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Aims

  • To facilitate the process of group formation by helping students to get to know each other and their facilitator, and by developing a group agreement;
  • To identify and explore the issues raised by the scenario;
  • To familiarise students with the assignment and project options;
  • To highlight the relevance and context of some of the main content areas to be addressed in this course.

Activities

  • Introductions and group formation;
  • Considering the course themes and objectives;
  • Identifying and exploring the issues raised by the scenario;
  • Considering the assignment and project options;
  • Introduction to paediatrics through an overview of the first four years of life.


  • Talked about Genograms
  • Readthe linked PDF

Key concepts

  • Normal growth
  • GIT development, structure and functions
  • Caloric requirements for normal growth
  • Families and parenting
  • Ear anatomy and physiology, audiometry and hearing loss

Assessments

  • Sort out your assignments really soon!
  • 40 MCQs, 24 min per block

Lord Robert Winston's video

  • Treacherous journey - from mother's womb to the outside. Once upon a time there was a huge infant mortality rate, but nowadays this is very rare. The mother often died, too.
  • As the baby is squeezed down the birth canal, many changes have to happen. It is so severe that the baby has a rush of adrenaline that is stronger than that in someone having a heart attack. This kickstarts its breathing. During birth, the baby's lungs and windpipe are full of amniotic fluid. The first breath lowers pulmonary vascular resistance and
  • The foramen ovale in the heart (used for pumping blood to the placenta) closes as a flap is shut in the heart and the 4 chambers of the heart are established, so the baby's heart can pump blood around the body.
  • The toes and nose of the baby are the coldest places - the womb is 15C warmer than the outside
  • Brown fat helps keep him worm via metabolism in emergency situations, but the baby needs blankets and cuddles to stay warm straight after the birth.
  • 22 bones of the skull haven't fused together, leaving the fontanelles soft, so the skull becomes a pointed shape from being pushed through the birth canal. These fuse later.
  • Parents find the new baby irresistible - this is a fantastic survival strategy. Bob has put his parents under a "spell".
  • Young baby tries to grip with his hands anything he touches (can be useful for holding on). The reflex is activated by any touch of the palm. Inside the hand, you can see the muscles that even just after birth can support the weight of the baby. The same thing happens with the toes. The fingers have to be
  • Rooting reflex - whenether something brushes his cheek, he turns his head and opens his mouth to get food.
  • The sound of the baby crying causes the mother to lactate.
  • Diving reflex: stops the baby from breathing under water. The mouth can be wide open, but the lungs are closed off and any water is diverted down the oesophagus
    • Can also do rudimentary swimming, but all need help from adults
  • These reflexes are later not needed, so they disappear
  • Early on, contrast is poor and sees double/blurred vision beyond 0.5m
  • The muscles controlling the lens are not strong enough to stretch the lens to focus (takes him a while to learn to do this too).
  • He likes looking at faces first, and eventually smiles for the first time.
  • Smiling (2 months) and recognising a smile are important milestones. We measure the electrical activity in the brain of the baby, and find that first the baby recognises the face (in one part of the brain) and then after that, the baby recognises whether it's smiling or scowling (in another part of the brain). Recognition even occurs
  • The brain is structurally sculpted in childhood.
  • Over half the food he eats goes to brain development
  • Therefore needs teething (burst through after 6 months old) -- occurs over 40 days to allow him to eat meat. This is why babies cry when teeth come through.
  • At birth, the child is a tiny bundle of reflexes; but later he has grown in size and his brain has developed too. This allows him to turn his desires into actions. The next step is taking his first step.
  • Conscious control of hands/grasping (6 months)
  • 7 months old - over the next few months, will take his first steps and speak his first words
  • Need his environment to be safe for him. Everything tends to go straight from hand to mouth. The tongue is very full of nerve endings, to babies are keen to use theirmouths to sxplore the world.
  • Crawling is associated with reptiles, but it is actually an efficient way to get around.
  • Diagonal crawl: move opposite limbs together. Arms absorb the shock of impact and the power is provided by the legs. Top speed of a crawling baby is 2km/hr. The average baby crawls 200m per day.
  • 7 different types of crawling: elephant crawl (one limb at a time). Diagonal crawl is the most popular, combining stability with speed, requires a lot of practice.
  • Until he started crawling, the baby had no fear of heights, but after starting to crawl, he develops a fear of heights. Babies can guage the angle of a safe slope within just 2 degrees. If they decide it's an unsafe slope, they adapt their crawling style or just avoid the slope altogether.
  • Learning to walk - comes not just from legs, but also from deep in the ear (vestibular system - behind the bones of hearing). This is made of 3 fluid-filled tubes containing tiny hairs. These detect roll, pitch and yaw. This allows you to walk.
  • For the first few attempts, he loses balance.
  • In the first 12 months, he can walk and crawl on his own.
  • Experience feeds brain development
  • The closest we get to being completely lost and confused is a holiday abroad. You can only get so far with just miming.
  • Every human culture has depended on words - either spoken or written. Words and language are the most important thing a child will ever learn. You need words not only for physical things, but also abstract information (to pass on knowledge/experience down the generations). The whole world we live in depends on language, but it all begins so simply.
  • It's amazing that babies can learn
  • When babies first learn to speak, they use a completely different part of the brain to that which adults use when they're trying to learn a second language. The larynx of the baby sticks up high above the surface of the oesophagus, like a snorkel, so you can suckle and breathe at the same time. This descends about 3cm throughout year 1-2, allowing you to speak.
  • Voice comes from tightening/loosening the vocal cords, blasting air through, and then subtle adjustments of the tongue.
  • The lowered larynx makes babies susceptible to choking. This is evolutionary paid for by the benefit of speech.
  • 2.5 years old - learning 10 new words a day. She starts off just reacting with words, but later she
  • Babies know automatically how to construct words into sentences - the grammar comes naturally to them (except for exceptions in grammar, which they must learn).
  • Language has evolved as a very complicated defence mechanism.
  • Humans are one of very few species to understand mirrors - we take them for granted (monkeys can't recognise themselves, but chimps can).
  • Young children lack self-awareness and don't recognise themselves in the mirror. At the age of 1-2 they develop self awareness (use words like my, mine, etc). They recognise themselves as separate entities to other people.
    • Tantrums - the "terrible twos": has the self awareness to recognise needs, and the language to express them
  • All of these different skills arise as there are structural changes in the brain
  • It takes 2 years to perfect the section of the brain regarding "getting on with other people".
  • Part of living in the world is learning and tolerating rules and behaviours that allow us to live and work with others
    • Therefore we give punishment to people who are naughty.
    • Breaking the rules leads to shame (hunched shoulders and drooped head - knowing you've done wrong, developing a conscience).
  • Lying starts surprisingly early, as soon as we've learned the rules we try to get around them.
  • Hidden toy experiment: they peak and they lie about it.
    • The smartest kids are not the ones who tell the truth, but are the ones who lie about it.
    • To lie deliberately, the children have to know what other people
  • Theory of mind: our human skill of working out what another person might be doing. To do it, we need to recognise that other people have different desires and needs to us.
  • Hide and seek - the children know that the Dad won't be able to see you if you exploit the fact that the Dad is too tall to see you under the table (know that different people have different viewpoints and knowledge).
  • Children younger than 3 - think Snow White knows the apple is poisoned (assume other people know the same information as they do).
    • After 3 - can recognise different knowledge that different people are privy to.
    • Area at the front of the brain light up at this age
    • Theory of mind marks the transition from babyhood to childhood.
  • Development: continual improvement of something
  • Milestone: a notable achievement

