Overall Physical Growth

The average newborn weighs approximately 7.5 pounds, although a healthy birth weight
for a full-term baby is considered to be between 5 pounds, 8 ounces (2,500 grams) and
8 pounds, 13 ounces (4,000 grams).[1] The average length of a newborn is 19.5 inches,
increasing to 29.5 inches by 12 months and 34.4 inches by 2 years old (WHO
Multicentre Growth Reference Study Group, 2006).

For the first few days of life, infants typically lose about 5 percent of their body weight as
they eliminate waste and get used to feeding. This often goes unnoticed by most
parents, but can be cause for concern for those who have a smaller infant. This weight
loss is temporary, however, and is followed by a rapid period of growth. By the time an
infant is 4 months old, it usually doubles in weight, and by one year has tripled its birth
weight. By age 2, the weight has quadrupled. The average length at 12 months (one
year old) typically ranges from 28.5-30.5 inches. The average length at 24 months (two
years old) is around 33.2-35.4 inches (CDC, 2010).

Figure 1. Children experience rapid physical changes through infancy and early childhood. (credit “left”:
modification of work by Kerry Ceszyk; credit “middle-left”: modification of work by Kristi Fausel; credit
“middle-right”: modification of work by “devinf”/Flickr; credit “right”: modification of work by Rose Spielman)

Monitoring Physical Growth

As mentioned earlier, growth is so rapid in infancy that the consequences of neglect can
be severe. For this reason, gains are closely monitored. At each well-baby check-up, a
baby’s growth is compared to that baby’s previous numbers. Often, measurements are
expressed as a percentile from 0 to 100, which compares each baby to other babies
the same age. For example, weight at the 40th percentile means that 40 percent of all
babies weigh less, and 60 percent weight more. For any baby, pediatricians and parents
can be alerted early just by watching percentile changes. If an average baby moves
from the 50th percentile to the 20th, this could be a sign of failure to thrive, which
could be caused by various medical conditions or factors in the child’s environment. The
earlier the concern is detected, the earlier intervention and support can be provided for
the infant and caregiver.

Body Proportions

Another dramatic physical change that takes place in the first several years of life is a
change in body proportions. The head initially makes up about 50 percent of a person’s
entire length when developing in the womb. At birth, the head makes up about 25
percent of a person’s length (just imagine how big your head would be if the proportions
remained the same throughout your life!). In adulthood, the head comprises about 15
percent of a person’s length.[2] Imagine how difficult it must be to raise one’s head during
the first year of life! And indeed, if you have ever seen a 2- to 4-month-old infant lying
on their stomach trying to raise the head, you know how much of a challenge this is.

Try It

The Brain in the First Two Years

Some of the most dramatic physical change that occurs during this period is in the
brain. At birth, the brain is about 25 percent of its adult weight, and this is not true for
any other part of the body. By age 2, it is at 75 percent of its adult weight, at 95 percent
by age 6, and at 100 percent by age 7 years.

Figure 2. Research shows that as early at 4-6 months, infants utilize similar areas of the brain as adults to
process information. Image from research article conducted by Ben Deen, Hilary Richardson, Daniel D. Dilks,
Atsushi Takahashi, Boris Keil, Lawrence L. Wald, Nancy Kanwisher & Rebecca Saxe.”Article | OPEN |
Published: 10 January 2017​
Organization of high-level visual cortex in human infants”. Image retrieved from
https://www.quantamagazine.org/infant-brains-reveal-how-the-mind-gets-built-20170110/.

Communication within the central nervous system (CNS), which consists of the brain
and spinal cord, begins with nerve cells called neurons. Neurons connect to other
neurons via networks of nerve fibers called axons and dendrites. Each neuron typically
has a single axon and numerous dendrites which are spread out like branches of a tree
(some will say it looks like a hand with fingers). The axon of each neuron reaches
toward the dendrites of other neurons at intersections called synapses, which are
critical communication links within the brain. Axons and dendrites do not touch, instead,
electrical impulses in the axons cause the release of chemicals called
neurotransmitters which carry information from the axon of the sending neuron to the
dendrites of the receiving neuron.

While most of the brain’s 100 to 200 billion neurons are present at birth, they are not
fully mature. Each neural pathway forms thousands of new connections during infancy
and toddlerhood. During the next several years, dendrites, or connections between
neurons, will undergo a period of transient exuberance or temporary dramatic growth
(exuberant because it is so rapid and transient because some of it is temporary). There
is a proliferation of these dendrites during the first two years so that by age 2, a single
neuron might have thousands of dendrites. After this dramatic increase, the neural
pathways that are not used will be eliminated through a process called pruning, thereby
making those that are used much stronger. It is thought that pruning causes the brain to
function more efficiently, allowing for mastery of more complex skills (Hutchinson, 2011).
Transient exuberance occurs during the first few years of life, and pruning continues
through childhood and into adolescence in various areas of the brain. This activity is
occurring primarily in the cortex or the thin outer covering of the brain involved in
voluntary activity and thinking.

Watch It

This brief video describes some of the remarkable brain development that takes places in the first few
years of life.

You can view the transcript for “How baby brains develop” here (opens in new window).
Figure 3. Parts of a neuron.

The prefrontal cortex, located behind the forehead, continues to grow and mature
throughout childhood and experiences an addition growth spurt during adolescence. It is
the last part of the brain to mature and will eventually comprise 85 percent of the brain’s
weight. Experience will shape which of these connections are maintained and which of
these are lost. Ultimately, about 40 percent of these connections will be lost (Webb,
Monk, & Nelson, 2001). As the prefrontal cortex matures, the child is increasingly able
to regulate or control emotions, to plan activity, to strategize, and have better judgment.
Of course, this is not fully accomplished in infancy and toddlerhood but continues
throughout childhood and adolescence.

Another major change occurring in the central nervous system is the development of
myelin, a coating of fatty tissues around the axon of the neuron. Myelin helps insulate
the nerve cell and speed the rate of transmission of impulses from one cell to another.
This enhances the building of neural pathways and improves coordination and control of
movement and thought processes. The development of myelin continues into
adolescence but is most dramatic during the first several years of life.
From Reflexes to Voluntary Movements

Every basic motor skill (any movement ability) develops over the first two years of life.
The sequence of motor skills first begins with reflexes. Infants are equipped with a
number of reflexes, or involuntary movements in response to stimulation, and some are
necessary for survival. These include the breathing reflex, or the need to maintain an
oxygen supply (this includes hiccups, sneezing, and thrashing reflexes), reflexes that
maintain body temperature (crying, shivering, tucking the legs close, and pushing away
blankets), the sucking reflex, or automatically sucking on objects that touch their lips,
and the rooting reflex, which involves turning toward any object that touches the cheek
(which manages feeding, including the search for a nipple). Other reflexes are not
necessary for survival, but signify the state of brain and body functions. Some of these
include:the babinski reflex (toes fan upward when feet are stroked), the stepping reflex
(babies move their legs as if to walk when feet touch a flat surface), the palmar grasp
(the infant will tightly grasp any object placed in its palm), and the moro reflex (babies
will fling arms out and then bring to chest if they hear a loud noise). These movements
occur automatically and are signals that the infant is functioning well neurologically.
Within the first several weeks of life, these reflexes are replaced with voluntary
movements or motor skills.

Watch It

Watch this video to see examples of newborn reflexes.

You can view the transcript for “Reflexes in newborn babies” here (opens in new window).

Motor development
Motor development occurs in an orderly sequence as infants move from reflexive
reactions (e.g., sucking and rooting) to more advanced motor functioning. This
development proceeds in a cephalocaudal (from head-down) and proximodistal (from
center-out) direction. For instance, babies first learn to hold their heads up, then sit with
assistance, then sit unassisted, followed later by crawling, pulling up, cruising, and then
walking. As motor skills develop, there are certain developmental milestones that young
children should achieve. For each milestone, there is an average age, as well as a
range of ages in which the milestone should be reached. An example of a
developmental milestone is a baby holding up its head. Babies on average are able to
hold up their head at 6 weeks old, and 90% of babies achieve this between 3 weeks
and 4 months old. If a baby is not holding up his head by 4 months old, he is showing a
delay. On average, most babies sit alone at 7 months old. Sitting involves both
coordination and muscle strength, and 90% of babies achieve this milestone between 5
and 9 months old (CDC, 2018). If the child is displaying delays on several milestones,
that is a reason for concern, and the parent or caregiver should discuss this with the
child’s pediatrician. Some developmental delays can be identified and addressed
through early intervention.

Link to Learning

For more information on developmental milestones, please see the CDC’s Developmental Milestones.

Gross Motor Skills

 Figure 1. This baby is working on his pincer grasp.

Gross motor skills are voluntary movements that involve the use of large muscle
groups and are typically large movements of the arms, legs, head, and torso. These
skills begin to develop first. Examples include moving to bring the chin up when lying on
the stomach, moving the chest up, rocking back and forth on hands and knees. But it
also includes exploring an object with one’s feet as many babies do, as early as 8
weeks of age, if seated in a carrier or other device that frees the hips. This may be
easier than reaching for an object with the hands, which requires much more practice
(Berk, 2007). And sometimes an infant will try to move toward an object while crawling
and surprisingly move backward because of the greater amount of strength in the arms
than in the legs!

Fine Motor Skills

Fine motor skills are more exact movements of the hands and fingers and include the
ability to reach and grasp an object. These skills focus on the muscles in the fingers,
toes, and eyes, and enable coordination of small actions (e.g., grasping a toy, writing
with a pencil, and using a spoon). Newborns cannot grasp objects voluntarily but do
wave their arms toward objects of interest. At about 4 months of age, the infant is able
to reach for an object, first with both arms and within a few weeks, with only one arm.
Grasping an object involves the use of the fingers and palm, but no thumbs. Stop
reading for a moment and try to grasp an object using the fingers and the palm. How
does that feel? How much control do you have over the object? If it is a pen or pencil,
are you able to write with it? Can you draw a picture? The answer is, probably not. Use
of the thumb comes at about 9 months of age when the infant is able to grasp an object
using the forefinger and thumb (the pincer grasp). This ability greatly enhances the
ability to control and manipulate an object, and infants take great delight in this
newfound ability. They may spend hours picking up small objects from the floor and
placing them in containers. By 9 months, an infant can also watch a moving object,
reach for it as it approaches, and grab it. This is quite a complicated set of actions if we
remember how difficult this would have been just a few months earlier.

Age Developmental Milestone

●​ Can hold head upright on own

~2 months ●​ Smiles at sound of familiar voices and follows movement with
eyes

●​ Can raise head and chest from prone position

●​ Smiles at others
~3 months ●​ Grasps objects
●​ Rolls from side to back

●​ Babbles, laughs, and tries to imitate sounds

~4-5 months ●​ Begins to roll from back to side
~6 months ●​ Moves objects from hand to hand

●​ Can sit without support

●​ May begin to crawl
~7-8 months ●​ Responds to own name
●​ Finds partially hidden objects

●​ Walks while holding on

~8-9 months ●​ Babbles “mama” and “dada”
●​ Claps

●​ Stands alone
●​ Begins to walk
~11-12 months ●​ Says at least one word
●​ Can stack two blocks

●​ Walks independently
●​ Drinks from a cup
~18 months ●​ Says at least 15 words
●​ Points to body parts

●​ Runs and jumps

●​ Uses two-word sentences
~2 years ●​ Follows simple instructions
●​ Begins make-believe play
 ●​ Speaks in multi-word sentences
~3 years ●​ Sorts objects by shape and color

●​ Draws circles and squares

●​ Rides a tricycle
~4 years ●​ Gets along with people outside of the family
●​ Gets dressed

●​ Can jump, hop, and skip

~5 years ●​ Knows name and address
●​ Counts ten or more objects

Try It

Sensory Development

As infants and children grow, their senses play a vital role in encouraging and
stimulating the mind and in helping them observe their surroundings. Two terms are
important to understand when learning about the senses. The first is sensation, or the
interaction of information with the sensory receptors. The second is perception, or the
process of interpreting what is sensed. It is possible for someone to sense something
without perceiving it. Gradually, infants become more adept at perceiving with their
senses, making them more aware of their environment and presenting more
affordances or opportunities to interact with objects.

