The material used from this text must be cited from the

next way: Cerutti Ana. Chap 1 Referential Framework

Conceptual about child development, its conception and
evaluation. In "The evaluation of child development in the
Early childhood in Uruguay: State of the art of the
first detection instruments" UNICEF document,
UCC, Montevideo, 2013
Chapter 1: Conceptual Referential Framework
Ana Cerutti

Studying a child's behavior is above all orienting oneself towards what can be improved; it
what we record at each level is not the maximum of what it is capable of doing, but the minimum of what
we have been able to observe that it can do" (Lézine, 1971:49)1.

1.1. About the conception of child development

Development is a process or set of complex, dynamic, and integral processes,

of transformations that produce more or less continuous changes and that involve a
increase in complexity that leads to a more or less stable and lasting final result.
In the child, these processes manifest through a set of stages.
temporarily ordered that lead him from a more primary state to a more
elaborate and complex temporary or definitive (Rebollo, A et al, 2007:11)2This process,
it is expressed through changes in their behaviors where the child learns to master
increasingly complex levels of movements and postures, of expression of their
thoughts, emotions, feelings, through different languages (verbal,
postural, tónico, gestual, de miradas, de emisión de sonidos, del tacto, pictórico,
graph) and of the ways of relating to others (GIEP, 1996, 2001)3

Sometimes the term development is used as a synonym for maturation.

(improvement of structures and functions) and growth (physical aspects–
somatic, increase in the size of tissues and organs). These processes in life are
closely linked, but they are not the same, the term development encompasses
maturation and growth. There is some difficulty in finding a definition that
including all three of them, while maintaining the specificity of each one, as well as their
complementarity and mutual influence.

1
Lézine, I. (1971) 'The Psychomotor Development of the Child' Mexico. Grijalbo Publishing
2
Rebollo, M.; Rodríguez, S.; Morel, S.; Montiel, E. (2007) “Neuropsychic Development and Its Evaluation”
Montevideo. Latin American Medical Press.
3
Development and Family: The Child from 0 to 5 Years
Editorial Classroom.
The most important connotation of development is to achieve the possibility of adapting.
actively to the environment, to control it and transform it

Scholars of child development who seek to explain different aspects of this

process, from different epistemological perspectives agree that:

1.1.1.) Development is a set of processes that extends widely over time, which
It starts from fertilization and encompasses the whole life, until death.

1.1.2.) Requires three energy sources: 'the maturation of the nervous system'
central as a force, and the interaction with external feedback systems and
"internals" (Brazelton, T. and Greenspan, S., 2005:41)4The normal progress of development
The brain requires the action of a specific condition or stimulus (external or internal).
The major nerve pathways are specified in the human genome but they
modeled by experience, the expression of genes will vary according to
experiences of the environment where the development is deployed. For the development of
In the brain, synaptogenesis requires the activation of two types of phenomena.
Some internal, independent of experience, adaptive and species-specific.
genetically programmed to receive information from different
stimuli from the environment. Others, dependent on experiences and cumulative, that
they develop from environmental stimuli from an early age (Eisemberg,
1999; Greenough and Juraska, 1986, cited by Lejarraga, H., 2004: 342,3435During the
early stages of development, the influences of environmental factors on the
the development of the central nervous system is more important than at other ages because here
differentiation, myelination, and dendritic arborization phenomena occur and
"formation of neuronal interconnections" (Elman et al., 1998) {…} These "activate or
they deactivate existing neural networks, stimulating the development of new ones
interconnections or triggering the pruning mechanism in which the synapses
"inactive or redundant ones are eliminated," this last one reaches its maximum expression
during adolescence (Shonkoff and Phillips 2001).

1.1.3.) Each child actively participates in the process of their development. The relationship
between the child and their environment are bidirectional processes, as the child influences the
amount and quality of care received, while being subjected to influences
from their environment.

The experiences of interaction between the environment and the child and vice versa contribute to the
maturation of the central nervous system, favoring that the brain cells
focus for a specific purpose. "The brain scan of older subjects
show that experiences with an appropriate, motivating emotional substrate and

4
Brazelton, T and Greenspan, S, (2005) 'The Basic Needs of Childhood What Every Child Needs
to live, grow and learn. Barcelona. GRAÒ Publishing
5
Lejarraga, H. (2004) 'Pediatric Approach to Development and Its Problems' In Lajarraga, H. Development
of the child in context. Buenos Aires. Paidós
interesting, they stimulate the brain's learning centers differently than how
it happens with less stimulating or too invasive experiences." Within these
experiences, they are the emotional ones, which constitute in the early years of life the
foundations of cognition and most later intellectual abilities,
including creativity and abstract thinking. Emotional interactions, the
Support, affection, and warmth help the proper evolution of the nervous system.
center for babies and young children. (Brazelton, T. and Greenspan, S., 2005:25,26 and 27)6.
Affective and emotional interactions are determinants at all stages of the
life, but it is in the early years that 'emotional experiences create much more
synthesis, activate different areas of the brain. The affective system is activated and branches out.
throughout the cortex, establishing connections with the visual, auditory, and spatial systems
(op.cit:40), transforming into pillars for brain development, as well as for the
cognitive and social.
Likewise, it is essential for good development (emotional, motor, and language) the
interpretation function that parents perform to the calls, to the signals (shouts,
postures, gestures, cries, smiles, sounds) that the child sends to express their
needs. Through this function, via interactions, they share:
emotions, glances, voices, the melody of gestures, of words, of support
tonically adjusted. Thus, parents give meaning to the first sensations.
of the child, fulfilling interactions a fundamental role in psychic structuring
of the child. An essential task for child development is then 'the construction of
links between the baby's initial sensations, their transformations by the parents and the
internalization by the baby." (Vaseur, R. and Delion, P., 2010)7.
From another perspective, Bruner argues that language development is a process that
it involves both of them. For it to happen, the parents and the child work together.
From birth, the child and the adult engage in communicative acts that
They take place in high-functional value environments, such as food, bathing, play. It is in
these formats or interactive routines that the language is appearing8
At the same time, the stimulation of language, motor activity, or sensory stimulation
they produce morphological effects on neuronal activity, on brain biochemistry and on
the number of synapses produced in the corresponding areas of the brain (Lejarraga,
H., 2004:1189

1.1.4.) It is a continuous and singular process. It follows a functional sequence and

chronological that involves the succession of different types of activities, behaviors,
behaviors, which appear or disappear in the same order but with
differences in both the speed of acquisition between one child and another, as well as in the duration
the time it takes for each behavior to be displayed from the moment it starts to when it ends

