Malnutrition--In 1998, approximately one-third of the world’s children suffered from hunger or a lack of needed nutrients. Malnutrition is most common in developing countries, but children in North America regularly experience hunger and food insecurity. Severe malnutrition can cause marasmus (typically infants with a diet low in all nutrients) and/or kwashiorkor (a lack of protein common to weaned toddlers).
Failure to thrive--This general diagnosis describes the inability of infants to gain expected weight and often height as well. There are many reasons babies may not be growing. These include physical causes, such as gastrointestinal disorders or genetic syndromes. But there can also be social-emotional reasons for the lack of growth. Babies need affection and emotional connections as much as they need nutrients to be healthy. Stunted growth without a medical cause is called nonorganic failure to thrive. Interventions for both physical and emotional failure to thrive syndrome are critical since babies can suffer permanent, or even fatal, damage as a result.
Head circumference--An abnormally large or small head is a developmental red flag. Both are associated with various disorders such as retardation. Recent research identifies abnormally rapid head growth in infancy as an indicator of autism.
Dwarfism--A condition, usually inherited, that causes short stature (defined as an adult 4’10” or smaller). There are different types of dwarfism; some affect the growth of the limbs, and others the size of the trunk. Dwarfism is just one example of the many genetic growth abnormalities.
Colic--Uncontrollable crying for unknown reasons in young infants. Colic occurs in 25% of all infants ages two weeks to three or four months, when it usually just vanishes. Colic has no known cause, though many theories exist, including problems with digestion, neurological immaturity, and environmental sensitivity due to temperament (more on this in Chapter Four). Similarly, there are many recommendations for treatment, but there is no real cure for colic. Suggestions to reduce crying include soothing techniques, homeopathic remedies, and avoidance of certain foods for nursing mothers or formulas for bottle-fed babies. A new study from the University of Turin in Italy has shown a dramatic reduction in the crying of colicky babies who were given probiotics, or so-called “good bacteria” (Savino, 2007). Colic is extremely stressful for all the members of the infant’s family, since infant crying is designed to be impossible to ignore.
Different conditions can cause variations in normal motor development. For example, infants with Down syndrome tend to have low muscle tone (hypotonic) and are less active. Some children with cerebral palsy have low tone while others may have high muscle tone (hypertonic), which can also slow development. Other disorders that impact motor development are congenital heart defects, clubfoot, visual impairments, and cleft lip or palate. Other malformations of the neuromotor or musculoskeletal systems can affect motor skill progression.
Atypical Sleep Issues--There are many types and causes of atypical sleep in infants. Sleep problems are rarely seen in countries where infants sleep with their parents. Physical causes should be ruled out first by the pediatrician before focusing on environmental factors.
Sudden Infant Death Syndrome (SIDS)--The unexplained death of a previously healthy infant younger than one year. While thankfully uncommon, SIDS is the leading cause of death for infants under 12 months. Most SIDS deaths are in babies younger than six months (90%) and older than one month (two to four months is the riskiest period). Infants are usually found dead in bed with no obvious signs of distress. No specific cause or prevention for this tragic syndrome has yet been identified, but there are ways to reduce risks:
- Put babies to sleep on their backs. “Back to Sleep” is the campaign slogan of an effort to reduce SIDS deaths by the National Institute of Child Health and Human Development (NICHD), as back-sleeping infants are much less likely to die of SIDS. Back sleeping has been linked to some unintended consequences with motor development (more below).
- Keep babies’ sleep areas (and faces) clear of bedding (such as pillows and bumpers) and use a firm mattress.
- Don’t overheat infants with covers and too many layers of clothes
- Don’t smoke around babies.
NICHD and the APA also recommend that babies should never sleep with another person because of risks of suffocation by smothering. This advice is controversial since research results are mixed and there is a strong cultural bias against the practice in many western countries.
Co-sleeping, or the family bed--This is the practice in most of the world. Sleeping arrangements, like other care routines, reflect cultural values. Western countries, such as the U.S., are considered individualistic cultures and believe that independence is very important. Collective cultures, such as those in Asia, value the group over the individual and view co-sleeping as necessary to social development.
Effects of back sleeping--While the rate of SIDS has lowered as intended, there have also been some unexpected consequences. Studies have found that back-sleeping infants (under one year) are reaching motor milestones later than front sleepers (such as rolling over, crawling, sitting, and standing). This is because babies who sleep on their backs do not have as many opportunities for “tummy time.” Infants need to have sufficient time on their stomachs to push up and strengthen their upper bodies. Delays caused by back sleeping are slight, however, and milestones are still met within the normal range of development.
It is important for caregivers to put awake babies down on their fronts regularly to encourage upper body development. This will also help minimize flat spots on the back of an infant’s head--the other main problem associated with infant back sleeping. Remember that neither of these consequences outweighs the benefits of back-to-sleep in reducing infant deaths from SIDS.
Atypical Feeding Issues
There are various problems that infants can experience with feeding--25% of babies have some sort or another, especially those with developmental delays (Penn State Children’s Hospital, 2008). One of the most common is gastro esophageal reflux disease (GER), when stomach acids flow backward (reflux). Other causes of feeding disorders include problems with the mouth and tongue, extended early tube feeding, or food allergies.
Safety Issues
Infants’ drive to explore often puts them in harm’s way, so adult guidance is essential. Choking and accidents such as falls pose the biggest risks to young babies. Adults can reduce dangers by childproofing, using appropriate car seats, and eliminating environmental risk factors (second-hand smoke, lead, inappropriate equipment, etc.).
Unfortunately, sometimes adults harm rather than protect infants. A large national study conducted by the CDC found that an alarming one in fifty infants suffer from non-fatal abuse or neglect. The most common abusive injury to infants is shaken baby syndrome, which can cause irreversible brain damage or death. This happens most often to three- to eight-month-olds from a caregiver in response to continued crying.