PRENATAL

DEVELOPMENT
Dr. Fathima Bushra Saliha
Prenatal Development:
Fertilization, Germinal Period, Embryonic Period, Fetal Period. Prenatal
environmental influences- Teratogens, other maternal factors
Birth Process: Types, methods- Prenatal and perinatal diagnostic tests.
Birth Complication and their effects
Physical and motor development: patterns of growth, the development of
brain and body, need for sleep and nutrition. New born Reflexes, Gross
and fine motor skills.
Sensory and perceptual development: development of visual and other
senses.
Pubertal changes in boys and girls. The impact of pubertal events. Factors
affecting physical development.
Parent child relationships
 Prenatal Development
 Begins with fertilization and ends with birth.
 Lasts between 266 and 280 days (38 – 40 weeks),
 Divided into three periods:
• Germinal period
• Embryonic period
• Fetal period
 Six major characteristics:
• The hereditary endowment which serves as the foundation for later development and it is
fixed.
• Favorable conditions in mother’s body can foster the development of hereditary potential
and unfavorable conditions can stunt their development.
• The sex of the baby is fixed at the time of conception (conditions within mother’s body
won’t affect it).
• Proportionally greater growth and development take place during this period than any
other time throughout the individual’s entire lifespan.
• It’s the time of many physical and psychological hazards.
• It’s the time when significant people form attitude towards the newly created individual. It
influence child development.
 Fertilization
 Fusion of haploid gametes, egg and sperm.
 Egg + Sperm < Zygote
 Zygote is a diploid cell.
 Zygote contain all the genetic material needed
to form a human – half from mother and half
from father.
 Germinal Period
 First two weeks after conception.
 Include the creation of the fertilized egg, the zygote, followed by
cell division and attachment of the zygote to the uterine wall.
 Rapid cell division by zygote continues throughout the germinal
period.
 At this stage, the group of cells is called the blastocyst (16 cells)
 Blastocyst consists of an inner cell mass, that will eventually develop
into the embryo.
 Trophoblast, an outer layer of cells, later provides nutrition and support for the embryo.
 Embryonic Period
 2 – 8 weeks.
 The rate of cell differentiation intensifies, support systems for cells form and organs appears.
 This period begins as the blastocyst attaches to the uterine wall.
 The mass of cell is now called embryo. It has three layers of cells.
• Endoderm – the inner layer of cells, which will develop into the digestive and respiratory
systems.
• Mesoderm – the middle layer, which will become the circulatory system, bones, muscles,
excretory system and reproductive system.
• Ectoderm – the outermost layer, which will become the nervous system and brain, sensory
receptors, and skin parts.
 The life-support systems like the amnion, the umbilical cord and the placenta will develop rapidly.
 Amnion – like a bag or an envelope and contains a clear fluid in which the developing embryo floats. The
amniotic fluid provides an environment that is temperature and humidity controlled.
 Umbilical cord – it contains two arteries and one vein, and connects the baby to the placenta.
 Placenta – it consists of a disk-shaped group of tissues in which small blood vessels from the mother
and the offspring intertwine but do not join.
 Organogenesis – organ formation that takes place during the first two months of prenatal development.
 Foetal Period
 Lasts about seven months (between 2 months after conception and birth).
 Begins during 9th week and lasts until birth.
 Growth and development continues dramatically.
 Between the 9th & 12th week of gestation, reflexes begin to emerge.
 During the 3rd month, the sex organs begin to differentiate.
 The foetus continues to grow in both weight and length, although the majority of physical
growth occurs in the later stages of pregnancy.

 Foetal development (week by week) : [Link]

 From fertilization to child birth- animation video : [Link]
 Trimesters
 Divides prenatal development into equal periods of three months, called trimesters.
 The three trimesters are not the same as the three prenatal periods.
 The germinal and the embryonic periods occur in the first trimester. The fetal period begins towards
the end of the first trimester and continues through the 2nd and 3rd trimesters.
 During 2nd trimester, the heart beat grows stronger and other body systems become further developed.
Fetus increases about six times in size.
 During the 3rd trimester, the fetus continues to develop, put on weight, and prepare for life outside the
womb.
 The lungs begins to expand and contract, preparing the muscles for breathing.
 Teratogens
 Environmental agents that can cause damage to the developing fetus during prenatal period.
 It cause a birth defect or negatively and alter cognitive and behavioral outcomes.
 The Greek word ‘tera’ means ‘monster’.
 It may take a long time for the effects of a teratogen to show up.
 Teratology – the field of study that investigates the cause of birth defects.
 Behavioral teratology – the field of study which investigates the teratogens altering the
developing brain and influencing cognitive and behavioral functioning.
 The harm caused by teratogens depends on many factors:
• Dose – the greater the dose of an agent, such as a drug, the greater the effect.

• Genetic susceptibility –the type or severity of abnormalities caused by a

teratogen is linked to the genotype of the pregnant woman and the genotype of
the embryo or fetus. Some individuals are able to better than others to withstand
harmful environment.

• The time of exposure – teratogens do more damage when they occur at some
points in development than at others. Damage during the germinal period may
even prevent implantation. In general, the embryonic period is more vulnerable
than the fetal period.
Drugs
 Prescription as well as nonprescription drugs may have effects on the embryo or fetus.

 Prescription drugs that can act as teratogens include antibiotics (streptomycin,

tetracycline), some anti depressants, certain hormones (such as progestin & synthetic
estrogen).

