Unit 3: The Physical, Cognitive, and Psychosocial Development of Children and Adolescents

Module 11: The Physical, Cognitive, and Psychosocial Development of Infants and Toddlers

Overview
This module presents the orderly and predictable sequence in the physical, cognitive, and
psychosocial development of infants and toddlers. It emphasizes the importance of
understanding the normal development and acceptable variations in normal developmental
pattern for early diagnosis of developmental disabilities and expedient referral for early
intervention programs.

It includes topics on the intrinsic and extrinsic influences factors that produce individual
variation and make each infant’s developmental path unique. Developmental milestones are
presented in those three areas of development to understand the developmental progress of
infants and toddlers over time

Technical Requirements

Content Outline:
1. Infant Growth and Development
I. Key Points
II. Introduction, Meaning of Infancy
III. Intrinsic and Extrinsic Influences
IV. Developmental Milestones
V. Developmental Snapshots: The first two years
2. Physical Growth
I. Gross Motor Development
II. Fine Motor Development
3. Cognitive Development
I. Problem-Solving Skills
II. Language Development
i. Stages of Language Development
1. Pre-speech Period
2. Naming Period
3. Word Combination Period
4. Psychosocial Development
I. Emotional Development
II. Social Development
5. Adaptive Skills
 6. Attachment Theory
I. Meaning and Assumptions
II. Stages of Attachment
III. 2 Main Theories of Attachment
i. Learning/Behavioral Theory of Attachment
ii. Evolutionary Theory of Attachment
IV. Harry Harlow’s Monkey Stuy
7. Positive Parenting Practices

Objectives:
At the end of this module, you are expected to:
1. Summarize
A. Physical Development of Infants and Toddlers
B. Cognitive Development of Infants and Toddlers
C. Psychosocial Development of Infants and Toddlers
2. Explain Attachment Theory and its implications to later development of children.
3. You are to write your own objective(s) for this module. What do you want to accomplish
at the end of this module? Write it/them here:
________________________________________________________________________
__________________________________________________________________

Preliminary Activity
Watch the video in youtube:

B1015FM. (2015, April 28). Family Fun Fest – Diaper Derby

[Link]

Then answer the following:

1. Write down some of your observations about the baby participants, in terms of
a. Physical development, strength, agility,
b. Cognitive development, following instructions, listening, attention
c. Socio-emotional, facial expressions, emotional reactions, reaction to the crowd,
etc.
2. How would you explain the variations in your observations

Discussion
 Infant Growth and Development
Johnson, C.P. and Blasco, P.A. (1997, July). Infant Growth and Development. In Pediatrics in
Review July 1997, 18 (7) 224-242; DOI: [Link]
[Link]

If you have wifi connection, for the source and original text please go to the link provided
above, The Pediatrics in Review, An Official Journal of the American Academy of Pediatrics.

IMPORTANT POINTS
1. Infant development occurs in an orderly and predictable manner that is determined
intrinsically. It proceeds from cephalic to caudal and proximal to distal as well as from
generalized reactions to stimuli to specific, goal-directed reactions that become increasingly
precise. Extrinsic forces can modulate the velocity and quality of developmental progress.
2. Each developmental domain must be assessed during ongoing developmental surveillance
within the context of health supervision. Generalizations about development cannot be based
on the assessment of skills in a single developmental domain (ie, one cannot describe infant
cognition based on gross motor milestones). However, skills in one developmental domain do
influence the acquisition and assessment of skills in other domains.
3. Speech delays are the most common developmental concern seen by the general pediatrician,
yet they often are not well understood or diagnosed expediently. A sound understanding of the
distinction between an isolated speech delay (usually environmental and often can be
alleviated) and a true language delay (a combined expressive and receptive problem that
implies more significant pathology) will help the clinician refer appropriately for precise
diagnosis and appropriate management.
4. It is essential to understand normal development and acceptable variations in normal
developmental patterns to recognize early patterns that are pathologic and that may indicate a
possible developmental disability.
5. Assessment of the quality of skills and monitoring the attainment of developmental milestones
are essential to early diagnosis of developmental disabilities and expedient referral to early
intervention programs.
Introduction

“Infant” is derived from the Latin word, “ infans,” meaning “unable to speak.” Thus, many
define infancy as the period from birth to approximately 2 years of age, when language begins
to flourish.

It is an exciting period of“ firsts”—first smile, first successful grasp, first evidence of separation
anxiety, first word, first step, first sentence. The infant is a dynamic, ever-changing being who
undergoes an orderly and predictable sequence of neurodevelopmental and physical growth.
This sequence is influenced continuously by intrinsic and extrinsic forces that produce individual
variation and make each infant’s developmental path unique.

Intrinsic influences include the child’s physical characteristics, state of wellness or illness,
temperament, and other genetically determined attributes. Extrinsic influences during infancy
originate primarily from the family: the personalities and style of caregiving by parents and
siblings, the family’s economic status with its impact on resources of time and money, and the
cultural milieu into which the infant is born.

Neurodevelopmental sequences can be viewed broadly in terms of the traditional

developmental milestones. Developmental milestones provide a systematic approach by which
to observe the progress of the infant over time. Attainment of a particular skill builds on the
achievement of earlier skills; only rarely are skills skipped. When this happens, the advanced
skill may represent a“ splinter” skill, that is, a deviant developmental pattern. For example, five-
word sentences in a 2-year-old child who does not follow simple commands may represent
echolalia typical of autism. The sentences are not meaningful and have no communicative
intent.

Delays in one developmental domain may impair development in another domain. For
example, immobility due to neuromuscular disorders prevents exploration of the environment
and, in turn, impedes cognitive development arising through manipulation of objects. Last, a
deficit in one domain may compromise the assessment of skill levels in another domain, even
though development in the second domain is normal. For example, it is difficult to assess
problem-solving skills in a child who has cerebral palsy because the child may understand the
concept of matching geometric forms, yet be unable to insert them physically into a formboard.

Developmental milestones serve as the basis of most standardized assessment and screening
tools. Although these screening tools provide the clinician with a structured method of
observing the infant’s progress and help define a developmental delay, many lack sensitivity.
Parental concern in the face of normal results in developmental screening should not be
disregarded. Focusing narrowly on discrete milestones may fail to reveal atypical organizational
processes that are involved in the child’s developmental progress. Thus, it is important to
analyze all milestones within the context of the child’s history, growth, and physical
 examination as part of an ongoing surveillance program. Only then is it possible to formulate an
overall impression of the child’s true developmental status and the need for intervention.

Although milestones form the foundation of the discussion, the primary intent of this article is
to provide broader insights into infant developmental processes and to help the clinician
recognize warning behaviors (“red flags”) indicative of developmental deficits. The milestone
ages are not repeated in the text to allow a more fluid discussion of developmental themes
within each domain. Milestones have been organized into domains to assist the clinician in
recognizing their independence as well as their interrelationships. Tables illustrating all domains
at each age can be found in Vaughan (see Suggested Reading). Problem-solving and language
milestones facilitate early identification of cognitive deficits.

Adaptive skills (ie, skills related to independence in feeding, dressing, toileting) traditionally
have been included within the fine motor domain. However, because these milestones are
influenced by the social environment, we have included them in a “ psycho-social domain.” Lists
for emotional and socialization milestones also are included in this domain. In contrast to
motor and cognitive milestones, psychosocial behaviors are influenced more by extrinsic
factors, making them less well-defined.

Developmental Snapshots: The First Two Years of Life

Before dissecting infant development into discrete steps within each developmental domain, it
is valuable to view the infant at discrete intervals. These 6-month “snapshots“ are displayed
graphically in Figure 1. This gestalt approach may help the clinician make sense of the
interrelatedness of the precise changes within each developmental domain.
 Figure 1.

Developmental “snapshots” at 6, 12, 18, and 24 months.

