Assignment: Gross and Fine Motor Skill Development
Assignment: Gross and Fine Motor Skill Development
Infants grow and develop at different and varying phases. As a school psychologist, you have been asked to describe motor skill development in infants for your child’s daycare.
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The educators and parents have specifically requested information related to gross and fine motor skill development. In your response, compare and contrast your perceptions with your classmates.
Also, be sure to reference minimally two (2) citations from this unit’s reading assignments.
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AssignedReadingUnit2.docchapter 3
PRENATAL DEVELOPMENT AND BIRTH
chapter outline
Learning Goal 1 Describe prenatal development.
The Course of Prenatal Development
Teratology and Hazards to Prenatal Development
Learning Goal 2 Describe the birth process.
Preterm and Low Birth Weight Infants
Learning Goal 3 Explain the changes that take place in the postpartum period.
Emotional and Psychological Adjustments
Diana and Roger married whenPage 75 he was 38 and she was 34. Both worked full-time and were excited when Diana became pregnant. Two months later, Diana began to have some unusual pains and bleeding. Just two months into her pregnancy she lost the baby. Although most early miscarriages are the result of embryonic defects, Diana thought deeply about why she had been unable to carry the baby to full term, and felt guilty that she might have done something “wrong.”
Six months later, Diana became pregnant again. Because she was still worried about her prior loss, she made sure to follow every government recommendation such as getting enough folic acid, avoiding certain types of dairy products that might harbor bacteria, and letting someone else change their cat’s litterbox to avoid toxoplasmosis. She and Roger read about pregnancy and signed up for birth preparation classes. Each Friday night for eight weeks they practiced techniques for dealing with contractions. They talked about what kind of parents they wanted to be and discussed what changes in their lives the baby would make. When they found out that their offspring was going to be a boy, they gave him a nickname: Mr. Littles.
Alex, also known as “Mr. Littles.” Courtesy of Dr. John Santrock
This time, Diana’s pregnancy went well, and Alex, also known as Mr. Littles, was born. During the birth, however, Diana’s heart rate dropped precipitously, and she was given a stimulant to raise it. Apparently the stimulant also increased Alex’s heart rate and breathing to a dangerous point, and he had to be placed in a neonatal intensive care unit (NICU).
Several times a day, Diana and Roger visited Alex in the NICU. A number of babies in the NICU with very low birth weights had been in intensive care for weeks, and some of the babies were not doing well. Fortunately, Alex was in better health. After he had spent several days in the NICU, his parents were permitted to take home a very healthy Alex.
topical connections looking back
Genes form the biological basis of our development. They are passed on through mitosis, meiosis, and, ultimately, fertilization. The impact of our genes involves the genetic principles of dominant-recessive genes, sex-linked genes, genetic imprinting, and polygenically determined characteristics. Approximately 10 to 15 percent of U.S. couples have problems with fertility. Some of these problems can be solved through surgery, drugs, or in vitro fertilization. Whether a pregnancy occurs naturally or with assistance, the resulting infant’s development is shaped both by his or her genes (nature) and environment (nurture).
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This chapter chronicles the truly remarkable developments from conception through birth. Imagine . . . at one time you were an organism floating in a sea of fluid in your mother’s womb. Let’s now explore what your development was like from the time you were conceived through the time you were born. We will explore normal development in the prenatal period, as well as the period’s hazards (such as high levels of mercury that were mentioned in the preceding story). We also will study the birth process and tests used to assess the newborn; discuss parents’ adjustment during the postpartum period; and evaluate parent-infant bonding.
1 Prenatal Development
LG1 Describe prenatal development.
The Course of Prenatal Development
Teratology and Hazards to Prenatal Development
Prenatal Care
Normal Prenatal Development
Imagine how Alex (“Mr. Littles”) came to be. Out of thousands of eggs and millions of sperm, one egg and one sperm united to produce him. Had the union of sperm and egg come a day or even an hour earlier or later, he might have been very different—maybe even of the opposite sex. Conception occurs when a single sperm cell from the male unites with an ovum (egg) in the female’s fallopian tube in a process called fertilization. Over the next few months, the genetic code discussed in the “Biological Beginnings” chapter directs a series of changes in the fertilized egg, but many events and hazards will influence how that egg develops and becomes tiny Alex.