6
As cited.
7
Vaseur, R. and Delion, P. (2010) Sensitive periods in the psychomotor development of the child from 0
3 years old. Toulouse, France. Érès Publishing.
8
Bruner, J. (1983) Child's talk: learning to use language. Oxford: Oxford University Press.
9
Lejarraga, H., (2004) "The interaction between genetics and environment" In Lajarraga, H. Development of
child in context. Buenos Aires. Paidós
its acquisition. This allows for grouping the behaviors that arise in stages. Each
child progresses through the same according to their rhythm or "tempo" of acquisition, within a
general sequence pattern. The order of succession of behaviors is the same for
all and it could be said that many are universal (example: cephalic control, position
sitting, standing, walking), varying the age at which they are acquired, depending on the peculiarities
of each population and of each child. The term developmental tempo refers to the speed at which
a child follows one guideline after another and over the time that passes between the
compliance with one guideline and another. For example, regarding the march, its
acquisition can be expected between 8 and 18 months, as there are children who are born with a
elevated muscle tone, which are little extensible and may start to walk between the
8 and 9 months, while those who have a low tone, very extensible, will do it.
between 15 to 18 months. Other behaviors are achieved in shorter intervals, such as for
example of the search for the source of the sound, whose acquisition interval spans
around 2 months (3 to 5 months). From the above, it follows that it is observed
different time intervals between the age when a behavior begins to appear
in children with supposedly normal development for a given population, up to
the age at which 100% of that population acquires it and differences are also presented
in the acquisition segments between the behaviors.
These processes of acquisition and transformation of behaviors and of the
behaviors are based on a foundation whose characteristic could be considered
universal and constant, linked to the child's relationship with their parents: quality of
communication, and of the interactions (emotional, social, and intellectual);
sensitivity to the child's demands and to the opportunities for everyday experiences
that are offered to him, among others.

On the other hand, the development of children exposed to similar conditions does not evolve from
the same way. Some will be more vulnerable than others, presenting a greater
sensitivity and fragility to respond to a disturbing factor than others,
but there is always the probability that there are children who do not have problems, to
less in appearance. This has led some authors to call them resilient children.
For resilience capacity to be deployed, it is not enough just with aspects of its own.
Child, it is necessary for these to be combined with the presence of protective factors.
coming from the context where the child develops. Hence today, there are authors
like Horacio Lejarraga (2004)10that they call social resilience, to underline the
importance of aspects arising from the environment.

1.1.5.) Development is a complex and dynamic process, fundamentally in the

first years of the life cycle. "Normal development occurs in a spiral with pauses,
regressions and jumps. It has been noted that around 7 months, the baby vocalizes a lot like
if I were training in all the sounds of language; but at 8 months, it happens
suddenly a phase of detention. As if I had lost all verbal wealth

10
Child Development in Context
acquired and after nine months, following a period {...}, the first words
They begin to stand out from the sound ensemble; one then witnesses a true explosion.
"acquired verbal, the child chatters again" (Gesell, cited by Lézine, 1971:34)11.
Reason why there are authors who prefer to talk about phases instead of stages of
development. The stages or phases are not synonymous with: stages of development, periods
sensitive, critical periods and key moments.
The stages are the descriptions of the milestones of development. In the form of bullet points
temporal references about the moments of appearance of the different behaviors. They are
more linked to its evolutionary aspects, can be identified with some
clarity and measuring.
Functional stadiums have been conceptualized and described from different perspectives.
epistemological perspectives by different authors, (Freud: development of sexuality;
Piaget: cognitive development; Wallon: emotional development, among others). The stages
they are a succession and chain of instinctive stages that mark life
psychic development of the child and intellectual functions. "According to Wallon, the stages are
discontinuous, which does not prevent the continuity of development, marking what is continuous and
The discontinuous know qualities that define the nature of development that is only
one" (quoted by Barreda and others, 2011:22)12The stadiums are more encompassing, they imply
more than one stage and they are less homogeneous.
Critical periods are those periods of rapid changes that operate in a
brief and limited lapse, during which the central nervous system is highly susceptible
for the effects of external or internal conditions or favorable stimuli. They are
common and specific to the species (species-specific). They are inserted in processes
organizational systems in which the systems at play interact with each other and become
increasingly complex, more stable, and more differentiated. During such periods, agents
externals can lead to an evolution in one direction or another, where it is done
essential the existence of certain specific conditions for the development of
nervous system progresses normally. If the process or processes become
seriously interfered with by an external agent to the process itself, preventing it from
Usually, the damage is irreversible in nature, although it can be renewed afterwards.
the noxa, the damage is already done. However, if that noxa acts outside the critical period,
it does not affect in the same way, nor to the same degree and damage may not occur.
In other words, during the critical periods for them to occur and consolidate.
rapid changes that are genetically determined and that coincide with periods of
synaptogenesis requires the presence of favorable conditions or not
there are too many dysfunctional or very severe noxious stimuli. They involve both the
development as growth Those linked to growth are more
related to bodily function, nutrition, and the preservation of life and
Those of development are more associated with maintaining the bond, the functions.
mental health and socialization. For example, the impact of an insult that causes delay
of growth and affects final height, it would be greater if it occurs when the speed

11
Op.cit.
12
Barreda, D. (2011) 'Continuous Development Record of the Child. Risk Detection.'
Córdoba, Argentina. Editions of the Copyist.
 13
of growth is greater. Alan Shore, (2001) suggests that: "during the periods
growth critics, the brain is very susceptible to environmental factors
adverse issues such as nutritional deficiency, interpersonal emotional experiences dis-
regulated, that negatively impact children's health." Regarding development
Frances Mustard, J. (2005:21)14trace:
The development of the brain is strongly influenced by experience in the
uterus and in the early years of development. Some of the sensory pathways such as the
vision, hearing, and touch have a critical period for their normal development in the
early life. The development of the SPA pathway (which affects cognition among other things,
emotion, behavior, and the immune system) is strongly influenced
due to the experience during the first years of life, even in the period within the
uterus. In contrast, some regions of the brain, such as the hippocampus and memory, thus
like the olfactory system, they retain their plastic capacity throughout life. The
differentiation of neuronal function and synapse formation are dependent on
experience, which influences which genes will be activated and how they will function.
It has also been shown that the ideal period to learn a second language and
manage it like the mother tongue, the first 12 months, then it can be learned,
but as age advances it will be more difficult and the trace will appear that it is a
foreign language. The footprint increases, the older the age of learning. Another
example, it is related to the impact of a conductive hearing loss, which would be
it is better to appear at 2 years than at 6 years, since at 2 years one is in full
rapid incorporation process of new words.