These four snapshots illustrate several generalizations about neuro-developmental maturation over time:

 Responses to stimuli proceed from generalized reflexes involving the entire body, as seen in
the newborn (and fetus), to discrete voluntary actions that are under cortical direction. This
specialization allows the child to move from obligatory symmetric reactions when attending to
a stimulus (ie, vocalizations, arm waving, and kicking) to voluntary, asymmetric, and precise
movements toward a stimulus (ie, grasping with one hand and inspecting with the other).
 Development proceeds from cephalic to caudal and proximal to distal. Thus, arm movement
comes under cortical direction and visual guidance before leg movement. With this, the child
progresses from hand-mouth to foot-mouth play. The upper extremities become increasingly
accurate in reaching, grasping, transferring, and manipulating. Distal development is seen when
the infant can isolate and use the index finger to poke and explore object parts. When this
occurs in concert with thumb opposition, the fine pincer grasp is mastered. Precise release of
tiny objects follows, so that fundamental manipulative skills reach adult levels by the end of
infancy.
 Developmental progression is from dependence to independence. The totally dependent
newborn progresses to a toddler who has mobility and manipulative skills that enable him or
her to explore most of the environment. Toddlers can move about the house independently,
opening doors, maneuvering stairs, and fetching desired objects. They can feed and undress
themselves and even may be toilet trained. This new autonomy becomes the foundation for the
challenging “ twos.’

Physical Growth

Growth milestones are the most predicable, although they must be viewed within the context
of each child’s specific genetic and ethnic influences. It is essential to plot the child’s growth on
gender- and age-appropriate charts. Charts now are available for some ethnic groups as well as
for a few genetic syndromes (eg, Down and Turner syndromes). Fetal weight gain is greatest
during the third trimester. During the first few months of life, this rapid growth continues, after
which the growth rate decelerates (Table 1 ). Birthweight is regained by 2 weeks of age and
doubles by 5 months. Height does not double until between 3 and 4 years of age. Head growth
during the first 5 or 6 months is due to continued neuronal cell division. Later, increasing head
size is due to neuronal cell growth and supporting tissue proliferation.
RED FLAGS IN PHYSICAL GROWTH

Occipitofrontal Circumference

Large and small head size both are relative red flags for developmental problems. Microcephaly
is associated with an increased incidence of mental retardation, but there is no straightforward
relationship between small head size and depressed intelligence. As a reflection of normal
variation, microcephaly is not associated with structural pathology of the nervous system or
with low intelligence. Furthermore, microcephaly can be seen with above-average cognitive
capability. Micro-cephaly associated with genetic or acquired disorders reflects cerebral
pathology and almost always has cognitive implications.

Image from [Link]. [Link]

Macrocephaly may be due to hydrocephalus, which is associated with an increased incidence of

cognitive deficits, especially learning disabilities. Macrocephaly without hydrocephalus, far from
being a predictor of advanced intelligence, also is associated with a higher prevalence of
cognitive deficits. It may be due to metabolic or anatomic abnormalities. In about 50% of cases,
macrocephaly is familial, and the implications are benign in terms of intellect. When evaluating
infants whose macrocephaly is isolated, the finding of a large head size in one or both parents
can be reassuring.
Image from [Link] [Link]

Height and Weight

Although the majority of individuals who are of below- or above-average size are otherwise
normal, there is an increased prevalence of developmental disabilities in these two
subpopulations. Many genetic syndromes are associated with short stature; large stature
syndromes are less common. Again, when considering deviation from the norm in the specific
child, family characteristics must be reviewed. The concept of mid-parental height is useful in
determining whether a given child’s size is appropriate for his or her familial growth pattern.

Dysmorphism

Although most isolated minor dysmorphic features are inconsequential, the presence of three
or more may indicate the presence of developmental dysfunction. Almost 75% of these minor
superficial dysmorphisms can be found by examining the face, skin, and hands. The presence of
both minor and major abnormalities may indicate a more serious genetic syndrome. In many
instances, dysmorphic features will lead to the diagnosis of a clinical syndrome during the
neonatal period and predate the recognition of any neurodevelopmental deficits.

Motor Development

To make a meaningful statement about an infant’s motor competence, the pediatrician should
organize data gathered from the history, physical examination, and neuro-developmental
examination according to the following schema: 1) motor developmental milestones, 2) the
classic neurologic examination, and 3) cerebral neuromotor maturational markers (primitive
reflexes and postural reactions). Motor milestones are extracted from the developmental
history as well as from observations during the neurodevelopmental examination. Reference
tables of sequential gross and fine motor milestones are necessary .

Motor Development
Results of assessment in any domain is summarized best as indicating a developmental age for
the child. This approach makes it possible to consider the child in terms of his or her level of
functioning compared against chronologic age. For example, the developmental quotient (DQ)
is the developmental age divided by chronologic age times 100 (see Example below). This
provides a simple expression of deviation from the norm. A quotient above 85 in any domain is
considered within normal limits; a quotient below 70 is considered abnormal. A quotient
between 70 and 85 represents a gray area that warrants close follow-up. Values in the upper
limit of normal do not particularly indicate supernormal abilities. Whether truly gifted athletes
can be recognized early by use of this method is thought-provoking but speculative.

GROSS MOTOR DEVELOPMENT

Gross motor development proceeds from a sequence of prone milestones (beginning with head
up and ending with rolling), to sitting, and then through a standing/ambulating sequence (Fig.
2). Motor milestones do not take into account the quality of a child’s movement. These
sequences must be considered in the context of the motor portion of the neurologic
examination, including observations of station and gait, where qualitative features can be
assessed.

Eliciting reflexes requires patience and repeated, yet gentle, trial and error. Muscle tone
(passive resistance) and strength (active resistance) are a challenge to distinguish in the
contrary infant. The best clues can be obtained from observation, not handling. Spontaneous or
prompted motor activities (eg, weight-bearing in sitting or standing) require adequate strength.
Thus, weakness may be appreciated best from observing the quality of stationary posture and
transition movements. The Gower sign (arising from sitting on the floor to standing, using the
hands to “walk up“ one’s legs) is a classic example and indicative of pelvic girdle and quadriceps
muscular weakness. Not until 2 to 3 years of age does the neurologic examination become
easier and more meaningful as cooperation improves.

Station refers to the posture assumed in sitting or standing and should be viewed from
anterior, lateral, and posterior perspectives, looking for body alignment. Gait refers to walking
and is examined in progress. Initially, the toddler walks on a wide base, slightly crouched, with
the arms abducted and slightly elevated. Forward progression is more staccato than smooth.
Movements gradually become more fluid, the base narrows, and arm swing evolves, leading to
an adult pattern of walking by 3 years of age.

The motor neuromaturational markers are the primitive reflexes, which develop during
gestation and generally disappear between the third and sixth month after birth, and the
postural reactions, which are not present at birth but develop sequentially between 3 and 10
months of age. The Moro, tonic labyrinthine, asymmetric tonic neck, and positive support
reflexes are the most useful clinically (Fig. 4 ).
Figure 4.

Clinically useful reflexes. A. Tonic labyrinthine reflex. In the supine position, the baby’s head is
extended gently to about 45 degrees below horizontal. This produces relative shoulder
retraction and leg extension, resulting in the “surrender posture.“ With head flexion to about
+45 degrees, the arms come forward (shoulder protraction) and the legs flex. B. Asymmetric
tonic neck reflex (ATNR). The sensory limb of the ATNR involves proprioceptors in the cervical
vertebrae. With active or passive head rotation, the baby extends the arm and leg on the face
side and flexes the extremities on the occiput side (the “fencer posture“). There also is some
mild paraspinous muscle contraction on the occiput side that produces subtle trunk curvature.
C. Positive support reflex. With support around the trunk, the infant is suspended and then
lowered to pat the feet gently on a flat surface. This stimulus produces reflex extension at the
hips, knees, and ankles so the infant stands up, completely or partially bearing weight. Children
may go up on their toes initially but should come down onto flat feet within 20 to 30 seconds
before sagging back down toward a sitting position. From Blasco PA. Pediatric Rounds.
1992;1(2): 1–6. Reprinted with permission.

