MODULE 2
Infancy and Toddlerhood
Human Behavior and the Social Environment
Overprotecting Henry
Irma Velasquez, a second-generation Hispanic American, is still mourning the death
of her little girl Angel, who was 2 years old when she was killed by a stray bullet that came
into their home through the living room window. The stray bullet was the result of a shoot-
out between two rival drug dealers in the family’s neighborhood. Velasquez is just glad that
now 14-month-old Henry was in his crib in the back of the house instead of in the living
room on that horrible evening. Velasquez confides in her social worker at Victim Services
that her family has not been the same since the incident.
Velasquez admits that she is afraid that something bad will also happen to Henry. She
is concerned that Henry will choke on a toy or food or become ill. Although she knows these
behaviors are somewhat irrational, she states that she is determined to protect Henry. She
further states that she just could not live through losing another child.
Toddler Development
What happens during the prenatal period and the earliest months and years of a child’s
life has a lasting impact on the life course journey. In the earliest moments, months, and
years, interactions with parents, family members, and other adults and children influence the
way the brain and the rest of the body develop, as do such factors as nutrition and
environmental safety. Although it is never too late to improve health and well-being, what
happens during infancy and toddlerhood sets the stage for the journey through childhood,
adolescence, and adulthood. We were all infants and toddlers once, but sometimes, in our
work as social workers, we may find it hard to understand the experience of someone 3 years
old or younger.
As adults, we have become accustomed to communicating with words, and we are not
always sure how to read the behaviors of the very young child. The best way to overcome
these limitations, of course, is to learn what we can about the lives of infants and toddlers. In
all three of the case studies at the beginning of this chapter, factors can be identified that may
adversely affect the children’s development. However, we must begin by understanding what
is traditionally referred to as normal development.
As you will see, young children go through a multitude of changes in all three areas
simultaneously. Parents get their ideas about parenting and about the nature of children from
the cultural milieu, and parents’ ideas are the dominant force in how the infant and toddler
develop. Exhibit 3.1 provides an overview of these three important components of the
developmental niche encountered by every newborn. Henry Velasquez as they begin their life
journeys.
In the United States and other wealthy postindustrial societies, many newborns enter a
developmental niche in which families have become smaller than in earlier eras. This results
in a great deal of attention being paid to each child. Parents take courses and read books
about how to provide the best possible care for their infants and toddlers. Infant safety is
stressed, with laws about car seats, guidelines about the position in which the baby should
sleep, and a baby industry that provides a broad range of safety equipment and toys, books,
and electronics to provide sensory stimulation. Of course, this developmental niche requires
considerable resources, and many families in wealthy nations cannot afford the regulation car
seat or the baby monitor.
Physical Development
The infant’s first test of physical development occurs about a minute after delivery.
Most infants who receive a score below 7 are retested every 5 minutes for up to 20 minutes.
APGAR score does not necessarily indicate long-term health problems or complications in
physical development, social workers in child welfare and health care settings should be
familiar with these types of standard assessment tools. Newborns depend on others for basic
physical needs. At the same time, however, newborns have an amazing set of physical
abilities and potentials right from the beginning.
Growth Patterns
The cephalocaudal development principle of growth refers to the idea that growth
proceeds from the head downward. The proximodistal development principle refers to the
idea that growth occurs from the center of the body outward. During prenatal development,
the internal organs develop before the arms and legs.
The World Health Organization undertook a project, called the Multicenter Growth
Reference Study, to construct standards for evaluating children from birth through 5 years of
age. One part of that project was to construct growth standards to propose how children
should grow in all countries, of interest because of whose commitment to eliminate global
health disparities. MGRS collected growth data from 8,440 affluent children from diverse
geographical and cultural settings, including Brazil, Ghana, India, Norway, Oman, and the
United States. To be eligible for the study, mothers needed to be breastfeeding and not
smoking, and the environment needed to be adequate to support unconstrained growth.
The researchers found no differences in growth patterns across sites, even though
there were some differences in parental stature. Given the striking similarity in growth
patterns across sites, they concluded that the data could be used to develop an international
standard. By 1 year of age, infant height was about 1.5 times birth height, and by 2 years, the
toddler had nearly doubled the birth height. Infants typically double their weight by age 5
months and triple their weight in the first year. The size of individual infants and toddlers can
vary quite a bit. Some ethnic differences in physical development have also been observed.
For example, Asian American children tend to be smaller than average, and African
American children tend to be larger than average. Nutrition affects physical stature, motor
skill development, brain development, and most every other aspect of development.
Maternal and Child Nutrition series indicates that, globally, malnutrition contributes
to 3.1 million deaths of children age 5 and younger each year. In 2011, 26% of children in
low-income countries suffered from stunted growth because of chronic maternal and child
undernutrition. This was down from 40% in 1990, but still a serious global public health
problem.
Self-Regulation
After birth, the infant must develop the capacity to engage in self-regulation. That
challenge is heightened for the premature or medically fragile infant, as Holly Hicks’s mother
is finding. Gestation, Holly Hicks did not have the benefit of the uterine environment to
support the development of these self-regulatory functions. With maturation of the central
nervous system in the first 3 months, and with lots of help from parents or other caregivers,
the infant’s rhythms of sleeping, eating, and eliminating become much more regular.
By about 8 weeks, infants begin to show signs of day night sleep rhythms. At the end
of 3 months, most infants are sleeping 14 to 15 hours per day, primarily at night, with some
well-defined nap times during the day. Parents also gradually shape infants’ eating schedules
so that they are eating mainly during the day. There are cultural variations in, and
controversies about, the way caregivers shape the sleeping behaviors of infants.
In some cultures, infants sleep with parents, and in other cultures, infants are put to
sleep in their own beds and often in their own rooms. In some cultures, putting an infant to
sleep alone in a room is considered to be neglectful. Some researchers have speculated that
the infant’s lighter and shorter sleep pattern may protect against sudden infant death
syndrome. What is not always clear in these studies is whether the infant is sleeping in the
same bed as the parents or whether he or she is sleeping in a type of bassinet attached to the
parental bed.
Parents in the United States look forward to the time when their infant will sleep
through the night. Many approaches to infant sleep training have been proposed, and
researchers continue to debate the merits of different methods. 52 sleep studies found that
almost all of the interventions were effective if applied consistently, but different methods
work with different infants. Feeding is another area in which parents must help infants and
toddlers to begin to develop self-regulation, and there are cultural variations and
controversies about breastfeeding versus formula feeding.
