Page 348 - Encyclopedia of Nursing Research

NeuROBeHAvIORAL DeveLOPMeNT n 315

functioning, which include the autonomic, primary expression of brain functioning
motor, state, attentional or interactive, and and the critical route for communication
regulatory systems. The autonomic system with adults. Investigation of these behaviors N
controls physiologic functions that are basic and their central mechanisms is essential
for survival such as respiration and heart for nursing in understanding of the needs
rate. The motor system involves muscle tone, of infants and in planning interventions to
infant movements, and posture. State organi- improve their neurodevelopmental status.
zation encompasses clarity of states and the The idea of evaluating the vitality and
pattern of transition from one state to another. central nervous system integrity of a neonate
The attentional or interactional system can be by assessing sucking is not new. Nutritive
observed only in the alert state and is indica- sucking is initiated in utero and continues to
tive of an infant’s ability to respond to visual develop in an organized pattern in the early
and auditory stimulation. An infant’s regula- weeks after birth. It involves the integration
tory system reflects the presence and success of multiple sensory and motor central ner-
of an infant’s efforts to achieve and maintain vous system function (Wolff, 1968). Sucking
a balance of these other subsystems. behaviors are thought to be an excellent
Another framework used is the perspec- barometer of central nervous system orga-
tive of developmental science, a multidisci- nization. They can be quantified in detailed
plinary field that brings together researchers analysis and are disturbed to various degrees
and theorists from psychology, biology, nurs- by neurologic problems.
ing, and other disciplines (Cairns, 1996; Miles The work of Medoff-Cooper and col-
& Holditch-Davis, 2003). In this perspective, leagues (Medoff-Cooper, Bilker, & Kaplan,
infants are viewed as developing in a contin- 2001; Medoff-Cooper, McGrath, & Shults,
uously ongoing, reciprocal process of inter- 2002; Medoff-Cooper, McGrath, & Biler, 2000)
action with the environment. Infants and demonstrated that changes in the pattern of
their environments form a complex system, nutritive sucking behaviors can be described
consisting of elements that are themselves as a function of gestational age in healthy
systems, such as the mother and child, inter- preterm and full-term infants. They reported
acting together so that the total system shows that sucking patterns change systematically
less variability than that of the individual ele- with increasing postmenstrual and gesta-
ments. Moreover, plasticity is assumed to be tional age, with a strong correlation between
inherent in the infants, their families, and the increasing maturation and more organized
environment. Infants are active participants sucking patterns (Medoff-Cooper et al., 2002).
in their families and the greater environ- When comparing sucking behaviors at term
ment, constantly changing them at the same of 213 extremely early born infants (gesta-
time that the physical and social environment tional age ≤29 weeks), more mature preterm
is influencing the infant. Interactions, rather infants (30–32 weeks gestational age), and
than causation, are the focus of this perspec- newly born term infants, sucking behaviors
tive. No action of one element can be said to were noted to be a function of gestational age
cause the action of another because interac- at birth and the interaction of maturation and
tions between elements are simultaneous experience. extremely early born preterm
and bidirectional. The interactions affect- infants demonstrated less competent feeding
ing development of infants are too complex behaviors than either more mature preterm
to ever be totally identified, and infants can infants or newly born full-term infants.
achieve the same developmental outcomes Lau, Smith, and Schandler (2003) also
through different processes. found that with increasing postmenstrual age
Newborn behavior, which includes suck- (PMA), preterm infants demonstrated signif-
ing and sleeping and waking, is the infant’s icant improvement in feeding performance.