Unit 2 Tutorials: Infancy

INSIDE UNIT 2

Infant and Maternal Health

Postpartum Period
Newborn Assessments, Vaccines, and Health Risks
Infant Nutrition
Infant Sleep Part I
Infant Sleep Part II
Environmental Risks

Infancy Development Part 1

Introduction to Infant Development

Physical Development in Infancy
Cognitive Development in Infancy Part I
Cognitive Development in Infancy Part II
Psychosocial Development in Infancy
Socioemotional Development in Infancy

Infancy Development Part 2

Language Development in Infancy

Motor and Sensory Development in Infancy
Benefits and Disadvantages of Various Childcare Options
The Cultural Impact on Infancy

Postpartum Period
by Sophia

 WHAT'S COVERED

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 In this lesson, you will learn about the postpartum period for both the mother and the infant, as well as
about breastfeeding. Specifically, this lesson will cover:
1. Postpartum Period
2. Acute Postpartum Period
3. Subacute Postpartum Period
3a. Psychological Disorders
3b. Infant Care
3c. Maternal-Infant Postpartum Evaluation
4. Delayed Postpartum Period
5. Postpartum Across Cultures
6. Breastfeeding
6a. A Historic Look At Breastfeeding
6b. When Breastfeeding Doesn’t Work

1. Postpartum Period
The postpartum (or postnatal) period begins immediately after childbirth as the mother’s body, including
hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal period, or
immediate postpartum period are commonly used to refer to the first six weeks following childbirth. The World
Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected
phase in the lives of mothers and babies; most maternal and newborn deaths occur during this period.

 DID YOU KNOW

The postpartum period is sometimes referred to as the “fourth stage of labor.” (Romano et al., 2010).
A woman giving birth in a hospital may leave as soon as she is medically stable, which can be as early as a few
hours postpartum, though the average for a vaginal birth is one to two days. The average Cesarean section
postnatal stay is approximately three to four days. During this time, the mother is monitored for bleeding, bowel
and bladder function, and baby care. The infant’s health is also monitored. Early postnatal hospital discharge is
typically defined as the discharge of the mother and newborn from the hospital within 48 hours of birth.

 KEY CONCEPT

The postpartum period can be divided into three distinct stages:

Initial or acute period (6–12 hours after childbirth)
Subacute postpartum period (two to six weeks)
Delayed postpartum period (may last up to six months)

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 In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long-term
health problems (persisting after the delayed postpartum period) are reported by 31% of women. Various
organizations recommend routine postpartum evaluation at certain time intervals in the postpartum period.

 TERMS TO KNOW

Postpartum Period
A period that begins immediately after childbirth as the mother’s body, including hormone levels and
uterus size, returns to a non-pregnant state.

Early Postnatal Hospital Discharge

The discharge of the mother and newborn from the hospital within 48 hours of birth.

2. Acute Postpartum Period

The first 6 to 12 hours after childbirth is the initial or acute phase of the postpartum period. During this time the
mother is typically monitored by nurses or midwives because complications can arise.

The greatest health risk in the acute period is postpartum bleeding. Following delivery, the area where the
placenta was attached to the uterine wall bleeds, and the uterus must contract to prevent blood loss. After
contraction takes place the fundus (top of the uterus) can be palpated or examined by touch as a firm mass at
the level of the navel. It is important that the uterus remains firm and that the nurse or midwife make frequent
assessments of both the fundus and the amount of bleeding. Postpartum uterine massage is commonly used to
help the uterus contract after the placenta has been expelled in the acute phase.

 DID YOU KNOW

In some cases, a woman may have a retained placenta where the placenta does not fully come out or parts
of it remain in the uterus. This can be life-threatening for the mother, as it can lead to excessive blood loss
and infection. There are medical procedures available to help clean out the uterus so that any remaining
placenta is flushed out.

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 Following delivery, if the mother had an episiotomy, or tearing at the opening of the vagina, it is stitched. In the
past, an episiotomy was routine. However, more recent research shows that routine episiotomy, when a normal
delivery without complications or instrumentation is anticipated, does not offer benefits in terms of reducing
perineal or vaginal trauma. Selective use of episiotomy results in less perineal trauma. A healthcare professional
can recommend comfort measures to help to ease perineal pain.

 TERMS TO KNOW

Acute Phase
The first 6 to 12 hours after childbirth.

Fundus
The top of the uterus.

Retained Placenta
When the placenta does not fully come out or parts of it remain in the uterus.

Episiotomy
Tearing at the opening of the vagina.

3. Subacute Postpartum Period

During the subacute postpartum period, the mother’s body is starting its recovery process. The mother’s body
experiences changes in emotional states, metabolism, genitourinary recovery, and blood flow (Romano et al.,
2010).

In the first few days following childbirth, the risk of deep vein thrombosis (DVT) (blood clot in a deep vein) is
relatively high, as hypercoagulability (tendency to develop blood clots) increases during pregnancy and is
maximal in the postpartum period, especially for women with C-sections and/or reduced mobility.

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 Anticoagulants or physical methods such as compression may be used in the hospital, particularly if the woman
has risk factors (e.g., obesity, prolonged immobility, recent C-section, swollen feet, and first-degree relative(s)
with a history of a thrombotic episode). For women with a history of a thrombotic event in pregnancy or prior to
pregnancy, anticoagulant medication is generally recommended.

There are many anticoagulant medications to help an individual with DVT. One of those prescription
medications is called Warfarin (brand name Coumadin) (Fiumara & Goldhaber, 2009). Warfarin works by
reducing an individual’s ability to form clots, not by stopping them completely but by preventing them from
forming. Vitamin K is a critical ingredient in making clots, therefore Warfarin directly targets clotting factors
dependent on Vitamin K.

IN CONTEXT

When an individual is diagnosed with a DVT, it is essential to figure out the location of the blood clot
and its size so that the most efficient and timely treatment regimen can take place. Depending on the
clot location and size, treatment may be short-term or long-term. During this time, the mother’s primary
healthcare physician is usually the one that schedules blood tests to make sure that Warfarin is
working and whether dose adjustments are needed.

The treatment not only involves taking the medication, doing lab tests, and sometimes ultrasounds,
but also changes in lifestyle. Diet should be monitored, especially vitamin K rich foods such as green,
leafy vegetables (spinach, lettuce, kale).

 TRY IT

Imagine that a mother who is vegetarian receives a postpartum diagnosis of a DVT in her left leg, right in
her calf. Research the types of foods that are rich in vitamin K, and make a list of foods that the mother can
potentially eat to maintain her current vitamin K intake. How do you think a registered dietitian can help the
mother throughout this process?
The increased vascularity (blood flow) and edema (swelling) of the woman’s vagina gradually resolve in about
three weeks. The cervix gradually narrows and lengthens over a few weeks. Postpartum infections can lead to

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 sepsis and if untreated, death. Postpartum urinary incontinence is experienced by about 33% of all women.

 DID YOU KNOW

Women who deliver vaginally are about twice as likely to have urinary incontinence as women who give
birth via a C-section. Urinary incontinence in this period increases the risk of long-term incontinence.
Kegel exercises are recommended to strengthen the pelvic floor muscles and control urinary incontinence.
Discharge from the uterus, called lochia, will gradually decrease and turn from bright red to brownish to yellow,
and cease at around five or six weeks. An increase in lochia between 7-14 days postpartum may indicate
delayed postpartum hemorrhage. In the subacute postpartum period, 87% to 94% of women report at least one
health problem.

 TERMS TO KNOW

Subacute Postpartum Period

The second postpartum period is the most important.

Hypercoagulability
The tendency to develop blood clots.

Lochia
Discharge from the uterus after birth.

3a. Psychological Disorders

During the subacute postpartum period, psychological disorders may emerge. Among these are postpartum
depression, post-traumatic stress disorder (PTSD), and in rare cases, postpartum psychosis. Postpartum mental
illness can affect both mothers and fathers, and it is not uncommon. Early detection and adequate treatment is
required.

 DID YOU KNOW

Approximately 70-80% of postpartum women experience the “baby blues” for at least a few days. Between
10-20% may experience clinical depression, with a higher risk among those women with a history of
postpartum depression, clinical depression, anxiety, or other mood disorders. The prevalence of PTSD
following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8% and
5.6% at six weeks postpartum.
Peripartum onset (commonly referred to as postpartum depression), applies to women who experience major
depression during pregnancy or in the four weeks following the birth of their child (American Psychological
Association, 2013). These women often feel very anxious and may even have panic attacks. They may feel
guilty, agitated, and weepy. They may not want to hold or care for their newborn, even in cases in which the
pregnancy was desired and intended. In extreme cases, the mother may have feelings of wanting to harm her
child or herself. Most women with postpartum depression do not physically harm their children, but some do
have difficulty being adequate caregivers (Fields, 2010). A surprisingly high number of women experience
symptoms of peripartum-onset depression. A study of 10,000 women who had recently given birth found that
14% screened positive for postpartum depression, and that nearly 20% reported having thoughts of wanting to
harm themselves (Wisner et al., 2013).

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  TERM TO KNOW

Peripartum Onset
Commonly referred to as postpartum depression.

3b. Infant Care

At two to four days postpartum, a woman’s breast milk will generally come in. Historically, women who were not
breastfeeding were given drugs to suppress lactation, but this is no longer medically indicated. In this period,
difficulties with breastfeeding may arise. Maternal sleep is often disturbed, as night waking is normal in
newborns, and newborns need to be fed every two to three hours, including throughout the night. The lactation
consultant, health visitor, or postnatal doula (a person who helps the mother following the birth process), may
be of assistance at this time.

 TERM TO KNOW

Postnatal Doula
A person who helps the mother following the birth process.

3c. Maternal-Infant Postpartum Evaluation

Various organizations across the world recommend routine postpartum evaluation during the postpartum
period. The American College of Obstetricians and Gynecologists (ACOG) recognizes the postpartum period
(the “fourth trimester”) as critical for women and infants. Instead of the traditional single four- to six-week
postpartum visit, as of 2018, ACOG recommends that postpartum care be an ongoing process. Therefore, they
recommend that all women have contact (either in-person or by phone) with their obstetric provider within the
first three weeks postpartum to address acute issues, with additional care as needed. A more comprehensive
postpartum visit should be done at four to twelve weeks postpartum, to address the mother’s mood and
emotional well-being, physical recovery after birth, infant feeding, pregnancy spacing and contraception,
chronic disease management, and preventive health care and health maintenance.

 KEY CONCEPT

Women with hypertensive disorders should have a blood pressure check within three to ten days
postpartum. More than one-half of postpartum strokes occur within ten days of discharge after delivery.
Women with chronic medical (e.g., hypertensive disorders, diabetes, kidney disease, thyroid disease) and
psychiatric conditions should continue to follow up with their obstetric or primary care provider for ongoing
disease management. Women with pregnancies complicated by hypertension, gestational diabetes, or
preterm birth should undergo counseling and evaluation for cardiometabolic disease, as the lifetime risk of
cardiovascular disease is higher in these women. The World Health Organization has similar
recommendations for maternal and infant postpartum evaluation at three days, one to two weeks, and six
weeks postpartum.

4. Delayed Postpartum Period

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 The delayed postpartum period starts after the subacute postpartum period and lasts up to six months. During
this time, muscles and connective tissue return to a pre-pregnancy state. Recovery from childbirth complications
in this period, such as urinary and fecal incontinence, painful intercourse, and pelvic prolapse, are typically very
slow and in some cases may not fully resolve. Symptoms of PTSD often subside in this period, dropping from
2.8% and 5.6% at six weeks postpartum to 1.5% at six months postpartum.

Approximately three months after giving birth (typically between two and five months), estrogen levels drop and
large amounts of hair loss is common, particularly in the temple area (postpartum alopecia). Hair typically grows
back normally and treatment is not indicated. Other conditions that may arise in this period include postpartum
thyroiditis, which is the inflammation or swelling of the mother’s thyroid. During the delayed postpartum period,
infant sleep during the night gradually increases and maternal sleep generally improves. Long-term health
problems, as defined by persisting problems after the delayed postpartum period, are reported by 31% of
women. Ongoing physical and mental health evaluation, risk factor identification, and preventive health care
should be provided.

 TERMS TO KNOW

Delayed Postpartum Period

The postpartum period that occurs after the subacute postpartum period and lasts up to six months.

Postpartum Alopecia
Hair loss after giving birth.

5. Postpartum Across Cultures

Postpartum confinement refers to a system for recovery following childbirth. It begins immediately after the
birth and lasts for a culturally variable length: from one month, to 40 days, to two months, to 100 days. This
postnatal recuperation can include “traditional health beliefs, taboos, rituals, and prescriptions.” One practice
used to be known as “lying-in”, which, as the term suggests, centers around bed rest. Maternity hospitals used
this phrase, as in the General Lying-in Hospital. Postpartum confinement customs are well-documented in
China, where it is known as “sitting the month”, and similar customs manifest all over the world. A modern
version of this rest period has evolved, to give maximum support to the new mother, especially if she is
recovering from a difficult labor and delivery.

In other cultures, like South Korea, a great level of importance is placed on postnatal care. Sanhujori is the term
for traditional postnatal care in South Korea and is a practice followed by the majority of women for the purpose
of proper recovery after giving birth. Deeply rooted in Korean culture, sanhujori has evolved with today’s society
from being heavily reliant on the mothers’ family members to include services that encompass all its principles,
which is apparent with the over 500 sanhujori centers (maternity hotels) in operation around Korea.

 TERM TO KNOW

Postpartum Confinement
A system for recovery following childbirth. It begins immediately after the birth and lasts for a culturally
variable length.

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 6. Breastfeeding
Breast milk is considered the ideal diet for newborns due to the nutritional makeup of the colostrum (the first
secretion from the mammary glands after giving birth, rich in antibodies) and subsequent breast milk
production. Colostrum has been described as “liquid gold.” Colostrum is packed with nutrients and other
important substances that help the infant build up his or her immune system. Most babies will get all the
nutrition they need through colostrum during the first few days of life (Centers for Disease Control & Prevention,
2018). 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. Below
are some of the benefits of breast milk:

Provides a source of iron more easily absorbed in the body than the iron found in dietary supplements
Provides resistance against many diseases (e.g., obesity, autoimmune disease, allergies, cancers, etc.)
Is usually more easily digested by infants than formula
Helps babies make a transition to solid foods more easily than if bottle-fed

 KEY CONCEPT

The reason infants need such a high-fat content is the process of myelination (the formation of myelin
sheath), which requires fat to insulate the neurons. There has been some research, including meta-

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 analyses, to show that breastfeeding is connected to the following advantages with cognitive development
(Anderson, Johnstone, & Remley, 1999):
1. Infants with a low birth weight experience greater benefits from breastfeeding than normal-weight
infants.
2. Breastfeeding may provide nutrients required for the rapid development of the immature brain and be
connected to more rapid or better development of neurological function.
3. 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, infants with a low birth weight showed a 5.18-point difference in IQ compared with weight-
matched, formula-fed infants.

Overall, these studies suggest that nutrients present in breast milk may have a significant effect on neurologic
development in both premature and full-term infants.

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).

 KEY CONCEPT

Several recent studies have reported that it is not just babies that benefit from breastfeeding but mothers
as well. Breastfeeding is beneficial to mothers for the following reasons among others:
Stimulates contractions in the uterus to help it regain its normal size
Helps space women’s pregnancies farther apart
Lowers the risk of developing breast cancer, especially among higher-risk racial and ethnic groups
(Islami et al., 2015)
Lowers rate of ovarian cancer (Titus-Ernstoff, Rees, Terry, & Cramer, 2010)
Reduces the risk of developing Type 2 diabetes (Schwarz et al., 2010)

 TERMS TO KNOW

Colostrum
The first secretion from the mammary glands after giving birth, rich in antibodies.

Myelination
The formation of myelin sheath.

6a. A Historic Look At Breastfeeding

The use of wet nurses, or lactating women, historically hired to nurse others’ infants, eventually declined, and
mothers increasingly breastfed their own infants by the late 1800s. In the early part of the 20th century,

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 breastfeeding went through another decline, and by the 1950s it was practiced less frequently by middle-class
and more affluent mothers, as formula was considered superior to breast milk. In the late 1960s and 1970s, a
greater emphasis was 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 strong messages to breastfeed.

IN CONTEXT

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 that they are given
support and encouragement in helping their infants grow 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 both
the baby and the mother are comfortable with 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).
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, welcoming infants,
and having a room dedicated to breastfeeding, but many do not. And public support of breastfeeding is
sometimes lacking.

We also observe differences in breastfeeding rates across the world.

EXAMPLE Women in Canada are more likely to breastfeed than their counterparts 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 typically found in the United States.
In addition to the nutritional and health benefits of breastfeeding, breast milk is free! Anyone who has priced
formulas 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, 2022).

 TERM TO KNOW

Wet Nurses
Lactating women, hired to nurse others’ infants, especially during the middle ages.

6b. When Breastfeeding Doesn’t Work

There are occasions when mothers may be unable to breastfeed babies, often for a variety of health, social, and
emotional reasons.

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 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 and anticoagulants)
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.

 SUMMARY

In this lesson you learned about the three different postpartum periods: acute postpartum period (6-12
hours post childbirth), subacute postpartum period (2-6 weeks), and delayed postpartum period (up to
6 months). Each period is marked by changes occurring with the mother and baby such as physical
recovery, psychological disorders, infant care, maternal-infant postpartum evaluations, and more. You
then learned about postpartum across cultures, and finally about breastfeeding, including a historic
look at breastfeeding, the maternal and child benefits, and reasons why breastfeeding doesn’t work.

Source: THIS TUTORIAL WAS AUTHORED BY SOPHIA LEARNING. PLEASE SEE OUR TERMS OF USE.

REFERENCES

Fiumara, K., & Goldhaber, S. Z. (2009). A patient’s guide to taking coumadin/warfarin. Circulation, 119(8), e220-
e222.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition
(DSM-V). Washington, DC: Author.

Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., ... & Hanusa, B. H. (2013). Onset
timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.
JAMA psychiatry, 70(5), 490-498.

Optimizing postpartum care. ACOG. (n.d.). Retrieved February 20, 2023, from www.acog.org/clinical/clinical-
guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care

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 Romano, M., Cacciatore, A., Giordano, R., & La Rosa, B. (2010). Postpartum period: three distinct but continuous
phases. Journal of prenatal medicine, 4(2), 22.

 TERMS TO KNOW

Acute Phase
The first 6 to 12 hours after childbirth.

Colostrum
The first secretion from the mammary glands after giving birth, rich in antibodies.

Delayed Postpartum Period

The postpartum period that occurs after the subacute postpartum period and lasts up to six
months.

Early Postnatal Hospital Discharge

The discharge of the mother and newborn from the hospital within 48 hours of birth.

Episiotomy
Tearing at the opening of the vagina.

Fundus
The top of the uterus.

Hypercoagulability
The tendency to develop blood clots.

Lochia
Discharge from the uterus after birth.

Myelination
The formation of myelin sheath.

Peripartum Onset
Commonly referred to as postpartum depression.

Postnatal Doula
A person who helps the mother following the birth process.

Postpartum Alopecia
Hair loss after giving birth.

Postpartum Confinement
A system for recovery following childbirth. It begins immediately after the birth and lasts for a
culturally variable length.

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 Postpartum Period
A period that begins immediately after childbirth as the mother’s body, including hormone levels
and uterus size, returns to a non-pregnant state.

Retained Placenta
When the placenta does not fully come out or parts of it remain in the uterus.

Subacute Postpartum Period

The second postpartum period. It is the most important.

Wet Nurses
Lactating women, hired to nurse others’ infants, especially during the middle ages.

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 Newborn Assessments, Vaccines, and Health
Risks
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about newborn health and well-being. Specifically, this lesson will cover:
1. The Newborn
2. Assessing the Neonate
2a. Appearance, Pulse, Grimace, Activity, & Respiration (APGAR) Test
2b. Low Birth Weight
2c. Premature Birth
2d. Anoxia and Hypoxia
3. Immunizations

1. The Newborn
 DID YOU KNOW

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 and 8 pounds, 13 ounces. The average length of a
newborn is approximately 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 new feeding patterns. Prior to birth, the infant was fed through the umbilical cord, but now the
infant must learn how to survive by breastfeeding, bottle-feeding, or both. The weight loss often goes unnoticed
by most parents but can be a cause for concern for those who have a smaller infant. This weight loss is
temporary, however, and is followed by a period of rapid growth.

 KEY CONCEPT

There are several ways to assess the condition of the newborn. This is important because early detection,
diagnosis, and treatment of conditions can impact the newborn’s overall well-being. There are many
screening assessments that can help determine if the newborn has any congenital disorders, hearing loss,
endocrine disorders, and much more.

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 2. Assessing the Neonate
The most widely used tool is the Neonatal Behavioral Assessment Scale (NBAS) developed by T. Berry
Brazelton in 1973. This tool has been used around the world to help parents get to know their infants and to
make comparisons of infants in different cultures (Brazelton & Nugent, 1995). It was originally intended as a
clinical assessment of the newborn but was later applied by healthcare professionals to include parental
dynamics.

The assessment is administered among full-term healthy infants from birth to 2 months old, developmentally
delayed infants, and infants born preterm as early as 35 weeks gestation (Brazelton, 1995; Hawthorne, 2004).
NBAS focuses on four key neurobehavioral competencies: 1) muscle tone, 2) motor development, 3) stress, and
4) social orientation (Brazelton & Nugent, 1995). It also includes assessments of reflexes, support, and
behaviors, each rated on different scales.

 TERM TO KNOW

Neonatal Behavioral Assessment Scale (NBAS)

Tool used around the world to help parents get to know their infants.

2a. Appearance, Pulse, Grimace, Activity, & Respiration (APGAR) Test

The APGAR test is another assessment that is conducted one minute and five minutes after birth. This is a very
quick and systematic method to assess the newborn’s overall physical condition. Five measures are assessed:

1. Heart rate
2. Respiration
3. Muscle tone (quickly assessed by a skilled nurse when the baby is handed to them or by touching the
baby’s palm)
4. Reflex response (the Babinski reflex is tested)
5. Color

Scores for each category can range from 0 to 2 with an overall score of 5 or less a cause for concern. Typically,
the second APGAR score should indicate improvement with a higher score. However, if the APGAR score is less
than 6 at the five-minute interval, then another assessment is done at ten minutes.

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 The Babinski test evaluates the newborn’s reflexes. The healthcare provider strokes the bottom of the newborn’s foot,

and the big toe goes upward while the rest of the toes spread out.

 TERM TO KNOW

Appearance, Pulse, Grimace, Activity, & Respiration Test (APGAR)

Assessment that is conducted one minute and five minutes after birth.

2b. Low Birth Weight

 DID YOU KNOW

A child is considered to have a low birth weight if they weigh less than 5 pounds, 8 ounces (2,500 grams);
moderately low birth weight if they weigh 1,500 grams to 2,499 grams (3.3 pounds to 5.5 pounds); and very
low birth weight if they weigh less than 1,500 grams (3.3 pounds).
According to national statistics, approximately 8.52 percent of babies born in the United States in 2021 were of
low birth weight, 7.14 percent were born of moderately low birth weight, and 1.38 percent were born of very low
birth weight (Osterman et al., 2023). A low-birth-weight baby has difficulty maintaining adequate body
temperature because it lacks the fat that would otherwise provide insulation. Such a baby is also at more risk of
infection. Sixty-seven percent of these babies are also preterm, which can make them more at risk for a
respiratory infection. Babies with very low birth weight (2 pounds or less) have an increased risk of developing
cerebral palsy. Many causes of low birth weight are preventable with proper prenatal care.

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 2c. Premature Birth
A child might also have a low birth weight if it is born at less than 37 weeks gestation (which qualifies it as a
preterm baby). In 2021, 10.49 percent of babies born in the U.S. were preterm (Osterman et al., 2023). Like low
birth weight, preterm can also be categorized as early preterm (less than 34 weeks gestation) or late preterm
(between 34-36 weeks gestation). Early birth can be triggered by anything that disrupts the mother’s system.

EXAMPLE Vaginal infections or gum disease can actually lead to premature birth because such
infection causes the mother to release anti-inflammatory chemicals which, in turn, can trigger contractions.
Smoking and the use of other teratogens (e.g., drugs, chemicals, toxic substances) can also lead to preterm
birth.
Smoking is considered a teratogen because nicotine travels through the placenta to the fetus. When the mother
smokes, the developing baby experiences a reduction in blood oxygen levels.

 KEY CONCEPT

Tobacco use during pregnancy has been associated with low birth weight, placenta previa (complete or
partial covering of the uterus by the placenta), birth defects, preterm delivery, fetal growth restriction, and
sudden infant death syndrome. Smoking in the month before getting pregnant and throughout pregnancy
increases the chances of these risks. Quitting smoking before getting pregnant is best. However, for
women who are already pregnant, quitting as early as possible can still help protect against some health
problems for the mother and baby. Similarly, prescription, over-the-counter, or recreational drugs can also
have serious teratogenic effects. In general, if medication is required, then the lowest dose possible should
be used. Combination drug therapies and first-trimester exposures should be avoided. Almost three
percent of pregnant women use illicit drugs such as marijuana, cocaine, ecstasy, other amphetamines, and
heroin. These drugs can cause low birth weight, withdrawal symptoms, birth defects, or learning or
behavioral problems. Babies born with a heroin addiction need heroin just like adult addicts. The child will
need to be gradually weaned from the heroin under medical supervision; otherwise, the child could have
seizures and die.

 TERMS TO KNOW

Preterm Baby
A child born at less than 37 weeks gestation.

Early Preterm Baby

A child born at less than 34 weeks gestation.

Late Preterm Baby

A child born between 34-36 weeks gestation.

2d. Anoxia and Hypoxia

One of the leading causes of infant brain damage is lack of oxygen shortly after birth. Hypoxia occurs when the
infant is deprived of an adequate amount of oxygen, leading to mild to moderate brain damage. Anoxia, on the
other hand, occurs when the infant undergoes a total lack of oxygen, which can lead to severe brain damage.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 18
 This lack of oxygen is typically caused by umbilical cord problems, birth canal problems, blocked airways, and
placenta abruption. Both hypoxia and anoxia can lead to cerebral palsy and a host of other medical disorders.

 TERMS TO KNOW

Hypoxia
When an infant is deprived of an adequate amount of oxygen leading to mild to moderate brain
damage.

Anoxia
When an infant undergoes a total lack of oxygen which can lead to severe brain damage.

3. Immunizations
Preventing communicable diseases from early infancy is one of the major tasks of the public health system in
the United States. Infants explore their environment by placing objects into their mouth, which is
developmentally appropriate. They learn through their senses and tasting objects not only stimulates their brain
but also provides a sensory and learning experience.

Infants also have frequent contact with dirty surfaces. They may 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; they play in community and school playgrounds; and much more. So, how do we
prevent infants from getting sick? One possible solution is through immunizations.

IN CONTEXT

According to the CDC, immunizations are critical to our health throughout the course of our lives but
most importantly in the early years because they offer immunity to life-threatening illnesses. Vaccines
are tested to ensure that they are safe and effective for children to receive at the recommended ages.
From chickenpox to polio to rubella and measles, there is a recommended schedule for vaccinating
your baby. Some vaccines are administered twice (e.g., measles, mumps, and rubella [MMR] is
recommended at 12-15 months of age and 4-6 years old), while others are a series of two or more
shots (e.g., Hepatitis B is first given at birth and then the rest of the shots are completed by 6-18
months of age). There are also some vaccines that we are given yearly, such as the influenza vaccine,
to protect us from the flu.

In today’s society, we are faced with the debate of the pros and cons of vaccinating children. This debate has
been further amplified by the COVID-19 pandemic. The rush to develop a vaccine to protect against the
coronavirus was received with mixed opinions by the public. While many people celebrated the vaccine and its
success in preventing the spread and the severity of COVID-19, others remained distrustful of potential side
effects. Questions and opinions circulating about vaccination led to increased social and political divisions
throughout the United States.

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 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, the remaining 10% are protected because
the disease will not spread among the vaccinated members of the community (World Health Organization,
2020). The threshold of herd immunity (whether it is 80%, 85%, 90%, etc.) depends on many factors such as the
organism, population demographics, living conditions, modes of transmission, etc.

 KEY CONCEPT

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.
Opinions surrounding vaccinations are not only rooted in an individual’s religious and medical beliefs but also in
perceptions of risk. We have seen throughout the COVID-19 pandemic that if individuals do not perceive
themselves to be at risk of getting the disease, then they are less likely to get fully vaccinated. On the other
hand, if the risk of getting sick increases because you belong to a vulnerable group (e.g., elderly, infants, young
children, first responders, immunocompromised, etc.), then you are more likely to get vaccinated.