Some cultures have historically supported feeding on demand in infancy whereas
others have preferred early attempts to shape infant feeding schedules. Throughout history,
most infants have been breastfed. However, alternatives to breastfeeding by the mother have
always existed, sometimes in the form of a wet nurse or in the form of animal milks.
Following World War II, breastfeeding ceased to be the primary nutritional source for infants
because of the promotion of manufactured formula in industrialized and nonindustrialized
countries.
Since the 1980s, cultural attitudes have shifted again in favor of breastfeeding. The
American Academy of Pediatrics argues that infant nutrition should be considered a public
health issue, not a lifestyle choice. The AAP recommends that infants be breastfed, or fed
with human milk, exclusively for the first 6 months, followed by continued breastfeeding
with some supplementary use of foods until the infant is at least 1 year old. Research
indicates that breastfeeding offers benefits for mothers and infants.
Breast milk has the right amount of fat, sugar, water, and protein for infant
development. Breastfeeding longer than 6 months is associated with reduced risk of obesity
and childhood cancer. Breastfeeding continues to rise in the United States. 27% were
breastfeeding at 12 months. There are racial, ethnic, and social class differences in the rate of
breastfeeding, suggesting that family, culture, and social policy play a role in the
breastfeeding decision. Countries where women have paid maternity leave for much of the
first year of life have very high breastfeeding rates of 94% and more. United States and the
United Kingdom, the lowest rates of breastfeeding are among low-income women, young
mothers, and mothers with low levels of education. In Saudi Arabia, a woman may breastfeed
her infant openly and receive no notice, although otherwise she is fully veiled.
In France, topless swimming is culturally acceptable, but breastfeeding in public is
not. Infants don’t always like these new tastes and textures, and foods may have to be
introduced over a dozen times before they are accepted. As infants become toddlers, their
appetites decrease and they begin to feed themselves. Feeding problems in infants and
toddlers are discussed in a later section in this chapter. Cultural variations exist in beliefs
about how to respond when infants cry and fuss, whether to soothe them or leave them to
learn to soothe themselves. Infants who have been consistently soothed usually begin to
develop the ability to soothe themselves after 3 or 4 months. Parents become less anxious as
the infant’s rhythms become more regular and predictable. At the same time, if the caregiver
is responsive and dependable, the infant becomes less anxious and begins to develop the
ability to wait to have needs met.
Toilet training is another area where caregivers assist infants and toddlers in their
development of self-regulation. Every human culture has mechanisms for disposing of human
waste and socializes infants and toddlers to that method. In places in the world where there
are no disposable diapers and no access to a washing machine, parents, even in the early
months, become sensitive to signs that the infant is about to defecate or urinate and hold him
or her over whatever type of toilet is available. This method, referred to as assisted infant
toilet training is expected to work by about age 6 months. This can take weeks or months. In
contrast, some parents use the train-in-a-day method developed by Azrin and Foxx, which is
recommended to start about the age of 20 months. In the United States, the average age to
complete toilet training has increased steadily over the past few decades, from 18 months in
the 1940s to 27 months in 1980, and 37 months in 2003.
Sensory Abilities
Indeed, in the early months the sensory system seems to function at a higher level
than the motor system, which allows movement. The sensory system allows infants, from the
time of birth, to participate in and adapt to their environments. Although the infant is
equipped with a full range of senses and ready to experience the world, perception develops
over time. In operant conditioning infants learn to behave in ways that are positively
reinforced and avoid behaviors that are punished.
For example, infants have been found to be conditioned to change the rate of sucking
on a pacifier to receive a positive reinforcement such as a tape recording of the mother’s
voice or other voices they find pleasing. All of us learn by imitating the behaviors of others,
but so can infants. The fetus hears the mother’s heartbeat, and this sound is soothing to the
infant in the early days and weeks after birth. Newborns show a preference for their mother’s
voice over unfamiliar voices, but one research team found that this is not the case for
newborns whose mothers were anxious or depressed during the third trimester.
Early infants can also distinguish changes in loudness, pitch, and location of sounds,
and they can use auditory information to differentiate one object from another and to track
the location of an object. These capacities grow increasingly sensitive across the first 6
months after birth. Infants appear to be particularly sensitive to language sounds, and the
earliest infant smiles are evoked by the sound of the human voice. Unfortunately, research
indicates that malnutrition during the infant’s first 3 months increases the likelihood of early
onset hearing loss.
At birth, vision is the least developed sense, but it improves rapidly during the first
few months of life. From the ages of 6 months to 1 year, the infant begins to see objects the
same way an adult does. Of course, infants do not have cognitive associations with objects as
adults do. Infants respond to a number of visual dimensions, including depth, brightness,
movement, color, and distance. Although conflicting evidence exists, research suggests that
several days after birth infants can discriminate between facial expressions. From 4 to 7
months, infants can recognize expressions, particularly happiness, fear, and anger. Infants
show preference for faces, and by 3 months, most infants can distinguish a parent’s face from
the face of a stranger.
Research suggests that the first few minutes after birth is a particularly sensitive
period for learning to distinguish smells. One research team found that newborns undergoing
a heel prick were soothed by the smell of breast milk, but only if the milk came from the
mother’s breast Nishitani et al., both animal and human research tell us that touch plays a
very important role in infant development. Skin-to-skin contact between parents and their
newborns has been found to have benefits for both infants and their parents.
Early infants use their mouths for exploring their worlds, but by 5 or 6 months of age,
infants can make controlled use of their hands to explore objects in their environment. Clear
evidence exists that from the first days of life, babies feel pain. One researcher found that
newborns who undergo repeated heel sticks learn to anticipate pain and develop a stronger
reaction to pain than other infants. These findings are leading pediatricians to develop
guidelines for managing pain in newborns.
Reflexes
Reflexes aid the infant in adapting to the environment outside the womb. The
presence and strength of a reflex is an important sign of neurological development, and the
absence of reflexes can indicate a serious developmental disorder. Newborns have two
critical reflexes. This reflex aids in feeding, because it guides the infant to the nipple. Many
infants would probably perish without the rooting and sucking reflexes. Both the rooting
reflex and sucking reflex disappear in the first few months. By this time, the infant has
mastered the voluntary act of sucking and is therefore no longer in need of the reflexive
response. Several other infant reflexes appear to have little use now but probably had some
specific survival purposes in earlier times. The presence of an infant reflex after the age at
which it typically disappears can be a sign of damage to the brain or nervous system.
