Chapter 8: Early Childhood: Biosocial Development

Corpus Callosum

-A long, thick band of nerve fibers that connects the left and right hemispheres of the brain and allows communication between them. -Grows particularly rapidly in early childhood ^Compared to toddlers, young children become much better at coordinating the two sides of the brain >Hence, both sides of their bodies >They can hop, skip, and gallop at age 5, unlike at age 2. -Serious disorders result when the corpus callosum fails to develop, almost always including intellectual disability. ^Abnormal growth of the corpus callosum is one symptom of autism spectrum disorder, as well as dozens of other disorders

Nutritional Deficiencies

-Although many young children consume more than enough calories, they do not always obtain adequate iron, zinc, and calcium. ex./ North American children now drink less milk than formerly, which means they ingest less calcium and have weaker bones later on. -. Compared with the average child, those preschoolers who eat more dark-green and orange vegetables and less fried food benefit in many ways. ^They gain bone mass but not fat, according to a study that controlled for other factors that might correlate with body fat, such as gender (girls have more), ethnicity (people of some ethnic groups are genetically thinner), and income (poor children have worse diets) -Sugar is a major problem because it is ingraciated in cultural customs ex./ Many customs entice children to eat sweets—in birthday cake, holiday candy, desserts, sweetened juice, soda, and so on. ^One result: Many children have cavities and decaying teeth before age 6.

Allergies

-An estimated 3 to 8 percent of children are allergic to a specific food, almost always a common, healthy one: Cow's milk, eggs, peanuts, tree nuts (such as almonds and walnuts), soy, wheat, fish, and shellfish are the usual culprits. ^Diagnostic standards for allergies vary (which explains the range of estimates), and treatment varies even more -Some experts advocate total avoidance of the offending food—there are peanut-free schools, where no one is allowed to bring a peanut-butter sandwich for lunch—but other experts suggest that tolerance should be gradually increased ^Indeed, exposure to peanuts can begin before birth: A study of pregnant women who ingested peanuts found that their children were less likely to be allergic >Fortunately, many childhood food allergies are outgrown, but allergies make a balanced diet even harder.

Prefrontal cortex

-As the prefrontal cortex matures, social understanding develops ^This is the key to survival:Although sometime evolution is thought to mean survival of the fittest, the human species developed "a mode of living built on social cohesion, cooperation and efficient planning. It was a question of survival of the smartest" ^Children gradually become better at controlling their emotions when they are with other people. >gradual self-control and development of the prefrontal cortex is apparent.

Brain Growth

-By age 2, most neurons have connected to other neurons and substantial pruning has occurred. >The 2-year-old's brain already weighs 75 percent of what it will weigh in adulthood; the 6-year-old's brain is 90 percent of adult weight.

Gross Motor skills

-Gross motor skills improve dramatically during early childhood. When playing, many 2-year-olds fall down and bump clumsily into each other. By contrast, some 5-year-olds perform coordinated dance steps, tumbling tricks, or sports moves. -Children learn best from peers who demonstrate whatever the child is ready to try, from catching a ball to climbing a tree. Of course, culture and locale influence particulars: Some small children learn to skateboard, others to sail. ^Recent urbanization concerns many developmentalists. A century ago, children with varied skill levels played together in empty lots or fields without adult supervision, but now more than half the world's children live in cities. >Busy or violent streets not only impede development of gross motor skills but also add to the natural fears of the immature amygdala, compounded by the learned fears of adults.

