• 23 AUG 18
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    Explain why nutrition is important for child development, and how it has evolved within the family unit

    Psychology homework help

    This week in our forum we are looking at things that impact the development of the child. We have two parts to our discussion.

    Part one-

    One of the things that impact a child’s overall development is nutrition.

    Explain why nutrition is important for child development, and how it has evolved within the family unit. Apply this concept to the lifestyle of busy parents and the impact it has had on the child, and within the family. How has the food industry responded?  How has our government responded?  How have schools responded both with what they serve students and also what they teach students?

    Part two-

    How does infectious disease and immunizations impact a child’s health? What concerns should parents have? How do parents evaluate false claims, and what is the impact of false claims?

     

    Criteria/ 300 Level Forum Rubric

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    Analyzed the question(s), fact(s), issue(s), etc. and provided   well-reasoned and substantive answers.

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    Post meets the 300 word minimum requirement and is free from   spelling/grammar errors

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    Physical Growth and Motor Development

    Physical growth and motor skill development are closely intertwined. The first two years of life are a period of rapid growth and development physically, from the newborn period through the active toddler and preschool years. Children’s growth and development is impacted by heredity, nutrition, illness, and environment.

    TOPICS IN THIS LESSON INCLUDE:

    · The effects of heredity and hormones on physical growth and health in early childhood

    · The impact of nutrition on early childhood physical growth and health

    · How infectious disease and immunizations impact early physical growth and health in early childhood

    · Major milestones of gross‐ and fine‐motor development in early childhood

    Effects of Heredity and Hormones

    · ROLE OF HEREDITY

    · HORMONES

    · GROWTH HORMONE

    · THYROID-STIMULATING HORMONE (TSH)

    The influence of heredity on physical growth is seen directly through the relationship between a child’s size and growth rate and those of his or her parents. A central mechanism is that of genes in producing growth hormones. Sleep is an important contributor as growth hormones are most actively released then.

    Genes influence growth in a number of ways, including controlling the body’s production of hormones. Around 60 to 80 percent of height is determined by heredity; the other 20 to 40 percent is impacted by nutrition and other environmental factors. The pituitary gland at base of brain releases two essential growth hormones. These are Growth Hormone or GH and Thyroid-Stimulating Hormone or TSH. Both of these are necessary for proper growth.

    Growth Hormone (GH) is necessary from birth forward for body tissue development or physical growth. Growth hormone acts directly on the body and also stimulates an ‘insulin‐like growth factor 1 (IGF‐1)’ to be released from the liver and the skeleton to trigger cell duplication in the body. A GH deficiency or IGF‐1 deficiency affects about two percent of children. Without growth hormone supplementation or treatment, these children will only reach an average height of 4 to 4 1⁄2 feet. With treatment, in the form of hormone injections, the child will grow at a normal rate. Intervention in growth hormone deficiencies has become quite common today, providing these children with physical development on a normal and typical timeline.

    The second of the two hormones released by the pituitary is thyroid-stimulating hormone or TSH. TSH prompts the thyroid gland to release thyroxine necessary for brain development. TSH allows growth hormone to have a full impact on body size and is essential for the child to grow properly. Infants without adequate thyroxine must receive synthetic thyroxine immediately or will be intellectually disabled as brain development cannot proceed properly. Once the rapid period of brain development in infancy is complete, too little thyroxine means that children’s growth‐rate will be below average. With treatment, these children can also reach a normal height.

    Emotional Well Being

    Emotional well‐being is also closely related to hormone production. Extreme stress can impact appropriate and normal growth patterns, both physically and developmentally. High stress suppresses the release of growth hormone.

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    · Extreme emotional deprivation can result in the growth disorder of psychosocial dwarfism. In this case, growth is suppressed not by physical means, but through the physical impact of psychological stress. Stress causes these children not to release GH, and therefore, not to grow properly. Psychosocial dwarfism appears between the ages of two and 15.

    Children with psychosocial dwarfism have adjustment problems as a result of their stressful home life. When removed from the negative environment, like a neglectful home, GH levels return to normal and the child can grow rapidly, catching up on missed growth.

    In addition to decreased secretion of GH, extreme emotional stress also reduces the release of melatonin. Melatonin is an essential hormone which promotes healthy sleep patterns–people sometimes use commercially available melatonin as a sleep aid. This creates a cycle by which poor sleep limits the release of hormones and limited hormones cause poor sleep.