Motor Skills
The infant gradually advances from reflex functioning to motor functioning. As a part
of the MGRS, WHO undertook a project to construct standards for evaluating the motor
development of children from birth through 5 years of age? Because WHO was trying to
establish standards for evaluating child development, healthy children were studied in all five
study sites. The researchers found that 90% of the children achieved five of the six milestones
in the same sequence, but of the sample never engaged in hands-and-knees crawling. The
results reveal that the range of the windows varies from 5.4 months for sitting without
support to 10.0 months for standing alone. This is quite a wide range for normal development
and should be reassuring to parents who become anxious if their child is not at the low end of
the window.
The physical environment as well as culture and ethnicity appear to have some
influence on motor development in infants and toddlers. MGRS found that girls were slightly
ahead of boys in gross motor development, but the differences were not statistically
significant. A longitudinal study of almost 16,000 infants in the United Kingdom took up this
issue of cultural differences in developmental motor milestones. In this study, Black
Caribbean infants, Black African infants, and Indian infants were, on average, more advanced
in motor development than White infants. Pakistani and Bangladeshi infants were more likely
than White infants to show motor delays.
The Growing Brain
We are living in the midst of a neuroscientific revolution clarifying the important role
of the brain in helping to shape human behavior. Like every other part of the human body, the
brain is made up of billions of cells. Neurogenesis, the creation of new neurons, begins before
birth. We are born with more than 100 billion neurons, much more than we will ever need
and more than we will ever have again.
Between the neurons are synapses, or gaps that function as the site of information
exchange from one neuron to another. Synaptogenesis, the creation of synapses, begins to
accelerate during the last trimester of pregnancy and peaks at 2 to 3 years of age, when the
brain has about twice the synapses it will have in adulthood. This rapid synaptogenesis results
in an overabundance of synapses and a tripling in brain weight during the first 3 years. The
period of overproduction of synapses, or synaptic blooming, is followed by a period of
synaptic pruning, or reduction, of the synapses to improve the efficiency of brain functioning.
It is through this process of creating elaborate communication systems between the
connecting neurons that more and more complex skills and abilities become possible. Thus,
during these early years of life, children are capable of rapid new learning. The blooming and
pruning of synapses process continues well into childhood and adolescence at different
timetables in different regions of the brain. In addition to synaptogenesis, myelination, a
process in which axons and neurons are coated with a fatty substance called myelin, begins
during the first 2 years.
Myelination causes faster neural communication, which results in faster information
processing. The available evidence suggests that both genetic processes and early experiences
with the environment influence the timing of brain development. Brain plasticity has been a
major finding of neuroscientific research of the past few decades. The human brain is
genetically designed to accommodate an incredibly wide range of human experiences, and
the environmental context helps to shape the brain for life in a particular developmental
niche.
The research hypothesis was that infants whose mothers demonstrate a higher quality
of interaction at 5 months will have a higher-level brain development at 10 and 24 months, as
measured by frontal resting EEG power. The researchers did find a relationship between
quality of mother–infant interaction and frontal brain activity. The higher the quality of
interaction, the higher the level of frontal brain functioning. Scientists continue to conduct
new and innovative research in this area.
See Harvard’s Center on the Developing Child for up-to-date research efforts in this
area. Some suggest that the entire infancy period is a crucial and sensitive time for brain
development, given the quantity and speed at which the neurons develop and connect. Certain
risks to brain development are associated with prematurity. Premature infants like Holly
Hicks, born at 24 to 28 weeks’ gestation, have high rates of serious intracranial hemorrhage,
which can lead to problems in cognitive and motor development, including cerebral palsy and
intellectual disability.
Vaccinations
Over the past 50 years, the incidence of childhood illnesses such as measles, mumps,
and whooping cough has dropped significantly because of widespread use of vaccines to
immunize infants and young children. Vaccines are provided early in life because many
preventable diseases are common in infants and young children whose immune systems are
not as well developed as they will be later.
Cognitive Development (Piaget’s Stages of Cognitive Development)
When we talk about how fast a child is learning, we are talking about cognitive
development. Researchers now describe the infant as wired to learn and agree that infants
have an intrinsic drive to learn and to be in interaction with their environments. To assess
children’s cognitive progress, many people use the concepts developed by the best-known
cognitive development theorist, Jean Piaget. Piaget proposed a cognitive-developmental
theory that views humans as active explorers who learn by interacting with the world. He
believed that cognitive development occurs in successive stages, determined by the age of the
child. Infants at this stage of development can look at only one frame of the movie at a time.
When the next picture appears on the screen, infants focus on it and cannot go back to
the previous frame. Not until this stage can children run the pictures in the movie backward
and forward to better understand how they blend to form a specific meaning. Children gain
the capacity to apply logic to various situations and to use symbols to solve problems. Adding
to Piaget’s metaphor, one cognitive scientist describes formal operations as the ability of the
adolescent not only to understand the observed movie but also to add or change characters
and create an additional plot or staging plan.
The first of Piaget’s stages applies to infants and toddlers. Piaget suggests that infant
and toddler cognitive development occurs in six sub stages during the sensorimotor period.
Reflexes are what infants build on. During this stage, infants repeat behaviors that bring them
a positive response and pleasure. The mastery of object permanence is a significant task
during this stage. Piaget contended that around 9 months of age, infants develop the ability to
understand that an object or a person exists even when they don’t see it. Piaget demonstrated
this ability by hiding a favored toy under a blanket. Infants are able to move the blanket and
retrieve the toy.
Object permanence is related to the rapid development of memory abilities during this
period and is necessary for mental representation to develop. Two other phenomena are
related to this advance in memory. Piaget described toddlers in this stage as actually able to
use thinking skills in that they retain mental images of what is not immediately in front of
them. As much as Piaget’s work has been praised, it has also been questioned and criticized.
Piaget constructed his theory based on his observations of his own three children.
Thus, one question has been how objective he was and whether the concepts can really be
generalized to all children. This research literature is immense but has been summarized by
several reviewers. Piaget’s sensorimotor stage has been studied less than his other cognitive
stages, but the existing research tends to support Piaget’s theory, even though some minor
cultural differences are noted. For example, some research has found that African infants
receive more social stimulation and emotional support than European and American infants,
and European and American infants get more experience with handling objects. This leads to
African infants and toddlers developing more social intelligence and European and American
children developing more technological intelligence. This supports the idea of the importance
of the developmental niche but, overall, suggests much more similarity than difference in
cognitive development across developmental niches during infancy and toddlerhood.
Research findings have called into question some aspects of Piaget’s theory.
For example, Piaget described young children as being incapable of object
permanence until at least 9 months of age. However, infants as young as 3½ and 4½ months
of age have been observed who are already proficient at object permanence. Other
researchers have found that although infants seem aware of hidden objects at 3½ months,
they fail to retrieve those objects until about 8 months of age. These researchers suggest that
cognitive skills such as object permanence may be multifaceted and gradually developed.
