Infant development: Milestones from 10 to 12 months

 

• Improved motor skills. Most babies this age can sit without help and pull themselves to a standing position. Creeping, crawling and walking while holding onto furniture will eventually lead to walking without support. By 12 months, many babies might take their first steps without support.
• Better hand-eye coordination. Most babies this age can feed themselves finger foods, grasping items between the thumb and forefinger. They might also be able to use a spoon. Your baby might delight in banging blocks together, placing objects in a container and taking them out, as well as poking things with a finger.
• Evolving language. Most babies this age respond to simple verbal requests. Your baby might become skilled at gestures, such as shaking the head no or waving bye-bye. Expect your baby's babbling to take on a new tone and evolve to words such as "dada" and "mama." You might hear certain exclamations, such as "uh-oh!"
• New cognitive skills. A baby's understanding that objects exist even when they're hidden will likely improve. This is called object permanence. Babies at this age can easily find hidden objects. Although your baby might cry when you leave the room, your baby will likely begin to realize that you still exist even when you're out of sight. You might find your baby imitating you by pushing buttons on the remote control or "talking" on the phone.

Promoting your baby's development

For most babies this age, their curiosity is growing, and your baby is able to move faster than before. An interesting and safe environment can help babies at this age keep learning.

• Create an exploration-safe environment. Move anything out of reach that could be poisonous, pose a choking hazard or break into small pieces. Cover electrical outlets and use stairway gates. Gates between rooms can help keep your fast-moving baby in safe areas too. Install child locks on doors and cabinets. If you have furniture with sharp edges, pad the corners or remove it from areas where your baby plays. The same goes for lightweight objects your baby might use to pull up to a standing position, such as plant stands and small tables. Anchor bookcases, televisions and their stands to the wall.
• Snuggle up and read. Set aside time for reading every day even if it's only a few minutes. At this age, your baby might love books with flaps, textures or activities. Make your reading more interesting by adding facial expressions, sound effects and voices for characters.
• Keep conversations going. Talk to your baby whenever you can and give your child a chance to reply. Using adult speech, not baby talk, teaches your baby to imitate words correctly. And using all the languages your family speaks helps your child learn them at the same time.
• Set limits. Babies don't have a sense of right or wrong. Praise your baby for good choices. Steer your baby away from unsafe situations. Use a calm no if your baby hurts others. Explain calmly why the action isn't OK, and then redirect your baby's attention.

When something's not right

Your baby might reach some developmental milestones ahead of schedule and lag behind a bit on others. It's a good idea, however, to be aware of the signs or symptoms of a problem.

Consult your baby's health care provider if you're concerned about your baby's development or your baby:

• Does not crawl or consistently drags one side of the body while crawling.
• Cannot stand with help.
• Does not use gestures, such as waving or shaking the head.
• Does not babble or attempt words such as "mama" or "dada."
• Does not search for objects that are hidden while your baby watches.
• Does not point to objects or pictures.

 