The history of man for the nine months preceding his birth would, probably, be far more interesting, and contain events of greater moment, than all the three score and ten years that follow it.
—Samuel Taylor Coleridge
English Poet and Essayist, 19th Century
THE COURSE OF PRENATAL DEVELOPMENT
Typical prenatal development, which begins with fertilization and ends with birth, takes between 266 and 280 days (38 to 40 weeks). It can be divided into three periods: germinal, embryonic, and fetal.
The Germinal Period The germinal period is the period of prenatal development that takes place during the first two weeks after conception. It includes the creation of the fertilized egg, called a zygote; cell division; and the attachment of the zygote to the uterine wall.
Rapid cell division by the zygote continues throughout the germinal period (recall that this cell division occurs through a process called mitosis). Differentiation—specialization of cells to perform various tasks—starts to take place by approximately one week after conception. At this stage, the group of cells, now called the blastocyst , consists of an inner mass of cells that will eventually develop into the embryo, and the trophoblast , an outer layer of cells that later provides nutrition and support for the embryo. Implantation, the attachment of the zygote to the uterine wall, takes place about 11 to 15 days after conception. Figure 1illustrates some of the most significant developments during the germinal period.
The Embryonic Period The embryonic period is the period of prenatal development that occurs from two to eight weeks after conception. During the embryonic period, the rate of cell differentiation intensifies, support systems for cells form, and organs appear.
This period begins as the blastocyst attaches to the uterine wall. The mass of cells is now called an embryo, and three layers of cells form. The embryo’s endoderm is the inner layer of cells, which will develop into the digestive and respiratory systems. The mesoderm is the middle layer, which will become the circulatory system, bones, muscles, excretory system, and reproductive system. The ectoderm is the outermost layer, which will become the nervous system and brain, sensory receptors (ears, nose, and eyes, for example), and skin parts (hair and nails, for example). Every body part eventually develops from these three layers. The endoderm primarily produces internal body parts, the mesoderm primarily produces parts that surround the internal areas, and the ectoderm primarily produces surface parts.
As the embryo’s three layers form, life-support systems for the embryoPage 77 develop rapidly. These life-support systems include the amnion, the umbilical cord (both of which develop from the fertilized egg, not the mother’s body), and the placenta. The amnion is a sac (bag or envelope) that contains a clear fluid in which the developing embryo floats. The amniotic fluid provides an environment that is temperature and humidity controlled, as well as shockproof. The umbilical cord contains two arteries and one vein, and connects the baby to the placenta. The placenta consists of a disk-shaped group of tissues in which small blood vessels from the mother and the offspring intertwine but do not join.
Figure 2 illustrates the placenta, the umbilical cord, and the blood flow in the expectant mother and developing organism. Very small molecules—oxygen, water, salt, food from the mother’s blood, as well as carbon dioxide and digestive wastes from the offspring’s blood—pass back and forth between the mother and embryo or fetus (Cuffe & others, 2017; Dube, Desparois, & Lafond, 2018). Virtually any drug or chemical substance the pregnant woman ingests can cross the placenta to some degree, unless it is metabolized or altered during passage, or the molecules are too large to pass through the placental wall (Pfeifer & Bunders, 2016). Of special concern is the transfer through the placenta of drugs that can be harmful to the fetus, such as alcohol, nicotine, marijuana, and cocaine (Koren & Ornoy, 2018). For example, one study confirmed that ethanol crosses the human placenta and primarily reflects maternal alcohol use (Matlow & others, 2013). Another study revealed that cigarette smoke weakened and increased the oxidative stress of fetal membranes, from which the placenta develops (Menon & others, 2011). The stress hormone cortisol also can cross the placenta (Parrott & others, 2014). Large molecules that cannot pass through the placental wall include red blood cells and harmful substances, such as most bacteria, maternal wastes, and hormones. The complex mechanisms that govern the transfer of substances across the placental barrier are still not entirely understood (Huckle, 2017; Jeong & others, 2018; Vaughan & others, 2017; Zhang & others, 2018). Assignment: Gross and Fine Motor Skill Development
By the time most women know they are pregnant, the major organs have begun to form. Organogenesis is the name given to the process of organ formation during the first two months of prenatal development. While they are being formed, the organs are especially vulnerable to environmental changes (Rios & Clevers, 2018; Schittny, 2017). In the third week after conception, the neural tube that eventually becomes the spinal cord forms. At about 21 days, eyes begin to appear, and at 24 days the cells for the heart begin to differentiate. During the fourth week, the urogenital system becomes apparent, and armPage 78 and leg buds emerge. Four chambers of the heart take shape, and blood vessels appear. From the fifth to the eighth week, arms and legs differentiate further; at this time, the face starts to form but still is not very recognizable. The intestinal tract develops and the facial structures fuse. At eight weeks, the developing organism weighs about 1/30 ounce and is just over 1 inch long.
