Physical Growth and Development

In the first year, children grow and develop more rapidly than at any other time of their life. Foundations for good health are built during this period. It is, therefore, very important that your baby be given a good start. This chapter addresses the physical, or bodily, development of the infant.

THE HEALTHY INFANT

Every newborn is different, in both physi­cal appearance and temperament. The healthy infant is round and cuddly, does more smiling than crying, and gets more and more active and curious by the day.

Newborns are calm and contented when given food or when picked up and rocked. From the very start, humming and soft words seem relaxing. During this period, the baby sleeps most of the time. The most highly developed senses are taste, smell, and touch. A new baby has a number of primitive reflexes.

Activity is otherwise limited to sneezing and coughing, swallowing and eating.

WEIGHT AND LENGTH

A child can weigh quite a lot less than "average," be shorter than "average," and still be absolutely normal in every aspect.

The average weight for a child is about 7-1/2 pounds at birth, a little more for boys and a little less for girls. During the first 3 days, the baby will lose about 5 to 10 ounces. Don't worry, this is perfectly normal. The birth weight will be gained back within 1 or 2 weeks. The weight doubles over the first 5 months, and triples by age 1. Babies gain the most weight in the beginning, particularly if they were premature or of low birth weight.

The average length of a baby at birth is between 18 and 21 inches. After 2 months the length is about 22-1/2 inches, after 4 months about 25 inches, and at 1 year about 30 inches.

Good indication that a baby is healthy is a smooth growth curve, with length increasing along with weight. But, "smooth" doesn't necessarily mean "constant"...Your child will probably go through a number of growth spurts and slow-growth periods, too. Try not to compare your own child's growth pattern too closely with other children's. There are always individual differences, and genetics plays an important role, too. Of far greater importance than weight and length is the baby's well-being — that he or she is healthy, energetic, and contented.

MOVEMENT

Development is a continuous process, which doesn't stop until the baby is full-grown. Children go through certain develop­mental stages. The timing may change, but the order is more or less the same for all children.

The newborn baby has a number of reflex­es, such as:

·     Rooting and sucking — When a new­born searches for the nipple after birth, he or she will turn the head to the side of the face that is being touched, grasp the nipple in his or her mouth, and start to suck.

·     Grasping — The baby's hand will automat­ically clasp around an object touching the hand.

·     Startling — At a sudden movement or noise, the baby will make a clasping motion with the arms.

• "Walking" — The baby will make a walking movement when the feet touch a hard surface.

The grasping, startling, and "walking" reflexes disappear after a while. They're usu­ally gone after 3 or 4 months, when the baby begins to make more conscious motions. It's always important that a baby be able to move freely in lying-down positions (both on the tummy and ^on the back), so he or she can explore new movements and activities.

During the first month, the baby will usu­ally be able to lift his or her head while lying on the tummy. Later, the baby can lift part of the chest, too, and finally the baby will pull himself or herself up by the arms. By then, he or she is probably 3 or 4 months old.

At 4 or 5 months of age, a baby can grab an object that's within reach. The eyesight has developed to the degree that he or she can "measure" distance. The baby enjoys being played with. At approximately 6 months, the baby will laugh when tickled, and just the sight of the finger coming close may be enough to trigger giggling.

The back and neck muscles gradually gain strength, and the baby will usually be able to sit up without support between 8 and 12 months.

Around 9 to 12 months of age, the baby can pull himself or herself up into a standing posi­tion while holding on to a piece of furniture, and then will "move" along the furniture.

There are great variations as to when children learn to walk, and even though some can tod­dle along at 9 months, most won't walk until sometime after their first birthday. The devel­opment of the feet depends somewhat on the opportunities the child has had to practice using them.

THE SENSES

The newborn's senses are more devel­oped than previously believed. The senses help a baby explore the world, and help him or her become better coordinated. In that way, the senses and movement go hand in hand. The more you look at, touch, and hold your baby, the more he or she will explore, vocalize, and learn.

PSYCHOLOGICAL DEVELOPMENT

A child's development is closely associat­ed with his or her understanding and intelli­gence, although there can be wide variations from one child to another. What's most important during the first ^year is that the baby feel safe and display trust.

The first smile can be seen in healthy, full-term babies sometime between the second and fifth week, or earlier.