As with all true reflexes, each requires a specific sensory stimulus to generate the stereotyped
motor response. Normal infants demonstrate these postures inconsistently and transiently;
those who have central neurologic (ie, cerebral) injuries show stronger and more sustained
primitive reflex posturing. Primitive reflexes are somewhat difficult to gauge, even in expert
hands. The appearance of postural reactions in sequence beginning after 2 or 3 months of age
is easier to elicit clinically and can provide great insight into the neuromotor integrity of young
infants. Postural reactions are sought in each of the three major categories: righting,
protection, and equilibrium. These movements are much less stereotyped than the primitive
reflexes, and they require a complex interplay of cerebral and cerebellar cortical adjustments to
a barrage of sensory inputs (proprioceptive, visual, vestibular) (Figs. and 6 ). They are easy to
elicit in the normal infant but are markedly slow in appearance in the infant who has central
nervous system damage.

Figure 5.

Normal parachute reaction. The examiner has suspended the child horizontally by the waist and
lowered him face down toward a flat surface. The arms extend in front, slightly abducted at the
shoulders, and the fingers spread as if to break a fall. From Blasco PA. Pediatric Rounds. 1992;
1(2):1–6. Reprinted with permission.
Figure 6.

The infant is seated comfortably, supported about the waist if necessary. The examiner gently
tilts the child to one side, noting righting of the head back toward the midline, protective
extension of the arm toward the side, and equilibrium countermovements of the arm and leg
on the opposite side. From Blasco PA. Pediatric Rounds. 1992;1(2): 1–6. Reprinted with
permission.

FINE MOTOR DEVELOPMENT

In the first year of life, fine motor development is highlighted by the evolution of a pincer grasp.
During the second year of life, the infant learns to use objects as tools during functional play.
There are many stages in accomplishing these two skills; selected ones are illustrated in Table
2⇑ . In the early months, the upper extremities assist with balance and mobility. As balance in
the sitting position improves and the infant assumes biped mobility, the hands become more
available for manipulation of objects—their ultimate function. Primitive reflexes are integrated,
and the upper extremities come under cortical control. Reaching becomes more accurate, and
objects are brought to the mouth for oral exploration. As development progresses from
proximal to distal, reaching and manipulative skills are enhanced further, and precise manual
exploration replaces oral exploration. During the second year, fine motor skills are assessed by
observing the manner in which the hands use objects as tools (eg, blocks to build and crayons
to draw). The close association between gross and fine motor skills in the first year of life
evolves into a similar relationship between problem-solving and fine motor skills during the
 second year. One skill enables or promotes the development of the other. If progress in manual
dexterity is slow, this may impede cognitive development via manipulation of objects.

RED FLAGS IN MOTOR DEVELOPMENT

It is important to begin the motor evaluation by observing the infant. Pay particular attention to
the hands; persistent fisting at 3 months of age often is the earliest indication of neuromotor
dysfunction. Spontaneous postures (eg, froglegs and scissoring) provide visual clues to
hypotonia/weakness and spastic hypertonus, respectively. Delays in thea ppearance of postural
reactions herald future delays in voluntary motor development. An infant will be unable to sit
or walk independently without intact protective and equilibrium mechanisms. Abnormal
movement patterns may indicate pathology. For example, early rolling (1 to 2 months), pulling
directly to a stand at 4 months (instead of to a sit), W-sitting, bunny hopping, and persistent toe
walking may indicate spasticity. Hand dominance prior to 18 months of age should prompt the
clinician to examine the contralateral upper extremity for weakness associated with a
hemiparesis.

Analysis of the information gathered in these areas makes it relatively easy for the practitioner
to reassure him- or herself (and the parents) about a child’s motor competence or to identify
motor impairment at an early age. Once a motor abnormality has been identified, further
assessment of its exact nature and etiology is essential. This almost always warrants referral to
an appropriate subspecialist or subspecialty team. Based on clinical examination and history,
the astute clinician usually can decide into which category the motor disorder falls: 1) static
central nervous system disorders, 2) progressive diseases, 3) spinal cord and peripheral nerve
injuries, or 4) structural defects.

Cognitive Development

Cognitive processing skills are the substrate for intelligence and include a wide range of abilities
(Table 3 ).
Intellectual development depends on learning that contains three components: attention,
information processing, and memory (which includes both encoding and retrieval of
information). Intellectual development is reflected in advancing abilities to comprehend,
reason, and make judgments. Standardized intelligence tests generally measure two forms of
intelligence in the school-age child: verbal and performance (or nonverbal). Such standardized
tests are not available to measure infant intelligence. How then, does one recognize the
attributes of verbal and nonverbal intelligence in infants? In the past two decades, the
discovery of visual habituation techniques to assess infants’ attention was considered a
breakthrough in the study of infant cognition. It is exemplified by one study that describes 4-
day-old infants listening to a long series of “ bee-see-lee” sounds. When a novel “da” sound was
heard, the infants responded with a change in heart rate and faster, stronger sucking on a
pacifier, thereby indicating that very young infants can perceive differences in vowel sounds.

More complex studies using simultaneous auditory and visual stimuli indicate that infants also
are capable of organizing perceptions across sensory modalities (cross-modal matching)
without the language skills to describe them. For example, 11-month-old infants were
presented a sequence of continuous and interrupted pure tones. Two pictures were in the
infants’ view throughout the experiment: one contained a continuous line, the other a dashed
line. The infants consistently matched the correct visual stimulus to the auditory one, inferring
cross-modal matching and some rudimentary understanding of the concept of interruptedness.
Using these techniques, it has been demonstrated that infants younger than 1 year old can
form a wide range of fairly complex categorical representations, including those for faces, color,
geometric shapes, and orientation of lines.

The attempts to measure infant responses precisely, such as those described previously,
depend on sophisticated technology, including infrared photography for tracking infant eye
gaze and pupillary dilatation, videotaping of facial reactions, and electrophysiologic monitoring
of heart rate and evoked potentials. The primary pediatrician can best estimate infant
intelligence by evaluating problem-solving and language milestones. Language is the single best
indicator of intellectual potential; problem-solving skills are the next best measure. Gross motor
skills correlate least with cognitive potential; most infants who are diagnosed later with mental
retardation walk on time.

PROBLEM-SOLVING

Problem-solving skills consist of manipulating objects to solve a problem (eg, choosing the
correct opening for a circular shape in a three-piece form board). The infant’s ability to solve a
problem depends on intact vision, fine motor coordination, and cognitive processing. During
the early weeks of life, the infant explores the environment visually. Later, these visual
experiences reinforce movement. As the upper extremities come under visual guidance,
reaching and grasping are enhanced. At first, the infant brings objects to the mouth for oral
exploration. Later, the infant visually examines an object held in one hand while
manipulating it with the other. Isolation of the index finger promotes more refined
manipulation of the various parts of objects, and the infant becomes successful in discovering
how they work (eg, fingering the clapper of the bell). Mouthing of objects becomes less
appealing. This precise manual-visual manipulation, triggered by a heightened curiosity and
facilitated by a longer attention span, heralds true “inspection” of objects.

The infant is progressing from “learning to manipulate” to“ manipulating to learn.” Improved
macular vision (via myelination of the fovea) and refinement of the pincer grasp promote
inspection of progressively smaller objects. As cognitive abilities continue to advance, the infant
learns to shift attention between two objects (one in each hand), compare, make choices, and
discard or combine objects. This sensory-motor phase of learning is the foundation for
ongoing nonverbal intellectual development.
The 1-year-old child recognizes objects and associates them with their functions. Thus, he or
she begins to use them functionally as“ tools ” instead of mouthing, banging, and throwing
them. This child has left the period of sensory-motor play and entered the stage of functional
play. Play serves as a window into the infant’s thoughts and becomes particularly important
during the next stage of symbolic play. At this point, the infant uses toys that represent real
objects in actions toward him- or herself (putting a toy telephone to the ear and vocalizing) and
later in actions toward dolls or teddy bears (putting a toy tea cup to the doll’s mouth). The use
of symbols lays the foundation for imaginary play. This next stage of play usually does not
appear until 24 to 30 months of age.