Vision
What can young infants see, hear, and smell? Newborn infants’ sensory abilities are
significant, but their senses are not yet fully developed. Many of a newborn’s innate
preferences facilitate interaction with caregivers and other humans. The womb is a dark
environment void of visual stimulation. Consequently, vision is the most poorly
developed sense at birth. Newborns typically cannot see further than 8 to 16 inches
away from their faces, have difficulty keeping a moving object within their gaze, and can
detect contrast more than color differences. If you have ever seen a newborn struggle to
see, you can appreciate the cognitive efforts being made to take in visual stimulation
and build those neural pathways between the eye and the brain.

Although vision is their least developed sense, newborns already show a preference for
faces. When you glance at a person, where do you look? Chances are you look into
their eyes. If so, why? It is probably because there is more information there than in
other parts of the face. Newborns do not scan objects this way; rather, they tend to look
at the chin or another less detailed part of the face. However, by 2 or 3 months, they will
seek more detail when visually exploring an object and begin showing preferences for
unusual images over familiar ones, for patterns over solids, faces over patterns, and
three-dimensional objects over flat images. Newborns have difficulty distinguishing
between colors, but within a few months are able to distinguish between colors as well
as adults. Infants can also sense depth as binocular vision develops at about 2 months
of age. By 6 months, the infant can perceive depth in pictures as well (Sen, Yonas, &
Knill, 2001). Infants who have experience crawling and exploring will pay greater
attention to visual cues of depth and modify their actions accordingly (Berk, 2007).

Try It

Hearing
The infant’s sense of hearing is very keen at birth. If you remember from an earlier
module, this ability to hear is evidenced as soon as the 5th month of prenatal
development. In fact, an infant can distinguish between very similar sounds as early as
one month after birth and can distinguish between a familiar and non-familiar voice even
earlier. Babies who are just a few days old prefer human voices, they will listen to voices
longer than sounds that do not involve speech (Vouloumanos & Werker, 2004), and they
seem to prefer their mother’s voice over a stranger’s voice (Mills & Melhuish, 1974). In
an interesting experiment, 3-week-old babies were given pacifiers that played a
recording of the infant’s mother’s voice and of a stranger’s voice. When the infants
heard their mother’s voice, they sucked more strongly at the pacifier (Mills & Melhuish,
1974). Some of this ability will be lost by 7 or 8 months as a child becomes familiar with
the sounds of a particular language and less sensitive to sounds that are part of an
unfamiliar language.

Pain and Touch

Immediately after birth, a newborn is sensitive to touch and temperature, and is also
sensitive to pain, responding with crying and cardiovascular responses. Newborns who
are circumcised (the surgical removal of the foreskin of the penis) without anesthesia
experience pain, as demonstrated by increased blood pressure, increased heart rate,
decreased oxygen in the blood, and a surge of stress hormones (United States National
Library of Medicine, 2016). According to the American Academy of Pediatrics (AAP),
there are medical benefits and risks to circumcision. They do not recommend routine
circumcision, however, they stated that because of the possible benefits (including
prevention from urinary tract infections, penile cancer, and some STDs) parents should
have the option to circumcise their sons if they want to (AAP, 2012).[3]

The sense of touch is acute in infants and is essential to a baby’s growth of physical
abilities, language and cognitive skills, and socio-emotional competency. Touch not only
impacts short-term development during infancy and early childhood but also has
long-term effects, suggesting the power of positive gentle touch from birth. Through
touch, infants learn about their world, bond with their caregiver, and communicate their
needs and wants. Research emphasizes the great benefits of touch for premature
babies, but the presence of such contact has been shown to benefit all children (Stack,
D. M. (2010).[4] In an extreme example, some children in Romania were reared in
orphanages in which a single care worker may have had as many as 10 infants to care
for at one time. These infants were not often helped or given toys with which to play. As
a result, many of them were developmentally delayed (Nelson, Fox, & Zeanah, 2014).[5]
When we discuss emotional and social development later in this module, you will also
see the important role that touch plays in helping infants feel safe and protected, which
builds trust and secure attachments between the child and their caregiver.

Taste and Smell

Not only are infants sensitive to touch, but newborns can also distinguish between sour,
bitter, sweet, and salty flavors and show a preference for sweet flavors. They can
distinguish between their mother’s scent and that of others, and prefer the smell of their
mothers. A newborn placed on the mother’s chest will inch up to the mother’s breast, as
it is a potent source of the maternal odor. Even on the first day of life, infants orient to
their mother’s odor and are soothed, when crying, by their mother’s odor (Sullivan et al.,
2011).[6]

Try It
Good nutrition in a supportive environment is vital for an infant’s healthy growth and
development. Remember, from birth to 1 year, infants triple their weight and increase
their height by half, and this growth requires good nutrition. For the first 6 months,
babies are fed breast milk or formula. Starting good nutrition practices early can help
children develop healthy dietary patterns. Infants need to receive nutrients to fuel their
rapid physical growth. Malnutrition during infancy can result in not only physical but
also cognitive and social consequences. Without proper nutrition, infants cannot reach
their physical potential.

Benefits of Breastfeeding

Figure 1. Breastmilk changes in composition with a newborn’s development and needs.

Breast milk is considered the ideal diet for newborns due to the nutritional makeup of
colostrum and subsequent breastmilk production. Colostrum, the milk produced during
pregnancy and just after birth, has been described as “liquid gold.” Colostrum is packed
with nutrients and other important substances that help the infant build up their immune
system. Most babies will get all the nutrition they need through colostrum during the first
few days of life (CDC, 2018).[1] Breast milk changes by the third to fifth day after birth,
becoming much thinner, but containing just the right amount of fat, sugar, water, and
proteins to support overall physical and neurological development. It provides a source
of iron more easily absorbed in the body than the iron found in dietary supplements, it
provides resistance against many diseases, it is more easily digested by infants than
formula, and it helps babies make a transition to solid foods more easily than if
bottle-fed.

The reason infants need such a high fat content is the process of myelination which
requires fat to insulate the neurons. There has been some research, including
meta-analyses, to show that breastfeeding is connected to advantages with cognitive
development (Anderson, Johnstone, & Remley, 1999)[2]. Low birth weight infants had
greater benefits from breastfeeding than did normal-weight infants in a meta-analysis of
twenty controlled studies examining the overall impact of breastfeeding (Anderson et al.,
1999). This meta-analysis showed that breastfeeding may provide nutrients required for
rapid development of the immature brain and be connected to more rapid or better
development of neurologic function. The studies also showed that a longer duration of
breastfeeding was accompanied by greater differences in cognitive development
between breastfed and formula-fed children. Whereas normal-weight infants showed a
2.66-point difference, low-birth-weight infants showed a 5.18-point difference in IQ
compared with weight-matched, formula-fed infants (Anderson et al, 1999). These
studies suggest that nutrients present in breast milk may have a significant effect on
neurologic development in both premature and full-term infants.

Figure 2. Most children are introduced to solid foods around six months old, like this girl who is having her
first taste of rice.
For most babies, breast milk is also easier to digest than formula. Formula-fed infants
experience more diarrhea and upset stomachs. The absence of antibodies in formula
often results in a higher rate of ear infections and respiratory infections. Children who
are breastfed have lower rates of childhood leukemia, asthma, obesity, type 1 and 2
diabetes, and a lower risk of SIDS. For all of these reasons, it is recommended that
mothers breastfeed their infants until at least 6 months of age and that breast milk be
used in the diet throughout the first year (U.S. Department of Health and Human
Services, 2004a in Berk, 2007).

Several recent studies have reported that it is not just babies that benefit from
breastfeeding. Breastfeeding stimulates contractions in the uterus to help it regain its
normal size, and women who breastfeed are more likely to space their pregnancies
farther apart. Mothers who breastfeed are at lower risk of developing breast cancer,
especially among higher-risk racial and ethnic groups (Islami et al., 2015).[3] Other
studies suggest that women who breastfeed have lower rates of ovarian cancer
(Titus-Ernstoff, Rees, Terry, & Cramer, 2010)[4], and reduced risk for developing Type 2
diabetes (Gunderson, et al., 2015)[5], and rheumatoid arthritis (Karlson, Mandl,
Hankinson, & Grodstein, 2004).[6]

A historic look at breastfeeding

The use of wet nurses, or lactating women, hired to nurse others’ infants, during the middle ages
eventually declined, and mothers increasingly breastfed their own infants in the late 1800s. In the early
part of the 20th century, breastfeeding began to go through another decline, and by the 1950s it was
practiced less frequently by middle class, more affluent mothers as formula began to be viewed as
superior to breast milk. In the late 1960s and 1970s, there was again a greater emphasis placed on
natural childbirth and breastfeeding and the benefits of breastfeeding were more widely publicized.
Gradually, rates of breastfeeding began to climb, particularly among middle-class educated mothers who
received the strongest messages to breastfeed.

Today, new mothers receive consultation from lactation specialists before being discharged from the
hospital to ensure that they are informed of the benefits of breastfeeding and given support and
encouragement to get their infants accustomed to taking the breast. This does not always happen
immediately, and first-time mothers, especially, can become upset or discouraged. In this case, lactation
specialists and nursing staff can encourage the mother to keep trying until the baby and mother are
comfortable with the feeding.

Most mothers who breastfeed in the United States stop breastfeeding at about 6-8
weeks, often in order to return to work outside the home (United States Department of
Health and Human Services (USDHHS), 2011[7]). Mothers can certainly continue to
provide breast milk to their babies by expressing and freezing the milk to be bottle fed at
a later time or by being available to their infants at feeding time, but some mothers find
that after the initial encouragement they receive in the hospital to breastfeed, the
outside world is less supportive of such efforts. Some workplaces support breastfeeding
mothers by providing flexible schedules and welcoming infants, but many do not. And
the public support of breastfeeding is sometimes lacking. Women in Canada are more
likely to breastfeed than are those in the United States, and the Canadian health
recommendation is for breastfeeding to continue until 2 years of age. Facilities in public
places in Canada such as malls, ferries, and workplaces provide more support and
comfort for the breastfeeding mother and child than found in the United States.

In addition to the nutritional and health benefits of breastfeeding, breast milk is free!
Anyone who has priced formula recently can appreciate this added incentive to
breastfeeding. Prices for a month’s worth of formula can easily range from $130-$200.
Prices for a year’s worth of formula and feeding supplies can cost well over $1,500
(USDHHS, 2011).
 Links to Learning

●​ To learn more about breastfeeding, visit this resource from the U.S. Department of
Health and Human Resources: Your Guide to Breastfeeding.
●​ Visit Kids Health on Breastfeeding vs. Formula Feeding to learn more about the benefits
and challenges of breastfeeding and formula-feeding. Click on the speaker icon to listen
to the narration of the article if you would like.
●​ Watch this video from the Psych SciShow “Bad Science: Breastmilk and Formula” to
learn about research related to both breastfeeding and formula-feeding. This will open
the door for further discussion about formula-feeding as we move to the next section
below.