Cognitive researchers have been interested in the development of object permanence
in children with very low birth weight and in children with a range of intellectual and
physical disabilities. One research team found that toddlers born full-term were more than 6
times more likely to have developed object permanence than children born prematurely with
very low birth weight. Zayyad Muhammad reviewed the research on the development of
object permanence in children with intellectual disability, physical disability, autism, and
blindness. They concluded that this research indicates that children with these disabilities
develop object permanence in a similar sequence as children without disabilities, but at a
slower rate.
They also found evidence that children with severe disability benefit from systematic
instruction in object permanence. Bruce and Vargas provide a case example of a successful
team effort to teach object permanence to a 4-year-old girl with severe multiple
developmental delays and visual impairment. It is interesting to note that much of the recent
research on object permanence studies nonhuman animals. For example, one research team
who studied Piagetian object permanence in carrion crows found support for Piagetian stages
of cognitive development in this avian species.
Information Processing Theory
Piaget sought to explain the stages by which cognition develops, but information
processing theory is interested in the mechanisms through which learning occurs, focusing
specifically on memory encoding and retrieval. Because a great deal of information is taken
in, much of it is discarded. All conscious mental activity occurs in working memory.
Research indicates that infants as young as 5 or 6 months can remember and manipulate
information to ascertain the locations of hidden objects.
The typical infant makes great strides in the development of working memory from 6
to 8 months of age. As information is manipulated in working memory, it becomes more
likely to enter long-term memory. Long-term memory has unlimited storage and can hold
information indefinitely. Exhibit 3.5 provides a visual representation of the information
processing system. There is evidence that by 6 months, infants begin to see patterns in and
make distinctions about human faces. There is also evidence that by 3 months of age, infants
can make a distinction between people and inanimate objects. As toddlers develop language
skills, they use language as well as visual cues to categorize objects.
Language Development
Some of the developmental milestones for language development are listed in Exhibit
3.6. By about age 4 to 6 months, infants babble. Eventually, at about 8 to 12 months, infants
make gestures to indicate their desires. The period from 16 to 24 months typically
corresponds to a spurt in vocabulary development, with new words being learned rapidly.
Piaget asserts that children develop language in direct correlation to their cognitive skills.
Thus, most of the words spoken at this age relate to people and significant objects in the
toddler’s environment. At about 21 months, toddlers begin to combine two words together to
form simple sentences such as Mommy milk. For example, children can say all gone as they
develop an understanding of object permanence.
Even with these skills, toddlers may be difficult to understand on occasion. From age
2 to 3, toddlers begin to put together sentences of more than two words. Cindy, the mom of
24-month-old Steven, describes collecting her son from day care. During the trip home,
Steven initiated conversation with Cindy by calling out Mama. He began to tell her about
something that Cindy assumes must have occurred during the day.
Steven continued to babble to his mother with animation and laughs and giggles
during the story. Although Cindy laughed at the appropriate moments, she was unable to
understand most of what Steven was sharing with her. The most important thing adults can do
to assist with language development is to provide opportunity for interactions. Adults can
answer questions, provide information, explain plans and actions, and offer feedback about
behavior.
Adults can also read to infants and toddlers and play language games. The opportunity
for interaction is important for deaf children as well as hearing children, but deaf children
need interaction that involves hand and eye, as with sign language. Of course, ability in any
language is not retained unless the environment provides an opportunity for using the
language.
Socioemotional Development (Erikson’s Theory of Psychosocial Development)
Development during these early ages may set the stage for socioemotional
development during all other developmental ages. If the task facilitating factors for a stage
are absent, the individual will become stuck in that stage of development. Each of Erikson’s
stages is overviewed in Exhibit 3.8 and discussed in the chapter regarding the part of the life
course to which it applies. The following two stages are relevant to infants and toddlers. The
overall task of this stage is for infants to develop a sense that their needs will be met by the
outside world and that the outside world is an okay place to be.
In addition, the infant develops an emotional bond with an adult, which Erikson
believes becomes the foundation for being able to form intimate, loving relationships in the
future. Erikson argues the need for one consistent mother figure. In addition, the infant has to
be protected from injury, disease, and so on and receive adequate stimulation. Infants who
develop mistrust at this stage become suspicious of the world and withdraw, react with rage,
and have deep-seated feelings of dependency.
These infants lack drive, hope, and motivation for continued growth. They cannot
trust their environment and are unable to form intimate relationships with others. These
children feel proud that they can perform tasks and exercise control over bodily functions.
They relate well with close people in the environment and begin to exercise self-control in
response to parental limits. To develop autonomy, children need firm limits for controlling
impulses and managing anxieties but at the same time still need the freedom to explore their
environment. Exhibit 3.9 summarizes possible sources of anxiety for toddlers. Toddlers also
need an environment rich with stimulating and interesting objects and with opportunities for
freedom of choice. At the other end of the spectrum are children who doubt themselves.
These children are ashamed of their abilities and develop an unhealthy kind of self-
consciousness. Critics also question Erikson’s emphasis on the process of individualization,
through which children develop a strong identity separate from that of their family.
Emotion Regulation
Researchers have paid a lot of attention to the strategies infants develop to cope with
intense emotions, both positive and negative. They have noted that infants use a range of
techniques to cope with intense emotions, including turning the head away, sucking on hands
or lips, and closing their eyes. By the middle of the second year, toddlers have built a
repertoire of ways to manage strong emotions. You may not be surprised to learn that
researchers have found that one of the most important elements in how an infant learns to
manage strong emotions is the assistance provided by the caregiver for emotion management.
Caregivers may offer food or a pacifier, or they may swaddle, cuddle, hug, or rock the
infant. By the time the infant is 6 months old, caregivers often provide distraction and use
vocalization to soothe. One research team found that for all levels of infant distress, the most
effective methods of soothing were holding, rocking, and vocalizing. Feeding and offering a
pacifier were effective when the infant was moderately distressed but not at times of extreme
distress.
Infants who demonstrate greater emotion regulation are much more likely to have
parents who use higher levels of positive parenting behaviors, such as sensitivity, positive
regard, stimulation, and animation. Another important element that impacts an infant’s ability
to manage emotions is whether the infant receives adequate sleep. Finally, there are cultural
differences in expectations for management of emotions in infants. For example, Japanese
parents try to shield their infants from the frustrations that would invite anger. Rican mothers,
Harwood found that Anglo mothers expected their infants to manage their stranger anxiety
and separation anxiety without clinging to the mother. The Puerto Rican mothers, conversely,
expected their infants to rely on the mother for solace.
