Category: Infant

Rationale

The exposure to narcotic substances before birth has tremendously adverse effects on a child, leading to multiple health complications, the development of the Narcotic Abstinence Syndrome (NAS) being the most negative one. The presence of chemical dependency in infants requires an elaborate treatment strategy to alleviate the health complications in infants (Klaman et al., 2017). To study the effects of the Eat, Sleep and Console therapy as a possible solution to the problem of NAS in the target population, a quantitative study will be needed (Oostlander et al., 2019). The choice of the quantitative design is justified by the necessity to prove the superiority of the proposed solution to the one that is currently deployed as the alternative way of managing the needs of the specified population. Specifically, it is suggested that a randomized controlled trial (RCT) should be deployed to compare the effects of the Eat, Sleep and Console therapy on infants with NAS and the outcomes of the present strategy for handling the specified health issue.

Clinical Significance

The study of managing NAS in infants with the help of the Eat, Sleep and Console therapy has a moderate level of clinical significance. While this paper is not going to revolutionize the management of NAS in infants since it does not offer a groundbreaking innovation, it will contribute to the discourse substantially (Grisham et al., 2019). By testing the efficacy of the Eat, Sleep and Console therapy on infants ability to fight the challenges caused by the exposition to drugs, particularly, opioids, before birth. Since the described concern affects a large number of infants, it is critical to research the available opportunities.

Moreover, given the fact that the effects of NAS are likely to affect an individuals health status throughout their entire life, early interventions aimed at alleviating the effects of exposure to drugs will have a massive effect on reducing the negative health outcomes in the future (Cree et al., 2019). In turn, this paper will contribute to fighting the NAS issue and evaluate the effects of one of the possible options. Therefore, the significance of this paper is moderate due to the urgency of the issue.

Determination of Data

The scope of the research will be restricted to a local healthcare facility, where infants with NAS are treated. To reduce the biases associated with the lack of diversity in the sample due to the location issue, the simple random sampling strategy will be used. A sample of 100 participants will be selected to ensure that the results are representative enough. The specified sample will allow determining possible connections between the research variables, as well as the existence of variation in the sample.

Statistical Analysis

To analyze the information collected during the trial, Students t-test will be utilized. The specified framework will allow finding the connections between the variables under analysis, specifically, the positive correlation between the use of the Eat, Sleep and Console therapeutic strategy and the intensity of the NAS symptoms in infants. The integration of Students t-test will be particularly helpful in determining whether the statistical hypothesis or the null hypothesis represents the situation with the management of NAS in infants by using the Eat, Sleep and Console method (Sanlorenzo et al., 2018). Namely, by evaluating the significance of differences in outcomes in the target group and the control group, one will be able to infer critical conclusions about the effects of the proposed therapy on the well-being of infants with NAS.

References

Cree, M., Jairath, P., & May, O. (2019). A hospital-level intervention to improve outcomes of opioid exposed newborns. Journal of Pediatric Nursing, 48, 77-81. Web.

Grisham, L. M., Stephen, M. M., Coykendall, M. R., Kane, M. F., Maurer, J. A., & Bader, M. Y. (2019). Eat, Sleep, Console approach: a family-centered model for the treatment of neonatal abstinence syndrome. Advances in Neonatal Care, 19(2), 138-144. Web.

Klaman, S. L., Isaacs, K., Leopold, A., Perpich, J., Hayashi, S., Vender, J.,& Jones, H. E. (2017). Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: literature review to support national guidance. Journal of Addiction Medicine, 11(3), 178-190. Web.

Oostlander, S. A., Falla, J. A., Dow, K., & Fucile, S. (2019). Occupational therapy management strategies for infants with Neonatal Abstinence Syndrome: Scoping review.Occupational Therapy in Health Care, 33(2), 197-226. Web.

Sanlorenzo, L. A., Stark, A. R., & Patrick, S. W. (2018). Neonatal abstinence syndrome: an update. Current Opinion in Pediatrics, 30(2), 182-186. Web.

Infants develop very quickly and are influenced by various factors, for example, nutrition and the environment. Physical development refers to changes in body size  height, weight, and organ size (Graber, 2021). Certain growth milestones will help parents and pediatricians assess the babys health. Even though nutrition has the most significant impact on a childs development, parents should also take care of some exercise and activity.

The first year after birth is a period of very rapid physical development. During the first year, the childs body length increases by about 25 centimeters or almost 50% compared to birth (Graber, 2021). Their weight also gradually increases  after some fluctuations in the first two months, babies begin to gain a pound per month (Graber, 2021). Doctors use special tables adopted by the World Health Organization to monitor changes.

Other crucial physical development aspects are changes in head size, teeth appearance, and motor skills development. The heads circumference reflects the brains size, and therefore it is measured until the child is three years old (Graber, 2021). The period and peculiarity of the appearance of teeth may differ in children as they depend on the heredity and presence of diseases. On average, they begin to appear at 5-9 months, and by the end of the first year, children have about six teeth (Graber, 2021). Motor skills are also essential: the fine motor is the hands movements responsible for grasping and taking, and the gross motor is body movements (Choi, Kang, & Chung, 2018). Parents must create favorable conditions for infants development and track all indicators.

Rapid growth requires much energy, so nutrition becomes critical in the childs development. Most infants receive breast milk from their mothers for some time after birth, gradually transitioning to baby formula. A study by Choi et al. (2018) found that children who receive exclusively breastfeeding for up to 4 months better correspond to the developmental milestones. In turn, children receiving breast milk less than this period may have delays in development (Choi et al., 2018). Breastfeeding and stopping it is a crucial decision in the family affecting the baby. Bigman, Homedes, and Wilkinson (2021) note that cultural and social norms influence feeding duration. Given the importance of nutrition to infants, parents need to consider the best recommendations.

In addition to nutrition, parents need to take care of the physical activity and calmness of the baby. In particular, some exercises and massages recommended by specialists can have a beneficial impact on development (Alves & Alves, 2019). The psychological well-being of the child and mother is also significant. A study by Racine et al. (2018) found that the adverse experience of a child and a mother can lead to various diseases and interfere with a childs development. Therefore, parents should carefully prepare for the appearance of babies and follow doctors instructions in the first months of their lives.

Thus, infants experience rapid physical development requiring consideration of various factors and careful monitoring. Babies height and weight increase, the heads circumference changes, and they have their first teeth. Parents and doctors can track key milestones using special tables recommended by specialists. Moreover, children develop motor skills  they begin to move and grab various things. The infants must receive the necessary nutrition for the correct development and absence of problems. Parents contribute to the better growth of babies by creating favorable and calm conditions for them.

References

Alves, J. G. B., & Alves, G. V. (2019). Effects of physical activity on childrens growth. Jornal de Pediatria, 95, S72-S78.

Bigman, G., Homedes, N., & Wilkinson, A. V. (2021). A commentary on A systematic review examining the association between body image and infant feeding methods (breastfeeding vs. bottle-feeding). Journal of Health Psychology, 26(8), 1126-1131.

Choi, H. J., Kang, S. K., & Chung, M. R. (2018). The relationship between exclusive breastfeeding and infant development: A 6-and 12-month follow-up study. Early Human Development, 127, 42-47.

Graber, E. G. (2021). Physical growth of infants and children. Web.