 DID YOU KNOW

As of the time of this writing, the COVID-19 vaccine has been developed for anyone 6 months old and older.
However, there is no vaccine available for anyone younger than 6 months of age which means that
newborns and infants up to 6 months of age are not protected from the coronavirus.
Until a vaccine is available for this age group, the best way to protect them is by ensuring that only vaccinated
individuals are allowed access to them in addition to preventative measures such as social distancing, masking,
and hand-washing and sanitizing.

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 As the perception of risk increases, so does the likelihood of vaccination.

During the COVID-19 pandemic, we observed the drastic impact of the coronavirus on hospital and/or clinic
policies surrounding pregnancy check-ups and deliveries. Some hospitals across the United States
implemented a policy of not allowing anyone outside of hospital staff to be with the mother when she delivered
her baby. This was done to protect the mother and baby from the coronavirus during this vulnerable time.

 THINK ABOUT IT

Look up the hospital birthing policy during the COVID-19 pandemic at one of your local hospitals. What was
the policy on this topic? What are your thoughts about this policy?

 TERM TO KNOW

Herd Immunity
If 90% of the people in a community (a herd) are immunized, the remaining 10% are protected because
the disease will not spread within the vaccinated members of the community.

 SUMMARY

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 In this lesson, you learned about the basics of the newborn - their average height and weight. You also
learned about assessing the neonate. Two ways are the Neonatal Behavioral Assessment Scale (NBAS)
and the APGAR test. In the next sections, you differentiated between categories of low birth weight
and premature birth, both of which are two outcomes of pregnancy-related factors. You then learned
about anoxia and hypoxia which are leading causes of infant brain damage due to lack of oxygen to
some degree. You ended the lesson with a look at immunizations and the important role they play in
promoting the health and well-being of infants.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

World Health Organization. (n.d.). Coronavirus disease (covid-19): Herd immunity, Lockdowns and covid-19.
World Health Organization. Retrieved February 20, 2023, from www.who.int/news-room/questions-and-
answers/item/herd-immunity-lockdowns-and-covid-19

World Health Organization. (n.d.). WHO child growth standards: Length/height-for-age, weight-for-age, weight-
for-length, weight-for-height and body mass index-for-age: Methods and development. World Health
Organization. Retrieved February 15, 2023, from www.who.int/publications/i/item/924154693X

Centers for Disease Control and Prevention. (2019, August 6). NVSS - facility worksheets guidebook - 32.
Centers for Disease Control and Prevention. Retrieved February 15, 2023, from www.cdc.gov/nchs/nvss/facility-
worksheets-guide/32.htm?Sort=URL%3A%3Aasc&Categories=Newborn+Information

Www.cdc.gov. (n.d.). Retrieved February 15, 2023, from www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01.pdf

2022 recommended immunizations for children from birth through 6 years old. (n.d.). Retrieved February 15,
2023, from www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf

Centers for Disease Control and Prevention. (2021, October 15). Hepatitis B vaccine information statement.
Centers for Disease Control and Prevention. Retrieved February 15, 2023, from
www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html

Centers for Disease Control and Prevention. (2019, January 14). Vaccines your baby needs: Immunization
schedule resources. Centers for Disease Control and Prevention. Retrieved February 15, 2023, from
www.cdc.gov/vaccines/parents/visit/birth-6-vaccine-schedule.html

Brazelton, T. B., & Nugent, J. K. (1995). Neonatal behavioral assessment scale. London: Mac Keith Press.

Brazelton, T. B., & Nugent, J. K. (1995). Neonatal behavioral assessment scale (No. 137). Cambridge University
Press.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 22
 Hawthorne, J. (2004). Training health professionals in the Neonatal Behavioral Assessment Scale (NBAS) and its
use as an intervention. The Signal, 12(3), 41-45.

Centers for Disease Control and Prevention (2016). Birthweight and Gestation. Retrieved from
www.cdc.gov/nchs/fastats/birthweight.htm

Benaron, Harry B.W. et al. (1960). Effect of anoxia during labor and immediately after birth on the subsequent
development of the child. American Journal of Obstetrics & Gynecology, Volume 80, Issue 6, 1129 - 1142.
Retrieved from www.ajog.org/article/0002-9378(60)90080-6/pdf

 TERMS TO KNOW

Anoxia
When an infant undergoes a total lack of oxygen which can lead to severe brain damage.

Appearance, Pulse, Grimace, Activity, & Respiration Test (APGAR)

Assessment that is conducted one minute and five minutes after birth.

Early Preterm Baby

A child born at less than 34 weeks gestation.

Herd Immunity
If 90% of the people in a community (a herd) are immunized, the remaining 10% are protected
because the disease will not spread within the vaccinated members of the community.

Hypoxia
When an infant is deprived of the adequate amount of oxygen leading to mild to moderate brain
damage.

Late Preterm Baby

A child born between 34-36 weeks gestation.

Neonatal Behavioral Assessment Scale (NBAS)

Tool used around the world to help parents get to know their infants.

Preterm Baby
A child born at less than 37 weeks gestation.

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 Infant Nutrition
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about the different ways an infant meets or lacks thereof his/her nutritional
needs. Specifically, this lesson will cover:
1. Breastfeeding
2. Donor Milk
3. Infant Formula
3a. Preparation & Storage
3b. Feeding Patterns
4. Vitamin D Supplementation
5. Introducing Solid Foods
6. Milk Anemia in the United States
7. Global Considerations & Malnutrition

1. Breastfeeding
Breast milk is considered the optimal diet for newborns for numerous reasons, especially because of its
nutrient-rich composition. Breast milk brings with it the following benefits for the mother and baby (Centers for
Disease Control & Prevention, 2021):

Offers the best nutrition source with the mother’s breast milk changing to meet the nutritional needs of her
baby.
Helps protect against short-term and long-term health conditions including, but not limited to, sudden infant
death syndrome, obesity, asthma, type I diabetes, ear infections, etc.
Helps build an immune system since antibodies are passed through breast milk.

 DID YOU KNOW

The American Academy of Pediatrics (AAP) recommends that mothers exclusively breastfeed their infant for
the first 6 months of life and continue breastfeeding beyond that. After 6 months, other healthy foods can
be introduced in addition to breastmilk (Meek & Noble, 2022).
Recent data from the United States Breastfeeding Report Card 2022 indicates almost 83.2% of infants born in
2019 began with some breast milk. At one and six months, this number dropped to 78.6% and 55.8%,

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 respectively. Approximately one-fourth of the infants were exclusively breastfed at six months of age.

This highlights the continuing challenges that mothers and their babies face when beginning and maintaining
breastfeeding. Yes, the data certainly shows that most infants start out breastfeeding, and many are still
receiving some breast milk at 6 months. Even some breast milk is beneficial to infants as opposed to no breast
milk at all. However, many families do not breastfeed for as long as they intend to and breastfeeding disparities
by race and ethnicity persist (CDC, 2019; Odom et al., 2013). The steady decline in any and exclusive
breastfeeding from month-to-month indicates that breastfeeding families may need stronger systems of support
to reach their breastfeeding goals.

 KEY CONCEPT

Breastfeeding could save the lives of millions of infants each year, according to the World Health
Organization (WHO), yet fewer than 50 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 and other national organizations are working together with the government to step up
support for breastfeeding globally.

2. Donor Milk
When the challenges of breastfeeding become overwhelming and/or breast milk is contraindicated (e.g.,
maternal infections or medications, drug use, etc.), mothers may also have the option of using donor’s milk.
Donor milk, as the name suggests, is breast milk but from another mother (Tran, Nguyen, & Mathisen, 2020).
Some mothers find it easy to breastfeed and may even have more supply of breast milk beyond the nutritional
needs of her baby. Under these circumstances, the mother may be encouraged to donate her breast milk to
other mothers who are unable to provide breast milk to their babies.

Breast milk given through this route is pasteurized. In other words, a human milk bank collects the milk and
stores it. They test the breast milk for any bacterial and other contaminants so that the distributed milk is safe
for babies and their families. In 2020, an estimated 700 milk banks operated across more than 60 countries
(PATH, 2019).

 DID YOU KNOW

The World Health Organization has developed a workgroup that focuses on establishing and carrying
through a human milk banking system that provides good quality and safe human milk to infants and their
families worldwide (WHO, 2022).
Evidence suggests that human donor milk is more advantageous for preterm or low birthweight infants.
Specifically, McGuire & Anthony (2003) found that infants who received donor breast milk were three times less
likely to have necrotizing enterocolitis, which is a gastrointestinal problem. However, mothers have some
concerns about human donor milk including screening protocols, any contaminants/substances in donor milk,
and purchasing methods (Rabinowitz et al., 2018). For example, mothers may opt to use donor milk from a family
or friend as opposed to purchasing it online.

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  THINK ABOUT IT

If you knew of someone who needed breast milk, and you were able to do so and/or knew of someone who
could help out, would you consider donating to the human milk bank? What factors would influence your
decision to donate or not?

 TERM TO KNOW

Donor Milk
Breast milk from another mother.

3. Infant Formula
Besides breast milk, mothers also have the option of giving their babies formula. It is important, however, to
better understand the type of formula, preparation and storage, and feeding pattern (Centers for Disease
Control & Prevention, n.d.).

With the booming formula industry, mothers have various options when it comes to choosing an infant formula.
Although in some countries and/or families it may be made at home, it is not recommended by both the
American Academy of Pediatrics and the Food & Drug Administration (CDC, n.d.). Infants have specific nutritious
needs therefore it is not ideal to experiment with proportions of vitamins, minerals, water, etc.

There is also the option of commercial formulas that can be purchased almost anywhere in the United States.
Regardless of whether they are made in the U.S. or are imported, they are all reviewed by the Food & Drug
Administration for health and safety reasons.

 KEY CONCEPT

Some of the factors to consider when buying infant formula include (CDC, n.d.):
Labeled specifically for infants and not toddlers - nutritional needs vary as we grow older therefore it is
important to buy formula made for infants.
Expiry date - make sure the formula is not expired.
All formula containers must be sealed - any holes, leaks, or damage to the container is risky so do not
feed any formula from such containers.
Infant allergies and/or sensitivities - it is possible that a specific formula does not suit your baby’s body
and causes a reaction so monitor your baby to ensure that s/he tolerates the formula.

3a. Preparation & Storage

When utilizing any formula, parents and/or caregivers should read all instructions. It is important to make sure
that the right proportions of water and formula are mixed otherwise there may be vitamin and/or mineral
imbalances. This would further impact the nutritional needs of the baby.

 KEY CONCEPT

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 Some key things to note while preparing formula are as follows:
Always wash your hands and the bottle thoroughly.
Separate all parts of the bottle (e.g., nipple, cap, valve, ring, etc.) prior to cleaning.
Warm the milk if your baby prefers warm milk as opposed to cold milk but never use a microwave to do
so.
Use safe drinking water (e.g., tap water if you know it is safe) if your infant drinks the powdered formula.

Once the milk has been made, it must be used within two hours otherwise it can be stored in the fridge and
used within 24 hours. Similar to foods and drinks adults consume, infant formula also has an expiration date so
the contents must be used by that date.

 HINT

Since many formulas are recommended to be used within one month from the date opened, the CDC
recommends writing the date you opened the formula container so you use it within that time frame.

3b. Feeding Patterns

From the first few days to the first few weeks and months, the baby’s growth and nutritional needs will fluctuate.
As a newborn, their stomach is really small so not a lot of formula is actually needed to fill the baby. If the infant
is only drinking formula, then they should be offered 1 to 2 ounces every 2 to 3 hours. At this age, a newborn
will probably need to be fed anywhere from 8 to 12 times in a 24-hour period. As they get older, the gap
between feedings will get longer to every 3 to 4 hours. By the time the baby is 6 to 12 months old, they will be
fed roughly 5 to 6 times in a 24-hour period.

 KEY CONCEPT

Feeding patterns will vary depending on the infant’s overall health and growth. This is another reason why it
is important that the pediatrician and family communicate about the baby’s feeding patterns.
Pediatricians and other healthcare providers use the Centers for Disease Control & Prevention clinical growth
charts to help track the infant’s progress. The charts are specific based on the infant’s gender and age.

 DID YOU KNOW

At the time of writing, some infant formulas were recalled and there were issues with the supply chain. This
has led to concerns among families on how to provide milk to their babies, especially if they are only
formula-fed. The U.S. Department of Health & Human Services (2022) created an information sheet to help
families find alternatives such as trying a different formula brand within or even outside the United States,
figuring out resources to support breastfeeding, and informing parents about unsafe feeding practices, and
limiting formula wastage.

4. Vitamin D Supplementation

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 Vitamin D is a vitamin that is commonly found in milk and a few other foods, supplemented with other foods,
and used as a dietary supplement (National Institutes of Health Office of Dietary Supplements (NIH ODS), 2022).
It is an important vitamin for the development and maintenance of healthy bones along with the prevention of
weak and/or deformed bones (CDC, 2021). An infant’s vitamin D levels depend on the mother’s levels of vitamin
D considering that it is passed through breast milk. However, the amount is not sufficient therefore infants who
are exclusively breastfed are also supplemented with 400 IU of vitamin D per day (DiMaggio, Cox, & Porto,
2017).

 KEY CONCEPT

Vitamin D deficiency is a concern when infants do not receive adequate sunlight exposure or do not
consume enough in their milk or diet. The following factors reduce vitamin D levels (CDC, 2021):
Living in areas of higher air pollution, cloudy weather, and higher altitudes
Always keeping the skin covered
Darker skin tone
Wearing sunscreen

 TERM TO KNOW

Vitamin D
A vitamin that is commonly found in milk and a few other foods, supplemented with other foods, and
used as a dietary supplement.

5. Introducing Solid Foods

Breast milk, formula, or donor milk is the only food a newborn needs. Solid foods can be introduced at about six
months, in accordance with the American Academy of Pediatrics’ guidelines, when a baby develops stable
sitting and oral feeding skills. Solid foods 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 recommend 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.

6. Milk Anemia in the United States

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  DID YOU KNOW

According to the Global Nutrition Report (2023), the United States is making progress or is ‘on course’
towards reducing stunted growth, wasting, and overweight among children under 5-years-old.
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). The body
gets iron through certain foods. Toddlers who drink too much cow’s milk can still become anemic if they are not
eating other healthy foods that have iron. This can also be due to the practice of giving toddlers milk as a
pacifier when resting, riding, walking, and so on. Appetite declines somewhat during as a toddler, and a small
amount of milk (especially with added chocolate syrup) can sometimes satisfy a child’s appetite for 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.

 KEY CONCEPT

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, limits cow’s milk consumption to less than 24 ounces per day, and includes a
daily iron-fortified vitamin.

 TERM TO KNOW

Milk Anemia
A condition in which milk consumption leads to a lack of iron in the diet.

7. Global Considerations & Malnutrition

In the 1960s, formula companies led campaigns in developing countries to encourage mothers to feed formula
to their infants. Many mothers felt that formula was superior to breast milk and began using it. The use of
formula can certainly be healthy under conditions in which there is adequate clean water to mix the formula and
adequate means to sanitize bottles and nipples. However, in many countries, such conditions were not available
and babies often were given diluted, contaminated formula which made them sick with diarrhea and
dehydration. These conditions continue today and now many hospitals prohibit the distribution of formula
samples to new mothers in an effort to encourage breastfeeding. Some mothers do not understand the
benefits, and have to be encouraged and supported to breastfeed.

IN CONTEXT

The World Health Organization (2023) recommends:

Initiation of breastfeeding within one hour of birth
Exclusive breastfeeding for the first six months of life

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 Introduction of solid foods at six months, with continued breastfeeding up to two years of age or
beyond

Children in developing countries and countries experiencing the harsh conditions of war are at risk for two
major types of malnutrition (a condition resulting from eating a diet where one or more nutrients are not
present). 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 have much less risk of malnutrition than those who are bottle-fed. After weaning (the process of
transitioning the baby off breast milk), children who have diets deficient in protein may experience kwashiorkor,
or the “disease of the displaced child,” which often occurs 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.

 TERMS TO KNOW

Malnutrition
A condition that results from eating a diet in which one or more nutrients are deficient.

Infantile Marasmus
Starvation due to a lack of calories and protein.

Weaning
The process of transitioning the baby off breast milk.

Kwashiorkor
Also known as the “disease of the displaced child,” a loss of appetite and a swelling of the abdomen as
the body begins to break down the vital organs as a source of protein.

 SUMMARY

In this lesson, you learned about the importance of breastfeeding and recommendations to exclusively
breastfeed an infant for the first six months of life. There are two alternatives or supplements to breast
milk: donor milk and infant formula. The preparation and storage of formula is critical. Parents must
make sure that the right proportions of water and formula are mixed, otherwise there may be vitamin or
mineral imbalances. Each of these has its advantages and disadvantages, and meeting the nutritional
needs of the baby is dependent on specific factors related to the mother and her baby.

In this lesson, you also learned about vitamin D supplementation, and the need to supplement to
ensure the infant’s vitamin D levels are adequate. Babies should have a slow introduction to solid
foods between the ages of 4 to 6 months. You also learned about milk anemia in the United States,
feeding patterns, and global considerations and malnutrition.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 30
 Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Centers for Disease Control and Prevention. (2021, July 27). Breastfeeding benefits both baby and mom.
Centers for Disease Control and Prevention. Retrieved February 23, 2023, from
www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/

Breastfeeding Report Card United States, 2020 - centers for disease ... (n.d.). Retrieved February 23, 2023, from
www.cdc.gov/breastfeeding/pdf/2020-Breastfeeding-Report-Card-H.pdf

Centers for Disease Control and Prevention. (n.d.). Centers for Disease Control and Prevention. Retrieved
February 23, 2023, from www.cdc.gov/breastfeeding/data/nis_data/data-files/2019/rates-any-exclusive-bf-
socio-dem-2019.html

Odom, E. C., Li, R., Scanlon, K. S., Perrine, C. G., & Grummer-Strawn, L. (2013). Reasons for earlier than desired
cessation of breastfeeding. Pediatrics, 131(3), e726-e732.

World Health Organization. (n.d.). Breastfeeding. World Health Organization. Retrieved February 23, 2023, from
www.who.int/health-topics/breastfeeding#tab=tab_1

Tran, H. T., Nguyen, T. T., & Mathisen, R. (2020). The use of human donor milk. BMJ, 371.

Assistant Secretary for Public Affairs (ASPA). (2022, July 11). Information for families during the formula shortage.
HHS.gov. Retrieved February 23, 2023, from www.hhs.gov/formula/index.html

PATH. (2019). Strengthening human milk banking: A resource toolkit for establishing and integrating human milk
bank programs—A global implementation framework.

World Health Organization. (n.d.). Who donor human milk banking guidelines development: Convening of the
guidelines development group meeting. World Health Organization. Retrieved February 23, 2023, from
www.who.int/news-room/events/detail/2022/12/12/default-calendar/who-donor-human-milk-banking-
guidelines-development-meeting

Rabinowitz, M. R., Kair, L. R., Sipsma, H. L., Phillipi, C. A., & Larson, I. A. (2018). Human donor milk or formula: A
qualitative study of maternal perspectives on supplementation. Breastfeeding Medicine, 13(3), 195-203.

Centers for Disease Control and Prevention. (2022, May 16). Choosing an infant formula. Centers for Disease
Control and Prevention. Retrieved February 23, 2023, from
www.cdc.gov/nutrition/infantandtoddlernutrition/formula-feeding/choosing-an-infant-formula.html

Center for Food Safety and Applied Nutrition. (n.d.). FDA advises parents and caregivers to not make or feed
homemade infant. U.S. Food and Drug Administration. Retrieved February 23, 2023, from
www.fda.gov/food/alerts-advisories-safety-information/fda-advises-parents-and-caregivers-not-make-or-feed-
homemade-infant-formula-infants

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 Centers for Disease Control and Prevention. (2022, July 13). Infant formula preparation and storage. Centers for
Disease Control and Prevention. Retrieved February 23, 2023, from
www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-feeding/infant-formula-preparation-and-
storage.html

Centers for Disease Control and Prevention. (2022, May 16). How much and how often to feed infant formula.
Centers for Disease Control and Prevention. Retrieved February 23, 2023, from
www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-feeding/how-much-how-often.html

Assistant Secretary for Public Affairs (ASPA). (2022, July 11). Information for families during the formula shortage.
HHS.gov. Retrieved February 23, 2023, from www.hhs.gov/formula/index.html

U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - vitamin D. NIH Office of
Dietary Supplements. Retrieved February 23, 2023, from ods.od.nih.gov/factsheets/VitaminD-
HealthProfessional/

DiMaggio, D. M., Cox, A., & Porto, A. F. (2017). Updates in infant nutrition. Pediatrics in review, 38(10), 449-462.

Kazal, L.A. (2002). Navajo Health Foundation/Sage Memorial Hospital, Ganado, Arizona Am Fam Physician.
66(7): 1217-1225.

Centers for Disease Control and Prevention. (2021, July 2). Vitamin D. Centers for Disease Control and
Prevention. Retrieved February 23, 2023, from www.cdc.gov/breastfeeding/breastfeeding-special-
circumstances/diet-and-micronutrients/vitamin-d.html

Meek, J. Y., & Noble, L. (2022, June 27). Policy statement: Breastfeeding and the use of human milk. American
Academy of Pediatrics. Retrieved February 23, 2023, from
publications.aap.org/pediatrics/article/150/1/e2022057988/188347/Policy-Statement-Breastfeeding-and-the-
Use-of?autologincheck=redirected&_ga=2.147762430.818032563.1677179494-899572606.1676132881

Country Nutrition Profiles. Global Nutrition Report | Country Nutrition Profiles - Global Nutrition Report. (n.d.).
Retrieved February 24, 2023, from globalnutritionreport.org/resources/nutrition-profiles/north-
america/northern-america/united-states-america/

Is homemade baby formula safe? HealthyChildren.org. (n.d.). Retrieved February 24, 2023, from
www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Is-Homemade-Baby-Formula-
Safe.aspx

 TERMS TO KNOW

Donor Milk
Breast milk from another mother.

Infantile Marasmus
Starvation due to a lack of calories and protein.

Kwashiorkor

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 Also known as the “disease of the displaced child,” 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.

Malnutrition
A condition that results from eating a diet in which one or more nutrients are deficient.

Milk Anemia
A condition in which milk consumption leads to a lack of iron in the diet.

Vitamin D
A vitamin that is commonly found in milk and a few other foods, supplemented with other foods,
and used as a dietary supplement.

Weaning
The process of transitioning the baby off breast milk.

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 Infant Sleep Part I
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about infant sleep patterns and behaviors. Specifically, this lesson will
cover:
1. Introduction to Sleep
2. Sleep Stages
3. Sleep Hygiene
4. Infant Sleep

1. Introduction to Sleep
 DID YOU KNOW

"Safe to Sleep" is an educational campaign started by the United States Department of Health & Human
Services to help promote safe sleeping practices among infants and reduce sleep-related mortality in this
age group.
Sleep is a dynamic, not static, physiological state that is important for functioning throughout our lives. It plays
an important role in our overall health and well-being not only during the infancy period but even as adults.
Some of the areas that sleep impacts our body are through:

Metabolism
Hormone regulation
Obesity
Cardiovascular (heart) health
Cognition
Respiration (breathing)
Immune response (the body’s ability to fight colds, viruses, etc.)
Mood

Sleep regulation is the ability to go from wakefulness to sleep with relative ease. Sleep consolidation, on the
other hand, is defined as being able to sustain sleep in a continuous manner (Sadeh & Anders, 1993). Both are
important when it comes to understanding and recognizing sleep and sleep-related disorders. The significance

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 of sleep cannot be emphasized enough because insufficient sleep may lead to poor health outcomes and, in
some extreme cases, even death.

 TERMS TO KNOW

Sleep
A dynamic, not static, physiological state that is important for functioning throughout our lives.

Sleep Regulation
The ability to go from wakefulness to sleep with relative ease.

Sleep Consolidation
Being able to sustain sleep in a continuous manner.

2. Sleep Stages
On a broad level, we all know that we need to sleep to some degree, and then wake up the next morning.
Some of us may even believe that sleep is a period of time when our body essentially shuts down. However,
evidence indicates that this is not the case: our brain and body are still functioning during sleep and do not shut
down.

Sleep architecture refers to the different stages of sleep. There are four stages of sleep, each with marked
characteristics which we will look at briefly below. Some sources also include the wake period as an additional
stage (Mindell & Owens, 2015; Patel, Reddy, & Araujo, 2022).

 KEY CONCEPT

1. Non-REM (NREM) sleep is marked by low brain activity as well as minimal to no changes in breathing
and cardiovascular functioning. It is not until after 6 months of age that NREM sleep becomes more
refined into the classically distinct stages.
a. Stage 1 sleep is characterized by brief and involuntary muscle contractions as well as remembering
visual imagery. During Stage 1, the brain selectively processes external stimuli and helps determine
whether the individual should continue sleeping or wake up (Tubbs, Dollish, Fernandez, & Grandner,
2019). This sleep stage, at least initially, can last anywhere from 30 seconds to 5 minutes and then
changes as the night progresses.
b. Stage 2 sleep is sometimes referred to as “true sleep” because of the brain activity that takes place.
Specifically, we begin to notice K complexes and sleep spindles which are hallmarks of this stage
and possibly related to cognitive functioning (Tubbs et al., 2019). When we first enter Stage 2 sleep
at night, it can last between 5 to 25 minutes and then, similar to the previous stage, varies as the
night progresses.
c. Stage 3 sleep is referred to as slow-wave sleep (SWS), delta sleep, or even “deep sleep.” This is the
period where our body has the highest arousal threshold. In other words, it is most difficult to wake
someone up while they are in Stage 3 sleep. Our body’s parasympathetic activity is high during this

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 stage, indicating restfulness, and breathing becomes slow. We typically spend 30 to 45 minutes in
this stage when we first enter it.
2. Rapid Eye Movement (REM) sleep is marked by the classical eye movements and dreaming that occurs
during this period. Other characteristics of this stage include inability to regulate temperature as you
normally would in the wake state and low muscle tone. In infants, REM sleep is considered “active
sleep.” The initial REM stage lasts approximately five minutes but does not begin until we are about 70
to 100 minutes into sleep.

The image shows how we progress through the different stages of sleep and cycle through them multiple times
during the night.

As highlighted by Mindell & Owens (2015), our sleep architecture changes as we grow older to meet our body’s
needs.

EXAMPLE While REM sleep is about 50% of sleep in newborns, it is significantly reduced to 25%-30%
among adolescents and adults. This pattern of change is also observed in Stage 3 sleep where there is a
40% decline by adolescence and adulthood.
One of the biggest changes that we see in our sleep comes in the form of average 24-hour sleep duration (so
total time sleeping in a 24-hour period) including daytime and nighttime sleep.

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  BIG IDEA

While there is greater individual variability in how much we need to sleep, we generally tend to see the
following sleep duration patterns:
Newborns: sleep 16 to 18 hours per day
Preschoolers: sleep 11 to 12 hours per day
School-aged children and teenagers: sleep 10 hours per day
Adults: sleep 7 to 8 hours per day

 TERMS TO KNOW

Sleep Architecture
The different stages of sleep.

Non-REM (NREM) Sleep

When there is low brain activity as well as minimal to no changes in breathing and cardiovascular
functioning during sleep.

Stage 1 Sleep
When there are brief and involuntary muscle contractions as well as remembering visual imagery during
sleep.

Stage 2 Sleep
Sometimes referred to as “true sleep” because of the brain activity that takes place during sleep.

Stage 3 Sleep
Referred to as slow-wave sleep (SWS), delta sleep, or even “deep sleep.”

Rapid Eye Movement (REM) Sleep

Marked by the classical eye movements and dreaming that occur during this sleep period.

3. Sleep Hygiene
Sleep habits, also known as sleep hygiene, form the foundation of good sleep across the lifespan. Sleep
hygiene encompasses a broad range of behaviors, or lack thereof, that help promote sleep so that an individual
can function throughout the day (U.S. Department of Health & Human Services, 2011). Some common sleep
practices for infants include the following (Galland & Mitchell, 2009; Mindell, Meltzer, Carksadon, & Chervin,
2009; National Heart, Lung, & Blood Institute, 2011):

Consistent and calming bedtime routine

Warm baths
Reading books
Listening to soft music
Singing lullabies

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 Consistent schedule for sleep time, wake time, and daytime naps
Turn off any electronics (e.g., phone, tablet, television) prior to bedtime
Avoid late afternoon naps
Avoid distractions such as bright lights, clocks, loud noises, etc.