Temperament
The best-known study of temperament in infants and young children was the New
York Longitudinal Study, begun in 1956. About 10% of infants fell in this category. There is
a tendency for recent researchers to focus on two clusters of temperamental traits, negative
emotions and regulatory capacity , as important to parent–infant relationships as well as to
future personality and behavior development see Bridgett et al. , For an idea of the
differences in infant temperament, consider the range of reactions you might see at a baptism
service.
One infant might scream when passed from one person to the other and when water is
placed on his or her forehead. The mother might have difficulty calming the infant for the
remainder of the baptism service. At the other extreme, one infant might make cooing noises
throughout the entire service and seem unbothered by the rituals. The slow-to-warm-up infant
might cautiously check out the clergy administering the baptism and begin to relax by the
time the ritual is completed.
Thomas and his colleagues believed that a child’s temperament appears shortly after
birth and is set, or remains unchanged, throughout life. Whether temperament is permanent or
not is still unresolved. Recent research suggests that temperament is less stable in infancy
than at any other time of life. Young infants’ temperaments may be shaped by sensitive
caregiving. By the second year of life, styles of responding to people and situations are more
established, and in early childhood temperament is even more stable and predictive.
Neurobiologists are suggesting that infants come into the world with preexisting
temperaments or emotional styles. They report strong evidence for a genetic basis of
emotional styles, with the genetic contribution varying from 20% to 60%for different
emotional style traits.
Recent research provides some insight about what could happen between Holly and
Mrs. Another research team found a relationship between infant regulatory capacity and
marital satisfaction. Following a group of infants and their families from the time the infants
were 7 months old until they were 14 months, these researchers found that marital
satisfaction increased as infants developed greater regulatory capacity and decreased when
infants failed to gain in regulatory capacity. The good news is that neuroscience research
suggests that how easily a baby can be soothed has little or no genetic contribution , so the
important thing is for Mrs. As parents discipline infants and toddlers to help them gain self-
control, different methods of discipline are indicated for children of different temperaments.
Infants and toddlers who are fearful and inhibited respond best to gentle, low-power
discipline techniques, but these techniques do not work well with fearless infants and toddlers
who do best when positive feelings between the caregiver and child are emphasized .
Researchers have also been interested in whether there are cultural and socioeconomic
differences in infant temperament. Several studies have found small to moderate cross-
cultural differences in infant temperament and have attributed these differences mainly to
genetics. Some researchers find no socioeconomic differences whereas other researchers find
that infants in more economically disadvantaged families have more difficult temperaments
and conclude that this difference is largely explained by family stress.
Bowlby’s Theory of Attachment
The infant is innately programmed to emit stimuli to which the mother responds. This
exchange between infant and mother creates an emotional bond. The infant initiates the
attachment process, but later the mother’s behavior is what strengthens the bond. Attachment
becomes fully developed during the second year of life, when the mother and toddler develop
a goal-corrected partnership.
During this later phase of attachment, the child is able to manipulate the mother into
desired outcomes, but the child also has the capacity to understand the mother’s point of
view. The mother and the child reach a mutually acceptable compromise. Attachment
explains the child’s anxiety when the parents leave. However, children eventually learn to
cope with separation.
Toddlers often make use of a transitional object, or comfort object, to help them cope
with separations from parents and to handle other stressful situations. The transitional object
is seen as a symbol of the relationship with the caregiver, but toddlers also see it as having
magic powers to soothe and protect them.
Ainsworth’s Theory of Attachment
One of the most widely used methods to investigate infant attachment, known as the
strange situation procedure, was developed by Ainsworth and colleagues. The Ainsworth
group believed that the level of infant attachment to the mother could be assessed through the
infant’s response to a series of strange episodes. The type of child attachment to the mother is
measured by how the child responds to the mother following the distressing separation.
Ainsworth and her colleagues identified three types of attachment.
Secure attachment. The infant uses the mother as a home base and feels comfortable
leaving this base to explore the playroom. The infant returns to the mother every so often to
ensure that she is still present. When the mother leaves the room and leaves the infant with a
stranger, the securely attached infant responds with separation anxiety and stranger anxiety.
The securely attached infant will cry and seek comfort from the mother when she
returns and is easily reassured and soothed by the mother’s return. Insecure anxious
attachment. The infant is reluctant to explore the playroom and clings to the mother. When
the mother leaves the room, the infant cries for a long time.
When the mother returns, this infant seeks solace from the mother but continues to cry
and may swat at or pull away from the mother. Insecure avoidant attachment. This infant
shows little distress during the strange situation and is not enthusiastic when reunited with the
mother. Whether the mother is present or absent from the room, these infant’s responses are
the same. Observations of mothers of infants with disorganized attachment style reveal two
patterns of parenting. Research indicates that fathers in both Western and Eastern cultures
interact with newborns in much the same way that mothers interact with them, cradling the
infant and performing care tasks such as diaper changing, bathing, and feeding the infant
when formula or bottled breastmilk are used . As the infant develops, however, fathers and
mothers develop different play and communicative styles with infants and toddlers, a subject
discussed later in this chapter and in Chapter 4 under the heading play as a Route to
Attachment with Fathers. The gender of the parent is irrelevant in the development of secure
infant attachment.
Rather, it is the behavior of the primary caregiver, regardless of whether it is the
mother or father that has the most influence on infant attachment. In one study, infants with
secure attachments to both parents demonstrated fewer behavioral difficulties as toddlers,
even fewer problems than toddlers with only secure mother–infant attachment. In addition to
a more prominent role by fathers over the past 20 to 30 years, more women have entered the
workforce, and many more children experience alternative forms of childcare, including
infant and toddler day care. The effect day care has on the development of attachment in
infants and toddlers continues to be hotly debated.
Some argue that day care has a negative effect on infant attachment and increases the
risk of the infant developing insecure and avoidant forms of attachment. The risks are thought
to be especially high if the infant attends day care during the first year of life. Others argue
that day care does not have a negative effect on infant and early childhood attachment. The
most robust finding was that mothers’ sensitivity to their infants during interaction is a
consistent predictor of secure attachment and positive child development.
No main effects were found between the quality and type of childcare and mother–
infant attachment. However, hours in alternative childcare was a risk factor for mother–infant
attachment if combined with other risk factors such as maternal insensitivity and poor quality
of childcare. A study in the Netherlands found that professional caregivers may be alternative
attachment figures for children when their parents are not available, but it is the professional
caregivers’ group-related sensitivity, rather than the child’s individual relationship with one
professional caregiver, that promotes a sense of security and safety in children. In one study
in the United States, day care was found to mitigate the adverse effects of insecure mother–
infant attachment Spiker, Nelson, & Petra’s, recently, researchers have begun to study
attachment among children in foster care.