In contrast, the definition of sensitive periods has more than one meaning according to the
authors: (i) On one hand, it refers to the real crises through which the child tells us
it shows what is its own and what it has acquired at certain stages. For example: from 8 to 10
months, shows the reaction towards strangers; between 18 to 30 months presents
sharp crises of opposition associated with profound restructurings of their possibilities
motors (Lézine, 1971: 17)15(ii) On the other hand, it can also refer to those periods
of development, where the brain is particularly receptive to harmful influences
that are produced by exposure to certain experiences (internal or external). Where to
At the same time, a strong relationship is established between psychoaffective and neurological development.
of the child. For example: in the first months, when the interpretations made by the
parents about the signals coming from the child do not correspond to their needs,
interests, always or most of the time, and parents cannot recognize and
fix the failures, that is, the errors in the interaction, the child is left in a situation of
suffering, of psychic abandonment. If an appropriate response does not come to pull him out of his
helplessness; it will affect their tonic - postural, sensory - motor and psychological organization of

13
Effects of secure attachment relationship slip on right brain development, affect regulation and infant
"mental health" Shore, A, Infant Mental Health Journal, V.22.2001.
14
Fraser Mustard, J.,(2005) "Development of the brain based on early experience and its effects on the
health, learning, and behavior." OAS document.
15
As cited.
more or less durable way, if not definitive. (Vaseur, R. and Delion, P., 2010)16No, not
the child benefits from timely responses or stimuli necessary for the period
referred, the signs of psychological or neurological suffering begin to manifest.
These at first are not very specific, inconsistent, poorly explored, and even
normalized, allowing for a vicious cycle to be established between the child's activity and the
abnormal coordination schemes. After this period, it is difficult for the structure
cerebral resume the path of normal development. (Vaseur, R. and Delion, P., 2010)17.
The difference between sensitive period and critical period is subtle, and there are authors who use both.
terms such as synonyms, as well as others, suggest that they are two sides of the same coin.
currency, given that in the conception of critical periods the circumstances are emphasized
in which the nervous system can be more vulnerable, while in the periods
sensible emphasizes the necessary conditions for normal development.
Meanwhile, the expression Key Moments for development is coined by Brazelton.
2005: 22118who considers the existence of 13 key moments during the 3
first years of life and defines them as those periods of time in which the
Child development causes a profound disruption of the family system. The Moments
Keys are precursors of the rapid and exciting progress in the development that will be presented.
later. For example, at 4 months the child begins to make extraordinary progress
in the cognitive knowledge of the environment. They are interested and attentive to each stimulus that
coming from the environment, will stop feeding to pay attention to these, just as it
will awaken again at night, interrupting the balance achieved in routines
from everyday life, which can affect relationships with their caregivers. The
The conception of key moments that Brazelton supports has a bidirectional approach.
focusing jointly on development and its influence on the
child/parent relationships.

The normal development process is also complex and dynamic due to what is
denominations of variations of normality. These refer both: a) to the behaviors that
they can manifest in some children and not in others, b) like those acquisitions that
they can stop or disappear momentarily, or c) certain disorganizations
typical of the normal process. In the first case, it relates to certain behaviors that
They do not necessarily have to be present for others to be acquired, as for example
example, crawling before walking. In the second, it pertains to regression periods, in
those that may present a temporary loss of behaviors already acquired. For
through which the child expresses his concern in response to an event that
anxiety (birth of a sibling, start of kindergarten, moving, separations). In
As for the third, it refers to the possibility of the emergence of certain disorganization.
transitory in the development, prior to the appearance of an important milestone. Before each
important leap in the different areas that integrate development, "there is a small
but predictable period of disorganization" (Brazelton, 1994)

16
Op.cit.
17
Op.cit.
18
As cited.
The above requires us to know how to differentiate between the possible variations inherent to
normal development; of the variations of pathological development. That is,
detention, regression or non-appearance of one or more behaviors, and/or the emergence of
strange, bizarre behaviors (staring steadily and persistently at one's hands,
absence of eye contact, absence of demonstration of affection or excessive fear;
persistent and compulsive repetitions of certain movements) derived from possible
developmental disorders. The latter can be developmental or non-developmental, varying
also its intensity (mild, moderate or severe), depending on the moment in which
it acts the noxa or of the type of pathology.

On the other hand, it has been found that it is difficult to assign prognostic value to the results of
the observations or tests made before the age of three. This is due to the
Characteristics of development: (i) On one hand, following Lézine (1971), it is emphasized that
incident that the sensitive periods as defined by the author can have on the
moment to observe the development. During them, it is possible that it may be more
complex that in others their evaluation, due to the influence that they can exert
during the administration of the test and therefore in its interpretation. For example: the
interference that may occur during observation, between 6 months to 8 months,
from the child's reaction to strangers; between 10 to 11 months, due to the possible
irritability that may manifest due to the teething process; between 15 to 30
months, given the probability of opposition crisis occurrence. (ii) On the other hand, the
Development in the early years of the life cycle is very dynamic and presents a great
potential for change, for rapid modifications. Development has great power
Regarding recanalization, it can be diverted due to adverse effects, but once these are eliminated,
it can also be reset. For the above reasons, the actions for evaluating development
they must always be linked to promotion, prevention, and/or treatment actions. If
Well, the central nervous system, due to its plasticity, is susceptible to being modified and
change throughout life, in the early years it is more ductile, more malleable and with
greater ability to respond by changing more quickly than at other times
of the vital cycle. From here, this period becomes a unique opportunity to
intervene. The parent/child interaction is also more modifiable in the first two
years of life. Likewise, when there is an already established pathology, the sooner it is...
intervention, the greater the chances of quality of life and well-being for the
boy and his family.

1.1.6.) Development is comprehensive, in the sense that they influence the development process:
the child's own characteristics (genetic factors, biological substrate, competencies,
temperament). This equipment is deployed in dynamic interaction between the
processes of development, maturation, growth, and learning. Joined also to the
interaction of the child's characteristics with those of their environment (family group, context)
socio-economic, cultural, and political; local and expanded) All of which affect the
exchanges between the child and their family environment.
1.1.7.) It is multidimensional; for its study, it is divided into areas/dimensions or sectors.
(motor, coordination, social, emotional, language, cognitive,) depending on the
predominant aspects of the behavior or the behaviors explored.
The WHO suggests taking into account the following areas: gross motor skills; coordination
manual and visomotor; language and hearing; personal and social skills
self-help.
In the period from 0 to 3 years, the different dimensions influence and interact with each other to
enable both progress and setbacks. Likewise, the same behavior
can provide information from more than one dimension and/or area. For example, the
The following behaviors in the language area may also indicate something else.
area: social smile (language and emotional); compare by sizes (language and
cognitive); turns his head in search of the sound (language and coordination). As soon as possible.
exposed, "it only serves to highlight that the areas that are defined with
analytical purposes in reality function with interdependence or superposition
19
{...} the study, sector by sector, is perhaps justified from a
didactic point of view, but it should not lead to a biased idea of the development that
it is a totality {...}” (Mazet and Stoleru, 1990:6)20
The study of child development has an interdisciplinary–transdisciplinary character.