    GH is released during sleep. Sleep contributes to physical growth, and children need to sleep appropriately in order to physically grow well. The production of melatonin is also influenced by exposure to light, particularly forms of blue light. Video games, televisions, tablets, and smartphones all produce these emissions of blue light and can reduce melatonin production, particularly in the several hours before sleep.

    Sleep supports the child’s emotional health as well. A well-rested child is better able to play, learn, and contribute to a positive family dynamic. Too little sleep is related to impaired cognitive functioning, such as decreased attention, lower thinking speed, reduced working memory, lower intelligence and achievement scores.

    In addition, sleep deprivation may impact the child’s ability to behave appropriately, with both internal and external behavior problems. Sleep problems related to cognitive and emotional difficulties are more pronounced for lower SES children. Sleep difficulties can heighten the impact of environmental stress. Disrupting parents’ sleep can cause family stress. Healthy sleep is critical for overall development.

    How Much Do Children Sleep

    Sleep is one of the biggest issues and concerns for parents, both in terms of infant well-being and coping with sleep deprivation. Infants naturally wake frequently to eat, for diaper changes, or just for comfort. This is a biologically normal process for babies. In fact, breastfed babies typically need to feed regularly through the night to meet their nutritional needs. Some infants develop better sleep patterns, sleeping longer stretches at night, fairly early. Others continue with night waking for several years, expressing higher needs for nighttime comfort.

    BEDTIME ISSUES

    NEWBORNS

    INFANTS

    TODDLERS

    PRESCHOOLERS

    Young children may have fear and try to resist bedtime once they become toddlers. Bedtime routines, comfortable sleeping spaces, and an easy-going temperament can all reduce bedtime difficulties for parents of toddlers and preschoolers. Parents who practice co-sleeping, or the practice of sleeping with an infant, may have fewer struggles with bedtime, but are apt to wake more frequently when the child moves or stirs. Parents who co-sleep are typically also less bothered by night wakings for feeding or comfort, since their sleep is less disrupted by getting up to care for a child at night.

    Sleep patterns change rapidly during the first three years of life. Newborns sleep 15 to 18 hours a day. Sleep patterns are commonly in short periods of 2 to 4 hours. Newborns do not distinguish between day and night. Parents are encouraged to keep things quiet and dull during the night to encourage daytime wakefulness.

    Infants sleep 9 to 12 hours at night. Most infants nap between 2 and 5 hours during the day, often in two to three naps. Naptimes become more regular, with many babies settling into regular morning and afternoon naps. Night waking remains normal, both for feedings and comfort; however, some babies may sleep long periods at night. Parents who value independent sleep may work to encourage it.

    Toddlers sleep 11 to 14 hours at night. Most toddlers take one nap of 1 to 2 hours in the afternoon. Some toddlers may still wake at night, primarily for comfort.

    Preschoolers sleep 10 to 12 hours at night. Some preschoolers nap every day, some occasionally take naps, and some do not nap at all. Each of these napping patterns can be normal. With naps outgrown, bedtime may need to be earlier to allow adequate rest. Most preschoolers routinely sleep through the night, but nightmares and other disturbances are common.

    Cultural Differences

    · DIFFERENCES IN WHERE CHILD SLEEPS

    · RISKS OF CO-SLEEPING

    · SAME ROOM, DIFFERENT BEDS

    Cultural differences can also impact infant, toddler and preschooler sleep. The cultural differences in sleep patterns impact both how children sleep and how parents expect children to sleep. Caucasian preschoolers are far more likely to sleep alone in a bedroom compared to African‐American and Hispanic preschoolers. African-American parents are more likely to put preschoolers to sleep in a bedroom with a sibling, while Hispanic parents are more likely to share their own room with a preschooler.

    Co‐sleeping is common in some cultures. Co-sleeping does present some risks–including soft bedding or the risk of a parent rolling over on a child. Parents should never co-sleep on a surface other than a firm mattress, or when taking medications, drinking or using illegal drugs. These all increase the risks of co-sleeping.