 A recent study revealed that, offspring of pregnant women who redeemed prescription for
more than one type of SSRIs (selective serotonin reuptake inhibitors) early in pregnancy
had an increased risk of heart defects.
 Nonprescription drugs that can be harmful include diet pills and high dosage of
aspirin (can cause maternal and fetal bleeding).
 Even prescription drugs can have impacts on development.
 Any drug taken by the mother that has a molecule small enough to penetrate
the placental barrier can affect the fetus.
 Even aspirin can relate to low birth weight, increased mortality, lower IQ and
poorer motor development.
Illegal drugs
 Mood altering drugs like cocaine, marijuana and heroin can cause many problems
including prematurity, low birth weight, physical defects, breathing difficulties and death.
 Use of cocaine may produce drug addicted babies and cocaine exposure during prenatal
development is associated with reduced birth weight, length and head circumference.
 These babies cry so shrill, irritable and troublesome sleep, these may affect the
caregivers.
 It may devolve into attachment problems if the mother can’t care for the infant
adequately.
 Babies exposed to cocaine or heroin seems to be less attentive to the environment.
 The use of illegal drugs affects the blood vessels, oxygenation, neural development, and
motor language functions.
Caffeine

 Coffee, tea, colas and chocolates contain caffeine.

 A recent study revealed that pregnant women who consumed 200 or more
milligrams of caffeine a day had an increased risk of miscarriage.
 The Food and Drug Administration recommends that pregnant women
either not consume caffeine or consume it only sparingly.
 Even caffeine links to low birth weight, miscarriage, withdrawal symptoms in
baby such as irritability, vomiting.
Tobacco
 Smoking by pregnant women can also adversely influence prenatal development,
birth, and postnatal development.
 Preterm births and low birth weights, fetal and neonatal deaths, respiratory problems,
sudden infant death syndrome (SIDS), and cardiovascular problems are all more
common among the offspring of mothers who smoked during pregnancy.
 Maternal smoking during pregnancy also has been identified as a risk factor for the
development of ADHD in offspring.
 A recent research review also indicated that environmental tobacco smoke was linked
to increased risk of low birth weight in offspring.
Alcohol
 Heavy drinking by pregnant women can be devastating to offspring.

 Foetal alcohol spectrum disorders (FASD) are a cluster of abnormalities and problems that appear
in the offspring of mothers who drink alcohol heavily during pregnancy.

 The abnormalities include facial deformities, microcephaly (small head) and defective limbs, face and
heart.

 Most children with FASD have learning problems and many are below average in intelligence with
some that are mentally retarded.
 Recent studies revealed that children and adults with FASD have impaired
memory development, impaired math ability linked to multiple regions of
the brain.

 Although many mothers of FASD infants are heavy drinkers, many mothers
who are heavy drinkers do not have children with FASD or have one child
with FASD and other children who do not have it.

 Mental retardation, impaired coordination, attention problems, impaired

memory and language, hyperactivity are the consequences and small skull
and brain are common.
Radiation
 Effects of radiation were clearly seen after Hiroshima , Chernobyl.
 A great many babies miscarried; others were born with underdeveloped brains,
deformities, and slow growth patterns.
 There may be heightened risk to the baby of childhood cancer, lower IQs,
learning and emotional disorders.
 X-ray radiation can affect the developing embryo or fetus, especially in the first
several weeks after conception, when women do not yet know they are
pregnant.
Pollution
 Exposure to air pollution during pregnancy can increase the risk of premature birth and
low birth weight.
 The chemicals in certain pesticides are also potentially damaging and may lead to birth
defects, learning problems, low birth weight, miscarriage and premature birth.
 Mercury – effects of exposure are physical deformities, mental retardation, speech
impairments and motor problems.
 Lead – effects are prematurity, low birth weight, brain damage and physical defects.
 Prenatal exposure to bisphenol A (BPA), a chemical commonly used in plastics and
food and beverage containers, may disrupt the action of certain genes contributing to
certain birth defects.
RH- Factor incompatibility

 It occurs when the mother is Rh- negative but the baby is Rh- positive.
 Erythroblastosis fetalis.
 The mother's body will form antibodies to fight the foreign blood protein being
produced by the baby.
 It can reduce oxygenation to the baby.
 First babies are usually not affected, but the risk occurs to later pregnancies.
 There is a vaccine given to the mother of a positive baby to prevent buildup of
antibodies.
 Blood transfusion may be necessary after birth.
Maternal diseases
 Maternal diseases and infections can produce defects in offspring by crossing the
placental barrier, or they can cause damage during birth.
 Rubella is one of the disease that can cause prenatal defects. Women who plan to have
children should have a blood test before they become pregnant to determine if they
are immune to the disease.
 Syphilis (a sexually transmitted infection) is more damaging later in prenatal
development- four months or more after conception. Damage include eye lesions,
which can cause blindness, and skin lesions.
 AIDS is a sexually transmitted infection that is caused by the human
immunodeficiency virus (HIV), which destroys the body’s immune system. A
mother can infect her offspring with HIV/AIDS in three ways:
• During gestation across placenta
• During delivery through contact with maternal blood.
• Through breast feeding.
Other Maternal Factors
 Apart from teratogens, there are several other factors that affects embryo and fetus.
1. Exercise – in healthy, physically fit women, regular moderate exercise such as walking,
swimming, aerobic workout are related to increase birth weight and reduction in risk for
certain complications.
2. Nutrition- during a healthy pregnancy, mom will gain about 25-30 pounds. If the baby is
malnourished, there is serious damage to CNS, seen in lower brain weight. It will also affect
other organ system development. Lack of folic acid particularly affects neural tube formation.
3. Stress- relates to miscarriage, prematurity, low birth weight and baby
irritability, respiratory illness. Stress hormones shift blood flow from the body
to the brain and reduce oxygenation. Stress also affects immunity, increasing
illness.
4. Maternal age/ previous births can affect the ability to get pregnant or
chances of having a baby with chromosomal defects.
Birth Process – Stages Of Birth
 Stage 1- Labor Stage
 Longest of the three stages.
 Uterine contractions are 15 to 20 minutes apart at the beginning and lasts up to a minute.
 These contractions cause the woman’s cervix to stretch and open.
 As the first stage progresses, the contractions come closer together, appearing every two to five
minutes. Their intensity increases.
 By the end of 1st stage, contractions dilate the cervix to an opening of about 10cm (4inches), so that
the baby can move from the uterus to the birth canal.
 For a woman having her first child, the first stage lasts an average of 6 to 12 hours; for subsequent
children, this stage typically is much shorter.
 During the labor stage, there are 3 phases:
1) Early labor, 2) Active labor, 3) Transition