1.1.8.) It has been demonstrated with greater rigor how stress acts on the
child development by modifying it. "A controlled amount of stress, within the framework of
stable and sustaining relationships can promote child development, helping to the
self-affirmation and the ability to face problems. While exposure to
chronic stress situations such as living in poverty; family conflict
Sustained, emotional deprivation negatively affects the child's development.
(Swartzmann, L., 2012)21"Sustained stress in the absence of a containing adult"
it can have devastating effects on the psyche and on the architecture itself
cerebral. When it is chronic and prolonged over time, it can affect the stages of
motor, cognitive, emotional, social development, and the recovery process is much
"slower and more expensive" (Brazelton, T. and Greenspan, S., 2005: 40)22
Psychosocial stress and psychological trauma in the early years of life, "produce
chronic elevation of serum cortisol and stress-related neurotransmitters, which
that causes damage in specific areas of the brain, among others, in the limbic area (the one that
it supports emotional development). This can adversely affect the ability of
child to feel empathy, compassion and to be able to self-regulate their level of activity, feel
normal fear and self-inhibit when necessary. For all of the above is
it is essential to intervene when the baby is exposed to too much stress,

19
Lira Letelier, M. I. (1992) "Construction and Evaluation of a Screening Technique for Delays"
Psychomotor Development – National Fund for Scientific and Technological Development P014/90 and 062/91.
Santiago de Chile .CEDEP
20
Mazet, P and Stoleru, S. (1990) "Manual of Psychopathology of Early Childhood"
21
Scwartzmann, L. (2012) Course on the use of instruments for the assessment of child development
CAIF Plan teams. Unpublished Montevideo. CAIF/INAU Plan
22
As cited above
abuse or emotional deprivation or lack of stimuli" (Maldonado Durán, Saucedo García,
Lartigue, Karacostas V., 2000)23

Frances Mustard, J (2005)24reinforces what the aforementioned authors expressed,

By proposing that: "Through the use of brain imaging techniques there is evidence
that children in the early years of life who are exposed to physical or sexual abuse
serious alterations occur in the structure of the brain and its function. This is
an example of a severe stress response involving the touch pathway in the
early years of life. In a study, it was found that these children, already as young people or
young adults showed depression, anxiety, suicidal tendencies, aggression,
impulsivity, criminal tendency, hyperactivity, and substance abuse
toxic."{...}"An adverse early childhood affects the neurobiological pathways that influence
in behavior. Approximately a quarter of boys show a
antisocial behavior at the time of their school start and of them 5%
they will remain dissociators in their adolescence and young adulthood. It seems that this
hardcore group is a product of poor early development, particularly
of circumstances associated with dysfunctional and violent families." (Frances
Mustard, J., 2005: 21)25

Certain early experiences and exposure to risk factors for development,

they can affect the present and future development of the child, depending on the number,
intensity and exposure time, (GIEP, 1996, 2001)26y27

In summary, the proposals of Brazelton and Greenspan are invoked.

23)28, to summarize the position of those who research and study early childhood: “The
early childhood is the most critical and vulnerable stage in a person's development. The
the consequences of the deprivations experienced during the first years of life are
irremediable frequency Different investigations, including ours,
It is shown that it is during the early years that the foundations for development are established.
"intellectual, emotional, moral"{…} Problems can be remedied but the cost
it is higher and the chances of success decrease with each passing year.
One cannot fail the person during the first years of life {...} and also to
society, as it will compromise the capacity of future generations
to maintain family units and provide economic and political stability

23
Maldonado Durán, Saucedo García, Lartigue, Karacostas V. "The mental health of the baby. New
Evidence (Infant mental Health. New evidence)
(http//www.kaimh.org/porque2.htm)
24
As cited previously.
25
As cited.
26
Bernardi, R; Swartzmann, L; Canetti, A.; Cerutti, A. and others - GIEP/Department of Medical Psychology/Faculty of
Medicine/UdelaR (1996) “Caring for the potential of the future” Montevideo.CSIC, CLAP/OPS, IIN,
UNICEF
27
Op.cit.
28
Op.cit.
The aforementioned has been influencing the development of methodologies and tools.
to continue advancing in the understanding and knowledge of development processes
childish, as well as in relation to its evaluation, both at the population level and
clinical. It also accounts for the complexity involved in the preparation and/or selection.
of the evaluation instruments for child development.

1.2.) What is understood by the evaluation of child development?

Until the early 20th century, the terms of measurement or examination were used.
subsequently, the evaluation one appears. This is broader than the previous ones and its
origin can be attributed to behaviorist psychology. In the topic we are addressing, it is used
to determine to what extent the child's development progresses as expected
for a given population. When comparing the results achieved with the
expected, it is deduced what has been achieved and what has not. From this position, the emphasis
is only included in the final result. Subsequently, the term evaluation and its
conception is revisited from other perspectives (constructivist, interactionist,
neuropsychological, cognitivists, others), complicating it.
Today, the evaluation of child development includes: a) both the final result
like the process; b) the prominence of the evaluated subject; c) the incidence of
those who surround him and the environment and d) the evaluating/observing subject, their degree of
involvement and the degree of appropriateness of the selected tools.
Development evaluation can then be defined as a continuous process,
complex, difficult, and committed to obtaining systematized data about the
child development. It also includes the analysis of information and decision-making.
decisions. This involves the involvement of the evaluator, who judges the data and
makes decisions. The one who observes, who evaluates, explicitly or implicitly issues
a value judgment, which can be decisive for the present and future of the child and their
family. Hence the need to provide well-founded, valid, and reliable information,
within the inherent limits that always come with the action of evaluating development
infantile, minimizing the risks of any arbitrary or random evaluation.
It is noteworthy that the evaluator's involvement is present in both assessments.
systematic as unsystematic or intuitive, but the latter are at greater risk of
increase the margin of error, than the first.
In every evaluative act, beyond the technique used, a vision is always obtained.
partial, never objective. According to Rumeau, an objective and subjective partiality to the
The objective partiality is expressed in the delimitation of the field of study,
in the selection of hypotheses, procedures, and tools. While the
subjective partiality is represented by the inevitable implication of
researcher (evaluator) in the observed environment, which is expressed in the
interactions that the observer must establish with this medium, without which no
there is observation” (Rumeau, cited by Auzias, M., 1995:512)29That is, the observer
is always involved in the reality it observes, is part of it, because
is in constant interaction with her. "He must analyze his behaviors, his attitudes
in light of the reactions she provokes in him and he must become aware of the
imaginary and symbolic reality in which he has been placed by his interlocutors
Rabain, J. cited by Auzias, M., 1995:58930In every evaluation or observation, there is always
values are attributed, is appreciated or measured (actions, situations, results, behaviors).
compared with a parameter that accounts for what is desired; against standards; against oneself
at the same time, against a baseline in accordance with objectives and goals. It is
necessary for these judgments to be well-founded and able to be transmitted and
communicable to others. The subjectivity of the evaluator is always present when saying
from Humberto Maturana: 'objectivity is always in quotes'. The evaluator
it contributes to increasing the balance between its objective and subjective partial vision when
has completed knowledge of the tools to be used, receives training
specific its use, and carries out the necessary controls: such as continuous reading
of the instructions or application manuals; participation in spaces of
exchange with others, (forums, working with another observer, task supervision,
etc). And it also maintains a committed attitude through training
permanent on child development and its evaluation.
Another aspect to consider about the evaluation of child development is its nature of
opportunistic31In the sense that this can be done gradually
non-systematic manner, as part of the pediatric consultation and/or within the activities
from a Child Education Center. Information can be obtained about the
motor skills, coordination, language, aspects of the personal-social area, among others,
through the observation of children's spontaneous activities (movements,
postures, ways of communicating, relating, playing); enriched by the contributions of the
parents. However, today there is enough evidence that this informal evaluation
and opportunistic it is necessary to combine it with the use of systematized tools to the
effects of increasing the detection capacity of the unobservable problems of
development (Lejarraga, H., 200432;Zill, N. and Ziv, Y.; 2007)33

