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Editor's Notes

• #4: Đặt câu hỏi và xin ý kiến từ 3 học viên. Lắng nghe và khích lệ
• #5: The embryo consists of a spherical mass of cells with a central cavity (the blastocyst). By 2 weeks, implantation is complete and the uteroplacental circulation has begun; the embryo has 2 distinct layers, endoderm and ectoderm, and the amnion has begun to form. By 3 wk, the 3rd primary germ layer (mesoderm) has appeared, along with a primitive neural tube and blood vessels. Paired heart tubes have begun to pump. By the end of wk 8, as the embryonic period closes, the rudiments of all major organ systems have developed; the crown-rump length is 3 cm.
• #8: Xem clip, cho nhận xét những gì quan sát đươjc từ clip Behavior development No behavioral evidence of neural function is detectable until the 3rd mo. Reflexive responses to tactile stimulation develop in a craniocaudal sequence. By wk 13-14, breathing and swallowing motions appear. The grasp reflex appears at 17 wk and is well developed by 27 wk. Eye opening occurs around 26-28 wk. By midgestation, the full range of neonatal movements can be observed.
• #9: During week two, the sperm and egg unite in the fallopian tube to form a zygote. The zygote will then travel down one of the fallopian tubes toward the uterus. Within the uterus, the zygote will divide to form a cluster of cells. The inner group of cells in the cluster is the embryo. The outer layer of cells acts as membranes that nourish and protect the embryo. Week 3: The developing embryo, also called a blastocyst, is looking for a spot to implant in the uterus. When the embryo reaches the uterus, it will burrow into the uterine wall for nourishment. The placenta also starts to form at this time. Amniotic fluid also begins to collect at this time around the ball of cells in the cavity that will become the amniotic sac. The fourth week marks the beginning of the embryonic period. During this week, the formation of the brain, digestive system, spinal cord, heart and other organs begins. At the end of this week the embryo is approx. 10,000 times larger the size at conception Week 5: During this week, the heart begins to beat. The brain has developed into 5 areas and cranial nerves are visible. Arm and leg buds are also visible, as well as the formation of the eyes, lips, nose and umbilical cord. this point, the spinal cord is growing more rapidly than the rest of the body, and gives for a tail-like appearance, which eventually disappears as the embryo grows. During this fifth week, it is the first time the blood vessels complete a circuit, meaning the circulatory system is the first functional organ system. Week 6: The formation of the lungs have begun at this time and further development of the brain. Arms and legs have lengthened with foot and hand areas distinguishable. The intestines begin to grow outside the body, within the umbilical cord, nostrils start to form as well as the pancreas. The embryo is about 1/8 of an inch long at this point. Week 7: Embryo has developed it’s own blood type and elbows and toes are visible. Also, all essential organs have at least begun to form. The teeth have also started to develop under the gums. Week 8: During this week, rotation of intestines occurs, facial features continue to develop, and eyelids are more developed. The external features of the ear also begin to take their final shape. The tongue starts to form, the intestines move into the abdomen from the umbilical cord and the fingers and toes are still partially webbed. At the end of this 8th week, the embryo is about ½ an inch in length. This week is also the end of the embryonic period.
• #10: Neuroectodermal cells differentiate into neurons, astrocytes, oligodendrocytes, and ependymal cells, whereas microglial cells are derived from mesoderm. By the 5th wk, the 3 main subdivisions of forebrain, midbrain, and hindbrain are evident. The dorsal and ventral horns of the spinal cord have begun to form, along with the peripheral motor and sensory nerves. Myelinization begins at midgestation and continues for years. By the end of the embryonic period (wk 8), the gross structure of the nervous system has been established. On a cellular level, neurons migrate outward to form the 6 cortical layers. Migration is complete by the 6th mo, but differentiation continues. Axons and dendrites form synaptic connections at a rapid pace, making the central nervous system vulnerable to teratogenic or hypoxic influences throughout gestation.
• #11: During the 3rd trimester, weight triples and length doubles as body stores of protein, fat, iron, and calcium increase.