The interdependence of language and problem-solving development becomes stronger as the

child begins to label objects and actions. Midway through the second year, this ability to label
and categorize allows the child to match objects that are the same (car to a car and spoon to a
spoon) and later to match an object to its picture. Nonverbal intelligence is assessed by
observing the infant interact with test objects. In the older child, it is assessed through
standardized pencil and paper tasks or computerized tests.

One aspect of nonverbal cognitive development deserves extra attention: object

permanence, a concept studied extensively by Piaget. Prior to the infant’s mastery of object
permanence, a person or object that moves “out of sight“ is“ out of mind”; its disappearance
does not evoke a reaction. The ability to maintain an image of a person develops before that of
an object. The child will show interest in peek-a-boo play, and separation anxiety will occur
when a loved one leaves the room. Shortly thereafter, the child will begin to look for an object
that has been dropped.

At first, an auditory cue when it hits the floor is necessary to locate it. Later, the child will
experience success in finding an object that was dropped from sight and landed silently.

Next, the child will progress to finding an object that has been hidden under a cloth or cup. A
more complex task is locating an object that has been wrapped inside a cloth.

Success requires persistence and memory of the object long enough to complete the three-part
unwrapping process. The next skill in this sequence is the ability to locate an object under
double layers (eg, a cube is placed under a cup and then the cup is covered with a cloth). This is
followed by the ability to locate an object after serial displacements. In this task, an object is
hidden under one cover and then changed to another one. The younger infant always will look
for it under the first cover, even though the position change was seen. Later, he or she will
become successful with this task, as long as each successive displacement still is witnessed. Not
until the end of the second year is the child able to deduce the location of an object that is
hidden without observing the displacement.

Another important concept dominating this period of development is causality. Initially, the
infant accidentally discovers that his or her actions produce a certain effect (eg, kicking the side
of the crib activates a mobile overhead). The infant learns to repeat these actions to obtain the
same effects. Later, he or she will vary actions to cause a novel effect (pulling a string to obtain
the ring). The concept of causality parallels social development in which the infant learns to
manipulate the environment by crying or smiling to obtain the desired reaction from caregivers.
As the infant approaches 2 years of age, he or she will learn that apparent unrelated actions can
be combined to produce an effect (eg, winding a key to make a toy move).

LANGUAGE DEVELOPMENT

Delays in language development are more common than delays in other developmental
domains. Parents and pediatricians generally are less familiar with language milestones.
Language is the most difficult domain to assess by observation because infants rarely vocalize
spontaneously in the clinician’s office. For this reason, it is essential for the clinician to obtain a
thorough and accurate language history. The pediatrician should become familiar with
milestone terminology and learn to give examples (eg,“ razzing”). Between 10 and 18 months of
age, word counts help in assessing a child’s expressive skills; after 18 months of age,
vocabularies increase exponentially, and it is difficult to keep up with counts.

Language includes receptive and expressive skills.

Receptive skills reflect the ability to understand language; expressive skills reflect the ability to
make thoughts, ideas, and desires known to others. Expression of language can take several
forms: speech, gestures, sign language, writing, typing, and“ body language.” Thus, language
and speech are not synonymous. Speech is simply the vocal expression of language. A child can
have normal language and yet be unable to speak. Examples include children who are deaf and
children who have severe cerebral palsy. The child who has a hearing impairment may use
manual sign language to communicate. A child who has normal intelligence but cannot speak
because of oral-motor dysfunction related to cerebral palsy may use a computer that is
activated with a head stick. Conversely, a few children talk but fail to use speech to
communicate (eg, children who have autism). Their vocalizations consist of “parrot talk” or
echolalia that has no communicative intent and, thus, does not represent language.

Language development during infancy can be divided into three periods: prespeech, naming,
and word combination periods.

1. Prespeech Period (0 to 10 months):

Receptive language is characterized by an increasing ability to localize sounds. Sound

localization is assessed by using a noisemaker such as a bell (Fig. 7).

Expressive language consists of musical-like vowel sounds (cooing) that are interrupted
by crying when the baby has a need.

At about 3 months, the infant will begin vocalizing immediately upon hearing an adult
speak. One or two months later the infant is silent and assumes a posture that implies
he or she truly is“ listening” to the speaker. These infants make no vocalizations until
the speaker is quiet, mimic the speaker, and then quiet again when the adult speaks.
They appear to enjoy the “vocal tennis” and repeat this for several cycles.
 At approximately 6 months of age, the infant adds consonants to the vowel sounds in a
repetitive fashion (babbling). Soon the infant appears to initiate conversations. When a
random vocalization (eg, “dada”) is interpreted by the parents as a real word, they show
pleasure and joy. In so doing, adults give meaning to these first “words” and reinforce
their repeated use.

2. Naming Period (10 to 18 months):

This period is characterized by the infant’s realization that people have names and
objects have labels. It is an important turning point in language development. The
“dada” and “mama” that were vocalized randomly have been reinforced, so the infant
now begins to use them appropriately. Infants next recognize and understand their own
names and the meaning of “no.” This marks the beginning of exponential growth in
receptive language.

By 12 months of age, some infants understand as many as 100 words. They also can
follow a simple command as long as the speaker uses a gesture. Early in the second
year, a gesture no longer is needed to aid in comprehension of the command.
Expressive language progresses at a somewhat slower rate. The infant will say at least
one “real” word (ie, other than mama, dada, or a proper name) before his or her first
birthday. At this time, the infant also will begin to verbalize with sentence-like
intonation and rhythm (immature jargoning). As the expressive vocabulary increases,
real words are added (mature jargoning). By the end of the naming period, the infant
will use approximately 25 words spontaneously.

During this period, pointing becomes important to both receptive and expressive
language skills. Pointing already has become a method of exploration within the
problem-solving domain. The infant beginning to look in the general vicinity where the
adult is pointing is a receptive language skill. This ability is facilitated by the
infantrsquo;s new realization that objects have labels. Later, the infant begins to take
part in pointing games. He or she will point first to family members, then objects, body
parts, articles of clothing, and pictures upon request. These all reflect receptive
language skills.

Pointing also is used for language expression. First, the infant points at an object and
uses the adult as a tool to retrieve the object, referred to by linguists as protoimperative
pointing.
The infant first points to the object (eg, a cookie) and then looks back and forth between
the adult and the object expectantly. At a later stage, he or she directs attention to the
 adult and alternately points at the adult and the desired object while vocalizing (eg,
“uh...uh”).

Next, the infant uses the object as a tool to obtain the parent’s attention
(protodeclarative pointing). Protodeclarative pointing is a social act; the parent is an
active and important partner in a shared world. Rather than acquisition of the object,
the infant’s goal becomes the parent’s acknowledgment of the interesting object. For
example, when an infant hears an airplane overhead, he or she points to it and vocalizes
to get the parent to look at it. If the parent does not comply with these initial efforts,
the infant may approach the parent and turn his or her face toward the plane in a more
determined effort to obtain what is sometimes called “joint attention.”

Finally, the infant will point at an object and vocalize (“uh?”) in an effort to obtain the
proper label or name for that object from the listener. This is called “pointing for
naming.”

3. Word Combination Period (18 to 24 months):

Typically, children begin to combine words approximately 6 to 8 months after they say
their first word. If word combinations appear much earlier, they are likely “giant words.”
Giant words are two- or three-word combinations that the infant hears frequently, such
as “Thank you,” “Stop it,” or “Let’s go.” When the infant says one of these, he or she
really is treating the phrase as a polysyllabic single word.

At this stage of development the infant does not use either word separately or in novel
combinations with other words.“ Holophrases” also are beginning to appear at this
time. For example, an infant may point to a mother’s keys and say “mommy” instead of
saying “keys.” In this context, the single word,“ mommy,” has a sentence-like meaning,
such as “These keys belong to mommy.” Single words take on multiple meanings and no
longer simply label an object. The infant usually does not combine words into true
phrases or sentences until he or she has acquired an expressive vocabulary of
approximately 50 words.