The systematized evaluation will include both diagnostic techniques and

first detection (screening) whose definition will be addressed in the section
corresponding. It is necessary to point out here that there are authors who reserve the term
evaluation only for diagnostic techniques, while for screening or
they call them screening for surveillance. They establish a difference between

29
Auzias, M. (1995) In Levobici, S. Weil Halperin, F. "The Psychopathology of the Baby" Mexico. Siglo XXI
Editors.
30
As cited.
31
Ripoli, M. (2004) "Difficulties and alternatives for monitoring and promoting development in the first
level of attention". In Lejarraga, H. (editor) "Child Development in Context". Buenos Aires. Paidós
32
Lejarraga, Horacio (2004) "Pediatric Approach to Development and Its Problems". In Lejarraga,
H.(editor) “Child Development in Context” Buenos Aires. Paidós,
33
Zill, N. and Ziv, Y. (2007) "Toward a Global Indicator of Early Child Development. Summary report."
UNICEF. ECD, UNÑ.
surveillance tests and proper evaluation (Grant, R., Gracy, D., Brito, A.,
2010)34But since both make judgments, they evaluate with inherent differences to their
objectives and specificities, all evaluation tools are considered
systematics of development. This position coincides with what is stated in the National Guide
for the monitoring of the development of children under 5 years old (MSP, 2010) and
also with the proposals by Horacio Lejarraga (2004)35.

The topic of development evaluation also involves aspects of the

methodology and techniques. In this regard, a brief reference is presented about this
point. Both the methodology and the techniques must align with the objectives
proposed for evaluation and the available resources (human and material).
Those who carry out the evaluation with a systematized instrument need
to rely on specific training in its use. In this regard, it is noted that
for the publication of works that involve the evaluation of development, in journals
international, fundamentally those arbitrated require within the requirements
have the certification of the training in the instrument used, and where
also include the degree of inter-judge agreement achieved by the one who conducts the
evaluation, an aspect that will be revisited later. In addition, it is mentioned as a title.
informative, that currently many techniques also require to be used to have
acquired the corresponding patent.

The methodology and techniques can be qualitative, quantitative, or combined and

studies can be cross-sectional or longitudinal.

Today, there are multiple procedures or techniques available to evaluate development.

childish, each of them presents its scope and limitations. There is not yet a technique
of first detection (screening) or diagnosis that alone answers all the
questions. All contribute data that demand to be discussed, compared, and associated
with the information coming from the context. All have the inherent limitations of
the evaluation of child development and its conceptions, and those imposed by the
nature of the method, the resources and the material collected.

The techniques have been and are very debated and questioned for various reasons. They go
from the impossibility of questioning the child in the early years with the language that
first in the adult world, which is the verbal. By being deprived of the verb and of the
controlled motor skills raise doubts and questions in the observer, as well as
it increases the likelihood that interpretations will emerge from the projections
more from the observer himself than from the observed reality. Up to the expression of struggles
of power, by the primacy of one discipline over another, of one technique over another,
often blurring the center of discussions.
which should focus on the child, their uniqueness and needs; as well as on the

34
Grant, R., Gracy, D., Brito, A., (2010) “Developmental and social emotional screening instruments for
Pediatric Primary Care in infants and young children. New York. Children's Health Fund.
35
Op. Cit.
theoretical references and objectives for which the techniques are created and to what degree
congruence with the objectives of the evaluation, as well as with the limits imposed by the
own reality.

The techniques cover a range that extends from observation to participant action.
child observation conducted without guidelines, natural or free, to the observations in
standardized situations. The latter through the situating of a child
in front of a specific material or event that is revealed by observing the response
of the child and/or the electrophysiological indices (heart rate, respiratory rate, etc). It is
it also includes here, those based on the direct observation of behaviors and
children's behaviors through questions to parents and teachers. Linked to
the previous ones, another aspect that has given rise to controversies is related to which
it is the least polluting place to conduct the assessment, if the everyday environment of
child or an external place. In this regard, Baudonnière and Nadel state: "They are no more
true, certain behaviors for having been recorded in a usual environment or
more spontaneous than others observed in the context of a controlled experiment.
In both there are always particular restrictions" (Baudonnière, P. and Nadel, J.,
1995:16836On the other hand, many precautions must be taken in the study of a
small child, since not every moment of the day is the most suitable. It is necessary to
to seek the state of vigilance and to be free from sleepiness, hunger, thirst, fatigue, or problems
of mood; and that it presents good health conditions. As well as taking care of the
conditions of the place, avoiding the presence of additional stimuli that divert the
child care.