Problems with attachment may contribute to foster home disruptions, but foster home
disruptions also contribute to attachment problems. Existing research suggests that neither of
these policy responses has sufficiently minimized attachment disruptions. Research by
Tucker & Mackenzie suggests that the age of child, the nature of the circumstances leading to
foster care placement, and the nature of the foster care situations and transitions must be
understood to develop interventions to minimize attachment disruptions in specific children.
Other researchers conclude that institutional care can also have the same devastating
effects on attachment as repeated foster care disruptions. Let’s look at one other issue
concerning attachment. Most studies of attachment have used the Ainsworth group’s strange
situation method. One study found that in Israeli kibbutz reared children, one negative
caregiving relationship could negatively affect other attachment relationships.
Some researchers are using methods other than the Ainsworth strange situation to
measure attachment. For example, in a longitudinal study, a Chilean research group used an
Attachment during Stress Scale to measure attachment and found that day care, compared
with maternal care, was not negatively associated with mother–child attachment, maternal
sensitivity, or quality of the home environment.
Attachment and Brain Development
The attachment relationship is a major organizer of brain development and the
facilitator of anxiety and stress management as well as emotion regulation. Attachment
directly affects brain development. Gerhardt concludes that without emotional bonding with
an adult, the orbitofrontal cortex in the brain of infants cannot develop well. In addition,
attachment with a sensitive caregiver appears to maximize the integration of neural circuitry
in the right and left hemisphere systems, which promotes the development of emotion
regulation, empathy, and motivation, as well as cognitive skills such as attention and decision
making.
Some research has found that mild-to-moderate disruptions in early attachment
relationships can interfere with right-hemisphere processing and lead to cell death. Among
other things, the right hemisphere is associated with attachment, interpersonal relationships,
nonverbal communication, and emotional awareness and memory. An often-cited study is a
brain imaging study that investigated brain activation in infants reared in orphanages in
Romania. The infants had little contact with an adult, were left in their cots for most of the
day, were fed with propped-up bottles, and were never smiled at or hugged.
The study found that these infants had abnormally low metabolism in a network of
areas involved in stress regulation, including the orbit-frontal cortex. One concern is whether
these deficiencies in brain development are permanent. Some suggest that the brain
impairments can be reversed if changes in care and attachment occur early enough. They
highlight the strides in brain development made by the Romanian orphans who were adopted
into caring homes before they were 6 months of age. Others suggest that the brain
impairments caused by lack of attachment with a primary caregiver are permanent.
The existing literature suggests that early intervention should focus on helping the
caregiver to be reflective about the inner world of the infant. Cooling suggests that although
early experiences are powerful brain shapers, it is never too late to modify brain structure and
functions through personal relationships, psychotherapy, and increased self-awareness.
Neuroscience research is finding that many emotions and cognitions happen at the
unconscious, automatic level and are not easily accessed for conscious exploration. Given our
commitment to evidence-based practice, social workers should be aware of empirical
evidence of the benefits of adjunct nontalking, somatic interventions for traumatic memories
and post-traumatic stress disorder, including eye movement desensitization and reprocessing,
neurofeedback, and yoga.
Such interventions include electrical stimulation of the vague nerve, yoga, and group
therapy. Mindfulness meditation has been found to build better connections between the
amygdala and prefrontal cortex and to improve stress reactivity and anxiety symptoms
associated with generalized anxiety disorder.
The Role of Play
Play is crucial to child development. Play allows infants and toddlers to enhance
motor, cognitive, language, emotional, social, and moral development. Because of their
differences in development in all areas, infants and toddlers play in different ways. These
later types of play begin in toddlerhood and develop in union with cognitive and motor
development. This mother wanted to be sure that her child had every opportunity to advance
in terms of motor and cognitive skills. Although this mother’s efforts are to be applauded, she
admits that these toys were very costly and that perhaps she could have achieved the same
outcome with other less costly objects.
One research team found that mothers interact less with their toddlers while engaged
in play with electronic toys than when engaged in other types of play. How this technology-
based play affects moral development is another area for further exploration. Infants do not
learn as readily from screen materials as do older children and adults. Infants learn more
readily from people than from television and videos.
Background television distracts the play of infants and toddlers. Infants spend more
time looking at a video if a parent views it with them and talks with them about it. Television
can provide a route to early language development in impoverished environments. These
researchers found that an average of 68% of infants and toddlers in the reviewed studies use
screen media, such as television, DVDs, and video games daily. The demographic variables
most commonly correlated with high screen time are the child’s age and race/ethnicity. Child
BMI, maternal distress/depression, media time of the mother, and cognitive stimulation in the
home were also correlated with screen time of infants and times. Child BMI increased as
screen time increased, screen time was greater if the mother was distressed or depressed,
screen time of the child increased as the mother’s screen time increased, and screen time
increased as cognitive stim.
Child BMI increased as screen time increased, screen time was greater if the mother
was distressed or depressed, screen time of the child increased as the mother’s screen time
increased, and screen time increased as cognitive stimulation in the home decreased.
Variables not associated with screen time include child sex, firstborn status, paternal
education, non–English speaking family, two225 parent household, number of children in the
home, and nonparent childcare. The associations were unclear for maternal age, maternal
education, and household income. Another important aspect of play is parent–child
interaction.
Parent–infant play may increase the likelihood of secure attachment between the
parent and child. The act of play at least provides the opportunity for infants and parents to
feel good about themselves by enjoying each other and by being enjoyed. Even before infants
can speak or understand language spoken to them, play provides a mechanism of
communication between parents and infants. Infants receive messages about themselves
through play, which promotes their sense of self.
Many similarities exist in the way that mothers and fathers play with infants and
toddlers but also some differences. Both mothers and fathers are teachers and sensitive
communicators, and both enjoy rough-and tumble play with their babies. But research has
also noted some differences in the ways that mothers and fathers play with infants and
toddlers. Fathers tend to be more stimulating when they play with infants and toddlers and
mothers tend to be more soothing.
The peer group becomes more important at earlier ages as family size decreases and
siblings are no longer available for daily social interaction. Although toddlers are capable of
establishing relationships, their social play is a struggle, and a toddler play session is quite a
fragile experience. Toddlers need help in structuring their play with each other. And yet
researchers have found that groups of toddlers in preschool settings develop play routines that
they return to again and again over periods of months.
