Early Development - VIA University College

IP, RANDERS August 2010
EARLY DEVELOPMENT FROM BIRTH TO 4 YEARS AND
SPECIFICITY OF PREMATURE BABIES: SENSORIALITY
MODELS AND NEUROPSYCHOMOTOR EVALUATION.
Abstract:
Premature babies have specificities in their skills, therefore the psychomotricist
should know that to understand and evaluate their development. We know the
importance of early sensoriality development during pregnancy and fetus has early
skills. However, the immaturity is important and we must evaluate their capacity to
prevent disabilities. To do this work, we now have scales. With those scales we can
propose adapted stimulations for babies with disabilities or with risk‟s possibilities in
their development. That‟s the work I‟ll present in that text.
Key words: Development; sensoriality, premature babies; psychomotricity; plasticity
Séverine BEKIER ([email protected])
Psychomotricienne D.E.
Teacher and student‟s coordination at the
Psychomotrice”, PARIS
University degree of neuropsychology
University degree of babies‟ cognitive development
International master degree
“Institut
Supérieur
de
Rééducation
To understand babies‟ development, it‟s important to know how they do their
development and maturation during pregnancy, specificity for premature babies. Few
years ago, we thought that babies had no capacity, only eat and sleep. During those
last years, researches teach us about early development and skills. There is
immaturity but early sensoriality skills.
Importance of the sensoriality:
In his birth the baby sees, hears and recognizes the smells. He possesses biological
equipment which we are going to make him develop: it is the difference between
anatomical maturation and physiological maturation. The sensory signals are at first
meaningless, the child is going to give gradually a meaning: the signals
(extéroception, proprioception, viscéroception) are combined, organized and put in
memory. The newborn child, to be endowed with sensory skills, is bombarded with
information which he is going to have to organize, elaborate; to be able to set up his
representation and understanding of the world where he‟s living. This stage remits in
the inter-sensoriality and in the intermodal coordination, the specific skill which allows
a coherent organization of objects, persons and the entire environment in which he‟s
going to evolve. These vague sensations are gradually identified and can then get
organized in perceptions, cognitive elaboration appealing to the representations.
Sensoriality development:
From 14/15 weeks of amenorrhea, oculomotor muscles and eyeballs are formed. But
the visual system in the birth is not mature because the cabling and the myélinisation
are not finished. The baby can manage his glance towards a point but he does not
accommodate. His visual acuteness is very low (approximately 60 times less than the
adult).
The binocular vision is set up during the first 3 months.
The eye fixation (binding) and the jerky eye pursuit exist from the birth but are
function of the quality of the stimulus.
The tactile sense is one of 1st sense for the intra-uterine period: It begins around the
mouth (7 weeks) then face (11 weeks), trunk and roots of the members (15 weeks),
At 20 weeks the entire coetaneous surface, mucous membranes and thermal
sensibility in 24 weeks. The fetus „skin is in contact with the amniotic liquid and
sensitive with all tactile stimulations.
The nose and the nostrils are formed dices 7/9th weeks and appearance of the first
taste buds on the tongue and on the palace.
In 2 months the olfactive epithelium is differentiated well
In 3 months all the gustative system is functional.
The amniotic liquid has a flavor which varies according to the mother‟s food.
At the premature baby of 34SA, we observe an increase of the movements of gulp if
we inject some sweet liquid.
The newborn child shows gustative and olfactive preferences, he feels the aroma of
the food. He make difference by a mime of refusal or pleasure a bitter taste, either
sweet, or acid, or salty(steep).
He feels the sensations of warmth and cold and the consistency of food.
The milk of the mother to a taste which varies according to the food which she eats
and the baby is sensitive to it.
So, the baby recognizes her mother and his breast by the taste of the milk, the smell
of his mother. The mother also recognizes the smell of her baby.
For hearing, from 20 weeks, all the anatomical structures are formed and are
functional. Indeed, unlike the vision which is little stimulated before the birth, the other
senses are functional before the birth. We know now with certainty which the fetus
hears. Driving Answers of the fetus in 24 weeks further to an acoustic stimulation, in
particular acceleration of the heart rhythm and the global movements. The duration of
sounds must be rather long to be perceived and the grave sounds cross better the
abdominal wall. The baby of 3 days recognizes the maternal voice, his stamp, his
rhythm and his intensity and in 4 days he prefers the mother tongue. They recognize
the PROSODY of the language. The infant of a few days is capable of differentiating
2 syllables «ba» and "pa". So, he‟s equipped with specific detectors of the linguistic
function allowing him to make the difference between the sounds "ta" and the "da", or
"pa" and "ma".