Age Related dangers

-In accidents overall, 2- to 6-year-olds are more often seriously hurt than 6- to 10-year-olds. -Immaturity of the prefrontal cortex makes young children impulsive; they plunge into danger. ^Unlike infants, their motor skills allow them to run, leap, scramble, and grab in a flash, before a caregiver can stop them. >Their curiosity is boundless; their impulses are uninhibited. ^Then, if they do something that becomes dangerous, such as lighting a fire while playing with matches, fear and stress might make them slow to get help. -Falls are more often fatal for the youngest (under 24 months) and oldest (over 80 years); preschoolers have high rates of poisoning and drowning; motor-vehicle deaths peak during ages 15 to 25. -Generally, as income falls, accident rates rise, but this is not always true. Not only are 1- to 4-year-olds more likely to die of drowning than any other age group, they drown in swimming pools six times more often than older children and adults

Left handedness

-Left-handed people tend to have thicker corpus callosa than right-handed people do, perhaps because they need to readjust the interaction between the two sides of their bodies, depending on the task. ex./most left-handed people brush their teeth with their left hand because using their dominant hand is more natural, but they shake hands with their right hand because that is what social convention requires. -Acceptance of left-handedness is more widespread now than a century ago. ^More adults in Great Britain and the United States claim to be left-handed today (about 10 percent) than in 1900 (about 3 percent) (McManus et al., 2010). ^ Developmentalists advise against trying to force a left-handed child to become right-handed, since the brain is the origin of handedness.

Lateralization

-Literally, sidedness, referring to the specialization in certain functions by each side of the brain, with one side dominant for each activity. The left side of the brain controls the right side of the body, and vice versa. -The entire human body is lateralized, apparent not only in right- or left-handedness but also in the feet, the eyes, the ears, and the brain itself. ex./ People prefer to kick a ball, wink an eye, or listen on the phone with their preferred foot, eye, or ear, respectively. ^Genes, prenatal hormones, and early experiences all affect which side does what.

left and right halves of the brain

-Logic (left brain) without emotion (right brain) is a severe impairment, as is the opposite -Typically, the left half controls the body's right side as well as areas dedicated to logical reasoning, detailed analysis, and the basics of language. ^The brain's right half controls the body's left side and areas dedicated to emotional and creative impulses, including appreciation of music, art, and poetry. >Thus, the left side notices details and the right side grasps the big picture. -Both sides of the brain are usually involved in every skill. That is why the corpus callosum is crucial. >As myelination progresses, signals between the two hemispheres become quicker and clearer, enabling children to become better thinkers and to be less clumsy. ex./ no 2-year-old can hop on one foot, but most 6-year-olds can—an example of brain balancing. Many songs, dances, and games that young children love involve moving their bodies in some coordinated way—challenging, but fun because of that. -

Myelin

-Myelin (sometimes called the white matter of the brain; the gray matter is the neurons themselves) is a fatty coating on the axons that protects and speeds signals between neurons -Myelin helps every part of the brain, especially the connections between neurons that are far from each other. >It is far more than mere insulation around the axons: "Myelin organizes the very structure of network connectivity . . . and regulates the timing of information flow through individual circuits" ^This is evident in the major link between the left and the right halves of the brain, the corpus callosum, as the following explains.

affects of Impulsiveness and Perseveration

-Neurons have only two kinds of impulses: on-off or, in neuroscience terms, activate-inhibit. ^Each is signaled by biochemical messages from dendrites to axons to neurons. The consequences are evident in executive function and emotional regulation, ^Activation and inhibition are necessary for thoughtful adults, who neither leap too quickly nor hesitate too long. ex./ A balanced brain is best throughout life: One sign of cognitive loss in late adulthood is when an elderly person becomes too cautious or too impulsive. >Many young children are notably unbalanced neurologically. They are impulsive, flitting from one activity to another. That explains why many 3-year-olds cannot stay quietly on one task, even in "circle time" -No young child is perfect at regulating attention, because immaturity of the prefrontal cortex makes it impossible to moderate the limbic system. Impulsiveness and perseveration are evident. ^Because the amygdala is not well connected to more reflective parts of the brain, many children become suddenly terrified—even of something that exists only in imagination. -Development continues as brain maturation (innate) and emotional regulation (learned) allow most children to pay attention and switch activities as needed. By adolescence, most teenagers change tasks at the sound of the school bell.