When Breastfeeding Doesn’t Work

There are occasions where mothers may be unable to breastfeed babies, often for a
variety of health, social, and emotional reasons. For example, breastfeeding generally
does not work:

●​ when the baby is adopted

●​ when the biological mother has a transmissible disease such as
tuberculosis or HIV
●​ when the mother is addicted to drugs or taking any medication that may be
harmful to the baby (including some types of birth control)
●​ when the infant was born to (or adopted by) a family with two fathers and
the surrogate mother is not available to breastfeed
●​ when there are attachment issues between mother and baby
●​ when the mother or the baby is in the Intensive Care Unit (ICU) after the
delivery process
●​ when the baby and mother are attached but the mother does not produce
enough breast-milk
One early argument given to promote the practice of breastfeeding (when health issues
are not the case) is that it promotes bonding and healthy emotional development for
infants. However, this does not seem to be a unique case. Breastfed and bottle-fed
infants adjust equally well emotionally (Ferguson & Woodward, 1999). This is good
news for mothers who may be unable to breastfeed for a variety of reasons and for
fathers who might feel left out as a result.

Try It

Introducing Solid Foods

Breast milk or formula is the only food a newborn needs, and the American Academy of
Pediatrics recommends exclusive breastfeeding for the first six months after birth. Solid
foods can be introduced from around six months onward when babies develop stable
sitting and oral feeding skills but should be used only as a supplement to breast milk or
formula. By six months, the gastrointestinal tract has matured, solids can be digested
more easily, and allergic responses are less likely. The infant is also likely to develop
teeth around this time, which aids in chewing solid food. Iron-fortified infant cereal,
made of rice, barley, or oatmeal, is typically the first solid introduced due to its high iron
content. Cereals can be made of rice, barley, or oatmeal. Generally, salt, sugar,
processed meat, juices, and canned foods should be avoided.

Though infants usually start eating solid foods between 4 and 6 months of age, more
and more solid foods are consumed by a growing toddler. Pediatricians recommended
introducing foods one at a time, and for a few days, in order to identify any potential
food allergies. Toddlers may be picky at times, but it remains important to introduce a
variety of foods and offer food with essential vitamins and nutrients, including iron,
calcium, and vitamin D.

Milk Anemia in the United States

About 9 million children in the United States are malnourished (Children’s Welfare,
1998). More still suffer from milk anemia, a condition in which milk consumption leads
to a lack of iron in the diet. The prevalence of iron deficiency anemia in 1- to 3-year-old
children seems to be increasing (Kazal, 2002)[8]. The body gets iron through certain
foods. Toddlers who drink too much cow’s milk may also become anemic if they are not
eating other healthy foods that have iron. This can be due to the practice of giving
toddlers milk as a pacifier when resting, riding, walking, and so on. Appetite declines
somewhat during toddlerhood and a small amount of milk (especially with added
chocolate syrup) can easily satisfy a child’s appetite for many hours. The calcium in milk
interferes with the absorption of iron in the diet as well. There is also a link between iron
deficiency anemia and diminished mental, motor, and behavioral development. In the
second year of life, iron deficiency can be prevented by the use of a diversified diet that
is rich in sources of iron and vitamin C, limiting cow’s milk consumption to less than 24
ounces per day, and providing a daily iron-fortified vitamin.

Global Considerations and Malnutrition

In the 1960s, formula companies led campaigns in developing countries to encourage

mothers to feed their babies on infant formula. Many mothers felt that formula would be
superior to breast milk and began using formula. The use of formula can certainly be
healthy under conditions in which there is adequate, clean water with which to mix the
formula and adequate means to sanitize bottles and nipples. However, in many of these
countries, such conditions were not available and babies often were given diluted,
contaminated formula which made them become sick with diarrhea and become
dehydrated. These conditions continue today and now many hospitals prohibit the
distribution of formula samples to new mothers in efforts to get them to rely on
breastfeeding. Many of these mothers do not understand the benefits of breastfeeding
and have to be encouraged and supported in order to promote this practice.

The World Health Organization (2018) recommends:

●​ initiation of breastfeeding within one hour of birth

●​ exclusive breastfeeding for the first six months of life
●​ introduction of solid foods at six months together with continued
breastfeeding up to two years of age or beyond

Link to Learning

Breastfeeding could save the lives of millions of infants each year, according to the World Health
Organization (WHO), yet fewer than 40 percent of infants are breastfed exclusively for the first 6 months
of life. Most women can breastfeed unless they are receiving chemotherapy or radiation therapy, have
HIV, are dependent on illicit drugs, or have active untreated tuberculosis. Because of the great benefits of
breastfeeding, WHO, UNICEF and other national organizations are working together with the government
to step up support for breastfeeding globally.

Find out more statistics and recommendations for breastfeeding at the WHO’s 10 facts on breastfeeding.
You can also learn more about efforts to promote breastfeeding in Peru: “Protecting Breastfeeding in
Peru”.

Children in developing countries and countries experiencing the harsh conditions of war
are at risk for two major types of malnutrition. Infantile marasmus refers to starvation
due to a lack of calories and protein. Children who do not receive adequate nutrition
lose fat and muscle until their bodies can no longer function. Babies who are breastfed
are much less at risk of malnutrition than those who are bottle-fed. After weaning,
children who have diets deficient in protein may experience kwashiorkor, or the
“disease of the displaced child,” often occurring after another child has been born and
taken over breastfeeding. This results in a loss of appetite and swelling of the abdomen
as the body begins to break down the vital organs as a source of protein.

Watch It

Watch this video to learn more about the signs and symptoms of kwashiorkor and marasmus.

You can view the transcript for “Child Malnutrition – What? How? And when to Refer..” here (opens in new
window).
Infant Sleep

Figure 1. Sleep is critical for healthy infant development.

Infants 0 to 2 years of age sleep an average of 12.8 hours a day, although this changes
and develops gradually throughout an infant’s life. For the first three months, newborns
sleep between 14 and 17 hours a day, then they become increasingly alert for longer
periods of time. About one-half of an infant’s sleep is rapid eye movement (REM) sleep,
and infants often begin their sleep cycle with REM rather than non-REM sleep. They
also move through the sleep cycle more quickly than adults.

Parents spend a significant amount of time worrying about and losing even more sleep
over their infant’s sleep schedule, but there remains a great deal of variation in sleep
patterns and habits for individual children. A 2018 study showed that at 6 months of
age, 62% of infants slept at least six hours during the night, 43% of infants slept at least
8 hours through the night, and 38% of infants were not sleeping at least six continual
hours through the night. At 12 months, 28% of children were still not sleeping at least 6
uninterrupted hours through the night, while 78% were sleeping at least 6 hours, and
56% were sleeping at least 8 hours.[1]
The most common infant sleep-related problem reported by parents is nighttime waking.
Studies of new parents and sleep patterns show that parents lose the most sleep during
the first three months with a new baby, with mothers losing about an hour of sleep each
night, and fathers losing a disproportionate 13 minutes. This decline in sleep quality and
quantity for adults persists until the child is about six years old. [2]

Figure 2. This newborn takes a nap with his dad. Co-sleeping is the norm in many regions of the world, and
controversial in others.

While this shows there is no precise science as to when and how an infant will sleep,
there are general trends in sleep patterns. Around six months, babies typically sleep
between 14-15 hours a day, with 3-4 of those hours happening during daytime naps. As
they get older, these naps decrease from several to typically two naps a day between
ages 9-18 months. Often, periods of rapid weight gain or changes in developmental
abilities such as crawling or walking will cause changes to sleep habits as well. Infants
generally move towards one 2-4 hour nap a day by around 18 months, and many
children will continue to nap until around four or five years old.[3]
Sudden Unexpected Infant Deaths (SUID)

Each year in the United States, there are about 3,500 Sudden Unexpected Infant
Deaths (SUID). These deaths occur among infants less than one-year-old and have no
immediately obvious cause (CDC, 2015). The three commonly reported types of SUID
are:

●​ Sudden Infant Death Syndrome (SIDS): SIDS is identified when the death
of a healthy infant occurs suddenly and unexpectedly, and medical and
forensic investigation findings (including an autopsy) are inconclusive. SIDS
is the leading cause of death in infants up to 12 months old, and
approximately 1,500 infants died of SIDS in 2013 (CDC, 2015). The risk of
SIDS is highest at 4 to 6 weeks of age. Because SIDS is diagnosed when
no other cause of death can be determined, possible causes of SIDS are
regularly researched. One leading hypothesis suggests that infants who die
from SIDS have abnormalities in the area of the brainstem responsible for
regulating breathing (Weekes-Shackelford & Shackelford, 2005). Although
the exact cause is unknown, doctors have identified the following risk
factors for SIDS:
○​ low birth weight
○​ siblings who have had SIDS
○​ sleep apnea
○​ of African-American or Inuit descent
○​ low socioeconomic status (SES)
○​ smoking in the home
●​ Unknown cause: The sudden death of an infant less than one year of age
that cannot be explained because a thorough investigation was not
conducted and the cause of death could not be determined.
●​ Accidental suffocation and strangulation in bed: Reasons for accidental
suffocation include the following: suffocation by soft bedding, another
person rolling on top of or against the infant while sleeping, an infant being
wedged between two objects such as a mattress and wall, and strangulation
such as when an infant’s head and neck become caught between crib
railings.

The combined SUID rate declined considerably following the release of the American
Academy of Pediatrics safe sleep recommendations in 1992, which advocated that
infants be placed on their backs for sleep (non-prone position). These recommendations
were followed by a major Back to Sleep Campaign in 1994. According to the CDC, the
SIDS death rate is now less than one-fourth of what is was (130 per 100,000 live birth in
1990 versus 40 in 2015). However, accidental suffocation and strangulation in bed
mortality rates remained unchanged until the late 1990s. Some parents were still putting
newborns to sleep on their stomachs partly because of past tradition. Most SIDS victims
experience several risks, an interaction of biological and social circumstances. But
thanks to research, the major risk, stomach sleeping, has been highly publicized. Other
causes of death during infancy include congenital birth defects and homicide.

Co-Sleeping

The location of sleep depends primarily on the baby’s age and culture. Bed-sharing (in
the parents’ bed) or co-sleeping (in the parents’ room) is the norm is some cultures, but
not in others (Esposito et al. 2015) [4]. Colvin, Collie-Akers, Schunn and Moon (2014)[5]
analyzed a total of 8,207 deaths from 24 states during 2004–2012. The deaths were
documented in the National Center for the Review and Prevention of Child Deaths Case
Reporting System, a database of death reports from state child death review teams.
The results indicated that younger victims (0-3 months) were more likely to die by
bed-sharing and sleeping in an adult’s bed or on a person. A higher percentage of older
victims (4 months to 364 days) rolled into objects in the sleep environment and changed
position from side/back to prone. Carpenter et al. (2013)[6] compared infants who died of
SIDS with a matched control and found that infants younger than three months old who
slept in bed with a parent were five times more likely to die of SIDS compared to babies
who slept separately from the parents, but were still in the same room. They concluded
that bed-sharing, even when the parents do not smoke or take alcohol or drugs,
increases the risk of SIDS. However, when combined with parental smoking and
maternal alcohol consumption and/or drug use, the risks associated with bed-sharing
greatly increased.
Despite the risks noted above, the controversy about where babies should sleep has
been ongoing. Co-sleeping has been recommended for those who advocate attachment
parenting (Sears & Sears, 2001) [7] and other research suggests that bed-sharing and
co-sleeping is becoming more popular in the United States (Colson et al., 2013) [8]. So,
what are the latest recommendations?

The American Academy of Pediatrics (AAP) actually updated their recommendations for
a Safe Infant Sleeping Environment in 2016. The most recent AAP recommendations on
creating a safe sleep environment include:

●​ Back to sleep for every sleep. Always place the baby on their back on a firm
sleep surface such as a crib or bassinet with a tight-fitting sheet.
●​ Avoid the use of soft bedding, including crib bumpers, blankets, pillows, and
soft toys. The crib should be bare.
●​ Breastfeeding is recommended.
●​ Share a bedroom with parents, but not the same sleeping surface,
preferably until the baby turns 1 but at least for the first six months.
Room-sharing decreases the risk of SIDS by as much as 50 percent.
●​ Avoid baby’s exposure to smoke, alcohol, and illicit drugs.