Early word combinations are“ telegraphic” in that they do not contain function words
(prepositions, pronouns, and articles). They do, however, convey the same meaning as
the more mature sentence. For example,“ Go out,” in the context of the situation,
conveys the same meaning as “I want to go outside.” Telegraphic speech is the first
stage in the child’s ability to“ grammaticize” speech, that is, to form sentences with
proper morphology and syntax. At this point in development, a stranger should be able
 to understand at least 50% of the infant’s speech (intelligibility). Language blossoms
after 2 years of age.

Figure 7.

Orienting to sound of bell. In the first stage (5 months), when a bell is rung at one side of the
infant’s head (A), the infant turns horizontally to the correct side (B). In the second stage (7
months), when a bell is rung at one side of hte head (A), the infant localizes the sound by a
compound visual maneuver consisting of a horizontal followed by a vertical component(C). In
the third stage (9 1/2 months), when a bell is rung to one side of the head (A), the infant
localizes the sound by a single visual movement (D). From Capute AJ, Accardo PJ. Clin
Pediatr. 1978;17:850. Reprinted with permission.

RED FLAGS IN COGNITIVE DEVELOPMENT

Language development provides the clinician with an estimate of verbal intelligence; skill
development in the problem-solving domain provides an estimate of nonverbal intelligence. If
deficiencies are global (ie, skills are delayed in both domains) and significant (ie, >2 standard
deviations below the mean), there is a possibility of mental retardation. Mental retardation
refers to significant sub-average general intellectual functioning as measured by standardized
tests. By current definition, these deficits must be associated with significant deficits in adaptive
functioning. About 3% of the population is mentally retarded. If the deficiencies are very mild
(ie, in the low range of normal), the child is considered to be of borderline intelligence or a
“slow learner.”
When a discrepancy exists between problem-solving and language abilities, with only language
being deficient, one must consider the possibility of a hearing impairment or a communication
disorder. If either language or problem-solving skills is deficient, the child is at high risk for
manifesting a learning disability later. A learning disability refers to academic achievement that
is substantially below what would be expected from a person’s general intellectual potential.
Approximately 5% to 7% of school-aged children have learning disabilities. A learning disability
cannot be diagnosed formally until the child reaches school age and demonstrates an inability
to keep up in one or more academic areas. Thus, a reading disability cannot be diagnosed until
at least age 6 or 7 years when children normally are expected to read. A delay in language
development is a “red flag” and should prompt careful monitoring and further evaluation if the
child later demonstrates reading difficulties in school. The neurologic substrate for specific
learning disabilities involves patchy dysfunction in cortical information processing that results in
specific difficulties with academic tasks.

Unless the deficiencies are severe during infancy, a child rarely presents with a parental
concern of“ cognitive delay.” Concerns usually present as speech delays, but such complaints
are infrequent before 24 months of age. The average age at which mental retardation is
diagnosed is 3 to 4 years. Usually, the more severe the degree of impairment, the earlier the
diagnosis is made. Because the majority of children who are mentally retarded are in the mild
category, most children are diagnosed well after infancy. Some are not diagnosed until they
enter school. The child who is born with dysmorphic features and has a recognizable syndrome
known to be associated with mental retardation will be diagnosed earlier regardless of the
degree of impairment. Additionally, abnormal findings on magnetic resonance imaging
(performed because of atypical head growth or because of a known cerebral insult) indicate
that the child is at risk for intellectual deficits.

Although a cognitive deficit is the most common reason for language delay, all children who
have delayed language development should receive audiologic testing to rule out hearing loss.
The child who has a hearing loss will demonstrate normal expressive language skills through the
babbling stage (6 months). He or she will begin to babble on time, but lack of auditory
reinforcement for these vocalizations results in their disappearance and a general decline in
verbal expression. Receptive language abilities continue to progress normally for a few more
months. A 1-year-old who is deaf will follow a command with a gesture (relying solely on the
gestural cue) and may seem to hear. This ability to use environmental cues can fool parents and
professionals and is one of the chief reasons that the average age of diagnosis of a severe
hearing loss is 2 years. Children who have a mild hearing loss will present even later with
articulation errors, inability to localize sounds, or “attentional problems.” An infant who is deaf
will attempt to communicate by using gestures. If a child has delayed speech and fails to
demonstrate a desire to communicate, a more pervasive problem, such as autism, should be
considered. Although children who have autism may demonstrate protoimperative pointing
(eg, pointing to obtain food or drink), they rarely point to the object for the purpose of having
the adult join in the pleasure of admiring an interesting object (protodeclarative pointing) or
point to obtain the name of an object. Prodeclarative pointing is a social action, and one of the
cardinal features of autism is the lack of social relatedness. Another red flag is the finding that a
child’s expressive skills are advanced compared with his or her receptive skills. A child who
speaks in five-word sentences but does not understand simple commands is at risk of having a
pervasive developmental disorder. The advanced speech may not be functional or have
communicative intent. Finally, some parents will excuse their child’s lack of speech because of
an “Uncle Albert” who didn’t speak until he was 4 years old but grew up to be a rocket scientist.
In reality, this is very rare. Normal receptive language skills in a child who has speech delay
would be reassuring and typically are easy to demonstrate.

Other problems may masquerade as cognitive delay or impair the assessment of cognitive
abilities. Problem-solving tasks require intact fine motor skills. Having poor fine motor skills
puts the child at a disadvantage with certain manipulative tasks used to assess nonverbal
cognition. Due to cerebral palsy, a child may not be able to place a square form in a form board;
 however, he or she might be able to indicate the correct position by pointing or by eye gaze.
Thus, the child actually could “pass” the form board item in the problem-solving assessment.
Similarly, visual impairment can interfere with a child’s ability to perform many problem-solving
tasks successfully.

Psychosocial Development

Emotional, social, and adaptive milestones have been assimilated from multiple sources (Table
4). These milestones are more variable than those in motor and cognitive domains because of
the greater influence of environmental factors (nurture). An infant inherits a set of emotional-
social characteristics and a style of interacting, but these are modified by parenting style,“
goodness of fit,” and the social environment.

Emotions include the infant’s feelings as well as the expression of these feelings. Social
milestones include the steps necessary to form interpersonal relationships. Temperament
influences social relationships and generally reflects a consistent pattern (or style) in “how” a
child reacts. It is different from the“ why” (motivation) and the “what” (content) of social
interactions. The inclusion of adaptive skills (ie, skills required for independence in feeding,
dressing, toileting, and other activities of daily living) is unique to the discussion of psychosocial
development and reflects the concept that these skills influence, and are influenced by, social
factors.

EMOTIONAL DEVELOPMENT

Emotions are present in infancy and motivate expression (pain elicits crying). Emotion has
three elements: neural processes, mental processes (feelings), and motor expression (facial,
verbal) and actions. Emotions are mediated through the limbic system, which is responsible for
receiving, interpreting, and processing emotion-producing stimuli and then initiating and
modulating emotional responses. There is evidence that an infant can express emotion without
direct cognitive mediation. An infant who has anencephaly or hydranencephaly may show
disgust at sour flavors and interest in sweet flavors in ways very similar to a normal infant.
Later, in the normal infant, these instinct-like reactions are modified by cognition. Although
emotional feelings are constant over the life span, their causes change and become more
abstract. The infant may show disgust for a bitter taste; the older child may show disgust for a
revolting idea. Other emotions have a definite cognitive foundation. To experience fear, the 7-
to 9-month-old child must be able to shift attention, compare, and recognize “familiar” from“
unfamiliar” in the development of stranger anxiety. As the child develops, the interrelationship
between emotion and cognition becomes increasingly complex. When the child begins to
associate language symbols with emotions and memory, he or she can remember prior
emotional experiences. A verbal reminder of the event then can evoke feelings identical to
those experienced previously. Thus, language and cognition add flexibility and complexity to
emotional behavior.

The expression of emotions also evolves with age and developmental advancement. Consider
this example of an emotional reaction (fear) to a stranger, based on skill level: In addition to
developmental progress, the feedback loop between care providers and child modifies
emotional expression. Social forces and cultural factors also modulate emotional expression to
produce more restrictive and controlled facial signals. An older child may learn to modulate the
expression of pain (a facial grimace only) and appear quite stoic. Furthermore, children can
learn to mask emotions such as smiling at a disappointing gift. At early stages, however, the
true emotion typically leaks out from under the mask.