The observation of child development without guidelines, called 'free' 'pencil and paper' is
a qualitative technique par excellence, it allows for deeper understanding about
each child and their context. It is used both in research and in the clinic. In the
First, to generate knowledge, formulate hypotheses to advance understanding.
of the mechanisms put in play during development and/or contribute new ones
discoveries about the process of child development. In the second, to contribute
relevant information on the diagnostic process of developmental disorders.
It is also a privileged tool in the training of human resources. The
technological changes (film, video, and the various possibilities of recording and re-reading,
as well as the progress in analysis procedures) are largely responsible
of the rapid advances in the knowledge of child development and the relationship of
small child with their caregivers, is being generated with this procedure, since
from the end of the last century to the present. It is noted that it demands a strong
training, along with the need to have enough time for it
implementation and for its analysis. Because of this, it is generally used in situations
individuals; or in studies that require the evaluation of few cases; or in those
investigations in which the time variable is not bounded, such as in studies
ethnographic, ethological, anthropological, psychoanalytic, others.
36
Baudonnière, P. and Nadel, J., (1995) "Behavior observation techniques" In Levobici, S. and
Because Halperin, F. op. cit.
In the first half of the last century, using unstructured observation and from
different epistemological positions have been fundamental to advancing in the
knowledge of child development the works of: Arnold Gesell prior to the
development of his scale; by Piaget on cognitive development; by Wallon on the
development of emotions and tone; of Vygotsky on language; of Freud on the
psychic apparatus, by Esther Bick on the formation of human resources, among others. And
In the second half of the last century, the contributions coming from the
research on communication (nonverbal and verbal); the development of the
emotions; the interactions in the mother/baby dyad, the competencies of the baby and the
attachment, among others. Most arise from work that uses the methodology and techniques
qualitative. It also requires rigorous training, as well as monitoring.
strict about certain requirements (place, time of day, method of registration), and
procedures for analysis. It requires very meticulous work for each case,
difficult to carry out in population tasks that require evaluating many cases
or for those for whom there is not enough time and resources and very
qualified. It is worth remembering here what Massie and Campbell suggested regarding the
Mother-child attachment indicator scale under stress conditions: 'many'
researchers today are focused on the mother/child interaction process through
micro-analytical studies in a 'laboratory' situation, measuring time and the
rhythm of dyadic behaviors as they occur in seconds and fractions of
seconds (Stern, 1971, Tronick et al., 1079). But these valuable and careful
measurements are not procedures that could be transferred to health control or to the
exploration of what happens with populations that require rapid applications without
specialized team. We emphasize then that a fundamental objective of the
the development of our scale has been to meet the need for simplicity and effectiveness in
the practice of periodic health checks to document the interaction process
progenitor-child (Massie and Campbell, 1986: 238)37.
The information presented in the previous paragraph, combined with the strength of the arguments regarding the
the need to evaluate child development leads to the creation of
standardized first detection instruments to explore with a first glance
the state of global development or its dimensions of all children,
regardless of the demand. They are also designed for diagnosis,
as complementary tools for other procedures.

The evaluation of the development is systematic, continuous, and without the child's explicit request, and their
family is necessary for several reasons. a) On one hand, many parents and family members of
health and education teams are unaware of the early behaviors and signs of
alarm and even when they observe them, sometimes they do not value their relevance and/or do not know what
measures to take, and/or where to turn for help. b) On the other hand, in the first years of life
easily detectable manifestations of development are presented at first glance and
others that did not, manifesting with greater visibility later, having lost a

37
Massie–Campbell Scale of mother–child attachment indicators under stress conditions (1986) In
Massie and Rosenthal "Childhood Psychoses in the First Four Years of Life", Buenos Aires. Paidós,
unique time in the life of the child and their family. c) Likewise, development is variable and
very vulnerable to environmental effects and can be affected in the same child in
any moment of his life due to the influence of different factors (of the child, of
environment). That is, continuous monitoring over time allows for comparison
the current observations with the previous ones, fundamentally when a change
sudden in the child's life like exposure to acute stress situations, can
change its pace of development. d) To which it is added, that the guidelines and support
that are provided to parents to be effective, must be linked to the moment for which
The child goes through their development. (Benguigui et al., 2001, Lejarraga, H, 2004)38;
Brazelton and Greenspan, 200539).

It is not enough to include some developmental milestones in the child's control card, it
it requires defining a technique, establishing the theoretical assumptions on which it is based, and evaluating
its rigor to allow the user to interpret it correctly
results and refer appropriately" (Frankenburg, W, 1988)40

As a result of the above, it is agreed with Horacio Lejarraga (2004)41in defining the
assessment of child development as "a systematic and standardized record of the
child behavior

Today, there is agreement in the scientific community that the different methodologies and techniques
complementary. It is reminded that a quantitative technique can have results
numerical or evaluative (for example, present/absent) as well as any instrument of
structured observation is a quantitative technique, even if the analysis is qualitative. There is
authors, who refer to scales or tests that obtain quotients or indices of development
semi-quantitative techniques because they evaluate qualitative variables (such as those that are
behaviors) that are assigned a score; then these scores are summed and obtained
a quantitative data" Surveillance Guide, MSP, 2010:6)42
Combined techniques can be used, both for data collection and for the
analysis, a quantitative technique can be accompanied by a qualitative analysis. As it
further on, most instruments allow for recording and analysis both
from the data obtained from the situation of standardized observation as from the
free observation. The latter, whether from the record of the aspects that arise in the form
spontaneous during the application, such as the inclusion within the test of a
supplementary section on the spontaneous observation of the child's behavior
and the relationship of this with the adults present.
It is reiterated that the selection of a technique will depend on the theoretical frameworks.
referential, of the evaluation objectives, and of human resources (training,

38
Op.cit
39
As cited.
40
Frankenburg, W. (1988) "Comment pitfalls in the evaluation of development screening test. The
Journal of Pediatrics. Dec, 1988, 1110 - 1113
41
Op.cit.
42
Cited work.
time) and materials available, and in both it is necessary to comply with the
rigor of the theoretical-technical procedures and the ethical framework.
The different techniques are a help, a tool, and as such, they should be used.
One must not forget that both working with large populations and with cases
Individuals should always focus on the child and their family.
singulars and in their context.

1.3.) Psychomotor development

1.3.1.) What is meant by psychomotor development?