As you can see, there is a recommendation to now “share a bedroom with parents,” but
not the same sleeping surface. Breastfeeding is also recommended as adding
protection against SIDS, but after feeding, the AAP encourages parents to move the
baby to their separate sleeping space, preferably a crib or bassinet in the parents’
bedroom. Finally, the report included new evidence that supports skin-to-skin care for
newborn infants.[9]

Link to Learning
The website Zero to Three has more information on infant sleep patterns and habits. Feel free to explore
their multiple topics on the subject.

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Immunizations

Preventing communicable diseases from early infancy is one of the major tasks of the
Public Health System in the USA. Infants mouth every single object they find as one of
their typical developmental tasks. They learn through their senses and tasting objects
stimulates their brain and provides a sensory experience as well as learning.

Infants have much contact with dirty surfaces. They lay on a carpet that most likely has
been contaminated by adults walking on it; they mouth keys, rattles, toys, and books;
they crawl on the floor; they hold on to furniture to walk, and much more. How do we
prevent infants from getting sick? One possible answer is immunizations.

Watch It

Watch the first ten minutes of this video clip from the Alexander Street Database that illustrates what has
become known as the vaccine war.

This debate continues on today, only amplified by the Covid-19 Pandemic. The rush to develop a vaccine
to protect against coronavirus resulted in many people celebrating the vaccine and its success in
preventing the spread and the severity of Covid-19, while others remained distrustful of potential side
effects. Questions and opinions circulating about vaccination led to increased social and political divisions
throughout the United States.

Many decades ago, our society struggled to find vaccines and cures for illnesses such
as Polio, whooping cough, and many other medical conditions. A few decades ago
parents started changing their minds on the need to vaccinate children. Some children
are not vaccinated for valid medical reasons, but some states allow a child to be
unvaccinated because of a parent’s personal or religious beliefs. At least 1 in 14
children is not vaccinated. What is the outcome of not vaccinating children? Some of the
preventable illnesses are returning. Fortunately, each vaccinated child stops the
transmission of the disease, a phenomenon called herd immunity. Usually, if 90% of the
people in a community (a herd) are immunized, no one dies of that disease.

In 2017, Community Care Licensing in California, the agency that regulates childcare
centers, changed regulations. Before it was possible for parents to opt-out of
vaccinations due to personal beliefs, but this changed after Governor Brown signed a
Bill in 2016 to only exclude children from being vaccinated if there were medical
reasons. Furthermore, all personnel working with children must be immunized.

Link to Learning

Read more information about vaccinations at the website Shots for School.

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Cognitive Development in Children

In order to adapt to the evolving environment around us, humans rely on cognition, both
adapting to the environment and also transforming it. In general, all theorists studying
cognitive development address three main issues:

1.​ The typical course of cognitive development

2.​ The unique differences between individuals
3.​ The mechanisms of cognitive development (the way genetics and
environment combine to generate patterns of change)

Piaget and Sensorimotor Intelligence

Figure 1. Toddlers happily explore the world, engaged in purposeful goal-directed behavior.
How do infants connect and make sense of what they are learning? Remember that
Piaget believed that we are continuously trying to maintain cognitive equilibrium, or
balance, between what we see and what we know (Piaget, 1954). Children have much
more of a challenge in maintaining this balance because they are constantly being
confronted with new situations, new words, new objects, etc. All this new information
needs to be organized, and a framework for organizing information is referred to as a
schema. Children develop schemas through the processes of assimilation and
accommodation.

For example, 2-year-old Deja learned the schema for dogs because her family has a
Poodle. When Deja sees other dogs in her picture books, she says, “Look mommy,
dog!” Thus, she has assimilated them into her schema for dogs. One day, Deja sees a
sheep for the first time and says, “Look mommy, dog!” Having a basic schema that a
dog is an animal with four legs and fur, Deja thinks all furry, four-legged creatures are
dogs. When Deja’s mom tells her that the animal she sees is a sheep, not a dog, Deja
must accommodate her schema for dogs to include more information based on her new
experiences. Deja’s schema for dog was too broad since not all furry, four-legged
creatures are dogs. She now modifies her schema for dogs and forms a new one for
sheep.

Let’s examine the transition that infants make from responding to the external world
reflexively as newborns, to solving problems using mental strategies as two-year-olds.
Piaget called this first stage of cognitive development sensorimotor intelligence (the
sensorimotor period) because infants learn through their senses and motor skills. He
subdivided this period into six substages:

Stage Age
 Stage 1 – Reflexes Birth to 6 weeks

Stage 2 – Primary Circular Reactions 6 weeks to 4 months

Stage 3 – Secondary Circular Reactions 4 months to 8 months

Stage 4 – Coordination of Secondary Circular Reactions 8 months to 12 months

Stage 5 – Tertiary Circular Reactions 12 months to 18 months

Stage 6 – Mental Representation 18 months to 24 months

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Substages of Sensorimotor Intelligence

For an overview of the substages of sensorimotor thought, it helps to group the six
substages into pairs. The first two substages involve the infant’s responses to its own
body, call primary circular reactions. During the first month first (substage one), the
infant’s senses, as well motor reflexes are the foundation of thought.

Substage One: Reflexive Action (Birth through 1st month)

This active learning begins with automatic movements or reflexes (sucking, grasping,
staring, listening). A ball comes into contact with an infant’s cheek and is automatically
sucked on and licked. But this is also what happens with a sour lemon, much to the
infant’s surprise! The baby’s first challenge is to learn to adapt the sucking reflex to
bottles or breasts, pacifiers or fingers, each acquiring specific types of tongue
movements to latch, suck, breathe, and repeat. This adaptation demonstrates that
infants have begun to make sense of sensations. Eventually, the use of these reflexes
becomes more deliberate and purposeful as they move onto substage two.

Substage Two: First Adaptations to the Environment (1st through 4th

months)

Fortunately, within a few days or weeks, the infant begins to discriminate between
objects and adjust responses accordingly as reflexes are replaced with voluntary
movements. An infant may accidentally engage in a behavior and find it interesting,
such as making a vocalization. This interest motivates trying to do it again and helps the
infant learn a new behavior that originally occurred by chance. The behavior is identified
as circular and primary because it centers on the infant’s own body. At first, most
actions have to do with the body, but in months to come, will be directed more toward
objects. For example, the infant may have different sucking motions for hunger and
others for comfort (i.e. sucking a pacifier differently from a nipple or attempting to hold a
bottle to suck it).

The next two substages (3 and 4), involve the infant’s responses to objects and people,
called secondary circular reactions. Reactions are no longer confined to the infant’s
body and are now interactions between the baby and something else.

Substage Three: Repetition (4th through 8th months)

During the next few months, the infant becomes more and more actively engaged in the
outside world and takes delight in being able to make things happen by responding to
people and objects. Babies try to continue any pleasing event. Repeated motion brings
particular interest as the infant is able to bang two lids together or shake a rattle and
laugh. Another example might be to clap their hands when a caregiver says
“patty-cake.” Any sight of something delightful will trigger efforts for interaction.

Figure 2. During the repetition stage, this baby enjoys interacting with others and clapping her hands.

Substage Four: New Adaptations and Goal-Directed Behavior (8th through

12th months)

Now the infant becomes more deliberate and purposeful in responding to people and
objects and can engage in behaviors that others perform and anticipate upcoming
events. Babies may ask for help by fussing, pointing, or reaching up to accomplish
tasks, and work hard to get what they want. Perhaps because of continued maturation
of the prefrontal cortex, the infant becomes capable of having a thought and carrying
out a planned, goal-directed activity such as seeking a toy that has rolled under the
couch or indicating that they are hungry. The infant is coordinating both internal and
external activities to achieve a planned goal and begins to get a sense of social
understanding. Piaget believed that at about 8 months (during substage 4), babies first
understood the concept of object permanence, which is the realization that objects or
people continue to exist when they are no longer in sight.

The last two stages (5 and 6), called tertiary circular reactions, consist of actions
(stage 5) and ideas (stage 6) where infants become more creative in their thinking.

Substage Five: Active Experimentation of “Little Scientists” (12th through

18th months)

The toddler is considered a “little scientist” and begins exploring the world in a
trial-and-error manner, using motor skills and planning abilities. For example, the child
might throw their ball down the stairs to see what happens or delight in squeezing all of
the toothpaste out of the tube. The toddler’s active engagement in experimentation
helps them learn about their world. Gravity is learned by pouring water from a cup or
pushing bowls from high chairs. The caregiver tries to help the child by picking it up
again and placing it on the tray. And what happens? Another experiment! The child
pushes it off the tray again causing it to fall and the caregiver to pick it up again! A
closer examination of this stage causes us to really appreciate how much learning is
going on at this time and how many things we come to take for granted must actually be
learned. This is a wonderful and messy time of experimentation and most learning
occurs by trial and error.

Watch It
See how even babies think like little scientists in this Ted talk.

You can view the transcript for “Laura Schulz: The surprisingly logical minds of babies” here (opens in
new window).

Substage Six: Mental Representations (18th month to 2 years of age)

The child is now able to solve problems using mental strategies, to remember
something heard days before and repeat it, to engage in pretend play, and to find
objects that have been moved even when out of sight. Take, for instance, the child who
is upstairs in a room with the door closed, supposedly taking a nap. The doorknob has a
safety device on it that makes it impossible for the child to turn the knob. After trying
several times to push the door or turn the doorknob, the child carries out a mental
strategy to get the door opened – he knocks on the door! Obviously, this is a technique
learned from the past experience of hearing a knock on the door and observing
someone opening the door. The child is now better equipped with mental strategies for
problem-solving. Part of this stage also involves learning to use language. This initial
movement from the “hands-on” approach to knowing about the world to the more mental
world of stage six marked the transition to preoperational thinking, which you’ll learn
more about in a later module.

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Development of Object Permanence

A critical milestone during the sensorimotor period is the development of object

permanence. Introduced during substage 4 above, object permanence is the
understanding that even if something is out of sight, it continues to exist. The infant is
now capable of making attempts to retrieve the object. Piaget thought that, at about 8
months, babies first understand the concept of objective permanence, but some
research has suggested that infants seem to be able to recognize that objects have
permanence at much younger ages (even as young as 4 months of age). Other
researchers, however, are not convinced (Mareschal & Kaufman, 2012).[1] It may be a
matter of “grasping vs. mastering” the concept of objective permanence. Overall, we
can expect children to grasp the concept that objects continue to exist even when they
are not in sight by around 8 months old, but memory may play a factor in their
consistency. Because toddlers (i.e., 12–24 months old) have mastered object
permanence, they enjoy games like hide-and-seek, and they realize that when someone
leaves the room they will come back (Loop, 2013). Toddlers also point to pictures in
books and look in appropriate places when you ask them to find objects.

Watch It

Although the styles and cinematography in this video are dated, the information is valuable in
understanding how researchers, like Dr. Rene Baillargeon, study object permanence in young infants.

You can view the transcript for “Object Concept VOE Ramp Study Baillargeon” here (opens in new
window).

Learning and Memory Abilities in Infants

Memory is central to cognitive development. Our memories form the basis for our sense
of self, guide our thoughts and decisions, influence our emotional reactions, and allow
us to learn (Bauer, 2008)[2].
It is thought that Piaget underestimated memory ability in infants (Schneider, 2015)[3].

As mentioned when discussing the development of infant senses, within the first few
weeks of birth, infants recognize their caregivers by face, voice, and smell. Sensory and
caregiver memories are apparent in the first month, motor memories by 3 months, and
then, at about 9 months, more complex memories including language (Mullally &
Maguire, 2014)[4]. There is agreement that memory is fragile in the first months of life,
but that improves with age. Repeated sensations and brain maturation are required in
order to process and recall events (Bauer, 2008). Infants remember things that
happened weeks and months ago (Mullally & Maguire, 2014), although they most likely
will not remember it decades later. From the cognitive perspective, this has been
explained by the idea that the lack of linguistic skills of babies and toddlers limit their
ability to mentally represent events; thereby, reducing their ability to encode memory.
Moreover, even if infants do form such early memories, older children and adults may
not be able to access them because they may be employing very different, more
linguistically based, retrieval cues than infants used when forming the memory.