SOCIAL DEVELOPMENT

The infant is surrounded by a social network. Sensory processing is influenced by the infant’s
social needs. The infant has greater discrimination ability for social voices) than for nonsocial
(environmental noise) stimuli. There are two primary theories: the Epigenetic Model and the
Social Network Model. In the Epigenetic Model, the mother-child relationship is considered to
be all important. If this relationship is negative, then other relationships will be poor. If it is
positive, then future relationships will be good. The Social Network Model recognizes the
relative importance of the mother-child relationship, but also recognizes the ability of other
relationships to compensate for absent or poor mother-child interactions. The devastating
effect of a poor relationship can be overcome by adequate substitutes and a supportive
environment. The latter reflects the popular concept of childhood resiliency.

Social milestones begin with bonding, which reflects the feeling of the caregiver for the child.
Attachment takes place within a few months and represents the feeling of the infant for the
caregiver. These social relationships are manifested by the evolution of the smile, in which the
level of stimulus required to elicit reciprocity decreases. At first, high-pitched vocalizations and
a smile from the adult are needed; later, a smile alone is successful. When recognition of and
attachment to a familiar caregiver develops, the simple sight of this person (smiling or
nonsmiling) will elicit a smile. The infant also becomes more discriminating in producing a smile
as he or she begins to differentiate between familiar and unfamiliar faces. As the infant
acquires the concept of causality, he or she begins to use smiling to manipulate the
environment and satisfy personal needs.

Later in infancy, other social relationships are established. Several behaviors are necessary for
the development of these relationships. First, the infant must have a concept of self versus
others. Next, he or she must be able to put self in the place of another, that is, to show
empathy. The infant must perceive a separate identity with a different set of needs. He or she
must realize the consequences of his or her interactions on others. Empathy is critical to
forming a relationship. Next the child must be able to share, which is critical to maintaining a
relationship.

There are four basic types of relationships:

  with acquaintances,
 strangers,
 friends, and
 loves.

Whereas relationships with acquaintances and strangers simply require a concept of self,
friendship and love require all three (a concept of self, empathy, and sharing). About the same
time that the child can label emotions (via language), he or she begins to think about social
interactions. A child will demonstrate recursive social thoughts, that is, show early signs of
thinking about how others behave toward him or her and how he or she behaves toward
others.

Temperament, or the infant’s overall style of reacting, can affect social relationships. The
precise definition of temperament is controversial, but it generally is believed to represent the
characteristic style of a child’s emotional and behavioral response in a variety of situations. It is
determined by genetic factors but is modified by environmental forces. Temperament shows
considerable stability over time. Thomas and Chess describe nine traits that determine whether
a child will have an “easy,”“ difficult,” or “slow-to-warm-up” temperament:

1. Activity level—proportions of periods of activity to inactivity

2. Adaptability to change
3. Positive or negative mood
4. Intensity of emotional responses
5. Rhythmicity of biologic functions
6. Persistence in the face of environmental counterforces
7. Distractibility or ease of soothing
8. Approach versus withdrawal tendencies in new situations
9. Threshold of stimulation necessary to produce a response

The Carey Infant Temperament Questionnaire often is used to evaluate these traits formally.
Approximately one third of infants will be characterized as difficult or slow-to-warm up. The
other two thirds will be classified as easy infants. The easy infants fall into three subcategories:
1) gentle, tender, sensitive, affectionate; 2) changeable, variable, adaptable; and 3) social,
playful, happy, attention-seeking. A child’s temperament can influence developmental testing.
The child who is difficult or slow to warm up may refuse to cooperate with test items, thereby
receiving lower scores that do not reflect his or her true abilities.

ADAPTIVE SKILL DEVELOPMENT

Adaptive skill development is influenced by the infant’s social environment, as well as by motor
and cognitive skill attainment. A child who has quadriparesis may not be able to feed him- or
herself, even with normal intelligence and a supportive social environment.

In contrast, acquisition of self-help skills by an able-bodied infant may be delayed in the face of
mental retardation and the lack of motivation to become independent. In spite of normal
 motor and cognitive skills, an infant may demonstrate delays in adaptive skills when social
support and encouragement are lacking. This is exemplified by delays in self-feeding skills when
the caregiver is overly concerned about messy spillage or feels the need to rush mealtime.
Additionally, parents may persist in dressing the older child in an effort to rush to child care.
The decision to initiate toilet training often is influenced by both family and culture.

RED FLAGS IN PSYCHOSOCIAL DEVELOPMENT

Decreased rhythmicity (eg, colic) may be an early indication of a“ difficult child.” Delay in the
appearance of a reciprocal smile may indicate an attachment problem, which may be
associated with maternal depression. In severe cases, child neglect or abuse may be suspected.
However, a delay in smiling also may be associated with visual or cognitive impairment. The
lack of social relationships plays a key role in the diagnosis of autism when it is accompanied by
delayed or deviant language development and stereotypic behaviors. History and observation
of an infant’s behavior at play may alert the clinician to abnormal social relationships. The
emotional status of the parents and parenting styles may affect the infant’s development of
adaptive skills. A controlling, rejecting parenting style may be revealed in an oppositional child
who refuses to cooperate with self-care. Delays in adaptive skills also may indicate
overprotective parents or an excessive emphasis on cleanliness.

Conclusion

The journey through infancy truly is fascinating—a time of incomparably rapid changes in
physical growth and motor development. By the end of this period, the child is mobile and
explores his or her environment independently. The child’s pincer grasp and release rival that of
the adult. Cognitive and social changes are equally prodigious. The baby has progressed from
simple methods of expression (crying and grimacing) to a “little person” who has a complex
array of emotional expressions that are becoming “socialized.” He or she has learned to use
these emotions to manipulate the environment and obtain the attention and the objects that
he or she desires. Additionally, the child can think about emotions and feel empathy for the
emotions of others. He or she has strong love and friendship relationships with family members
and a few significant others. The next few years are characterized by exponential language
development, which will reveal the complex thoughts, feelings, and humor owned by this
amazing creature destined to become an adult.

OOOOOOOOOOOOOOOOOOOO

Additional Information on Infants and Toddlers for Parents and Caregivers. The text is from:
Center for Disease Control and Prevention., (2020, March 6 Infants). 1 year of age. Retrieved
from CDC. [Link]

Developmental Milestones

Skills such as taking a first step, smiling for the first time, and waving “bye-bye” are called
developmental milestones. Developmental milestones are things most children can do by a
certain age. Children reach milestones in how they play, learn, speak, behave, and move (like
crawling, walking, or jumping).
In the first year, babies learn to focus their vision, reach out, explore, and learn about the things
that are around them. Cognitive, or brain development means the learning process of memory,
language, thinking, and reasoning. Learning language is more than making sounds (“babble”), or
saying “ma-ma” and “da-da”. Listening, understanding, and knowing the names of people and
things are all a part of language development. During this stage, babies also are developing
bonds of love and trust with their parents and others as part of social and emotional
development. The way parents cuddle, hold, and play with their baby will set the basis for how
they will interact with them and others.

The Attachment Theory

Text from McLeod, S. A. (2017, Febuary 05). Attachment theory. Simply Psychology.
[Link]

Attachment is a deep and enduring emotional bond that connects one person to another
across time and space (Ainsworth, 1973; Bowlby, 1969).

Attachment does not have to be reciprocal. One person may have an attachment to an
individual which is not shared. Attachment is characterized by specific behaviors in children,
such as seeking proximity to the attachment figure when upset or threatened (Bowlby, 1969).
Attachment behavior in adults towards the child includes responding sensitively and
appropriately to the child’s needs. Such behavior appears universal across cultures.
Attachment theory explains how the parent-child relationship emerges and influences
subsequent development.