Environmental hazards

-Observable dangers and restricted exploration are not the only reasons some children are slow to develop motor skills. ^In addition, children who breathe heavily polluted air exercise less. >Often they live in crowded neighborhoods and attend poor schools. -Environmental substances directly impair brain development in young children, especially those in low-SES families ^Of course, many factors impact learning, but the conclusion that pollution harms the brain seems valid -Asthma: In the United States, asthma is more prevalent among children who live in poverty than among those who do not. ^Pollution from traffic and industry during early childhood was a cause, not just a correlate, of asthma >This study began with all 37,401 births in 1999 and 2000 in southwest British Columbia (which includes a major city, Vancouver). ^ By age 3, almost 10 percent (3,482) of these children were asthmatic. ^Each of those 3,482 was matched on SES, gender, and so on with five other children from the same birth group. Exposure to air pollution (including carbon monoxide, nitric oxide, nitrogen dioxide, particulate matter, ozone, sulfur dioxide, black carbon, wood smoke, car exhausts, and smoke from parents' cigarettes) was carefully measured. -However, although carbon monoxide emissions are not visible, when compared to their five matched peers, those children who were diagnosed with asthma were more likely to live near major highways, where carbon monoxide is prevalent. ^ Other research finds that cigarette smoke affects a child's brain as well as their breath—a problem not recognized a decade ago ^From this and other research, we now know that hundreds of substances in air, food, and water affect the brain and thus impede balance, motor skills, and motivation. ^Many substances have not been tested, but some—including lead in the water and air, pesticides in the soil or on clothing, bisphenol A (BPA) in plastic, and secondhand cigarette smoke—are known to be harmful. -E-waste: which refers to discarded computers, cell phones, and other outmoded electronic devices. E-waste may spew pollutants that affect the brains of infants and children, although the data are not yet definitive. ^exposure to e-waste is harmful to health, more well designed epidemiological investigations in vulnerable populations, especially pregnant women and children, are needed to confirm these associations" -Lead, however, has been thoroughly researched, and there is no doubt that lead is severely toxic. The history of lead exposure in the following illustrates the tortuous path from science to practice.

Maturation of the Prefrontal Cortex

-The entire frontal lobe continues to develop for many years after early childhood; dendrite density and myelination are still increasing in emerging adulthood. -Nonetheless, neurological control advances significantly between ages 2 and 6, evident in several ways: >Sleep becomes more regular. >Emotions become more nuanced and responsive. >Temper tantrums subside. >Uncontrollable laughter and tears are less common. ex./ One example of the maturing brain is evident in the game Simon Says. ^ Young children lose at this game because they impulsively do what they see and hear.

Myelination

-The process by which axons become coated with myelin, a fatty substance that speeds the transmission of nerve impulses from neuron to neuron. -After infancy, most of the increase in brain weight occurs because of myelination.

Stress and the Brain

-The relationship between stress and brain activity depends partly on the age of the person and partly on the degree of stress. Both too much and too little impair learning. experiment: In an experiment, brain scans and hormone measurements were taken of 4- to 6-year-olds immediately after a fire alarm. -As measured by their cortisol levels, some children were upset and some were not. Two weeks later, they were questioned about the event. ^Those with higher cortisol reactions to the alarm remembered more details than did those with less stress. >That conclusion is found in other research as well—some stress, but not too much, aids cognition example: if children are witnesses to a crime (a stressful experience) or experience abuse, memory is more accurate when an interviewer is warm and attentive, listening carefully but not suggesting answers -Studies of maltreated children suggest that excessive stress-hormone levels in early childhood permanently damage brain pathways, blunting or accelerating emotional responses lifelong

Obesity

-There is a connection between obesity and low SES ^includes less exercise, more tv, fewer veggies and more fast food >"food deserts" -Traditional diets in low income nations are actually healthier ^regions are adopting Western diets and, as a result, "childhood obesity is one of the most serious public health challenges of the twenty-first century. >The problem is global and is steadily affecting many low and middle income countries, particularly in urban settings" -For all children, appetite decreases between ages 2 and 6, and obesity increases every year from birth through adolescence. -There is some good news in the United States, however. Young children are eating more fruit and are obese less often, from 12.1 percent of 2- to 5-year-olds in 2010 to 8.4 percent in 2012