This is not to say that every sleep hygiene technique must be applied so that the infant can experience good
sleep. Depending on an infant’s temperament and personality, some practices may be more effective than
others (e.g., singing lullabies as opposed to reading books). The larger environmental context also plays a role.

EXAMPLE In rural areas among developing countries, parents and/or caregivers may not have access
to books. In some cultures, multiple generations live in the same household so completely avoiding noise
and distractions may not be possible while the baby is trying to go to sleep.
The ultimate goal of these methods is to ensure that the baby has good quality and quantity of sleep.

 TERM TO KNOW

Sleep Hygiene
A broad range of behaviors, or lack thereof, that help promote sleep so that an individual can function
throughout the day.

4. Infant Sleep
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. While there is no precise science as to when and how an infant will sleep, there are
general trends in sleep patterns.

IN CONTEXT

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.

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. In a
2018 study by Pennestri and colleagues, researchers looked at uninterrupted nighttime sleep among 6-month-
old and 12-month-old infants. Results indicated 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

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 uninterrupted hours through the night, while 78% were sleeping at least 6 hours, and 56% were sleeping at
least 8 hours.

The variability that we observe in sleep patterns also extends to infant and toddler sleep across different
cultures. Mindell et al. (2010) conducted a study evaluating cross-cultural differences in infant sleep from birth to
36 months old. Parents from the following countries and/or regions completed a self-report questionnaire about
their child’s sleep:

Predominantly-Asian (P-A) Predominantly-Caucasian (P-C)

China Malaysia Australia

Hong Kong Philippines Canada
India Singapore New Zealand
Indonesia Taiwan United Kingdom
Korea Thailand United States
Japan Vietnam

Results showed that children from P-A regions had significantly shorter total sleep times (12.31 hours versus
13.02 hours) and later bedtimes (9:44 PM versus 8:42 PM). Children from P-A regions were also reported to bed-
share and room-share more so than children from P-C regions.

EXAMPLE 5.8% and 8.6% of children in New Zealand and Australia, respectively, shared their parents’
bed. This was in comparison to Thailand and Vietnam where 77.2% and 83.2% of parents shared the bed
with their children.
These differences in sleep patterns and behaviors are important to understand because the cultural context
provides us with a unique lens for understanding whether something is more or less accepted in society.

 SUMMARY

In this lesson, you received an introduction to sleep. You learned about the sleep stages: Non-REM
sleep, stage 1, stage 2, stage 3, and Rapid Eye Movement or REM sleep. Sleep habits or sleep hygiene
form the foundation of good sleep across the lifespan. You also learned about infant sleep. Infants ages
0-12 months sleep about 12.8 hours a day. This changes and develops gradually throughout an infant’s
life.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

U.S. Department of Health and Human Services. (n.d.). About sids and safe infant sleep. Eunice Kennedy Shriver
National Institute of Child Health and Human Development. Retrieved February 20, 2023, from

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 safetosleep.nichd.nih.gov/safesleepbasics/about

Sadeh, A., & Anders, T. F. (1993). Infant sleep problems: Origins, assessment, interventions. Infant mental health
Journal, 14(1), 17-34.

Mindell, J. A., & Owens, J. A. (2015). A clinical guide to pediatric sleep: diagnosis and management of sleep
problems. Lippincott Williams & Wilkins.

Patel, A. K., Reddy, V., & Araujo, J. F. (2022). Physiology, sleep stages. In StatPearls [Internet]. StatPearls
Publishing.

Tubbs, A. S., Dollish, H. K., Fernandez, F., & Grandner, M. A. (2019). The basics of sleep physiology and behavior.
In Sleep and health (pp. 3-10). Academic Press.

U.S. Department of Health and Human Services. (n.d.). Your guide to healthy sleep. National Heart Lung and
Blood Institute. Retrieved February 20, 2023, from www.nhlbi.nih.gov/resources/your-guide-healthy-sleep

Galland, B. C., & Mitchell, E. A. (2010). Helping children sleep. Archives of Disease in Childhood, 95(10), 850-
853.

Mindell, J. A., Meltzer, L. J., Carskadon, M. A., & Chervin, R. D. (2009). Developmental aspects of sleep hygiene:
findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep medicine, 10(7), 771-779.

Pennestri, M. H., Laganière, C., Bouvette-Turcot, A. A., Pokhvisneva, I., Steiner, M., Meaney, M. J., ... & Mavan
Research Team. (2018). Uninterrupted infant sleep, development, and maternal mood. Pediatrics, 142(6).

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. (2010). Cross-cultural differences in infant and
toddler sleep. Sleep medicine, 11(3), 274-280.

 TERMS TO KNOW

Non-REM (NREM) Sleep

When there is low brain activity as well as minimal to no changes in breathing and cardiovascular
functioning during sleep.

Rapid Eye Movement (REM) Sleep

Marked by the classical eye movements and dreaming that occur during this sleep period.

Sleep
A dynamic, not static, physiological state that is important for functioning throughout our lives.

Sleep Architecture
The different stages of sleep.

Sleep Consolidation
Being able to sustain sleep in a continuous manner.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 40
 Sleep Hygiene
A broad range of behaviors, or lack thereof, that help promote sleep so that an individual can
function throughout the day.

Sleep Regulation
The ability to go from wakefulness to sleep with relative ease.

Stage 1 Sleep
When there are brief and involuntary muscle contractions as well as remembering visual imagery
during sleep.

Stage 2 Sleep
Sometimes referred to as “true sleep” because of the brain activity that takes place during sleep.

Stage 3 Sleep
Referred to as slow-wave sleep (SWS), delta sleep, or even “deep sleep.”

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 Infant Sleep Part II
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about infant sleep patterns and behaviors. Specifically, this lesson will
cover:
1. Sleep Arrangements
2. Sudden Unexpected Infant Deaths (SUID)
2a. Sudden Infant Death Syndrome (SIDS)
2b. Unknown Cause
2c. Accidental Suffocation and Strangulation in Bed
3. Sleep Issues & Disorders

1. Sleep Arrangements
 REFLECT

When you were younger, did you sleep in your own room or did you sleep in your parent’s room? Did you
have a sibling? If so, did you sleep together in the same room or bed or in different rooms? How did you
feel about your sleeping arrangements when you were younger? Do you think that you would practice
similar sleeping arrangements with your children? Why or why not?
The location of sleep depends primarily on the baby’s age and culture. Bed-sharing can be defined as sharing
the bed with the parents, sibling(s), or both. In our mindset, we sometimes forget to mention that there might be
more than one child in the household and that introduces unique dynamics within the family. Room-sharing
refers to sharing the physical environment with the parents, sibling(s), or both. It is possible that a mother sleeps
in her own bed and has her baby’s crib nearby so that she can attend to her baby if they wake up at night. Co-
sleeping occurs when the parents and children sleep together on the same bed. We note individual variability
here as well, because a child can start off sleeping in their own bed or room but then transition into their
parent’s bed later in the night. Or, a child can begin the night co-sleeping but then end up sleeping in their own
bed as the night progresses. The following example highlights the complexity and variability of children’s sleep.

EXAMPLE Jackie and James were already the proud parents of their two-year-old daughter, Lucy, when
they found out that they were expecting another child. They were happy and were hoping for a healthy
child regardless of gender. Baby Michael was born full-term in September without any complications or
health problems. Jackie and James were expecting that Michael would be an easy-going baby similar to

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 Lucy. In their experience, Lucy was a good eater, always happy, never really fussy, and always went to sleep
and woke up with minimal problems. Unknown to the couple, they were in for an adventure!

Lucy had slept in her own room next to her parent’s bedroom, but now she needed to share her space with
her baby brother who would sleep in a crib. Jackie wanted to breastfeed Michael as long as he was willing,
because she knew how important it was for her son’s development.

During the night, Michael would wake up crying, and Lucy would also wake up because of her brother’s
cries. Jackie would come into the room, pick up Michael and rock him in her arms, while singing lullabies.
The lullabies soothed Lucy and she would go back to sleep immediately, but Michael was hungry so Jackie
went back to her bedroom to breastfeed. After feeding him, Michael would go onto Jackie’s shoulder for a
few minutes, burp, and fall back to sleep. Noticing that Michael was asleep, Jackie would quietly try placing
him back in his crib. As soon as Jackie placed Michael in his crib, he would wake up and cry. Jackie did not
want Lucy to get disturbed by her brother’s crying so she would bring Michael back into bed and co-sleep
the rest of the night.
Jackie’s family is just like any other family. Lucy and Michael’s behaviors are within the realm of parental
challenges when it comes to sleep behaviors among children, especially within the family. We cannot compare
Lucy and Michael’s sleep because they are different ages and their needs are different as well. Lucy does not
need to be breastfed and has started to learn how to self-regulate her sleep. Michael, on the other hand, is
merely a baby who has no knowledge of what to do, when, and how. He is just starting to get accustomed to
life outside of the womb.

Most importantly, this example illustrates the various factors that impact infant sleep, from maternal behaviors,
to breastfeeding, to sibling behaviors. They are all interconnected and play an important role in the baby’s
quality and quantity of sleep.

 REFLECT

Imagine what would happen if Lucy could not regulate her sleep and needed help going back to sleep
every time she woke up at night. Or if Lucy and Michael slept in the same room as their parents. What do
you think the outcome would be for the family?

 KEY CONCEPT

Esposito et al. (2015) notes that co-sleeping is the norm in some cultures but not in others. When it comes to
co-sleeping we are faced with risks as well. It may be culturally appropriate to co-sleep but there are safe
and unsafe ways to co-sleep.
Colvin, Collie-Akers, Schunn & Moon (2014) analyzed a total of 8,207 deaths from 24 states during 2004-2012
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.

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 Carpenter et al. (2013) compared infants who died of Sudden Infant Death Syndrome (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.

IN CONTEXT

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), and other research suggests that bed-sharing and co-sleeping is becoming more popular in the
United States (Colson et al., 2013). So, what are the latest recommendations?

The American Academy of Pediatrics (AAP) actually updated its recommendations for a Safe Infant Sleeping
Environment in 2022. The most recent AAP recommendations for creating a safe sleep environment include:

Back to sleep for every sleep until the child is 1 year old. 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 and overheating, including crib bumpers, blankets, pillows, and soft toys.
A crib, portable crib, play yard, or bassinet that adheres to safety standards is recommended.
Breastfeeding is recommended.
Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns one but at
least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.
Avoid the baby’s exposure to smoke, alcohol, and illicit drugs.

The recommendations also include non-inclined sleep surfaces, home cardiorespiratory monitors, tummy time,
use of cardboard boxes for sleep environment, short-term emergency locations for sleep, and much more.

 BIG IDEA

Overall, you can see that the most recent guideline is to “share a bedroom with parents” but not the same
sleeping surface. Breastfeeding is also recommended as adding protection against SIDS (which we will go
over later), 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.

 TERMS TO KNOW

Bed-Sharing
Sharing the bed with the parents, sibling(s), or both.

Room-Sharing

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 Sharing of the overall physical environment with the parents, sibling(s), or both.

Co-Sleeping
When the parents and children sleep together on the same bed.

2. 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, 2022). The three
commonly reported types of SUID are:

Sudden Infant Death Syndrome (SIDS)

Unknown cause
Accidental suffocation or strangulation in bed

2a. Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (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 1,400 infants died of SIDS in 2020
(CDC, 2022). 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).

 KEY CONCEPT

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

 TERM TO KNOW

Sudden Infant Death Syndrome (SIDS)

When the death of a healthy infant occurs suddenly and unexpectedly, and medical and forensic
investigation findings (including an autopsy) are inconclusive.

2b. Unknown Cause

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 The sudden death of an infant less than one year of age, which cannot be explained because a thorough
investigation was not conducted, and the cause of death could not be determined, falls under the unknown
cause category. Data from 2020 indicates that slightly over 1,000 infant deaths were due to unknown causes.

2c. 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.

 DID YOU KNOW

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 it was (130.3 per 100,000 live
births in 1990 versus 38.4 in 2020). However, accidental suffocation and strangulation in bed mortality rates
were unchanged until the late 1990s. Some parents were still putting newborns to sleep on their stomachs,
sometimes because of past traditions. Most SIDS victims experience several risks, through an interaction of
biological and social circumstances. However, due to research, the major risk—sleeping on your stomach—has
been highly publicized. Other causes of death during infancy include congenital birth defects and homicide.

3. Sleep Issues & Disorders

Parents report their infants exhibiting sleep problems, especially in the first two years of life (Sadeh & Anders,
1993). There are many reasons why infants may experience difficulties with their sleep, including general health
(e.g., being sick with a cold, getting a vaccine), comorbid health conditions (e.g., Down syndrome, autism),
parent behaviors (e.g., work schedules, breastfeeding, expectations), and family dynamics.

IN CONTEXT

Here are some examples of types of sleep issues that are present among infants:
Nighttime waking—disruption of sleep by waking up at night; this may be accompanied with or
without signaling, as well as with or without parental intervention to go back to sleep (Karraker,
2008).
Insomnia—difficulty falling and maintaining sleep, and can be seen through resistance at bedtime
as well as taking a long time falling asleep (Owens & Moore, 2017).
Sleep-disordered breathing—dysfunction of the upper airway during sleep with symptoms such
as snoring and/or resistance and increased effort in the upper airway (Memon & Manganaro,
2022).

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 Sleep apnea—gasping or “snorting” sounds that disrupt sleep, which may also include snoring
(CDC, 2022).
Nightmares—scary dreams that often wake up the infant during REM sleep; tend to occur later in
the night and the infant is comforted in response to the presence of the parental/caregiver (Blum
& Carey, 1996).
Night terrors—marked by screaming, sitting upright in bed, and being disoriented, afraid, and/or
confused; tend to occur earlier at night; the infant is inconsolable and usually not aware of
parental/caregiver presence (Blum & Carey, 1996).

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 (Richter et al., 2019).

 KEY CONCEPT

Individuals with Down syndrome are predisposed to health conditions including, but not limited to
congenital heart disease, hearing problems, vision problems, and hypothyroidism. Most importantly,
however, anywhere from 50 percent to 75 percent of individuals with DS are also diagnosed with
obstructive sleep apnea (OSA) (Bull & the Committee on Genetics, 2011).
It is recommended that the pediatrician discuss with parents the signs and symptoms of OSA within the first six
months of life and refer to a pediatric sleep specialist if there are any sleep concerns. Sleep health supervision
should continue, as needed, through a two-pronged approach:

1. Educating parents on monitoring and recognizing their baby’s symptoms

2. Training healthcare professionals on the sleep needs of infants with DS and addressing these concerns
early in life

 DID YOU KNOW

Polysomnography (PSG) is the golden standard for diagnosing sleep disorders.

Patients are asked to visit a clinical sleep laboratory where they are hooked up to sensors monitoring their brain
activity, respiration, heart rate, and face, eyes, and/or leg movements. PSG is not an inexpensive assessment
and there are long waiting times due to accessibility and the availability of trained professionals and certified
sleep clinics. Ambulatory PSG may possibly be an alternative to laboratory PSG, as it takes place in the natural
setting of the infant or child’s home, but there are benefits and risks associated with each.

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 Infants are non-verbal and cannot effectively communicate that they have difficulty sleeping. Therefore, it is the
parents’ and/or caregivers’ responsibility to be educated in infant sleep behaviors and patterns and to
recognize when a particular behavior or pattern is negatively impacting the baby. Parents and caregivers are
generally asked to complete questionnaires, but do you believe that they are accurate reporters of their baby’s
sleep?

We discussed different infant sleeping arrangements and some factors that can impact nighttime sleep. Imagine
the mother and baby sleeping in separate rooms throughout the night. Is the mother able to report on any and
all nighttime behaviors, especially if there are some instances where the infant is awake, but is not making loud
noises that need her intervention?

A caveat to this is the booming industry of baby monitors that can help parents and/or caregivers monitor their
babies without physically going into the room. Some parents can and may invest in a baby monitor, while others
cannot do so.

 THINK ABOUT IT

Ultimately, how can a healthcare provider get an accurate picture of an infant’s sleep? What other
individuals can provide information on the infant’s sleep?

 TERMS TO KNOW

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 Nighttime Waking
Disruption of sleep by waking up at night.

Insomnia
Difficulty falling and maintaining sleep, which can be seen through resistance at bedtime as well as
taking a long time falling asleep.

Sleep-Disordered Breathing
Dysfunction of the upper airway during sleep, with symptoms such as snoring and/or resistance and
increased effort in the upper airway.

Sleep Apnea
Gasping or “snorting” sounds that disrupt sleep.

Nightmares
Scary dreams that often wake up the infant during REM sleep, they tend to occur later in the night and
the infant is typically comforted in response to a parental/caregiver presence.

Night Terrors
Screaming, sitting upright in bed, and being disoriented, afraid, and/or confused; tend to occur earlier at
night.

Polysomnography (PSG)
The golden standard for diagnosing sleep disorders.

 SUMMARY

In this lesson, you learned about sleep arrangements. The location of a baby when they are sleeping
depends primarily on the baby’s age and culture. Babies may share a room or even their bed with their
parents or other family members. Each year in the United States, there are about 3,500 Sudden
Unexpected Infant Deaths (SUID). The three main causes of SUID are Sudden Infant Death Syndrome
(SIDS), unknown causes, and accidental suffocation and strangulation in bed. In this lesson, you also
learned about sleep issues and disorders. A few sleep issues that infants might have are insomnia,
sleepwalking, night terrors, and nightmares.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Esposito, G., Setoh, P., & Bornstein, M. H. (2015). Beyond practices and values: toward a physio-bioecological
analysis of sleeping arrangements in early infancy. Frontiers in psychology, 6, 264.

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 Colvin, J. D., Collie-Akers, V., Schunn, C., & Moon, R. Y. (2014). Sleep environment risks for younger and older
infants. Pediatrics, 134(2), e406-e412.

Carpenter, R., McGarvey, C., Mitchell, E. A., Tappin, D. M., Vennemann, M. M., Smuk, M., & Carpenter, J. R. (2013).
Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–
control studies. BMJ open, 3(5), e002299.

Sears, W. & Sears, M. (2001). The attachment parenting book: A commonsense guide to understanding and
nurturing your baby. Boston: MA: Little Brown

Moon, R. Y., Carlin, R. F., & Hand, I. (n.d.). Evidence Base for 2022 Updated Recommendations for a Safe Infant
Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Publications.aap.org. Retrieved
February 22, 2023, from publications.aap.org/pediatrics/article/150/1/e2022057991/188305/Evidence-Base-
for-2022-Updated-Recommendations-for?searchresult=1%3Fautologincheck

Centers for Disease Control and Prevention. (2022, June 28). About sids and suid. Centers for Disease Control
and Prevention. Retrieved February 22, 2023, from www.cdc.gov/sids/about/index.htm

Centers for Disease Control and Prevention. (2022, June 21). Data and statistics for SIDS and suid. Centers for
Disease Control and Prevention. Retrieved February 22, 2023, from www.cdc.gov/sids/data.htm

Sadeh, A., & Anders, T. F. (1993). Infant sleep problems: Origins, assessment, interventions. Infant mental health
Journal, 14(1), 17-34.

Karraker, K. (2008). The role of intrinsic and extrinsic factors in infant night waking. Journal of Early and
Intensive Behavior Intervention, 5(3), 108.

Weekes-Shackelford, V. A. & Shackelford, T. K. (2005). Sudden Infant Death Syndrome (SIDS). In N. J. Salkind
(Ed.), Encyclopedia of human development (pp. 1238-1239). New York: Sage Publications.

Owens, J. A., & Moore, M. (2017). Insomnia in infants and young children. Pediatric annals, 46(9), e321-e326.

Memon, J., & Manganaro, S. N. (2022). Obstructive sleep-disordered breathing. In StatPearls [Internet].
StatPearls Publishing

Centers for Disease Control and Prevention. (2022, December 14). Key sleep disorders - sleep and sleep
disorders. Centers for Disease Control and Prevention. Retrieved February 22, 2023, from
www.cdc.gov/sleep/about_sleep/key_disorders.html

Blum, N. J., & Carey, W. B. (1996). Sleep problems among infants and young children. Pediatrics in Review, 17(3),
87-92.

Richter, D., Krämer, M. D., Tang, N. K., Montgomery-Downs, H. E., & Lemola, S. (2019). Long-term effects of
pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers.
Sleep, 42(4), 1-10.

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 Bull, M. J., & Committee on Genetics. (2011). Health supervision for children with Down syndrome. Pediatrics,
128(2), 393-406.

 TERMS TO KNOW

Bed-Sharing
Sharing the bed with the parents, sibling(s), or both.

Co-Sleeping
When the parents and children sleep together on the same bed.

Insomnia
Difficulty falling and maintaining sleep, which can be seen through resistance at bedtime as well as
taking a long time falling asleep.

Night Terrors
Screaming, sitting upright in bed, and being disoriented, afraid, and/or confused; tend to occur
earlier at night.

Nightmares
Scary dreams that often wake up the infant during REM sleep, they tend to occur later in the night
and the infant is typically comforted in response to a parental/caregiver presence.

Nighttime Waking
Disruption of sleep by waking up at night.

Polysomnography (PSG)
The golden standard for diagnosing sleep disorders.

Room-Sharing
Sharing of the overall physical environment with the parents, sibling(s), or both.

Sleep Apnea
Gasping or “snorting” sounds that disrupt sleep.

Sleep-Disordered Breathing
Dysfunction of the upper airway during sleep, with symptoms such as snoring and/or resistance
and increased effort in the upper airway.

Sudden Infant Death Syndrome (SIDS)

When the death of a healthy infant occurs suddenly and unexpectedly, and medical and forensic
investigation findings (including an autopsy) are inconclusive.

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 Environmental Risks
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about various environmental risk factors impacting maternal and infant
health and well-being. Specifically, this lesson will cover:
1. Environmental Factors & Risks
2. Maternal-Level Factors
2a. Alcohol
2b. Malnutrition
2c. Tobacco
2d. Drugs
2e. Sexually Transmitted Infections
2f. Maternal Diseases
2g. Maternal Stress
3. Environmental Chemicals
4. Poverty
5. Family Stress
6. Vector-Borne Diseases
7. Climate Change

1. Environmental Factors & Risks

Environmental factors are a broad range of things in our environment that can impact our health, either in a
positive or negative manner.

 DID YOU KNOW

According to the World Health Organization, a healthy environment can prevent 1 in 4 child death,s and
environmental risks accounted for approximately 1.7 million deaths in children under 5 years of age in 2012.
Environment encompasses so many different contexts including homes, schools, hospitals, clinics, daycares,
backyards, playgrounds, office buildings, parks, and much more. Environmental risks can impact both a mother
and her infant, adolescents, and adults. These risks can affect the mother and her infant either by working alone
or simultaneously.

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 EXAMPLE Poverty alone is a significant factor in poor maternal and infant health and well-being.
Poverty, in conjunction with mental illness and minority status, may have an even bigger impact on mothers
and infants because of three risk factors working in tandem, not just one.
It is important to address environmental risks in the early years because infants and young children are a
vulnerable population. Air pollution, climate change, hazardous chemicals, and inadequate water and hygiene
are just a few risks that have a detrimental impact on infant health and development (World Health
Organization, 2023). Let’s take a look at some environmental risks for mothers and infants.

 KEY CONCEPT

It is important to note that the mother’s womb is also an environment for the developing fetus and some
factors begin their impact during pregnancy and continue beyond.

 TERM TO KNOW

Environmental Factor
A broad range of things in our environment that can impact our health, either in a positive or negative
manner.

2. Maternal-Level Factors
There are several maternal-level factors that can impact pregnancy.

2a. Alcohol
One environmental factor that begins its impact during pregnancy is alcohol. Since half of all pregnancies in the
United States are unplanned, it is recommended that women of child-bearing age take great caution against
drinking alcohol when not using birth control and when pregnant (Surgeon General’s Advisory on Alcohol Use
During Pregnancy, 2005). Alcohol consumption, particularly during the second month of prenatal development,
but at any point during pregnancy, may lead to neurocognitive and behavioral difficulties that can last
throughout the child’s lifetime.

 KEY CONCEPT

There is no acceptable safe limit for alcohol use during pregnancy, but binge drinking (5 or more drinks on
a single occasion) or having 7 or more drinks during a single week places a child at particularly high risk. In
extreme cases, alcohol consumption can lead to fetal death, but more frequently it can result in fetal
alcohol spectrum disorders (FASD). This terminology is now used when looking at the effects of exposure
and replaces the term fetal alcohol syndrome. It is preferred because it recognizes that symptoms occur on
a spectrum and that all individuals do not have the same characteristics. Children with FASD share certain
physical features such as flattened noses, small eye openings, small heads, intellectual developmental
delays, and behavioral problems. Those with FASD are more at risk for lifelong problems such as criminal
behavior, psychiatric problems, and unemployment (CDC, 2022).

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  TERMS TO KNOW

Binge Drinking
Drinking 5 or more drinks on a single occasion.

Fetal Alcohol Spectrum Disorder (FASD)

Terminology used when looking at the effects of exposure and replaces the term fetal alcohol
syndrome.

2b. Malnutrition
Pregnant women who are not getting enough calories and important micronutrients are at increased risk for
having low birth weight babies (under 2,500 grams or 5 1/2 pounds) and other complications. One vital nutrient
is folic acid, found in leafy green vegetables, legumes, egg yolk, liver, and citrus fruit (Greenberg et al., 2011).
Folic acid deficiency during pregnancy is associated with neural tube disorders, like spina bifida, where the end
of the spine does not close, and anencephaly, when the brain does not fully develop. Some common genetic
variations reduce how women metabolize folic acid, which is why women of reproductive age are
recommended to take 400 micrograms of folic acid each day (U.S. Preventive Services Task Force, 2017).

 TERMS TO KNOW

Folic Acid
Nutrient found in leafy green vegetables, legumes, egg yolk, liver, and citrus fruit.

Spina Bifida
Where the end of the spine does not close.

Anencephaly
When the brain does not fully develop.

2c. Tobacco
Smoking is a teratogen similar to alcohol because nicotine travels through the placenta to the fetus. When the
mother smokes, the developing baby experiences reduced blood oxygen levels.

 KEY CONCEPT

Tobacco use during pregnancy has been associated with low birth weight, placenta previa, birth defects,
preterm delivery, fetal growth restriction, and sudden infant death syndrome.
Smoking in the month before getting pregnant and throughout pregnancy increases the chances of these risks.

 BIG IDEA

Quitting smoking before getting pregnant is best. However, for women who are already pregnant, quitting
as early as possible can still help protect against some health problems for the mother and baby.

2d. Drugs
Prescription, over-the-counter, or recreational drugs can have serious teratogenic effects as well. In general, if
medication is required, the lowest dose possible should be used. Combination drug therapies and first-trimester

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 exposures should be avoided. Almost three percent of pregnant women use illicit drugs such as marijuana,
cocaine, ecstasy, and other amphetamines, and heroin. These drugs can cause low birth-weight, withdrawal
symptoms, birth defects, or learning or behavioral problems.

 KEY CONCEPT

Babies born with a heroin addiction need heroin just like an adult addict. The child will need to be gradually
weaned from the heroin under medical supervision; otherwise, the child could have seizures and die.

2e. Sexually Transmitted Infections

Sexually transmitted infections (STIs) are diseases caused by infection with certain bacteria, viruses, or other
microorganisms that can be passed from one person to another through blood, semen, vaginal fluids, or other
body fluids, during oral, anal, or genital sex with an infected partner .STIs can complicate pregnancy and may
have serious effects on both the mother and the developing baby. Most prenatal care today includes testing for
STIs, and early detection is important. STIs such as chlamydia, gonorrhea, syphilis, trichomoniasis, and bacterial
vaginosis can all be treated and cured with antibiotics that are safe to take during pregnancy. STIs that are
caused by viruses, like genital herpes, hepatitis B, or HIV, cannot be cured. However, in some cases these
infections can be treated with antiviral medications or other preventive measures can be taken to reduce the
risk of passing the infection to the baby.

 TERM TO KNOW

Sexually Transmitted Infections (STIs)

Diseases caused by infection with certain bacteria, viruses, or other microorganisms that can be passed
from one person to another through blood, semen, vaginal fluids, or other body fluids, during oral, anal,
or genital sex with an infected partner.

2f. Maternal Diseases

Maternal illnesses increase the chance that a baby will be born with a birth defect or have a chronic health
problem. Some of the diseases that are known to potentially have an adverse effect on the fetus include
diabetes, cytomegalovirus, toxoplasmosis, Rubella, varicella, hypothyroidism, and Strep B.