ANAL CANAL

  Anal canal is the terminal part of large intestine. It is situated below the level of pelvic diaphragm, lies in anal triangle of perineum between right and left ischiorectal fossae. Length, extent and direction:- Anal canal is 3.8 to 4 cm. in length and extends from anorectal junction to anus and directed downwards and forwards. Though it is only 3.8 cm. long it is of greatest surgical importance because of its role in the mechanism of rectal continence and because it is prone to harbour certain diseases, for these reason its anatomy and closely related levator ani muscle require to be considered in detail. In normal living subject the anal canal is completely collapsed owing to tonic contracture of the anal sphincter and the anal orifice, it is represented by an anterioposterior slit situated in midline. Posteriorly the canal is related to coccyx with a certain amount of fibrous fatty and muscle lining intervening known as “Anococcygeal” ligament. Laterally there is ischiorectal fossa on either sides which is ladened with fat and inferior haemorrhoidal vessel and nerve which crosses it to enter the wall of the canal. 34 Anteriorly in male the canal is related to the (1) central point of perineum i.e. the perineal body (2) Bulb of the urethra and posterior border of urogenital diaphragm (triangular ligament) containing the membranous urethra. In Female the canal is related in front to (1) Perineal body and (2) lowest part of posterior vaginal wall. Anal canal musculature:- The anal wall is surrounded by complex of anal sphincters. 1) Internal sphincter:- This is involuntary muscle and thickened muscle coat of rectum, commence where the rectum, pass through pelvic diaphragm and ends at the anal orifice. It surrounds the upper 3/4th of anal canal i.e. 3 cm. long and ends at intersphincteric groove. The fibres are pearly white and runs transversally. 2) Conjoint longitudinal muscle:- It lies between the external and internal sphincter and is formed by fusion of the puborectalis with longitudinal muscle coat of rectum and anorectal junction. At lower level it becomes fibroelastic and spread out fanwise piercing the subcutaneous part of external sphincter and attaches to skin around the anus. Most lateral of these form the perianal fascia. 3) External sphincter:- It is striated muscle covering whole length of the anal canal and at lower end placed little below the internal sphincter and has three parts viz. subcutaneous, superficial and deep. 35 i) Subcutaneous:- Lies below level of internal sphincter and surrounds lower part of anal canal. It is 15 mm. broad and has no bone attachment. ii) Superficial:- It is elliptical in shape and arises from posterior surface of the terminal segment of coccyx and the anococcygeal ligament or raphe. The fibres surround the lower part of the internal sphincter and are inserted into perineal body. iii) Deep part:- Surrounds the upper part of internal sphincter and fused with puborectalis it has no bone attachment. Internal of anal canal It can be divided into three parts i) Upper part about 15 mm. long ii) Middle part of about 15 mm. long iii) Lower part of about 8 mm. long I) Upper mucosal part:- The mucosa is thrown into 8-14 longitudinal folds known as anal columns or column of Morgagni. Lower end of each column are united to each other by short transverse fold of mucous membrane and is called Anal valves. Above each valve there is depression in mucosa which is called as anal sinus. The anal valves together form a transverse line that run all round the anal canal and is known as pectinate line, it is situated just opposite the internal sphincter. The pectinate line is also known as Dentate line because of serrated fringe produced by the valves. 36 Pecten = Cock‟s comb ( Latin ) Dentate = Toothed ( Latin ) II) Middle part or Transitional zone of Pecten:- It is about 15 mm. and lined by mucous membrane but anal columns are absent. It has bluish appearance because of dense venous plexus that lies between it and muscle coat. The mucosa is mobile than in upper part of anal canal, it is devoid of sweat glands. III) Lower cutaneous part:- It is about 8 mm. long and is lined by true skin containing sweat and sebaceous gland. The Dentate line or Pectinate line:- It is the most important landmark both pathologically and surgically, it represents 1) The site of fusion of the proctoderm and post allantoic gut. 2) The position of the anal membrane remnants of which frequently may be seen as anal papillae situated on the free margin of the anal valves. Anatomical and Surgical importance of the Dentate line:- 1) It forms the embryological watershed between visceral structure above and somatic structure below. 2) The mucosa above the line has autonomic nerve supply and is thus insensitive to cutting and pricking where as the skin and mucosa below is supplied by the inferior rectal branch of the pudendal nerve and is actually sensitive to these stimulii. 3) The anal glands open into the anal sinuses above the anal valve at this level. Infection in an anal gland may lead to an anal abscess which may extend into ischiorectal space and perianal space. 37 4) In the finer control of continence stimulation of nerve endings in the region of the dentate line may initiate reflex or voluantry changes on sphincter tone. The Dentate line seperates:- Above Below Cubical epithelium Squamous epithelium Autonomic nerve Spinal nerve (Pain insensitive) (Very much pain sensitive) i.e. Pudendal nerve Portal venous system Systemic venous system The anal valve of Ball:- The anal valves of Ball are a series of transversally placed semilunar folds linking the columns of Morgagni, they lie along and actually constitute the wavieness of the dentate line. Crypts of Morgagni:- These are small pockets between inferior extremities of the colums of Morgagni about 8 to 14 in number most of them are situated at posterior side and each open into anal glands by a narrow duct called anal duct, this duct bifurcate and pass to enter the internal sphincter muscle where there is ampulla. Infection of an anal gland can give rise to an abscess. Anorectal ring:- It is a muscular ring present at anorectal junction and is formed by fusion of upper end of external and internal sphincter and puborectalis it is more marked posteriorly and laterally than anteriorly. Surgical division of this ring results in rectal incontinence. 