Academics before 6

-Traditional school necessitates fine motor skills and body control. Writing requires finger control, reading print requires eye control, classroom schedules require bladder control, and so on. -Fine motor skills—like many other biological characteristics, such as bones, brains, and teeth—mature about six months earlier in girls than in boys. These gender differences may be biological, or they may result from practice Boys: boys more often climb and kick (gross motor skills) ^Boys, of course, catch up, and they should not be blamed if they are not as accomplished as their female classmates. Girls: Young girls more often dress up and play with dolls (fine motor skills) ^In grade school, girls are, on average, ahead of boys in behavior and reading because of fine motor maturation.

Importance of Artistic expression

-Young children are imaginative, creative, and not yet self-critical. -The fact that their fine motor skills are immature, and thus their drawings lack precision, is irrelevant. ^Perhaps the immaturity of the prefrontal cortex is a blessing, allowing creativity without self-criticism. -All forms of artistic expression blossom during early childhood; 2- to 6-year-olds love to dance around the room, build an elaborate tower of blocks, make music by pounding in rhythm, and put bright marks on shiny paper. ex./when drawing a person, 2- to 3-year-olds usually draw a "tadpole"—a circle head, dots for eyes, sometimes a smiling mouth, and then a line or two beneath to indicate the rest of the body. ^Children's artwork is not intended to be realistic: It communicates thoughts and self-expression -Cultural and cohort differences are apparent in all artistic skills. ^Neurological evidence finds that their brains reflect their new auditory abilities, a remarkable testimony to the role of family and culture

Injuries and Abuse

-far more children die from violence—either accidental or deliberate—than from any specific disease. ^The contrast between disease and violent (usually accidental) death is most obvious in developed nations, where medical prevention, diagnosis, and treatment make fatal illness rare until late adulthood. >In the United States, four times as many 1- to 4-year-olds die of accidents than of cancer, which is the leading cause of disease death during these years >Indeed, in 2013, more 1- to 4-year-old U.S. children were murdered (337) than died of cancer (328). >This was not always true, but cancer deaths have decreased during the past half-century, while child homicide has increased.

The 5-to-1 ratio of reported versus substantiated cases occurs because:

1. Each child is counted only once, so five verified reports about a single child result in one substantiated case. 2. Substantiation requires proof. Most investigations do not find unmistakable harm or a witness. 3. Many professionals are mandated reporters, required to report any signs of possible maltreatment. In 2014, two-thirds of all reports came from professionals. Usually an investigation finds no harm (Pietrantonio et al., 2013). 4. Some reports are "screened out" as belonging to another jurisdiction, such as the military or a Native American tribe, who have their own systems. In 2014, many (about 39 percent) referrals were screened out. 5. A report may be false or deliberately misleading (though few are) (Sedlak & Ellis, 2014).

kinship care

A form of foster care in which a relative of a maltreated child, usually a grandparent, becomes the approved caregiver. -In every nation, most foster children are from low-income, ethnic-minority families—a statistic that reveals problems in the macrosystem as well as the microsystem. ^ In the United States, most foster children have physical, intellectual, and emotional problems that arose in their original families—evidence of their abuse and neglect >

Foster care

A legal, publicly supported system in which a maltreated child is removed from the parents' custody and entrusted to another adult or family, who is reimbursed for expenses incurred in meeting the child's needs. -Foster parents are paid for the child's expenses and trained to provide good care, although specifics vary from state to state. Every year for the past decade in the United States, almost half a million children have been officially in foster care. ^At least another million are unofficially in kinship care, because relatives realize that the parents are unable or unwilling to provide good care.

post-traumatic stress disorder (PTSD)

An anxiety disorder that develops as a delayed reaction to having experienced or witnessed a profoundly shocking or frightening event, such as rape, severe beating, war, or natural disaster. Its symptoms may include flashbacks to the event, hyperactivity and hypervigilance, displaced anger, sleeplessness, nightmares, sudden terror or anxiety, and confusion between fantasy and reality.