In general, most instruments that investigate the overall development of the child ...
Over the first 6 years, they are based on what is known as psychomotor development. The
the term psychomotricity refers to the close relationship and interaction that occurs between the
development of motor skills, intelligence, affectivity, and emotions.
"Psychomotricity is written as one word because the child who awakens and grows,
develops both their psyche and motor skills in a constant interaction {...}
His body, and mainly his motor skills, are the means of expression of the child.
fundamentally in the period from birth to 3 years {...} The baby
it has no body, it is a body and all its development goes through its body. Its
needs, the desires he expresses, the responses his mother gives to his demands, the
place that results from it, its actions, the communication and interaction it establishes,
everything passes through the body, it is a body of relationship (Lèvy, J. 1980:13,14)43The first
the child's learning is closely linked to the body, at the same time
that they build. Body that is constructed from support, companionship and
provocation of the adult or adults who perform parenting functions” (Calmels,
D.1997:3244

Psychomotor development is understood as 'the progress that the child makes

forward in different dimensions or domains to manage by himself,
that is to say, in the progressive process of conquering its autonomy (learning to sit down,
to walk, to master different ways of positioning oneself in space and postures, to speak,
manipulate objects, laugh, sing, play music, play). The above concerns development:
cognitive, character-related, emotional but also to the development of their skills
social and motor skills” (Georgette D et al., 1994: 83)45

Cusminsky defines it as a dynamic and continuous process of progressive organization.

and complex of biological, psychological, and socio-cultural functions" (cited by

43
Awakening to the World. The First Three Years of Life.
44
Calmels, Daniel (1997) "Body and knowledge" Buenos Aires. D&B.
45
Georgette D et al. (1994) "On the road to life". Belgium. King Baudouin Foundation, ATD Movement
Fourth World
Lejarraga, H., 2004: 34146The different trajectories that development can take
are the product of the interaction between the child's genetic program and their environment
environment (risk and protective factors)

Psychomotor development is a process of vital importance for the child, as it has

what to see with intellectual performance, the ability to integrate into society and the
exercise of full life"The problems of psychomotor development are part of
what has been called the new 'morbidity', along with behavioral disorders
food, AIDS, drug addiction, among others (Bedregal, P., Margozzini, P., Molina,
H. et al. 2002)47.
In this regard, it is essential to remember Robert Myers, who in 1993 published
The twelve who survive
intellectual, social, and emotional delay or weakness is not as impressive as the
death or third-degree malnutrition, and the effect of the conditions that deteriorate the
development is not so evident. Consequently, only now does it begin to
document, understand and act on the 'silent urgency of child development'

In the same vein as stated above, Horacio Lejarraga (2004:595)48argument

on the relevance of incorporating the state of the child's psychomotor development as
health indicator. Add that the most used indicator in the region is mortality.
childhood (MI), and analyzes certain limitations of this indicator in the present. On one hand,
the Infant Mortality rates are declining in all countries of the region,
reaching hard levels, difficult to modify, given that many of the causes
Underlying issues are somewhat unavoidable. On the other hand, MI is only a visible part of the iceberg,
given that this indicator accounts for all those who die, but leaves aside those
where many will be hindered in their growth and development and whose
"we are unaware of the conditions." It also states that it will begin to be presented.
an increase in demand to detect, diagnose, and treat possible disorders of
development, given that among other things, more and more low-weight children survive; that the
society is more demanding of its members and there is a greater accumulation of
knowledge about the subject.

On the other hand, it is highlighted that the study of psychomotor development is interdisciplinary and
covers all disciplines that deal with childhood. The evaluation of
it corresponds to all those who are qualified in the use of the tools
to be used. Both should not be confused with psychomotor skills as a discipline, although
this last one has a lot to contribute in this field.

46
Op.cit.
47
Bedregal, P., Margozzini, P., Molina, H. (2002) "Systematic review on efficacy and cost of
interventions for the bio-psycho-social development of childhood" Washington D.C., Ed. OPS/WHO.
48
Lejarraga, H. "The Integrated Attention to Prevalent Diseases (AIPI) and disorders of
child development" chap. 18 In Lejarraga, H, (2004) "Child development in context". Buenos Aires.
Paidós.
1.3.2.) Developmental disorders

Psychomotor development problems encompass a wide variety of disorders.

or alterations, due to a delay in one or more areas due to lack of environmental stimuli,
to severe limitations of diverse etiology, pathology, and prognosis. The first ones
are addressed at the primary level of health care, while for others the actions
they are more associated with the second and third level.

The term disorders is chosen because it is considered broader than that of alterations.
adapting better to the incorporation of advancements in knowledge on the subject and
to the new meanings in this field.

Following Caputte and Accardo, 1996 (cited by Lejarraga, H. 2004: 343, 344)49it is proposed
that among the developmental disorders are: a) the delay understood as the
compliance with developmental guidelines at ages later than the expected limits
for the reference population; b) dissociation, as the lack of correspondence between
2 different areas of development, one goes back much further than the other and c) the deviation, the
which implies changes in the order, in the sequence of acquisition of the patterns of
development. These are presented outside of the normal sequence, with distortions. c) And others
authors add the term regression. This refers, both, to the loss of patterns
acquired due to the presence of degenerative or progressive diseases of the System
Central Nervous, like, to the periods of disorganization and transitory regression that
they occur in the process of normal development.

On the other hand, the classification of developmental disorders is a complex topic and
varies according to the framework or the reference frameworks on which the practice is based
the different professionals. Among the most used are: the Manual of
Diagnosis and Statistics of Mental Disorders IV (DSM IV, 2000) and the
Primary care, version Children and Adolescents, 1996; the Diagnostic Classification of
The Mental Health and Early Childhood Development Disorders: 0 to 3 (Zero
to three, 1998), the International Classification of Diseases (ICD 10, WHO 1992),
the French Classification of Mental Disorders of Children and Adolescents
(CFTMEA, Misès et al., 2002).

For the topic at hand, it is necessary to specify what is meant by delay.

maturation, delay, developmental delay, setback, lag, risk. These terms,
they are often used as synonyms, since in a generic sense they mean to go
slower, go back, acquire the patterns of development but at a slower pace than
expected for the population.
Maturity delay refers to a temporary diagnosis that is managed until 36 -
48 months accounts for a slowness in the acquisition of developmental guidelines. The
which are met but not within the expected range, progresses but at a slower pace than

49
Lejarraga, H. (2004) "Pediatric approach to development and its problems," in Lejarraga, H. (editor)"
Child development in context. Buenos Aires. Paidós.
others lag behind, in one or more areas. It is considered a diagnosis.
temporary, given the potential for change and reversal that development has in this.
period of life. A development quotient of delay in the first 3 years of life,
does not necessarily imply subsequent mental retardation.
The term delay is reserved for the diagnosis of intellectual disability, according to the
results obtained through the applied intelligence assessment tests
generally from 6 to 7 years old. To avoid confusion, it is not advisable to
substitution of the term mental retardation with that of developmental delay.
Delays can be classified into: a) Organic delays, which refer to
when the child suffers from an organic neurodevelopmental problem, due to
biological causes that affect the CNS (congenital malformations, infections)
prenatal, sequelae of postnatal infections, sensory or CNS injuries, anoxia
postnatal, low birth weight, others). In these cases, referral to consultation is necessary.
specialists for diagnosis and treatments. b) Environmental type delay, is
when the disorder is caused by exposure to risk factors for development
(lack of stimuli, emotional and/or nutritional deficiencies, infections) Its frequency is
very high in the populations of children living in poverty, but also
it can be present in other socioeconomic contexts. It is noted that the presence of
risk factors for development associated with the situation of socio-economic poverty
economic, empowers the first, producing devastating effects on development
of the child. (GIEP, 1996)50Environmental delays are multifactorial and many
sometimes they are combined with a biological component (nutritional deficiencies, low weight at
birth, frequent infections, exposure to toxic substances, etc). c) Mixed delays
when combined with the environmental type and d) Delays caused by
unknown.
In many first detection instruments (screening) for evaluation of the
development, are used as categories to interpret the obtained results
terms of normality, risk or lag and delay. These are handled both in the
instruments that interpret results by levels of development as in those
that use the Development Quotient (DQ) or indices. The category of normality refers to
a development that progresses as expected for a given population,
according to the established assumptions for it. The delay for the tests that
establish the obtaining of CDs or indexes, correspond to those scores that
They locate two standard deviations or more to the left of the population mean. While
What risk or delayed account is there of a lesser or moderate gap than the
previous (a standard deviation from the mean). The term lag is of recent origin.
as a category to account for the state of development in early childhood; yes, it is
has been used for a long time to classify school-aged children's performance. Lag and
risk in first detection or screening instruments is generally
equivalents.