Milestones

  • Vocal: Making sensible sounds
  • Motor: Physical movement- crawling, standing, walking

Human body worksheets

  1. Note the features highlighted at birth
  2. What was the feature of the fetal heart that was highlighted in the video?
  3. What did the video highlight as a feature of the fetal head that was required for its passage through the birth canal?
  4. Note the various reflexes that are shown in the video
  5. Note the features highlighted at 6/12 (6 months)
  6. What do you understand about the terms ‘development’ and ‘milestones’?
  7. Note down a few of the milestones that are highlighted in relation to:
    1. Motor development (e.g. walking)
    2. Language development


1a: Features highlighted at birth
  • Elevated adrenaline level to boost breathing
  • Resorption of liquid in lungs
  • Brown fat; temperature control is weak
  • Bonding and attachment
1b: Features highlighted at 6/12
  • Teeth
  • Increase in size (2x)
  • Can consciously reach out and grab objects
  • 7 months onwards: crawling, talking
  • Blurred vision (>0.5m contrast is poor). Improves at 2 months; can recognise people
  • Rapid brain development
1c: Features highlighted at 1 year
  • Walking
  • 15 months: language
1d: Features highlighted at 4 years
  • Self-awareness
  • Lying
  • Theory of minds

2: Feature of the fetal heart

Foramen ovale – shunt closes (blood flow out to pulmonary artery shuts the flap over the foramen ovale; see wikipedia:Foramen ovale (heart))

3: Feature of the fetal head
  • Fontanelles, skull not full formed to allow exit through birth canal
  • 22 separate bones
4: Reflexes
  • Grip anything that touches palm Rooting reflex
  • Dive reflex
  • Mother: lactation on baby crying
5: Development + milestones A way of measuring the developmental level of a child and ensure that they are progressing normally
6a: Milestones related to motor development
  • Reflexes – few weeks after birth
  • Vision – can focus on faces and smile at 2 months Grab objects – 6 months
  • Crawling – 7 months onwards
  • Walking unaided – 11-12 months
6b: Milestones related to language development
  • Talking – 7 months onwards
  • Language – 15 months
  • Self-awareness – 2.5 years
  • Lying – 3 years