permanency planning

An effort by child-welfare authorities to find a long-term living situation that will provide stability and support for a maltreated child. A goal is to avoid repeated changes of caregiver or school, which can be particularly harmful to the child. In many cases, the best permanency plan for children is to be adopted by another family, who will care for them lifelong. However, adoption is difficult, for many reasons: 1. Judges and biological parents are reluctant to release children for adoption. 2.Most adoptive parents prefer infants, but few maltreating adults realize at birth that they cannot be good parents and thus decide that someone else should care for their newborn. 3.Some agencies screen out families not headed by heterosexual couples. 4.Some professionals insist that adoptive parents be of the same ethnicity and/or religion as the child.

Studies of Severed Corpus Callosa

Astonishing studies of humans whose corpus callosa were severed to relieve severe epilepsy, as well as research on humans and other vertebrates with intact corpus callosa, reveal how the brain's hemispheres specialize.

Secondary Prevention

Danger in high risk situations -School crossing guards and flashing lights on stopped schoolbuses are secondary prevention, as are salt on icy roads, warning signs before blind curves, speed bumps, and walk/don't walk signals at busy intersections.

Child abuse

Deliberate action that is harmful to a child's physical, emotional, or sexual well-being.

Growth pattern

During each year of early childhood, well-nourished children grow about 3 inches (about 7½ centimeters) and gain almost 4½ pounds (2 kilograms). By age 6, the average child in a developed nation: is at least 3½ feet tall (more than 110 centimeters). weighs between 40 and 50 pounds (between 18 and 23 kilograms). looks lean, not chubby. has adultlike body proportions (legs constitute about half the total height).

Child neglect

Failure to meet a child's basic physical, educational, or emotional needs -Neglect is worse than abuse. It also is "the most common and most frequently fatal form of child maltreatment" ^ About three times as many neglect cases occur in the United States as abuse cases, a ratio probably found in many other nations.

Fine motor skills

Fine motor skills are harder to master than gross motor skills. Whistling, winking, and especially writing are difficult. ex./ Pouring juice into a glass, cutting food with a knife, and achieving anything more artful than a scribble with a pencil all require a level of muscular control, patience, and judgment that is beyond most 2-year-olds. -Many fine motor skills involve two hands and thus both sides of the brain ^Brain lateralization is needed.

Types of analysis for cause

For developmentalists, two types of analysis are useful to predict and prevent danger. - Every level must be considered: Causes can be found in the child, the microsystem, the exosystem, and the macrosystem. 1st: The first is to use a dynamic-systems or ecological approach. ex./ when a child is hit by a car, the child might have been impulsive, the parents neglectful (microsystem), the community not child-friendly (no parks, traffic lights, sidewalks, or curbs—all exosystem), and/or the culture may have prioritized fast cars over slow pedestrians (macrosystem). 2nd: The second type of analysis involves understanding statistics. ex./ the rate of childhood poisoning decreased markedly when pill manufacturers adopted bottles with safety caps that are difficult for children to open; such a statistic goes a long way in countering individual complaints about inconvenience. -New statistics show a rise in the number of children being poisoned by taking adult recreational drugs, such as cocaine, alcohol, or marijuana, and adult prescription drugs, such as opioids, and being shot by household guns not locked away.

Reported Maltreatment

Harm or endangerment about which someone has notified the authorities. -Since 1993, the number of children referred to authorities in the United States has ranged from about 2.7 million to 3.6 million per year, with 3.6 million in 2014

Substantiated maltreatment

Harm or endangerment that has been reported, investigated, and verified. - In 2014, about 800,000 children suffered substantiated abuse in the United States. Substantiated maltreatment harms about 1 in every 90 children aged 2 to 5 annually. Data on cases of substantiated maltreatment in the United States in 2014 indicate that 77 percent were neglect, 17 percent physical abuse, 6 percent emotional abuse, and 8 percent sexual abuse. -Ironically, neglect is too often ignored by the public, who are "stuck in an overwhelming and debilitating" concept of maltreatment as something that causes immediate bodily harm

