. As long as yourbaby attains motor skills at an appropriate age,there is nothing to worry about.

■ What can I expect my baby to do as hegrows?

Newborn to 1 MonthYour baby will have rooting, sucking, and swal-lowing reflexes.

He will begin to develop the ability to start andstop sucking.

He will wake up and fall asleep easily.

3 to 4 MonthsYour baby will raise her head when she is on her stomach.

She will follow objects and sounds with her eyes.

She will put her hand in her mouth a lot.

She will sit with support.

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6 MonthsYour baby’s torso will move in the direction ofhis head when he turns his head while lying onhis back.

He will reach for objects and pick them up withone hand.

He will hold his hands together.

He will sit with support.

7 to 9 MonthsYour baby will reach for pieces of food and pickthem up between her thumb and forefinger.

9 to 12 MonthsYour baby will play games such as peek-a-boo.

He will explore toys with his eyes and mouth,and will transfer a toy from one hand to theother.

He will sit and crawl, and may walk without support.

Resources for FamiliesSee Tool F: Physical Activity Resources for con-

tact information on national organizations that can

provide information on physical activity. State and

local departments of public health and education

and local libraries are additional sources of

information.

Bressler KW, Parker D. 2000. Yoga Baby: Exercises to HelpYou Bond with Your Baby Physically, Emotionally, andSpiritually. New York, NY: Broadway Books.

Clements RL, Lee M. 1998. Parent’s Guide to Physical Play.New York, NY: American Association for the Child’sRight to Play.

Cooper KH. 1999. Fit Kids! The Complete Shape-Up Programfor Birth Through High School. Nashville, TN: Broad-man and Holman Publishers.

Eliot L. 1999. What’s Going On in There? How the Brain andMind Develop in the First Five Years of Life. New York,NY: Bantam Books.

Fox S. 1999. Baby Steps: Exercises for Baby’s First Year ofLife. New York, NY: Berkley Publishing Group.

Meltzoff AN, Gopnik AM, Kuhl PK. 1999. The Scientist inthe Crib: Minds, Brains and How Children Learn. NewYork, NY: Morrow/Avon.

Segal M. 1998. Your Child at Play: Birth to One Year. NewYork, NY: New Market Press.