Racine, N., Plamondon, A., Madigan, S., McDonald, S., & Tough, S. (2018). Maternal adverse childhood experiences and infant development. Pediatrics, 141(4), 1-9.

Background

Breastfeeding is one of the most key aspects of post-partum care. Mothers are generally encouraged to breastfeed and many express desire to do so. However, despite recommendations, many introduce formula partially or fully in the first months or even weeks of an infants life. Formula is an FDA approved product that mimics human milk and has many of similar nutrients, but is unable to match all the natural elements that breastmilk may include. Due to social pressures, breastfeeding is a point of contention, therefore even with identified benefits there has been a continuous discussion regarding the efficacy of formula as a potential replacement for breastfeeding.

Selection of the topic

The topic is undoubtedly interesting, and it pivots into my personal interest in neonatal and post-partum care. Anecdotal data indicating that millennial mothers are choosing formula more, particularly due to reasons of convenience, is concerning. Although the subject has been studied excessively, modern evidence could provide new insights on the issue. In turn, it will guide decision-making in clinical healthcare and patient guidance to ensure mothers are making the right choices for themselves and their infants.

PICOT Question

The PICOT question highlights the fundamentals of the investigation. The population are breastfeeding mothers, that is intentional, not new mothers. That is because if a mother is unable to breastfeed for some medical reason, it is evident that formula will be necessary for the survival of the infant. Here, the investigation focuses on choice. The use of breast milk is the intervention because even thought it is the recommended standard, it is ultimately the action that health professionals want to take. Obviously, the comparison being to formula. Outcomes are general focused on infant health and development with an impact that breastfeeding has. Finally, the time is 6 months, because that is the recommended time period for exclusive breastfeeding post-partum.

Evidence

It is important to note that every major U.S. and global, both private and public, health organizations or agencies have continuously emphasized the importance of breastfeeding as the primary source of infant feeding. Breastfeeding is known to aid in establishing a stronger immune system which benefits both the mother and the infant, decreasing incidence and severity of a wide range of infections such as respiratory or GI tract. Breast milk contains vital antibodies, which have the unique capacity to stimulate the infants immune system and offer passive protection until it is safe to administer vaccinations. Formula cannot do this in any capacity, and only offers the nutritional elements (also arguably not as rich compared to breast milk) but not the health benefits.

As a result of protection against infections and other health conditions, mortality has been generally lower in breastfed infants. Important to note, that researchers generally emphasize the difficulty of comparison because so many other factors come into play both in the context of the breastfeeding issue and overall infant health. However, associations have been found to reduce risks of allergies, asthma, diabetes, and even obesity.

Breastmilk is also generally more easily digestible by infants due to their digestive system and components of the human milk that cannot be recreated in formula. Neurodevelopmental elements as well as the emotional concept of skin-to-skin contact are other benefits. Overall, it is strongly recommended to engage in exclusive breastfeeding for at least 6 months prior to introducing formula or other foods.

As part of the evidence, it is important to consider not only the start of breastfeeding when the mother is in the hospital, but the continuation of it. While most mothers express desire to fully breastfeed, they stop it early, at around 4 months, with only half the mothers feeding their infants at all by 6 months, with a significant portion switching partially or fully to formula. This is due to personal factors such as pain, poor body image, convenience, as well as social pressures or lack of a support system, including in healthcare. Therefore, it is necessary to provide a system of support and education, both for mothers and the general public on continuous benefits of breastfeeding until 6 months at the very least.

Integration into Practice

Evidence should be integrated into practice through post-partum counseling offered by physicians, nurses, or midwives. Evidence continues to demonstrate overwhelming support for exclusive breastfeeding, without formula in the first six months of the infants life. Staff play a critical role in educating and advising mothers on the best course of action. It is vital to present all the benefits and information in a manner which is understandable to the patients.

Nevertheless, it should be understood that breastfeeding is a highly sensitive issue from all kinds of perspectives, social, cultural, psychological, individual health. Western society both pushes mothers to breastfeed, making it an association of good motherhood, but at the same time shames them in many ways. Staff have to weigh these considerations and provide support for mothers. As mentioned, formula feeding may be often used unnecessarily and early, due to convenience or poor experiences with breastfeeding. Experienced staff can guide mothers in dealing with these issues, i.e. if an infant has trouble latching which is often distraught to mothers, there are techniques that can be tried before resorting to formula. Providers should not pressure mothers to breastfeed but give them the information and tools to make their own decision.

Evaluation

While evaluation may be difficult to gauge with this type of intervention, particularly because ethics do not allow for double blind studies giving infants formulas. Therefore, evaluation of effectiveness will have to rely on observation and statistics. It is important for staff to keep track of the effectiveness of the intervention and counseling to identify if any changes have to be made in the process or if something is not being received well by the mothers. The key objective is to provide accurate information and recommendations so that the mothers choose the best evidence-based practice from a clinical standpoint.

Conclusion

Evidence demonstrates that breastmilk has significant benefits over the use of formula. There is general intent among Western mothers to breastfeed but various factors ranging from physiological to psychological and socio-cultural create barriers. Formula is not inherently bad, but it can cause complications with breastfeeding and should not be used unnecessarily, especially in the first months. Health professionals should counsel and encourage mothers towards exclusive breastfeeding, providing the guidance to navigate individual or social support issues they may face.

References

Brown, A. (2018). Breastfeeding as a public health responsibility: A review of the evidence. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 30(6), 759770. 

Feldman-Winter, L., & Kellams, A. (2020). In-hospital formula feeding and breastfeeding duration. Pediatrics, 146(1), e20201221. 

Hanawalt, Z. H. (2019). Millennial moms choose formular feeding for convenience. Parents. 

Holcomb, J. (2017). Resisting guilt: Mothers breastfeeding intentions and formula use. Sociological Focus, 50(4), 361374. Web.

McCoy, M. B., & Heggie, P. (2020). In-hospital formula feeding and breastfeeding duration. Pediatrics, 146(1), e20192946. 

U.S. Food & Drug Administration. (2018). Questions & answers for consumers concerning infant formula. 

Wagner, C. L. (2021). Counseling the breastfeeding mother. Medscape. Web.

Blackeney, E. R., Herting, J. R., Bekemeier, B., & Zierler, B. K. (2019). Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010. BMC Pregnancy & Childbirth, 19(1):390. Web.

This article explores the question of why different racial and ethnic groups within the US have unequal access to prenatal care, which is a strong predictor of infant mortality rates. The authors cross-reference approximately 670,000 birth certificates with community data to find that young age and low education correlate strongly with insufficient prenatal care, disproportionally affecting young black mothers. This source may be used to demonstrate how racial disparity in infant mortality rates depends on the lack of prenatal as well as postnatal care.

Gillespie-Bell, V. (2021). The contrast of color: Why the black community continues to suffer health disparities. Obstetrics & Gynecology, 137(2), 220-224. Web.

This article poses the question of what are the defining reasons for the racial disparity in infant mortality in the United States. Using historical statistics, she points out that the root of the problem is not merely several select social health determinants but structural racism that defines how healthcare is delivered. The article may be used to demonstrate that, while individual social health determinants are important, racial bias within the healthcare system may also be a prominent cause of higher rates of infant mortality in black mothers.

Green, T., & Hamilton, T. G. (2019). Maternal educational attainment and infant mortality in the United States: Does the gradient vary by race/ethnicity and nativity? Demographic Research, 43, 713-752. Web.