• #12: Nhìn và nhận xét: tuổi thai tương ứng? Đặc điểm quan sát? (Khen thưởng và khích lệ) Week 10-12: Embryo measures 30–80��mm (1.2–3.2��inches) in length. Intestines rotate. Facial features continue to develop. The��eyelids��are more developed. The external features of the ear begin to take their final shape. The head comprises nearly half of the fetus' size. The face is well formed The eyelids close and will not reopen until about the 28th week. Tooth buds appear. The fetus can make a fist with its fingers. Genitals appear well differentiated. Red blood cells are produced in the��liver Week 13-16: The fetus reaches a length of about 15��cm (6��inches). A fine hair called��lanugo develops on the head. Fetal��skin is almost transparent. More muscle tissue and bones have developed, and the bones become harder. Sucking motions are made with the mouth. Meconium is made in the intestinal tract. The liver and��pancreas produce fluid secretions. From week 13,��sex prediction�� At week 15, main development of external genitalia is finished Abdominal wall closes Week 17-21: The fetus reaches a length of 20��cm (8��inches). Lanugo��covers the entire body. Eyebrows and eyelashes appear. Nails appear on fingers and toes. The fetus is more active with increased muscle development. "Quickening" usually occurs (the mother and others can feel the fetus moving). The fetal heartbeat can be heard with a��stethoscope. Week 36-40: The fetus is considered full-term at the end of the 39th week of gestational age. It may be 48 to 53��cm (19 to 21��inches) in length. The lanugo is gone except on the upper arms and shoulders. Fingernails extend beyond fingertips. Small��breast buds are present on both sexes. Head hair is now coarse and thickest
• #14: Bất thường gì? Tương ứng tuổi thai nào? Abdominal wall defects (13-16 weeks)
• #17: Prenatal Factors Các yếu tố ảnh hưởng quan hệ mẹ con: gia đình gâần đây có người bị mất/có anh hoặc chị chết trước đó/mẹ bỏ thai/mẹ trầm cảm, rối loạn tâm lý/bố mẹ ly hôn/ có vấn đề tài chính/không việc làm/quan hệ kém với xã hội/có thai ngoài ý muốn/bố hay mẹ nghiện rượu/trẻ sinh cực non Peripartum and Postpartum Influences The continuous presence during labor of a woman trained to offer friendly support and encouragement (a doula) results in shorter labor, fewer obstetric complications (including cesarean section), and reduced postpartum hospital stays. Early skin-to-skin contact between mothers and infants immediately after birth may correlate with an increased rate and longer duration of breastfeeding. Most new parents value even a brief period of uninterrupted time in which to get to know their new infant, and increased mother–infant contact over the 1st days of life may improve long-term mother–child interactions. Nonetheless, early separation, although predictably very stressful, does not inevitably impair a mother’s ability to bond with her infant. Early discharge home from the maternity ward may undermine bonding, particularly when a new mother is required to resume full responsibility for a busy household. Postpartum depression may occur in the 1st wk or up to 6 mo after delivery and can adversely affect neonatal growth and development. Screening methods are available for use during neonatal and infant visits to the pediatric provider (Table 9-2). Referral for care will greatly accelerate recovery
• #18: Neonates are nearsighted, having a fixed focal length of 8-12 inches, approximately the distance from the breast to the mother’s face, as well as an inborn visual preference for faces. (1 inch = 2.54 cm  8-12inches ~ 20-30 cm) approximately the distance from the breast to the mother’s face, as well as an inborn visual preference for faces. Hearing is well developed, and infants preferentially turn toward a female voice. These innate abilities and predilections increase the likelihood that when a mother gazes at her newborn, the baby will gaze back. The initial period of social interaction, usually lasting about 40 minutes, is followed by a period of somnolence. After that, brieferperiods of alertness or excitation alternate with sleep. If a mother misses her baby’s first alert-awake period, she may not experience as long a period of social interaction for several days. The hypothalamic– midbrain–limbic–paralimbic–cortical circuit of the parents interact to support responses to the infants that are critical for effective parenting (e.g., emotion, attention, motivation, empathy, and decision making).