Watch It

Watch this Ted talk from Alison Gopnik to hear about more research done on cognition in babies.

You can view the transcript for “Alison Gopnik: What do babies think?” here (opens in new window).
Given the remarkable complexity of a language, one might expect that mastering a
language would be an especially arduous task; indeed, for those of us trying to learn a
second language as adults, this might seem to be true. However, young children master
language very quickly with relative ease. B. F. Skinner (1957) proposed that language is
learned through reinforcement. Noam Chomsky (1965) criticized this behaviorist
approach, asserting instead that the mechanisms underlying language acquisition are
biologically determined. The use of language develops in the absence of formal
instruction and appears to follow a very similar pattern in children from vastly different
cultures and backgrounds. It would seem, therefore, that we are born with a biological
predisposition to acquire a language (Chomsky, 1965; Fernández & Cairns, 2011).
Moreover, it appears that there is a critical period for language acquisition, such that this
proficiency at acquiring language is maximal early in life; generally, as people age, the
ease with which they acquire and master new languages diminishes (Johnson &
Newport, 1989; Lenneberg, 1967; Singleton, 1995).

Children begin to learn about language from a very early age (Table 1). In fact, it
appears that this is occurring even before we are born. Newborns show a preference for
their mother’s voice and appear to be able to discriminate between the language
spoken by their mother and other languages. Babies are also attuned to the languages
being used around them and show preferences for videos of faces that are moving in
synchrony with the audio of spoken language versus videos that do not synchronize
with the audio (Blossom & Morgan, 2006; Pickens, 1994; Spelke & Cortelyou, 1981).

Stage Age Developmental Language and Communication

1 0–3 months Reflexive communication

 2 3–8 months Reflexive communication; interest in others

3 8–12 months Intentional communication; sociability

4 12–18 months First words

5 18–24 months Simple sentences of two words

6 2–3 years Sentences of three or more words

7 3–5 years Complex sentences; has conversations

Each language has its own set of phonemes that are used to generate morphemes,
words, and so on. Babies can discriminate among the sounds that make up a language
(for example, they can tell the difference between the “s” in vision and the “ss” in
fission); early on, they can differentiate between the sounds of all human languages,
even those that do not occur in the languages that are used in their environments.
However, by the time that they are about 1 year old, they can only discriminate among
those phonemes that are used in the language or languages in their environments
(Jensen, 2011; Werker & Lalonde, 1988; Werker & Tees, 1984).

Watch It

This video explains some of the research surrounding language acquisition in babies, particularly those
learning a second language.
You can view the transcript for “How Do Babies Become Bilingual?” here (opens in new window).

Newborn Communication

Figure 2. Before they develop language, infants communicate using facial expressions.

Do newborns communicate? Certainly, they do. They do not, however, communicate

with the use of language. Instead, they communicate their thoughts and needs with
body posture (being relaxed or still), gestures, cries, and facial expressions. A person
who spends adequate time with an infant can learn which cries indicate pain and which
ones indicate hunger, discomfort, or frustration.

Intentional Vocalizations

Infants begin to vocalize and repeat vocalizations within the first couple of months of
life. That gurgling, musical vocalization called cooing can serve as a source of
entertainment to an infant who has been laid down for a nap or seated in a carrier on a
car ride. Cooing serves as practice for vocalization. It also allows the infant to hear the
sound of their own voice and try to repeat sounds that are entertaining. Infants also
begin to learn the pace and pause of conversation as they alternate their vocalization
with that of someone else and then take their turn again when the other person’s
vocalization has stopped. Cooing initially involves making vowel sounds like “oooo.”
Later, as the baby moves into babbling (see below), consonants are added to
vocalizations such as “nananananana.”

Babbling and Gesturing

Between 6 and 9 months, infants begin making even more elaborate vocalizations that
include the sounds required for any language. Guttural sounds, clicks, consonants, and
vowel sounds stand ready to equip the child with the ability to repeat whatever sounds
are characteristic of the language heard. These babies repeat certain syllables
(ma-ma-ma, da-da-da, ba-ba-ba), a vocalization called babbling because of the way it
sounds. Eventually, these sounds will no longer be used as the infant grows more
accustomed to a particular language. Deaf babies also use gestures to communicate
wants, reactions, and feelings. Because gesturing seems to be easier than vocalization
for some toddlers, sign language is sometimes taught to enhance one’s ability to
communicate by making use of the ease of gesturing. The rhythm and pattern of
language are used when deaf babies sign just as when hearing babies babble.

At around ten months of age, infants can understand more than they can say. You may
have experienced this phenomenon as well if you have ever tried to learn a second
language. You may have been able to follow a conversation more easily than to
contribute to it.

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Holophrasic Speech
Children begin using their first words at about 12 or 13 months of age and may use
partial words to convey thoughts at even younger ages. These one-word expressions
are referred to as holophrasic speech (holophrase). For example, the child may say
“ju” for the word “juice” and use this sound when referring to a bottle. The listener must
interpret the meaning of the holophrase. When this is someone who has spent time with
the child, interpretation is not too difficult. They know that “ju” means “juice” which
means the baby wants some milk! But, someone who has not been around the child will
have trouble knowing what is meant. Imagine the parent who exclaims to a friend,
“Ezra’s talking all the time now!” The friend hears only “ju da ga” which, the parent
explains, means “I want some milk when I go with Daddy.”

Underextension

A child who learns that a word stands for an object may initially think that the word can
be used for only that particular object. Only the family’s Irish Setter is a “doggie.” This is
referred to as underextension. More often, however, a child may think that a label
applies to all objects that are similar to the original object. In overextension, all animals
become “doggies,” for example.

First words and cultural influences

First words for English-speaking children tend to be nouns. The child labels objects
such as a cup or a ball. In a verb-friendly language such as Chinese, however, children
may learn more verbs. This may also be due to the different emphasis given to objects
based on culture. Chinese children may be taught to notice action and relationship
between objects while children from the United States may be taught to name an object
and its qualities (color, texture, size, etc.). These differences can be seen when
comparing interpretations of art by older students from China and the United States.

Vocabulary growth spurt

One-year-olds typically have a vocabulary of about 50 words. But by the time they
become toddlers, they have a vocabulary of about 200 words and begin putting those
words together in telegraphic speech (short phrases). This language growth spurt is
called the naming explosion because many early words are nouns (persons, places,
or things).

Two-word sentences and telegraphic speech

Words are soon combined and 18-month-old toddlers can express themselves further
by using phrases such as “baby bye-bye” or “doggie pretty.” Words needed to convey
messages are used, but the articles and other parts of speech necessary for
grammatical correctness are not yet included. These expressions sound like a telegraph
(or perhaps a better analogy today would be that they read like a text message) where
unnecessary words are not used. “Give baby ball” is used rather than “Give the baby
the ball.” Or a text message of “Send money now!” rather than “Dear Mother. I really
need some money to take care of my expenses.” You get the idea.

Child-directed speech

Why is a horse a “horsie”? Have you ever wondered why adults tend to use “baby talk”
or that sing-song type of intonation and exaggeration used when talking to children?
This represents a universal tendency and is known as child-directed speech or
motherese or parentese. It involves exaggerating the vowel and consonant sounds,
using a high-pitched voice, and delivering the phrase with great facial expression. Why
is this done? It may be in order to clearly articulate the sounds of a word so that the
child can hear the sounds involved. Or it may be because when this type of speech is
used, the infant pays more attention to the speaker and this sets up a pattern of
interaction in which the speaker and listener are in tune with one another. When I
demonstrate this in class, the students certainly pay attention and look my way.
Amazing! It also works in the college classroom!
 Watch It

This video examines new research on infant-directed speech.

You can view the transcript for “Why Baby Talk Is Good for Babies” here (opens in new window).

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Theories of Language Development

How is language learned? Each major theory of language development emphasizes

different aspects of language learning: that infants’ brains are genetically attuned to
language, that infants must be taught, and that infants’ social impulses foster language
learning. The first two theories of language development represent two extremes in the
level of interaction required for language to occur (Berk, 2007).

Chomsky and the language acquisition device

This theory posits that infants teach themselves and that language learning is
genetically programmed. The view is known as nativism and was advocated by Noam
Chomsky, who suggested that infants are equipped with a neurological construct
referred to as the language acquisition device (LAD), which makes infants ready for
language. The LAD allows children, as their brains develop, to derive the rules of
grammar quickly and effectively from the speech they hear every day. Therefore,
language develops as long as the infant is exposed to it. No teaching, training, or
reinforcement is required for language to develop. Instead, language learning comes
from a particular gene, brain maturation, and the overall human impulse to imitate.

Skinner and reinforcement

This theory is the opposite of Chomsky’s theory because it suggests that infants need to
be taught language. This idea arises from behaviorism. Learning theorist, B. F. Skinner,
suggested that language develops through the use of reinforcement. Sounds, words,
gestures, and phrases are encouraged by following the behavior with attention, words of
praise, treats, or anything that increases the likelihood that the behavior will be
repeated. This repetition strengthens associations, so infants learn the language faster
as parents speak to them often. For example, when a baby says “ma-ma,” the mother
smiles and repeats the sound while showing the baby attention. So, “ma-ma” is
repeated due to this reinforcement.

Social pragmatics

Another language theory emphasizes the child’s active engagement in learning the
language out of a need to communicate. Social impulses foster infant language
because humans are social beings and we must communicate because we are
dependent on each other for survival. The child seeks information, memorizes terms,
imitates the speech heard from others, and learns to conceptualize using words as
language is acquired. Tomasello & Herrmann (2010) argue that all human infants, as
opposed to chimpanzees, seek to master words and grammar in order to join the social
world [1] Many would argue that all three of these theories (Chomsky’s argument for
nativism, conditioning, and social pragmatics) are important for fostering the acquisition
of language (Berger, 2004).

Try It
The Foundation of Moral Reasoning in Infants

Figure 1. Maybe babies know more than we think they do!

The work of Lawrence Kohlberg was an important start to modern research on moral
development and reasoning. However, Kohlberg relied on a specific method: he
presented moral dilemmas and asked children and adults to explain what they would do
and—more importantly—why they would act in that particular way. Kohlberg found that
children tended to make choices based on avoiding punishment and gaining praise. But
children are at a disadvantage compared to adults when they must rely on language to
convey their inner thoughts and emotional reactions, so what they say may not
adequately capture the complexity of their thinking.

Starting in the 1980s, developmental psychologists created new methods for studying
the thought processes of children and infants long before they acquire language. One
particularly effective method is to present children with puppet shows to grab their
attention and then record nonverbal behaviors, such as looking and choosing, to identify
children’s preferences or interests.
A research group at Yale University has been using the puppet show technique to study
moral thinking of children for much of the past decade. What they have discovered has
given us a glimpse of surprisingly complex thought processes that may serve as the
foundation of moral reasoning.

EXPERIMENT 1: Do children prefer givers or

takers?

In 2011, J. Kiley Hamlin and Karen Wynn put on puppet shows for very young children:
5-month-old infants. The infants watch a puppet bouncing a ball. We’ll call this puppet
the “bouncer puppet.” Two other puppets stand at the back of the stage, one to left and
the other to the right. After a few bounces, the ball gets away from the bouncer puppet
and rolls to the side of the stage toward one of the other puppets. This puppet grabs the
ball. The bouncer puppet turns toward the ball and opens its arms as if asking for the
ball back.