IN CONTEXT

If the mother contracts Rubella during the first three months of pregnancy, damage can occur in the
eyes, ears, heart, or brain of the unborn child. On a positive note, Rubella has been nearly eliminated
in the industrial world due to the vaccine created in 1969.

Diagnosing these diseases early and receiving appropriate medical care can help improve the outcomes.
Routine prenatal care now includes screening for gestational diabetes and Strep B.

2g. Maternal Stress

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 Stress represents the effects of any factor able to threaten the homeostasis of an organism; these either real or
perceived threats are referred to as “stressors” and comprise a long list of potential adverse factors, which can
be emotional or physical. Because of a link in blood supply between a mother and fetus, it has been found that
stress can leave lasting effects on a developing fetus, even before a child is born. The best-studied outcomes
of fetal exposure to maternal prenatal stress are preterm birth and low birth weight. Maternal prenatal stress is
also considered responsible for a variety of changes of the child’s brain, and a risk factor for conditions such as
behavioral problems, learning disorders, high levels of anxiety, attention deficit hyperactivity disorder, autism,
and schizophrenia. Furthermore, maternal prenatal stress has been associated with a higher risk for a variety of
immune and metabolic changes in the child such as asthma, allergic disorders, skin illnesses, general health
complaints, cardiovascular diseases, hypertension, diabetes, and obesity (Beijers, Jansen, Riksen-Walraven, &
de Weerth, 2010; Eberle, Fasig, Brueseke, & Stichling, 2021).

 TERM TO KNOW

Stressors
The effects of any factor able to threaten the homeostasis of an organism; can be either real or
perceived threats.

3. Environmental Chemicals
Environmental chemicals can include exposure to a wide array of agents including pollution, organic mercury
compounds, herbicides, and industrial solvents. Some environmental pollutants of major concern include lead
poisoning, which is connected with low birth weight and slowed neurological development. Children who live in
older housing in which lead-based paints have been used have been known to eat peeling paint chips thus
being exposed to lead. The chemicals in certain herbicides are also potentially damaging. Radiation is another
environmental hazard that a pregnant woman must be aware of. If a mother is exposed to radiation, particularly
during the first three months of pregnancy, the child may suffer some congenital deformities. There is also an
increased risk of miscarriage and stillbirth. Mercury leads to physical deformities and intellectual disabilities
(Dietrich, 1999).

4. Poverty
Poverty is a significant environmental factor that has been continuously shown to impact outcomes across the
lifespan. From 1964 to 2012, the national poverty rate in the United States fluctuated but did not improve (23%
and 22%, respectively) (Murphey & Redd, 2014). There is also evidence of racial/ethnic disparities in poverty
rates because the rates for Hispanic children and Black children are much higher at 34% and 39%, respectively.

Murphey & Redd (2014) highlight the following ways in which poverty negatively impacts development:

1. Damages the brain and overall body (e.g., changes in brain architecture, increased risk for chronic
diseases, etc.)

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 2. Creates and further increases the achievement gap (e.g., delays in social-emotional development, reading
ability, executive functioning, attending post-secondary education, etc.)
3. Poor behavioral, mental, physical, and emotional outcomes (e.g., increased risk for food insecurity, less
likelihood to obtain health care and preventative services, etc.)
4. Poor social, academic, health, and other outcomes in part due to concentrated poverty.
5. Secondary outcomes resulting from stress and poor mental health of parents (e.g., poor parents have
limited resources so children tend to have fewer books, educational resources, enrichment opportunities,
etc.)

5. Family Stress
While maternal stress is an environmental factor we already discussed above, the larger family environment can
be supportive and/or stressful, depending on the circumstances. An important concept to consider is the
separation or divorce of families during the infancy period. When the separation or divorce is high in conflict,
then the infant’s physical, mental, social, emotional, and developmental well-being may be jeopardized.

Solomon & George (1999) conducted a systematic review of infant (ages 12-20 months old) attachment between
separated/divorced families and dual-parent families. Results indicated a negative impact on infant attachment
when there was overnight visitation with the father. Specifically, when an infant had overnight visits with their
father, they were less likely to be securely attached and more likely disorganized and unclassified in their
attachment to their mothers. They also found that when the visitation conditions were poor (e.g., inadequate
psychological support for the infant, high parent conflict, low parent communication, etc.) then the mother-infant
attachment was most impacted. This is not to say a specific form of visitation or parenting time is better than the
other (e.g., more time with one parent, deviates from equal time with both parents, etc.) but there are context-
and family-dependent factors such as history of caregiving that impact the infant’s environment and
developmental well-being.

IN CONTEXT

A potentially high conflict situation can arise during separation or divorce when an infant is involved
and if they are breastfeeding. Every state and, even counties, have different ways to address
parenting time issues when breastfeeding is involved.

This is a highly debatable topic because it intersects with how the legal community views parental rights and
whether breastfeeding is really necessary.

EXAMPLE On one hand, the mother breastfeeds because she knows it is best for her baby and wants
to continue doing so for at least the first year, if not more. On the other hand, the father cannot obviously
breastfeed but may want to spend additional time.
In the eyes of the court, this scenario can be misunderstood as a mother purposely interfering with the father’s
rights even if that is not the case and she is trying to provide only what is best for her baby.

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  THINK ABOUT IT

What are your initial thoughts about breastfeeding in divorced/separated families?

6. Vector-Borne Diseases
Vector-borne diseases are defined as health conditions among humans that are passed on by vectors (World
Health Organization, 2020). Vectors are organisms that have the ability to infect humans and/or animals with
infectious pathogens (World Health Organization, 2020). Examples of vector-borne diseases are malaria,
dengue, yellow fever, Zika virus, leishmaniasis, and chikungunya.

Mosquitoes are a common vector and the Anopheline mosquito transmits malaria while the Aedes mosquito
transmits dengue. Vector-borne diseases are a huge public health focus because they can be prevented
through awareness, education, and protective measures.

 DID YOU KNOW

There were 247 million cases of malaria globally in 2021 with approximately 619,000 deaths (World Health
Organization, 2022).
The breeding ground for mosquitoes is standing water because it helps with larvae and pupae growth. An
infected mosquito passes the parasite during a blood meal. In other words, when it bites a human the parasite
is passed into the human’s bloodstream. One of the many strategies to reduce malaria rates, especially among
developing countries, is to eliminate areas of standing water, specifically near homes and people. With no
breeding ground, the risk of malaria reduces. Other strategies to avoid getting bitten by a mosquito include, but
are not limited to, medications, pesticides, mosquito nets, and insect repellent.

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 While the prevalence of malaria remains extremely high in the African region, the United States also has its
share of tick-borne (e.g., Lyme disease) and mosquito-borne diseases (e.g., West Nile virus) (Rosenberg et al.,
2018; World Health Organization, 2022). According to data collected from the National Notifiable Diseases
Surveillance System (NNDSS), the United States reported nine new vector-borne diseases from 2004 to 2016
(Rosenberg et al. 2018). In addition to these vector-borne diseases, research indicated that some diseases were
not as common as in the past yet they remain a global threat for three main reasons:

1. High fatality rate (e.g., Eastern equine encephalitis)

2. Ability to cause epidemics (e.g., St. Louis encephalitis virus)

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 3. Likelihood of being bioterror agents (e.g., plague).

 BIG IDEA

The presence of vector-borne diseases in the United States is a growing public health concern and their
patterns are impacted by climate change which we discuss next.

 TERMS TO KNOW

Vector-Borne Diseases
Health conditions among humans that are passed on by vectors.

Vector
Organisms that have the ability to infect humans and/or animals with an infectious pathogen.

7. Climate Change
 DID YOU KNOW

Developing nations, also referred to as third-world countries, are not as well-equipped as other countries to
timely and effectively address and respond to events and/or diseases attributed to climate change (World
Health Organization, 2021).
Climate change is a broad term to describe long-term changes in global patterns, weather, temperature, and
other climate-related phenomena. At the time of writing this lesson, climate change is debated worldwide but
evidence indicates this to be a huge threat. It is the driving force behind issues such as unclean and polluted air,
unsafe drinking water, food insecurity, temperature-related illnesses, vector-borne diseases, and much more
(World Health Organization, 2021). Furthermore, it has led to the emergence of pathogenic diseases: 58% of
infectious diseases worldwide are related to climate change effects (Mora et al., 2022).

An example of how climate change can impact infant health can be found in heat-related illnesses.

EXAMPLE When temperatures continue to increase beyond normal levels in a region, the mother and
surrounding individuals responsible for the health and safety of the community (e.g., government, public
health workers, healthcare professionals, etc.) must be able to recognize, evaluate, and treat conditions
such as dehydration, heat stroke, or heat exhaustion.

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  TERM TO KNOW

Climate Change
A broad term to describe long-term changes in global patterns, weather, temperature, and other
climate-related phenomena.

 SUMMARY

In this lesson, you learned about various environmental factors and risks. You first learned about
maternal-level factors which impact the infant while they are in the mother’s womb. Since the womb is
an environment and the mother’s behaviors impact the developing baby, these are also considered
environmental risks. These factors include alcohol, malnutrition, tobacco, drugs, sexually transmitted
infections, maternal diseases, and maternal stress. Next, you learned about how environmental
chemical exposure (e.g., lead, herbicides, radiation) can impact infants and young children. You then
learned about five significant ways in which poverty can affect infant developmental outcomes. Larger
family stress and dynamics, not just specific to the mother, can influence decisions involving the baby
(e.g., breastfeeding duration). You also learned about vector-borne diseases and climate change, both
of which are becoming increasingly relevant in today’s society.

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REFERENCES

Mora, C., McKenzie, T., Gaw, I. M., Dean, J. M., von Hammerstein, H., Knudson, T. A., ... & Franklin, E. C. (2022).
Over half of known human pathogenic diseases can be aggravated by climate change. Nature climate change,
12(9), 869-875.

World Health Organization. (n.d.). Climate change and health. World Health Organization. Retrieved February 27,
2023, from www.who.int/news-room/fact-sheets/detail/climate-change-and-health

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 Rosenberg, R., Lindsey, N. P., Fischer, M., Gregory, C. J., Hinckley, A. F., Mead, P. S., ... & Petersen, L. R. (2018).
Vital signs: trends in reported vectorborne disease cases—United States and Territories, 2004–2016. Morbidity
and Mortality Weekly Report, 67(17), 496.

World Health Organization. (n.d.). Fact sheet about malaria. World Health Organization. Retrieved February 27,
2023, from www.who.int/news-room/fact-sheets/detail/malaria

World Health Organization. (n.d.). Vector-borne diseases. World Health Organization. Retrieved February 27,
2023, from www.who.int/news-room/fact-sheets/detail/vector-borne-diseases

Solomon, J., & George, C. (1999). The development of attachment in separated and divorced families: Effects of
overnight visitation, parent and couple variables. Attachment & Human Development, 1(1), 2-33.

Murphey, D., & Redd, Z. (2020, July 8). 5 Ways Poverty Harms Children. Child Trends. Retrieved February 27,
2023, from www.childtrends.org/publications/5-ways-poverty-harms-children

Dietrich, K. N. (1999). Environmental toxicants and child development. In Tager-Flusberg (Ed.),

Neurodevelopmental disorders (pp. 469-490). Boston: MIT Press.

US Preventive Services Task Force. (2017). Folic acid supplementation for the prevention of neural tube defects:
US Preventive Services Task Force recommendation statement. JAMA, 317(2). 183–189.
www.doi.org/10.1001/jama.2016.19438

Greenberg, J. A., Bell, S. J., Guan, Y., & Yu, Y-h. (2011). Folic acid supplementation and pregnancy: More than just
neural tube defect prevention. Reviews in Obstetrics & Gynecology, 4(2), 52–59.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/

Advisory on alcohol use in pregnancy - centers for Disease Control and ... (n.d.). Retrieved February 27, 2023,
from www.cdc.gov/ncbddd/fasd/documents/sg-advisory.pdf

World Health Organization. (n.d.). Social Determinants of Health. World Health Organization. Retrieved February
27, 2023, from www.who.int/health-topics/social-determinants-of-health

World Health Organization. (n.d.). Children's Environmental Health. World Health Organization. Retrieved
February 27, 2023, from www.who.int/health-topics/children-environmental-health

Beijers, R., Jansen, J., Riksen-Walraven, M., & de Weerth, C. (2010). Maternal prenatal anxiety and stress predict
infant illnesses and health complaints. Pediatrics, 126(2), e401-e409.

Eberle, C., Fasig, T., Brueseke, F., & Stichling, S. (2021). Impact of maternal prenatal stress by glucocorticoids on
metabolic and cardiovascular outcomes in their offspring: a systematic scoping review. PLoS One, 16(1),
e0245386.

Centers for Disease Control and Prevention. (2022, November 14). FASDs: Research. Centers for Disease
Control and Prevention. Retrieved March 2, 2023, from www.cdc.gov/ncbddd/fasd/research.html

 TERMS TO KNOW

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 Anencephaly
When the brain does not fully develop.

Binge Drinking
Drinking 5 or more drinks on a single occasion.

Climate Change
A broad term to describe long-term changes in global patterns, weather, temperature, and other
climate-related phenomena.

Environmental Factor
A broad range of things in our environment that can impact our health, either in a positive or
negative manner.

Fetal Alcohol Spectrum Disorder (FASD)

Terminology used when looking at the effects of exposure and replaces the term fetal alcohol
syndrome.

Folic Acid
Nutrient found in leafy green vegetables, legumes, egg yolk, liver, and citrus fruit.

Sexually Transmitted Infections (STIs)

Diseases caused by infection with certain bacteria, viruses, or other microorganisms that can be
passed from one person to another through blood, semen, vaginal fluids, or other body fluids,
during oral, anal, or genital sex with an infected partner.

Spina Bifida
Where the end of the spine does not close.

Stressors
The effects of any factor able to threaten the homeostasis of an organism; can be either real or
perceived threats.

Vector
Organisms that have the ability to infect humans and/or animals with an infectious pathogen.

Vector-Borne Diseases
Health conditions among humans that are passed on by vectors.

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 Introduction to Infant Development
by Sophia

 WHAT'S COVERED

In this lesson, you will learn the importance of studying infant development and, in particular, how to
study it from a research lens. Specifically, this lesson will cover:
1. Introduction to Infant Development
2. Research in Infant Development
3. How Do We Know What We Know?
3a. Personal Knowledge
3b. Scientific Methods
4. Challenges Associated with Conducting Developmental Research
4a. Ethical Concerns
4b. Recruitment
4c. Attrition

1. Introduction to Infant Development

Did you ever wonder how babies grow from tiny, helpless infants into well-developed and independent adults?
It doesn’t happen overnight, but the process begins right from day one. Infancy is a time when tremendous
growth, coordination, and mental development occur. Most infants learn to walk, manipulate objects, and form
basic words by the end of infancy. By about 4 months, a baby will usually have doubled its birth weight and will
have tripled its birth weight by the first year. By the age of 2, a baby’s weight will have quadrupled!

Researchers have given this part of the lifespan more attention than any other period, perhaps because
changes during this time are so dramatic and noticeable. We know that much of what happens during these
years provides a foundation for one’s life to come; however, it has been argued that the significance of
development during these years has been overstated (Bruer, 1999). Nevertheless, this is a period of life that
contemporary educators, healthcare providers, and parents have focused on quite heavily. It is also a time
period that can be tricky to study—how do we learn about infant speech when they cannot articulate their
thoughts or feelings?

EXAMPLE Through research we know that infants understand speech much earlier than their bodies
have matured enough to physically perform it; thus it is evident that their speech patterns develop before
the physical growth of their vocal cords is adequate to facilitate speech.

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 In this lesson, we will begin examining the rapid physical growth and development of infants, look at the
influences on physical growth and cognitive development, then turn our attention toward emotional and social
development in the early years of life. Before going in-depth, however, let’s take a look at how we have come to
the following conclusion: the early years are a critical window where rapid physical, cognitive, social, and
emotional development have a direct effect on a baby’s overall development and the adult they will become.

2. Research in Infant Development

 THINK ABOUT IT

How do we know what changes and stays the same (and when and why) over our lifespan?
We rely on research that utilizes the scientific method so that we can have confidence in the findings. How data
is collected may vary by age group (e.g., infants vs. adolescents) and by the type of information sought. The
developmental design (for example, following individuals as they age over time or comparing individuals of
different ages at one point in time) will affect the data and the conclusions that can be drawn from them about
actual age changes.

Infants communicate in different ways because they are mostly non-verbal. Until they have learned a language,
they may use gestures, eye contact, emotional states, and much more to communicate with people around
them. The experiences of an infant in the early years is significant to their development and much of this is
dictated by how people around the infant respond to him/her.

EXAMPLE When an infant keeps pulling at their ears, then it may be a sign of an ear infection. Or, when
an infant is tugging at their mother’s breast, then they are hungry for milk.

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 The baby is using gestures of the hand outward and may be reaching for their parent or caregiver. It may also be a

gesture for someone to come close to them.

3. How Do We Know What We Know?

An important part of learning any science, let alone lifespan development, is having a basic knowledge of the
techniques used in gathering information. The hallmark of scientific investigation is that of following a set of
procedures designed to keep questioning or skepticism alive while describing, explaining, or testing any
phenomenon. Science involves continuously renewing our understanding of the subjects in question and an
ongoing investigation of how and why events occur. It is a vehicle for going on a never-ending journey. In the
area of infant development, we have seen changes in recommendations for nutrition, explanations of socio-
emotional states, and in parenting advice.

3a. Personal Knowledge

One way that we know information is through personal knowledge.

EXAMPLE Imagine yourself as a baby and how you might have reacted to strangers. Or maybe your
family went on a vacation and you had to adjust to living in a hotel for a week. Chances are you know these
things based on your own experience if you can remember it (experiential reality), what others have told

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 you, or cultural ideas or agreement reality (ideas and beliefs that members of a group such as a society or
culture typically accept as true) (Seccombe & Warner, 2004).
There are several problems with a personal inquiry or drawing conclusions based on our personal experiences.

An issue with personal inquiry is the inherent tendency to see what we believe. Our assumptions very often
guide our perceptions. Consequently, when we believe something, we tend to see it even if it is not there. This
problem may just be a result of cognitive ‘blinders,’ or it may be part of a more conscious attempt to support our
own views. Confirmation bias is the tendency to look for evidence that we are right and in so doing, ignore
contradictory evidence. Science offers a more systematic way to make comparisons and guard against bias.

IN CONTEXT

Now, can we directly ask infants what they are feeling and expect them to answer without any
problems? Most likely not. Why? Because infants cannot recognize, understand, and relay this
information to us without us making any assumptions. Therefore, instead of personal knowledge, we
use scientific inquiry or methods to help answer research questions and understand the youngest
members of our society.

 TERMS TO KNOW

Experiential Reality
Something you have experienced that you know is true.

Agreement Reality
Ideas and beliefs that members of a group such as a society or culture typically accept as true.

Confirmation Bias
The tendency to look for evidence that we are right.

3b. Scientific Methods

The particular method used to conduct research may vary by discipline. Since lifespan development is
multidisciplinary, more than one method may be used to study human development.

 STEP BY STEP

One method of scientific investigation involves the following steps:

1. Determining a research question
2. Reviewing previous studies addressing the topic in question (known as a literature review)
3. Determining a method of gathering information
4. Conducting the study
5. Interpreting the results
6. Drawing conclusions; stating limitations of the study and suggestions for future research

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 7. Making the findings available to others (both to share information and to have the work scrutinized by
others)

The findings of these scientific studies can then be used by others as they explore the area of interest. Through
this process, a literature or knowledge base is established. This model of scientific investigation presents
research as a linear process guided by a specific research question. It typically involves quantitative research,
which relies on numerical data or statistics to understand and report what has been studied.

 DID YOU KNOW

When you learned about attachment in an earlier lesson, Ainsworth’s Strange Situation Paradigm was
presented. Researchers looked at the behaviors of infants and mothers under certain environmental
conditions. This is a type of quantitative research method.
Quantitative research can come in many forms when we are investigating infant development. One method is
through surveys and/or questionnaires completed by a proxy, such as a parent, caregiver, and/or teacher.
Obviously, infants cannot engage in self-report so the aforementioned individuals can help shed light on infant
developmental outcomes. However, one issue with this method is the accuracy of information provided
depending on certain factors (e.g., variables of interest, who spends the most time with the child, etc.).

Another quantitative method that we can utilize to gain insight into infant development is the habituation
paradigm that assesses the difference between a familiar and novel stimulus. Infants are active participants and
may sometimes sit on a parent and/or caregiver’s lap or even a car seat situated across from a large screen, etc.
The parent and/or caregiver is instructed to not cue their baby to anything that happens during the study and
may sometimes be asked to wear dark glasses to prevent interference. Infants are then shown a stimulus (e.g.,
image) for a specified period of time and frequency. Habituation occurs when an infant’s looking time begins to
decrease over time. There are many variations of how habituation helps us learn about infant cognition but it is
an effective method depending on what aspect of cognition we are interested in studying (Turk-Browne, Scholl,
& Chun, 2008).

 STEP BY STEP

Another model of research, referred to as qualitative research (collecting and analyzing non-numerical data
to understand concepts, opinions, or experiences), may involve steps such as these:
1. Begin with a broad area of interest and a research question
2. Gain entrance into a group to be researched
3. Gather field notes about the setting, the people, the structure, the activities, or other areas of interest
4. Ask open-ended, broad “grand tour” types of questions when interviewing subjects
5. Modify research questions as the study continues
6. Note patterns or consistencies
7. Explore new areas deemed important by the people being observed
8. Report findings

Similar to quantitative research, there are multiple ways of collecting qualitative data (e.g., interviews, open-
ended questionnaires, focus groups, etc.). Each method has its own strengths and limitations. When looking at

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 opportunities for infants to engage in play, community members and stakeholders can be interviewed to
determine ‘open play’ spaces throughout the community.

Observational studies, also called naturalistic observation, involve watching and recording the actions of
participants. This may take place in a natural setting (such as observing children at play in a park), or behind a
one-way glass while children are at play in a laboratory playroom. The researcher may follow a checklist and
record the frequency and duration of events (perhaps how many conflicts occur among 2-year-olds), or may
observe and record as much as possible about an event as a participant.

 BIG IDEA

In general, observational studies have the strength of allowing the researcher to see how people behave
rather than relying on self-report. One weakness of self-report studies is that what people do and what they
say they do are often very different. A major weakness of observational studies is that they do not allow the
researcher to explain causal relationships. Yet, observational studies are useful and widely used when
studying children. It is important to remember that most people tend to change their behavior when they
know they are being watched (known as the Hawthorne effect) and children may not survey well.

 TERMS TO KNOW

Literature Review
Reviewing previous studies addressing the topic in question.

Quantitative Research
Research which relies on numerical data or statistics to understand and report what has been studied.

Habituation Paradigm
Assesses the difference between a familiar and novel stimulus.

Qualitative Research
Collecting and analyzing non-numerical data to understand concepts, opinions, or experiences.

Observational Studies
Research that involves watching and recording the action of participants.

Hawthorne Effect
When one changes their behavior when they know they are being watched.

4. Challenges Associated with Conducting

Developmental Research
Before anyone begins conducting developmental research, regardless of the developmental period, they must
also be aware that testing individuals of certain ages (such as infants and children) or making comparisons
across ages (such as children compared to teens) comes with its own unique set of challenges. Let’s briefly look

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 at some of the main issues that are encountered when conducting developmental research, namely ethical
concerns, recruitment issues, and participant attrition.

4a. Ethical Concerns

You may already know that Institutional Review Boards (IRBs) (typically a panel of experts who read and
evaluate proposals for research) must review and approve all research projects that are conducted at
universities, hospitals, and other institutions, and that each broad discipline or field, such as psychology or
social work, often has its own code of ethics that must also be followed, regardless of institutional affiliation.

IRB members want to ensure that the proposed research will be carried out ethically and that the potential
benefits of the research outweigh the risks and potential harm (psychological as well as physical) to
participants.

 KEY CONCEPT

The IRB considers some groups of participants to be more vulnerable or at-risk than others. Whereas
university students are generally not viewed as vulnerable or at-risk, infants and young children commonly
fall into this category. What makes infants and young children more vulnerable during research than young
adults? One reason infants and young children are perceived as being at increased risk is due to their
limited cognitive capabilities, which makes them unable to state their willingness to participate in research
or tell researchers when they would like to drop out of a study. For these reasons, infants and young
children require special accommodations as they participate in the research process. Similar issues and
accommodations would apply to adults who are deemed to be of limited cognitive capabilities.
When thinking about special accommodations in developmental research, consider the informed consent
process. As part of this process, participants are informed of the procedures to be used in the research, along
with any expected risks or benefits. Infants and young children cannot verbally indicate their willingness to
participate, much less understand the balance of potential risks and benefits. As such, researchers are often
required to obtain written informed consent from the parent or legal guardian of the child participant, an adult
who is almost always present as the study is conducted.

 DID YOU KNOW

Children are not asked to indicate whether they would like to be involved in a study until they are
approximately 7 years old. Similar to adult consent, an assent form is for any minor (less than 18 years old)
and provides them with information about the research study and indicates their willingness to participate.
Depending on the child’s age and maturity, the child is asked to write their name on the assent form.
Since infants and young children cannot easily indicate if they would like to discontinue their participation in a
study, researchers must be sensitive to changes in the state of the participant (determining whether a child is
too tired or upset to continue) as well as to parent desires (in some cases, parents might want to discontinue
their involvement in the research). In adult studies, researchers must always strive to protect the rights and well-
being of the minor participants and their parents when conducting developmental research.

 TERMS TO KNOW

Institutional Review Boards (IRBs)

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 Typically a panel of experts who read and evaluate proposals for research.

Assent Form
A form for any minor (less than 18 years old) and provides them with information about the research
study and indicates their willingness to participate.

4b. Recruitment
An additional challenge in developmental science is participant recruitment. Recruiting university students to
participate in adult studies is typically easy. Many colleges and universities offer extra credit for participation in
research and have locations such as bulletin boards and school newspapers where research can be advertised.
However, young children cannot be recruited by making announcements in courses, by posting ads on
campuses, or through online platforms.

 BRAINSTORM

Given the limitations of recruiting infants for research, how do you think researchers go about finding
infants and young children to be in their studies?
The answer to this question varies along multiple dimensions.

Researchers must consider the number of participants they need and the financial resources available to
them, among other things.
Location may also be an important consideration. Researchers who need large numbers of infants and
children may attempt to recruit them by obtaining infant birth records from the state, county, or province in
which they reside.
Researchers can choose to pay a recruitment agency to contact and recruit families for them.
More economical recruitment options include posting advertisements and fliers in locations frequented by
families, such as mommy-and-me classes, local malls, and preschools or daycare centers.
Researchers can also utilize online social media outlets like Facebook, which allows users to post
recruitment advertisements for a small fee.

 BIG IDEA

Any type of recruiting requires IRB approval. If children are recruited and/or tested in school settings,
permission would need to be obtained ahead of time from teachers, schools, and school districts (as well as
informed consent from parents or guardians).

4c. Attrition
Another important consideration when conducting research with infants and young children is attrition or study
dropout rate. Although attrition is quite common in longitudinal research in particular, it is also problematic in
developmental science more generally, as studies with infants and young children tend to have higher attrition
rates than studies with adults.

EXAMPLE High attrition rates in ERP (event-related potential, which is a technique to understand brain
function) studies oftentimes result from the demands of the task: infants are required to sit still and have a

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 tight, wet cap placed on their heads before watching still photographs on a computer screen in a dark,
quiet room.
In other cases, attrition may be due to motivation or a lack thereof. Whereas adults may be motivated to
participate in research in order to receive money or extra course credit, infants and young children are not as
easily enticed. In addition, infants and young children are more likely to tire easily, become fussy, and lose
interest in the study procedures than are adults. For these reasons, research studies should be designed to be
as short as possible: it is likely better to break up a large study into multiple short sessions rather than cram all
of the tasks into one long visit to the lab. Researchers should also allow time for breaks in their study protocols
so that infants can rest or have snacks as needed. Happy, comfortable participants provide the best data.

 BIG IDEA

Infant development is a fascinating field of study, but care must be taken to ensure that researchers use
appropriate methods to examine human behavior, use the correct experimental design to answer their
questions, and be aware of the special challenges that are part-and-parcel of developmental research.

 TERM TO KNOW

Attrition
The study dropout rate.

 SUMMARY

In this lesson, you were provided with an introduction to infant development. Since infant development
has been given more attention than any other developmental period, it is important to understand how
research in infant development is conducted. In other words, how do we know what we know when it
comes to infants’ physical, cognitive, psychosocial, and emotional well-being? There are two ways of
knowing: personal knowledge and scientific methods. While personal knowledge has its own
strengths, it does not necessarily apply to infants as they are non-verbal and communicate in different
ways (e.g., gestures, babbling, showing emotions, etc.). This is where rigorous scientific methods
categorized under quantitative research and qualitative research are explored.