Early Labor Phase

 Longest stage.
 Contraction begins in this stage.
 The middle layer of uterus, myometrium, is the actual muscle that contracts during
childbirth.
 In this stage, uterine contractions are mild to moderately painful and patients can talk
through the contractions in this phase.
 The contractions may be also be irregular starting between 15 to 20 minutes apart and
may even stop.
 First births can have many hours of early labor without the cervix dilating.
 It can be long and uncomfortable.
Active Labor Phase

 Contractions are more intense and frequent starting every 2 to 3 minutes and
lasting a longer range of 50 to 70 seconds.
 In active labor the cervix dilates to about 3cm to 4cm.
 If the membranes of amniotic sac have not ruptured, the physician may
choose to rupture the membranes to facilitate the birth.
 This process is called breaking the water.
 The phase of active labor is complete when the cervix is fully effaced (thinned
out) and dilated (open) and the baby is ready to be pushed out.
Transition Phase

 Labor contractions become more intense, longer and closer together.

 A first time mother may take up to 3 hours in the transition phase.
 A mother who has had a vaginal birth before may take no longer than an
hour.
 As the name of the phase suggests, the transition phase moves from stage
one to stage two which is the actual birth of the baby.
 Stage 2 – Baby Delivery
 It begins when the baby’s head starts to move through the cervix and the birth canal.
 It terminates when the baby completely emerges from the mother’s body.
 With each contraction, the mother bears down hard to push the baby out of her body.
 By the time the baby’s head is out of the mother’s body, the contractions come almost every minute
and lasts for about a minute.
 This stage typically lasts approximately 45minutes to an hour.
 When the baby crowns (baby’s head starts to emerge), one may feel a burning pain caused by the
stretching of the perineum.
 Stage 3 - Afterbirth
 The placenta, umbilical cord and other membranes are detached and
expelled.
 Also called placental delivery, which is the shortest of the three stages,
lasting only minutes.
 While contraction will continue, they are less intense but help the placenta
separate from the inside of the uterus and expel the placenta.
 Breastfeeding right away can help to shrink the uterus and reduce the
amount of bleeding.
Types Of Birth Process
Natural and Prepared Childbirth
 Today, at least some medication is used in the typical childbirth, but elements of natural
childbirth and prepared child birth remain popular.
 It is the method that aims to reduce the mother’s pain by decreasing her fear through
education about childbirth and by teaching her and her partner to use breathing methods and
relaxation techniques during delivery.
 Ferdinand Lamaze developed a method similar to natural childbirth that is known as
prepared childbirth or Lamaze method.
 It includes a special breathing technique to control pushing in the final stages of labor, as
well as more detailed education about anatomy and physiology.
 Breach Birth
 It occurs when baby’s bottom (buttocks or feet) come first instead of head during delivery.
Transverse Birth
 The foetus is positioned crosswise in mother’s uterus.
 Instruments must be used for delivery unless the position can be changed
before the birth process begins.

Cesarean Section
 A caesarean section, also called a C-section, is a surgical procedure performed
if a vaginal delivery is not possible.
 During this procedure, the baby is delivered through surgical incisions made in
the abdomen and the uterus.
 Appropriate anaesthesia will be administered.
Conditions for cesarean
 Mother may have concerning medical issues such as high blood pressure or diabetes.
 Mother may be positive for HIV or herpes.
 Baby may be in breech position or be a large baby.
 There may be problems with the placenta.
 Failure to progress, such as when contraction may not open the cervix enough for
the baby to move into the vagina.
 Twins, triplets or other multiple pregnancies where the babies are being born too
early.
 Previous cesarean birth so second birth usually have a cesarean.
 Abruption placentae- In rare occurrence the placenta separates from the wall of the
uterus before the baby is born.
Forceps Delivery

 This is a rather peculiar type of delivery method and is required in certain

cases of vaginal birth.
 This is assistance to the usual vaginal delivery when the baby is on its way via
the birth canal but fails to fully emerge out.
 This could be because of small obstructions, or the mother being tired and
exhausted and hence being unable to push the baby out.
 In these cases, the doctor makes use of specially created tongs which resemble
forceps, and inserts them slowly into the birth canal.
Vacuum Extraction
 This delivery technique is also used in the case of vaginal birth.
 If the baby is on the way out but has stopped moving further down the canal,
the vacuum extraction method is applied.
 The doctors make use of a specialised vacuum pump which is inserted up to
the baby via the canal. The vacuum end has a soft cup which is placed on the
top of the baby’s head. Vacuum is created so that the cup holds the head, and
the baby is gently guided outwards through the canal.
 A vacuum extractor looks like a small suction cup that is placed on the baby’s
head to help deliver the baby.
Prenatal Diagnostic Methods
Amniocentesis

 Most widely used technique.

 A hollow needle is inserted through the abdominal wall to obtain a sample
of fluid in the uterus.
 Cells are examined for genetic defects.
 Can be performed by the fourteenth week after conception.
 1 to 2 more weeks are required for test results.
 Small risk of miscarriage is associated with this diagnosis.
Chorionic villus sampling

 A thin tube is inserted into the uterus through the vagina, or a hollow needle
is inserted through the abdominal wall.
 A small plug of tissue is removed from the end of one or more chorionic
villi, the hair like projections on the membrane surrounding the organism.
 Cells are examined for genetic defects.
 It can be performed by the ninth week after conception, and results are
available within 24 hours.
 There is a slightly greater risk of miscarriage than amniocentesis.
Fetoscopy

 A small tube with a light source at one end is inserted into the uterus to
inspect the fetus for defects of the limbs and face.
 Also sample of fetal blood to be obtained, permitting diagnosis of such
disorders as hemophilia and sickle cell anemia, as well as neural defects.
 Usually performed between 15 and 18 weeks after conception, but can be done
as early as 5 weeks.
 Some risk of miscarriage.
Ultrasound

 High frequency sound waves are beamed at the uterus; their reflection is translated into
a picture on a video screen that reveals the size, the shape, and placement of the fetus.

