From birth to twelve

1. From birth to twelve Development in a nutshell

2. Primary prevention principles CACH works from a primary health care framework • Accessibility • Appropriate technology • Emphasis on health promotion • Inter sectoral collaboration • Community participation

3. Prevention levels CACH works predominantly in the area of primary prevention. Primary – health promoting strategies aimed at protection of health and wellbeing and prevention of illness (upstream) Secondary – strategies taken to recover from illness or to prevent further deterioration in health (mid stream) Tertiary – strategies to help cope with illness, disease or disability (down stream)

4. What are social determinants of health Social determinants of health are the economic and social conditions under which people live which determine their health. Virtually all major diseases are primarily determined by a network of interacting exposures that increase or decrease the risk for the disease.

5. Social gradient between groups and within groups Stress Early life Social exclusion Social support Addiction Food Transport Unemployment Work Social determinants of health

6. Life course determinants of health • Multiple determinants of health have different magnitudes of effect at different stages of life course • Health and disease status is the result of cumulative effects of risk factors and determinants across the life course and in certain circumstances • Early experiences effects later health status and decline in health status.

7. Importance of early years & brain development ‘Early brain development is one of the most important pathways to lifelong learning, behavioural competence, positive social relationships and health’

8. Developmental concepts By the 17th week of pregnancy the foetus has 1 billion brain cells proliferating at 50,000/second. The setting down of neuron connections continues rapidly and by 8 months of age there are approximately 1,000 trillion synapses. Pruning of unused connections continues for most of childhood though the brain retains flexibility for future learning. The brain works on a ‘use it or lose it’ principal

9. Developmental concepts Early brain development influences how we are wired up for life. The influence of stress, through the release of cortisol on the developing brain, impacts on children’s self regulation and effort control. Securely attached infants produce less cortisol in response to stress than children who are not having their emotional needs met.

10. Science of brain development • Brain is immature at birth • Brain is changed by experiences • Brains of infants, toddlers and preschoolers develop best in a nurturing environment • Adversity impacts brain development

11. Strategies to improve school readiness trajectories (Halfon and McLearn, 2002)

12. Human Brain Development – Language and Cognition Language Sensing Pathways Higher (vision, hearing) Cognitive Function 9 -3 3 1 0 6 4 8 12 16 -6 Months Years Conception AGE C. Nelson, in From Neurons to Neighborhoods, 2000.

13. How the brain reacts to lack of stimulation http://www.healthychild.ucla.edu/dropdownmenu/Powerpoints/BrownGR2405.pdf

14. Developmental concepts • Early brain development influences how we are wired up for life. • Infants are not blank slates and passive recipients • Parents are their child’s first and most influential teachers.

15. Cycle of early life experiences Developmentally not ready for school Poor health Poor educational & behavioural attainment at school Low-status, low-control jobs Increased risk of unemployment & social marginality

16. Growth and development Put simply • Growth is an increase in size • Development is an increase in complexity

17. Development What affects growth & development • Genetics • Intrauterine environment • Extrauterine environment • Basics of life available • Stimulation, opportunity and encouragement • Health – impact of life course and social determinants of health.

18. Capabilities of the newborn- one smart little vegemite. • Visual – can focus best at cradling distance, likes bright objects, programmed to faces • Hearing – knows parents voice from utero, stills or startles to sound • Taste – can determine salt and sweet, prefers breast over water any day • Smells – can identify mums breast milk within days • Touch – is comforted by touch, able to feel and react to pain. • Communicates through cry, has only needs not wants.

19. Developmental concepts • We all develop in the same sequence but the rate may vary. • Development progresses in a direction of cephlo – caudal and proximo –distal What that means is from top of head down and from the middle of the body out. • We master simple things first before progressing to more complex

20. Learning to walk take solid food to talk to control elimination of body waste Achieving physiological stability Slee,P.T Child, Adolescent and Family Development(2nd ed) Forming simple concepts regarding social and physical reality Learning about sex differences and sexual modesty to relate emotionally to parents, siblings and others to distinguish right and wrong and developing a conscience Developmental tasksEarly childhood

21. The challenges0-5 years • Attachment & bonding • Object permanence • Stranger anxiety • Safety • Play • Referral – who is out there ????

22. Theoristsbut don’t panic • Freud - Psychosexual theorist (you know the one who talks about the mouth, anus and penis amongst other things) The oral stage 0-1.5 years energy focused on the mouth, gains pleasure from mouth and attention is focused on the person gratification / help. The anal stage 1.5 -3.5 years energy focused on the anal area, gains pleasure from elimination or retention of faeces

23. Theoristsbut don’t panic • Freud The phallic stage 3.5 – 5.5 years energy focused on the genitals, issues become orientation to male and female identification The latency stage 5.5 -12 years energy / impulses are relatively dormant, focused on learning, mastering skills and acquiring new interests. And then comes ADOLESCENCE!