This article investigates whether and how the correlation between maternal education levels and infant mortality rates in the US changes depending on race or ethnicity. The authors use the statistics from the National Center for Health Statistics and logical regression models to find that, among racial and ethnic groups, black mothers have the lowest return to education. This article may be useful to demonstrate that maternal education level as a social health determinant cannot be the only explanation for the disparity in infant mortality rates.

Kirby, A. S. (2017). The US black-white infant mortality gap: Marker of deep inequities. American Journal of Public Health, 107(5), 644645. Web.

This article poses the question of what the underlying causes of the racial disparity in infant mortality in the US are. The author analyzes the birth statistics data from the CDC and arrives at a conclusion that quotable access to healthcare is not enough, and the solution should lie on the policy level. This source may be used to demonstrate how an exclusive focus on a selected range of social health determinants may be a limited approach.

Loggins, S., & Andrade, F. C. D. (2014). Despite an overall decline in US infant mortality rates, the black/white disparity persists: Recent trends and future projections. Journal of Community Health, 39(1), 118-23. Web.

This article analyzes the black/white disparity in infant mortality in the US. Its research question is how this disparity manifested between 1995 and 2009 and what the future projections are. The study uses CDC data on birth and infant mortality to establish that black mothers suffer 2.2 times more infant death due to social health determinants, and the pattern is likely to persist. This source would be useful for outlining the historical context of racial disparity in infant mortality and comparing the authors estimations with actual figures for later years.

MacDorman, M. F. (2011). Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: An overview. Seminars in Perinatology, 35(4), 200-8. Web.

This article poses the question of how significant the racial disparities in infant mortality and related issues actually are and what are the reasons for that. The authors use data from both National Center for Health Statistics and the Center for Disease Control to establish that infant mortality rates among black women are more than twice those of white women. It also highlights that many such deaths are due to preterm births. This article is useful for both demonstrating the general historian trend and stressing the higher incidence of preterm birth in black mothers as an immediate cause of infant mortality.

Matoba, N., & Collins, J. W. (2017). Racial disparity in infant mortality. Seminars in Perinatology, 41(6), 354-359. Web.

This article aims to establish how the social context of race in the US rather than just the select social determinants of health impact racial disparity in infant mortality. They conduct a review of existing research to find out that stress and exposure to racism likely play a role in increasing infant mortality in black mothers. This source is best used to demonstrate how the social environment of the contemporary US, rather than merely disparate health determinants, impacts the situation.

Pabayo, R., Ehntholt, A., Davis, K., Liu, S. Y., Muennig, P., & Cook, D. (2019). Structural racism and odds for infant mortality among infants born in the United States 2010. Journal of Racial and Ethnic Health Disparities, 6(6), 10951106. Web.

This article aims to establish how the estimations for structural racism impacting infant death mortality manifest in individual-level data. The authors use data on 2,163,096 white and 590,081 black infants and employ multilevel logistic regression to cross-reference them with structural racism indicators. Their findings suggest that uneven levels of education and judicial persecution correlate strongly with the rates of infant mortality. This source may be used to highlight the importance of both aforementioned factors as likely causes of higher infant mortality in black mothers.

Singh, J, K., & Yu, S. M. (2019). Infant mortality in the United States, 1915-2017: Large social inequalities have persisted for over a century. International Journal of Maternal and child health and AIDS, 8(1): 1931. Web.

This article aims to establish the historical background of racial disparities in infant mortality rates in the US. The authors use statistics over more than a hundred years to find that the black-white disparity, while always present, is near its all-time high in the early 21^st century. This data may be used to demonstrate that the growing disparity in mortality rates is best explained by the fact that newer and more efficient methods of preventing it are accessible to whites but not blacks.

Stiffler, D., Ayres, B., Fauvergue, C., & Cullen, D. (2018). Sudden infant death and sleep practices in the Black community. Journal for Specialists in Pediatric Nursing, 23(2), e12213. Web.

This article discusses the possible reasons for the higher incidence of sudden infant death in blacks. Its research question is why black mothers are less inclined to adopt sleep practices known to reduce the rates of sudden infant death. Using meta-analysis of seven qualitative studies, the authors find out that the black mothers refusal to adopt better sleeping practices is primarily rooted in cultural norms and beliefs. This source may be used to highlight the cultural aspect of higher infant mortality and link it to insufficient education as a social health determinant preventing mothers from learning about better practices.

References

Blackeney, E. R., Herting, J. R., Bekemeier, B., & Zierler, B. K. (2019). Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010. BMC Pregnancy & Childbirth, 19(1):390. Web.

Gillespie-Bell, V. (2021). The contrast of color: Why the black community continues to suffer health disparities. Obstetrics & Gynecology, 137(2), 220-224. Web.

Green, T., & Hamilton, T. G. (2019). Maternal educational attainment and infant mortality in the United States: Does the gradient vary by race/ethnicity and nativity? Demographic Research, 43, 713-752. Web.

Kirby, A. S. (2017). The US black-white infant mortality gap: Marker of deep inequities. American Journal of Public Health, 107(5), 644645. Web.

Loggins, S., & Andrade, F. C. D. (2014). Despite an overall decline in US infant mortality rates, the black/white disparity persists: Recent trends and future projections. Journal of Community Health, 39(1), 118-23. Web.

MacDorman, M. F. (2011). Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: An overview. Seminars in Perinatology, 35(4), 200-8. Web.

Matoba, N., & Collins, J. W. (2017). Racial disparity in infant mortality. Seminars in Perinatology, 41(6), 354-359. Web.

Pabayo, R., Ehntholt, A., Davis, K., Liu, S. Y., Muennig, P., & Cook, D. (2019). Structural racism and odds for infant mortality among infants born in the United States 2010. Journal of Racial and Ethnic Health Disparities, 6(6), 10951106. Web.

Singh, J, K., & Yu, S. M. (2019). Infant mortality in the United States, 1915-2017: Large social inequalities have persisted for over a century. International Journal of Maternal and child health and AIDS, 8(1): 1931. Web.

Stiffler, D., Ayres, B., Fauvergue, C., & Cullen, D. (2018). Sudden infant death and sleep practices in the Black community. Journal for Specialists in Pediatric Nursing, 23(2), e12213. Web.

Poor diet is a significant cause of death in the US. The New York State Department of Health Division of Nutrition (NYSDF) aims at establishing a conducive environment that empowers residents to adopt healthy eating habits and physical activity. The NYSDF provides WIC foods for mothers and baby formula feeding, aimed at promoting the nutritional health of the mother and child. Adopting healthy feeding practices is crucial to encourage the growth and development of infants and babies, especially those with special needs.

Current Nutritional Practices

Breastfeeding exclusively for six months, and continuing with it while introducing complementary foods up to 12 months or older is a primary nutritional practice. If the mother is a career woman, she may pump breastmilk for the baby. Pumping should begin weeks before resuming work to give the baby time to get used to feeding on a bottle. Breastfeeding provides children with ideal nutrition while supporting growth and development. It protects the baby from short- and long-term diseases.