 By itself, permits assessment of fetal age, detection of multiple pregnancies, and

identification of gross physical defects.

 It also used to guide amniocentesis, chorionic villus sampling, and fetoscopy.

 When used five or more times, may increase the chances of low birth weight.
Preimplantation Genetic Diagnosis

 After in vitro fertilization (IVF) and duplication of the zygote into a cluster
of about eight cells, one cell is removed and examined for hereditary defects.
 Only if that cell is free of detectable genetic disorders is the fertilized ovum
implanted in the woman’s uterus.
 It permits parents avoid the high risk of bearing offspring with a genetic
disorder and women of advanced childbearing age to avoid implantation of
most abnormal embryos.
 Perinatal Tests

 Almost immediately after birth, after the baby and its parents have been
introduced, a newborn is taken to be weighed, cleaned up, and tested for
signs of developmental problems that might require urgent attention.
Apgar Scale
 A widely used method to assess the health of newborns at one and five minutes after
birth.
 It evaluates an infant’s heart rate, respiratory effort, muscle tone, body color and reflex
irritability.
 A physician or nurse does the evaluation and gives the newborn a score, or reading of 0,
1, or 2 on each of these five health signs.
 A total score of 7 to 10 indicates that the newborn’s condition is good.
 A score of 5 indicates there may be developmental difficulties.
 A score of 3 or below signals an emergency and indicates that the baby might not
survive.
 The Apgar Scale is especially good at assessing the newborn’s ability to respond to the
stress of delivery and the new environment.
Brazelton Neonatal Behavioral Assessment Scale (NBAS)
 It is typically performed within 24 to 36 hours after birth.
 It assesses the newborn’s neurological development, reflexes, and reactions to people and
objects. Sixteen reflexes such as sneezing, blinking and rooting are assessed.
 Assess normal, healthy, term infants
• Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS)
 It provides another assessment of the newborn’s behavior, neurological and
stress responses and regulatory capacities.
 Assess the risk infants.
 It is especially useful for evaluating preterm infants (although it may not be
appropriate for those less than 30 weeks’ gestational age) and substance
exposed infants.
 A recent NNNS assessment (at 1month of age) of preterm infant who were
exposed to substance abuse prenatally revealed that the NNNS predicted
certain developmental outcomes, such as neurological difficulties, IQ, and
school readiness at 4.5 years of age.
 Birth Complications
 It is any problem that is a risk to the health of the mother or the baby that
occurs during the birth.
 There are also complications of pregnancy, which are health problems
occurring in the pregnant woman or in the developing fetus before labor
begin.
 Birth complications occur during labor and delivery of the baby and can
have serious repercussions for both the mother and the baby.
Birth Injury
 Any kind of physical damage to a baby as it is being delivered.
 This is sometimes caused by medical negligence, such as when a doctor uses forceps
or a vacuum extractor with too much force. The skull and brain may be damaged.
 Failing to address an abnormal presentation can also lead to a birth injury if the baby
gets stuck in the birth canal.

Detached Placenta
 Placental abruption occurs when the placenta detaches from the wall of the uterus
before the baby is born.
 This can be very serious and may result in the fetus not getting enough oxygen to
the brain with a potential for resulting brain damage.
Haemorrhage
 Heavy uncontrolled bleeding during or after the delivery of a baby.
 A life threatening haemorrhage after childbirth is when a woman loses more than 500ml
of blood.
 This might be in the first 24 hours or up to 6 weeks after the birth.
 Haemorrhage can have several causes including:
• When the womb doesn't contract naturally.
• Trauma (e.g. rupture of the womb)

• (when it’s not delivered after the birth as it should be)

• Other problems with the placenta.
 In some cases, if the bleeding can’t be stopped, a hysterectomy (removal of the womb)
may have to be performed to save the mother’s life.
Infections
 A variety of bacterial, viral, and parasitic infections may complicate a
pregnancy.
 Infections can be harmful to both the mother and the baby, so it’s important to
seek treatment right away.
 Some examples include:
• Urinary tract infection
• Cytomegalovirus
• Group B Streptococcus
• Hepatitis B virus, which can spread to the baby during birth
• influenza
Failure to Progress
 If delivery takes longer than expected, this may be described as “failure to
progress”. This can happen for a number of reasons.
 Prolonged labor, labor that doesn’t progress or failure to progress is when labor
lasts longer than expected.
 Studies suggest that this affects around 8% of those giving birth. It can happen
for a number of reasons.
Causes of prolonged labor
• Slow cervical dilation
• Large baby
• Small birth canal or pelvis
• Delivery of multiple babies
• Emotional factors, such as worry, stress and fear
Perinatal asphyxia
 It’s defined as “failing to initiate and sustain breathing at birth”.
 It can happen before, during or immediately after delivery, due to an inadequate
supply of oxygen.
 It’s a non-specific term that involves a complex range of problems.

It can lead to:

• Hypoxemia, or low oxygen levels.
• High levels of carbon dioxide
• Acidosis, or too much acid in the blood
• Cardiovascular problems and organ malfunction can result
Malposition
 A caesarian delivery, episiotomy, or forceps delivery may be necessary if the
baby’s position is preventing the birth.
 Not all babies will be in the best position for vaginal delivery.
 Facing downward is the most common fetal birth position, but babies can be in
other positions.