You also learned about three challenges associated with conducting developmental research during
the infancy period: 1) ethical concerns (the nonexistent ability of infants to independently consent to a
research study; 2) recruitment (targeting parents or caregivers in study recruiting methods considering
that infants cannot read ads, etc.); and 3) attrition (a research study may require infants to sit still for
periods of time or wear something on their head which is difficult for them).

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

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 REFERENCES

Iannelli, V. (2018). What Parents Need to Know About Baby Weight Trends and Newborn Gaining. Retrieved from
www.verywellfamily.com/baby-birth-weight-statistics-2633630

Huelke D. F. (1998). 'An Overview of Anatomical Considerations of Infants and Children in the Adult World of
Automobile Safety Design. Annual Proceedings / Association for the Advancement of Automotive Medicine, 42,
93–113.

Bruer, J. T. (1999). The myth of the first three years: A new understanding of early brain development and
lifelong learning. New York: Simon and Schuster.

Turk-Browne, N. B., Scholl, B. J., & Chun, M. M. (2008). Babies and brains: habituation in infant cognition and
functional neuroimaging. Frontiers in human neuroscience, 16.

 TERMS TO KNOW

Agreement Reality
Ideas and beliefs that members of a group such as a society or culture typically accept as true.

Assent Form
A form for any minor (less than 18 years-old) and provides them with information about the research
study and indicates their willingness to participate.

Attrition
The study dropout rate.

Confirmation Bias
The tendency to look for evidence that we are right.

Experiential Reality
Something you have experienced that you know is true.

Habituation Paradigm
Assesses the difference between a familiar and novel stimulus.

Hawthorne Effect
When one changes their behavior when they know they are being watched.

Institutional Review Boards (IRBs)

Typically a panel of experts who read and evaluate proposals for research.

Literature Review
Reviewing previous studies addressing the topic in question.

Observational Studies

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 Research that involves watching and recording the action of participants.

Qualitative Research
Collecting and analyzing non-numerical data to understand concepts, opinions or experiences.

Quantitative Research
Research which relies on numerical data or using statistics to understand and report what has been
studied.

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 Physical Development in Infancy
by Sophia

 WHAT'S COVERED

In this lesson, you will begin learning about the infancy period by first examining physical growth and
development. Specifically, this lesson will cover:
1. Overall Physical Growth
1a. Monitoring Physical Growth
1b. Body Proportions
2. The Brain in the First Two Years

1. Overall Physical Growth

Physical development starts at birth and continues as we grow older. It is a period of rapid growth during
infancy, not only in observable changes like height and weight, but also in brain development. At birth, infants
are equipped with a number of reflexes, which are involuntary movements in response to stimulation. These
involuntary reflexes are eventually modified through experiences to become voluntary movements and the
basis for motor development as skills emerge that allow an infant to grasp food, roll over, and take the first step.

In this lesson, we will examine physical development on a broader level, while in the next unit we will address
different aspects of development in the early years of life (e.g., language, motor, sensory, etc.).

 TERM TO KNOW

Reflexes
Involuntary movements in response to stimulation.

1a. 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 charted on a graph and
compared to previous numbers. Often, measurements are expressed as a percentile (a point on a ranking scale
of 0 to 100; the 50th percentile is the midpoint), which compares each baby to other babies the same age
and/or gender.

EXAMPLE Weight at the 40th percentile means that 40 percent of all babies weigh less, and 60 percent
weigh more than that baby. For any baby, pediatricians and parents can be alerted to possible concerns

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 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, or a
decelerated or arrested physical growth in which height and weight measurements fall below the third or fifth
percentile, or a downward change in growth across two major growth percentiles. This is associated with
abnormal growth and development, 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.

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  TERMS TO KNOW

Percentile
A point on a ranking scale of 0 to 100. The 50th percentile is the midpoint; half of the infants in the
population being studied rank higher and half rank lower.

Failure to Thrive
Decelerated or arrested physical growth in which height and weight measurements fall below the third
or fifth percentile, or a downward change in growth across two major growth percentiles. This is
associated with abnormal growth and development.

1b. Body Proportions

Another dramatic physical change that takes place in the first several years of life is a change in body
proportions.

 DID YOU KNOW

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 (Huelke, 1998). 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 their head,
you know how much of a challenge this is.

 KEY CONCEPT

Physical growth in infants can be impacted by many factors, one of which is infant massage. There are
many benefits to infant massage:
1. Stimulates growth (Heath & Bainbridge, 2004)
2. Facilitates mother-infant relationship (Bagshaw & Fox, 2005)
3. Helps with recovery when infant is sick (Abdallah, Kurdahi, & Hawwari, 2013)
4. Increases sleep duration and reduces frequency and duration of night wakings (Hartanti, Salimo, &
Widyaningsih, 2019)

Gultom, Sinaga, & Sianipar (2019) looked at the impact of infant massage on physical development among
babies in rural Indonesia. Mothers were placed into two groups: 1) the intervention group and 2) the control
group (those receiving no intervention). The actual intervention included infant massage training for four
consecutive days, a notebook for growth monitoring (e.g., length, weight, upper arm circumference, suckling
duration, and suckling frequency), and an information leaflet about infant massage. Mothers were trained to
massage the infant for 25 minutes using baby oil and begin on the face followed by the chest, abdomen, arms,
and back of the head. Key to the massaging technique was maintaining eye contact between the mother and
her baby.

Results showed significant differences between the intervention and control groups on body length, body
weight, and suckling frequency. The maximum weight gain was different, 1000 grams (2.2 pounds) versus 700
grams (1.5 pounds), in the intervention and control groups, respectively. Moreover, a pattern was observed

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 where growth is similar in the first two weeks but there is a significant increase in body length from Weeks 3 to
4 in the intervention group.

 BIG IDEA

This study highlights the benefits of infant massage to help promote physical health and suckling
characteristics. While in some Eastern cultures infant massage is common, in Western cultures this is a
relatively new concept (Cooke, 2015). Regardless of one’s background, all infants benefit from massages
and it can be done anytime. Therefore, educating and training mothers and/or caregivers becomes an
integral part of this process.

2. The Brain in the First Two Years

 DID YOU KNOW

Some of the most dramatic physical changes that occur during the infancy period are in the brain. At birth,
the brain is about 25 percent of its adult weight, which 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.

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 Brain imaging, specifically magnetic resonance imaging (MRI), shows how similar regions are activated by adult
brains and infant brains while looking at either scenes or faces. As early as 4-6 months of age, infants utilize
areas similar to adults to process information (Deen et al., 2017).

IN CONTEXT

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 (fibers that extend from the neurons and transmit electrochemical impulses) and
dendrites (connections between neurons). 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 (the intersection between the axon of one neuron to the dendrites of another neuron), 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 (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 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 the mastery of more complex skills (De Bot, 2006; Sakai, 2020). Transient
exuberance occurs during the first few years of life, and pruning continues through childhood and into
adolescence in various areas of the brain.

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 This is an image of the different parts of a neuron with its cell body and extended branches, an extended axon, and
the myelin sheath. The gap between the myelin sheaths is called the Node of Ranvier.

Most of the neural activity is occurring in the cortex or the thin outer covering of the brain involved in voluntary
activity and thinking. The cortex is divided into two hemispheres, and each hemisphere is divided into four
lobes, each separated by folds known as fissures. If we look at the cortex starting at the front of the brain and
moving over the top, we see first the frontal lobe (behind the forehead), which is responsible primarily for
thinking, planning, memory, and judgment. Following the frontal lobe is the parietal lobe, which extends from
the middle to the back of the skull and which is responsible primarily for processing information about touch.
Next is the occipital lobe, at the very back of the skull, which processes visual information. Finally, in front of the
occipital lobe, between the ears, is the temporal lobe, which is responsible for hearing and language.

The prefrontal cortex, located behind the forehead, continues to grow and mature throughout childhood and
experiences an additional 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, plan activities, 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 speeds the rate of transmission
of impulses from one cell to another. This enhances the building of neural pathways and improves coordination

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 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.

 DID YOU KNOW

Infants with autism spectrum disorder (ASD) display a significant and rapid increase in head circumference
in comparison to infants with pervasive developmental disorder not otherwise specified (PDD-NOS) during
the first two years of life (Courchesne, Redcay, & Kennedy, 2004).
Using the Centers for Disease Control & Prevention norms, the head circumference of infants with ASD was at
the 25th and 84th percentile, at birth and 6-14 months of age, respectively. By the time the infants were two
years of age, brain growth was almost largely complete. Differences in brain volumes and other
neuroanatomical abnormalities also became evident in autistic toddlers between 2-5 years of age.

 TERMS TO KNOW

Neurons
Nerve cells in the central nervous system, especially in the brain.

Axons
Fibers that extend from the neurons and transmit electrochemical impulses from that neuron to the
dendrites of other neurons.

Dendrites
Fibers that extend from neurons and receive electrochemical impulses transmitted from other neurons
via their axons.

Synapses
The intersection between the axon of one neuron to the dendrites of another neuron.

Neurotransmitters
Brain chemicals that carry information from the axon of a sending neuron to the dendrites of a receiving
neuron.

Transient Exuberance
The great but temporary increase in the number of dendrites that develop in an infant’s brain during the
first two years of life.

Pruning
The process by which unused connections in the brain atrophy and die.

Cortex
The outer layers of the brain in humans and other mammals. Most thinking, feeling, and sensing
involves the cortex.

Frontal Lobe
Located behind the forehead and responsible for thinking, memory, planning, and judgment.

Parietal Lobe
Located from middle of the skull to the back of the skull and processes touch information.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 83
 Occipital Lobe
Located at the back of the skull and processes visual information.

Temporal Lobe
Located behind the ears and responsible for hearing and language.

Prefrontal Cortex
The area of the cortex at the very front of the brain that specializes in anticipation, planning, and
impulse control.

Myelin
A coating of fatty tissues around the axon of the neuron.

 SUMMARY

In this lesson, you learned about overall physical growth during the infancy period. This included
monitoring physical growth as well as body proportions to help evaluate whether an infant is thriving
or not. Infant massage is one factor that impacts physical development. You also learned about the
brain in the first two years of life. The key to brain development in the early stages is the maturation of
neural connections through temporary rapid growth in conjunction with pruning to ultimately help the
brain become more efficient in processing information and remaining healthy.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Iannelli, V. (2018). What Parents Need to Know About Baby Weight Trends and Newborn Gaining. Retrieved from
www.verywellfamily.com/baby-birth-weight-statistics-2633630

Huelke D. F. (1998). An Overview of Anatomical Considerations of Infants and Children in the Adult World of
Automobile Safety Design. Annual Proceedings / Association for the Advancement of Automotive Medicine, 42,
93–113.

Bruer, J. T. (1999). The Myth of the First Three Years: A New Understanding of Early Brain Development and
Lifelong Learning. New York: Simon and Schuster.

Huelke, D. F. (1998). An overview of anatomical considerations of infants and children in the adult world of
automobile safety design. In Annual Proceedings/Association for the Advancement of Automotive Medicine
(Vol. 42, p. 93). Association for the Advancement of Automotive Medicine.

Heath, A., & Bainbridge, N. (2004). Baby Massage. Dorling Kindersley Ltd.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 84
 Bagshaw, J., & Fox, I. (2005). Baby Massage for Dummies. John Wiley & Sons.

Abdallah, B., Badr, L. K., & Hawwari, M. (2013). The efficacy of massage on short and long term outcomes in
preterm infants. Infant Behavior and Development, 36(4), 662-669.

Hartanti, A. T., Salimo, H., & Widyaningsih, V. (2019). Effectiveness of infant massage on strengthening bonding
and improving sleep quality. Indonesian Journal of Medicine, 4(2), 165-175.

Gultom, L., Sinaga, R., & Sianipar, K. (2019). The effects of infant massage on the physical development of baby
in indonesian rural areas. Global Journal of Health Science, 11(10), 142.

Cooke, A. (2015). Infant massage: The practice and evidence-base to support it. Journal of Health Visiting, 3(11),
598-602.

Deen, B., Richardson, H., Dilks, D. D., Takahashi, A., Keil, B., Wald, L. L., ... & Saxe, R. (2017). Organization of high-
level visual cortex in human infants. Nature communications, 8(1), 13995.

De Bot, K. (2006). The plastic bilingual brain: Synaptic pruning or growth? Commentary on Green, et al.
Language Learning, 56, 127-132.

Sakai, J. (2020). How synaptic pruning shapes neural wiring during development and, possibly, in disease.
Proceedings of the National Academy of Sciences, 117(28), 16096-16099.

Webb, S. J., Monk, C. S., & Nelson, C. A. (2001). Mechanisms of postnatal neurobiological development:
implications for human development. Developmental Neuropsychology, 19(2), 147-171.

Courchesne, E., Redcay, E., & Kennedy, D. P. (2004). The autistic brain: birth through adulthood. Current opinion
in neurology, 17(4), 489-496.

 TERMS TO KNOW

Axons
Fibers that extend from the neurons and transmit electrochemical impulses from that neuron to the
dendrites of other neurons.

Cortex
The outer layers of the brain in humans and other mammals. Most thinking, feeling, and sensing
involves the cortex.

Dendrites
Fibers that extend from neurons and receive electrochemical impulses transmitted from other
neurons via their axons.

Failure to Thrive
Decelerated or arrested physical growth (height and weight measurements fall below the third or
fifth percentile or a downward change in growth across two major growth percentiles) and is
associated with abnormal growth and development.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 85
 Frontal Lobe
Located behind the forehead and responsible for thinking, memory, planning, and judgment.

Myelin
A coating of fatty tissues around the axon of the neuron.

Neurons
Nerve cells in the central nervous system, especially in the brain.

Neurotransmitters
Brain chemicals that carry information from the axon of a sending neuron to the dendrites of a
receiving neuron.

Occipital Lobe
Located at the back of the skull and processes visual information.

Parietal Lobe
Located from middle of the skull to the back of the skull and processes touch information.

Percentile
A point on a ranking scale of 0 to 100. The 50th percentile is the midpoint; half of the infants in the
population being studied rank higher and half rank lower.

Prefrontal Cortex
The area of the cortex at the very front of the brain that specializes in anticipation, planning, and
impulse control.

Pruning
The process by which unused connections in the brain atrophy and die.

Reflexes
Involuntary movements in response to stimulation.

Synapses
The intersection between the axon of one neuron to the dendrites of another neuron.

Temporal Lobe
Located behind the ears and responsible for hearing and language.

Transient Exuberance
The great, but temporary increase in the number of dendrites that develop in an infant’s brain
during the first two years of life.

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 Cognitive Development in Infancy Part I
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about cognitive development during the infancy period. The foundation of
this lesson resides in Jean Piaget’s theory of cognitive development which is considered a landmark
theory when studying infants. Specifically, this lesson will cover:
1. Infant Cognitive Development
2. The Cognitive Perspective: The Roots of Understanding
2a. Changes in Thought With Maturation
2b. Making Sense of the World
3. Stages of Cognitive Development
3a. Sensorimotor Stage
3b. Preoperational Stage
3c. Concrete Operational Stage
3d. Formal Operational Stage

1. Infant Cognitive Development

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:

The typical course of cognitive development

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

2. The Cognitive Perspective: The Roots of

Understanding

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 87
 Cognitive theories focus on how our mental processes or cognitions change over time. The theory of cognitive
development is a comprehensive theory about the nature and development of human intelligence first
developed by Jean Piaget (1896-1980). It is primarily known as a developmental stage theory, but in fact, it deals
with the nature of knowledge itself and how humans come gradually to acquire it, construct it, and use it.
Moreover, Piaget claims that cognitive development is at the center of the human organism and language is
contingent on cognitive development. Let’s learn more about Piaget’s views about the nature of intelligence
and then dive deeper into the stages that he identified as critical in the developmental process.

 TERM TO KNOW

Theory of Cognitive Development

A comprehensive theory about the nature and development of human intelligence first developed by
Jean Piaget.

2a. Changes in Thought With Maturation

Piaget is one of the most influential cognitive theorists in development, inspired to explore children’s ability to
think and reason by watching his own children’s development. He was one of the first to recognize and map out
the ways in which children’s intelligence differs from that of adults. He became interested in this area when he
was asked to test the intelligence quotient (IQ) of children and began to notice that there was a pattern in their
wrong answers. He believed that children’s intellectual skills change over time and that maturation rather than
training brings about that change. Children of differing ages interpret the world differently.

2b. Making Sense of the World

Piaget believed that we are continuously trying to maintain cognitive equilibrium or a balance or cohesiveness
in what we see and what we know. Children have much more of a challenge in maintaining this balance
because they are constantly being confronted with new situations, new words, new objects, new animals, etc.
When faced with something new, a child may either fit it into an existing framework (schema) and match it with
something known (assimilation), or expand the framework of knowledge to accommodate the new situation
(accommodation) by learning a new word to more accurately name the object, animal, etc. This is the
underlying dynamic in our own cognition. Even as adults we continue to try and make sense of new situations
by determining whether they fit into our old way of thinking or whether we need to modify our thoughts.

EXAMPLE Assimilation is calling all animals with four legs “doggies” because the child knows the word
doggie.

 BRAINSTORM

Now think about your childhood experiences. Do you recall when you might have assimilated or
accommodated? For example, when you had an existing schema that anything with feathers will fly (e.g.,
birds), but then you had to change your existing schema because peacocks have feathers but do not fly,
while a jet and airplane does not have feathers but does fly.

 TERMS TO KNOW

Cognitive Equilibrium

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 A balance or cohesiveness in what we see and what we know.

Schema
A cognitive framework.

Accommodation
Expanding the framework of knowledge to accommodate the new situation.

3. Stages of Cognitive Development

Like Sigmund Freud and Erik Erikson, Piaget thought development unfolded in a series of stages approximately
associated with age ranges. Therefore he proposed a theory of cognitive development that unfolds in four
stages: sensorimotor, preoperational, concrete operational, and formal operational.

Let’s take a look at each of the stages.

3a. Sensorimotor Stage

The first stage is the sensorimotor stage, which lasts from birth to about 2 years old. During this stage, children
learn about the world through their senses and motor behavior. Young children put objects in their mouths to
see if the items are edible, and once they can grasp objects, they may shake or bang them to see if they make
sounds. Between 5 and 8 months old, the child develops object permanence, which is the understanding that
even if something is out of sight, it still exists (Bogartz, Shinskey, & Schilling, 2000). According to Piaget, young
infants do not remember an object after it has been removed from sight. Piaget studied infants’ reactions when
a toy was first shown to an infant and then hidden under a blanket. Infants who had already developed object
permanence would reach for the hidden toy, indicating that they knew it still existed, whereas infants who had
not developed object permanence would appear confused.

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 In Piaget’s perspective, around the same time that children develop object permanence, they also begin to
exhibit stranger anxiety, which is a fear of unfamiliar people. Babies may demonstrate this by crying and turning
away from a stranger, by clinging to a caregiver, or by attempting to reach their arms toward familiar faces such
as parents. Stranger anxiety results when a child is unable to assimilate the stranger into an existing schema;
therefore, they cannot predict what their experience with that stranger will be like, which results in a fear
response.

 TERMS TO KNOW

Object Permanence
The understanding that even if something is out of sight, it still exists.

Stranger Anxiety
A fear of unfamiliar people.

3b. Preoperational Stage

Piaget’s second stage is referred to as the preoperational stage, which is from approximately 2 to 7 years old.
During this stage, children can use symbols to represent words, images, and ideas, which is why children in this
stage engage in pretend play. A child’s arms might become airplane wings as he zooms around the room, or a
child with a stick might become a brave knight with a sword. Children also begin to use language in the
preoperational stage, but they cannot understand adult logic or mentally manipulate information (the term
operational refers to logical manipulation of information, so children at this stage are considered to be pre-
operational). Children’s logic is based on their own personal knowledge of the world so far, rather than on
conventional knowledge.

EXAMPLE Mom gave a slice of pizza to 10-year-old Keiko and another slice to her 3-year-old brother,
Kenny. Kenny’s pizza slice was cut into five pieces, so Kenny told his sister that he got more pizza than she
did.
Children in this stage cannot perform mental operations because they have not developed an understanding of
conservation, which is the idea that even if you change the appearance of something, it is still equal in size as
long as nothing has been removed or added.

We also expect children to display egocentrism, which means that the child is not able to take the perspective
of others. A child at this stage thinks that everyone sees, thinks, and feels just as they do.

EXAMPLE Let’s look at Kenny and Keiko again. Keiko’s birthday is coming up, so their mom takes Kenny
to the toy store to choose a present for his sister. He selects an Iron Man action figure for her, thinking that if
he likes the toy, his sister will too.
An egocentric child is not able to infer the perspective of other people and instead attributes his own
perspective. At some point during this stage and typically between 3 and 5 years old, children come to
understand that people have thoughts, feelings, and beliefs that are different from their own. This is known as
theory-of-mind (TOM).

 TERMS TO KNOW

Conservation

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 The idea that even if you change the appearance of something, it is still equal in size as long as nothing
has been removed or added.

Egocentrism
When a child is not able to take the perspective of others.

Theory of Mind
When children come to understand that people have thoughts, feelings, and beliefs that are different
from their own.

3c. Concrete Operational Stage

Piaget’s third stage is the concrete operational stage, which occurs from about 7 to 11 years old. In this stage,
children can think logically about real (concrete) events. They have a firm grasp on the use of numbers and start
to employ memory strategies. Moreover, they can perform mathematical operations and understand
transformations, such as addition is the opposite of subtraction, and multiplication is the opposite of division.

Children in this stage are also able to master the concept of conservation. In other words, even if something
changes shape, its mass, volume, and number stay the same.

EXAMPLE If you pour water from a tall, thin glass to a short, fat glass, you still have the same amount of
water. Remember Keiko and Kenny and the pizza? How did Keiko know that Kenny was wrong when he said
that he had more pizza?

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 Children in the concrete operational stage also understand the principle of reversibility, which means that
objects can be changed and then returned back to their original form or condition. Take, for example, water that
you poured into the short, fat glass. You can pour water from the fat glass back into the thin glass and still have
the same amount (minus a couple of drops).

 TERM TO KNOW

Reversibility
The understanding that objects can be changed and then returned back to their original form or
condition.

3d. Formal Operational Stage

The fourth, and last, stage in Piaget’s theory is the formal operational stage, which is from about age 11 to
adulthood. Whereas children in the concrete operational stage are able to think logically only about concrete
events, children in the formal operational stage can also deal with abstract ideas and hypothetical situations.
Children in this stage can use abstract thinking to problem solve, look at alternative solutions, and test these
solutions. In adolescence, a renewed egocentrism occurs.

EXAMPLE A 15-year-old with a very small pimple on her face might think it is huge and incredibly
visible, under the mistaken impression that others must share her perceptions.

 SUMMARY

In this lesson, you were introduced to infant cognitive development. While there are many theories
addressing different aspects of cognitive development, you learned about the cognitive perspective
from Jean Piaget’s lens where the focus was on changes in thought with maturation and how infants
make sense of the world around them. You then learned about Piaget’s four stages of cognitive
development each marked with specific skills, thoughts, and behaviors: sensorimotor stage,
preoperational stage, concrete operational stage, and formal operational stage. These stages
highlight how an infant interacts with his/her environment and emphasizes their active, not passive, role
in each of the stages.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Iannelli, V. (2018). What Parents Need to Know About Baby Weight Trends and Newborn Gaining. Retrieved from
www.verywellfamily.com/baby-birth-weight-statistics-2633630

Huelke D. F. (1998). An Overview of Anatomical Considerations of Infants and Children in the Adult World of
Automobile Safety Design. Annual Proceedings / Association for the Advancement of Automotive Medicine, 42,

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 92
 93–113.

Bogartz, R. S., Shinskey, J. L., & Schilling, T. H. (2000). Object permanence in five‐and‐a‐half‐month‐old infants.
Infancy, 1(4), 403-428.

 TERMS TO KNOW

Accommodation
Expanding the framework of knowledge to accommodate the new situation.

Cognitive Equilibrium
A balance or cohesiveness in what we see and what we know.

Conservation
The idea that even if you change the appearance of something, it is still equal in size as long as
nothing has been removed or added.

Egocentrism
When a child is not able to take the perspective of others.

Object Permanence
The understanding that even if something is out of sight, it still exists.

Reversibility
The understanding that objects can be changed and then returned back to their original form or
condition.

Schema
A cognitive framework.

Stranger Anxiety
A fear of unfamiliar people.

Theory of Cognitive Development

A comprehensive theory about the nature and development of human intelligence first developed
by Jean Piaget.

Theory of Mind
When children come to understand that people have thoughts, feelings, and beliefs that are
different from their own.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 93
 Cognitive Development in Infancy Part II
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about cognitive development during the infancy period. The foundation of
this lesson resides in Jean Piaget’s theory of cognitive development which is considered a landmark
theory when studying infants. Specifically, this lesson will cover:
1. Criticisms of Piaget’s Theory
2. Sensorimotor Intelligence
2a. Substage One: Reflexive Action
2b. Substage Two: First Adaptations to the Environment
2c. Substage Three: Repetition
2d. Substage Four: New Adaptations and Goal-Directed Behavior
2e. Substage Five: Active Experimentation of “Little Scientists”
2f. Substage Six: Mental Representations
3. Memory Abilities in Infants

1. Criticisms of Piaget’s Theory

As with other major contributors to theories of development, several of Piaget’s ideas have come under
criticism based on the results of further research. For example, several contemporary studies support a model
of development that is more continuous than Piaget’s discrete stages (Courage & Howe, 2002; Siegler, 2005,
2006). Many others suggest that children reach cognitive milestones earlier than Piaget describes (Baillargeon,
2004; de Hevia & Spelke, 2010). Looking across cultures reveals considerable variation in what children are
able to do at various ages, and Piaget may have underestimated what children are capable of given the right
circumstances.

IN CONTEXT

According to Piaget, the highest level of cognitive development is formal operational thought, which
develops between 11 and 20 years old. However, many developmental psychologists disagree with
Piaget, suggesting a fifth stage of cognitive development, known as the postformal stage (Commons &
Bresette, 2006; Commons & Richards, 2003; Sinnott, 1998). In postformal thinking, decisions are made
based on situations and circumstances, and logic is integrated with emotion as adults develop

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 principles that depend on contexts. One way that we can see the difference between an adult in
postformal thought and an adolescent (or adult) in formal operations is in terms of how they handle
emotionally charged issues or integrate systems of thought.

It seems that once we reach adulthood our problem-solving abilities change: as we attempt to solve problems,
we tend to think more deeply about many areas of our lives, such as relationships, work, and politics (Labouvie-
Vief & Diehl, 1999). Because of this, postformal thinkers are able to draw on past experiences to help them
solve new problems. Problem-solving strategies using postformal thought vary, depending on the situation.
What does this mean? Adults can recognize, for example, that what seems to be an ideal solution to a problem
at work involving a disagreement with a colleague may not be the best solution to a disagreement with a
significant other.

2. Sensorimotor Intelligence
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, which we discussed earlier.

EXAMPLE Two-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 dogs
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 seen in the table below:

Sensorimotor Substages Age

Substage 1 - Reflexes Birth to 6 weeks

Substage 2 - Primary Circular Reactions 6 weeks to 4 months

Substage 3 - Secondary Circular Reactions 4 months to 8 months

Substage 4 - Coordination of Secondary Circular Reactions 8 months to 12 months

Substage 5 - Tertiary Circular Reactions 12 months to 18 months

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 Substage 6 - Mental Representation 18 months to 24 months

2a. Substage One: Reflexive Action

Active learning begins with automatic movements or reflexes such as sucking, grasping, staring, and 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, breatheÍ, and repeat.

 BIG IDEA

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.

2b. Substage Two: First Adaptations to the Environment

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.

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.

 TERM TO KNOW

Secondary Circular Reactions

The infant’s responses to objects and people.

2c. Substage Three: Repetition

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.

2d. Substage Four: New Adaptations and Goal-Directed Behavior

Now the infant becomes more deliberate and purposeful in responding to people and objects, engaging in
behaviors that others perform and anticipating 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 the continued

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 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 5-8 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.

IN CONTEXT

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 5-8 months of age, 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). 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 (e.g., 12-24 month-olds) 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 the appropriate places when you ask them to find objects.

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.

 TERM TO KNOW

Tertiary Circular Reactions

Actions and ideas where infants become more creative in their thinking.