The other practice is introducing solid foods at six months. At this age, the infant shows signs of developmental readiness, including head control, reduced tongue thrusting, and consumes about 32 ounces of breastmilk or formula per day. WIC provides breastfeeding mothers with infant formula. When infants are six months of age, mothers receive iron-fortified cereal, baby food, fruits, and vegetables, all in amounts that meet the babys individual needs (NYSDH, n.d.). Mothers are encouraged to eat WIC foods to have the strength to take care of the growing baby.

Activities for Promoting Healthy Eating

Food presentation is a primary activity of promoting healthy eating. Present small portions of the novel and non-preferred foods. The goal is to avoid making the child overwhelmed, so the plate should not be filled with new food. For instance, put a single pea on the plate, and increase the amount slowly as the child becomes more accepting of fresh food. The parent should also provide choices of novel and non-preferred foods (Vandeweghe et al., 2016). Allowing the child some level of control over the food they consume can help them adopt healthy eating.

The other strategy is developing a rewards system for encouraging healthy eating. Selective eaters are usually demotivated to have a more extensive food repertoire. A parent should consider reinforcing trying new foods by including extra electronics time after the meal or simply praising them for finishing their meals (Dwyer, 2018). Celebrating the success of appropriate mealtime behavior such as taking a bite of new food can encourage the child.

Children with an autism spectrum disorder, for instance, may negatively react to particular texture, taste, or colors. Those with Downs Syndrome tend to prefer softer food due to swallowing difficulties (Polfuss et al., 2017). In this case, the parent can consider food supplements or giving homemade pureed food to advance the texture. Parents should limit the childrens experiences with processed foods to develop a taste for fresh foods. They can consider making shopping interesting for children by having them choose preferred fruits or healthy snack options, for example, those with low saturated fats or higher fiber content.

In conclusion, diet is a critical consideration in promoting the growth and development of children. It is the responsibility of parents to ensure their kids take a balanced diet for their physical wellbeing. A recommendation is to engage with medical practitioners to know the health necessities of the child, especially with special needs.

References

Dwyer, J. T. (2018). The feeding infants and toddlers study (FITS) 2016: Moving forward. The Journal of Nutrition, 148(suppl_3), 1575S1580S.

New York State Department of Health. (n.d.). WIC foods for mom and baby formula feeding.

Polfuss, M., Simpson, P., Neff Greenley, R., Zhang, L., & Sawin, K. J. (2017). Parental feeding behaviors and weight-related concerns in children with special needs. Western Journal of Nursing Research, 39(8), 10701093.

Vandeweghe, L., Moens, E., Braet, C., Van Lippevelde, W., Vervoort, L., & Verbeken, S. (2016). Perceived effective and feasible strategies to promote healthy eating in young children: Focus groups with parents, family child care providers and daycare assistants. BMC Public Health, 16(1), 1045.

How does language develop?

There is a first pre-linguistic stage. Babies appear to be biologically ready to pay attention to and discriminate against the sounds of human speech. Dialogues between babies and parents begin in the newborn period. At two months of age, babies respond regularly with attention to adults, orient their faces, focus their eyes, smile, move more actively, and articulate. During the expressive phase, they make mouth movements often accompanied by sounds and gestures.

During the first 6 months, conversations and dialogues are mainly carried out by adults, but afterwards babies are more active. So also, from this age, it seems that they understand certain games. At 12 months, they understand some rules of social exchange and take a more active role in following the exchange.

As mentioned above, babies seem predisposed to pick up the sounds of human speech. Babies like to hear voices. Perceptual abilities play an important role in the formation of the child’s vocal performance and language development.

During the first month of life, babies make vegetative sounds. From 5 weeks to three months, laughter appears as a response to the voices and faces of others. These sounds are made by repeating the same vowel or consonant (for example ‘g’ or ‘k’) sounds related to the movement of the tongue. Between 4 and 6 months, babies perform a variety of vocalizations such as screaming, complaining, and making vowels as sounds. Between 7 and 10 months, language is reduced by duplicating the same consonant and vowel (for example, ‘ba, ba, ba’). Between 11 and 12 months, they produce a variety of sounds in which syllables, consonants and vowels can vary (‘tata’, ‘baby’).

How do changes in vocal skills occur?

They occur through changes in the anatomy and physiology of the vocal apparatus, suggesting the relationship between developmental changes in vocal behavior and structural changes in the otopharyngeal anatomy. It is evident that this initial production follows a universal model.

Children make those sounds that they will normally hear in the future. They imitate the rhythm and intonation of their native language before they know what the words mean.

Does language development have environmental influences?

Children articulate substantially more words when they are socially stimulated. Also, when adult vocalizations occur, babies suppress their own vocalizations, creating a silence, as if listening for something, in this way allowing them to learn the basic interactive pattern: speak-listen.

Hearing impaired children produce fewer consonant types and a lower proportion of multisyllabic pronunciations. Therefore, the acoustic environment influences both vocalizations and language.

How and when do the first words develop?

Children usually start producing recognizable words more or less around their first birthday. Although children in this period may be trying to express more meaning than their one-word expressions suggest, it seems wrong to think of these expressions as ‘phrases.’

When they first learn a new word, the meaning they give it may differ from the usual meaning (for example, ‘dog’ used to refer to all animals, or to refer only to the family dog). There are individual differences both in the emission and in the moment of making the first words. In a study carried out, it was found that the most advanced children imitated a word at 9 months and the later ones at 18 months, just as in comprehension, in general, the understanding of words precedes their production.

To produce and understand words, an understanding of referents is necessary. Before the acquisition of language, this reference of objects occurs through gestural communication.

How is gestural communication carried out?

During the second half of the first year, babies begin to understand and use communicative signs, enhancing attention to external stimuli. Attention to external referents is the basis of symbolic communication, whether gestural or vocal. There is evidence that children who experience more with attention experiences tend to speak earlier and develop faster vocabulary.

Towards the end of the first year, children begin to share objects, using conventional gestures such as pointing, showing, etc., in order to direct the adult’s attention to objects that arouse interest in the child. Towards the end of the second year, children frequently use conventional gestures (such as showing and offering objects) with parents.

Conventional gestures and language follow a parallel course of development. Children begin to use the shared, gestural or verbal referent, around the year-year and a half, when Piaget suggests the beginning of the capacity for symbolic representation.

How are pre-linguistic conversations conducted?

Interactive routines not only help children understand semantics, but also understand the pragmatism of language.

By 2 months, babies respond regularly to adult verbalizations, orienting their faces, focusing their eyes, smiling, becoming more active, and articulating. During the expressive phase, they perform mouth movements, often accompanied by gestures and sounds. The mothers respond with their own talk, towards 3 months, parents and baby alternate their vocalizations, the mothers being mainly responsible for the beginning of these exchanges.

During the first 6 months, conversations and dialogues are mainly held by adults. At 12 months they understand certain rules of social exchange and take a more active role.

The construction of the syntax is done while learning the succession of subject, action, object and recipient. Therefore, Bruner argues that before children actually speak, with adult guidance, they learn language formats.