This is where the puppet show gets interesting (for a young infant, anyway!).
Sometimes, the puppet with the ball rolls it back to the bouncer puppet. This is the
“giver puppet” condition. Other times, the infant sees a different ending. As the bouncer
puppet opens its arms to ask for the ball, the puppet with the ball turns and runs away
with it. This is the “taker puppet” condition. Although the giver and taker puppets are two
copies of the same animal doll, they are easily distinguished because they are wearing
different colored shirts, and color is a quality that infants easily distinguish and
remember. It looks like this:

Each infant sees both conditions: the giver condition and the taker condition. Just after
the end of the second puppet show (i.e., the second condition), a new researcher, who
doesn’t know which puppet was the giver and which was the taker, sits in front of the
infant with the giver puppet in one hand and the taker puppet in the other. The
5-month-old infants are allowed to reach for a puppet. The one the child reaches out to
touch is considered the preferred puppet.

Try It

Remember that Lawrence Kohlberg thought that children at this age—and, in fact,
through 9 years of age—are primarily motivated to avoid punishment and seek rewards.
Neither Kohlberg nor Carol Gilligan nor Jean Piaget was likely to predict that infants
would develop preferences based on the type of behavior shown by other individuals.

Work It Out

The puppet show is over and the experimenter is holding the two dolls—the giver puppet and the taker
puppet—in front of the infant. The reaching behavior of the infant is being videotaped for later analysis.

What do you think? Make a prediction about the results of this study—which should reflect your own
theory of an infant’s ability to judge and care about the types of behavior others display. Do you think
infants will choose the taker or the giver puppet? Do you expect the results to be significant?

INSTRUCTIONS: Adjust the pink bar on the left to show the percentage of infants who reached for the
giver puppet. The yellow bar on the right will automatically adjust to make the total (sum of both bars)
equal 100%.

Show Answer
But this isn’t the end of the story…

EXPERIMENT 2: Do infants judge others based on

their behavior?

In the research world, the early attempts to study something, when the researchers
work to develop a solid and reliable research procedure, is often the most challenging
time. Once the researcher works through initial problems and issues and begins to get
consistent results, they can gain a deeper understanding by adding new variables or
testing different groups of subjects (e.g., older children or children with some interesting
psychological characteristics).

The study you just read about is an example of a simple, basic study. The researchers
found that infants preferred puppets that help another puppet (the puppet in the giver
condition) over puppets that are not nice to another puppet (the puppet in the taker
condition). A common sense interpretation of this simple result is that infants like nice
behavior and they dislike hurtful behavior. And perhaps that is as complicated as an
8-month-old infant’s thoughts can be. But maybe not.

Dr. Hamlin and her colleagues wondered if infants might consider more factors when
judging an event. Adults generally prefer situations where good things happen to
someone rather than something harmful. However, when adults see someone do
something bad, they may find satisfaction in seeing that person punished by having
something bad happen to them. In a nutshell: good things should happen to good
people and bad things should happen to bad people. This is what is called “just world”
thinking, where people get what they deserve.
In the study we will call Experiment 2, Hamlin’s team tested 8-month-old infants and
repeated the procedures from Experiment 1 with a major addition. In Experiment 1
(described above), the puppet bouncing the ball was a neutral character, neither good
nor bad. In Experiment 2, the infants saw 2 different shows. First, they saw the bouncer
puppet either helping or hindering another puppet. Then, they watched the same
ball-bouncing puppet show. Here is what happened:

●​ Puppet Show #1: A puppet is trying to open a box, but cannot quite
succeed. Two puppets stand in the background. For some infants, as the
first puppet struggles to open the box, one of the puppets in the back comes
forward and helps to open the box. This is the helper puppet. For other
children, as the first puppet struggles, a puppet comes from the back and
jumps on the box, slamming it shut. This is the hinderer puppet. Each infant
sees only a helper or a hinderer—not both. Here is a video showing the
helper puppet situation:
●​ Puppet Show #2: Just after the infants have watched the first show, the
second puppet show begins. This is the show that you read about in
Experiment 1. The only thing that is new is that the bouncer puppet, the one
that loses the ball, is either the helper puppet from Puppet Show #1 or the
hinderer puppet from Puppet Show #1. Each infant sees this puppet lose
the ball to a giver, who returns the ball, and to a taker, who runs off with the
ball.

This video demonstrates show #2. The elephant in the yellow shirt from the first show is
now bouncing a ball. After dropping the ball, the moose in the green shirt gives it back
to him, while the moose in the red shirt takes it away.

Try It
So far we have concluded that even young babies prefer the “nice” puppet and show a
preference for a puppet who helps another puppet. But this only happened when the
bouncer puppet was the helper from the first puppet show. What if, instead of the nice
elephant in the yellow shirt bouncing the ball, the elephant in the red shirt (the one who
jumped on the duck’s box, remember?) was the one bouncing the ball? Imagine the
same scenario: the mean elephant in the red shirt is bouncing the ball, he drops it, and
the moose in the green shirt gives it to him or the moose in the red shirt takes it away.

Try It

Figure 3. This bar graph shows the results of Experiment 2 for 8-month-old infants. The blue bars show the
preferences for the infants who saw the helper from the first show as the bouncer in the second. Bar A is
taller than Bar B, showing the greater choice of the giver than the taker puppet. The red bars show the
reverse effect. The babies strongly preferred the taker (Bar C) to the giver (Bar D) when the puppet bouncing
the ball had been the hinderer, who jumped on the box in the first show.

So now things are getting interesting, right? Do 8-month old infants understand the
concepts of revenge or justice? We must always be careful when labeling behaviors of
children (or animals) with characteristics we use for human adults. In the description
above, we have talked of “nice puppets” and “mean puppets” and used other loaded
terms. It is tempting to interpret the choices of the 8-month-olds as a kind of revenge
motive: the bad guy gets its just desserts (the hinderer puppet has its ball stolen) and
the good guy gets its just reward (the helper puppet is itself helped by the giver). Maybe
that is what is going on, but we encourage you to consider these very sophisticated
types of thinking as merely one hypothesis. Remember the facts—what did the puppets
do and what choices did the infants make?—without committing yourself to the
adult-level interpretation.

The researchers believe that this type of thinking, which is remarkably sophisticated,
takes some cognitive development. They tested 5-month-olds using the same
procedures, and the results with these younger infants were different. The 5-month-olds
showed an overwhelming preference for the giver puppets, regardless of who was
bouncing the ball. Maybe it is too complex for them to understand that the bouncer
puppet in the second show was the same puppet from the first show. Or perhaps their
memory processes are too fragile to hold onto information for that length of time. Maybe
the revenge motive is too advanced. Or maybe something else is going on. What is
clear is that 5-month-olds and 8-month-olds respond differently to the situations tested
in the second experiment.

EXPERIMENT 3: Do infants judge others based on

their preferences?

Across the first two experiments, infants appear to prefer puppets (and, by extension,
maybe people, as well) that are helpful over those that are not helpful. Experiment 2
complicated our story a bit, but it still appears that prosocial behavior is attractive to
infants and antisocial behavior is unattractive. But another experiment, again using the
bouncing ball show, suggests that infants as young as 8-months of age may have some
other motives that are less altruistic than the first two experiments indicate.

In a study by Hamlin, Mahanjan, Liberman, and Wynn from 2013, 9-month-old infants
watched the bouncing ball show, but with a new twist.

At the beginning of the experiment—Phase 1—the infants were given a choice between
graham crackers and green beans. The experimenters determined which food the infant
preferred.

You can view the transcript for “Graham Cracker Choice” here (opens in new window).

Then, in Phase 2, the infants watched a puppet make the same choice. For half of the
infants, the puppet chose the same food that they preferred, saying “Mmmm, yum! I like
___(graham crackers or green beans)!” and saying “Eww, yuck! I don’t like _____
(graham crackers or green beans!” This was called the SIMILAR condition because the
puppet was similar to the child in its food preference. For the other half of the infants,
the puppet chose the other food, choosing graham crackers if the infant preferred green
beans and preferring green beans if the infant liked graham crackers. This was the
DISSIMILAR condition.

You can view the transcript for “Similar / Dissimilar Puppet Preference Example” here
(opens in new window).

Why did the experimenters do this? They wanted to know if young children form
in-groups and out-groups by perceiving some people as being like them and other
people as being unlike them. The experimenters noted in their research introduction that
we (adults) are influenced by our perception that others are similar to us or not like us.
We tend to project positive qualities—being trustworthy, intelligent, kind—on people we
perceive as similar to ourselves, and people we see as unlike us are seen as having
negative qualities—being relatively untrustworthy, unintelligent, and unkind.[1]

Of course, there is a big difference between claiming that adults use similarity to make
judgments about others and saying that infants less than a year of age do the same
thing. However, the researchers note that some recent research has suggested that
infants less than a year old are more likely to develop peer friendships with other infants
who “share their own food, clothing, or toy preferences” compared to those who don’t.

So, back to the experiment. In Phase 3, the infants either saw a similar puppet (one that
chose the food the baby preferred) or a dissimilar puppet (one that chose the food the
baby did not prefer) bouncing the ball. As in the other experiments, the ball got away
from the bouncer and rolled to the back of the stage. In one instance, the giver puppet
returned the ball and, in the other instance, the taker puppet ran away with the ball.
Finally, in Phase 4, the 9-month-old baby was shown the giver and taker puppet and the
experimenters recorded which of the two puppets the baby preferred (reached out to
touch). This video shows the dog in the light blue shirt giving the ball back to the red
bunny that preferred graham crackers.

Here is a summary of the four phases in Experiment 3:

●​ Phase 1: The infant chooses graham crackers or green beans.

●​ Phase 2: The bouncer puppets choose graham crackers or green beans.
○​ Similar condition: The bouncer chooses the same food that the
infant chose.
○​ Dissimilar condition: The bouncer chooses the food that the
infant did not choose.
●​ Phase 3: This is the same bouncing ball experiment that you have been
reading about.
○​ Remember that each child sees both the Giver and Taker
shows.
 ●​ Phase 4: This is the same choice—Giver or Taker—that was the final phase
in the other two experiments

Try It

Work It Out

Now make predictions for the results. Here is a matrix picture of the design of the experiment:

INSTRUCTIONS: Adjust bars A and C to make your predictions. Bar A represents the “nice” puppet who
gave the ball to the bouncer puppet that liked the same food as the child, while bar B represents the
“mean” puppet who took the ball away from the bouncer puppet who liked the same food as the child. Bar
C represents the “nice” puppet who gave the ball back to the puppet who did not like the same food as
the child, and bar D represents the puppet who took the ball away from the puppet who did not like the
same food.

As before, move the bars on the left to indicate the percentage of infants preferring the giver puppet in the
similar condition (purple bars) and in the dissimilar condition (green bars). The bars on the right will adjust
to make the total in each of the similarity conditions equal 100%.

After you have recorded your predictions, click the “Show Answer” link to see the results from the
experiment.
Show Answer

The experimenters also tested an older group of babies that were 14-months-old. The
results for these older babies were consistent with the 9-month-old and, if anything, the
effects were stronger. Their results showed that all infants preferred when the giver
puppet was nice to the puppet that was similar to them and all infants preferred when
puppets were mean to the puppet that was dissimilar to them.

Figure 5. These bar graphs show the results of the experiment when 14-month-olds were tested. One hundred
percent of the children chose the puppet that gave the ball back to the puppet that was similar to them, and
100% of children chose the puppet that took the ball away from the puppet that had a different preference than
they did.

CONCLUSIONS

This exercise started with a reminder that Lawrence Kohlberg found that children went
through a long developmental process in their moral reasoning. Based on children’s
reasoning aloud about moral dilemmas, Kohlberg concluded that children younger than
about 8 or 9 years of age make moral decisions based on avoiding punishment and
receiving praise. Neither his research nor that of most others in the 1970s and 1980s
suggested that young children would use multiple sources of information and judgments
about the meaning of behaviors in their thinking about what sorts of behaviors are better
or worse.