    Co-sleeping cribs are an option for parents who would like to keep baby close, but in a separate bed. Today, the American Academy of Pediatrics supports room-sharing with the infant in an appropriate infant bed during the first six months, or longer if preferred. Parents can use bassinets or cribs in their bedroom if they prefer this option. Room sharing is favored in the early months over a separate nursery to reduce the risk of SIDS. In addition, parents and caregivers should be aware that infants should always be put to sleep on their backs, without soft bedding nearby.

    Effects of Nutrition

    Children need proper nutrition for optimal physical growth and good health. Nutrition has a substantial overall impact on adult size and eventual growth.

    NUTRITIONAL NEEDS CHANGE

    Children’s nutritional needs change rapidly from infancy through early childhood. While feeding patterns are controlled by parents during the first year, children pick up on the attitudes of their parents very early.

    ROLE OF THE FAMILY

    NEED FOR ADEQUATE NUTRITION

    The role of the family and parenting practices strongly contribute to whether children acquire positive or negative attitudes and habits toward food, meals and eating.

    All children need proper nutrition for optimal physical growth and good health. Adequate nutrition has been linked to some of the significant increases in average height recorded over the last century.

    Feeding Infants

    Breastfeeding is best for infants if at all possible. Human breast milk provides the exact balance of vitamins, protein, and fat necessary for growth and development. In addition, breast milk provides significant antibodies to fight disease and help support the growing child’s immune system. Breastmilk is more easily digested than formula, and supports an ideal weight. Breastmilk is especially important for premature or ill infants. Infants that are not breastfed should receive an appropriate infant formula. Most infant formulas are based on cow’s milk; however, soy and hypoallergenic formulas are available for children with allergies

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    · Exclusive breastfeeding or breastfeeding without supplementation of any sort is recommended for the first six months. The American Academy of Pediatrics recommends that breastfeeding continue for at least the first year, while the World Health Organization suggests at least the first two years. In most cases, mothers who are HIV positive, those with tuberculosis, those undergoing chemotherapy or using illegal drugs should not breastfeed.

    Infants should be introduced to solids at around six months of age. Typically, infants are ready for solid foods when they can sit up with support, turn their heads away, make chewing motions, and have lost the tongue thrust reflex. Most parents choose rice cereal (single grain iron-fortified) mixed with breast milk (or formula) as a first food; however, many fruits and vegetables are also appropriate early foods. Solids should be introduced in small amounts as a fun learning experience. The meal should stop when the baby loses interest.

    Most infants are ready to try soft, safe finger foods at around eight to nine months old. Cow’s milk is typically avoided through the first year as it is hard to digest, and honey for the first one to two years due to the risk of botulism. Recommendations regarding which solids to introduce and when to introduce them may vary depending upon an individual’s family history of food allergies.

    Feeding Toddlers and Preschoolers

    By the first birthday, most babies will have tripled their birth weight. So a seven pound newborn will now be a sturdy 21 pound toddler. In the second year, growth slows and the appetite drops. A baby that ate everything may become pickier in the second year, and parents are known to say that toddlers (ages one and two) seem to live on air. With reduced growth, the child needs significantly less food. Toddler portions are typically around a quarter of a small adult portion and toddlers may favor certain foods or refuse others from day to day.

    WEANING

    CHOKING HAZARDS

    BALANCE IN LONG RUN

    PRESCHOOLERS (AGES 3 TO 5)

    Role of Family in Developing Eating Habits

    Breastfeeding may continue through the second year; however, most formula-feeding parents will transition one year olds from formula to whole milk, and mothers who wean from breastfeeding will typically offer whole milk. Whole milk is important, rather than low fat or skim, because toddlers need adequate fat for proper growth, brain development, energy and wound healing.

    While toddlers can eat any of the foods the family eats, parents do need to continue to be thoughtful about their child’s food intake. Parents need to remain aware of choking hazards and encourage toddlers to eat while seated. Choking hazards are an ongoing issue for children of this age; some common choking hazards include popcorn, hot dogs and grapes.

    Since toddlers may eat erratically, many parents find it helpful to think of meals as a balance over several days rather than each meal. If one day, the toddler only ate macaroni and cheese and the next he ate only broccoli and apples, it balances out. Toddlers can also be more sensitive to flavors, and may prefer blander, rather than more flavorful foods.