The first words. At 9 months, the baby understands the meaning of certain words, and within the next few months starts utter­ing "words."

If you think that your child is late in devel­oping, try not to rush things. Remember that development should be natural for each child. But if you are still concerned, check with your doctor.

More information about babies' psycho­logical development is in chapter 13, on pages 82 to 89 and in the table on pages 80 to 81.

SLEEPING

The need for sleep varies greatly. From birth to 3 months, some babies sleep less than 12 hours a day, whereas others sleep a total of 20 hours! Some children sleep through the night at 2 or 3 weeks, but others need a night­ly feeding for 3 or 4 months. As long as your baby seems alert and contented when awake, the number of hours doesn't much matter.

During the rest of the first year, a baby might sleep 12 hours during the night and 4 hours dur­ing the day, for a total of 16 hours. At 5 months, quiet children can still sleep for most of the day, whereas active children will want to be awake most of the time. When children are around 9 months old, they can decide for themselves whether or not they want to sleep, and they can resist the urge to fall asleep for several hours.

At 3 months, many babies have 3 or 4 peri­ods of sleep each day. At 1 year of age, this may decline to 2 or 3 times a day. Only at 2 to 3 years of age do they tend to give up the afternoon nap.

Children sleep very deeply for the first 4 months or more. During these first months, it's difficult to disturb a child enough to wake him or her, especially right after a feed­ing. Later on, he or she may wake up from unusual sounds.

Sleeping positions

Recent studies suggest that the rare sud­den infant death syndrome (or crib death) occurs more often with babies sleeping on the tummy than on the back or side. For this reason, always put your baby on his or her back or side when sleeping. When a baby is awake and under supervision, however, it's good for development to let him or her lie in a variety of positions.

Sleep interruptions

Children may wake up because they're thirsty (especially during the summer), because they have a wet diaper, because they are teething, because they're too cold or too hot, because their clothes are too tight, because they are overdressed, or because they have been given too much or too little food. And, they'll wake up when they're done sleeping!

Fortunately, addressing the baby's imme­diate need will usually solve the problem, and he or she will usually go back to sleep.

Family members needn't tip-toe around in

the evening out of fear of waking the baby. Children should become accustomed to nor­mal sounds in the home.

During the first 3 or 4 months, some chil­dren have long bouts of crying, especially in the evening and at night. If this is happening to your child, you might want to read Chapter 7, on pages 45 to 47 for a discussion about colic.

Nightmares

After about 6 months of age, your sleeping child might suddenly scream and wake up. This is probably because of some kind of a nightmare. It's generally hard to find the exact cause. However, the baby often will quiet down as soon as you attend to him or her.

THE TEETH AND TEETHING

The first "milk" teeth (or baby teeth) are

already formed by the time a baby is born. So, the mother's diet and health during preg­nancy are crucial for the quality of the milk teeth. On the other hand., dietary deficiencies and illness during the child's early years can greatly affect the quality of the "adult" teeth.

The timing of the appearance of teeth can vary a great deal. Once in a while (in 1 out of 2,000 cases), 1 or 2 teeth will have already emerged at birth. Some other children have their first tooth by the time they reach 3 months of age, and others at around 1 year.

Any of these timings is considered normal. The order of the appearance of teeth may vary, but is usually approximately as follows:

1.    The 2 middle lower teeth at 6 to 9 months

2.    The 4 middle upper teeth at 8 to 12 months

3.    The 2 outer lower teeth between 12 and 15 months

4.    The 4 front molars (the grinding teeth) between 14 and 16 months

5.    The 4 corner teeth (the eye teeth) at 19 to 22 months

6.    The 4 back molars at 24 to 30 months That means that your child will have all

20 milk teeth by about 2-1/2 ^years of age. During the last weeks or

months before

the teeth appear, babies often get itchy gums. They want to bite and rub the gums against everything, they drool constantly, and they may become irritable and whin^y. Just before a tooth breaks through, you may see a blue swelling. If your child has a fever over 101 °F, something besides teething is the cause.

Can something be done to help children suf­fering from teething pains? It's usually much better to give them something to chew on —like filled with water — than to use medicines.