Vision is the faculty of being able to see. The human eye allows us to have a sense of sight, enabling us to learn more about the world than we do with any other senses, hence why it is so crucial to maintain our vision by getting routine checkups. I will discuss many properties of vision development including Visual acuity, contrast sensitivity, the retina, color vision and depth perception. An infant’s vision changes drastically in the first year of their lives (American Academy of Ophthalmology, 2020). Babies are born with very near-sighted vision and can’t focus on items further than 25 cm (10 inches) from their face. Over the next 12 months, a baby’s vision will gradually strengthen, improving to near normal (Aboutkidshealth.ca, 2020). Newborns can detect changes in brightness, and distinguish between stationary and mobile objects. Although most visual elements aren’t fully developed, with increases in: distances between the cornea and retina, pupil size, and stronger rods and cones, visual ability improves drastically (En.wikipedia.org, 2020). The axial length of an eye is 17mm from birth which grows to 21mm by age 2. At birth babies are adjusting to light and beginning to focus and see up to 12 inches in front of them(Complete Eye Care, 2020), up to 6 months they’re reaching and tracking for objects, recognizing people and focusing and up to 12 months they’re able to judge distances pretty well and seeing color clearly. (American Academy of Ophthalmology, 2020)

Visual acuity is the ability of the eye to see and distinguish fine details. It can be influenced by a variety of factors such as: color, brightness, and contrast. (wiseGEEK, 2020) Visual acuity uses the muscles of the eye (ciliary muscles and muscles of orbit) as well as the retina and fovea to focus on objects. A newborn’s acuity is 6/133 (measured from a 6 meters distance using teller cards) and develops to 6/6 at 6 months. At 2 months, babies have control over eye muscles movements which become stronger, but they still see unclear images as the fovea and retina are still developing, and acuity improves to 6/45. Due to the small distance between the cornea and retina of 17mm, infants have smaller retinal images. At 4 months acuity improved to 6/18 vision and at 6 months to 6/6 vision.

The diagram shows the relative acuity of the human eye on the horizontal meridian.

In human foveal cone receptors, spacing declines after birth, the increased density if cones contribute to the development in increasing visual acuity. The density of cones at birth is 19 cones/100mm2 to 42 cones/100mm2 in adulthood (Barnard.S, Edgar.D)

A recent study showed that two weeks before birth, cone density distribution was 20–30 x 103/mm2 across the retina. Density increased on a postnatal day 1 around the foveal center and reached a 45–55 x 103/mm2 by day 10. Between days 10 and 33, cone density at the foveal center increased dramatically, reaching 283 x 103/mm2 by 3.5 months and 600 x 103/mm2 by 5.4 months. Peak foveal density then lowered to 440 x 103/mm2 at 6 months and onwards. (Ncbi.nlm.nih.gov, 2020) This further proved that a high cone density (photopic vision) results in high visual acuity.

Another reason why visual acuity improves in infants is due to the development in the ciliary muscles. These develop from mesenchyme and allow infants to accommodate their vision by contraction/relaxation. To be able to measure visual acuity is an important factor in understanding pediatric vision. One way to measure an infant’s vision is to test sensitivity to visual details by using a set of black stripes. Studies show that a child of one week can distinguish a grey field from a fine black-striped field, one foot away, showing that they will look at a simulated pattern rather than a plain background. As vision develops, infants can differentiate strips in lines that are closer together, so by changing up distances between the lines, we are able to measure VA (En.wikipedia.org. (2020)

Contrast sensitivity is the difference in luminance that allows us to distinguish an object, it is a very essential component of functioning vision. It measures the amount of contrast needed to detect the presence of a grating of different spatial frequencies (units’ are cycles/degrees). Sensitivity at its peak is said to be 4 cycles/degree which shifts to higher frequencies with age.

Contrast sensitivity functions for individual subjects with static grating patterns (Ncbi.nlm.nih.gov. (2020).

In a study, contrast sensitivity development was measured using the sweep VEP method from ages 2 to 40 weeks old (48 infants) and 10 adults. The sweep VEP estimate of grating acuity showed a slow increase in spatial frequency with age, in the first month; 5 c/deg and reaching 16.3 c/deg at 8 months. Results indicated that increases in peak sensitivity and spatial resolution lead to increased contrast sensitivity development. At lower spatial frequencies (5 cycles/deg) CS develops at a rapid rate up to 10 weeks after birth. Development of higher spatial frequency and grating acuity sensitivity continues to develop until 40 weeks after birth. (gratings over 15 cycles/deg). Development after 9 weeks is influenced by changes in the retina(fovea) and cortex (Norcia, Tyler and Hamer, 2020) Wilson (1988) suggested that changes in the spatial scale/curve are caused by the movement of foveal cones. This allows the progression of the shift toward increased spatial frequencies, and the growth of foveal cones causes a rise in sensitivity (Barnard.S, Edgar.D)

The retina is a thin layer of light-sensitive tissue made of photoreceptor cells that is responsible for detecting the color and intensity of light. The purpose of the retina is to receive and convert light into nerve impulses, and send them to the brain via the optic nerve (Healthline, 2020)

From a study on cadaver neonate retinas, researched and performed by Yuodelis and Hendrickson, showed that the diameter of the fovea decreases from 1000 micrometers at birth to 650-700 at 45 months. The main reason why the diameter decreases is due to cones migrating towards the central fovea, increasing its density from 18 cones/100 mm2 in newborns to 42 cones/100 mm2 in adults. Postnatal cone development demonstrates maturation, elongation and increase packing density. Electro-oculography results have shown electrical activity in the cones of newborn babies proving that the cones are functioning despite the immaturity of vision development. The more peripheral regions develop faster than the foveal region; amacrine, bipolar and ganglion cells also migrate as the fovea starts to develop during the first 4 months, as a result, light entering the eye will be detected by a changing array of receptor cells. Myelination of the optic nerve begins and completes for the ganglion cell region by the 6th month after birth (Barnard.S, Edgar.D)

Colour vision is the ability to differentiate among a range of wavelengths of light waves and to see different colors. Colour perception is coordinated by a process between neurons that stimulates different types of photoreceptors by light entering the eye. Those photoreceptors then output impulses via neurons to the brain. Colour perception starts with cells called cones, there are three different types of cones, each of which contains different types of pigments; longer wavelengths, middle wavelengths, and lastly the shorter wavelengths, resulting in trichromatic color vision (Encyclopedia Britannica, 2020) (En.wikipedia.org, 2020)

Colour vision improves at a steady pace over the first 12 months of life, this is due to the strengthening of cones in the fovea. Red is the first color a newborn sees once color vision develops. At one month, babies become sensitive to the brightness of colors and will spend most of their time looking at bold colors and contrasting patterns compared to lighter colors. Vision is limited as nerve cells in the retina that control vision development aren’t developed yet. Around 2 months, a baby is able to tell the difference between two shades of gray that differ by 0.5 percent in brightness, at 4 months babies are able to distinguish an entire range of colors and by 6 months babies are able to see 6/6 vision. (theAsianparent – Your Guide to Pregnancy, Baby & Raising Kids, 2020)

Depth perception is the ability to see the world in three dimensions and to judge the distance of objects. In order to be able to have depth perception, binocular vision is needed. If binocular vision isn’t possible(blind in one eye, etc.), then other factors can aid for some sense of depth perception such as: Motion parallax – which occurs when we move our head back and forth, objects move at different speeds depending on their distance, Interposition – When objects overlap allowing those with monocular vision to judge distances of objects and lastly aerial perspective – this is when color and contrast together tell us the distance of an object: when light travels from a distance, it’s scattered, this light blurs the outlines of things and our brain interprets this as being farther away.(Verywell Health, 2020)

Newborns aren’t able to tell distinguish or see two images. A 1 month can focus on objects 8 to 10 inches from their face however after this vision starts to quickly improve. By 2 months, they can focus on faces, at 3 months babies can follow moving objects and reach for things in front of their face. From months 5 to 9, eye-body coordination improves. From 10 to 12 months, improvements occur in hand-eye coordination and judging distances. The development of depth perception occurs around the time infants start crawling (Hello Motherhood, 2020)

From research, it has been proved that the strength of eye muscle control has a strong positive correlation with depth perception.

