Development of the Senses

Andrea Stout, MD

A healthy term newborn fails the universal hearing screening. Follow-up testing reveals that he has profound hearing loss. His parents inquire about the development of young children who have congenital hearing loss. The BEST response is that:
a. b. c. d. e. early amplification and development services improve overall outcome hearing aids promote language development only for children who have mild hearing loss lip reading encourages the child to speak and understand language faster prelingual deafness is associated with better cognitive outcome than postlingual deafness severe or profound hearing loss is associated with impaired cognitive skills.

A healthy term newborn fails the universal hearing screening. Follow-up testing reveals that he has profound hearing loss. His parents inquire about the development of young children who have congenital hearing loss. The BEST response is that:
a. b. c. d. e. early amplification and development services improve overall outcome hearing aids promote language development only for children who have mild hearing loss lip reading encourages the child to speak and understand language faster prelingual deafness is associated with better cognitive outcome than postlingual deafness ( severe or profound hearing loss is associated with impaired cognitive skills.

HEARING
Fetuses at 23 weeks respond to sound
What does the fetus hear?
Microphones into womb after rupture of membranes Low tones >> High tones Male voice >> Female voice (expect own mother)

Babies remember early auditory experiences

Cat in the Hat versus The King, Mice, and the Cheese

Babies prefer to listen to their mothers

Tape of Dr. Seuss book being read by mother versus another female voice

HEARING
Speaking in Motherese
Slow, high-pitched, highly intonated, and loud Instinct or just better response?

Sound Localization
Newborns localize sounds in horizontal plane 4-5 months can localize sound in the vertical plane

Hearing impairment
Middle ear infections - 80% of kids will have at least one before age 3
OM with effusion can interfere with ability to hear (loose about 10-40 decibels) Generally does not produce long-term hearing deficits Studies looking at kids with chronic OM and verbal skills PE tubes does not seem to improve language development 1994 Agency for Health Care Policy
Fluid for > 3 months AND loss of 20 decibels in both ears

SMELL
Ability to smell begins at 28 weeks gestation
Fetus can smell in-utero
Rat fetus more active when mint and lemon were injected into amniotic fluid In-utero smells will bias later experiences

Olfactory bulb neurons are part of limbic system

Emotions and memories

Distinction for good vs. bad odor doesnt develop until toddler years

SMELL
Babies can smell their own amniotic fluid
Prefer to nurse on nipple moistened with amniotic fluid

Babies are good at smelling mothers milk and breast odor

Prefer unwashed breast to washed breast Orient toward a lactating woman

Bottle fed babies loose recognition at 2 weeks

Bottle feed without a shirt on Avoid strong soaps, lotions, perfumes, etc.

SMELL
Babies and children are comforted by own scents and scents of family members
3yo children can identify siblings T-shirt Mark a transitional object Hold close to mouth and nose Upset when item is washed

The mother of a healthy infant in the newborn nursery notes that her daughter has a good ability to focus when held close but not while lying in bed. She asks you whether her child really is seeing her. The BEST response is that infants:
a. b. c. cannot see colors at birth do not have conjugate gaze at birth focus best on facial constructs

d.
e.

focus only on their mothers faces

Have visual acuity equivalence to a 1 year old child

The mother of a healthy infant in the newborn nursery notes that her daughter has a good ability to focus when held close but not while lying in bed. She asks you whether her child really is seeing her. The BEST response is that infants:
a. b. c. cannot see colors at birth do not have conjugate gaze at birth focus best on facial constructs

d.
e.

focus only on their mothers faces

Have visual acuity equivalence to a 1 year old child

SIGHT
Eye forms at 4 weeks gestation Vision is still very primitive at birth
Maximize the role that experience plays in shaping the visual center in the brain.

By 6 months of age all primary visual abilities will have emerged [fine acuity, color, depth perception, and well controlled EOM].