 They include:
• Facing upward
• Breech, either buttocks first (frank breech) or feet first (complete
breech)
• Lying sideways, horizontally across the uterus instead of vertically
Breech position
 A baby is considered in a breech position when their feet are positioned to be
delivered before their head.
 According to APA, this occurs in about 4% of full-term births. Most babies
born in this position are healthy.
 Doctor will recommend against a vaginal birth if the baby shows signs of
distress or is too big to pass safely through the birth canal.
 If the doctor finds out that the baby is in the breech position a few weeks before
delivery, they might try to change the position of the baby.
 If the baby is still in the breech position when the labor starts, most doctors
recommend a cesarean delivery.
Consequences of complications
 Complications during delivery can cause many problems for children including
problems in:
• Physical development
• Learning
• Communicating with others
• Getting along with others
• Taking care of himself
• Behavior problems, including ADHD and anxiety
• Neurological disorders, like cerebral palsy, that affect the brain, spinal
cord and nerves throughout the body.
 Postpartum Period
 Begins immediately after the birth of a child as the mother’s body, including hormone
levels and uterus size returns to a non-pregnant state.
 WHO describes the postnatal period as the most critical and yet the most neglected phase
in the lives of mothers and babies; most maternal and new-born deaths occur during the
postnatal period.
 Also known as the puerperium.
 In addition to physiologic changes and medical issues that may arise during this period,
health care providers should be aware of the psychological needs of the postpartum
mother and sensitive to cultural differences that surround childbirth, which may involve
eating particular foods and restricting certain activities.
Physical adjustment
 A woman’s body makes numerous physical adjustments in the first days and weeks after
childbirth.
 These changes are normal; the fatigue can undermine the new mother’s sense of wellbeing and
confidence in her ability to cope with a new baby and a new family life.
 A concern is the loss of sleep that the primary caregiver experiences in the postpartum period.
 The loss of sleep can contribute to stress, marital conflict, and impaired decision making.
 After delivery, a mother’s body undergoes sudden and dramatic changes in hormone production.
 When the placenta is delivered, estrogen and progesterone levels drop steeply and remain low
until the ovaries start producing hormones again.
 Involution is the process by which the uterus returns to its pre-pregnant size five or six weeks
after birth.
Emotional and Psychological adjustment

 Emotional fluctuations are common for mothers in postpartum period.

 For some women, emotional fluctuations decrease within several weeks after
the delivery, but other women experience more long-lasting emotional swings.
 About 2 to 3 days after birth, they begin to feel depressed, anxious and upset.
 These feelings may come and go for several months after the birth, often
peaking about 3 to 5 days after birth. Eve without treatment, these feelings
usually go away after one or two weeks.
Postpartum blues
 These are very common.
 The symptoms typically include changeable mood, crying easily, sadness, and irritability, often
liberally intermixed with happy feelings.
Postpartum depression (PPD)
 When postpartum blues last longer than 2 weeks then it may develop to postpartum depression.
 It involves a major depressive episode that typically occurs about 4 weeks after delivery.
 Women with PPD has such strong feelings of sadness, anxiety or despair that for at least 2 week
period they have trouble coping with their daily tasks.
 Without treatment postpartum depression may become worst and last for
many months.
 Several antidepressant drugs are effective in treating PPD, and appear to be
safe for breastfeeding women.
 Psychotherapy, especially cognitive therapy, also is an effective treatment of
PPD for many women.
 Sadness, anxiety, irritability and crying are common symptoms.
Postpartum Psychosis

 A rare condition that typically develops within first week after delivery.
 The signs are:
• Confusion and disorientation.
• Obsessive thought about baby.
• Hallucination.
• Delusion.
• Sleep disturbances.
Physical and motor development : patterns of growth
Patterns of Growth
Orderly and Predictable Process
Development follows a regular, sequential pattern across individuals.
Cephalocaudal Pattern
Growth proceeds from head to toe.
Control of head and neck develops before trunk and legs.
Proximodistal Pattern
Development progresses from the center of the body outward.
Trunk control precedes arm, hand, and finger movements.
General to Specific Development
Broad, gross movements develop before fine, precise movements.
Example: whole-arm movements before finger control.
Physical and motor development : patterns of growth
Gross Motor to Fine Motor Development
Large muscle activities (sitting, crawling, walking) develop before fine motor skills (grasping, writing).
Differentiation and Integration
Simple movements become more complex and coordinated over time.
Individual Differences in Growth Rate
While the sequence is similar, timing and speed vary among individuals.
Influence of Maturation and Environment
Growth is shaped by genetic factors and environmental experiences (nutrition, stimulation, health).
The development of brain and body
Development of the Brain and Body
Rapid Early Growth
Brain and body growth is fastest during prenatal period and early childhood.
Brain Development and Maturation
Increase in neuron formation, synaptic connections, and neural networks.
Myelination improves speed and efficiency of neural transmission.
Sensitive and Critical Periods
Certain periods are crucial for optimal brain development.
Lack of stimulation or adverse conditions can affect development.
Cerebral Cortex Development
Higher cognitive functions such as thinking, language, memory, and self-regulation emerge with
cortical maturation.
The development of brain and body
Development of the Brain and Body
Rapid Early Growth
Brain and body growth is fastest during prenatal period and early childhood.
Brain Development and Maturation
Increase in neuron formation, synaptic connections, and neural networks.
Myelination improves speed and efficiency of neural transmission.
Sensitive and Critical Periods
Certain periods are crucial for optimal brain development.
Lack of stimulation or adverse conditions can affect development.
Cerebral Cortex Development
Higher cognitive functions such as thinking, language, memory, and self-regulation emerge with
cortical maturation.
•Hemispheric Specialization
•Left and right hemispheres develop specialized functions (e.g., language, spatial skills).
•Physical Growth of the Body
•Increase in height, weight, bone density, and muscle mass.
•Growth follows cephalocaudal and proximodistal patterns.
•Brain–Body Coordination
•Development of motor skills depends on interaction between neurological maturation and physical
growth.
•Role of Genetics and Environment
•Genetic blueprint guides development, while nutrition, health, stimulation, and care shape outcomes.
•Impact of Nutrition and Health
•Adequate nutrition, sleep, and healthcare are essential for healthy brain and body development.
Need for Sleep and Nutrition
Essential for Growth and Development
Sleep and nutrition are fundamental for physical, brain, and motor development.
Role of Sleep in Development
Supports brain maturation, memory consolidation, and learning.
Promotes physical growth through release of growth hormone.
Sleep and Emotional Regulation
Adequate sleep helps in attention, emotional control, and behavior regulation.
Importance of Balanced Nutrition
Provides energy and nutrients required for growth, tissue repair, and brain function.
Nutrition and Brain Development
Nutrients like proteins, iron, iodine, and essential fatty acids support cognitive development.
Impact on Physical Health
Proper sleep and nutrition strengthen immunity, bone growth, and muscle development.
Consequences of Sleep and Nutritional Deficiency
Inadequate sleep or poor nutrition can lead to delayed growth, poor concentration, and health problems.
Interaction of Sleep and Nutrition
Good nutrition supports healthy sleep patterns, while adequate sleep improves appetite regulation and metabolism.
Role of Environment and Care
Regular routines, healthy diet, and supportive caregiving promote optimal sleep and nutrition.
 Newborn Reflexes
• The newborn is not completely helpless. Among other things, it has some
basic reflexes.
• built-in reactions to stimuli; they govern the newborn’s movements, which
are automatic and beyond the newborn’s control.
• genetically carried survival mechanisms.
• They allow infants to respond adaptively to their environment before they
have had the opportunity to learn.
• The rooting reflex occurs when the infant’s cheek is stroked or the side of the
mouth is touched. In response, the infant turns its head toward the side that was
touched in an apparent effort to find something to suck.