The Fetal Period The fetal period , lasting about seven months, is the prenatal period between two months after conception and birth in typical pregnancies. Growth and development continue their dramatic course during this time.
Three months after conception (13 weeks), the fetus is about 3 inches long and weighs about four-fifths of an ounce. Its arms, legs, and head move randomly (or spontaneously), and its mouth opens and closes. The face, forehead, eyelids, nose, and chin are distinguishable, as are the upper arms, lower arms, hands, and lower limbs. In most cases, the genitals can be identified as male or female. By the end of the fourth month of pregnancy (17 weeks), the fetus has grown to about 5.5 inches in length and weighs about 5 ounces. At this time, a growth spurt occurs in the body’s lower parts. For the first time, the mother can feel the fetus move.
By the end of the fifth month (22 weeks), the fetus is about 12 inches long and weighs close to a pound. Structures of the skin have formed—toenails and fingernails, for example. The fetus is more active, showing a preference for a particular position in the womb. By the end of the sixth month (26 weeks), the fetus is about 14 inches long and has gained another half pound to a pound. The eyes and eyelids are completely formed, and a fine layer of hair covers the head. A grasping reflex is present and irregular breathing movements occur.
As early as six months of pregnancy (about 24 to 25 weeks after conception), the fetus for the first time has a chance of surviving outside the womb—that is, it is viable. Infants who are born early, or between 24 and 37 weeks of pregnancy, usually need help breathing because their lungs are not yet fully mature. By the end of the seventh month, the fetus is about 16 inches long and weighs about 3 pounds.
During the last two months of prenatal development, fatty tissues develop, and the functioning of various organ systems—heart and kidneys, for example—steps up. During the eighth and ninth months, the fetus grows longer and gains substantial weight—about another 4 pounds. At birth, the average American baby weighs 8 pounds and is about 20 inches long.
Figure 3 gives an overview of the main events during prenatalPage 79 development. Notice that instead of describing development in terms of germinal, embryonic, and fetal periods, Figure 3 divides prenatal development into equal periods of three months, called trimesters. Remember that the three trimesters are not the same as the three prenatal periods we have discussed. The germinal and embryonic periods occur in the first trimester. The fetal period begins toward the end of the first trimester and continues through the second and third trimesters. Viability (the chances of surviving outside the womb) begins at the end of the second trimester. Assignment: Gross and Fine Motor Skill Development
developmental connection
Brain Development
At birth, infants’ brains weigh approximately 25 percent of what they will weigh in adulthood. Connect to “Physical Development in Infancy.”
Brain Development One of the most remarkable aspects of the prenatal period is the development of the brain (Andescavage & others, 2017). By the time babies are born, it has been estimated that they have as many as 20 to 100 billion neurons , or nerve cells, which handle information processing at the cellular level in the brain. During prenatal development, neurons spend time moving to the right locations and are starting to become connected. The basic architecture of the human brain is assembled during the first two trimesters of prenatal development. In typical development, the third trimester of prenatal developmentPage 80 and the first two years of postnatal life are characterized by gradual increases in connectivity and functioning of neurons.