SIGHT
Acuity
Best acuity about 8-12 inches from face
Mothers face when nursing

20/400 to 20/600 Frosted window pane or shower door Better able to discern 2 objects separated by a large distance

SIGHT
Acuity

SIGHT
Acuity

3 months

6 months

9 months

Adult

SIGHT
Color
Initially contrast sensitivity is poor
Black and white is best

Color starts to develop at 2-3 weeks; fully mature by 4 mo

Cones are immature; stubby and widely spaced

Visual system most sensitive to Red, Blue, and Green wavelengths

Reds and Greens more distinct to babies Blues develop later

Pure forms of colors are better than blends

Red >> Tangerine and Blue >> Plum

SIGHT
Depth Perception - requires integration at visual cortex
Early vision is 2D 3D vision emerges between 3-4 months

Peripheral Vision
Perimeter of retina is more mature than fovea Frame of 8x10 picture Facial hair and hairline Mobiles in cribs

Faces
Innate preference for faces (mothers face at 1 day old!) Facelike images >> scrambled images

SIGHT
Movement
Slow moving face >> Stationary face

Eye movements
Newborns: Jerky saccades, fall behind the image 2 months: Track with smooth eye movements 3-6 months: Anticipate movement

You are counseling the mother of a 3 month old breastfed infant whose family has been urging her to introduce cereals to her babys diet. She asks your advice. The MOST likely outcome of introducing solid foods at this age is to :
a. b. c. accelerate the development of motor skills help the infant sleep through the night increase the risk of food allergies

d.
e.

increase the risk of gastroesophageal reflux

increase the risk of gastrointestinal infections

You are counseling the mother of a 3 month old breastfed infant whose family has been urging her to introduce cereals to her babys diet. She asks your advice. The MOST likely outcome of introducing solid foods at this age is to :
a. b. c. accelerate the development of motor skills help the infant sleep through the night increase the risk of food allergies

d.
e.

increase the risk of gastroesophageal reflux

increase the risk of gastrointestinal infections

TASTE
Functional during the third trimester
Injections into amniotic fluid

Interactions between sweet, salty, sour, and bitter (?umani)

Dependent on intrauterine exposures for development

Preferences for intrauterine exposures
Amniotic fluid changes with mothers diet Alcoholism?

TASTE
Newborns and Taste
Sweet = Like Sour and Bitter = Dislike Salty = Indifferent
Formula mishap Salty preference emerges at 4 months Thought to be related to kidney maturation

Sweets
Coupled with endogenous opiate release
Circumcision NAS babies on Methadone

TASTE
Breastmilk and Taste
Breastmilk composition changes
Time elapsed post-partum Time of day Maternal diet

Milk experience may bias later taste preferences

Nurture not nature

Breastfed infants more apt to consume foods on first exposure Communicates which foods are safe Prior exposure

TOUCH
Sense of touch is babys most advanced sense at birth Components include pressure, pain, temperature, and proprioception Cutaneous neurons --> thalamus --> somatosensory cortex
Mapping requires input from sensory fibers Mapping begins at 20 weeks gestation
Babies movement in womb provide somatosensory input

Not all areas are created equal Size of cortex is dependent on amount of input
Anything that increases babies touch stimulation enhances brain development

Sensory fibers arent fully myelinated until 6 months of age

TOUCH
Touch sensitivity develops from head to toe
Mouth first

Discrimination Ten weeks: can distinguish different shaped objects Six months: can distinguish different textures Hand preferences
By age two; slightly better at identifying objects with left >> right hand

Females slightly better than males

Girls are more sensitive!!

TOUCH
Pain
Probably emerges at beginning of third trimester Modified by circumstance What about ear piercing? Circumcision?
Lack the emotional concept of suffering No conscious memory of pain until age 2

Temperature
Cannot regulate temperature well Compensate by modifying their activity level

TOUCH
Benefits of early touch Harry Harlow and rhesus monkeys with surrogate mothers
Mesh body with milk versus soft cloth body without milk Tactile contact NOT nourishment comforts infants!

NICU Application
Nesting Kangaroo care

Improved immune function Infant massage Touch reduces reactivity of nervous system
Sling carriers

IN SUMMARY Talk to your baby Snuggle with your baby Interact with your baby Feed your baby Touch your baby