2e. Substage Five: Active Experimentation of “Little Scientists”

The toddler is considered a “little scientist” and begins exploring the world in a trial-and-error manner, using
motor skills and planning abilities.

EXAMPLE 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

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 for granted must actually be learned. This is a wonderful and messy time of experimentation and most learning
occurs by trial and error.

2f. Substage Six: Mental Representations

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 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 lesson.

3. Memory Abilities in Infants

Memory is central to cognitive development and information processing theories. 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).

It is thought that Piaget underestimated memory ability in infants (Jones & Herbert, 2006). This belief came in
part from findings that adults rarely recall personal events from before the age of 3 years old (a phenomenon
that is known as infantile or childhood amnesia). However, research on infants and young children has made it
clear that they can and do form memories of events. Infants show evidence of implicit memories early in life.
Implicit memories are for automatic processes, like motor skills, whereas explicit memories, those you can
consciously recall, develop later (Rovee-Collier, 1997).

As mentioned when discussing the development of infant senses, infants recognize their caregivers by face,
voice, and smell within the first few weeks of birth. Sensory and caregiver memories are apparent in the first
month, motor memories by 3 months, and more complex memories including language at about 9 months
(Mullally & Maguire, 2014). There is an agreement that memory is fragile in the first months of life, but 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 limits 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.

 DID YOU KNOW

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 Our memories are processed so that they can be encoded and stored into short-term and long-term
memory in our brains through what is called memory consolidation. For a long time it was believed that
new memories were susceptible to change for only a limited period of time, after which they became stable
and less susceptible to change. However, researchers have shown that memory reconsolidation can occur
when memories are reactivated and can be modified and undergo consolidation once again (Alberini &
LeDoux, 2013).
This is important from a behavioral and psychological lens because memory reconsolidation may modify
learning and reactions to stimuli and/or experiences, especially adverse experiences.

 TERMS TO KNOW

Infantile or Childhood Amnesia

The understanding that adults rarely recall personal events from before the age of 3 years old.

Implicit Memories
Memories for automatic processes, like motor skills.

Explicit Memories
Memories you can consciously recall.

Memory Consolidation
When memories are processed so that they can be encoded and stored into short-term and long-term
memory in our brains.

Memory Reconsolidation
When memories are reactivated and can be modified and undergo consolidation once again.

 SUMMARY

In this lesson, you were introduced to some criticisms of Piaget’s theory on infant cognitive
development. You learned about specifics of the sensorimotor stage, in particular sensorimotor
intelligence, which helps us understand how infants transition from responding to the external world to
utilizing mental strategies to solve problems. Sensorimotor intelligence is further divided into six
substages grouped as primary, secondary, and circular reactions: reflexive action, first adaptations to
the environment, repetition, new adaptations and goal-directed behavior, active experimentation of
“little scientists”, and mental representations.

You also learned about memory abilities in infants and issues such as infantile amnesia, which is the
inability of adults to recall personal events and experiences prior to 3 years of age. You also learned
about memory consolidation and reconsolidation which are important for memory storage, retrieval,
and modification.

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FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Iannelli, V. (2018). What Parents Need to Know About Baby Weight Trends and Newborn Gaining. Retrieved from
www.verywellfamily.com/baby-birth-weight-statistics-2633630

Huelke D. F. (1998). An Overview of Anatomical Considerations of Infants and Children in the Adult World of
Automobile Safety Design. Annual Proceedings / Association for the Advancement of Automotive Medicine, 42,
93–113.

Courage, M. L., & Howe, M. L. (2002). From infant to child: The dynamics of cognitive change in the second year
of life. Psychological Bulletin, 128(2), 250.

Siegler, R. S. (2005). Children's learning. American Psychologist, 60(8), 769.

Siegler, R. S. (2006). Microgenetic analyses of learning.

Baillargeon, R. (2004). Infants' physical world. Current Directions in Psychological Science, 13(3), 89-94.

de Hevia, M. D., & Spelke, E. S. (2010). Number-space mapping in human infants. Psychological Science, 21(5),
653-660.

Commons, M. L., & Bresette, L. M. (2006). Illuminating Major Creative Scientific Innovators with Postformal
Stages. Handbook of Adult Development and Learning, 255-280.

Commons, M. L., & Richards, F. A. (2003). Four Postformal Stages. Handbook of Adult Development, 199-219.

Sinnott, J. (1998). The Development of Logic in Adulthood: Postformal Thought and Its Applications. Springer
Science & Business Media.

Labouvie-Vief, G., & Diehl, M. (1999). Self and personality development. Gerontology: An interdisciplinary
perspective, 238-268.

Piaget, J., & Cook, M. T. (1954). The Development of Object Concept.

Mareschal, D., & Kaufman, J. (2012). Object permanence in infancy: revisiting Baillargeon's drawbridge study.

Jones, E. J., & Herbert, J. S. (2006). Exploring memory in infancy: Deferred imitation and the development of
declarative memory. Infant and Child Development: An International Journal of Research and Practice, 15(2),
195-205.

Rovee-Collier, C. (1997). Dissociations in infant memory: rethinking the development of implicit and explicit
memory. Psychological review, 104(3), 467.

Alberini, C. M., & LeDoux, J. E. (2013). Memory Reconsolidation. Current Biology, 23(17), R746-R750.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 100
  TERMS TO KNOW

Explicit Memories
Memories you can consciously recall.

Implicit Memories
Memories for automatic processes, like motor skills.

Infantile or Childhood Amnesia

The understanding that adults rarely recall personal events from before the age of 3 years old.

Memory Consolidation
When memories are processed so that they can be encoded and stored into short-term and long-
term memory in our brains.

Memory Reconsolidation
When memories are reactivated and can be modified and undergo consolidation once again.

Secondary Circular Reactions

The infant’s responses to objects and people.

Tertiary Circular Reactions

Actions and ideas where infants become more creative in their thinking.

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 Psychosocial Development in Infancy
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about how infants begin to form relationships, interact with others, and
explore their environment. The emphasis in this lesson is on an infant’s psychosocial development with
an in-depth look at Erik Erikson’s psychosocial theory of development. Specifically, this lesson will
cover:
1. Psychosocial Development
2. Temperament
3. Psychosocial Theory
3a. Trust vs. Mistrust
3b. Autonomy vs. Shame and Doubt

1. Psychosocial Development
Psychosocial development occurs as children form relationships, interact with others, and understand and
manage their feelings. In emotional and social 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 and a
topic we discussed in an earlier lesson of this course. 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?

2. Temperament
 THINK ABOUT IT

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. It 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.

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  KEY CONCEPT

According to Chess and Thomas (1977), children vary on nine dimensions of temperament highlighted
below:
Activity Level. Does the child display mostly active or inactive states?
Rhythmicity or Regularity. Is the child predictable or unpredictable regarding sleeping, eating, and
elimination patterns?
Approach-Withdrawal. Does the child react or respond positively or negatively to a newly encountered
situation?
Adaptability. Does the child adjust to unfamiliar circumstances easily or with difficulty?
Responsiveness. Does it take a small or large amount of stimulation to elicit a response (e.g., laughter,
fear, pain) from the child?
Reaction Intensity. Does the child show low or high energy when reacting to stimuli?
Mood Quality. Is the child normally happy and pleasant, or unhappy and unpleasant?
Distractibility. Is the child’s attention easily diverted from a task by external stimuli?
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.
Undifferentiated babies (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 may react
negatively to new situations.

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  KEY CONCEPT

It is inappropriate to think or say that one type of temperament is better than another. We should take into
account any cultural and/or family dynamics, among other factors, that may impact a child’s temperament.
There is a possibility that a child may display characteristics of different temperament styles in different
environments and/or caregivers depending on the dynamics of the situation.
As an example, infants with difficult temperaments are more likely than other infants to develop socio-emotional
problems, especially if their mothers were depressed or anxious caregivers (Garthus-Niegel et al., 2017).
Therefore the association between maternal mental health and the child’s socio-emotional well-being was
moderated by the child’s temperament.

EXAMPLE Imagine how you might approach a child in each temperament classification in order to
improve your interactions with them. An easy or flexible child may 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 respond to the child will experience a high goodness-of-fit, meaning their styles match, and
communication and interaction can flow. The temperamentally active children can do well with parents
and/or caregivers who support their curiosity but could have problems in a more rigid family.
It is this goodness-of-fit (the notion that development is dependent on the degree of match between children’s
temperament and the nature and demands of the environment in which they are being raised) between a child’s
temperament and parental temperament, demands, and expectations that can cause struggles. Rather than

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 believing that discipline alone will bring about improvements in children’s behavior, our knowledge of
temperament may help a parent, teacher, another caregiver, or even older siblings gain insight to work more
effectively with a child. It is important to approach 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 them 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 does not 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.

 TERMS TO KNOW

Easy Baby
Babies who are generally positive, showing curiosity about new situations, and whose emotions are
moderate or low in intensity.

Difficult Baby
Babies who 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 Baby
Babies who are inactive, showing relatively calm reactions to their environment. Their moods are
generally negative, and they withdraw from new situations, adapting slowly.

Undifferentiated Baby
Babies who show a variety of combinations of characteristics.

Goodness-of-Fit
The notion that development is dependent on the degree of match between children’s temperament
and the nature and demands of the environment in which they are being raised.

3. Psychosocial Theory
 PEOPLE TO KNOW

Erik Erikson (1902-1994) is a somewhat less controversial psychodynamic theorist and is sometimes
considered the father of developmental psychology. Erikson was a student of Sigmund Freud and
expanded on his theory of psychosexual development by emphasizing the importance of culture in
parenting practices and motivations, and adding three stages of adult development (Erikson, 1950; 1968).
Erikson’s psychosocial theory emphasizes the social relationships that are important at each stage of
personality development. There are a total of eight stages across the lifespan, each with a major psychosocial
task to accomplish or crisis to overcome. The table below lists each stage of development. For the purposes of
this lesson, we will focus on the first two stages as they correspond to the infancy period.

Stage Approximate Age Virtue Developmental Task

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 1 0-1 years Hope Trust vs. Mistrust

2 1-3 years Will Autonomy vs. Shame

3 3-6 years Purpose Initiative vs. Guilt

4 7-11 years Competence Industry vs. Inferiority

5 12-18 years Fidelity Identity vs. Role Confusion

6 19-39 years Love Intimacy vs. Isolation

7 40-64 years Care Generativity vs. Stagnation

8 65+ years Wisdom Integrity vs. Despair

3a. Trust vs. Mistrust

From birth to 12 months of age, infants must learn that adults can be trusted, hence the name of this stage is
trust vs. mistrust. This is Erikson’s first crisis of psychosocial development, during which infants learn basic trust
if the world is a secure place where their needs (food, comfort, attention) are met. Trust develops when adults
meet a child’s basic needs for survival. Infants are very much dependent upon their caregivers, so caregivers
who are responsive and sensitive to their infant’s physical needs, as well as their needs for stimulation and
comfort, help their baby to develop a sense of trust. Their baby will see the world as a safe, predictable place. 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.

 KEY CONCEPT

Unresponsive caregivers who do not meet their baby’s needs can engender feelings of anxiety, fear, and
mistrust. Their baby may perceive the world as unpredictable. If infants are treated cruelly or their needs are
not met appropriately, then they will likely grow up with a sense of mistrust for people in the world.

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 This image illustrates that the parent/caregiver is meeting the baby's physical and basic needs by helping clear out the

nose. This is one step toward building trust.

 THINK ABOUT IT

Consider the implications for establishing trust if a caregiver is unavailable or is upset and ill-prepared to
care for a child. Similarly, consider if a child is born prematurely, is unwanted, or has physical problems that
could make them less desirable to a parent.
One thing to keep in mind is that children can also exhibit strong resiliency (the capability to withstand or
recover from difficulties) to harsh or adverse 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.

 TERMS TO KNOW

Trust vs. Mistrust

Erikson’s first crisis of psychosocial development, during which infants learn basic trust if the world is a
secure place where their needs (food, comfort, attention) are met.

Resiliency
The capability to withstand or recover from difficulties.

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 3b. Autonomy vs. Shame and Doubt
As toddlers (aged 1-3 years) begin to explore their world, they learn that they can control their actions and act
on their environment to get results. They begin to show clear preferences for certain elements of the
environment, such as food, toys, and clothing. A toddler’s main task is to resolve the issue of autonomy vs.
shame and doubt (Erikson’s second crisis of psychosocial development, during which toddlers strive to gain a
sense of self-rule over their actions and their bodies) by working to establish independence. This is the “me do
it” stage.

EXAMPLE We might observe a budding sense of autonomy in a 2-year-old child who wants to choose
her clothes and dress herself. Although her outfits might not be appropriate for the situation, her input in
such basic decisions has an effect on her sense of independence. If denied the opportunity to act in her
environment, she may begin to doubt her abilities, which could lead to low self-esteem and feelings of
shame.
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, develop a sense of
independence that will later grow into 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, then 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.

 HINT

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).

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 The baby is exploring and trying to figure out what a toothbrush is and is being allowed to do so. This helps facilitate

the sense of autonomy that is necessary at this age.

 TERM TO KNOW

Autonomy vs. Shame and Doubt

Erikson’s second crisis of psychosocial development, during which toddlers strive to gain a sense of
self-rule over their actions and their bodies.

 SUMMARY

In this lesson, you learned about psychosocial development among infants which covers a broad range
of topics including, but not limited to, the formation of relationships, managing feelings, and forming
healthy attachments. You next learned about infant temperament which can be categorized as easy,
difficult, slow-to-warm, and undifferentiated. Each temperament style has its unique characteristics and
no one temperament is better or worse than another. A key element of the parent-infant bond is
goodness-of-fit which relates to the compatibility between the parent’s responsiveness and interaction,

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 and the infant’s temperament. Last but not least, you learned about Erikson’s psychosocial theory,
specifically trust versus mistrust and autonomy versus shame and doubt which apply to the first three
years of life.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Garthus-Niegel, S., Ayers, S., Martini, J., von Soest, T. & Eberhard-Gran, M. (2017). The impact of postpartum
post-traumatic stress disorder symptoms on child development: A population based, 2-year follow-up study.
Psychological Medicine, 47(1), 161-170.

Thomas, A., & Chess, S. (1977). Temperament and Development. Brunner/Mazel.

Erikson, E. H. (1950). Growth and crises of the "healthy personality."

Erikson, Erik (1968). Identity: Youth and Crisis. Chapter 3: W.W. Norton and Company. p. 92.

Newton, R. (2022, October 28). 4.3 Psychosocial growth in infancy. Human Growth and Development. Retrieved
March 13, 2023, from pressbooks.pub/mccdevpsych/chapter/4-3-psychosocial-growth-in-infancy/

 TERMS TO KNOW

Autonomy vs. Shame and Doubt

Erikson’s second crisis of psychosocial development, during which toddlers strive to gain a sense
of self-rule over their actions and their bodies.

Difficult Baby
Babies that have more negative moods and are slow to adapt to new situations. When confronted
with a new situation, they tend to withdraw.

Easy Baby
Babies that are generally positive, showing curiosity about new situations and their emotions are
moderate or low in intensity.

Goodness-of-Fit
The notion that development is dependent on the degree of match between children’s
temperament and the nature and demands of the environment in which they are being raised.

Resiliency
The capability to withstand or recover from difficulties.

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 Slow-to-Warm Baby
Babies that are inactive, showing relatively calm reactions to their environment. Their moods are
generally negative, and they withdraw from new situations, adapting slowly.

Trust vs. Mistrust

Erikson’s first crisis of psychosocial development, during which infants learn basic trust if the world
is a secure place where their needs (food, comfort, attention) are met.

Undifferentiated Baby
Babies that show a variety of combinations of characteristics.

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 Socioemotional Development in Infancy
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about how infants develop emotions and proceed through different stages
of self-awareness. Specifically, this lesson will cover:
1. Emotional Development
2. Self-Awareness
2a. Stage 1—Differentiation
2b. Stage 2—Situation
2c. Stage 3—Identification
2d. Stage 4—Permanence
2e. Stage 5—Self-Consciousness or Meta-Self-Awareness

1. Emotional Development
 REFLECT

As we grow older, we are able to better handle our emotions, but some emotions remain more easily
managed than others. Think about a time when you were young and you felt that the situation was out of
your control, and you became overwhelmed with emotions. What did you feel at that moment (e.g., in your
body, mentally, etc.)? How did you bring yourself back to your normal, stable state?
At birth, infants exhibit two emotional responses: attraction and withdrawal. While infants are attracted to
pleasant situations that bring comfort, stimulation, and pleasure, 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 (smiling in response to a human face or other social stimulus) as they respond with smiles
to those who engage their positive attention. Pleasure is expressed in 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. While anger can be a healthy response to frustration, sadness, which appears in the first months
as well, usually indicates withdrawal (Thiam, Flake, & Dickman, 2017).

 KEY CONCEPT

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. Fear is often associated with the presence of strangers

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 or the departure of significant figures, known respectively as stranger wariness and separation anxiety,
which usually appear between 6 and 15 months. There is even some indication that infants may experience
jealousy as young as 6 months of age (Hart & Carrington, 2002).
Stranger wariness is the fear associated with the presence of strangers, when an infant expresses concern or
fear while clinging to a familiar person. The presence of stranger wariness among infants 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. Unlike stranger wariness,
separation anxiety is often fear and/or distress caused by the departure of familiar significant others (e.g.,
primary caregiver, sibling). 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, 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.

 KEY CONCEPT

Separation anxiety and separation anxiety disorder (SAD) are two different phenomena. While separation
anxiety is a normal part of development, SAD is a clinical diagnosis in the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV) (Feriante & Bernstein, 2022). A key difference between normal anxiety and
SAD is the latter’s impairment in everyday living. SAD is usually diagnosed at approximately 6-7 years of
age and is prevalent in 1-4% of the overall pediatric population, although rates may vary depending on data
sources (Feriante & Bernstein, 2022). However, routine mental and behavioral screenings are highly
recommended for early diagnosis and intervention, especially when genetic predispositions (e.g., parental
anxiety, etc.) and/or environmental factors (e.g., parental conflict, low parental warmth, etc.) are present.
The caregiver’s thoughts, behaviors, actions, and other factors play an important role in an infant’s emotional
development and emotion 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). “Emotions as regulated” 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 because parents and children both modify their reactions to each other based on 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, infants are capable of engaging in self-regulation strategies as
young as 4 months old. At this age, infants can intentionally avert their gaze from overstimulating stimuli. By 12
months of age, infants use their mobility in walking and crawling to intentionally approach or withdraw from
stimuli.

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 This image shows a baby crying and their mother. Since the baby is young and relies heavily on their mother to help

regulate emotions, the mother can be seen maintaining eye contact and using physical touch to help the process of

calming her baby.

Whether infants or toddlers, caregivers remain important for the emotional development and socialization of
their children, through the following behaviors:

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
Modeling coping strategies

 BIG IDEA

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, are more likely to express positive
emotions, easier to soothe, more engaged in the environmental exploration, and have enhanced social
skills in the toddler and preschool years.

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  TERMS TO KNOW

Social Smiling
Smiling that is evoked by a human face or other social stimulus.

Stranger Wariness
The fear associated with the presence of strangers that an infant expresses as concern or fear while
clinging to a familiar person.

Separation Anxiety
Fear or distress caused by the departure of familiar significant others (e.g., primary caregiver, sibling).

Emotional Regulation
Can be defined by two components: emotions as regulating and emotions as regulated.

Co-Regulation
When children rely heavily on their caregivers for emotional regulation.

2. 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). 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, or my” 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. Let’s take a look at these stages.

 TERMS TO KNOW

Self-Awareness
The realization that one’s body, mind, and activities are distinct from those of other people.

Rouge Test
A mirror test that is the most common technique used in testing for self-awareness in infants.

2a. Stage 1—Differentiation

Starting from birth, infants are able to differentiate the self from the non-self. Rochat & Hespos (1997) conducted
a study with five newborns and eleven 4-week-old infants to observe the rooting responses between an
external stimulus (experimenter’s index finger touching the infant’s cheeks) and self-stimulation (spontaneous
touching of their own cheek). A rooting response occurs when the infant turns their head towards the stimulus,

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 while also opening their mouth and/or placing the tongue out. Researchers found that newborn infants rooted
significantly more to the external stimulus whereas 4-week-old infants rooted more to self-stimulation.

2b. Stage 2—Situation

In addition to differentiation, infants at this stage can also situate themselves in relation to a model. Meltzoff &
Moore (1977) found that infants between 12-21 days old were able to imitate tongue protrusion from an adult
model. In a similar study, Meltzoff & Moore (1992) extended their previous findings to include the body space of
the model. Specifically, 6-week-old infants were able to not only imitate tongue protrusion but also the tongue
orientation of the model (e.g., placing the tongue to the left or right but not at the midline). Another sign of
differentiation has been noted when infants bring themselves into contact with objects by reaching for them.

2c. Stage 3—Identification

At this stage, the more common definition of “self-awareness” comes into play, when infants can identify
themselves in a mirror through the “Rouge test” and they begin to use language to refer to themselves.

EXAMPLE A child had a “Post-It” placed on their forehead before being shown a mirror (Rochat,
Broesch, & Jayne, 2012). Once the child looked at the mirror, they reached for the Post-It on their own
forehead to remove it or touch it. In the same study, the child, parent, and experimenter all had a Post-It
note on their forehead, and slightly over two-thirds of the children showed hesitation in removing or
touching the Post-It note.
These results highlight not only self-awareness but also the notion of the self in relation to others.

2d. Stage 4—Permanence

This stage occurs after infancy when children are aware that their sense of self continues to exist across both
time and space. Younger children first express the “Me-But-Not-Me” dilemma which occurs when they see
themselves on television but do not quite understand that it is them. Povinelli (2001) conducted an experiment
where children played a game and while they were playing, an experimenter placed a sticker on the child’s
head. Two photographs were taken, one as the sticker was being placed on the child’s head and one at the end
of the game. The verbal responses of young children varied but they tended to describe themselves separately
from the image (e..g, referring to the child, themself, by name).

EXAMPLE For instance, a 3-year-old expressed “It’s Jennifer….it’s a sticker” followed by “but why is she
wearing my shirt?” (pg. 81).
As children grow older, they are able to look at pictures of themselves when they were younger or watch videos
of themself and relate to the child in the picture or video (Rochat, 2003).

2e. Stage 5—Self-Consciousness or Meta-Self-Awareness

The final stage, which also occurs after infancy, is when children can see themselves in third-person, or how
they are perceived by others. They are aware that people around them may view them in different ways. 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 require an understanding of the
mental state of others, which is acquired around 3 to 5 years of age (Berk, 2007).

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  SUMMARY

In this lesson, you learned about infant emotional development beginning with two basic responses—
withdrawal and attraction. These emotional responses, especially among infants, are displayed through
social smiling, stranger wariness, and separation anxiety. Regardless of the emotion, an infant relies on
their caregiver to help with emotion regulation, and with such dependency on the caregiver, co-
regulation becomes an important phenomenon. You also learned about self-awareness, specifically
Rochat’s five stages of awareness: differentiation (self versus non-self), situation (differentiate the self
in comparison to a model or other figure), identification (identifying with the self especially through a
mirror), permanence (expanding concept of self across time and space), and self-consciousness
(understanding the self from a third-person lens).

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Thiam, M.A., Flake, E.M. & Dickman, M.M. (2017). Infant and child mental health and perinatal illness. In Melinda
A. Thiam (Ed.), Perinatal mental health and the military family: Identifying and treating mood and anxiety
disorders. New York, NY: Routledge.

Kopp, C.B. (2011). Development in the early years: Socialization, motor development; and consciousness. Annual
Review of Psychology, 62, 165-187.

Hart, S., & Carrington, H. (2002). Jealousy in 6-month-old infants. Infancy, 3(3), 395-402.

Feriante, J., & Bernstein, B. (2020). Separation anxiety.

Rochat, P. (2003). Five levels of self-awareness as they unfold early in life. Consciousness and cognition, 12(4),
717-731.

Meltzoff, A. N., & Moore, M. K. (1977). Imitation of facial and manual gestures by human neonates. Science,
198(4312), 75-78.

Rochat, P., Broesch, T., & Jayne, K. (2012). Social awareness and early self-recognition. Consciousness and
cognition, 21(3), 1491-1497.

Povinelli, D. J. (2001). The self: Elevated in consciousness and extended in time. In C. Moore & K. Lemmon (Eds.),
The self in time: Developmental perspectives (pp. 75-95). Mahaw, NJ: Lawrence Erlbaum Associates.

 TERMS TO KNOW

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 Co-Regulation
When children rely heavily on their caregivers for emotional regulation.

Emotional Regulation
Can be defined by two components: emotions as regulating and emotions as regulated.

Rouge Test
A mirror test that is the most common technique used in testing for self-awareness in infants.

Self-Awareness
The realization that one’s body, mind, and activities are distinct from those of other people.

Separation Anxiety
Fear or distress caused by the departure of familiar significant others (e.g., primary caregiver,
sibling).

Social Smiling
Smiling that is evoked by a human face or other social stimulus.

Stranger Wariness
The fear associated with the presence of strangers that an infant expresses as concern or fear
while clinging to a familiar person.

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 Language Development in Infancy
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about how language development occurs beginning in infancy. Different
aspects of language including verbal and non-verbal will be discussed. Specifically, this lesson will
cover:
1. Language Development
2. Theories of Language Development
2a. Chomsky and the Language Acquisition Device
2b. Skinner and Reinforcement Theory
2c. Social Pragmatics Theory
3. Intentional Vocalizations
4. Babbling and Gesturing
5. Holophrasic Speech
6. Underextension and Overextension
7. First Words and Cultural Influences
8. Vocabulary Growth Spurt
8a. Two-Word Sentences and Telegraphic Speech
8b. Child-Directed Speech

1. Language Development
Language and speech development is most intense during the first three years of life (National Institute on
Deafness & Other Communication Disorders, 2022). This is a critical period of time when infants and young
children are best able to learn languages. If this time passes without any exposure, then an infant and/or child
will encounter more challenges in language development.

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 (e.g., being relaxed or still), gestures
(e.g., reaching with hands out), 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.

 THINK ABOUT IT

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 Think about a time when you interacted with a baby or even watched a video with a baby in it. How did the
baby communicate with the individuals around them?
Given the remarkable complexity of a language, one might expect that mastering a language would be an
especially difficult 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 and with relative ease. B. F. Skinner (1957), a
prominent behavioral psychologist, 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, 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).

As illustrated in the table below, children begin to learn about language from a very early age. 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 et al., 1994; Spelke & Cortelyou, 1981). By 4½ months of age, infants will turn
their heads to hear their own names but not to other names, even when the other names have a similar sound
pattern. At 6 months of age, infants pay particular attention to vowel sounds and, at 9 months, consonants.

Stages of Language and Communication Development

Stage Age Developmental Language & 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 (e.g., they can tell the difference between the “s”
in vision and the “ss” in fission). Early on, babies 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 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). Social interaction,
therefore, is a vital component to language learning.

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 2. Theories of Language Development
Each major theory of language development emphasizes different aspects of language learning:

Infants’ brains are genetically attuned to language

Infants must be taught a language
Infants’ social impulses foster language learning

We will take a look at three different theories of language development with the first two representing the two
extremes in the level of interaction required for language to occur (Berk, 2007).

2a. Chomsky and the Language Acquisition Device

The language acquisition device 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 to derive the rules of grammar quickly and
effectively from the speech they hear every day, as their brains develop. 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.

 TERM TO KNOW

Language Acquisition Device (LAD)

A neurological construct that makes infants ready for language.

2b. Skinner and Reinforcement Theory

The reinforcement 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

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 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.

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.

2c. Social Pragmatics Theory

The social pragmatics theory is another language theory that 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. Many would argue that all three of these theories (Chomsky’s argument for
nativism, reinforcement, and social pragmatics) are important for fostering the acquisition of language (Berger,
2004).

3. 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, consonants are added to vocalizations such as
“nananananana.”

 KEY CONCEPT

Social input, such as mother-infant interactions, plays a critical role in determining the timing of infants’
speech sound discrimination. Infants who experience high-quality interactions with their mothers,
characterized by frequent speech, show a narrowing as early as 6 months of age.

 TERM TO KNOW

Cooing
Gurgling, musical vocalization.

4. Babbling and Gesturing

Babies learn by hearing others speak and by noticing the reactions that their vocalizations evoke in caregivers.
Between 6 and 9 months, infants begin making even more elaborate vocalizations that include the sounds

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 required for any language. Guttural sounds (heavy sounds made in the back of the throat), clicks, consonants,
and vowel sounds stand ready to equip the child with the ability to repeat whatever sounds are characteristic of
the language heard. 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. Babies who are deaf 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.