Four important phases of the brain’s development during the prenatal period involve: (1) the neural tube, (2) neurogenesis, (3) neuronal migration, and (4) neural connectivity.
Neural Tube As the human embryo develops inside its mother’s womb, the nervous system begins forming as a long, hollow tube located on the embryo’s back. This pear-shaped neural tube, which forms at about 18 to 24 days after conception, develops out of the ectoderm. The tube closes at the top and bottom ends at about 27 days after conception (Keunen, Counsell, & Bender, 2017). Figure 4 shows that the nervous system still has a tubular appearance six weeks after conception.
Two birth defects related to a failure of the neural tube to close are anencephaly and spina bifida. The highest regions of the brain fail to develop when fetuses have anencephaly or when the head end of the neural tube fails to close, and these fetuses die in the womb, during childbirth, or shortly after birth (Steric & others, 2015). Spina bifida results in varying degrees of paralysis of the lower limbs (Li & others, 2018; Miller, 2017). Individuals with spina bifida usually need assistive devices such as crutches, braces, or wheelchairs (Grivell, Andersen, & Dodd, 2014). Both maternal diabetes and obesity place the fetus at risk for developing neural tube defects (Yu, Wu, & Yang, 2016). Also, one study found that maternal exposure to secondhand tobacco smoke was linked to neural tube defects (Suarez & others, 2011). Further, one study revealed that a high level of maternal stress during pregnancy was associated with neural tube defects in offspring (Li & others, 2013). A strategy that can help to prevent neural tube defects is for pregnant women to take adequate amounts of the B vitamin folic acid (Li & others, 2018; Viswanathan & others, 2017). A recent large-scale study in Brazil found that fortifying flour with folic acid significantly reduced the rate of neural tube defects (Santos & others, 2016).
Neurogenesis In a normal pregnancy, once the neural tube has closed, a massive proliferation of new immature neurons begins to takes place at about the fifth prenatal week and continues throughout the remainder of the prenatal period. The generation of new neurons is called neurogenesis , a process that continues through the remainder of the prenatal period but is largely complete by the end of the fifth month after conception (Keunen, Counsell, & Benders, 2017). At the peak of neurogenesis, it is estimated that as many as 200,000 neurons are generated every minute. Assignment: Gross and Fine Motor Skill Development
Neuronal Migration At approximately 6 to 24 weeks after conception, neuronal migration occurs. This involves cells moving outward from their point of origin to their appropriate locations and creating the different levels, structures, and regions of the brain (Keunen, Counsell, & Benders, 2017). Once a cell has migrated to its target destination, it must mature and develop a more complex structure.
Neural Connectivity At about the 23rd prenatal week, connections between neurons begin to occur, a process that continues postnatally (Miller, Huppi, & Mallard, 2016). We will have much more to say about the structure of neurons, their connectivity, and the development of the infant brain in the chapter on “Physical Development in Infancy.”
TERATOLOGY AND HAZARDS TO PRENATAL DEVELOPMENT
For Alex, the baby discussed at the opening of this chapter, the course of prenatal development went smoothly. His mother’s womb protected him as he developed. Despite this protection, the environment can affect the embryo or fetus in many well-documented ways.
General Principles A teratogen is any agent that can potentially cause a birth defect or negatively alter cognitive and behavioral outcomes. (The word comes from the Greek word tera, meaning “monster.”) So many teratogens exist that practically every fetus is exposed to at least some teratogens. For this reason, it is difficult to determine which teratogen causes which problem. In addition, it may take a long time for the effects of a teratogen to show up. Only about half of all potential effects appear at birth. Assignment: Gross and Fine Motor Skill Development
The field of study that investigates the causes of birth defects isPage 81 called teratology (Boschen & others, 2018; Cassina & others, 2017). Some exposures to teratogens do not cause physical birth defects but can alter the developing brain and influence cognitive and behavioral functioning. These deficits in functioning are explored by researchers in the field of behavioral teratology.