24. Theoristsbut don’t panic • Erikson - Psycho social theorist Viewed development as stages where we have to meet a crisis/ challenge before moving onto the next stage. Infancy Basic trust versus mistrust Through experiencing the world and consistency and continuity of care the infant develops a sense of trust, providing the foundation for a ‘sense of identity’ 1.5 – 3.5 years Autonomy versus shame and doubt Through experiencing independence they develop a sense of autonomy, if restricted they may feel shame or doubt

25. Theoristsbut don’t panic • Erikson - Psycho social theorist. 3.5 – 5.5 years Initiative versus guilt Through increasing independence and physical competency they have the opportunity to be themselves and develop a concept of who they are, if they don’t make the separation guilt can arise 5.5 – 12 years Industry versus inferiority The child aims for productivity and mastery but feels inferior if this is not achieved. But over the horizon is adolesence with all its issues

26. Theoristsbut don’t panic • Piaget – Cognitive development theorist Piaget identified that children think and understand the world differently from adults. He was a stage theorist where each level of knowledge incorporates and builds onto existing patterns of thought and behaviour. Over time children modify the way they think to deal with new information

27. Theoristsbut don’t panic • Piaget – Cognitive development theorist The Sensori – motor period 0-2 years Infants use their sensory systems and motor activity to help acquire knowledge about the world. This stage has 6 substages covering the period from primary reflexes through to representational thought. The Pre – operational period 2 -7 years The child develops symbolism, an understanding that enables one object or action to represent another, the development of language assist them to make further sense of their world and interact with others.

28. Theoristsbut don’t panic • Piaget – Cognitive development theorist The Concrete operational period 7 - 11 years The child can apply simple logic to solve problems, they begin to understand the relationship between things but still cannot think in abstract terms The Formal operational period 11+ years The child develops abstract reasoning and are able to think beyond the present and can appreciate possible relations among sets of elements.

29. Social Behaviour and play

30. Key stages in social development 0-5 years • 0-6 weeks Preference for attending to people Recognition of Mothers voice Intent regard of faces • 6-8 weeks Smiling emerges Imitation of facial expressions

32. Key stages in social development • 3 months Smiling and other facial expressions synchronised with those of caregivers • 5 months Growing interest in objects Some refusal to look at parents • 9 months Using referential gaze to direct parent’s attention to objects

34. Key stages in social development • 10 months Wary of strangers • 1-2 years Reactions to novel situations largely dependent on that of caregivers ( social referencing) Development of teasing – anticipating parents reaction to forbidden actions Protest and tantrums – limit testing

36. Key stages in social development • 2 -3 years Understanding of responsibility – leading to denial of transgressions Asking ‘what’ , ‘where’ questions Captivated by stories – focus shifts from actions of characters to feelings. • 3-4 years Breadth of interest in social world Asking ‘why’ questions Talk about inner states and rules – what is good, bad, naughty, allowed etc Able to adopt emotional states within pretend play.

37. Key stages in social development • 4 -5 years Growing understanding of rules Increasing understanding of the links between people’s mental state and actions – theory of mind.

38. Stages in development of friendships • 18 months Child shows awareness of another child’s distress • 20 months Mutual imitation Beginning to cooperate with a sibling / peer in order to achieve a goal • 2 years Development of preferences for particular companions Cooperating within a shared play theme eg tea party

39. Stages in development of friendships • 2 ½ years Able to adopt complementary roles within play scenarios eg mother – baby, doctor – patient Awareness of what is pretence eg pretending to be in pain, a hungry baby • 3 years Using references to friendship to include and exclude eg ‘I’m not your friend today’ Tendency to label any play companion as a friend so can appear fickle Development of ‘fighting friends’ ie reciprocal relationships that include both harmonious play and conflict Some children develop imaginary friends

41. Stages in development of friendships • 4 years Children are clear about who their friends are and will differentiate between friends and other peers Development of sophisticated sharing of a pretend world. Play includes sustained adventures, often including favourite characters from books or films, or everyday events. Fantasy play with strong emotional components such as fear, abandonment, bravery Alternative types of reciprocal play include sharing physical activities ( chasing, playing football, skipping) or shared mischief

43. Stages in development of friendships • 5 years Increasing understanding of the needs, feelings and wishes of friends Bargaining, compromise and reconciliation Able to talk about what makes someone a friend

44. Middle Childhood Middle childhood is often called a ‘quiet period ‘ developmentally but there’s is still a lot happening

46. The challenges5-12 years • Friendships and growing independence • Transition to school • Literacy acquisition • Safety • Obesity epidemic • Referral – who is out there ????

47. Learning Physical skills necessary for ordinary games To get along with age -mates An appropriate masculine or feminine role Building wholesome attitudes towards themselves as they grow Achieving personal independence Developing Fundamental skills in reading, writing and calculating Concepts needed for everyday living A conscience, morality and a scale of values Attitudes towards social groups and institutions Slee,P.T Child, Adolescent and Family development(2nd ed) Developmental tasksMiddle childhood

49. 7-8 year olds PHYSICAL DEVELOPMENT • Large muscles in arms and legs are more developed than small muscles. Children can bounce a ball and run, but it is difficult to do both at the same time. • There may be quite a difference in the size and abilities of children. This will affect the way they get along with others, how they feel about themselves, and what they do. Seven to nine-year-old children are learning to use their small muscle skills (printing with a pencil) and their large muscle skills (catching a fly ball). • Even though children are tired, they may not want to rest. You will need to plan time for them to rest.

50. 7-8 year olds SOCIAL AND EMOTIONAL DEVELOPMENT • Children want to do things by and for themselves, yet they need adults who will help when asked or when needed. • Seven to nine-year-old children of the same age and sex help each other: • have fun and excitement by playing together, • learn by watching and talking to each other, • in time of trouble by banning together, • by giving support in time of stress, and • understand how they feel about themselves.