    Preschoolers need a high-quality, balanced diet consisting of the same foods as adults, but in smaller amounts. At around this time many children want foods high in processed sugar. This is not good for their physical growth and health. In addition, diets high in sugar are related to tooth decay. The pickiness of the toddler years may continue into the preschool years; parents are encouraged to help their children make healthy choices during these years.

    Role of Family in Developing Eating Habits

    · FAMILY INFLUENCES

    · HAPPY MEALTIMES

    · STRESSFUL MEALTIMES

    Children are influenced by habits and attitudes of their parents. Even young children will begin to model attitudes and habits taught at home. Take a minute to think about two different family cultures with regard to food.

    In the first scenario, baby joins in family mealtimes. The family laughs and sits together. From baby’s first meals, food is a happy and engaging activity.

    In the second scenario, the baby is fed separately, and is, from a very young age, expected to consume all of his food. Meals are often stressful, with crying and upset babies. The baby has already developed negative connections with food and mealtimes.

    Food Preferences

    Food preferences appear in the toddler and preschool years, whether healthy or unhealthy.

    Parenting cannot necessarily change these food preferences, but some behaviors are associated with better eating habits in early childhood. Some of the common attitudes shared by parents with their children include:

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    · Openness

    Openness to trying new foods. A family that values adventurous and open eating habits is more likely to produce children willing to try new foods; however, many young children will need as many as 15 exposures to be willing to try a new food.

    Relaxed Attitude

    A relaxed or more tense attitude to food and eating. If parents are tense about what is eaten, this tension is likely to be recognized by the child and shared.

    Food as Reward

    Treating food as a reward. This can raise the value of food too high, and may interfere with natural cues of the body.

    Coercion

    Coercing children to eat is associated with both low and high body weights, as well as an unhealthy attitude toward food.

    Family Meals

    Toddlers and young children develop the best attitudes toward food and eating when they are included in family mealtimes. Family meals offer the opportunity for children to learn table manners, as well as social interaction.

    Quality of Food

    Insufficient access to high quality food is an issue in U.S. for many children. This is also a problem in developing countries. A lack of access to high quality food may limit needed essential vitamins and minerals, causing lasting physical difficulties for children. Nutrients essential for the wellbeing of children include:

    IRON

    Correct iron levels in the diet prevent anemia, a deficiency of red blood cells. Anemia results in tiredness, weakness and fatigue.

    CALCIUM

    Calcium supports the development of bone and teeth.

    ZINC

    Zinc supports the function of the immune system, neural communication, and cell duplication.

    VITAMIN A

    Vitamin A maintains the health of the eyes, skin, and many internal organs.

    VITAMIN C

    Vitamin C promotes iron absorption and wound healing.

    EFFECT OF INADEQUATE FOOD

    Inadequate access to food is related to being shorter than same-age peers, or inadequate physical growth. Insufficient nutritious food is also associated with difficulty with attention and memory, poorer intelligence and achievement test scores, and behavior problems such as hyperactivity and aggression.

    Effects of Childhood Illness and Immunization

    Infectious diseases contribute to many child deaths and compromised health around the world, including the United States. Early immunizations to prevent common childhood illnesses are critically important for optimal physical growth and development.

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    · Infectious diseases are illnesses caused by certain germs–these can be viral (caused by a virus) or bacterial(caused by a bacteria). Bacterial illnesses can be treated with antibiotics, but viral ones cannot. Infections can be passed from person-to-person. Common infectious illnesses in childhood include colds and diarrhea.

    Bowel-related illnesses, including forms of diarrhea are more common in countries with unsafe water and food supplies. Globally, there are around one million childhood deaths per year as a result of unclean water. Children who survive serious childhood illnesses may experience stunted growth and lower IQ.

    Serious illnesses used to be common in childhood. Fortunately, these are less common today, but still pose a serious risk to children, particularly those that have not been vaccinated. Measles is the leading cause of death in children worldwide. Complications include brain infection and blindness. Measles is highly contagious.

    Rubella, also called German measles, is particularly dangerous for unborn babies. If contracted during pregnancy, rubella leads to heart defects, mental retardation, bone alterations, vision problems, and hearing loss in the infant.