Infants often use simple gestures, such as pointing and nodding their heads, before they can speak. The use of
gestures and the ability to jointly attend, directing an adult’s attention to an object, predicts later language
development. 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. The first words that infants use are those that
they hear often or are meaningful for them, such as their own name, the word "no," or the word for their
caregiver.

 DID YOU KNOW

Joint attention is one of the many factors used to evaluate social interaction skills among children with
autism.
This skill involves the infant and/or child focusing on a stimulus or area with another person. Young children with
autism display deficits in joint attention, and it has become an important indicator for possible autism diagnosis
as the child is older (Bruinsma, Koegel, & Koegel, 2004).

 TERMS TO KNOW

Guttural Sound
Heavy sounds made in the back of the throat.

Babbling
When a baby repeats certain syllables such as ma-ma-ma, da-da-da, and ba-ba-ba.

Jointly Attend
Directing an adult’s attention to an object.

5. Holophrasic Speech
Children begin using their first words at about 12-13 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).

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

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 milk! However, someone who has not been around the child will have trouble knowing what is meant by the
holophrase.
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.”

 TERM TO KNOW

Holophrasic Speech
One-word expressions used by children, also known as a holophrase.

6. Underextension and Overextension

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.

EXAMPLE 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 which is called overextension. In overextension, for instance, all animals
become “doggies.”

 TERMS TO KNOW

Underextension
When a child learns a word stands for an object and initially thinks that the word can be used for only
that particular object.

Overextension
When a child thinks that a label applies to all objects that are similar to the original object.

7. First Words and Cultural Influences

Culture shapes the word types infants learn. First words for English-speaking children tend to be nouns and
include more referential language, or naming words such as “ball,” “cat,” “dog,” etc. 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 actions and relationships between objects while children from the United States may be taught
to name an object and its qualities (e.g., color, texture, size, etc.). These differences can be seen when
comparing interpretations of art by older students from China and the United States.

 KEY CONCEPT

Parents from different cultures vary in how they respond to infants. Those responses that are warm,
consistent, and contingent on infant actions seem to be associated with positive language development in

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 all cultures.

8. 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 (a sudden increase in an infant’s vocabulary,
especially in the number of nouns, that begins at about 18 months of age) because many early words are nouns
(persons, places, or things).

 TERM TO KNOW

Naming Explosion
A sudden increase in an infant’s vocabulary, especially in the number of nouns, that begins at about 18
months of age.

8a. 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.” In telegraphic speech, 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.

EXAMPLE “Give baby ball” is used rather than “give the baby the ball.”

 TERM TO KNOW

Telegraphic Speech
When words needed to convey messages are used but the articles and other parts of speech
necessary for grammatical correctness are not included.

8b. Child-Directed Speech

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? For example, instead of saying horse, adults say “horsie”? This
represents a universal tendency and is known as child-directed speech (also sometimes called motherese or
parentese). It involves exaggerating the vowel and consonant sounds, using a high-pitched voice, and
delivering the phrase with great facial expressions. 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.

 TERM TO KNOW

Child-Directed Speech

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 Speech that involves exaggerating the vowel and consonant sounds, using a high-pitched voice, and
delivering the phrase with great facial expressions. Also sometimes called motherese or parentese.

 SUMMARY

In this lesson, you learned how infant language development progresses from reflexive communication
to babbling to first words and combining words. You learned about three different theories of language
development: Chomsky and the language acquisition device (infants’ inherent language acquisition
device makes them ready to learn language); Skinner and reinforcement theory (language is
developed through reinforcement); and social pragmatics theory (social impulses are a driving factor to
language development). Language development is complex, so you then learned about different
components of language including intentional vocalizations, babbling and gesturing, holophrasic
speech, and underextension and overextension. This was followed by a brief introduction of first
words and cultural influences on language (e.g., emphasis on verbs versus nouns). A naming explosion
also referred to as a vocabulary growth spurt occurs so that an infant can begin to form two-word
sentences and eventually telegraphic speech which is similar to a text message we typically write. You
also learned about child-directed speech which is marked by exaggerating vowels and consonant
sounds alongside facial expressions.

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

U.S. Department of Health and Human Services. (n.d.). Speech and language developmental milestones.
National Institute of Deafness and Other Communication Disorders. Retrieved March 24, 2023, from
www.nidcd.nih.gov/health/speech-and-language

Skinner, B. F. (1957). The experimental analysis of behavior. American Scientist, 45(4), 343-371.

Chomsky, N. Aspects of theory of syntax, MIT Press, Cambridge, MA (1965).

Johnson, J. S., & Newport, E. L. (1989). Critical period effects in second language learning: The influence of
maturational state on the acquisition of English as a second language. Cognitive Psychology, 21(1), 60-99.

Lenneberg, E. H. (1967). The biological foundations of language. Hospital Practice, 2(12), 59-67.

Blossom, M., & Morgan, J. L. (2006). Does the face say what the mouth says? A study of infants’ sensitivity to
visual prosody. In 30th annual Boston University conference on language development, Somerville, MA.

Pickens, J. (1994). Perception of auditory-visual distance relations by 5-month-old infants. Developmental

Psychology, 30(4), 537.

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 Spelke, E. S., & Cortelyou, A. (1981). Perceptual aspects of social knowing: Looking and listening in infancy. Infant
Social Cognition, 61, 84.

Pickens, J., Field, T., Nawrocki, T., Martinez, A., Soutullo, D., & Gonzalez, J. (1994). Full-term and preterm infants'
perception of face-voice synchrony. Infant Behavior and Development, 17(4), 447-455.

Werker, J. F., & Lalonde, C. E. (1988). Cross-language speech perception: Initial capabilities and developmental
change. Developmental Psychology, 24(5), 672.

Werker, J. F., & Tees, R. C. (1984). Cross-language speech perception: Evidence for perceptual reorganization
during the first year of life. Infant Behavior and Development, 7(1), 49-63.

Berk, L. (2007). Development through the life span (4th ed.). Boston: Allyn and Bacon.

Berger, K. S. (2014). The developing person: Through the lifespan. NY: Worth Publishers.

Bruinsma, Y., Koegel, R. L., & Koegel, L. K. (2004). Joint attention and children with autism: A review of the
literature. Mental retardation and developmental disabilities research reviews, 10(3), 169-175.

 TERMS TO KNOW

Babbling
When a baby repeats certain syllables such as ma-ma-ma, da-da-da, and ba-ba-ba.

Child-Directed Speech
Speech that involves exaggerating the vowel and consonant sounds, using a high-pitched voice,
and delivering the phrase with great facial expressions. Also sometimes called motherese or
parentese.

Cooing
Gurgling, musical vocalization.

Guttural Sound
Heavy sounds made in the back of the throat.

Holophrasic Speech
One-word expressions used by children, also known as a holophrase.

Jointly Attend
Directing an adult’s attention to an object.

Language Acquisition Device (LAD)

A neurological construct that makes infants ready for language.

Naming Explosion
A sudden increase in an infant’s vocabulary, especially in the number of nouns, that begins at about
18 months of age.

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 Overextension
When a child thinks that a label applies to all objects that are similar to the original object.

Telegraphic Speech
When words needed to convey messages are used but the articles and other parts of speech
necessary for grammatical correctness are not included.

Underextension
When a child learns a word stands for an object and initially thinks that the word can be used for
only that particular object.

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 Motor and Sensory Development in Infancy
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about motor and sensory development in infants. Specifically, this lesson
will cover:
1. Motor Development
1a. Motor Skills
1b. Gross Motor Skills
1c. Fine Motor Skills
2. Sensory Development
2a. Vision
2b. Hearing
2c. Pain and Touch
2d. Taste and Smell

1. Motor Development
 DID YOU KNOW

The Centers for Disease Control & Prevention (CDC) has apps to help parents and/or caregivers track
developmental milestones with motor development being one of them (CDC, 2022). This helps parents
and/or caregivers stay informed about their infant’s development while also tracking developmental
progress, or lack thereof, so that timely and effective intervention can occur.
Every basic motor skill (any movement ability) develops over the first two years of life. The sequence of motor
skills first begins with reflexes (involuntary movements). Infants are equipped with a number of reflexes in
response to stimulation, and some are necessary for survival. Examples of reflexes include:

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)
Sucking reflex or automatically sucking on objects that touch their lips

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 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:
Babinski reflex (toes fan upward when feet are stroked)
Stepping reflex (babies move their legs as if to walk when feet touch a flat surface)
Palmar grasp (the infant will tightly grasp any object placed in its palm)
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.

 TERM TO KNOW

Motor Skill
Any movement ability.

1a. Motor Skills

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.

EXAMPLE 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 his/her head. Babies on average are able to
hold up their heads 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/her head by 4 months old, s/he is showing a delay.

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 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).

 KEY CONCEPT

If the child is displaying delays on several milestones, then 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.

 TERMS TO KNOW

Cephalocaudal
Development that happens from a head-down direction.

Proximodistal
Development that happens from a center-out direction.

1b. Gross Motor Skills

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, and rocking back and forth on hands and

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 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). 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!

 TERM TO KNOW

Gross Motor Skills

Voluntary movements that involve the use of large muscle groups and are typically large movements of
the arms, legs, head, and torso.

1c. 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.

 THINK ABOUT IT

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.

The table below highlights developmental milestones in the early years (Berk, 2007; Rauh, n.d.).

Age Developmental Milestone

2 months Can hold head upright on own

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 Smiles at sound of familiar voices and follows movement with eyes

3 months Can raise head and chest from prone position

Smiles at others
Grasps objects
Rolls from side to back

4-5 months Babbles, laughs, and tries to imitate sounds

Begins to roll from back to side

6 months Moves objects from hand to hand

7-8 months Can sit without support

May begin to crawl
Responds to own name
Finds partially hidden objects

8-9 months Walks while holding on

Babbles “mama” and “dada”
Claps

11-12 months Stands alone

Begins to walk
Says at least one word
Can stack two blocks

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

2 years Runs and jumps

Uses two-word sentences
Follows simple instructions
Begins make-believe play

3 years Speaks in multi-word sentences

Sorts objects by shape and color

4 years Draws circles and squares

Rides a tricycle
Gets along with people outside of the family
Gets dressed

5 years Can jump, hop, and skip

Knows name and address
Counts ten or more objects

 TERMS TO KNOW

Fine Motor Skills

More exact movements of the hands and fingers, including the ability to reach and grasp an object.

Pincer Grasp
When one grasps an object using the forefinger and thumb.

2. 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.

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  TERMS TO KNOW

Sensation
The interaction of information with the sensory receptors.

Perception
The process of interpreting what is sensed.

2a. 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.

IN CONTEXT

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
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). Once babies can walk, their entire visual field changes. Whereas crawling
babies are more likely to look at the floor as they move, walking babies gaze straight ahead at caregivers, walls,
and toys.

2b. Hearing

 DID YOU KNOW

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 The infant’s sense of hearing is very keen at birth. The 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, will listen to voices longer than sounds that do not involve speech (Vouloumanos & Werker,
2004), and seem to prefer their mother’s voice over a stranger’s voice (Mills & Melhuish, 1974). In one study, 3-
week-old babies were given pacifiers that played a recording of the infant’s mother’s voice and of a stranger’s
voice (Mills & Melhuish, 1974). When the infants heard their mother’s voice, they sucked more strongly at the
pacifier. By 7 or 8 months a child becomes familiar with the sounds of a particular language and less sensitive to
sounds that are part of an unfamiliar language.

2c. Pain and Touch

Immediately after birth, a newborn is sensitive to touch and temperature, and is also 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 (Fikin & Yohanna, 2020). According to the
American Academy of Pediatrics (AAP), there are medical benefits and risks to circumcision (AAP, 2012). AAP
does not recommend routine circumcision, however, they stated that because of the possible benefits
(including prevention from urinary tract infections, penile cancer, and some sexually transmitted infections),
parents should have the option to circumcise their sons if they want to and/or if it aligns with their religious
beliefs and practices.

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 caregivers, 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, 2010).

EXAMPLE 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).

 BIG IDEA

Helping infants feel safe and protected builds trust and secure attachments between the child and their
caregiver.

2d. 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

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 mother’s breast, as it is a potent source of maternal odor. Even on the first day of life, infants orient themselves
to their mother’s odor and are soothed, when crying, by their mother’s odor (Sullivan et al., 2011).

 SUMMARY

In this lesson, you learned about infant motor development which is an important developmental
milestone. Motor development can be distinguished from reflexes to voluntary movements. Reflexes
are involuntary movements and include the breathing, sucking, and rooting reflexes, among others. You
then learned about the development of motor skills, specifically gross motor skills and fine motor skills
which complement each other. For example, while gross motor skills involve large muscle groups and
movements, fine motor skills are more precise and exact.

In the section on sensory development, you learned to distinguish between sensation (interaction of
information with sensory receptors) and perception (the process of interpreting sensation). You learned
about vision and how it is the most poorly developed sense at birth. Unlike vision, infants have a keen
hearing at birth and a newborn already begins to show preferences for human voices, specifically their
mother’s voice over a stranger’s voice. You then learned about infant sensitivity to pain and touch. This
is observed immediately after birth. Last but not least, you also learned how infants show preferences
for taste (e.g., sweet flavors) and smell (e.g., smell of mother).

Source: THIS TUTORIAL HAS BEEN ADAPTED FROM LUMEN LEARNING'S LIFESPAN DEVELOPMENT. ACCESS
FOR FREE AT https://courses.lumenlearning.com/wm-lifespandevelopment/. LICENSE: CREATIVE COMMONS
ATTRIBUTION 4.0 INTERNATIONAL.

REFERENCES

Rauh, Sherry (n.d.). Is Your Baby on Track? WebMD. Retrieved from

www.webmd.com/parenting/baby/features/is-your-baby-on-track#1

Berk, L. (2007). Development Through the Lifespan (4th ed.) (pp 137). Pearson Education.

Circumcision Policy Statement. Pediatrics. Retrieved from pediatrics.aappublications.org/content/130/3/585

Stack, D. M. (2010). Touch and Physical Contact during Infancy: Discovering the Richness of the Forgotten
Sense. The Wiley-Blackwell Handbook of Infant Development, 532-567

Nelson, C. A., Fox, N. A., and Zeanah, C. H. (2014). Romania's abandoned children: Deprivation, brain
development, and the struggle for recovery. Cambridge, MA, and London, England: Harvard University Press.

Sullivan, R., Perry, R., Sloan, A., Kleinhaus, K., & Burtchen, N. (2011). Infant bonding and attachment to the
caregiver: insights from basic and clinical science. Clinics in Perinatology, 38(4), 643–655.
doi:10.1016/j.clp.2011.08.011

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 Sen, M. G., Yonas, A., & Knill, D. C. (2001). Development of infants' sensitivity to surface contour information for
spatial layout. Perception, 30(2), 167-176

Blank, S., Brady, M., Buerk, E., Carlo, W., Diekema, D., Freedman, A., Maxwell, L., & Wegner, S. (2012, September
1). Circumcision policy statement. American Academy of Pediatrics. Retrieved March 28, 2023, from
publications.aap.org/pediatrics/article/130/3/585/30235/Circumcision-Policy-Statement?
autologincheck=redirected

Fikin, A. G., & Yohanna, S. (2020). A comparison of pain scores in neonatal circumcision with or without local
anesthesia in Jos, Nigeria. Nigerian Medical Journal: Journal of the Nigeria Medical Association, 61(1), 11.

Mills, M., & Melhuish, E. (1974). Recognition of mother's voice in early infancy. Nature, 252(5479), 123-124.

Vouloumanos, A., & Werker, J. F. (2004). Tuned to the signal: the privileged status of speech for young infants.
Developmental Science, 7(3), 270-276.

Centers for Disease Control and Prevention. (2022, August 9). CDC's Milestone Tracker App. Centers for
Disease Control and Prevention. Retrieved March 28, 2023, from www.cdc.gov/ncbddd/actearly/milestones-
app.html

 TERMS TO KNOW

Cephalocaudal
Development that happens from a head-down direction.

Fine Motor Skills

More exact movements of the hands and fingers, including the ability to reach and grasp an object.

Gross Motor Skills

Voluntary movements that involve the use of large muscle groups and are typically large
movements of the arms, legs, head, and torso.

Motor Skill
Any movement ability.

Perception
The process of interpreting what is sensed.

Pincer Grasp
When one grasps an object using the forefinger and thumb.

Proximodistal
Development that happens from a center-out direction.

Sensation

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 The interaction of information with the sensory receptors.

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 Benefits and Disadvantages of Various Childcare
Options
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about different child care arrangements and factors that influence whether
a family opts for child care arrangements, if any. Specifically, this lesson will cover:
1. Child Care
1a. Relatives
1b. Home-Based
1c. Center-Based
2. Factors Influencing Child Care Decisions
2a. Availability
2b. Accessibility
2c. Affordability

 WATCH

View this video to see how Anais’ parents decide on the type of childcare she will receive.

1. Child Care
 DID YOU KNOW

The American Rescue Plan, implemented by the White House, provides stabilization for child care
programs, with aid already provided to more than 200,000 child care providers and 9.5 millions children in
the United States (White House, 2022).

 THINK ABOUT IT

Think back about your experiences as far back as you can remember and/or from what your family, friends,
and relatives have shared with you. Who took care of you during your early years? Why was your child care
situation the way it was? How do you think your child care arrangements impacted you (e.g., if your
parent(s) worked, then did you spend more time in out-of-home child care)?
Parents shape an infant’s experience by providing food, health care, a home, and stimulation that influences
their cognitive development. Infants also are influenced by child care, and in the US, more than two-thirds of

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 mothers of children under 6 are employed. Infants’ developmental outcomes are influenced more by
characteristics of the family, such as parenting, maternal education, and maternal sensitivity, than by the type of
child care.

Child care refers to caring and/or providing for a child in some manner. This is an important topic among
families and the professional community because child care options vary across the world and are rooted in
cultural perspectives on development. Moreover, since the environment plays an important role in infant
developmental outcomes, child care settings are important to consider, especially if an infant spends a
significant amount of time there. There are four categories of child care options which we will discuss in depth
below:

Relatives
Home-based child care
Center-based child care
Other informal child care

 TERM TO KNOW

Child Care
Caring and/or providing for a child in some manner.

1a. Relatives
Relatives, as the name implies, are individuals who are related to the infant through blood or marriage. This
includes mother(s), father(s), sibling(s), grandparent(s), aunt(s), uncle(s), and cousin(s). According to the U.S.
Census Bureau’s Survey of Income & Program Participation (SIPP), approximately 42.1% of children under 5
years of age are in the regular care of a relative (Laughlin, 2013). The following is a breakdown of the regular
care arrangement (at least one time per week) of children under 5 in a typical week during spring 2011:

Grandparent(s) - 23.7%
Father(s) - 17.8%
Mother(s) - 3.5%
Sibling(s) - 2.6%
Other relative(s) - 7.4%

When relative care is involved, care for the infant is provided at either their home or that of the caregiver.
Moreover, the caregiver may or may not receive any compensation for providing care (Anderson & Mikesell,
2017).

 KEY CONCEPT

Some of the benefits of utilizing relatives as a form of child care include:

1. Cost-effective - parent(s) do not need to pay for additional help, especially if the relative is living in the
same household as the infant.

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 2. Flexibility - parent(s) can work alongside the relative with a less rigid schedule, especially in situations
where employment hours may not be consistent.
3. Trust - parent(s) are more likely to trust a relative than a non-relative, but that varies from family to
family.
4. Better transitions - since the infant may already be exposed to the relative, the transition from one
caregiver to another may be easier than other types of child care arrangements.

In a study by Riley and Glass (2004), data was collected from 247 pregnant women who resumed paid
employment within one year after the birth of their child. Researchers found that mothers preferred their infant
to be cared for by the father or relatives and in the infant’s home. One factor, among many, that impacted the
type of child care at 6 months of age was the mother’s employment schedule. Specifically, mothers working
evening or night shifts were more likely to use kinship care. Mothers who worked less hours were also more
likely to use infant child care through a relative or an in-home sitter while mothers with longer hours used
formalized daycare or home daycare.

 BRAINSTORM

Given the various benefits of kinship care, what do you think are some disadvantages? Consider whether
the relative’s age, experience with children, and the number of children to provide care for impact the
decision to use kinship care.

1b. Home-Based
Home-based child care involves care provided in either the child or caregiver’s home but the caregiver is not a
relative. It is possible that there may be multiple children that are being taken care of simultaneously in a home-
based setting. Within home-based care, we often hear caregivers referred to as a nanny or a babysitter, both of
whom are different. A babysitter is usually an individual who cares for a child for fewer hours, may not be as
experienced as a nanny (e.g., credentials), and is hired for a short period of time. On the other hand, a nanny is
a professional caregiver who has extensive credentials and/or experience working with children, cares for a
child for long hours, and will help out in the long term.

An estimated 11.2% of children under 5 years of age had a regular non-relative child care arrangement in 2011
(Laughlin, 2013). 7.6% of the children were cared for in the provider’s home while only 3.7% were cared for in the
child’s own home.

 KEY CONCEPT

It is a challenging decision to determine the appropriate child care that meets the family’s needs. Being able
to trust someone, especially a stranger, to independently provide for your baby can seem daunting. It is
always recommended that parent(s) conduct a thorough background check on a potential babysitter or
nanny to ensure that they are making the best decision for their baby. One way to ensure that a parent is
choosing the right nanny or babysitter is through word-of-mouth (e.g., asking people around you whether
they know of anyone that would be a good fit for your family).

 TERMS TO KNOW

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 Home-Based Child Care
Child care that is provided in either the child or caregiver’s home but the caregiver is not a relative.

Babysitter
An individual who cares for a child for fewer hours, may not be as experienced as a nanny (e.g.,
credentials), and is hired for a short period of time.

Nanny
A professional caregiver who has extensive credentials and/or experience working with children, cares
for a child for long hours and will help out in the long term.

1c. Center-Based
Center-based child care is a more organized type of facility that can include daycare, child care center,
preschool, Head Start, and nursery school (Laughlin, 2013). Data from the SIPP indicates approximately 23.5% of
children under 5 years were in some form of organized care in 2011. This type of child care is much different
from the others because it is structured with set schedules and a curriculum. Depending on whether it is a small
or large facility, the center can have classrooms and certified teachers who work with young children.

With infants, daycare centers have strict protocols they must follow.

EXAMPLE It is sometimes the parent(s)’ responsibility to provide additional diapers, diaper cream, milk,
and clothes in case of any mishap. Everything must be labeled with the baby’s name.
The local county health department monitors the facility to ensure that infant care is being provided with certain
standards and all documentation is filed at the facility.

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 You were introduced to Jackie and James, alongside their two children Lucy and Michael, in a previous lesson.
Let’s take the example further to gain insight into factors impacting child care decision-making.

IN CONTEXT

Lucy was two-years-old and always at home with her relatives; she had never been exposed to any
formal care outside of the home. This was only possible because she was living with her maternal
grandparents who were older. Lucy’s parents also alternated their work schedules so that at least one
parent was always at home working and available in case of an emergency.

Jackie and James wondered how to manage child care for Michael. They were not in a position to
work from home anymore and the kids’ grandparents had physical limitations due to their growing
age. Jackie was favoring formal center-based daycare where professionals skilled in providing care
for infants were available. James, on the other hand, wanted to hire a babysitter because it was more
cost-effective. Both tried to understand the pros and cons of each option and came up with the
following non-exhaustive list:

Daycare Advantages Babysitter Advantages

Structured setting More affordable than daycare

More energetic and match energy level

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 Social development through interaction with More fun
peers Works at your home so less transitioning
Ample opportunities to learn and play in challenges for infant
stimulating environment Individualized attention
Consistent caregiving

Daycare Disadvantages Babysitter Disadvantages

Expensive (could cost thousands of dollars May or may not be flexible

per year) Lack responsibility, depending on age
Exposed to more illnesses Lack boundaries with the infant
Limited to standard work schedule and not Lack of experience with infants
evening/night shift workers
Possible learning of negative behaviors (e.g.,
hitting, spitting, pushing, etc.)

There were many deciding factors but ultimately, the parents wanted to do what was best, and most
appropriate for Michael at a developmental level. Instead of selecting one option, Jackie felt that they
needed to do more research and would also talk to their friends and see whether there were any
other options that could be considered. Every family is different and so is every child, so exploring
other options might help them decide on consistent child care arrangements.

 TERM TO KNOW

Center-Based Child Care

An organized type of facility that can include daycare, child care center, preschool, Head Start, and
nursery school.

2. Factors Influencing Child Care Decisions

There are many factors that impact whether an infant has access to good-quality and consistent child care,
when necessary. These factors pertain to both the family as well as the child care facility. On a large scale, we
should take into consideration the availability, accessibility, and affordability of child care (the three A’s; Yerkes &
Javornik, 2019).

2a. Availability
Availability can be defined as the extent to which a child care provider and/or facility has resources to meet the
needs of families.

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 EXAMPLE For example, does the facility have the trained professionals to be able to accommodate a
good provider-to-infant ratio? How many cribs are available, and what measures have been taken to reduce
risk and promote infant health and safety?

2b. Accessibility
While some child care options may be available, they may not be accessible. Accessibility refers to being able
to obtain the services and is closely tied to geographic location. For example, in rural areas parents are more
likely to utilize home-based care and family care as opposed to center-based care (Anderson & Mikesell, 2019).
In urban areas, it is possible that child care is accessible but not available (e.g., infant daycare is within walking
distance but is at maximum capacity) or child care is available but not accessible (e.g., there are openings at the
facility but it takes 45 minutes to get there).

 THINK ABOUT IT

Imagine that you have a baby and need to consider child care arrangements that work with your
employment and family life. You already drive 30 minutes to get to work and another 30 minutes to come
home but you find that there is a highly-rated daycare with another 10-minute drive. They only have one
opening but placing your baby with that particular provider would mean doing all the routines and getting
out of the house earlier in the morning.

What do you think you might do in this situation? Would you send your baby to that child care provider or
not? Why?

2c. Affordability
The financial aspect of child care arrangements is related to affordability. Does a parent and/or caregiver have
the financial means to pay for the child care expenses? Are there government programs available to help fund
families, especially those below the poverty line? Relating this to availability, does a child care facility have part-
time options so that there is a minimal financial burden on the family? These questions regarding finances are
vital determinants of child care arrangements across the world.

 SUMMARY

In this lesson, you first learned about the basics of child care followed by an in-depth look at three child
care categories: relatives (care is provided by individuals related to the infant and include mother,
father, sibling, etc.), home-based (infant care is provided at the provider’s home or infant’s home), and
center-based (infant care is in an organized facility such as daycare, nursery school, etc.). You then
learned about three factors influencing child care decisions: availability, accessibility, and
affordability. The three A’s cannot be looked at individually because they are interrelated, as we
illustrated through examples.

Source: THIS TUTORIAL WAS AUTHORED BY SOPHIA LEARNING. PLEASE SEE OUR TERMS OF USE.

© 2025 SOPHIA Learning, LLC. SOPHIA is a registered trademark of SOPHIA Learning, LLC. Page 146
 REFERENCES

The United States Government. (2022, October 21). Fact sheet: American rescue plan funds provided a critical
lifeline to 200,000 child care providers – helping millions of families to work. The White House. Retrieved March
28, 2023, from www.whitehouse.gov/briefing-room/statements-releases/2022/10/21/fact-sheet-american-
rescue-plan-funds-provided-a-critical-lifeline-to-200000-child-care-providers-helping-millions-of-families-to-
work/

Who’s minding the kids? child care arrangements: Spring 2011 - census.gov. (n.d.). Retrieved March 28, 2023,
from www2.census.gov/library/publications/2013/demo/p70-135.pdf

Anderson, S., & Mikesell, M. (2019). Child care type, access, and quality in rural areas of the United States: A
review. Early Child Development and Care, 189(11), 1812-1826.

Riley, L. A., & Glass, J. L. (2002). You can't always get what you want—Infant care preferences and use among
employed mothers. Journal of Marriage and Family, 64(1), 2-15.

Yerkes, M. A., & Javornik, J. (2019). Creating capabilities: Childcare policies in comparative perspective. Journal
of European Social Policy, 29(4), 529-544.

 TERMS TO KNOW

Babysitter
An individual who cares for a child for fewer hours, may not be as experienced as a nanny (e.g.,
credentials), and is hired for a short period of time.

Center-Based Child Care

An organized type of facility that can include daycare, child care center, preschool, Head Start, and
nursery school.

Child Care
Caring and/or providing for a child in some manner.

Home-Based Child Care

Child care that is provided in either the child or caregiver’s home but the caregiver is not a relative.