TOOTH DECAY AND FLUORIDE

Tooth decay (cavities) can happen even during the early years. Teeth decay when bacteria that live in the mouth break down sugars that we eat and drink. This makes an acid that dissolves the enamel (outer coating) of the teeth and causes the decay.

Because sugars are the major cause of cav­ities, it's very important to keep the amount of sugars in your child's diet to a minimum. Look out for sugars in cereals, drinks, cook­ies, desserts, and jellies. Some fruits, such as raisins, are very high in sugars... They're nutritious for other reasons, but large quanti­ties can harm the teeth. Another "hidden" source of sugars is some medicines. The good news is that "sugar-free" sweets, drinks, vit­amins, medicines, and so forth that taste sweet don't cause tooth decay.

It's best not to leave your child unattend­ed with a bottle. Give the drink, remain with the child, and then remove the bottle. Also avoid putting honey or other sweets on a pacifier. Either of these things can really damage the teeth.

It's hard to break bad habits, so try to get your child used to a healthful, sensible diet right from the start. Let him or her eat well at meal-time, and try to avoid between-meal snacking. If your child is still hungry, give a slice of bread with cheese, a vegetable, or some other food that isn't sugary or fatty. The most

sensible advice is to read labels carefully, and ask your dentist or doctor for advice.

Tooth brushing should start as a game when the first teeth come through. Make sure you use the kind of small, soft brush recom­mended by your dentist or doctor. The tooth-brushing game should become more serious when the milk molars appear, at around 18 months of age.

In addition to good tooth hygiene and a sensible low-sugar diet, fluoride is important in strengthening the teeth against tooth decay. Many water-supply systems are fluo­rinated (add fluoride), which helps. And, most major brands of toothpaste have fluo­ride. But your doctor or dentist may recom­mend fluoride tablets if your child is at risk for getting a lot of cavities.

THE EYES AND EYESIGHT

Infants' eyes should be the same size as each other and should look clear and shiny. The true eye color will develop toward the end of the first year.

The pupils (hole in the very middle of each eye) should be completely black and of equal size. Gray or whitish pupils may mean cataract or other eye diseases. Such problems are rare, but they do require the advice of an eye doctor as soon as possible.

If a newborn's eyes are a little crusty, it's usually quite harmless. Red eyes and larger

amounts of pus may, however, be signs of a serious infection and should be examined by a doctor.

Babies don't produce many tears immedi­ately after birth, but this will increase in the first month. At that point, some children will develop too much moisture in the eyes, and tears will run easily even when the child isn't crying. For some, the eyes will get pus, too, which may look sticky and dirty. This is caused by a blocked tear duct, which may open up by itself in the first year. In the meantime, your doctor may advise that you gently massage the tear sac at the inside cor­ner of the eye.

During the first days of life, your baby's eyesight is worse than that of older children and adults, but it's still better than what peo­ple previously imagined. Even over the first few weeks, the eyesight will improve a lot, and the infant will start gazing toward visu­ally interesting objects. Your face will proba­bly attract the most interest.

When a baby is looking at something, the eyes should both look straight ahead and not squint. If your child doesn't start "fix­ing the gaze" on objects in the first month, you should talk with an eye doctor. A "shy­ness from light" — turning away from nor­mal sources of light — may also indicate eye disease and should be checked by an eye doctor.

"Normal" vision is developed by around 1 year of age. In the first few years, binocular vision develops. Binocular (meaning "two-eye") vision lets us make sense of images that come from both eyes at the same time. For instance, this gives us depth perception, which means that it allows us to see in three dimensions. If you think that ^your baby doesn't see well, consult ^your doctor.

THE EARS AND HEARING

The ears are shaped to direct sound into the ear canal. At the end of the canal, there is an ear drum that vibrates when sound strikes it.

At birth, some babies' ears are covered by fine hairs. These hairs will fall out in the first month or so. If your baby has wax or other material in the ears, never place a cotton-tipped swab into the ear canal to tr^y to clean it out. The swab could slip in too far or push the material deep into the canal. This can severely damage the ear drum and impair hearing.

It's been shown that babies can hear even before birth. Newborns react to loud noises by startling (see page 72). Later, they'll respond to voices by smiling or turning toward the direction of the voice. If you are concerned that your baby might ha^ve a hear­ing problem, see the doctor. The sooner a hearing loss is treated, the better the chance is that your child will develop normal speech and language skills.