Developmental Disruptions
Premature infants like Holly Hicks, for example, often need time to catch up in terms
of physical, cognitive, and emotional development. Because early interventions for infants
and toddlers produce better outcomes in comparison with interventions for school-aged
children, early detection and diagnosis is key. They found that infants with the most severe
symptoms at 24 months had pervasive impairment on all social and communication items at
12 and 18 months. There was more variability in the impairments of 12- and 18-month-old
infants who would later demonstrate less severe impairments at 24 months but were still on
the autism spectrum. The infants and toddlers with developmental delays at 12 and 18 months
had typical development in every area but language at 24 months.
Childcare Arrangements in Infancy and Human infants start life in a remarkably
dependent state, in need of constant care and protection. Toddlers are full of life and are
making great strides in development in all areas. With large numbers of mothers of infants
and toddlers in the paid workforce and not at home, this question becomes a challenging one.
United States seems to be responding to this challenge more reluctantly than other high-
income capitalist countries.
Because of changes in the economic institution in the United States from 1975 to
1999, the proportion of children under the age of 3 who have mothers in paid employment
increased from 24% to 54% and leveled off at about 58% by 2016. About one third of the
employed mothers in 2016 were employed part-time, working less than 35 hours per week at
all jobs. In 2016, the employment rate of mothers increased slightly across infancy and
toddlerhood, with a 55% maternal employment rate for infants under 1 year of age, a 58%
maternal employment rate for toddler’s ages 1 to 2, and a 62% maternal employment rate for
toddler’s ages 2 to 3. In response, most wealthy industrialized countries have instituted social
policies that provide for job-protected leave for parents to allow them to take off from work
to care for their infants.
Most of the countries listed, including the United States, require that fathers are
entitled to the same leave as mothers. In 2011, the United States and Australia were the only
affluent countries of the world that did not offer some paid parental leave at the time of birth
and adoption, but Australia provided families with a universal, flat-rate maternity grant of
$5,000 for each new child to assist with the costs of birth or adoption. Four years later, on
Mother’s Day 2015, the Australian government announced that mothers could no longer
double dip to receive more weeks of paid leave.
Mothers with no employer-provided leave will continue to receive the full Australian
paid leave, but mothers who receive more employer-paid leave than the government provides
will get nothing from the government. This leaves the United States as the only high-income
country without a federal paid parental leave plan. In addition to paid parental leave,
European countries also provide birth or maternity grants and family allowances. Clinton lost
the election to Donald Trump, and although President other research has found that paid
parental leave for both mothers and fathers improves family health and well-being and
contributes to greater father involvement in parenting and more egalitarian parent–child
relationships.
Paid Childcare
If mothers were not available, it was expected that children would be cared for by
domestic help or a close relative but still in the home setting. United States younger than age
5 were involved in some type of regular childcare arrangement. About one third were not
involved in any regular childcare arrangement, mostly children with unemployed mothers.
Another 11% were in home-based care with other nonrelative childcare providers, 5% of
these in family day care.
The numbers don’t total 100% because some children are cared for in multiple
arrangements. Many advocates for early childcare and education refer to the European model
as an ideal for the United States. Countries in Europe provide universal childcare for all
children, regardless of the parents’ income, employment status, race, age, and so forth. 2012,
only 1 in 6 eligible low-income families in the United States received federal childcare
assistance. The type of nonparent childcare must be put in ecological context and considered
along with other variables such as the quality of the childcare, the amount of time spent in
nonparent care, the sensitivity of both parental and nonparent care providers, and
characteristics of the child.
Family
Maria, a new mom, describes the first visit her mother and father made to her home
after the birth of Maria’s new infant. I quickly realized that my status as their ‘princess’ was
now replaced with a new little princess. During their visit, my husband and I had to fight to
see our own child. Yet the specific roles of grandparents and other extended family members
are rarely discussed within the family, which is why conflicts often occur.
When these roles are clearly articulated and agreed on, extended family members can
provide support that enhances infant and toddler development. Family involvement as a form
of social support is further discussed as a protective factor later in this chapter. The birth of a
child, especially of a first child, brings about a major transition not only for parents but also
for the entire kin network. The social status of the extended family serves as the basis of the
social status of the child, and the values and beliefs of the extended family will shape the way
they care for and socialize the child. In addition, many children’s names and child-rearing
rituals, decisions, and behaviors are passed from past generations to the next. To illustrate
this point, there is an old joke about a mother who prepared a roast beef for most Sunday
family dinners.
It seems that this skin rash was common among infant girls in each generation in this
family. There are many ways to grandparent, and grandparents often jump into the new role
without prior planning or discussion with their children about expectations about the
grandparent role. Complaints can arise about intrusive or indifferent grandparents or, on the
other hand, about demanding or neglectful adult children. New parents inherit any unresolved
family issues that should be dealt with at this time to avoid engulfing the new family in
lasting emotional problems. Suggest that this is a good time to engage new parents in family-
of origin work. It is also a good time for the grandparent generation to make renewed efforts
to give up old grievances and accept their adult children and their partners as the adults that
they are.
Collectively, the adults of the world have not ensured that every child has the
opportunity for a good start in life. Not only do these adversities have consequences for the
infant’s or toddlers immediate development, but research indicates that adversities
experienced in childhood can also have negative consequences throughout the individual’s
life span. As the number of adverse childhood experiences increased so did the likelihood of
risky health behaviors, chronic physical and mental health conditions, and early death. You
have probably already surmised what some of the environmental factors are that inhibit
healthy growth and development in infants and toddlers.
Poverty
Although there are many ways of measuring poverty, it is generally agreed that 1
billion children across the world live in poverty, representing 1 in 2 children. Although
children living in the poorest countries are much more likely than children living in wealthy
countries to be poor, the proportion of children living in poverty has been rising in many of
the wealthiest nations. 50% of the national median income, the UNICEF researchers found
that the percentage of children living in poverty in 35 economically advanced countries
ranged from 4.7% in Iceland to 25.5% in Romania. In the United States, the National Center
for Children in Poverty estimates that families need an income about 2 times the U. federal
poverty level to meet basic needs, and they refer to families below this level as low income.
NCCP reports that, in 2016, 5.0 million infants and toddlers lived in low-income families, 3.4
million lived in families below the poverty level, and 1.1 million lived in deep poverty.
61% of Black children live in low-income families, compared with 60% of American
Indian children, 59% of Hispanic children, and 28% of White and Asian children. When
looking at these overall rates for children under the age of 18, it is important to remember that
low-income status is slightly more prevalent in the families of infants and toddlers than in
families with older children. Children with immigrant parents are more likely than children
with native-born parents to live in low-income families, 51%compared with 38%. South and
West being more likely to live in low-income families than children in the Northeast.