• The sucking reflex occurs when newborns automatically suck an object placed in
their mouth. This reflex enables newborns to get nourishment before they have
associated a nipple with food and also serves as a self-soothing or self-regulating
mechanism.
• Moro reflex, which occurs in response to a sudden, intense noise or movement.
When startled, the newborn arches its back, throws back its head, and flings out its
arms and legs. Then the newborn rapidly closes its arms and legs.

• Some reflexes -coughing, sneezing, blinking, shivering, and yawning, for example-
persist throughout life.

• Other reflexes, though, disappear several months following birth, as the infant’s
brain matures, and voluntary control over many behaviors develops

• The rooting and Moro reflexes, for example, tend to disappear when the infant is 3
to 4 months old.
• The movements of some reflexes eventually become incorporated into more
complex, voluntary actions. One important example is the grasping reflex,
which occurs when something touches the infant’s palms. The infant responds by
grasping tightly.

• Human infants have an estimated twenty-seven major reflexes, many of which

are present at birth or soon after.

• Primitive reflexes, such as sucking, rooting for the nipple, and the Moro, are
related to instinctive needs for survival and protection.
• As the higher brain centers become active during the first two to four months,
infants begin to show postural reflexes: reactions to changes in position or
balance. For example, infants who are tilted downward extend their arms in the
parachute reflex, an instinctive attempt to break a fall.

• Locomotory reflexes, such as the walking and swimming reflexes, resemble

voluntary movements that do not appear until months after the reflexes have
disappeared.
Other Reflexes
• Babinski reflex- It occurs after the sole of the foot has been firmly stroked.
The big toe then moves upward or toward the top surface of the foot. The other
toes fan out.
• Blinking reflexes- blinking the eyes when they are touched or when a sudden
bright light appears. It will not disappear.
• stepping reflex- in newborns is also known as the "walking" or "dancing
reflex". This reflex can be seen when a baby is held upright or when the baby's
feet are touching the ground.
• Tonic neck- When a baby's head is turned to one side, the arm on that side
stretches out and the opposite arm bends up at the elbow.
 Grasping reflex

Tonic neck reflex Babinski reflex

 GROSS MOTOR SKILLS
• Skills that involve large-muscle activities, such as moving one’s arms and walking.

• These skills are built upon, improved and better controlled throughout early childhood, and continue
in refinement throughout most of the individual’s years of development into adulthood.

• These skills develop in a head-to-toe order.

• Within a few weeks, though, they can hold their heads erect, and soon they can lift their heads while
prone.
• By 2 months of age, babies can sit while supported on a lap or an infant seat, but they cannot sit
independently until they are 6 or 7 months of age.

• Standing also develops gradually during the first year of life.

• By about 8 to 9 months of age, infants usually learn to pull themselves up and hold on to a chair, and
they often can stand alone by about 10 to 12 months of age.

• In the second year of life, toddlers become more motorically skilled and mobile.

• At 3 years of age, children enjoy simple movements such as hopping, jumping and running back
and forth, just for the sheer delight of performing these activities.
• At 4 years, children are still enjoying the same kind of activities, but they
have become more adventurous.

• At 5 years, children are even more adventuresome than they were at 4. They
may try to perform hair-raising stunts on practically any climbing object.

• During middle and late childhood, children’s motor development becomes

much smoother and more coordinated than it was in early childhood.

• As children move through the elementary school years, they gain greater
control over their bodies and can sit and pay attention for longer periods of
time.
 FINE MOTOR SKILLS
• Whereas gross motor skills involve large muscle activity, fine motor skills involve
finely tuned movements.

• Grasping a toy, using a spoon, buttoning a shirt, or anything that requires finger
dexterity demonstrates fine motor skills.

• Infants have hardly any control over fine motor skills at birth,
• but newborns do have many components of what will become finely coordinated
arm, hand, and finger movements.
• The onset of reaching and grasping marks a significant achievement in infants’ ability to interact
with their surroundings.

• Infants refine their ability to grasp objects by developing two types of grasps.

• Initially, infants grip with the whole hand, which is called the palmer grasp.

• Later, toward the end of the first year, infants also grasp small objects with their thumb and
forefinger, which is called the pincer grip.

• Their grasping system is very flexible

• They vary their grip on an object depending on its size, shape, and texture, as well as the size of
their own hands relative to the object’s size.
• Infants grip small objects with their thumb and forefinger (and sometimes their middle finger
too),

• whereas they grip large objects with all of the fingers of one hand or both hands.

• Perceptual-motor coupling is necessary for the infant to coordinate grasping.

• Which perceptual system the infant is most likely to use in coordinating grasping varies with age.

• Experience plays a role in reaching and grasping.

• Just as infants need to exercise their gross motor skills, they also need to exercise their fine motor
skills.
 PERCEPTUAL DEVELOPMENT IN
INFANCY
• Sensation occurs when information interacts with sensory receptors -the eyes, ears,
tongue, nostrils, and skin.

• Sensation is the process that allows our brains to take in information through our
five senses, Sensation occurs through our five sensory systems: vision, hearing, taste,
smell and touch.

