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PS937: Infancy and Childhood - Coggle Diagram

- - - - why?
        
        immature development of organs
        
        rapid brain growth in 3rd trimester
        
        being cared for extra-uterine may lead to superimposed damage to organs
      - realities of survival
        
        pre-term birth (<37 weeks)
        
        10% chance of survival
        
        very pre-term birth (<32 weeks)
        
        1 to 2 %
    - - in utero perturbations alter foetal development
        
        'programming' effect on foetus
        
        affects future mental health
- - - - All babies wake up at night
        
        Night waking is adaptive in the 1st 6 months
        
        frequent waking stimulates breastfeeding
        
        breast milk breaks down quicker than formula milk
        
        means that it requires more frequent feeding (also at night)
        
        babies DOUBLE their weight in 1st 6 months
        
        totally determined by ENERGY intake
      - Basic sleep organisation (by 6 months)
        
        most babies (70%) can sleep > 6 hours in one piece by 6 months at night
    - - Increases over 1st 6 weeks
        
        reduces by 3 months
      - excessive crying
        
        excessive crying in 1st 3 months has NO impact on later developmental problems (Bell, et. al., 2018)
        
        BUT
        
        serious consequence: Shaken Baby Syndrome (or infant abuse)
        
        aka infantile colic
        
        Wessel, et. al. (1954) - rules of three
        
        3 or > hours of crying per day
        
        on 3 or > days per week
    - - 12 - 20 weeks
        
        may introduce pureed foods
  - - - Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Childhood: DC: 0 - 5 (2017) - note (from 7 months onwards)
        
        Sleep Onset
        
        1 hour to fall asleep at night
        
        30 min to fall asleep with parent present
        
        5 to 7 episodes per week
        
        at least 4 weeks in duration
        
        Night Waking
        
        waking on 5 or > nights per week that require parental intervention
    - - consistently eating less than expected for age
      - extremely picky eater
      - maladaptive eating behaviours
        
        consistent lack of interest in eating
        
        fearful avoidance of eating
        
        difficulty regulating state during feedings (e.g. falls asleep / becomes agitated)
        
        refusing to transition to solid foods
        
        eating ONLY WHEN specific conditions are fulfilled (e.g. tablet, TV, toys, etc.)
    - - can be comorbid
      - if persist > 3 months
      - single / persistent / multiple may have adverse long-term adverse effects
      - exact mechanisms not as yet known
      - larger studies needed
      - CASCADE Model
        
        early risk predictors can cumulatively influence maladaptive outcomes over time (Hentges, et. al., 2019)
        
        risk factors assessed in early childhood may affect the next phase of development, which in turn affects the following stage and so on
      - Possible Mechanisms
        
        Neurobiological
        
        HPA axis dysregulation
        
        Neurodevelopmental problems
        
        Genetics
        
        Pre-term birth / Neonatal Complications
        
        Parent-Child Interaction
      - Blaming the Parents?
        
        mother-child interaction not worse than those without RP (Postert, et. al., 2012)
        
        maternal sensitivity has little or no influence on excessive crying (Bilgin & Wolke, 2017)
        
        impact on parents
        
        increased risk of postnatal depression by 30 to 45%
        
        increased stress, anxiety & tiredness
        
        affect relationship quality
- - - - serious changes in the way children learn, behave or handle their emotions
      - when persistent, severe & impair functioning -> mental health disorders
        
        most common are
        
        neurodevelopmental
        
        ADHD
        
        autism spectrum
        
        learning disabilities
        
        Anxiety
        
        separation anxiety
        
        specific phobias
        
        Behaviour Disorders
        
        Oppositional Defiance Disorder
        
        Conduct Disorder
  - - - Healthy CAREGIVER-CHILD relationship provides the STRONGEST PROTECTIVE effects for infant / child's mental health
    - - Possible Explanations
        
        Broadening Diagnostic Criteria
        
        Better public & professional awareness
        
        Changes in individual vulnerability
        
        increased survival of very pre-term babies
        
        advanced maternal age
        
        in-utero exposure to anti-depressant medication
        
        secular trends in timing of puberty
        
        sleep problems
        
        Changes in family life
        
        changes in family composition
        
        parental mental health problems
        
        Changes in extra-familial psychosocial influences
        
        more stressful educational experiences
        
        socioeconomic & cultural influences
        
        strong links between poverty & child mental health problems
        
        disparty in rates of emotional problems between low and high income families increased
        
        social inequalities / adversities
        
        maternal distress
        
        exposure to stressful life events
        
        family conflict
    - - lack of studies in middle and low-income countries
      - change in risk factors over time
      - reasons for trends in population mental health are complex & multi-faceted
      - mechanisms underlying secular change remains poorly understood