Researchers Gibson and Walk developed a study in which an apparatus called the Visual Cliff to test depth perception in infants. Infants were placed on a surface that contained a steep drop and shallow illusion on either half of the surface. In fact, both sides were covered in glass making it a plane surface allowing infants to crawl or move safely. From their experiment, it was found that most infants from 6–14 months would not cross from the shallow side to the deep side due to fear of heights. Gibson and Walk concluded that by six months an infant has developed a sense of depth.

To show that depth perception occurs before infants start to crawl, 1.5-month-old infants were placed on the deep end of the visual cliff, the 1.5-month-old infants’ heart rate decreased, and interest was shown by the infants rather than fear. However, when repeated with six-month-old infants, their heart rates increased rapidly and showed signs of strong discomfort. Therefore, it could be concluded that sometime around 4–5 months, depth perception is developed fully (En.wikipedia.org, 2020).

In conclusion, at birth, pupils can’t fully dilate; lens curvature is practically spherical; the retina is undeveloped, and the infant suffers from astigmatism and mild farsightedness. The baby has poor fixation ability and is unable to discriminate color. By 3 months, control of head movements has improved, and is attraction occurs for colored targets as well as acknowledging smaller targets. They are also able to associate objects with an event (e.g., the bottle and feeding). From 5-6 months, infants have the ability to see an object in their hands, the infant is aware of their surroundings and can look around easily; the infant can observe objects from close distances and can accommodate the eyes to do so. Between 6-9 months acuity improves to almost mature levels. Between 9 months to 1 year, the infant can spot small monuments nearby and watches faces trying to imitate expressions. Infant is very alert to new people around them. They can also recognize familiar and unfamiliar people. (Encyclopedia on Early Childhood Development, 2020)

Introduction

Domestic violence is a concerning issue within the U.S. wherein statistics show that 1 in every 4 women will encounter some form of domestic violence within their lifetime (Get the Facts, 2014). On average, there are nearly 4 million cases of assault related to this issue yet only a small percentage of such cases truly get prosecuted (Domestic Violence: Statistics & Facts, 2014). Through the analysis of Breiding, Smith, Basile, Walters, Jieru & Merrick (2014), it was noted that immediate intervention is needed in such cases due to the long term psychological and physical damage that can occur over continued exposure to violent altercations at home.

Psychological Issues Related to Intimate Partner Violence

Victimhood

One of the more common attributes of victims of domestic violence are instances where they feel that they deserve the abuse that they are receiving. Hatcher, Colvin, Ndlovu & Dworkin (2014) explain that this often comes about through a lack of self-esteem due to repeated psychological and physical abuse. The end result is that victims start to think that being abused is “normal” and that they merely have to put up with it. Such a state of affairs is further compounded by the social stigma surrounding domestic abuse victims which often results in them refusing to even acknowledge that they are victims.

It is due to this that it is recommended that victims undergo some form of psychological counseling in order to help them deal with their lack of self-esteem and their belief that they deserve the punishment that they are getting. By addressing the emotional turmoil that they are going through, this helps to prevent future cases of depression, anxiety and stress which tends to manifest overtime the longer the abuse occurs.

Physical Issues Related to Intimate Partner Violence

Aside from psychological problems that arise from intimate physical partner violence, it is important to note that the most obvious signs often manifest via external injures. Such injuries often come in the form of trauma to the head (from an object being thrown at the victim), bruising around the face and wrists as well as injuries to knees or ribs as a result of being pushed into objects or downstairs.

While the treatment of these external injuries is actually pretty straightforward, it is important to note that victims of domestic abuse are often reluctant to actually say that they are victims at all. As such, it is often hard for on call nurses to distinguish between simple accidents or people who are actually victims. One of the best ways of doing so though is by identifying people who keep on coming in to the hospital with repeated injuries yet are not in careers or professions that would warrant such cases (ex: construction worker, boxer, etc.) In cases where a potential victim has been identified, it is important to note that directness is often not the best route when it comes to helping such individuals.

As Clark, Allen, Goyal, Raker & Gottlieb (2014) explain, these people often feel ashamed that they are victims of abuse or they fear the repercussions should they tell anyone about what is happening to them. It is due to this that nurses need to be able to assure apparent victims that they are in a safe place and if they need help, there are resources that they can access in order to resolve their problem. What is important is to show that you care without outright discussing the topic which may in fact scare the person off.

Impact on Infants

Based on the observations of Yount, VanderEnde, Zureick-Brown, Anh, Schuler & Minh (2014), it was noted that the impact of intimate partner violence on infants often manifest in abuse or neglect involving 30 to 60 percent of cases with women that have infants. This at times manifested in malnutrition, bacterial infections due to a lack of care, frequent sickness as well as marks of physical abuse that are often causes by the parent either gripping the child too hard, holding them the wrong way or shaking them in order to keep them quiet. This often results in minor to severe physical trauma which can be life threatening if unaddressed in the long term.

It is important to note that the adverse effect of intimate partner violence on infants is merely a byproduct of the abuse received by the victim (i.e. the partner being abused) (Taft, Small, Humphreys, Hegarty, Walter, Adams & Agius, 2012). Normally, it is not the intention of the victim to abuse the child, rather, the stress, anxiety and fear that were mentioned earlier manifest in such a way that it causes the abuse and neglect of the infant in question.

Treatment procedures for such cases often involve an evaluation of the current health of the infant both from a nutritional and physical standpoint. Deficiencies in immune system health and nutrition are addressed through external supplementation and physical ailments that are identified are immediately presented to the required specialist. Fortunately, infants tend to recover quickly and there is little, if any, long term psychological damage that comes from their exposure to such an experience.

Reference List

Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Jieru, C., & Merrick, M. T. (2014). Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization — National Intimate Partner and Sexual Violence Survey, United States, 2011. MMWR Surveillance Summaries, 63(8), 1-18.

Clark, L. E., Allen, R. H., Goyal, V., Raker, C., & Gottlieb, A. S. (2014). Reproductive coercion and co-occurring intimate partner violence in obstetrics and gynecology patients. American Journal Of Obstetrics & Gynecology, 210(1), 42.

Domestic Violence: Statistics & Facts. (2014). Web.

Get the Facts. (2014). Web.

Hatcher, A. M., Colvin, C. J., Ndlovu, N., & Dworkin, S. L. (2014). Intimate partner violence among rural South African men: alcohol use, sexual decision-making, and partner communication. Culture, Health & Sexuality, 16(9), 1023-1039.

Taft, A. J., Small, R., Humphreys, C., Hegarty, K., Walter, R., Adams, C., & Agius, P. (2012). Enhanced maternal and child health nurse care for women experiencing intimate partner/family violence: protocol for MOVE, a cluster randomised trial of screening and referral in primary health care. BMC Public Health, 12(1), 1-11.

