with preemies: why “catchup” is for french fries or…… what ......to summarize: why...
TRANSCRIPT
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Problems with Preemies: Why “catchup” is for french fries
Or…… What’s the rush?
Penny Glass, PhDDevelopmental PsychologistChild Development Program
Children’s National Health System
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Objectives
• Identify the scope of the morbidity problem• Describe fundamental competency of fullterm infants from birth
• Contrast experience after preterm birth• Identify environmental and social risk factors which impact development.
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Developmental Outcome VLBW
• Motor and mental handicap
• Learning disability (LD) more pervasive– Visual perception, – Visual motor integration– Language– Attention/Memory – Hyperactivity/self‐regulation– Social immaturity
10%
50%
(FT =10%)
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Scope of the Problem
• As mortality rate improves,– given the same morbidity rate….
• Result: increase in absolute number of children with developmental problems:– Controlling the muscles of their body– Paying attention to what is important
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Factors impacting child development
child and parent
Biological Predisposition
*Relative brain maturity
*Physical environment
Genetic factors
Relative brain damage
*Social environment
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Early human development at term:Biologically predisposed social beings:
• Recognize/prefer mom’s: – scent, taste, voice, language
• Equipped with: – “Innate releasers”
– Root/suck, cling, nestle, cry, – Visual regard– Empathic distress
Fostered by: – Interactional synchrony
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Social Predisposition: mirror neurons?
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Smile in response to a smile+ Mirror parent’s emotion
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Object permanence and impossible events…
(a) Object identity
(b) Follow the ball……
(c) to the possible
(d) and impossible….
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Social referencing
Looks for information in facial expression on whether to proceed or inhibit
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Picture to be a representation
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Mastery motivation: just because it’s there….
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Preterm infant and disruption of parenting experience
• “6 sticks of butter”
• physical separation
• vulnerable appearance
• disruption of biological clock
• change of itinerary
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Loss of Identity as Parent
• Nurse…Therapist….
Teacher…
• The feeling of – “not good enough”
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Problems of prematurity: 1. Feeding issues/mixed signals2. Controlling the muscles of their body2. Not paying attention to what is important
Fullterm Preterm
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Parents model their NICU experience
• NICU parenting is measured by: ‐amount consumed (cc’s)‐amount gained (grams)
• Post‐natal growth by chronological age means parent is ‐“not good enough”
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Corrected age is the“Real Age”
for someone not readyto be born
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Correccted age helps ease the tendency to over‐feed…
to make him “catch up”
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Mealtime routines are important moments for social engagement, attention, & self‐regulation
enchanted disenchanted
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Sensory/Physical Environment gone overboard
OBSERVATION:• The more anxious the parents are about “catch‐up”, the more they seem to “over‐do”.
• Terrified they may hold back development if they don’t do everything
• Excess early visual stimulation skips a milestone (hand regard) and delays visually directed reaching
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If we do this because they can see it better, it’s equivalent to shouting
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Non‐contingent stimulation
impedes development
“Pattern” stimulation isequivalent to wallpaper
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Let’s Animate!
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Messing with visually‐directed reach
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Let’s not forget “Tummy Time”!
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Objects should fall when a baby lets go.(visualize in relative adult size)
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Why should a child respond to their name when they “choose” whether or not to attend to TV/video input
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Practice increases the relative brain area….
Relative area of Motor cortex
Note the glazed expression…..
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Preparing to go for a walk
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Importance of mastery motivation and risks of “pushing” to catch up
• Impact of excess reinforcement– loss of internal motivation – becomes overly dependent on adult– Stop repeated to wait for cheering squad rather than focus on the goal
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To summarize: Why “Catch‐up” is for french fries, not for preemies!
• Preemies do not need to develop at a faster rate than expected of a FT baby.
• Parental stress of a premature birth is further burdened by the pressure to get the baby to do more than they are ready for.
• Baby becomes overly reliant on adult support for a task that is too complex and skips the underlying skill development which would have led to independence.