    Immunization

    · IMMUNIZATION

    · SOME PARENTS REFUSE IMMUNIZATION

    · IMMUNIZATION IN OTHER COUNTRIES

    Immunization is the process of introducing a vaccine into the body. Vaccines work by stimulating the body’s natural immune system to fight a specific disease. Due to widespread immunization, childhood diseases declined dramatically in industrialized nations during past half century. Vaccination has prevented over 300 million illnesses and 700,000 deaths in just the last two decades.

    While immunization is widely available in the United States, many children are not fully immunized. Around 20 percent of the infants and toddlers in the U.S., have not gotten the full series of recommended immunizations. Many others do not receive the full set needed as preschoolers. Vaccinations are required for school, so many American parents catch up prior to kindergarten.

    In many other countries like Australia, Netherlands, and United Kingdom, vaccination rates are very high. In some cases, public health nurses go to the family home to immunize if parents don’t bring a child in when scheduled for vaccinations.

    Reasons to Not Immunize

    There are a number of reasons why parents do not immunize their children.

    ACCESS TO HEALTH CARE

    Lack of access to health insurance for low income children, even with the passage of the Affordable Care Act and the Children’s Health Insurance Program or CHIP.

    PARENTS NOT UNDERSTANDING HEALTH CARE SYSTEM

    Parents may not know how to access health insurance for their children.

    STRESS

    Parents may be too stressed in daily life to make time for appointments.

    LACK OF INFORMATION

    Families may be uninformed about the benefits of vaccination.

    INACCURATE INFORMATION

    Parents may buy into inaccuracies perpetuated by media, including an inaccurate link between vaccinations and autism.

    RELIGIOUS AND CULTURAL OBSTACLES

    Families may have a religious or philosophical belief that children should develop natural immunity.

    CHILD’S HEALTH CONDITION

    Some children may have a medical condition preventing vaccination.

    Body Growth

    The growth rate of children progresses at an astonishing pace the first two years of life and then slows. Children make remarkable strides in gross and fine motor skills which contribute to being actively engaged with their environment, promoting learning in particular.

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    The first two years of life are an essential time for physical growth and development. Some 95 percent of full term newborns weigh between 5.5 lbs and 10 lbs. Birth weight doubles by five months, triples by 12 months, and quadruples by 24 months of age. These are broad generalities, and every child’s growth is individual, based on hormones, genetics and environmental considerations.

    Infants and toddlers grow in spurts rather than steady gain, particularly after the first weeks. During growth spurts, infants are more irritable, very hungry, and may require significantly more sleep. Parents often find these times trying, then realize that baby has grown or perhaps developed new physical skills as her behavior returns to normal.

    Infants and toddlers grow in spurts rather than steady gain, particularly after the first weeks. During growth spurts, infants are more irritable, very hungry, and may require significantly more sleep. Parents often find these times trying, then realize that baby has grown or perhaps developed new physical skills as her behavior returns to normal.

    Fat and Muscle

    While growth is often associated with the brain or skeleton, babies and toddlers must also grow fat and muscle tissue. While newborns may vary significantly in the amount of fat present, most babies become rather chubby over their first nine months. ‘Baby fat’ develops to help maintain a constant body temperature, and peaks at nine months of age. Muscle tissue increases slowly during infancy, but does not reach its peak until the teen years.

    BODY PROPORTION

    The proportions of an infant or toddler’s body are significantly different than an adult’s body. The parts of the body grow at different rates. In early infancy, growth is on a ‘cephalocaudal trend’. From head to tail, the newborn’s head is much larger than her legs. Later, growth moves into a ‘proximodistal trend’. This is the reversal of the cephalocaudal trend. Now, the infant’s trunk grows, along with the arms and legs. Typically, infants slim down over the course of the second year of life, losing the “baby fat” associated with infancy.

    INDIVIDUAL DIFFERENCES

    Individual differences in growth are impacted by a number of factors; including gender, ethnicity, and genetics. In infancy, boys are typically larger, with a lower ratio of fat to muscle. This persists into childhood and adulthood. In addition, some ethnic groups are likely to bear smaller children–Asian children rarely meet North American standards for growth. Girls grow faster than boys, with more rapid organ maturation. In addition, some children grow faster than others over time, progressing at a more rapid rate.

    SKELETAL AGE

    The best estimate of individual adult growth is skeletal age. Assessing skeletal age requires an x-ray of the long bones of the body to look at the growth space available at the ends of the long bones.