If Dr. Hamlin and her colleagues are right, then infants are much more sophisticated and
complex in their thinking about the world than these earlier researchers thought. In Dr.
Hamlin’s view, infants like good things to happen to good puppets and people, and bad
things to happen to bad puppets and people. Experiment 3 suggests that they make
judgments about more than helping and harming behavior. They prefer others who are
like them (green beans vs. graham crackers) and they don’t mind if others who are not
like them have unpleasant experiences.

The research we have been reviewing is just part of an impressive set of research on
infant thinking. The ideas that the researchers have developed are intriguing and they
are consistent with the modern view of the infant as an active, creative thinker. At the
same time, remember that science doesn’t rest on an early set of explanations based
on a small set of complicated experiments. Science pushes beyond what we currently
know and believe. This starts with curiosity on your part. Are the experimenters correct
in interpreting reaching behavior as showing a preference or is something else going
on? Do infants really prefer prosocial behaviors to antisocial behaviors, or is there some
other explanation for their preferences? How else could we test the moral judgments of
infants without using puppet shows? The next generation of creative scientists will push
beyond what we know now, with new research methods and new ideas about the mind.

We’ll give Dr. Hamlin the last word. Here is part of her conclusion section from an article
that summarizes some of the research we have been studying: “In sum, recent
developmental research supports the claim that at least some aspects of human
morality are innate…Indeed, these early tendencies are far from shallow, mechanical
predispositions to behave well or knee-jerk reactions to particular states of the world.
Infant moral inclinations are sophisticated, flexible, and surprisingly consistent with
adults’ moral inclinations, incorporating aspects of moral goodness, evaluation, and
retaliation.“ (Hamlin, 2013, p. 191)
Emotional Development

At birth, infants exhibit two emotional responses: attraction and withdrawal. They
show attraction to pleasant situations that bring comfort, stimulation, and
pleasure. And they withdraw from unpleasant stimulation such as bitter flavors or
physical discomfort. At around two months, infants exhibit social engagement in
the form of social smiling as they respond with smiles to those who engage their
positive attention. Pleasure is expressed as laughter at 3 to 5 months of age, and
displeasure becomes more specific to fear, sadness, or anger (usually triggered
by frustration) between ages 6 and 8 months. Where anger is a healthy response
to frustration, sadness, which appears in the first months as well, usually
indicates withdrawal (Thiam et al., 2017). [1]

Figure 1. This baby is a social smiler!

As reviewed above, infants progress from reactive pain and pleasure to complex
patterns of socioemotional awareness, which is a transition from basic instincts
to learned responses. Fear is not always focused on things and events; it can
also involve social responses and relationships. The fear is often associated with
the presence of strangers or the departure of significant others known
respectively as stranger wariness and separation anxiety, which appear sometime
between 6 and 15 months. And there is even some indication that infants may
experience jealousy as young as 6 months of age (Hart & Carrington, 2002).

Stranger wariness actually indicates that brain development and increased

cognitive abilities have taken place. As an infant’s memory develops, they are
able to separate the people that they know from the people that they do not. The
same cognitive advances allow infants to respond positively to familiar people
and recognize those that are not familiar. Separation anxiety also indicates
cognitive advances and is universal across cultures. Due to the infant’s increased
cognitive skills, they are able to ask reasonable questions like “Where is my
caregiver going?” “Why are they leaving?” or “Will they come back?” Separation
anxiety usually begins around 7-8 months and peaks around 14 months, and then
decreases. Both stranger wariness and separation anxiety represent important
social progress because they not only reflect cognitive advances but also
growing social and emotional bonds between infants and their caregivers.

As we will learn through the rest of this module, caregiving does matter in terms
of infant emotional development and emotional regulation. Emotional regulation
can be defined by two components: emotions as regulating and emotions as
regulated. The first, “emotions as regulating,” refers to changes that are elicited
by activated emotions (e.g., a child’s sadness eliciting a change in parent
response). The second component is labeled “emotions as regulated,” which
refers to the process through which the activated emotion is itself changed by
deliberate actions taken by the self (e.g., self-soothing, distraction) or others
(e.g., comfort).
Throughout infancy, children rely heavily on their caregivers for emotional
regulation; this reliance is labeled co-regulation, as parents and children both
modify their reactions to the other based on the cues from the other. Caregivers
use strategies such as distraction and sensory input (e.g., rocking, stroking) to
regulate infants’ emotions. Despite their reliance on caregivers to change the
intensity, duration, and frequency of emotions, infants are capable of engaging in
self-regulation strategies as young as 4 months old. At this age, infants
intentionally avert their gaze from overstimulating stimuli. By 12 months, infants
use their mobility in walking and crawling to intentionally approach or withdraw
from stimuli.

Throughout toddlerhood, caregivers remain important for the emotional

development and socialization of their children, through behaviors such as
labeling their child’s emotions, prompting thought about emotion (e.g., “why is
the turtle sad?”), continuing to provide alternative activities/distractions,
suggesting coping strategies, and modeling coping strategies. Caregivers who
use such strategies and respond sensitively to children’s emotions tend to have
children who are more effective at emotion regulation, are less fearful and fussy,
more likely to express positive emotions, easier to soothe, more engaged in
environmental exploration, and have enhanced social skills in the toddler and
preschool years.

Self-awareness

During the second year of life, children begin to recognize themselves as they
gain a sense of the self as an object. The realization that one’s body, mind, and
activities are distinct from those of other people is known as self-awareness
(Kopp, 2011).[2] The most common technique used in research for testing
self-awareness in infants is a mirror test known as the “Rouge Test.” The rouge
test works by applying a dot of rouge (colored makeup) on an infant’s face and
then placing them in front of the mirror. If the infant investigates the dot on their
nose by touching it, they are thought to realize their own existence and have
achieved self-awareness. A number of research studies have used this technique
and shown self-awareness to develop between 15 and 24 months of age. Some
researchers also take language such as “I, me, my, etc.” as an indicator of
self-awareness.

Cognitive psychologist Philippe Rochat (2003) described a more in-depth

developmental path in acquiring self-awareness through various stages. He
described self-awareness as occurring in five stages beginning from birth.

Stage Description

Right from birth infants are able to differentiate the self from the
Stage 1 –
non-self. A study using the infant rooting reflex found that infants
Differentiation (from
rooted significantly less from self-stimulation, contrary to when the
birth)
stimulation came from the experimenter.

In addition to differentiation, infants at this stage can also situate

themselves in relation to a model. In one experiment infants were able
Stage 2 – Situation
to imitate tongue orientation from an adult model. Additionally, another
(by 2 months)
sign of differentiation is when infants bring themselves into contact
with objects by reaching for them.

Stage 3 – At this stage, the more common definition of “self-awareness” comes

Identification (by 2 into play, where infants can identify themselves in a mirror through the
years) “rouge test” as well as begin to use language to refer to themselves.
 Stage 4 – This stage occurs after infancy when children are aware that their
Permanence sense of self continues to exist across both time and space.

Stage 5 –
Self-consciousness This also occurs after infancy. This is the final stage when children can
or see themselves in 3rd person, or how they are perceived by others.
meta-self-awareness

Once a child has achieved self-awareness, the child is moving toward

understanding social emotions such as guilt, shame or embarrassment, and
pride, as well as sympathy and empathy. These will require an understanding of
the mental state of others which is acquired around age 3 to 5 and will be
explored in the next module (Berk, 2007).

Watch It

This video shows one study that demonstrates how toddlers become aware of their bodies around
18 months.

You can view the transcript for “The Baby Human – Shopping Cart Study” here (opens in new window).

Try It

Attachment
Psychosocial development occurs as children form relationships, interact with
others, and understand and manage their feelings. In social and emotional
development, forming healthy attachments is very important and is the major
social milestone of infancy. Attachment is a long-standing connection or bond
with others. Developmental psychologists are interested in how infants reach this
milestone. They ask such questions as: How do parent and infant attachment
bonds form? How does neglect affect these bonds? What accounts for children’s
attachment differences?

Researchers Harry Harlow, John Bowlby, and Mary Ainsworth conducted studies
designed to answer these questions. In the 1950s, Harlow conducted a series of
experiments on monkeys. He separated newborn monkeys from their mothers.
Each monkey was presented with two surrogate mothers. One surrogate mother
was made out of wire mesh, and she could dispense milk. The other surrogate
mother was softer and made from cloth: This monkey did not dispense milk.
Research shows that the monkeys preferred the soft, cuddly cloth monkey, even
though she did not provide any nourishment. The baby monkeys spent their time
clinging to the cloth monkey and only went to the wire monkey when they needed
to be feed. Prior to this study, the medical and scientific communities generally
thought that babies become attached to the people who provide their
nourishment. However, Harlow (1958) concluded that there was more to the
mother-child bond than nourishment. Feelings of comfort and security are the
critical components of maternal-infant bonding, which leads to healthy
psychosocial development.

watch it
Harlow’s studies of monkeys were performed before modern ethics guidelines were in
place, and today his experiments are widely considered to be unethical and even cruel.
Watch this video to see actual footage of Harlow’s monkey studies.

You can view the transcript for “Harlow’s Studies on Dependency in Monkeys” here (opens in
new window).

Building on the work of Harlow and others, John Bowlby developed the concept
of attachment theory. He defined attachment as the affectional bond or tie that an
infant forms with the mother (Bowlby, 1969). He believed that an infant must form
this bond with a primary caregiver in order to have normal social and emotional
development. In addition, Bowlby proposed that this attachment bond is very
powerful and continues throughout life. He used the concept of a secure base to
define a healthy attachment between parent and child (1988). A secure base is a
parental presence that gives children a sense of safety as they explore their
surroundings. Bowlby said that two things are needed for a healthy attachment:
The caregiver must be responsive to the child’s physical, social, and emotional
needs; and the caregiver and child must engage in mutually enjoyable
interactions (Bowlby, 1969).
 Figure 2. Mutually enjoyable interactions promote the mother-infant bond. (credit: Peter Shanks)

While Bowlby thought attachment was an all-or-nothing process, Mary

Ainsworth’s (1970) research showed otherwise. Ainsworth wanted to know if
children differ in the ways they bond, and if so, how. To find the answers, she
used the Strange Situation procedure to study attachment between mothers and
their infants (1970). In the Strange Situation, the mother (or primary caregiver)
and the infant (age 12-18 months) are placed in a room together. There are toys
in the room, and the caregiver and child spend some time alone in the room. After
the child has had time to explore their surroundings, a stranger enters the room.
The mother then leaves her baby with the stranger. After a few minutes, she
returns to comfort her child.

Based on how the toddlers responded to the separation and reunion, Ainsworth
identified three types of parent-child attachments: secure, avoidant, and resistant
(Ainsworth & Bell, 1970). A fourth style, known as disorganized attachment, was
later described (Main & Solomon, 1990).

The most common type of attachment—also considered the healthiest—is called

secure attachment. In this type of attachment, the toddler prefers their parent
over a stranger. The attachment figure is used as a secure base to explore the
environment and is sought out in times of stress. Securely attached children were
distressed when their caregivers left the room in the Strange Situation
experiment, but when their caregivers returned, the securely attached children
were happy to see them. Securely attached children have caregivers who are
sensitive and responsive to their needs.
Figure 3. In secure attachment, the parent provides a secure base for the toddler, allowing him to
securely explore his environment. (credit: Kerry Ceszyk)

With avoidant attachment, the child is unresponsive to the parent, does not use
the parent as a secure base, and does not care if the parent leaves. The toddler
reacts to the parent the same way they react to a stranger. When the parent does
return, the child is slow to show a positive reaction. Ainsworth theorized that
these children were most likely to have a caregiver who was insensitive and
inattentive to their needs (Ainsworth, Blehar, Waters, & Wall, 1978).