Avoidable Injury

In some nations, malnutrition, malaria, and other infectious diseases combined cause more infant and child deaths than injuries do, but those nations also have high rates of child injury. -Southern Asia and sub-Saharan Africa have the highest rates of motor-vehicle deaths, even though the number of cars is relatively low. Most children who die in such accidents are pedestrians, or are riding—without a helmet—on motorcycles

Signs of Maltreatment in Children Aged 2 to 10

Injuries that are unlikely to be accidents, such as bruises on both sides of the face or body; burns with a clear line between burned and unburned skin 1. Repeated injuries, especially broken bones not properly tended (visible on X-ray) 2. Fantasy play with dominant themes of violence or sex 3.Slow physical growth 4. Unusual appetite or lack of appetite 5.Ongoing physical complaints, such as stomachaches, headaches, genital pain, sleepiness 6.Reluctance to talk, to play, or to move, especially if development is slow 7.No close friendships; hostility toward others; bullying of smaller children 8.Hypervigilance, with quick, impulsive reactions, such as cringing, startling, or hitting 9. Frequent absence from school 10. Frequent change of address 11. Frequent change in caregivers 12. Child seems fearful, not joyful, on seeing caregiver

Child Maltreatment

Intentional harm to or avoidable endangerment of anyone under 18 years of age. -Maltreatment is neither rare nor sudden, and 92 percent of the time the perpetrators are one or both of the child's parents—more often the mother than the father

injury control/harm reduction

Practices that are aimed at anticipating, controlling, and preventing dangerous activities; these practices reflect the beliefs that accidents are not random and that injuries can be made less harmful if proper controls are in place. -Accident implies that an injury is random, unpredictable; if anyone is at fault, it's a careless parent or an accident-prone child. ^ Instead, injury control suggests that the impact of an injury can be limited if appropriate controls are in place, and harm reduction implies that harm can be minimized. - In 2013 in the entire United States, only 60 infant passengers died in car accidents, about one-eighth the number in 2003. ^The research concludes that motivation and education help, but laws mandating primary prevention are more effective

Preventing Maltreatment

Primary: Just as with injury control, the ultimate goal with regard to child maltreatment is primary prevention, a social network of customs and supports that help parents, neighbors, and professionals protect every child. Neighborhood stability, parental education, income support, and fewer unwanted children all reduce maltreatment. -Such measures are more effective in the long run, but governments and private foundations are more likely to fund projects that focus on high-risk families Secondary: involves spotting warning signs and intervening to keep a risky situation from getting worse. ex./ insecure attachment, especially of the disorganized type, is a sign of a disrupted parent-child relationship. Thus, insecure attachment should be repaired before it becomes harmful. - Unfortunately, relatively few reports come from neighbors (5 percent) or relatives (7 percent), who are usually the first to notice when a young child is mistreated. One reason is that they may not know what is normal and what is not. ^ Another reason is that many abusers hide from outsiders, deliberately changing residences and isolating from relatives. Social isolation itself is a worrisome sign. Tertiary: limits harm after maltreatment has occurred. Reporting is the first step; investigating and substantiating is second. -The crucial step, however, is helping the caregiver provide better care (specifics may include treating addiction, assigning a housekeeper, locating family helpers, securing better living quarters).

impulse control

The ability to postpone or deny the immediate response to an idea or behavior. -poor impulse control signifies a personality disorder in adulthood, but is normal in childhood