The dose, genetic susceptibility, and the time of exposure to a particular teratogen influence both the severity of the damage to an embryo or fetus and the type of defect:
· Dose. The dose effect is rather obvious—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 (Lin & others, 2017). For example, how a mother metabolizes a particular drug can influence the degree to which the drug’s effects are transmitted to the embryo or fetus. The extent to which an embryo or fetus is vulnerable to a teratogen may also depend on its genotype (Middleton & others, 2017). Also, for unknown reasons, male fetuses are far more likely to be affected by teratogens than female fetuses.
· Time of exposure. Exposure to teratogens does more damage when it occurs at some points in development than at others (Feldkamp & others, 2017). Damage during the germinal period may even prevent implantation. In general, the embryonic period is more vulnerable than the fetal period.
Figure 5 summarizes additional information about the effects of time of exposure to a teratogen. The probability of a structural defect is greatest early in the embryonic period, when organs are being formed (Mazzu-Nascimento & others, 2017). Each body structure has its own critical period of formation. Recall from earlier discussions that a critical period is a fixed time period very early in development during which certain experiences or events can have a long-lasting effect on development. The critical periodPage 82 for the nervous system (week 3) is earlier than for arms and legs (weeks 4 and 5). Exposure to teratogens in the fetal period is more likely to cause problems in how organs function and may result in stunted growth rather than structural damage.
After organogenesis is complete, teratogens are less likely to cause anatomical defects. Instead, exposure during the fetal period is more likely to stunt growth or to create problems in the way organs function. This is especially true for the developing fetal brain, which continues to develop connections throughout pregnancy. To examine some key teratogens and their effects, let’s begin with drugs. Assignment: Gross and Fine Motor Skill Development
Prescription and Nonprescription Drugs Many U.S. women are given prescriptions for drugs while they are pregnant—especially antibiotics, analgesics, and asthma medications. Prescription as well as nonprescription drugs, however, may have effects on the embryo or fetus that the women never imagine.
Prescription drugs that can function as teratogens include antibiotics, such as streptomycin and tetracycline; some antidepressants; certain hormones, such as progestin and synthetic estrogen; and Accutane (the trade name for isotretinoin, a form of Vitamin A that is often used to treat acne) (Brown & others, 2018; Dathe & Schaefer, 2018). Among the birth defects caused by Accutane are heart defects, eye and ear abnormalities, and brain malformation. In a recent study, isotretinoin was the fourth most common drug given to female adolescents who were seeking contraception advice from a physician (Stancil & others, 2017). However, physicians did not give the adolescent girls adequate information about the negative effects of isotretinoin on offspring if the girls were to become pregnant. In a recent review of teratogens that should never be taken during the first trimester of pregnancy, isotretinoin was on the prohibited list (Eltonsy & others, 2016).
Nonprescription drugs that can be harmful include diet pills and high dosages of aspirin (Cadavid, 2017). Research indicates that low doses of aspirin pose no harm for the fetus but that high doses can contribute to maternal and fetal bleeding (Osikoya & others, 2017).
Psychoactive Drugs Psychoactive drugs act on the nervous system to alter states of consciousness, modify perceptions, and change moods. Examples include caffeine, alcohol, and nicotine, as well as illicit drugs such as cocaine, marijuana, and heroin.
Caffeine People often consume caffeine when they drink coffee, tea, or cola, or when they eat chocolate. Somewhat mixed results have been found for the extent to which maternal caffeine intake influences an offspring’s development (Adams, Keisberg, & Safranek, 2016; de Medeiros & others, 2017). However, a large-scale study of almost 60,000 women revealed that maternal caffeine intake was linked to lower birth weight and babies being born small for gestational age (Sengpiel & others, 2013). Also, the influence of maternal consumption of highly caffeinated energy drinks on the development of offspring has not yet been studied. The U.S. Food and Drug Administration recommends that pregnant women either not consume caffeine or consume it only sparingly.