Yount, K., VanderEnde, K., Zureick-Brown, S., Anh, H., Schuler, S., & Minh, T. (2014). Measuring Attitudes About Intimate Partner Violence Against Women: The ATT-IPV Scale. Demography, 51(4), 1551-1572.

Introduction

Infant and child mortality rates are considered unacceptably high in Africa. According to the World Health Organization, numerous factors have contributed to the high number of child death in the region (Global Health Observatory). Issues such as extreme poverty, lack of access to quality health care, and cultural ignorance have all been influential towards this front. Therefore, in trying to find a solution to the problem, one must acknowledge the various factors that cause the same. This makes the challenge more complex as there is no “one size fits all” solution. Indeed, some countries have managed to lower their infant mortality rates significantly over the years. However, some are still struggling to achieve the same. This essay looks into child death in Uganda, which is a third-world country in Africa. The essay gives a background to the challenge and highlights some of the things that have been done to lower infant and child mortality. Additionally, personal interpretation of the challenge and three design-thinking principles will be used to create a design thinking innovative framework.

Background/Context

Child mortality rates are a big concern for many countries and governments. According to WHO, 75% of all recorded infant and child deaths happen to children who are yet to reach their fifth birthday (Global Health Observatory). Numerous countries have cited various reasons as to why this happens. Forty-three children in Uganda die for every 1000 born due to similar reasons (LeAnne 183). According to LeAnne, one driving cause of the infant mortality rate in Uganda is poor access to health facilities (183). The Government of Uganda states that the country has 155 hospitals, with only two being referral hospitals for approximately 43 million people (Hospitals). The statistics show that there is a dire shortage of these critical facilities in the region. A second driving cause of infant and child death in the country is poverty. 20% of the population lives below the dollar, and more are barely just over these statistics (Uganda Poverty Assessment 2016). This makes it difficult for families to prioritize health over other needs, such as food and shelter.

Critically, numerous studies have tried to prove (or disprove) that there is a link between environmental factors and high infant mortality rates. Arguably, the most common link is that areas that have been exposed to toxic waste from industrial productions are expected to have high child death. However, this does not apply to Uganda as it is a third-world country, but it does not have a fully developed industrial sector (compared to other countries that record lower child deaths). Despite this, it is debatable that there is still an environmental link that can be explored. Theoretically, environmental factors affect the socio-economic nature of a community. Thereby, the affected are either able to access the needed health services or not; have the knowledge required to take care of newborns better or not; and demand for their and their children’s rights or not. In Uganda, the political environment has enhanced the poor socio-economic statuses of a majority of the citizens that, arguably, has led to high child and infant mortality rates.

A significant percentage of the most affected people are vulnerable, poor, and illiterate individuals. The level of education is critical in discussing child mortality issues as it underscores the relevance of exposure. It can be stated that people who are educated will adhere to health guidelines such as attending antenatal care and taking the necessary vitamins before and during pregnancy, but they will also lobby for quality health care for themselves. The country has a 76.53% literacy rate and is ranked 120 in the world (LeAnne 183). Additionally, the most affected are living in rural areas compared to the urban centers due to ease of access to information and healthcare facilities. One can argue that the affected behavior is laid-back, as they do not expect much assistance since they are not well educated either.

Possibly, there are a few unique circumstances that have contributed to the high child death in the country. First, the political scene can be attributed to the unfortunate health statistics shared. Historically, Uganda has not had a chance to vote in a seating president democratically. This is because each seating president has been forcefully removed from office, and a new one installed through military coups. Therefore, the administration has been described as being military-oriented as opposed to people-centered. Any solution to the problem should fully appreciate the extent of this political history in ensuring quality health care for the people.

Personal Interpretation of Underlying Complications of the Challenge

As stated, various underlying complications are linked to the selected challenge. A personal interpretation of the same reveals that Uganda, like other developing countries struggling with high infant and child mortality rates, is ultimately unlikely to lower these numbers. Arguably, the population carries significant blame for the unique challenges presented in the country’s politics. Notably, the country is described as being a democratic state with an active opposition party. However, over the years, there has been little, if any, support from the general public that motivates the opposition leaders to seek changes such as better access to health care and education. Whereas this is not a direct link to the stated problem, it provides a reason why a majority of the affected appear to remain in the same poverty cycle. This allows parents to raise kids with the same perceptions about society and some of the things that affect them, such as child and infant mortality.

On the same note, the citizens’ economic status influences policy development when the reverse should be true. Arguably, public participation is not encouraged in the country, and the policies that are eventually adopted do not address the immediate needs of the public. Critical discussions have to be held at the state level to develop ways the public can engage with their government on critical issues such as child mortality. Ideally, such action will take time, and it is for this reason that the innovation framework suggests a way of enhancing knowledge among the population. Arguably, a more knowledgeable community will ensure the population can lobby for the services they require and hold the government accountable if they fail to offer the same.

Design Thinking Principles

The three principles of design thinking that have been used to develop the stated framework are empathy, brainstorming, and experimentation. Innovators often design products and services that they believe will help society. However, numerous such projects have failed to kick off simply because they lacked empathy. Empathy refers to the ability of the innovation to solve a crucial need for a community. The suggested framework works with the assumption that child mortality is a concern for the government and the citizens of Uganda. Arguably, it is a significant concern for the whole world as WHO supports different governments to lower these preventable deaths. It is critical to point out that ideation should go hand-in-hand with the empathy principle. This means that once the idea is conceived, the innovator should discuss it with the target group to ensure that it solves their problems rather than the challenges the innovator has come up with on their own.

The issue of empathy also encourages the re-shaping of the idea once consultations with the target group have been done. For example, after discussions with parents in Uganda, one might realize that access to USSD enabled phones might still be a challenge to a significant percentage of the target population. If such a realization arises, the innovator has to come up with a solution or create an innovation altogether. Although the empathy principle suggests repeat consultation exercises, it is one of the most basic design thinking standards as it allows the innovator to come up with a solution that works.

The second principle that should be used in the process is brainstorming, which is also referred to as expansive thinking. One would imagine that brainstorming should come before empathy. However, in design thinking, this is hardly the case. The reason behind this is that the dire concern for the community might not change for months, but solutions to the same can frequently change before one ideal product is designed. As stated, the challenge is the high mortality rates for under-5 children in Uganda. This challenge has not changed since 2000, yet numerous solutions have tried to address the same issue. The brainstorming session can be divided into two main phases. The first is for the initial product – where different solutions are provided to the challenge, and the best one is then selected. The second phase is on the different aspects that make up the product selected. Each step will require some level of brainstorming to ensure it is done in the best way possible.

One element of brainstorming that can be considered for the solution given is that it has to apply to both the urban and the rural parents. Indeed, whereas parents living in urban set-ups have a higher chance of giving birth and raising healthy kids, a significant number still do not have the same knowledge. Secondly, the selected solution should also be easily accessible to the different cohorts that make up the target group. For instance, it should apply to people with access to mobile phones, the internet, and data network while at the same time can be utilized by people with no access to the mentioned elements.

As the name suggests, this principle is pegged on the fact that the idea created has to be tested. Indeed, even after the target group has agreed that the solution is viable for their situation, the idea’s practicality must be tested. Towards this end, the creation of a prototype would be crucial to make the idea tangible. One advantage of experimentation is that it allows the innovator to identify any loopholes, gaps, or challenges that might occur later. These loopholes can then be addressed before the innovation is complete. Experimentation also allows the innovator to see and feel his or her innovation physically. The chance to test the draft design will not only motivate the innovator but also ensure appreciation for the work done.