Attachment theory in psychology originates with the seminal work of John Bowlby (1958). In
the 1930s John Bowlby worked as a psychiatrist in a Child Guidance Clinic in London, where he
treated many emotionally disturbed children. This experience led Bowlby to consider the
importance of the child’s relationship with their mother in terms of their social, emotional and
cognitive development. Specifically, it shaped his belief about the link between early infant
separations with the mother and later maladjustment, and led Bowlby to formulate his
attachmenttheory.

John Bowlby, working alongside James Robertson (1952) observed that children experienced
intense distress when separated from their mothers. Even when such children were fed by
other caregivers, this did not diminish the child’s anxiety.
These findings contradicted the dominant behavioral theory of attachment (Dollard and Miller,
1950) which was shown to underestimate the child’s bond with their mother. The behavioral
theory of attachment stated that the child becomes attached to the mother because she fed
the infant. Bowlby defined attachment as a 'lasting psychological connectedness between
human beings.'(1969, p. 194)

Bowlby (1958) proposed that attachment can be understood within an evolutionary context in
that the caregiver provides safety and security for the infant. Attachment is adaptive as it
enhances the infant’s chance of survival. This is illustrated in the work of Lorenz
(1935) and Harlow (1958). According to Bowlby infants have a universal need to seek close
proximity with their caregiver when under stress or threatened (Prior & Glaser, 2006).
Most researchers believe that attachment develops through a series of stages.

Stages of Attachment
Rudolph Schaffer and Peggy Emerson (1964) studied 60 babies at monthly intervals for the first
18 months of life (this is known as a longitudinal study). The children were all studied in their
own home, and a regular pattern was identified in the development of attachment.
The babies were visited monthly for approximately one year, their interactions with their carers
were observed, and carers were interviewed. A diary was kept by the mother to examine the
evidence for the development of attachment. Three measures were recorded:

 Stranger Anxiety - response to the arrival of a stranger.

 Separation Anxiety - distress level when separated from a carer, the degree of comfort
needed on return.
 Social Referencing - the degree a child looks at their carer to check how they should
respond to something new (secure base).

They discovered that baby's attachments develop in the following sequence:

Stage Period Description
Asocial 0-6 Very young infants are asocial in that many kinds of stimuli, both
weeks social and non-social, produce a favorable reaction, such as a
smile.
Indiscriminate 6 weeks Infants indiscriminately enjoy human company, and most babies
Attachment to 7 respond equally to any caregiver. They get upset when an
months individual ceases to interact with them.
From 3 months infants smile more at familiar faces and can be
easily comfortable by a regular caregiver.
Specific 7 to 9 Special preference for a single attachment figure. The baby looks
Attachment months to particular people for security, comfort, and protection. It
shows fear of strangers (stranger fear) and unhappiness when
separated from a special person (separation anxiety).
Some babies show stranger fear and separation anxiety much
more frequently and intensely than others, nevertheless, they are
seen as evidence that the baby has formed an attachment. This
has usually developed by one year of age.
Multiple 10 The baby becomes increasingly independent and forms several
Attachment months attachments. By 18 months the majority of infants have formed
onwards multiple attachments.
The results of the study indicated that attachments were most
likely to form with those who responded accurately to the baby's
signals, not the person they spent more time with. Schaffer and
Emerson called this sensitive responsiveness.
Intensely attached infants had mothers who responded quickly to
their demands and, interacted with their child. Infants who were
weakly attached had mothers who failed to interact.
Many of the babies had several attachments by ten months old,
including attachments to mothers, fathers, grandparents, siblings,
and neighbors. The mother was the main attachment figure for
about half of the children at 18 months old and the father for
most of the others.
The most important fact in forming attachments is not who feeds
and changes the child but who plays and communicates with him
or her. Therefore, responsiveness appeared to be the key to
attachment.

Attachment Theories
Psychologists have proposed two main theories that are believed to be important in forming
attachments.
The learning / behaviorist theory of attachment (e.g., Dollard & Miller, 1950) suggest that
attachment is a set of learned behaviors. The basis for the learning of attachments is the
provision of food. An infant will initially form an attachment to whoever feeds it.
They learn to associate the feeder (usually the mother) with the comfort of being fed and
through the process of classical conditioning, come to find contact with the mother comforting.
They also find that certain behaviors (e.g., crying, smiling) bring desirable responses from
others (e.g., attention, comfort), and through the process of operant conditioning learn to
repeat these behaviors to get the things they want.

Image from [Link]

The evolutionary theory of attachment (e.g., Bowlby, Harlow, Lorenz) suggests that children
come into the world biologically pre-programmed to form attachments with others, because
this will help them to survive.

The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate
innate caregiving responses from adults. The determinant of attachment is not food, but care
and responsiveness. Bowlby suggested that a child would initially form only one primary
attachment (monotropy) and that the attachment figure acted as a secure base for exploring
the world. The attachment relationship acts as a prototype for all future social relationships so
disrupting it can have severe consequences.

This theory also suggests that there is a critical period for developing an attachment (about 0 -5
years). If an attachment has not developed during this period, then the child will suffer from
irreversible developmental consequences, such as reduced intelligence and increased
aggression.

Harry Harlow’s Monkey Studies

Harlow (1958 wanted to study the mechanisms by which newborn rhesus monkeys bond with
their mothers. These infants were highly dependent on their mothers for nutrition, protection,
comfort, and socialization. What, exactly, though, was the basis of the bond?

The behavioral theory of attachment would suggest that an infant would form an attachment
with a carer that provides food. In contrast, Harlow’s explanation was that attachment
develops as a result of the mother providing “tactile comfort,” suggesting that infants have an
innate (biological) need to touch and cling to something for emotional comfort.
Harry Harlow did a number of studies on attachment in rhesus monkeys during the 1950's and
1960's. His experiments took several forms:
1. Infant monkeys reared in isolation – He took babies and isolated them from birth. They had
no contact with each other or anybody [Link] kept some this way for three months, some for
six, some for nine and some for the first year of their lives. He then put them back with other
monkeys to see what effect their failure to form attachment had on behavior.

Results: The monkeys engaged in bizarre behavior such as clutching their own bodies and
rocking compulsively. They were then placed back in the company of other monkeys.
To start with the babies were scared of the other monkeys, and then became very aggressive
towards them. They were also unable to communicate or socialize with other monkeys. The
other monkeys bullied them. They indulged in self-mutilation, tearing hair out, scratching, and
biting their own arms and legs.

Harlow concluded that privation (i.e., never forming an attachment bond) is permanently
damaging (to monkeys). The extent of the abnormal behavior reflected the length of the
isolation. Those kept in isolation for three months were the least affected, but those in isolation
for a year never recovered the effects of privation.
2. Infant monkeys reared with surrogate mothers – 8 monkeys were separated from their
mothers immediately after birth and placed in cages with access to two surrogate mothers, one
made of wire and one covered in soft terry toweling cloth.

Four of the monkeys could get milk from the wire mother and four from the cloth mother. The
animals were studied for 165 days.
See video of the experiment:
Baker, M. (2010, December 16). Harlow’s Studies on Dependency in Monkeys. In Youtube
[Link]
Description: Harry Harlow shows that infant rhesus monkeys appear to form an affectional
bond with soft, cloth surrogate mothers that offered no food but not with wire surrogate
mothers that provided a food source but are less pleasant to touch.

Both groups of monkeys spent more time with the cloth mother (even if she had no milk). The
infant would only go to the wire mother when hungry. Once fed it would return to the cloth
mother for most of the day. If a frightening object was placed in the cage the infant took
refuge with the cloth mother (its safe base).

This surrogate was more effective in decreasing the youngsters fear. The infant would explore
more when the cloth mother was present. This supports the evolutionary theory of attachment,
in that it is the sensitive response and security of the caregiver that is important (as opposed to
the provision of food).

The behavioral differences that Harlow observed between the monkeys who had grown up with
surrogate mothers and those with normal mothers were;
a) They were much more timid.
b) They didn’t know how to act with other monkeys.
c) They were easily bullied and wouldn’t stand up for themselves.
d) They had difficulty with mating.
e) The females were inadequate mothers.
These behaviors were observed only in the monkeys who were left with the surrogate mothers
for more than 90 days. For those left less than 90 days the effects could be reversed if placed in
a normal environment where they could form attachments.

