1. Developmental Interventions In Neonatal Care Washington, DC 2006 Highlights Patricia Boyle, PT LDSH NICH EI Consultant

2. The Earliest Relationship: The Nature of Maternal-Fetal Synchrony Presented by Janet DiPietro, Ph.D a Developmental Psychologist in Baltimore Maryland Mothers and fetuses have a second by second relationship beginning at least at 20 weeks. Questions? Does preterm maternal-fetal synchrony set the stage for postnatal synchrony in maternal-child interaction?

3. The Earliest Relationship Prenatally are mothers who are more physiologically responsive to fetal movements more responsive to their infant’s behaviour? Are fetuses who are more reactive to maternal stress more engaged and interactive as children? Are fetuses “paying attention”?

4. The Earliest Relationship Mothers are given a stressful psychological test (Stroop test) Infants respond by becoming less motorically active and have increased variability in their heart rate Mothers given relaxation activities also causes decreased fetal movement and an increase in heart rate variability. Is the fetus “orienting” to differences in the intrauterine sensory environment?

5. The Earliest Relationship Greater maternal anxiety and perceived stress during pregnancy has been associated with more ACCELERATED developmental skills at age 2.(Stress affects the development of the fetus in a positive way????) Women who were more negative ABOUT their pregnancy their infants had delayed motor development and poorer social engagement

6. The Earliest Relationship Take home message??? Embrace stress But be positive??? More research needed

7. The Earliest Relationship The Psychophysiology of the maternal- fetal relationship Psychophysiology,41 (2004),510-520 DiPietro et al

8. Effect of Movement and Posture on the Respiratory and GI system John Chappel, MA PT, Morristown New Jersey Heidelise Als, PhD reveals in her Synactive Theory of Development the delicate interplay between the physiologic and motoric systems.

9. Respiration and GI Any impulse entering the spinal cord at any level could cause any structure innervated by any neurological structure emanating from that level to be stimulated Hands on ribcage Respiratory system is a system that responds well when not restricted

10. Respiratory and GI How does the baby’s physical environment impact respiration and GI NG tubes Extended upper extremity posture Excessive hip flexion Diaper Tightness The “Vulcan Feeding Pinch”

12. The Hyoid bone Free floating bone with no other bony attachments Supports the tongue and muscles associated with speech and SWALLOWING Until six months of age the hyoid is at the level of C1 C1 gets “stuck” with excessive extensive force

13. The Hyoid bone Force to C1 : a large amount of force over a short time – precipitous delivery – may be responsible for TTN (Transient tachypnea of the newborn) Force to C1 : A small amount of force over a long period of time – The “Vulcan Feeding Pinch”

14. The Vulcan Feeding Pinch C1 gets jammed in extension over C2 and C3 Pressure over C1 compresses the 4 th ventricle which houses the vagal nerve Vagal nerve innervates the stomach, lungs affects heart rate, innervates the larynx which keeps the airway open for breathing, affects peristalsis