The suggested solution will also have a prototype that will be tested by both the innovator and a select group of the target audience. The initial prototype is a storyboard that can indicate how the information will be packaged in the application. Additionally, the storyboard will inform the user interface and determine how the voice aspect will be implemented. The solution will then be tested for practicability – to ensure both the application and the USSD code are running as expected. After the practicability test, the solution will be tested among a select group of the same target audience or people with similar characteristics to the end-user. It is critical to note that this phase of the innovation process can provide critical information that leads to the change of some or all aspects of the solution.

Innovation Framework

A lack of knowledge links the numerous factors contributing to child and infant mortality rates in Uganda. Therefore, any framework suggested should try to resolve this issue. It is imperative to note that lack of knowledge refers to both school-based and health-based information. The suggested solution is the design of a platform that teaches some school-related courses and general health information. This will be presented in both a mobile application and a USSD code for people who do not own smartphones.

Importantly, many people like to play games on their phones. The suggested application and USSD code will playfully combine both voice and text to ensure a smooth uptake of the same. Information will be provided both in short prose form and in question format to allow the recipients to test their knowledge. For example, where users can read a short paragraph or listen to the same, they will get two quick questions to test their knowledge. It is essential to state that the application will be accessible in both English and the local dialect. As mentioned, a significant number of those affected are illiterate. The voice aspect of the application will make sure the users understand, and they can also quickly answer the questions by pressing the correct key on their phone.

Conclusion

In conclusion, the process of design thinking is essential in the creation of practical solutions for modern problems. It is a relatively new concept that has already been used to come up with innovative solutions. Indeed, not only does this approach help come up with ideas that are viable but also sustainable. In this instance, principles of design thinking have been applied to address the challenge of high child mortality rates in Uganda, which is considered to have one of the highest child death rates in Africa. Some of the reasons the area has significant cases of child death include culture, poverty, political ignorance, lack of access to healthcare facilities, and poor quality healthcare services. All these aspects have to be considered when coming up with a practical solution to the problem. Importantly, three fundamental design thinking principles must be considered when coming up with the ideal solution for the identified challenge. The three principles are empathy, brainstorming, and experimentation.

Works Cited

“Global Health Observatory (GHO) Data.” WHO, 2020. Web.

“Hospitals.” Ministry of Uganda, 2020. Web.

LeAnne, Rheta Steen, editor. Emerging Research in Play Therapy, Child Counseling, and Consultation. IGI Global, 2017.

“Uganda Poverty Assessment 2016: Fact Sheet.” World Bank, Web.

Introduction

Milk is the primary source of food for newborns and infants. The best and natural source of milk is from a lactating mother’s breast; hence, it is greatly recommended for newborns aged six years and below. Moreover, breastfeeding should be continued for approximately two years. Human milk is composed of several nutrients and minerals; nevertheless, a special diet may be recommended for infants in certain situations due to metabolic reasons or other pressing factors. As a result, in these cases, artificial feeding is embraced. Powdered milk contains nutrients and minerals, including trace elements.²Examples of trace elements in infant milk formula are iron, lead, copper, manganese, cadmium, lead, and chromium.

The presence of metals in food is best determined by atomic absorption spectrometry (AAS), with the two main ones being the flame atomic absorption spectrometry (FAAS) and graphite furnace atomic absorption spectrometry (GFAS). In AAS, the flame vaporizes the sample and decomposes it into gaseous atoms. The concentration of individual atoms is then measured by the absorption of their specific wavelengths of radiation. For some metals, GFAS expresses superiority over FAAS and this is because each metal has its distinct absorbance wavelength. AAS is generally used to evaluate the concentration of an analyte in a sample. It requires the use of standards with known analyte concentrations to establish the association between the measured absorbance and the unknown analyte concentration. Therefore, entails the application of Beer-Lambert’s principle. This experiment aims to achieve the following objectives:

• To determine the amount of copper, one of the main trace elements, in an infant milk formula sample.
• To utilize serial dilution to generate a standard calibration curve.
• To evaluate the sensitivity of the GFAS using standard solutions.

Results and Discussion

In this experiment, the concentration of copper (Cu) in the infant milk formula was determined using the GFAS technique. Calibration standards were prepared from:

• Exact concentration of the stock copper = 602.4µg/ml
• Exact concentration of the working standard copper solutions = 24.1µg/ml

Four samples were obtained and absorption was measured using AAS. Before subjecting the sample to spectroscopy, the powdered milk sample was subjected to dry ashing (heating it in high temperatures of 600˚C in the furnace) and the wet digestion procedure (addition of concentrated nitric acid) to remove organic matter. The absorbance values of different samples are represented in Table 1 below.

Table 1: Sample solution preparation

The absorbance against the volume of the standard Cu solution calibration graph was constructed from the results in table 1. The calibration curve is essential in determining the overall concentration of Cu in the infant milk formula, as is represented in the figures below. The graph adhered to Beer-Lambert’s law since the volume of the Cu solution added was directly proportional to the corrected absorbance, and as such is a useful analytical tool. Furthermore, the relatively high R² values of 0.9905, 0.999, 0.9898, and 0.9948 for samples 1, 2, 3, and 4, respectively, suggest that the data is a good fit.

The average amount of Cu in the infant formula is determined by the value of the x-intercept on the calibration line. The following was calculated from the equations in Figures 1, 2, 3, and 4:

Table 2: Multiple increment standard addition analysis

Based on Table 2 above, the average amount of Cu in the infant formula, which is the unknown, was 0.1151mgCu/100g. This amount is below the recommended daily amount of Cu intake in infants, which is 200 to 340 mcg (National Institute of Health, 2021).

The amount of Cu obtained had a percentage relative standard deviation of 16.63%. This low relative standard deviation suggests that the amount of Cu detected was closely scattered around the mean, therefore, suggesting minimal errors. Nevertheless, it is essential to recognize the existence of probable errors since the experiment has a relative error percentage of 2.17%.

The probable sources of error in the experiment might result from ashing altering the concentration of Cu in the powder due to volatilization. In addition, there might be contaminants present in reagents, water, or glassware that might interfere with the accuracy of the results. It is important to note that the blank was used to negate the effects of the contaminants on data interpretation.

Summary

The GFAS technique coupled with the multiple standard additions is effective in determining the concentration of copper in infant milk formula. The quality of the analytical method has been illustrated by the linearity of the calibration curve with correlation coefficients close to 1. Furthermore, the relatively small amount of Cu, 0.1151mgCu/100g, illustrates the superiority of the GFAS detection limits.

References

Lutfullah, G., Khan, A., Amjad, A., & Perveen, S. (2014). Comparative study of heavy metals in dried and fluid milk in Peshawar by atomic absorption spectrophotometry. The Scientific World Journal, 2014(715845), 1-5. Web.

National Institute of Health. (2021). Copper. Web.

Ziarati, P., Shirkhan, F., Mostafidi, M., & Zahedim M. (2018). An overview of the heavy metal concentration in milk and dairy products. ACTA Scientific Pharmaceutical Sciences, 2(7), 8-21. Web.