    PRESCHOOL YEARS

    Compared to infancy and toddlerhood, physical growth is less rapid during the preschool years. Growth and development slows as children get older. Boys continue to be somewhat larger and more muscular than girls who have more body fat. The proportions of the body continue to change. The body becomes thinner with a wider torso. The internal organs are tucked inside the torso. A straighter spine provides better balance and motor coordination. Individual differences in height and weight are more obvious in early childhood than in infancy and toddlerhood.

    Motor Development

    · MOTOR DEVELOPMENT

    · GROSS MOTOR SKILLS

    · GROSS MOTOR DEVELOPMENT

    Motor development consists of a complex system of actions. Separate activities must blend together and work with others to produce a more effective outcome. This is the premise of the dynamic systems theory of motor development.

    Gross motor skills are actions that help the child move around his environment. These involve large muscles of the body.

    Gross motor development plays a critical role in allowing children to be able to engage with a wider circle of activities and experiences and to move away when overwhelmed.

    Physical Milestones

    Milestones are the typical age by which a child will show the ability to do a specific action. Normal gross motor milestones fall within a range of ages, with a typical or average age. Some children will reach these milestones earlier and others later, while still being in a normal range of development.

    Injuries

    Unintentional injuries increase as the child gains more gross motor skills in particular.

    Accidental injuries are the leading cause of death in industrial nations for children. Injury occurs more frequently for boys than for girls. In addition, children who are temperamentally irritable, inattentive, overactive, or aggressive are more susceptible to serious injury. Educational campaigns can reduce the risk of accidental injury, as can improved access to safe play areas for toddlers and preschoolers.

    Fine Motor Skills

    Fine Motor skills are actions related to the small muscles of the body, particularly the hands and fingers. Fine motor skills play a critical role in cognitive development as the child learns by manipulating objects. When the child manipulates objects, she can see what occurs, particularly reaching and grasping motions.

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    ·

    As with gross motor skills, fine motor skills are marked by a number of milestones. Fine motor milestones are achieved at varying ages, like gross motor skills.

    Newborns: Works to bring hands into field of vision, engage in ‘prereaching’ and make poorly coordinated swipes toward objects even though they rarely make contact

    2 months: Inspects own hands; may reach but not be able to touch objects

    3 to 4 months: Grasps cube

    4 to 5 months: Touches fingers together; touches/bangs object on table

    Reaching and Grasping

    · REACHING AND GRASPING

    · ULNAR AND PINCER GRASP

    · TWISTING AND MAKING LINES

    Reaching and grasping are particularly important for increasing quantity and variety of exploration of objects. Once children can grasp and move objects, they can explore using mouthing, fingering, and close visual analysis. By about ten months of age, infants start using these skills to search for objects and toys.

    Works Cited:

    • AAP. (n.d.). Infant Food and Feeding. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/pages/infant-food-and-feeding.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token
    • CDC.Immunization Schedules. (February 1, 2016). Retrieved from http://www.cdc.gov/vaccines/schedules/.
    • Illinois Department of Public      Health. (n.d.). Congenital Hypothyroidism. Retrieved      from http://www.dph.illinois.gov/sites/default/files/publications/Congenital%20Hypothyroidism%202012.pdf.
    • Lai, Chao-Qiang. (December 11,      2006) How Much of Human Height Is Genetics? Retrieved from http://www.scientificamerican.com/article/how-much-of-human-height/.
    • Lucile Packard Children’s      Hospital, Stanford University. (n.d.). Infant Sleep. Retrieved from http://www.stanfordchildrens.org/en/topic/default?id=infant-sleep-90-P02237.
    • Medline Plus.(July 10,      2015). Growth Hormone Deficiency. Retrieved      from https://www.nlm.nih.gov/medlineplus/ency/article/001176.htm.
    • Medline Plus. (February 2,      2015). Infant-Newborn Development. Retrieved      from https://www.nlm.nih.gov/medlineplus/ency/article/002004.htm.
    • Oswalt, Angela. (n.d.). Infancy-Physical      Development. Retrieved from http://gracepointwellness.org/461-child-development-parenting-infants-0-2/article/10111-infancy-physical-development-average-growth.
    • World Health Organization.      (January 2016). Child Mortality. Retrieved from http://www.who.int/mediacentre/factsheets/fs178/en/.

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