• Perception is the interpretation of what is sensed.

Visual Acuity and Human Face

• At birth, the nerves and muscles and lens of the eye are still developing. As a result,
newborns cannot see small things that are far away.

• The newborn’s vision is estimated to be 20/240 on the well-known Snellen chart used
for eye examinations, which means that a newborn can see at 20 feet what a normal
adult can see at 240 feet.

• By 6 months of age, though, on average vision is 20/40.

• Infants show an interest in human faces soon after birth and spend more time looking
at their mother’s face than a stranger’s face as early as 12 hours after being born.
• By 3 months of age, infants match voices to faces, distinguish between male and
female faces, and discriminate between faces of their own ethnic group and those of
other ethnic groups.

• From 3 to 9 months of age, infants gradually began focusing their attention more on
the faces in the animated film and less on salient background stimuli.

• Robert Fantz(1963) revealed that even 2- to 3-week-old infants prefer to look at

patterned displays rather than nonpatterned displays.
Colour vision
• By 8 weeks, and possibly by even 4 weeks, infants can discriminate some
colors.
• By 4 months of age, they have color preferences that mirror adults’ in some
cases.
• In part, these changes in vision reflect maturation.
• Experience, however, is also necessary for vision to develop normally.
• one study found that experience is necessary for normal color vision to
develop.
Perceptual Constancy
• Perceptual constancy, in which sensory stimulation is changing but perception
of the physical world remains constant.
• Two types of perceptual constancy are size constancy and shape constancy.
• Size constancy is the recognition that an object remains the same even though
the retinal image of the object changes as you move toward or away from the
object.
• Shape constancy is the recognition that an object remains the same shape
even though its orientation to us changes.
• Researchers have found that babies as young as 3 months of age show size
constancy.
• As with size constancy, researchers have found that babies as young as 3
months of age have shape constancy.
• Three-month-old infants, however, do not have shape constancy for irregularly
shaped objects.
Perception of Occluded Objects
• In the first two months of postnatal development, infants don’t perceive
occluded objects as complete, instead only perceiving what is visible.
• Beginning at about 2 months of age, infants develop the ability to perceive
that occluded objects are whole.
• learning, experience, and self-directed exploration via eye movements play
key roles in the development of perceptual completion in young infants.
• Infants develop the ability to track briefly occluded moving objects at about 3
to 5 months of age.
Depth perception
• It is the ability to judge the distance of objects from one another and from
ourselves.
• Visual cliff, designed by Eleanor Gibson and Richard Walk (1960)and used in the
earliest studies of depth perception.
• It consist of a Plexiglas- covered table with a platform at the centre, a “shallow”
side with a checkboard pattern just under the glass, and a “deep” side with a
checkboard several feet below the glass.
• The researchers found that crawling babies readily crossed the shallow side, but
most avoided the deep side.
• They concluded that around the time that infant crawl, most distinguish deep
from shallow surfaces and avoid drop-offs.
• The visual cliff shows that crawling and avoidance of drop-off are linked, but not
hoe they are related or when depth perception first appears.
Hearing
• During the last two months of pregnancy, as the fetus nestles in its mother’s womb, it can
hear sounds such as the mother’s voice, music, and so on.
• The fetus can also recognize the mother’s voice, as one study demonstrated.
• Loudness: Immediately after birth, infants cannot hear soft sounds quite as well as adults
can; a stimulus must be louder to be heard by a newborn than by an adult
• Pitch: Infants are also less sensitive to the pitch of a sound than adults are. Pitch is the
perception of the frequency of a sound.
• By 2 years of age, infants have considerably improved their ability to distinguish sounds
with different pitches.
• Localization: Even newborns can determine the general location from where a sound is
coming, but by 6 months of age, they are more proficient at localizing sounds or detecting
their origins. Their ability to localize sounds continues to improve in the second year
Touch and Pain
• Newborns do respond to touch.

• A touch to the cheek produces a turning of the head; a touch to the lips
produces sucking movements.

• Newborns can also feel pain.

• Touch is a fundamental means of interaction between parents and babies.

• Touch helps easily stimulate early physical growth.

• Coordination of vision and touch has been well documented in 6-month-

olds.
Smell
• Newborns can differentiate odours.

• The expressions on their faces seem to indicate that they like the way vanilla
and strawberry smell but do not like the way rotten eggs and fish smell.

• In one investigation, 6-day-old infants who were breast fed showed a clear
preference for smelling their mother’s breast pad rather than a clean breast pad
Taste
• Sensitivity to taste might be present even before birth.

• When saccharin was added to the amniotic fluid of a near-term foetus,

swallowing increased.

• In one study, even at only two hours of age, babies made different facial
expressions when they tasted sweet, sour, and bitter solutions.

• At about 4 months of age, infants begin to prefer salty tastes, which as

newborns they had found to be aversive
 PHYSICAL DEVELOPMENT FROM
CHILDHOOD TO ADOLESCENCE
Early childhood
• Children grow rapidly between ages 3 & 6, but less quickly than before.
• At about 3, children normally begin to lose their babyish roundness and take on to lose
the slender, athletic appearance of childhood.
• As abdominal muscles develop, the toddler potbelly tightens.
• The trunk, arms and legs grow longer.
• The head is still relatively large, but the other parts of the body continue to catch up as
proportion steadily become more adult like.
• Cartilage turns to bones at a faster rate.
• Sleep patterns changes and problems: sleep patterns change throughout the
growing years and childhood has its own distinct rhythms.

• Brain development: Brain development during early childhood is less

dramatic than during infancy.

• A brain growth spurt continues until at least age 3, when the brain is
approximately 90%of adult weight.

• The density of synapses at prefrontal cortex peaks at age 4.

• Myelination of hearing pathways completed.