• #20: Nhiễm HSV2
• #21: Nhiễm Toxoplasma gondii
• #24: 12 tháng: CNLS x3 CC tăng 25cm (75cm) VĐ tăng 10cm (45cm) Não đạt 75% thể tich não trưởng thành Total brain volume doubles in the 1st yr of life and increases by an additional 15% over the 2nd yr. Total brain volume at age 1 mo is approximately 36% of adult volume but by age 1 yr is approximately 72% (83% by 2 yr)
• #25: Crying normally peaks at about 6 wk of age, when healthy infants may cry up to 3 hr/day, then decreases to 1 hr or less by 3 mo.
• #26: Growth slows more (see Table 15-1 and Figs. 11-1 and 11-2). By the 1st birthday, birth weight has tripled, length has increased by 50%, and head circumference has increased by 10 cm. The ability to sit unsupported (6-7 mo) and to pivot while sitting (around 9-10 mo) provides increasing opportunities to manipulate several objects at a time and to experiment with novel combinations of objects. These explorations are aided by the emergence of a thumb–finger grasp (8-9 mo) and a neat pincer grasp by 12 mo. Voluntary release emerges at 9 mo. Many infants begin crawling and pulling to stand around 8 mo, followed by cruising. Some walk by 1 yr. Motor achievements correlate with increasing myelinization and cerebellar growth. These gross motor skills expand infants’ exploratory range and create new physical dangers, as well as opportunities for learning. Tooth eruption occurs, usually starting with the mandibular central incisors. Tooth development reflects skeletal maturation and bone age, although there is wide individual variation (see Table 10-3 and Chapter 307).
• #27: Quan sát, dự đoán độ tuổi của 2 trẻ trong video clip, nhận xét đặc điểm của 2 trẻ này.  giới thiệu qua độ tuổi răng sữa Phim Baby geniuses (1999): Dao dien: Bob Clark Dien vien: Kathleen Turner, Christopher Lloyd, Kim Cattrall The loai: Hai – Vien tuong
• #28: The normal decrease in appetite at this age may cause parental concern about nutrition; growth charts should reassure parents that the child’s intake is adequate. Children normally modulate their food intake to match their somatic needs according to feelings of hunger and satiety. Daily intake fluctuates, at times widely, but intake during the period of a week is relatively stable. A complete multivitamin can be used to assure adequate vitamin and mineral intake. Parents should provide a predictable eating schedule, with 3 meals and 2 snacks per day, allowing the child to choose how much to eat. Highly active children face increased risks of injury, and parents should be counseled about safety precautions. Parental concerns about possible hyperactivity may reflect inappropriate expectations, heightened fears, or true overactivity. Children who engage in impulsive activity with no apparent regard for personal safety should be evaluated further. By age 3, children have self-identified their sex, and are actively seeking understanding of the meaning of gender identification. There is a developmental progression from rigidity (boys and girls have strict gender roles) in the early preschool years to a more flexible realistic understanding (boys and girls can have a variety of interests). Play Play involves learning, physical activity, socialization with peers, and practicing adult roles. Play increases in complexity and imagination, from simple imitation of common experiences, such as shopping and putting baby to bed (2 or 3 yr of age), to more extended scenarios involving singular events, such as going to the zoo or going on a trip (3 or 4 yr of age), to the creation of scenarios that have only been imagined, such as flying to the moon (4 or 5 yr of age). By age 3 yr, cooperative play is seen in activities such as building a tower of blocks together; later, more structured role-play activity, as in playing house, is seen. Play also becomes increasingly governed by rules, from early rules about asking (rather than taking) and sharing (2 or 3 yr of age), to rules that change from moment to moment, according to the desires of the players (4 and 5 yr of age), to the beginning of the recognition of rules as relatively immutable (5 yr of age). Electronic forms of play (games) are best if interactive and educational.