Nanny
A professional caregiver who has extensive credentials and/or experience working with children,
cares for a child for long hours and will help out in the long term.

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 The Cultural Impact on Infancy
by Sophia

 WHAT'S COVERED

In this lesson, you will learn about infant development from a cross-cultural perspective. Specifically,
this lesson will cover:
1. Why Take a Cultural Perspective?
2. Cross-Cultural Similarities & Differences
2a. Parenting
2b. Attachment
2c. Meeting Developmental Milestones
2d. Language
2e. Emotions

1. Why Take a Cultural Perspective?

 BEFORE YOU START

Before we delve into the impact of culture on infant development, it is important to recognize that culture
provides a context to understand development. Cultures vary in their values but there are also common
themes embedded across cultures. The ultimate goal is to gain insight into infant developmental outcomes
at a cross-cultural level. We can always learn from other cultures; no one culture is above or beneath
another and all are treated equally.
Culture is embedded throughout our lives and there is no doubt that it plays a role in infant development. The
impact of culture on developmental outcomes can come directly and/or indirectly (e.g., cultural practices and
beliefs that a family adheres to). Most importantly, people belonging to the same culture may vary in the extent
to which they adhere to their culture’s beliefs, practices, etc. Culture shapes the overall environment and also
promotes the development of one’s identity. Bornstein (2015) explains how culture can be viewed across two
characteristics: normativeness (existence of a majoritarian view on certain topics and/or issues) and thematicity
(same cultural beliefs, practices, etc. are observed across different contexts and mechanisms) (Quinn & Holland,
1987).

EXAMPLE In collectivist cultures (e.g., East Asia), there are norms on parenting and how cultural values
are transmitted from one generation to the next. As such, infants may be exposed to these cultural values
that are practiced within the family, outside in the community, and at school. Therefore, parents gravitate

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 towards experiences that align with their cultural beliefs and create a normative environment in which they
raise their babies.

 TERMS TO KNOW

Normativeness
The existence of a majoritarian view on certain topics and/or issues.

Thematicity
The same cultural beliefs, practices, etc. are observed across different contexts and mechanisms.

2. Cross-Cultural Similarities & Differences

While there are many cultures, it can be all too easy to differentiate their practices and beliefs as they relate to
infant development. However, research suggests that culture informs many different aspects of development at
the parent and infant levels, and these similarities are noteworthy.

2a. Parenting
Family dynamics and structure are impacted by cultural norms; for example, culture may inform who gets cared
for, how they are cared for, and when they should be cared for, among other things (Bornstein, 2015). Moreover,
parental expectations towards raising their children, instilling cultural values, and dividing labor are all guided
by culture.

A large similarity across cultures when it comes to parenting is ensuring infant survival (Lansford, 2021). This
may include a wide range of tasks such as the following:

Feeding the baby

Taking the baby to regular well-baby checks
Protecting the baby from environmental hazards and abuse
Providing medication for the baby when s/he is not feeling well
Exposing the baby to a safe and nurturing environment
Ensuring the baby’s overall safety
Attending to and providing for the baby’s basic needs

 KEY CONCEPT

It is important to keep in mind that meeting the baby’s needs is a priority for parenting across cultures.
However, which parent and/or caregiver meets those needs may vary. Research suggests that parents
delegate care-giving tasks with mothers providing direct care while fathers serve as playmates (Barnard &
Solchany, 2022; Parke, 2002). This is what we observe in some Eastern cultures where male members of
the household are breadwinners (they go out for work), whereas female members take care of children,
cooking, cleaning, laundry, etc.

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 2b. Attachment
Infant attachment, as we have discussed in earlier lessons, is the tendency to stay close to a primary attachment
figure, especially when faced with threats (e.g., sickness, distress, strangers) (Bowlby, 1984). From a Western
perspective, attachment is emphasized in the context of the mother-infant bond even though attachment theory
is not biased towards the mother or father. However, in many non-Western cultures, attachment extends beyond
the mother-infant relationship to include non-maternal caregivers such as grandparents, older siblings, and
fathers (Van Ijzendoorn, Bakermans-Kraneburg, & Sagi-Schwartz, 2006). More emphasis is placed on the
infant’s social interactions among all of these individuals.

IN CONTEXT

The Dogon of Mali is an ethnic group in West Africa. Researchers looked at attachment behaviors
among 25 mothers and their 12-month-old infants (True, 1994; True, Pisani, & Oumar, 2001). Overall, a
majority of the families lived in compounds alongside other family members. There were many
children and males had several wives. For the firstborn male infant, primary caregiving varied. For
example, the infant’s paternal grandmother provided for the baby during the day while the mother was
available to feed her baby and sleep with her baby at night. Given that the Dogon have high infant
mortality rates - 25% die within the first five years of life - mothers are extremely protective and feed
their infants frequently and on-demand while also keeping close to them as much as possible.

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 Results from the Strange Situation paradigm with the mother-infant dyads indicated almost 24% of the
infants were classified as disorganized. This is in comparison to 15% of infants in Western samples.
Rates of the other attachment classifications were as follows: secure (68%), insure-resistant (8%), and
avoidant (almost none). Therefore, we can see how attachment, a universal phenomenon, can vary
across families given the cultural context.

2c. Meeting Developmental Milestones

Developmental milestones are skills and abilities that are consistently seen across infants and children. They
may include things such as smiling, crawling, lifting up one’s head without support, babbling, grasping objects,
and much more!

EXAMPLE By two months of age, babies are able to reach the following milestones (CDC, 2022):
Communication (e.g., reacting to loud noises, crying, and other sounds)
Cognitive (e.g., watching people as they move around, looking at toys for longer periods of time)
Physical (e.g., moving arms and legs together, briefly opening hands)
Socio-emotional (e.g., looking at faces, smiling when picked up or spoken to)

The milestone checklists are a tool among many for parents and/or caregivers to monitor their baby’s
development. They are not, however, a substitute for medical advice, especially when milestones are not
achieved. When this occurs, parents and/or caregivers should bring this to the attention of their pediatrician
who can then discuss developmental screening and evaluation.

IN CONTEXT

In a study by Lohaus et al. (2011), researchers assessed infants from Cameroon (Nso people from
Cameroon) and Germany, at 3 months and 6 months of age. The Bayley Scales of Infant Development
were administered and looked at both child interactions and parent-completed questionnaires. Results
indicated statistically significant differences in gross motor development and some communication
outcomes. Specifically, Cameroonian Nso infants showed enhanced gross motor development at both
time points in comparison to German infants. This could be attributed to the socialization approaches
seen in that culture.

On the other hand, German infants had increased abilities related to rolling from the back to the side
and to the stomach along with using their hands to grasp their feet. The differences between both
groups of infants can be explained by cultural differences. Cameroonian Nso infants are mostly carried
around and begin to sit at an earlier age, therefore they do not experience rolling from back to the
side or onto their stomach. Similarly, German infants are exposed to lying more on their backs which
helps facilitate grasping of their feet. Therefore, cultural approaches to child-rearing end up impacting
infant developmental abilities. This, by no means, indicates that one culture is better than the other but
places the cultural context at the forefront when evaluating developmental outcomes worldwide.

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  TERM TO KNOW

Developmental Milestones
Skills and abilities that are consistently seen across infants and children.

2d. Language
While all infants learn the language that they are exposed to, regardless of what the specific language is,
cultures differ in the use of infant-directed speech and help shape the types of words infants learn.

EXAMPLE In Asian cultures that stress interpersonal harmony, such as Japanese, Chinese, and Korean,
children tend to acquire verbs and social words much more quickly than toddlers in North America (Gopnik
& Choi, 1995; Tardif et al., 2008).
Although parents from different cultures vary in how often they respond to their infants, parental response
patterns that are warm, consistent, and contingent on infant actions are associated with positive language
development in infants across cultures.

IN CONTEXT

Rochanavibhata and Marin (2022) conducted a study with American and Thai mothers and their young
children on maternal language and child language outcomes. Mothers completed questionnaires
about their language and also completed language assessments alongside their children to better
understand their language proficiency. Researchers visited the families in their homes and recorded
mother-child interactions while playing with a culturally and gender-neutral toy set of farm animals.

Some of the results indicated that American mothers significantly produced more utterances, positive
feedback, and close-ended questions than their Thai counterparts. Thai mothers, on the other hand,
were more likely to use open-ended questions, direct action requests, attention directives, and labels.
The maternal narrative style was also different for both cultures if the child was a boy or a girl. Overall,
the speech patterns of mothers and their children were related in the context of play. Since American
culture is individualistic and fosters independence and letting the child lead pretend play, the
language patterns observed in American mothers are closely aligned with that. Similarly, collectivist
cultures like Thai culture, emphasize interdependence and following adults and groups, which was
also seen in this study.

2e. Emotions
Besides language, emotions play a role in communication (e.g., how we feel) and this is especially important for
infants because they are non-verbal and need to express themselves in some way. Emotions are universal: a
happy face indicates that someone is happy while a sad face shows that they are sad. However, cultures place
value on different emotions and sometimes certain emotions are stigmatized.

EXAMPLE In male-dominant cultures, boys are taught early on that they cannot cry because that is a
sign of weakness. But, that may not be the case because crying is also the body’s way of dealing with the

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 circumstances. The stigma placed on crying, however, begins early on which then impacts the extent to
which this emotion is valued and passed on in that individual.
One way to understand culture is through the collectivist-individualistic lens. In collectivist cultures, more
emphasis is placed on group identity, interdependence, and shared goals. Meanwhile, individualistic cultures
place more value on individual identity, autonomy, and personal goals and achievements (Hofstede, 1980, 2001;
Markus & Kitayama, 1991; Triandis, Bontempo, Villareal, Asai, & Lucca, 1988).

 KEY CONCEPT

In the context of emotions, learning self-control is characteristic among collectivist societies because it
promotes harmony and emotions are a reflection of the entire group. This is contrary to individualistic
societies where children learn how to express themselves because their feelings are unique and do not
necessarily reflect the emotions of individuals around them.

It is important to understand these cultural values because it translates into parent-infant interactions. For
instance, comparing Chinese and European American mothers of 3-month-old infants, the former display
more allocentric and socialization strategies that follow relational-related and interdependent themes (Keller
et al., 2007).
In a study on cultural differences in the onset of emotional competency, researchers compared Japanese-
American, American-Italian, and Lebanese-Australian mothers (Edwards, Gandini, & Giovaninni, 1996; Goodnow
et al., 1984; Hess, 1980). Results showed that Japanese, American, and Lebanese mothers believe that young
children can regulate their emotions at an early age (e.g., 4-5 years old).

 SUMMARY

In this lesson, you first learned about the importance of cultural perspective when it comes to
understanding infant development. Culture is a broad term and encompasses language, clothing, way
of living, food, etc. Therefore it becomes embedded throughout our lives beginning as early as in the
womb, which we had discussed in a previous lesson. You then learned about cross-cultural similarities
and differences in certain developmental arenas and behaviors: parenting, attachment, meeting
developmental milestones, language, and emotions. The underlying notion across these five topic
areas is that the overarching behavior(s) is universal but the methods to attain it or how it is practiced
varies from culture to culture.

Source: THIS TUTORIAL WAS AUTHORED BY SOPHIA LEARNING. PLEASE SEE OUR TERMS OF USE.

REFERENCES

Bornstein, M. H. (2015). Culture, parenting, and zero-to-threes. Zero to three, 35(4), 2.

Quinn, N., Holland, D. Culture and cognition. In: Holland, D., Quinn, N., editors. Cultural models in language and
thought. Cambridge: Cambridge University Press; 1987. p. 3-42.

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 Lansford, J. E. (2022). Annual Research Review: Cross‐cultural similarities and differences in parenting. Journal
of Child Psychology and Psychiatry, 63(4), 466-479.

Barnard, KE., Solchany, JE. Mothering. In: Bornstein, MH., editor. Handbook of parenting, Vol. 3: Status and
social conditions of parenting. 2. Mahwah: Erlbaum; 2002. p. 3-25.

Parke, RD. Fathers and families. In: Bornstein, MH., editor. Handbook of parenting. 2. Mahwah: Erlbaum; 2002. p.
27-73.

Van Ijzendoorn, M. H., Bakermans-Kranenburg, M. J., & Sagi-Schwartz, A. (2006). Attachment across diverse
sociocultural contexts: The limits of universality. Parenting beliefs, behaviors, and parent-child relations: A cross-
cultural perspective, 107-42.

Edwards, C. P., Gandini, L., & Giovaninni, D. (1996). The contrasting developmental timetables of parents and
preschool teachers in two cultural communities. In S. Harkness & C. M. Super (Eds.), Parents’ cultural belief
systems: Their origins, expressions, and consequences (pp. 270–288). New York, NY: Guilford Press.

Goodnow, J., Cashmore, J., Cotton, S., & Knight, R. (1984). Mothers’ developmental timetables in two cultural
groups. International Journal of Psychology, 19, 193–205. doi: 10.1080/00207598408247526

Hess, R. (1980). Maternal expectations for mastery of developmental tasks in Japan and the United States.
International Journal of Psychology, 15, 259–271. doi: 10.1080/00207598008246996

Keller, H., Abels, M., Borke, J., Lamm, B., Su, Y., Wang, Y., & Lo, W. (2007). Socialization environments of Chinese
and Euro-American middle-class babies: Parenting behaviors, verbal discourses and ethnotheories.
International Journal of Behavioral Development, 31(3), 210-217.

Hofstede, G. (1980). Cultures consequences: International differences in work-related values. Beverly Hills, CA:
Sage.

Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions and organizations
across nations. Thousand Oaks, CA: Sage.

Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation.
Psychological Review, 98, 224–253. doi: 10.1037/0033-295X.98.2.224

Triandis, H. C., Bontempo, R., Villareal, M. J., Asai, M., & Lucca, N. (1988). Individualism and collectivism: Cross-
cultural perspectives on self–ingroup relationships. Journal of Personality and Social Psychology, 54, 323–338.
doi: 0022-3514/88

Rochanavibhata, S., & Marian, V. (2022). Culture at play: A cross-cultural comparison of mother-child
communication during toy play. Language Learning and Development, 18(3), 294-309.

Lohaus, A., Keller, H., Lamm, B., Teubert, M., Fassbender, I., Freitag, C., ... & Schwarzer, G. (2011). Infant
development in two cultural contexts: Cameroonian Nso farmer and German middle‐class infants. Journal of
Reproductive and Infant Psychology, 29(2), 148-161.

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 Centers for Disease Control and Prevention. (2022, December 8). Important milestones: Your baby by two
months. Centers for Disease Control and Prevention. Retrieved March 31, 2023, from
www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html

True, M. M. (1994). Mother-infant attachment and communication among the Dogon of Mali. Unpublished
dissertation, University of California at Berkeley.

True, M. M., Pisani, L., & Oumar, F. (2001). Infant-mother attachment among the Dogon of Mali. Child
Development, 72, 1451–1466.

 TERMS TO KNOW

Developmental Milestones
Skills and abilities that are consistently seen across infants and children.

Normativeness
The existence of a majoritarian view on certain topics and/or issues.

Thematicity
The same cultural beliefs, practices, etc. are observed across different contexts and mechanisms.

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 Terms to Know
Accommodation
Expanding the framework of knowledge to accommodate the new situation.

Acute Phase
The first 6 to 12 hours after childbirth.

Agreement Reality
Ideas and beliefs that members of a group such as a society or culture typically accept as
true.

Anencephaly
When the brain does not fully develop.

Anoxia
When an infant undergoes a total lack of oxygen which can lead to severe brain damage.

Appearance, Pulse, Grimace, Activity, & Respiration Test (APGAR)

Assessment that is conducted one minute and five minutes after birth.

Assent Form
A form for any minor (less than 18 years-old) and provides them with information about the
research study and indicates their willingness to participate.

Attrition
The study dropout rate.

Autonomy vs. Shame and Doubt

Erikson’s second crisis of psychosocial development, during which toddlers strive to gain a
sense of self-rule over their actions and their bodies.

Axons
Fibers that extend from the neurons and transmit electrochemical impulses from that neuron
to the dendrites of other neurons.

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 Babbling
When a baby repeats certain syllables such as ma-ma-ma, da-da-da, and ba-ba-ba.

Babysitter
An individual who cares for a child for fewer hours, may not be as experienced as a nanny
(e.g., credentials), and is hired for a short period of time.

Bed-Sharing
Sharing the bed with the parents, sibling(s), or both.

Binge Drinking
Drinking 5 or more drinks on a single occasion.

Center-Based Child Care

An organized type of facility that can include daycare, child care center, preschool, Head
Start, and nursery school.

Cephalocaudal
Development that happens from a head-down direction.

Child Care
Caring and/or providing for a child in some manner.

Child-Directed Speech
Speech that involves exaggerating the vowel and consonant sounds, using a high-pitched
voice, and delivering the phrase with great facial expressions. Also sometimes called
motherese or parentese.

Climate Change
A broad term to describe long-term changes in global patterns, weather, temperature, and
other climate-related phenomena.

Co-Regulation
When children rely heavily on their caregivers for emotional regulation.

Co-Sleeping
When the parents and children sleep together on the same bed.

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 Cognitive Equilibrium
A balance or cohesiveness in what we see and what we know.

Colostrum
The first secretion from the mammary glands after giving birth, rich in antibodies.

Confirmation Bias
The tendency to look for evidence that we are right.

Conservation
The idea that even if you change the appearance of something, it is still equal in size as long
as nothing has been removed or added.

Cooing
Gurgling, musical vocalization.

Cortex
The outer layers of the brain in humans and other mammals. Most thinking, feeling, and
sensing involves the cortex.

Delayed Postpartum Period

The postpartum period that occurs after the subacute postpartum period and lasts up to six
months.

Dendrites
Fibers that extend from neurons and receive electrochemical impulses transmitted from other
neurons via their axons.

Developmental Milestones
Skills and abilities that are consistently seen across infants and children.

Difficult Baby
Babies that have more negative moods and are slow to adapt to new situations. When
confronted with a new situation, they tend to withdraw.

Donor Milk
Breast milk from another mother.

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 Early Postnatal Hospital Discharge
The discharge of the mother and newborn from the hospital within 48 hours of birth.

Early Preterm Baby

A child born at less than 34 weeks gestation.

Easy Baby
Babies that are generally positive, showing curiosity about new situations and their emotions
are moderate or low in intensity.

Egocentrism
When a child is not able to take the perspective of others.

Emotional Regulation
Can be defined by two components: emotions as regulating and emotions as regulated.

Environmental Factor
A broad range of things in our environment that can impact our health, either in a positive or
negative manner.

Episiotomy
Tearing at the opening of the vagina.

Experiential Reality
Something you have experienced that you know is true.

Explicit Memories
Memories you can consciously recall.

Failure to Thrive
Decelerated or arrested physical growth (height and weight measurements fall below the
third or fifth percentile or a downward change in growth across two major growth percentiles)
and is associated with abnormal growth and development.

Fetal Alcohol Spectrum Disorder (FASD)

Terminology used when looking at the effects of exposure and replaces the term fetal
alcohol syndrome.

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 Fine Motor Skills
More exact movements of the hands and fingers, including the ability to reach and grasp an
object.

Folic Acid
Nutrient found in leafy green vegetables, legumes, egg yolk, liver, and citrus fruit.

Frontal Lobe
Located behind the forehead and responsible for thinking, memory, planning, and judgment.

Fundus
The top of the uterus.

Goodness-of-Fit
The notion that development is dependent on the degree of match between children’s
temperament and the nature and demands of the environment in which they are being
raised.

Gross Motor Skills

Voluntary movements that involve the use of large muscle groups and are typically large
movements of the arms, legs, head, and torso.

Guttural Sound
Heavy sounds made in the back of the throat.

Habituation Paradigm
Assesses the difference between a familiar and novel stimulus.

Hawthorne Effect
When one changes their behavior when they know they are being watched.

Herd Immunity
If 90% of the people in a community (a herd) are immunized, the remaining 10% are protected
because the disease will not spread within the vaccinated members of the community.

Holophrasic Speech
One-word expressions used by children, also known as a holophrase.

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 Home-Based Child Care
Child care that is provided in either the child or caregiver’s home but the caregiver is not a
relative.

Hypercoagulability
The tendency to develop blood clots.

Hypoxia
When an infant is deprived of the adequate amount of oxygen leading to mild to moderate
brain damage.

Implicit Memories
Memories for automatic processes, like motor skills.

Infantile Marasmus
Starvation due to a lack of calories and protein.

Infantile or Childhood Amnesia

The understanding that adults rarely recall personal events from before the age of 3 years
old.

Insomnia
Difficulty falling and maintaining sleep, which can be seen through resistance at bedtime as
well as taking a long time falling asleep.

Institutional Review Boards (IRBs)

Typically a panel of experts who read and evaluate proposals for research.

Jointly Attend
Directing an adult’s attention to an object.

Kwashiorkor
Also known as the “disease of the displaced child,” 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.

Language Acquisition Device (LAD)

A neurological construct that makes infants ready for language.

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 Late Preterm Baby
A child born between 34-36 weeks gestation.

Literature Review
Reviewing previous studies addressing the topic in question.

Lochia
Discharge from the uterus after birth.

Malnutrition
A condition that results from eating a diet in which one or more nutrients are deficient.

Memory Consolidation
When memories are processed so that they can be encoded and stored into short-term and
long-term memory in our brains.

Memory Reconsolidation
When memories are reactivated and can be modified and undergo consolidation once again.

Milk Anemia
A condition in which milk consumption leads to a lack of iron in the diet.

Motor Skill
Any movement ability.

Myelin
A coating of fatty tissues around the axon of the neuron.

Myelination
The formation of myelin sheath.

Naming Explosion
A sudden increase in an infant’s vocabulary, especially in the number of nouns, that begins at
about 18 months of age.

Nanny

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 A professional caregiver who has extensive credentials and/or experience working with
children, cares for a child for long hours and will help out in the long term.

Neonatal Behavioral Assessment Scale (NBAS)

Tool used around the world to help parents get to know their infants.

Neurons
Nerve cells in the central nervous system, especially in the brain.

Neurotransmitters
Brain chemicals that carry information from the axon of a sending neuron to the dendrites of
a receiving neuron.

Night Terrors
Screaming, sitting upright in bed, and being disoriented, afraid, and/or confused; tend to
occur earlier at night.

Nightmares
Scary dreams that often wake up the infant during REM sleep, they tend to occur later in the
night and the infant is typically comforted in response to a parental/caregiver presence.

Nighttime Waking
Disruption of sleep by waking up at night.

Non-REM (NREM) Sleep

When there is low brain activity as well as minimal to no changes in breathing and
cardiovascular functioning during sleep.

Normativeness
The existence of a majoritarian view on certain topics and/or issues.

Object Permanence
The understanding that even if something is out of sight, it still exists.

Observational Studies
Research that involves watching and recording the action of participants.

Occipital Lobe

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 Located at the back of the skull and processes visual information.

Overextension
When a child thinks that a label applies to all objects that are similar to the original object.

Parietal Lobe
Located from middle of the skull to the back of the skull and processes touch information.

Percentile
A point on a ranking scale of 0 to 100. The 50th percentile is the midpoint; half of the infants
in the population being studied rank higher and half rank lower.

Perception
The process of interpreting what is sensed.

Peripartum Onset
Commonly referred to as postpartum depression.

Pincer Grasp
When one grasps an object using the forefinger and thumb.

Polysomnography (PSG)
The golden standard for diagnosing sleep disorders.

Postnatal Doula
A person who helps the mother following the birth process.

Postpartum Alopecia
Hair loss after giving birth.

Postpartum Confinement
A system for recovery following childbirth. It begins immediately after the birth and lasts for a
culturally variable length.

Postpartum Period
A period that begins immediately after childbirth as the mother’s body, including hormone
levels and uterus size, returns to a non-pregnant state.

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 Prefrontal Cortex
The area of the cortex at the very front of the brain that specializes in anticipation, planning,
and impulse control.

Preterm Baby
A child born at less than 37 weeks gestation.

Proximodistal
Development that happens from a center-out direction.

Pruning
The process by which unused connections in the brain atrophy and die.

Qualitative Research
Collecting and analyzing non-numerical data to understand concepts, opinions or
experiences.

Quantitative Research
Research which relies on numerical data or using statistics to understand and report what
has been studied.

Rapid Eye Movement (REM) Sleep

Marked by the classical eye movements and dreaming that occur during this sleep period.

Reflexes
Involuntary movements in response to stimulation.

Resiliency
The capability to withstand or recover from difficulties.

Retained Placenta
When the placenta does not fully come out or parts of it remain in the uterus.

Reversibility
The understanding that objects can be changed and then returned back to their original form
or condition.

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 Room-Sharing
Sharing of the overall physical environment with the parents, sibling(s), or both.

Rouge Test
A mirror test that is the most common technique used in testing for self-awareness in infants.

Schema
A cognitive framework.

Secondary Circular Reactions

The infant’s responses to objects and people.

Self-Awareness
The realization that one’s body, mind, and activities are distinct from those of other people.

Sensation
The interaction of information with the sensory receptors.

Separation Anxiety
Fear or distress caused by the departure of familiar significant others (e.g., primary caregiver,
sibling).

Sexually Transmitted Infections (STIs)

Diseases caused by infection with certain bacteria, viruses, or other microorganisms that can
be passed from one person to another through blood, semen, vaginal fluids, or other body
fluids, during oral, anal, or genital sex with an infected partner.

Sleep
A dynamic, not static, physiological state that is important for functioning throughout our
lives.

Sleep Apnea
Gasping or “snorting” sounds that disrupt sleep.

Sleep Architecture
The different stages of sleep.

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 Sleep Consolidation
Being able to sustain sleep in a continuous manner.

Sleep Hygiene
A broad range of behaviors, or lack thereof, that help promote sleep so that an individual can
function throughout the day.

Sleep Regulation
The ability to go from wakefulness to sleep with relative ease.

Sleep-Disordered Breathing
Dysfunction of the upper airway during sleep, with symptoms such as snoring and/or
resistance and increased effort in the upper airway.

Slow-to-Warm Baby
Babies that are inactive, showing relatively calm reactions to their environment. Their moods
are generally negative, and they withdraw from new situations, adapting slowly.

Social Smiling
Smiling that is evoked by a human face or other social stimulus.

Spina Bifida
Where the end of the spine does not close.

Stage 1 Sleep
When there are brief and involuntary muscle contractions as well as remembering visual
imagery during sleep.

Stage 2 Sleep
Sometimes referred to as “true sleep” because of the brain activity that takes place during
sleep.

Stage 3 Sleep
Referred to as slow-wave sleep (SWS), delta sleep, or even “deep sleep.”

Stranger Anxiety
A fear of unfamiliar people.

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 Stranger Wariness
The fear associated with the presence of strangers that an infant expresses as concern or
fear while clinging to a familiar person.

Stressors
The effects of any factor able to threaten the homeostasis of an organism; can be either real
or perceived threats.

Subacute Postpartum Period

The second postpartum period. It is the most important.

Sudden Infant Death Syndrome (SIDS)

When the death of a healthy infant occurs suddenly and unexpectedly, and medical and
forensic investigation findings (including an autopsy) are inconclusive.

Synapses
The intersection between the axon of one neuron to the dendrites of another neuron.

Telegraphic Speech
When words needed to convey messages are used but the articles and other parts of speech
necessary for grammatical correctness are not included.

Temporal Lobe
Located behind the ears and responsible for hearing and language.

Tertiary Circular Reactions

Actions and ideas where infants become more creative in their thinking.

Thematicity
The same cultural beliefs, practices, etc. are observed across different contexts and
mechanisms.

Theory of Cognitive Development

A comprehensive theory about the nature and development of human intelligence first
developed by Jean Piaget.

Theory of Mind

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 When children come to understand that people have thoughts, feelings, and beliefs that are
different from their own.

Transient Exuberance
The great, but temporary increase in the number of dendrites that develop in an infant’s brain
during the first two years of life.

Trust vs. Mistrust

Erikson’s first crisis of psychosocial development, during which infants learn basic trust if the
world is a secure place where their needs (food, comfort, attention) are met.

Underextension
When a child learns a word stands for an object and initially thinks that the word can be used
for only that particular object.

Undifferentiated Baby
Babies that show a variety of combinations of characteristics.

Vector
Organisms that have the ability to infect humans and/or animals with an infectious pathogen.

Vector-Borne Diseases
Health conditions among humans that are passed on by vectors.

Vitamin D
A vitamin that is commonly found in milk and a few other foods, supplemented with other
foods, and used as a dietary supplement.

Weaning
The process of transitioning the baby off breast milk.

Wet Nurses
Lactating women, hired to nurse others’ infants, especially during the middle ages.

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