Balance: Semi-circular canals and labyrinth are mature from the 15è week. The fetus
receives vestibular stimulations by the movements of the body of the mother and by
its own movements.
The vestibular device gives information to the location of the head and its movements
in the space, as well as those of the trunk.
It controls the static and dynamic balances of the body as well as the oculomotricité.
The vestibular system is mature forward with the complete myélinisation of the fibers
of the nerve.
So we can observe that all the sense are ready to work from the birth and even
before, as we can see with premature babies.
Prematurity:
The frequency of the prematurity always progress in France these last years. The
prematurity (birth before the 37th week of amenorrhea) concerned 7, 1 % of the
births in 2003. This figure exceeds the 8 % today, whereas France appears among
the European countries where this frequency is the highest.
The most frequent prematurity is the one from 32 to 37 weeks (4 in 5 % of the total
births). The big prematurity, of 27-32 weeks, represents approximately 1 % of the
births. We speak about very big premature babies even about prématurissimes for
the children been born unless 27 weeks. In France the limit of the prematurity is fixed
to 24 weeks.
If 30 % to a 40 % of them live without aftereffects or heavy infirmities (hemiplegic,
deep deafness, vegetative state), some suffer nevertheless from mild problems
(hyperactivity, attention disorders).
The prematurity is responsible for the majority of the premature neonatal mortality
and for numerous complications such as:
·
Pulmonary: the disease of membranes hyalines which is a secondary
pathology in incapacity or an absence of surfactant production, meaning respiratory
distress syndrome. It requires mostly an important care in neonatology with in
particular artificial ventilation which considerably improved Forecast of the children.
The major risk is the evolution in a dysplasia, requiring a long-term care.
·
Neurological: we find mainly the intra-ventriculaires bleedings (they are found
in 15 in 50 % of cases with premature babies having a lower born weight than 1500g)
and the leucomalacie périventriculaire (15 to 25 % of cases with premature babies
having a lower born weight than 1500g). These two pathologies are the main found
neurological complications and the most serious aftereffects of which are the cerebral
palsy or the intellectual driving infirmity
·
Digestive: the ulcéro-necrotizing entérocolite is a serious complication which
gets approximately 1 3 % of the hospitalized premature babies.
·
Intellectuals: the biological immaturity has a long impact on what these
children are going to make at school. If a moderate prematurity occurred and if others
factors are present, a minor delay of development is likely. The children of primary
school who were very born prematurely they are 3 - 4 times as susceptible to
difficulties of learning as the forward born children or the premature children followed
enough early on the neurodéveloppemental plan.
As we saw, there are many possibilities of disabilities for premature babies, that‟s
why it‟s important to evaluate and prevent impair of development. We must have
tools to realize this evaluation and it‟s important to know everything about normal
development of fetus and babies from birth to 4 years old.
We know now the importance of cerebral plasticity, and early rehabilitation with
psychomotor stimulations is demonstrated.
Neuropsychomotor evaluation:
Premature baby presents an important axial and peripheral hypotonicity which we
have to take into account. He must not be compared with a normal born baby but by
taking care about the specificity of his gestational age.
The evaluation, realized according to the railing of L.VAIVRE-DOURET, is inspired by
works of S. SAINT-ANNE OF ARGASSIES, C. AMIEL-TISON and A. GRENIER. It‟s
based on the observation and the quotation of the passive tonus, active tonus,
primary reflexes and capacities of awakening (eye pursuit, reaction to the noise…).
Every item is quoted and allows determining a score of maturation in touch with the
gestational age of the baby. It allows detecting the early signs of neurological
aftereffects on a said population “at risk”.
During the first year a special attention is proposed to passive and active tonus. We
also look at psychomotor and intermediate stages: reversal, based station, crawl,
climb, 4 legs…
That‟s why I use the scale of L. Vaivre-Douret for child from 0 to 48 month. This
permitted to evaluate a level of functional motor. It takes also into account the
motility, cognitive evolution, comportment and capacities of manipulation of the child.
So, it is important to take care of babies and child development during the first years,
to be able to propose intervention if it‟s needed, even more for a population said at
risk. This work can be specifically realized by the psychomotrician which has the
specificity of a global approach around the body and self-fulfillment of the child
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