Alcohol Heavy drinking by pregnant women can be devastating to their offspring (Jacobson & others, 2017). Fetal alcohol spectrum disorders (FASD) are a cluster of abnormalities and problems that appear in the offspring of mothers who drink alcohol heavily during pregnancy (Del Campo & Jones, 2017; Helgesson & others, 2018). The abnormalities include facial deformities and defects of the limbs and heart (Pei & others, 2017; Petrenko & Alto, 2017). Most children with FASD have learning problems and many are below average in intelligence, with some having an intellectual disability (Khoury & Milligan, 2017). Also, in a recent study in the United Kingdom, the life expectancy of individuals with FASD was only 34 years of age, about 42 percent of the average life expectancy in the general population (Thanh & Jonsson, 2016). In this study, the most common causes of death among individuals with FASD were suicide (15 percent), accidents (14 percent), and poisoning by illegal drugs or alcohol (7 percent). A recent research review concluded that FASD is linked to a lower level of executive function in children, especially in planning (Kingdon, Cardoso, & McGrath, 2016). And in a recent study, FASD was associated with both externalized and internalized behavior problems in childhood (Tsang & others, 2016). 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. Assignment: Gross and Fine Motor Skill Development
What are some guidelines for alcohol use during pregnancy?Page 83 Even drinking just one or two servings of beer or wine or one serving of hard liquor a few days a week can have negative effects on the fetus, although it is generally agreed that this level of alcohol use will not cause fetal alcohol syndrome (Valenzuela & others, 2012; Sarman, 2018). The U.S. Surgeon General recommends that no alcohol be consumed during pregnancy, as does the French Alcohol Society (Rolland & others, 2016). Despite such recommendations, a recent large-scale U.S. study found that 11.5 percent of adolescent and 8.7 percent of adult pregnant women reported using alcohol in the previous month (Oh & others, 2017).
However, in Great Britain, the National Institutes of Care and Health Excellence have concluded that it is safe to consume one to two drinks not more than twice a week during pregnancy (O’Keeffe, Greene, & Kearney, 2014). Nonetheless, some research suggests that it may not be wise to consume alcohol at the time of conception.
Nicotine Cigarette smoking by pregnant women can also adversely influence prenatal development, birth, and postnatal development (Shisler & others, 2017). Preterm births and low birth weights, fetal and neonatal deaths, respiratory problems, and sudden infant death syndrome (SIDS, also known as crib death) are all more common among the offspring of mothers who smoked during pregnancy (Zhang & others, 2017). Prenatal smoking has been implicated in as many as 25 percent of infants being born with a low birth weight (Brown & Graves, 2013).
Maternal smoking during pregnancy also has been identified as a risk factor for the development of attention deficit hyperactivity disorder in offspring (Pohlabein & others, 2017; Weissenberger & others, 2017). A recent meta-analysis of 15 studies concluded that smoking during pregnancy increased the risk that children would have ADHD, and the risk of ADHD was greater for children whose mothers were heavy smokers (Huang & others, 2018). And in a recent study, maternal cigarette smoking during pregnancy was linked to higher rates of cigarette smoking among offspring at 16 years of age (De Genna & others, 2016). Further, a recent study revealed that daughters whose mothers smoked during their pregnancy were more likely to subsequently smoke during their own pregnancy (Ncube & Mueller, 2017). Studies also indicate that environmental tobacco smoke is linked to impaired connectivity of the thalamus and prefrontal cortex in newborns (Salzwedel & others, 2016). Another study found that maternal exposure to environmental tobacco smoke during prenatal development increased the risk of stillbirth (Varner & others, 2014). Also, one study found that maternal smoking during pregnancy was associated with increased risk of asthma and wheezing in adolescence (Hollams & others, 2014). Assignment: Gross and Fine Motor Skill Development
Despite the plethora of negative outcomes for maternal smoking during pregnancy, a recent large-scale U.S. study revealed that 23 percent of adolescent and 15 percent of adult pregnant women reported using tobacco in the previous month (Oh & others, 2017). And a final point about nicotine use during pregnancy involves the recent dramatic increase in the use of e-cigarettes (Wagner, Camerota, & Propper, 2017; Tegin & others, 2018). A recent study found that misconceptions about e-cigarettes were common among pregnant women (Mark & others, 2015). Women who were using e-cigarettes during pregnancy often stated that e-cigarettes were less harmful than regular cigarettes (74 percent) and helpful in easing smoking cessation (72 percent).