Old notes

Plenary responses

  • Themes
    • Viral infections
    • Milestones, growth and development
    • Families and parenting
    • Nutrition
    • Failure to feed/gain weight
  • Issues:
    • Mother’s care for baby–came to see doctor for otherchild
    • Doctor needs to elicit details about baby in a non-judgemental way

DVD: first steps

  • Birth
    • Fraught with danger
      • Baby is in the womb for 9 months, relies on mother for food and oxygen
    • Process is severe, adrenaline increases and kick starts the baby’s breathing
      • Lungs are full of liquid – drained by absorption and air rushes in
    • Foramen ovale shuts
  • Postnatal
    • Keeping warm
      • Brown fat, found in the back/chest
        • Broken down for heat
      • Can’t keep warm for the first 6 months of life by ourselves
    • Skull not yet fused together–fontanelles open
      • Allows exit from the womb
    • Parents find baby cute–bonding and attachment
  • Reflexes – last for a few weeks after birth
    • Grip with hands anything baby touches–activated by touch of palm
      • Toes grip as well
      • Involuntary, hard to let go
    • If something brushes baby’s cheek, turns head side to side and parts lips–Rooting reflex
    • Diving reflex–stops baby breathing underwater
      • Water is diverted into the stomach
      • Arms/legs are coordinated and the torso flexes allowing movement
    • Sound of baby crying causes lactation
    • Involuntary reflexes are suppressed by voluntary movements
  • Vision
    • Initially, contrast is poor,>0.5m is a blur
      • Control of lens muscles is not great yet
    • 2months, vision improves, able to focus on faces and can smile
      • Recognition of faces uses a different part of the brain to recognition of expression
    • More than half of food eaten at this stage drives brain development
  • Teeth
    • 6months, teeth grow from gums
  • Size – doubles in 6 months
    • 6months:can grab and reach out for objects
      • Ready for mobility
        • 7 months onwards
    • Take 1st steps and say first words
    • Mouth (tongue) used to explore the world
  • Crawling (7 months onwards)
    • Diagonal:opposite limbs together
      • There are 7 types (elephant: 1 limb at a time)
    • Can go up to 2km/hr
    • Crawling and heights
      • Slope is measured using the hands and the safety of the slope assessed
        • Crawl is adjusted if the slope is too steep – possible they may go backwards
  • 11-12 months – walking to free the hands
    • Balance is based on the vestibular system in the ear
      • 3 circular tubes with liquid and hairs in the tubes
      • Tubes have own orientation and allow balance
  • Experience grows the brain
  • Expressing desires:
    • Need words and language–to describe both solid and abstract
    • 15months–language
      • Babies learning to speak uses a different part of the brain than when adults learn languages
      • Structure of larynx:
        • Initially, larynx is much higher up and allows breathing and suckling at the same time o Later,itmovesfurtherdowntothepositionofanadult
      • Can easily choke on food but can't talk properly
        • Need to coordinate 30 muscles to make a single word
      • At 2 and a half: the toddler, can learn 10 new words/day
        • Know innately how to construct new words into sentences
        • Learn languages quickly – adaptive, the faster we learn language, the faster we could respond to danger and evolve to survive
      • Gives rise to the social/cultural aspects of the world
  • Mirrors and self-awareness
    • Humans are not born able to recognise themselves in the mirror
      • Lack self-awareness
    • At21⁄2,become aware of self
      • This can lead to tantrums, wants and needs
  • Rules/learning and complying
    • Lying and getting around the rules
      • At 3 years old, 70% peak and lie about it
        • Lie to not get into trouble
        • The smartest kids lie
      • Lying requires that we can understand that people have different thoughts, wishes, intentions and points of view
        • Allows us to function in society
    • Theory of minds:
      • Marks the beginning of childhood
      • Allows us to understand other people and other points of view:
        • Hiding, stories (not everyone knows the same information you do)

Table of developmental milestones

1a: Features highlighted at birth
  • Resorption of liquid in lungs
  • Brown fat
  • Bonding and attachment
1b: Features highlighted at 6/12
  • Teeth
  • Increase in size (2x)
  • Can reach out and grab objects
  • 7 months onwards: crawling, talking
1c: Features highlighted at 1 year
  • Walking
  • 15 months: language
1d: Features highlighted at 4 years
  • Self-awareness
  • Lying
  • Theory of minds

2: Feature of the fetal heart

Foramen ovale – shunt closes

3: Feature of the fetal head
  • Fontanelles, skull not full formed to allow exit through birth canal
4: Reflexes
  • Grip anything that touches palm Rooting reflex
  • Dive reflex
  • Mother: lactation on baby crying
5: Development + milestones A way of measuring the developmental level of a child and ensure that they are progressing normally
6a: Milestones related to motor development
  • Reflexes – few weeks after birth
  • Vision – can focus on faces and smile at 2 months Grab objects – 6 months
  • Crawling – 7 months onwards
  • Walking unaided – 11-12 months
6b: Milestones related to language development
  • Talking – 7 months onwards
  • Language – 15 months
  • Self-awareness – 2.5 years
  • Lying – 3 years