Pediatric Services Pediatric Services: An intervention team serving children with developmental delays.

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Development of the typical child

Lacey

Lacey is a little girl who was born in August of 2000. Her mother was one week past her due date, and it was decided to induce labor. After mom checked into the hospital she was given a course of Pitocin, even though mom had begun to have some labor pains on her own. Four hours later labor had begun in earnest. At 9:00 AM the doctor broke the baby's amniotic sac to hurry things along.

Before Lacey's birth, it had been Mom had tested positive for Strep B, and when she checked into the hospital, along with Pitocin and painkillers, Mom was started on a course of antibiotics to aleviate the Strep B being passed on to the baby. At this time Mom had a slightly elevated fever due to an upper respiratory infection.

Approximately 3 hours after the breaking of the waters, Mom's physician decided to up the course of the antibiotics that were being given - using a stronger antibiotic. Mom's fever had increased somewhat at this time. Labor was still progressing, but slowly.

Four hours after that Mom's physician decided it was time to really push. Mom did for an hour, but the baby had turned somewhat in the birth canal, and it was becoming obvious that it would be difficult to have the baby delivered naturally. Mom's fever was going up steadily, and the baby's heart was beating somewhat erratically. A Ceasarian section was planned, and as soon as an anesthesiologist was available, was performed.

Lacey weighed 8 pounds, 12 ounces at birth. She was somewhat tachycardiac - meaning it took a few minutes for her heart to beat normally. Her color was a little dusky at first, but she turned pink quite quickly. She too had a small fever at birth, and was tested right away for Strep B. Her Apgar scores were 8 and 9. After being weighed and measured (she was 21 inches long) she was placed on IV antibiotics and an apnea monitor. Mom's fever had spiked and she was somewhat dehydrated, plus with the shock of the sudden surgery, and she was unable to see the baby right away. The NICU physicians, however, did allow Dad free access and her family was also able to see her. She was so beautiful! Dad took some digital photos so Mom could see what her baby looked like right away.

By the next morning Mom was much better - her fever had broken and she had gotten some rest. Lacey still had a small fever, but had started eating formula and it was decided to begin breast feeding. It was slow going for both Mom and Lacey, and they were taking the time to get to know each other. Lacey was still in the NICU, so rooming in was not possible.

That afternoon one of the pediatricians who had seen Lacey contacted Dad with a concern about Lacey's fever. The pediatrician was concerned because the fever was not abating even with the antibiotics, and she wanted to test to rule out meningitis. This was very frightening for the parents, and they decided to wait 24 more hours and see how Lacey was doing. She was eating slowly but taking in more and more, and everything else was working fine. She was also becoming more alert.

On Sunday another pediatrician checked Lacey, and then came to speak to her parents. He explained why they wanted to check for meningitis, and how a spinal tap would work on such a small baby. Lacey's parents asked many questions, such as long term effects that both meningitis and a spinal tap could have on their baby, and if this meant she would have special needs down the road. The doctor explained that the chances of that were slim, and her parents agreed to the spinal tap.

The doctor returned with the news that the spinal tap had not worked. Babies are born with a patch of fat right over the area where the tap must take place, and no fluid was able to be taken. They wanted to try again the next day. In the meantime Mom was working closely with lactation specialists to nurse Lacey.

On Monday they tried another spinal tap. Lacey's father had already decided that if this one produced no fluid, that they would not try another, because he didn't want her to go through it again. The pediatrician was able to retrieve the necessary amount of fluid for testing, and it was sent to the laboratory. Lacey's family would have to wait 24 more hours to find out anything.

On Tuesday it was time for Mom to go home, and it was so difficult for Lacey's parents to have to leave her at the hospital for a few more days. Nursing and pumping were starting to get a little easier, and Lacey's mom knew that when they could spend all of their time together it would all work out. On Tuesday night Lacey's parents were told that the tests were negative for meningitis and that she would be able to come home on Friday, when she was a week old.

On Wednesday, Thursday, and Friday Lacey's mom spent as much time as possible at the hospital. The nurses in the NICU were wonderful, as were the lactation consultants, and Lacey was able to be off of her monitors and come into the family room with mom, dad and other visitors. She was still getting antibiotics intravenously.

Friday afternoon was the big day - Lacey was going to get to come home! It took forever, it seemed, for the doctors to check her out and let her go, but finally she was strapped into her car seat and off she went on the 5 mile ride to her house. It was great to have her home to sleep in her own bed and for the little family to get to know each other. Nursing did start to come easier for Mom and for Lacey as they were able to relax and rest.

At Lacey's first pediatrician checkup her parents were told that she was doing great and to not worry. And that is true! When she was four weeks old she weighed in at 9 1/2 pounds and 23 inches. She sleeps well at night, stays awake more in the day time, and is really nursing very well. She is a very happy baby. Soon she will be eight weeks old, and we will continue her story then....

Four Weeks

Head at midline

Head at midline

Head up in prone position Head up in prone position

Two Months

At the age of two months, Lacey is able to hold her head and her shoulders up very well when lying on her tummy.

Lacey has begun to verbalize vowel sounds and make all types of noises. Babies at this age love to "talk" to you, so remember to take the time to talk with your baby, and let her listen and look at your face and mouth. This is the beginning of speech developmen
At the age of two months babies have discovered their hands and like to bring them to their mouths, often held together. A rattle such as this one increases their interest, because they can shake it and make noise while still chewing on their hands
At the age of two months, Lacey is able to hold her head up and see an object that is up to 8 to 10 inches away very well. At this age babies will begin to reach for a toy. Red, black and white toys are particularly good at this age because they are easy for a baby to see.

Four Months

At four months of age, Lacey is sitting propped in a variety of locations, including the couch and her high chair with toys to play with. She is beginning to vocalize to both people and to inanimate objects.
 

Lacey is beginning to show a preference for specific toys, and will often choose one over the other.

In this case it's her little bug - she really likes it.

 
 

Six Months

At the age of 4 months, Lacey began to eat solid foods, starting with rice cereal. Now she has tried oatmeal, and is enjoying it. At this age, babies will often "help" you with their feeding by grabbing the spoon and trying to guide it into their mouth. Sometimes giving baby a spoon of their own to play with will help distract them from "helping" you.
At the age of 5 months Lacey is bearing weight in her arms when on her tummy. Placing a fun toy just out of reach will encourage her to move toward it, which is called pre-crawling. All babies should spend time each day on the floor on their tummies to encourage crawling.
 

Seven Months

At seven months Lacey has begun to crawl. Here she is pulling up to kneeling position, readying to crawl or to pull to stand.
 
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Last modified: January 26, 2013