About half of low-income children under the age of 18 and 32% of children living
under the poverty line live with at least one parent employed full time, year-round Kimball &
Jiang, Although some young children who live in poverty flourish, poverty presents
considerable risks to children’s growth and development. Children living in poverty often
suffer the consequences of poor nutrition and inadequate health care. Three-year-olds who
live in deep poverty have been found to display more internalizing behavior symptoms, such
as anxiety, withdrawal, and depression, than other children of the same age. Children are
affected not only by the direct consequences of poverty but also by indirect factors such as
family stress, parental depression, and inadequate or no supportive parenting.
The infant mortality rate in the United States is high compared with other high-
income nations, but Per 1,000 births among American Indian/Alaska Natives, 5.0 per 1,000
births among Hispanics, 4.9 per 1,000 births among non-Hispanic Whites, and 4.2 per 1,000
births among Asian/Pacific Islanders.
Inadequate Caregiving
Because they are so dependent on caregiver assistance in all areas of their lives,
infants and toddlers’ developmental risk is heightened when parents fail to carry out
caregiving functions. There are many reasons why infants and toddlers may receive
inadequate care. The care of some infants is compromised when their mothers suffer from
depression. Research indicates that about 8% to 19% of women experience clinical
depression following childbirth.
Mothers who are depressed have been found to interact differently with their infants
than no depressed mothers. They may fail to protect their infants from harm, and they rate
their infants’ behavior more negatively. Infants of depressed mothers have been found to
show some negative outcomes, including overall distress, withdrawn behavior, and deficits in
social engagement, problems with sleep and feedings, and difficulty regulating emotions.
Family dynamics are often altered when mothers are depressed following childbirth, and
research indicates that infant relationships with fathers and other caregivers can buffer the
negative effects of poor interactions with a depressed mother.
Very little research exists on psychosocial and mental health issues for new fathers,
but the Australian First Time Fathers Study attempted to address this gap in knowledge. The
most pervasive response to inadequate caregiving is nonorganic failure to thrive, a condition
in which infants and toddlers have poor feeding habits and fail to make weight gains while
having no underlying medical condition. Feeding disorders usually show up as food refusal or
low food intake in relation to the infant or toddler age. Feeding problems have been found to
be a concern of 10% to 25% of parents of healthy children under the age of 3, but only 1% to
5% of infants and toddlers suffer from the severe feeding problems that result in failure to
thrive.
Infants and toddlers with feeding difficulties are a heterogeneous group that are
challenging for both parents and health care providers. Feeding problems occur in 30% of
preterm infants and in up to 80% of infants with neurological impairments or inborn
metabolic dysfunctions. One recent longitudinal study produced findings consistent with an
international scientific literature that infants and toddlers with feeding problems without
organic origin tend to have mothers who are depressed or have a feeding disorder themselves.
Cornelia and Camino also found that the fathers of infants and toddlers with nonorganic
feeding problems are more likely than other fathers to have obsessive/compulsive behaviors
and anxiety.
Another research team has found that sensory processing problems involving an
aversion or negative reaction to certain types of sensory stimuli are more common among
toddlers with NOFFT. Research also indicates that around 18 months of age, many toddlers
demonstrate a period of neophobic and begin to reduce the number and variety of accepted
foods, with the consumption of meat, vegetables, and fruits being dramatically reduced.
Ongoing parental conflict, harsh parenting, and parental mental illness and substance abuse
are also risk factors for infant and toddler development. When there is a high level of parental
anger and conflict, parents typically become less available to the infant or toddler, creating an
insecure home environment.
Research indicates that infants and toddlers raised with high parental conflict have
more active stress response systems. Serious parental mental illness, including chronic
depression, bipolar disorder, post-traumatic stress disorder, and schizophrenia, often
compromise the ability of parents to meet the needs of infants and toddlers. Parents whose
lives are organized around accessing and abusing legal and illegal substances are 4 times
more likely than other parents to neglect their infants and toddlers. NAS develops in infants
exposed to opiates during pregnancy and often leads to infant withdrawal, with symptoms
typically appearing 48 to 72 hours after birth.
The limited research available suggests that in general, opioid-exposed infants are
more likely to have attention deficit disorders, disruptive behavior, and the need for
psychiatric referrals. Also of concern is the effect of withdrawal on the infant’s growth and
development and the impact it has on maternal bonding. Infants with NAS often demonstrate
excessive crying, irritability, poor sleep, rigid muscle tone, tremors, hyperthermia, excessive
sucking with poor feeding, loose stools, yawning, sweating, nasal stuffiness, and sneezing, all
of which can affect mother–child bonding and attachment. The hospital made a referral to
child protective services who investigated but did not take custody of Kim’s infant after
learning from the social worker the consistent work Kim had demonstrated in remaining
drug-free.
Child Maltreatment and Trauma
Infants from birth to 1 year of age have the highest rate of victimization, at 24.2 per
1,000. The youngest children are the most vulnerable to child maltreatment. For all age
groups, 75.3% of confirmed cases of child maltreatment involved neglect, 17.2% involved
physical abuse, 8.4% involved sexual abuse, and 6.2% involved psychological abuse. The
effect of child maltreatment and other trauma on the brain during the first 3 years of life has
been the subject of considerable study in recent years.
Research indicates that early life stress, such as child maltreatment, can lead to
disruptions in HPA axis functioning and result in anxiety disorders and depression in
adulthood. The child who experiences maltreatment or other trauma at the age of 2, 3, or 4 is
at risk of developing memory problems, difficulty regulating emotions, and problems
integrating sensory experiences. When a child is exposed to extreme stress or trauma, the
autonomic nervous system is activated, resulting in increased heart rate, respiration, and
blood pressure. The child may freeze in place before beginning to fight.
In the case of child sexual abuse, the child may dissociate, or detach from what is
happening, becoming compliant and emotionally numb. As noted, 75.3% of all confirmed
cases of child maltreatment involve neglect. Child neglect is thought to occur when
caregivers are ignorant of child development, overwhelmed by life stresses, or struggling
with mental health or substance abuse problems. Much of the early human research on child
neglect focused on Romanian children who were placed in state-run institutions with few
staff and very little sensory and emotional stimulation.
Infants who have difficult temperament are more likely to be abused and neglected.
The combination of difficult temperament and environmental stress increases the risk of child
abuse. Infants and toddlers with mental, physical, or behavioral abnormalities are also at a
higher risk for abuse. Regardless, interventions with infants and toddlers who have
experienced abuse and neglect should be administered as soon as possible with the infant and
caregiver, and focus on the infant–caregiver relationship.