• By age 6, the brain has attained about 95%of peak volume.
Middle childhood
• Height and weight: Growth during middle childhood slows considerably.
• Children grows about 2-3 inches each year between 6-11 years and double their
weight during that period.
• Girls retain somewhat more fatty tissues.
• Nutrition and sleep: To support their steady growth and constant exertion
school children need on average 2400 calories every day.
• Sleep needs decline from about 11 hours a day at age 5 to a little more than 10
hours at age 9 and about 9 hours at age 13.
• 4: Maturation and learning in middle childhood and beyond depends on fine
tunings of the Brain’s connections along with more efficient selection of the
regions of the brain appropriate for particular tasks.
• These changes increase the speed and efficiency of brain processes and enhance
the ability to filter out irrelevant information.
Puberty
• The Physical Transition from Child to Adult.
• The onset of adolescence is heralded by two significant changes in physical
development.
• First, children change dramatically in size and shape as they enter the adolescent
growth spurt.
• Second, they also reach puberty, the point in life when an individual reaches
sexual maturity and becomes capable of producing a child.

The Adolescent Growth Spurt:

• The term growth spurt describes the rapid acceleration in height and weight that
marks the beginning of adolescence (a growth rate that is faster than any growth
rate since the children were infants).
• Girls typically enter the growth spurt by age 10, reach a peak growth rate by age
12 (about 1.3 years before menarche)
• Boys lag behind girls by 2 to 3 years: they typically begin their growth spurt by
age 13, peak at age 14 (mid- puberty), and return to a more gradual rate of
growth by age 16.
• In addition to growing taller and heavier, the body assumes an adult like
appearance during the adolescent growth spurt.
• The most noticeable changes are the appearance of breasts and a widening of the
hips for girls, and a broadening of the shoulders for boys.
• Facial features also assume adult proportions as the forehead protrudes, the nose
and jaw become more prominent, and the lips enlarge
Sexual Maturation
• Maturation of the reproductive system occurs at roughly the same time as the adolescent growth spurt and
follows a predictable sequence for girls and boys.
• For most girls, sexual maturation begins at about age to 11 as fatty tissue accumulates around their nipples,
forming small breast buds”. Full breast development, which takes about 3 to 4 years, finishes around age
14.
• Usually pubic hair begins to appear a little later, although as many as one-third of all girls develop
some pubic hair before their breasts begin to develop.

• Ovulatory menstrual cycles (menstruation without ovulation) are often associated with irregular
and painful periods. After 1 to 2 years, cycles become ovulatory, more regular, and less painful.

• In the year following menarche, female sexual development concludes as the breasts complete
their development and axillary (underarm) hair appears. Hair also appears on the arms, legs, and,
to a lesser degree, on the face.
• For boys, sexual maturation begins at about 11 to 12 (9.5 to 13.5) with an enlargement of the
testes.

• Meanwhile, the penis lengthens and widens. At about age 13 to 14%, sperm production begins.
•
• Body hair also grows on the arms and legs, although signs of a hairy chest may not appear until
the late teens or early 20s, if at all.

• Another hallmark of male sexual maturity is a lowering of the voice as the larynx grows and the
vocal cords lengthen.
Impact of Pubertal Events
Rapid Physical Changes
Sudden increase in height, weight, and body proportions (growth spurt).
Sexual Maturation
Development of primary and secondary sexual characteristics.
Onset of menstruation in girls and spermarche in boys.
Hormonal Changes
Increased secretion of sex hormones (estrogen, testosterone) influencing growth and behavior.
Body Image and Self-Concept
Physical changes affect self-esteem, body image, and self-awareness.
Emotional and Mood Changes
Greater emotional intensity, mood swings, and sensitivity due to hormonal fluctuations.
Cognitive and Psychological Impact
Improvement in abstract thinking, self-reflection, and identity formation.
Social and Interpersonal Changes
Increased interest in peer relationships, independence, and opposite-sex interactions.
Health and Adjustment Issues
Early or late maturation may lead to stress, anxiety, or social difficulties.
Need for Guidance and Support
Supportive family, education, and health care help adolescents cope with pubertal changes.
Factors Affecting Physical Development
Heredity (Genetic Factors)
Determines height, body structure, growth rate, and physical potential.
Nutrition
Adequate and balanced diet is essential for normal growth, energy, and body functioning.
Health and Illness
Chronic illness, infections, and disabilities can slow or impair physical development.
Prenatal Factors
Maternal health, nutrition, stress, and exposure to substances affect fetal development.
Hormonal Influences
Growth hormone, thyroid hormones, and sex hormones play a key role in physical maturation.
Physical Activity and Exercise
Regular activity promotes muscle strength, bone density, and overall fitness.
Sleep and Rest
Proper sleep supports growth, tissue repair, and hormonal balance.
Environmental Conditions
Living conditions, sanitation, climate, and pollution influence physical health.
Socio-economic and Cultural Factors
Family income, access to healthcare, education, and cultural practices impact growth patterns.
Parent–Child Relationship
Foundation of Development
The parent–child relationship forms the basis for physical, emotional, social, and cognitive
development.
Attachment and Emotional Security
Warm, responsive caregiving promotes secure attachment and a sense of safety.
Role in Socialization
Parents transmit values, norms, behavior patterns, and cultural practices.
Influence on Personality Development
Parenting behaviors shape self-esteem, confidence, and emotional regulation.
Communication and Interaction
Open, positive communication strengthens trust and mutual understanding.
Discipline and Guidance
Consistent and supportive discipline helps children develop self-control and responsibility.
Impact on Academic and Cognitive Growth
Parental involvement enhances learning, motivation, and achievement.
Changing Relationship Across Development
Relationship evolves from dependence in childhood to autonomy in adolescence.
Effects of Family Environment
Supportive and nurturing family environments promote healthy adjustment and well-being.
References
• Santrock, J.W. (2007). Life-span Development (13th ed). New York: McGraw Hill
Publishing Company
• Papalia, D.E [Link] (2004). Human Development (11th ed). New Delhi: Tata
McGraw Hill Publishing Company.
• Hurlock, E.B (1996). Developmental Psychology- A Lifespan Approach. New
Delhi: Tata McGraw Hill Publishing Company
• Berk, L.E (2003). Child Development (9th ed). New Delhi: Pearson Education
Pvt Ltd.