BOWEL MOVEMENTS

During the first 3 or 4 days after birth, the infant's bowel contains a greenish-black, sticky substance called meconium. Later, the color of the stool that comes out into the dia­per will depend on what the baby has had to eat or drink.

Children on breast milk have a fre­quent, greenish, loose, and somewhat slimy stool during the first 1 or 2 weeks. Some children have this type of bowel movement over a longer period, but most babies develop the typical mother's milk stool, which is yellow and creamy and smells pleasantly sour. Breast-fed babies sometimes have loose, greenish, slimy stools when the mother has eaten certain foods (like shellfish, cabbage, or onions). Breast-fed babies may have between 1 and 4 bowel movements each day, but there are a lot of variations. It is important to be aware that real constipation (hard stools) never occurs with breast-fed babies. Some babies go for up to 7 days between bowel movements, now and then, but the stools still will not be too hard. This "false consti­pation" doesn't cause the baby any discom­fort, and it shouldn't be treated with ene­mas, suppositories, etc.

Children on formula have several "seedy" stools a day for the first several weeks. The consistency is that of scrambled

eggs, and the color can vary from green to yellow. If your baby has frequent, watery stools, severe tummy aches associated with feeding, or bright red blood in the stools, contact your doctor immediately. These symptoms could be due to allergy to the for­mula — in which case the formula may need to be changed — or an illness requiring immediate attention.

At the transition to solid food such as cereals and soft stews, the stools get browner. They may periodically become more loose and slimy — this often happens if the baby is given too much solid food in the beginning.

Children on cow's milk (including milk-based formulas) have stools that are more solid, yellowish-white, and rotten smelling. These babies usually have 1 or 2 such bowel movements daily, but they may get consti­pated. Loose and frequent bowel movements are not normal, and should prompt a call to the doctor. Very white stools over a long peri­od of time can be a sign of serious disease.

CRYING

The reasons for crying can largely be the same as those mentioned in the section called "Sleep interruptions" on page 72.

Crying can also be a "stage." Even though hunger is the most common cause for cry­ing, a baby might also cry because of strong light in the eyes, sudden sounds, cold and heat, and so on. A baby may also cry if he or she can't move freely, kick the legs, wave the arms, or turn or lift the head. As babies grow older, they cry when they want com­pany, and from 1-1 /2 years the^y may show fear at being left alone in an unfamiliar place or at being approached or touched by strangers.

FINGER-SUCKING

All children will at some sta^ge suck their fingers, especially during teething. As long as the sucking doesn't make your baby's gums sore, some doctors will tell you not to worry about it during the first year. Other doctors discourage finger-sucking because it may be a hard habit to break later on.

HEAD-BANGING AND SELF-ROCKING

A 6- to 12-month-old may start banging his or her head on the crib right after being put down to sleep. This behavior may con­tinue until he or she is 2 or 3 years old. Treatment is usually not necessary, but head-banging may rarely be a sign of some­thing serious. The same applies to children who sit and rock back and forth for long periods of time.

SWEATING

Some larger infants sweat from the head during sleep or feeding. This doesn't mean anything, so long as the child doesn't have a fever. You can, however, make sure that you don't over-dress your baby.

SNEEZING

Infants are nose breathers! And, in order for an infant to be able to suck — and thus to feed — he or she has to be able to breathe through the nose, too. To keep his or her nose clean, a baby will sneeze when something blocks the nose. Your baby, therefore, should sneeze. It doesn't necessarily mean that the baby has a cold.

TUMMY ACHES

Some babies get tummy aches, which may appear when the baby is 2 or 3 weeks old and last until he or she is 3 or 4 months old. The crying spells often happen between 5:00 PM and 10:00 PM. The baby may quiet down during the day and sleep well at night. When picked up during the crying spell and gently massaged on the tummy, the baby may quiet down for a while, but might then continue to cry and pull up the legs toward the chest. There is often no effective treatment for colic. Sometimes, drops that help the baby pass gas may help. (See Chapter 7 on pages 45 to 47, for more information on colic.)

PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT IN THE FIRST YEAR

The following are general guidelines, with considerable variation from child to child.