• #32: PHYSICAL DEVELOPMENT Growth occurs discontinuously, in 3-6 irregularly timed spurts each year, but varies both within and among individuals. Growth during the period averages 3-3.5 kg (6.6-7.7 lb) and 6-7 cm (2.4-2.8 in) per year (Fig. 13-1). The head grows only 2 cm in circumference throughout the entire period, reflecting a slowing of brain growth. Myelinization continues into adolescence, with peak gray matter at 12-14 yr. Body habitus is more erect than previously, with long legs compared with the torso. Growth of the midface and lower face occurs gradually. Loss of deciduous (baby) teeth is a more dramatic sign of maturation, beginning around 6 yr of age. Replacement with adult teeth occurs at a rate of about 4 per year, so that by age 9 yr, children will have 8 permanent incisors and 4 permanent molars. Premolars erupt by 11-12 yr of age (see Chapter 307). Lymphoid tissues hypertrophy, often giving rise to impressive tonsils and adenoids. Implications for Parents and Pediatricians Middle childhood is generally a time of excellent health. However, children have variable sizes, shapes, and abilities. Children of this age compare themselves with others, eliciting feelings about their physical attributes and abilities. Fears of being “abnormal” can lead to avoidance of situations in which physical differences might be revealed, such as gym class or medical examinations. Children with actual physical disabilities may face special stresses. Medical, social, and psychologic risks tend to occur together. Children should be asked about risk factors for obesity. Participation in physical activity, including organized sports or other organized activities can foster skill, teamwork, and fitness, as well as a sense of accomplishment, but pressure to compete when the activity is no longer enjoyable has negative effects. Counseling on establishing healthy eating habits and limited screen time should be given to all families. Prepubertal children should not engage in high-stress, highimpact sports, such as power lifting or tackle football, because skeletal immaturity increases the risk of injury (see Chapter 693).
• #33: Vòng đầu tăng chỉ khoảng 2cm trong suốt giai đoạn này. Myelin hóa tiếp tục diễn ra với đỉnh ở 12-14 tuổi. Thay răng với tốc độ khoảng 4 răng 1 năm, lúc 9 tuổi trẻ sẽ có 8 răng cửa vĩnh viễn và 4 răng hàm vĩnh viễn. Răng tiền hàm nhú lúc trẻ 11-12 tuổi. Hệ cơ chưa hoàn toàn trưởng thành  tránh các môn như cử tạ, bóng bầu dục.
• #35: Implications for Parents and Pediatricians Children need unconditional support as well as realistic demands as they venture into a world that is often frightening. A daily query from parents over the dinner table or at bedtime about the good and bad things that happened during the child’s day may uncover problems early. Parents may have difficulty allowing the child independence or may exert excessive pressure on their children to achieve academic or competitive success. Children who struggle to meet such expectations may have behavior problems or psychosomatic complaints. Many children face stressors that exceed the normal challenges of separation and success in school and the neighborhood. Divorce affects nearly 50% of children. Domestic violence, parental substance abuse, and other mental health problems may also impair a child’s ability to use home as a secure base for refueling emotional energies. In many neighborhoods, random violence makes the normal development of independence extremely dangerous. Older children may join gangs as a means of self-protection and a way to attain recognition and belong to a cohesive group. Children who bully others, and/or are victims of bullying, should be evaluated, since this behavior is associated with mood disorders, family problems, and school adjustment problems. Parents should reduce exposure to hazards where possible. Because of the risk of unintentional firearm injuries to children, parents should be encouraged to ask parents of playmates whether a gun is kept in their home and, if so, how it is secured. The high prevalence of adjustment disorders among school-age children attests to the effects of such overwhelming stressors on development. Pediatrician visits are infrequent in this period; therefore each visit is an opportunity to assess children’s functioning in all contexts (home, school, neighborhood). Maladaptive behaviors, both internalizing and externalizing, occur when stress in any of these environments overwhelms the child’s coping responses. Due to continuous exposure and the strong influence of media (programming and advertisements) on children’s beliefs and attitudes, parents must be alert to exposures from the television and Internet. An average American youth spends over 6 hr/day with a variety of media, and 2 3 of these children have a television in their bedrooms. Parents should be advised to remove the television from their children’s rooms, limit viewing to 2 hr/day, and monitor what programs children watch. The Draw-a-Person (for ages 3-10 yr, with instructions to “draw a complete person”) and Kinetic Family Drawing (beginning at age 5 yr, with instructions to “draw a picture of everyone in your family doing something”) are useful office tools to assess a child’s functioning.