In cases of resistant attachment, children tend to show clingy behavior, but then
they reject the attachment figure’s attempts to interact with them (Ainsworth &
Bell, 1970). These children do not explore the toys in the room, appearing too
fearful. During separation in the Strange Situation, they become extremely
disturbed and angry with the parent. When the parent returns, the children are
difficult to comfort. Resistant attachment is thought to be the result of the
caregivers’ inconsistent level of response to their child.

Finally, children with disorganized attachment behaved oddly in the Strange

Situation. They freeze, run around the room in an erratic manner, or try to run
away when the caregiver returns (Main & Solomon, 1990). This type of attachment
is seen most often in kids who have been abused or severely neglected.
Research has shown that abuse disrupts a child’s ability to regulate their
emotions.

While Ainsworth’s research has found support in subsequent studies, it has also
met criticism. Some researchers have pointed out that a child’s temperament
(which we discuss next) may have a strong influence on attachment (Gervai,
2009; Harris, 2009), and others have noted that attachment varies from culture to
culture, a factor that was not accounted for in Ainsworth’s research (Rothbaum,
Weisz, Pott, Miyake, & Morelli, 2000; van Ijzendoorn & Sagi-Schwartz, 2008).

Watch It

Watch this video to better understand Mary Ainsworth’s research and to see examples of how she
conducted the experiment.

You can view the transcript for “The Strange Situation | Mary Ainsworth, 1969 | Developmental
Psychology” here (opens in new window).

Attachment styles vary in the amount of security and closeness felt in the
relationship and they can change with new experiences. The type of attachment
fostered in parenting styles varies by culture as well. For example, German
parents value independence and Japanese mothers are typically by their
children’s sides. As a result, the rate of insecure-avoidant attachments is higher
in Germany and insecure-resistant attachments are higher in Japan. However,
these differences reflect cultural variation rather than true insecurity (van
Ijzendoorn and Sagi, 1999). Keep in mind that methods for measuring attachment
styles have been based on a model that reflects middle-class, US values and
interpretation. Newer methods for assessing attachment styles involve using a
Q-sort technique in which a large number of behaviors are recorded on cards and
the observer sorts the cards in a way that reflects the type of behavior that
occurs within the situation.

Try It

Attachment is classified into four types: A, B, C, and D. Ainsworth’s original

schema differentiated only three types of attachment (types A, B, and C), but, as
mentioned above, later researchers discovered a fourth category (type D). As we
explore styles of attachment below, consider how these may also be evidenced in
adult relationships. We’ll come back to this idea in later modules.

Types of Attachments

Secure

A secure attachment (type B) is one in which the child feels confident that their
needs will be met in a timely and consistent way. The caregiver is the base for
exploration, providing assurance and enabling discovery. In North America, this
interaction may include an emotional connection in addition to adequate care.
However, even in cultures where mothers do not talk, cuddle, and play with their
infants, secure attachments can develop (LeVine et. al., 1994). Secure
attachments can form provided the child has consistent contact and care from
one or more caregivers. Consistency of contacts may be jeopardized if the infant
is cared for in a daycare with a high turn-over of caregivers or if institutionalized
and given little more than basic physical care. And while infants who, perhaps
because of being in orphanages with inadequate care, have not had the
opportunity to attach in infancy can form initial secure attachments several years
later, they may have more emotional problems of depression or anger, or be
overly friendly as they make adjustments (O’Connor et. al., 2003).

Insecure Resistant/Ambivalent

Insecure-resistant/ambivalent (type C) attachment style is marked by insecurity

and resistance to engaging in activities or play away from the caregiver. It is as if
the child fears that the caregiver will abandon them and clings accordingly. (Keep
in mind that clingy behavior can also just be part of a child’s natural disposition
or temperament and does not necessarily reflect some kind of parental neglect.)
The child may cry if separated from the caregiver and also cry upon their return.
They seek constant reassurance that never seems to satisfy their doubt. This
type of insecure attachment might be a result of not having their needs met in a
consistent or timely way. Consequently, the infant is never sure that the world is a
trustworthy place or that they can rely on others without some anxiety. A
caregiver who is unavailable, perhaps because of marital tension, substance
abuse, or preoccupation with work, may send a message to the infant they cannot
rely on having their needs met. A caregiver who attends to a child’s frustration
can help teach them to be calm and to relax. But an infant who receives only
sporadic attention when experiencing discomfort may not learn how to calm
down.

Insecure-Avoidant

Insecure-avoidant (type A) is an attachment style marked by insecurity. This style

is also characterized by a tendency to avoid contact with the caregiver and with
others. This child may have learned that needs typically go unmet and learns that
the caregiver does not provide care and cannot be relied upon for comfort, even
sporadically. An insecure-avoidant child learns to be more independent and
disengaged. Such a child might sit passively in a room filled with toys until it is
time to go.

Disorganized

Disorganized attachment (type D) represents the most insecure style of

attachment and occurs when the child is given mixed, confused, and
inappropriate responses from the caregiver. For example, a mother who suffers
from schizophrenia may laugh when a child is hurting or cry when a child exhibits
joy. The child does not learn how to interpret emotions or to connect with the
unpredictable caregiver.

How common are the attachment styles among children in the United States? It is
estimated that about 65 percent of children in the United States are securely
attached. Twenty percent exhibit avoidant styles and 10 to 15 percent are
resistant. Another 5 to 10 percent may be characterized as disorganized.
Temperament

Perhaps you have spent time with a number of infants. How were they alike? How
did they differ? Or compare yourself with your siblings or other children you have
known well. You may have noticed that some seemed to be in a better mood than
others and that some were more sensitive to noise or more easily distracted than
others. These differences may be attributed to temperament. Temperament is an
inborn quality noticeable soon after birth. Temperament is not the same as
personality but may lead to personality differences. Generally, personality traits
are learned, whereas temperament is genetic. Of course, for every trait, nature
and nurture interact.

According to Chess and Thomas (1996), children vary on nine dimensions of

temperament. These include activity level, regularity (or predictability), sensitivity
thresholds, mood, persistence or distractibility, among others. These categories
include the following:[foodnote]Thomas, A., & Chess, S. (1977). Temperament and
development. New York: Brunner/Mazel[/footnote].

1.​ Activity level. Does the child display mostly active or inactive states?
2.​ Rhythmicity or Regularity. Is the child predictable or unpredictable
regarding sleeping, eating, and elimination patterns?
3.​ Approach-Withdrawal. Does the child react or respond positively or
negatively to a newly encountered situation?
4.​ Adaptability. Does the child adjust to unfamiliar circumstances easily
or with difficulty
5.​ Responsiveness. Does it take a small or large amount of stimulation to
elicit a response (e.g., laughter, fear, pain) from the child?
6.​ Reaction Intensity. Does the child show low or high energy when
reacting to stimuli?
 7.​ Mood Quality. Is the child normally happy and pleasant, or unhappy
and unpleasant?
8.​ Distractibility. Is the child’s attention easily diverted from a task by
external stimuli?
9.​ Persistence and Attention Span. Persistence – How long will the child
continue at an activity despite difficulty or interruptions? Attention
span – For how long a period of time can the child maintain interest in
an activity?

The New York Longitudinal Study was a long term study of infants, on these
dimensions, which began in the 1950s. Most children do not have their
temperament clinically measured, but categories of temperament have been
developed and are seen as useful in understanding and working with children.
Based on this study, babies can be described according to one of several
profiles: easy or flexible (40%), slow to warm up or cautious (15%), difficult or
feisty (10%), and undifferentiated, or those who can’t easily be categorized (35%).

Easy babies (40% of infants) have a positive disposition. Their body functions
operate regularly and they are adaptable. They are generally positive, showing
curiosity about new situations and their emotions are moderate or low in
intensity. Difficult babies (10% of infants) have more negative moods and are slow
to adapt to new situations. When confronted with a new situation, they tend to
withdraw. Slow-to-warm babies (15% of infants) are inactive, showing relatively
calm reactions to their environment. Their moods are generally negative, and they
withdraw from new situations, adapting slowly. The undifferentiated (35%) could
not be consistently categorized. These children show a variety of combinations of
characteristics. For example, an infant may have an overall positive mood but
react negatively to new situations.
No single type of temperament is invariably good or bad, however, infants with
difficult temperaments are more likely than other babies to develop emotional
problems, especially if their mothers were depressed or anxious caregivers
(Garthus-Niegel et al., 2017).[1] Children’s long-term adjustment actually depends
on the goodness-of-fit of their particular temperament to the nature and demands
of the environment in which they find themselves. Therefore, what appears to be
more important than child temperament is how caregivers respond to it.

Think about how you might approach each type of child in order to improve your
interactions with them. An easy or flexible child will not need much extra
attention unless you want to find out whether they are having difficulties that
have gone unmentioned. A slow to warm up child may need to be given advance
warning if new people or situations are going to be introduced. A difficult or feisty
child may need to be given extra time to burn off their energy. A caregiver’s ability
to accurately read and work well with the child will enjoy this goodness-of-fit,
meaning their styles match and communication and interaction can flow. The
temperamentally active children can do well with parents who support their
curiosity but could have problems in a more rigid family.

It is this goodness-of-fit between child temperament and parental demands and

expectations that can cause struggles. Rather than believing that discipline alone
will bring about improvements in children’s behavior, our knowledge of
temperament may help a parent, teacher or other caregiver gain insight to work
more effectively with a child. Viewing temperamental differences as varying styles
that can be responded to accordingly, as opposed to ‘good’ or ‘bad’ behavior. For
example, a persistent child may be difficult to distract from forbidden things such
as electrical cords, but this persistence may serve her well in other areas such as
problem-solving. Positive traits can be enhanced and negative traits can be
subdued. The child’s style of reaction, however, is unlikely to change.
Temperament doesn’t change dramatically as we grow up, but we may learn how
to work around and manage our temperamental qualities. Temperament may be
one of the things about us that stays the same throughout development.

Try It

Link to Learning

Read the article “Lasting Effects of a Goodness- or Poorness-of-fit” from Psychology Today to learn
more about goodness-of-fit and poorness-of-fit.

Erikson’s Stages for Infants and Toddlers

Trust vs. mistrust

Erikson maintained that the first year to year and a half of life involves the
establishment of a sense of trust. Infants are dependent and must rely on others
to meet their basic physical needs as well as their needs for stimulation and
comfort. A caregiver who consistently meets these needs instills a sense of trust
or the belief that the world is a safe and trustworthy place. The caregiver should
not worry about overindulging a child’s need for comfort, contact, or stimulation.
This view is in sharp contrast with the Freudian view that a parent who
overindulges the infant by allowing them to suck too long or be picked up too
frequently will be spoiled or become fixated at the oral stage of development.
Figure 2. Exploring the environment allows the toddler to develop a sense of autonomy and
independence.

Consider the implications for establishing trust if a caregiver is unavailable or is

upset and ill-prepared to care for a child, or if a child is born prematurely, is
unwanted, or has physical problems that could make them less desirable to a
parent. However, keep in mind that children can also exhibit strong resiliency to
harsh circumstances. Resiliency can be attributed to certain personality factors,
such as an easy-going temperament and receiving support from others. A
positive and strong support group can help a parent and child build a strong
foundation by offering assistance and positive attitudes toward the newborn and
parent.

Autonomy vs. shame and doubt

As the child begins to walk and talk, an interest in independence or autonomy

replaces their concern for trust. The toddler tests the limits of what can be
touched, said, and explored. Erikson believed that toddlers should be allowed to
explore their environment as freely as safety allows and, in doing so, will develop
a sense of independence that will later grow to self-esteem, initiative, and overall
confidence. If a caregiver is overly anxious about the toddler’s actions for fear
that the child will get hurt or violate others’ expectations, the caregiver can give
the child the message that they should be ashamed of their behavior and instill a
sense of doubt in their abilities. Parenting advice based on these ideas would be
to keep your toddler safe, but let them learn by doing. A sense of pride seems to
rely on doing rather than being told how capable one is (Berger, 2005).