Cocaine Does cocaine use during pregnancy harm the developing embryo and fetus? A research review concluded that cocaine quickly crosses the placenta to reach the fetus (De Giovanni & Marchetti, 2012). The most consistent finding is that cocaine exposure during prenatal development is associated with reduced birth weight, length, and head circumference (Gouin & others, 2011). Also, in other studies, prenatal cocaine exposure has been linked to impaired connectivity of the thalamus and prefrontal cortex in newborns (Salzwedel & others, 2016); impaired motor development at 2 years of age and a slower rate of growth through 10 years of age (Richardson, Goldschmidt, & Willford, 2008); self-regulation problems at age 12 (Minnes & others, 2016); elevated blood pressure at 9 years of age (Shankaran & others, 2010); impaired language development and information processing (Beeghly & others, 2006), including attention deficits (especially impulsivity) (Accornero & others, 2006; Richardson & others, 2011); learning disabilities at age 7 (Morrow & others, 2006); increased likelihood of being in a special education program that involves supportive services (Levine & others, 2008); and increased behavioral problems, especially externalizing problems such as high rates of aggression and delinquency (Minnes & others, 2010; Richardson & others, 2011).
Some researchers argue that these findings should be interpreted cautiously (Accornero & others, 2006). Why? Because other factors in the lives of pregnant women who use cocaine (such as poverty, malnutrition, and other substance abuse) often cannot be ruled out as possible contributors to the problems found in theirPage 84 children (Hurt & others, 2005; Messiah & others, 2011). For example, cocaine users are more likely than nonusers to smoke cigarettes, use marijuana, drink alcohol, and take amphetamines.
Despite these cautions, the weight of research evidence indicates that children born to mothers who use cocaine are likely to have neurological, medical, and cognitive deficits (Cain, Bornick, & Whiteman, 2013; Field, 2007; Martin & others, 2016; Mayer & Zhang, 2009; Parcianello & others, 2018; Richardson & others, 2011; Scott-Goodwin, Puerto, & Moreno, 2016). Cocaine use by pregnant women is never recommended. Assignment: Gross and Fine Motor Skill Development
Marijuana An increasing number of studies find that marijuana use by pregnant women also has negative outcomes for offspring (Ruisch & others, 2018; Volkow, Compton, & Wargo, 2017). For example, researchers found that prenatal marijuana exposure was related to lower intelligence in children (Goldschmidt & others, 2008). Research reviews concluded that marijuana use during pregnancy alters brain functioning in the fetus (Calvigioni & others, 2014; Jaques & others, 2014). In a recent meta-analysis, marijuana use during pregnancy was linked to offsprings’ low birth weight and greater likelihood of being placed in a neonatal intensive care unit (Gunn & others, 2016). One study also indicated that prenatal exposure to marijuana was linked to marijuana use at 14 years of age (Day, Goldschmidt, & Thomas, 2006). Another study discovered that marijuana use by pregnant women was associated with stillbirth (Varner & others, 2014). In sum, marijuana use is not recommended for pregnant women.
Despite increasing evidence of negative outcomes, a recent survey found that marijuana use by pregnant women increased from 2.4 percent in 2002 to 3.85 percent in 2014 (Brown & others, 2016). And there is considerable concern that marijuana use by pregnant women may increase further given the growing number of states that have legalized marijuana (Chasnoff, 2017; Hennessy, 2018).
Heroin It is well documented that infants whose mothers are addicted to heroin show several behavioral difficulties at birth (Angelotta & Appelbaum, 2017). The difficulties include withdrawal symptoms, such as tremors, irritability, abnormal crying, disturbed sleep, and impaired motor control. Many still show behavioral problems at their first birthday, and attention deficits may appear later in development. The most common treatment for heroin addiction, methadone, is associated with very severe withdrawal symptoms in newborns (Lai & others, 2017). Assignment: Gross and Fine Motor Skill Development