38 Arterial supply:- 1) The part above pectinate line is supplied by superior rectal artery. 2) Below pectinate line it is supplied by inferior rectal artery. Venous drainage:- 1) The internal rectal venous plexus or haemorrhoidal plexus lies in submucosa of the anal canal,it drains into superior rectal vein but communicates freely with external plexus i.e. middle and inferior rectal vein and thus is an important site of communication on between portal and systemic veins. Veins present in the three anal columns situated at 3,7 and 11o clock position as seen in the lithotomy position and is site for formation of primary internal piles 2) The external rectal venous plexus lies out side the muscular coat of the rectum and anal canal and communicates freely with internal plexus and is drained by internal rectal vein into pudendal vein. 3) The middle rectal vein drains inta internal iliac vein. 4) The anal veins are arranged radially around the anal margin, they communicate with internal rectal plexus and inferior rectal vein. Excessive straining during defecation may rupture one of these veins subcutaneous perianal haematoma known as external piles. Nerve supply:- 1) Above the pectinate line the anal canal is surrounded by autonomic nerve both sympathetic ( inferior hypogastric plexus 4 to 12) and parasympathetic (pelvic splanchanic S 2, 3 and 4) nerves. 2) Below the pectinate line it is supplied by somatic ( inferior rectal S 2,3 and 4) nerve. 39 3) The internal sphincter is contracted by sympathetic and relaxed by parasympathetic nerve. 4) The external sphincter is supplied by inferior rectal and perineal branch of S4 nerve. Pelvic diaphragm:- It supports the rectum and other pelvic organ and prevents prolapsed of pelvic organ, it is formed by levator ani and coccygeous muscle. I) The levator ani:- It forms the pelvic diaphragm supporting pelvic viscera. The structures passing through pelvic diaphragm lies within the sling of puborectalis muscle. It arises in continuity from pelvic bone in front and thickened obturator fascia and ischial spine, it is inserted into coccyx and anocccygeal ligament posteriorly. II) Coccygeous muscle:- It forms posterior part of pelvic floor; it‟s under surface being continuous with sacro coccygeal ligament. PHYISIOLOGY OF ANO RECTAL CANAL Mechanism of defecation Defecation:- Defecation is an act of emptying the distal colon from the spleenic flexure through the anal orifice into exterior, which is a reflex process. The mechanism of defecation plays an important role in the development of haemorrhoids, if there is any alteration in the process of normal defecation there are more chances of 40 development of haemorrhoids. The main function of the rectum and anal canal is to expel the faeces which is present in the terminal part of alimentary canal viz. the descending colon. Defecation is a complex reflex mechanism which is under voluntary control of cerebral cortex at least in the ordinary condition of life, usually the rectum is empty in normal individual and contain faeces in cases of chronic constipation the urge of defecation occur after the stimulus to the initiation of the distension of rectum. It is likely that a summation of impulse is necessary to achive consciousness of a certain level of filling of rectum together with conditional reflex at the habitual time of the day. Apart from the cerebral cortex there is a center in lumbo sacral region of spinal cord. The reflex centre for defecation is located in hypothalamus, lower lumbar and upper sacral segment of spinal cord and ganglionic plexus of the gut. The reflex is initiated by rise in intra luminal pressure pressure of about 20 to 25 cm. of water in rectum containing pressure receptors which not only detects increase of pressure but also differentiate whether the increase in pressure is due to gas, liquid or solid substance. A factor of prime importance in beginning of the act is the assumption of the squatting position which straightens out the angulation between the rectum and anal canal which facilitates emptying of the rectum. The pelvic floor descends and the physical forces in the anal canal are overcome by intra abdominal pressure. After the main mass of the faeces has passed through the anal canal muscles regain activity and finally discharge the stool.

Helping baby development at 11-12 months

 Here are simple things you can do to help your baby’s development at this age:

 

Talk to your baby: you can help your baby understand what words mean by chatting as you do everyday activities like bathing your baby or changing nappies. Your baby is interested in conversation, so the more talk the better!

Respond to ‘dada’, ‘mama’ and other words: give meaning to your baby’s talking by listening and talking back. This encourages conversation and builds your baby’s communication skills.

Play together: give your baby toys that encourage imagination and creativity, like blocks and cardboard boxes. Paints are also fun – but be prepared for some mess! Playing together helps your baby feel loved and secure.

Spend time playing outdoors: being out and about with you gives your baby many different experiences – there’s so much to see, smell, hear and touch. When you’re outside, remember to be safe in the sun.

Read with your baby: you can encourage your baby’s talking and imagination by reading together, telling stories, singing songs and reciting nursery rhymes. These activities also help your baby learn to read as they get older.

Encourage moving: moving and exploring build your baby’s muscle strength. This is important for more complex movements like pulling to stand and walking.

Feed your baby healthy food: your baby probably enjoys finger food, which is also good for developing their fine motor skills. Make sure your baby sits while they’re eating – this can help to prevent choking.