Consequences of maltreatment

The consequences of maltreatment involve not only the child but also the entire community. -Regarding specifics, much depends on the culture as well as resilience—not only in the child but also in the social context. -Certain customs (such as circumcision, pierced ears, and spanking) are considered abusive among some groups but not in others; their effects vary accordingly. ^The long-term effects of maltreatment depend partly on the child's interpretation at the time (punishment considered unfair is especially harmful) and, in adulthood, on the current relationship between the adult and the punishing parent. ^If the adults have a good relationship (more common if abuse was not chronic), then the adult may recover from past maltreatment > However, when researchers follow maltreated children over the years, deficits in social skills and self-esteem seem more crippling than physical or intellectual damage. ^Maltreated children tend to hate themselves and then hate everyone else. Even if the child was mistreated in the early years and then not after age 5, emotional problems (externalizing for the boys and internalizing for the girls) linger. >Adult drug abuse, social isolation, and poor health may result from maltreatment decades earlier >Many studies find that mistreated children typically regard other people as hostile and exploitative; hence, they are less friendly, more aggressive, and more isolated than other children. -Further, finding and keeping a job is a critical aspect of adult well-being, yet adults who were maltreated suffer in this way as well. ^One study carefully matched 807 children who had experienced substantiated abuse with other children who were of the same sex, ethnicity, and family SES. ^About 35 years later, long after maltreatment had stopped, those who had been mistreated were 14 percent less likely to be employed than those who had not been abused. The researchers concluded: "abused and neglected children experience large and enduring economic consequences" >It may be that self-esteem, emotional stability, and social skills are even more important for female employees than for male ones.

Plumbism

The symptoms of plumbism, as lead poisoning is called, were obvious—intellectual disability, hyperactivity, and even death if the level reached 70 micrograms per deciliter of blood. -Further, since children with high levels of lead in their blood were often from low-SES families, some argued that malnutrition, inadequate schools, family conditions, or a host of other causes were the reasons for their reduced IQ

perseveration

The tendency to persevere in, or stick to, one thought or action for a long time. ex./ Young children may repeat one phrase or question again and again, or cannot stop giggling once they start. That is perseveration.

Frequency of maltreatment

Unknown how frequent it is -Part of the problem is in drawing the line between harsh discipline and abuse, and between momentary and ongoing neglect. ^ If the standard were perfect parenting all day and all night from birth to age 18, as judged by neighbors, professionals, as well as the parent, then every child has been mistreated. ^Only the most severe cases are tallied. >If we rely on official U.S. statistics, positive trends are apparent. Substantiated child maltreatment increased from about 1960 to 1990 but decreased thereafter (see Figure 8.5). >Other sources also report declines, particularly in sexual abuse, over the past two decades. >Perhaps national awareness has led to better reporting and then more effective prevention. ex./ Pennsylvania reports fewer victims than Maine (3,262 compared to 3,823 in 2014), but the child population of Pennsylvania is more than 10 times that of Maine. -Pennsylvania has 20 times more employees screening and investigating than Maine (2,803 to 145). There is another oddity in the data: Only 3 percent of the Pennsylvania victims are classified as neglected, but 62 percent suffered sexual abuse. (National rates are 75 percent neglect and 8 percent sexual abuse.) -From a developmental perspective, beyond the difficulty in getting accurate data, another problem is that most maltreatment occurs early in life, before children are required to attend school, where a teacher would notice a problem. ^One infant in 45 is substantiated as maltreated, as is 1 preschooler in 90

Primary prevention

includes sidewalks, pedestrian overpasses, streetlights, and traffic circles. - Cars have been redesigned (e.g., better headlights, windows, and brakes), and drivers' competence has improved (e.g., stronger penalties for drunk driving). ^Reduction of traffic via improved mass transit provides additional primary prevention.

Levels of Prevention

primary prevention Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse. secondary prevention Actions that avert harm in a high-risk situation, such as stopping a car before it hits a pedestrian. tertiary prevention Actions, such as immediate and effective medical treatment, that are taken after an adverse event (such as illness or injury) and that are aimed at reducing harm or preventing disability.

Tertiary prevention

reduces damage after an accident ex./ include speedy ambulances, efficient emergency room procedures, effective follow-up care, and laws against hit-and-run drivers, all of which have been improved from decades ago. -Medical personnel speak of the golden hour, the hour following an accident, when a victim should be treated. ^Of course, there is nothing magical about 60 minutes in contrast to 61 minutes, but the faster an injury victim reaches a trauma center, the better the chance of recovery