Harlow concluded that for a monkey to develop normally s/he

 1. must have some interaction with an object to which they can cling during the
first months of life (critical period). Clinging is a natural response - in times of
stress the monkey runs to the object to which it normally clings as if the clinging
decreases the stress.

2. He also concluded that early maternal deprivation leads to emotional damage

but that its impact could be reversed in monkeys if an attachment was made
before the end of the critical period.

3. if maternal deprivation lasted after the end of the critical period, then no
amount of exposure to mothers or peers could alter the emotional damage that
had already occurred.

4. it was social deprivation rather than maternal deprivation that the young
monkeys were suffering from.

When he brought some other infant monkeys up on their own, but with 20 minutes a day in a
playroom with three other monkeys, he found they grew up to be quite normal emotionally
and socially.

Ethics of Harlow’s Study

Harlow’s work has been criticized. His experiments have been seen as unnecessarily cruel
(unethical) and of limited value in attempting to understand the effects of deprivation on
human infants.

It was clear that the monkeys in this study suffered from emotional harm from being reared in
isolation. This was evident when the monkeys were placed with a normal monkey (reared by a
mother), they sat huddled in a corner in a state of persistent fear and depression.

Also, Harlow created a state of anxiety in female monkeys which had implications once they
became parents. Such monkeys became so neurotic that they smashed their infant's face into
the floor and rubbed it back and forth.

Harlow's experiment is sometimes justified as providing a valuable insight into the development
of attachment and social behavior. At the time of the research, there was a dominant belief
that attachment was related to physical (i.e., food) rather than emotional care.
It could be argued that the benefits of the research outweigh the costs (the suffering of the
animals). For example, the research influenced the theoretical work of John Bowlby, the most
important psychologist in attachment theory. It could also be seen a vital in convincing people
about the importance of emotional care in hospitals, children's homes, and day care.

Positive Parenting Tips

Following are some things you, as a parent, can do to help your baby during this time:

 Talk to your baby. She will find your voice calming.

 Answer when your baby makes sounds by repeating the sounds and adding words. This
will help him learn to use language.
 Read to your baby. This will help her develop and understand language and sounds.
 Sing to your baby and play music. This will help your baby develop a love for music and
will help his brain development.
 Praise your baby and give her lots of loving attention.
 Spend time cuddling and holding your baby. This will help him feel cared for and secure.
 Play with your baby when she’s alert and relaxed. Watch your baby closely for signs of
being tired or fussy so that she can take a break from playing.
 Distract your baby with toys and move him to safe areas when he starts moving and
touching things that he shouldn’t touch.
 Take care of yourself physically, mentally, and emotionally. Parenting can be hard work!
It is easier to enjoy your new baby and be a positive, loving parent when you are feeling
good yourself.

Child Safety First

When a baby becomes part of your family, it is time to make sure that your home is a safe
place. Look around your home for things that could be dangerous to your baby. As a parent, it is
your job to ensure that you create a safe home for your baby. It also is important that you take
the necessary steps to make sure that you are mentally and emotionally ready for your new
baby. Here are a few tips to keep your baby safe:

 Do not shake your baby―ever! Babies have very weak neck muscles that are not yet
able to support their heads. If you shake your baby, you can damage his brain or even
cause his death.
 Make sure you always put your baby to sleep on her back to prevent sudden infant
death syndrome (commonly known as SIDS). Read more about new recommendations
for safe sleep for infants here.
  Protect your baby and family from secondhand smoke. Do not allow anyone to smoke in
your home.
 Place your baby in a rear-facing car seat in the back seat while he is riding in a car. This is
recommended by the National Highway Traffic Safety Administration pdf icon[1.15 MB /
1 page]external icon.
 Prevent your baby from choking by cutting her food into small bites. Also, don’t let her
play with small toys and other things that might be easy for her to swallow.
 Don’t allow your baby to play with anything that might cover her face.
 Never carry hot liquids or foods near your baby or while holding him.
 Vaccines (shots) are important to protect your child’s health and safety. Because
children can get serious diseases, it is important that your child get the right shots at the
right time. Talk with your child’s doctor to make sure that your child is up-to-date on her
vaccinations.

Healthy Bodies

 Breast milk meets all your baby’s needs for about the first 6 months of life. Between 6
and 12 months of age, your baby will learn about new tastes and textures with healthy
solid food, but breast milk should still be an important source of nutrition.
 Feed your baby slowly and patiently, encourage your baby to try new tastes but without
force, and watch closely to see if he’s still hungry.
 Breastfeeding is the natural way to feed your baby, but it can be challenging. If you need
help, you can call the National Breastfeeding Helpline at 800-994-9662 or get help on-
line at [Link] icon. You can also call
your local WIC Program to see if you qualify for breastfeeding support by health
professionals as well as peer counselors. Or go
to [Link] icon to find an International Board-
Certified Lactation Consultant in your community.
 Keep your baby active. She might not be able to run and play like the “big kids” just yet,
but there’s lots she can do to keep her little arms and legs moving throughout the day.
Getting down on the floor to move helps your baby become strong, learn, and explore.
 Try not to keep your baby in swings, strollers, bouncer seats, and exercise saucers for
too long.
 Limit screen time. For children younger than 18 months of age, the American Academy
of Pediatrics (AAP) recommends that it’s best if babies do not use any screen media
other than video chatting.
 Make sure your child gets the recommended amount of sleep each night: For infants 4-
12 months, 12–16 hours per 24 hours (including naps)
Additional Readings on the Development of Infants and Toddlers

1. Physical Development of Infants and Toddlers. Lumen Learning Physical Growth and
Development in Newborns and Toddlers.[Link]
lifespandevelopment/chapter/physical-growth-and-development-in-newborns-and-
toddlers/

Physical Growth and Development in Newborns and Toddlers. Authored by: Tera Jones
for Lumen Learning. Provided by: Lumen Learning. License: CC BY: Attribution

2. Cognitive Development of Infants and Toddlers. Lumen Learning Cognitive Development

in Infants and Toddlers
[Link]
development-in-infants-and-toddlers/
Cognitive Development in Infants and Toddlers. Authored by: Tera Jones for Lumen
Learning. Provided by: Lumen Learning. License: CC BY: Attribution

3. Socio-Emotional Development of Infants and Toddlers’. Emotional and Social

Development During Infancy

Introduction to Emotional and Social Development During Infancy. Authored by: Tera
Jones for Lumen Learning. Provided by: Lumen Learning. License: CC BY: Attribution
[Link]

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Post Activity
3 W’s
1. What did you learn from this module?
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2. So what? (Relevance, Importance,
Usefulness)______________________________________________________________
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3. Now What? (How does this fit into what we are learning? Does it affect our thinking?
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Evaluation:

1. Summarize
A. Physical Development of Infants and Toddlers
B. Cognitive Development of Infants and Toddlers
C. Psychosocial Development of Infants and Toddlers
2. Explain Attachment Theory and its implications to later development of children.
3. Revisit what you wrote as your own objective/s at the Objectives part of this module.
You are to convert that into a question, or a product, or create anything to prove that
you have attained your own objective.

Reflective Writing

Those helpless bundles of power and promise that come into our world show us
our true selves — who we are, who we are not, who we wish we could be.

— Hillary Rodham Clinton.

Quote Retrieve from [Link]
 It's perfectly possible to love your toddler
but struggle to like them when times are hard.

- Mariella Frostrupinin
Quote Retrieve from [Link]

References

Center for Disease Control and Prevention., (2020, March 6 Infants). 1 year of age. Retrieved
from CDC.
[Link]
Corpuz, B. et. al. (2010). Child and Adolescent Development Looking at Learners at Different Life
Stages. QC: Lorimar Publishing, Inc.
Johnson, C.P. and Blasco, P.A. (1997, July). Infant Growth and Development. In Pediatrics in
Review July 1997, 18 (7) 224-242; DOI: [Link] Retrieved
from
[Link]
McLeod, S. A. (2017, Febuary 05). Attachment theory. Simply Psychology.
[Link]