50
Op.cit.
1.3.4) Risk and protective factors for development,

1.3.4.1. Risk factors

Risk factors for child development are certain conditions,
events, whose presence and exposure by the child and/or the family increases the
probabilities of damage occurring in development. This is a conception
coming from epidemiology and always represents a probability of experiencing a
damage, never a certainty. Just as, the correlation between the risk factor and the state
about child development tells us about the degree of association between both, which does not
It means causality by itself. The probability of damage occurring in development.
it will depend on the number of risk factors, the duration of exposure, of the
stability of the same, of the enhancement mechanisms between factors and of the degree
of association with child development, as well as the number and strength of the
protective factors present in the child, the family, and the community. The latter act
as a protective screen, minimizing risks.

Risk factors can be classified into:

a) Risk factors related to the child's equipment: biological and inherent

its characteristics, among which are considered: (i) low birth weight; (ii) exposure to
fetal toxins: (intrauterine infections, legal and illegal drugs, radiation, anti
(iii) uncontrolled diabetes during pregnancy; (iv) postnatal:
asphyxia at birth; prolonged respiratory assistance; CNS infections; retardation of
growth in the first and second year of life; malnutrition; sensory deficit.
Established or installed risk, this implies the presence of medical conditions or
diseases that affect psychomotor development. These can disturb in
different degrees of potential child development, depending on the conditions of the
families and/or the support they have to accept and process the situation.
(vi) Sex: In this regard, it is noteworthy, on the one hand, the findings of research
national and international sources cited in this work that have detected a greater
vulnerability of men to exposure to environmental risk factors and
biological, as well as greater stability in the development of girls. On the other hand, it
you should consider the couple's expectations regarding the child's sex. Along with
the cultural aspects linked to the gender perspective (what it means for the
different families culturally being a man, being a woman). It has been established that the
parenting practices based on macho beliefs are a risk factor for the
psychomotor development (GIEP, 1996)51.

Risk factors linked to the child's own characteristics (vii) The type of
temperament of the child at birth, that is, the different ways of reacting (reactivity)
of the child that express their ability to self-regulate; those that affect and are seen
affected by the baby's immediate environment; (viii) Mode of reaction to the

51
Op.cit.
channels and sensory thresholds. At the level of the central nervous system, the
neurotransmitters condition sensitivity to stimuli and possibilities of
responses, while they are influenced by experiences from the environment.
Each child reacts differently, both in response to the intensity of the stimuli.
received, as well as the sensory sources from which they come (visual, tactile, auditory,
tonic, postural). Some tolerate receiving information through the different
channels at the same time, as they have greater tolerance to intensity. Others are more
sensible, becoming disorganized more easily in response to direct stimuli and
indirect influences coming from the environment, affecting the child's interactions with his
caretakers. (x) The physical traits, their physical appearance and resemblance, which will also go
influence the interactions.

b) Environmental or psychosocial risk factors. It is necessary to mention here

Sameroff's studies (1998) serve as a reference for many
research on the subject. Many of the risk factors found by this author,
they are repeated in several works, such as: (i) Low socioeconomic level of the nucleus
familiar; (ii) Low educational level of the mother; (iii) Low level of interaction
parents/children and home stimulation; (iv) disintegrated families, absent parents
or with chronic diseases; alcoholism; drug addiction; domestic violence; (v)
maternal depression; parental intellectual disability; (vi) absence of access to services of
health and social protection networks; (v) presence of stressful family events:
prolonged hospitalizations, exposure to traumatic events such as fires,
floods, continuous relocations (cited by Lejarraga, H., 2004: 352)52However, it
should take into account that they are conditioned by the context, that is to say to the
country or region where studies are conducted, as they can influence in different ways each one
of them. Hence, the importance of epidemiological studies in each country to
identify the most significant risk factors in development and the mechanisms by
those who act.
In Uruguay, in different population studies (Terra et al., 198953
199654200155conducted with children under 5 years old and their families, who live in
poverty situation, it is found that the risk factors present in the context
with a statistically significant association with the likelihood of children
they present damage in their development, are:
extreme poverty or indigence measured by income (p < .05);
no use of early childhood education services when they are present and
has access (p < .05);
maternal employment with physical wear and few gratifications (p<.005);

52
Lejarraga, H., (2004) Pediatric approach to development and its problems” In Lejarraga, H. (editor)
Child Development in Context Buenos Aires. Paidós.
53
Terra and colleagues (1989) "Poor children in present-day Uruguay, living conditions, malnutrition and
psychomotor delay" CLARH, UNICEF, IDRC Montevideo, Cuadernos del CLAEH Research Series
No. 61 Volume III.
54
Cited work.
55
Canetti, A., Cerutti, A., Zubillaga, B., Schwartzmann, L., Roba, O. (2001) "Development and Family: The
child from 0 to 5 years old” Montevideo Aula Editorial
 overcrowding and promiscuity ((p <.00001);
negative family perception (p <.05);
poor family communication (p <.005) ;
violent discussions in the family (p <.05);
incomplete primary education of the mother (p <.0001) currently the limit is
statistically significant, when having less than 9 years of schooling,
incomplete first cycle of secondary education (Canetti, A., Roba, O., Navarrete, C.)
Álvarez, M. et al., GIEP, 2009; Bove, I., 2012) and5657
habitual maternal depression (p<.005);
maternal dissatisfaction with self-fulfillment (p<.005); macho practices of
upbringing (p<.005);
punitive practices against disobedience (p<.05);
negative image of the father in the mother's speech (p<.05).

As can be seen, not everyone presents the same strength of association, being the
most relevant: overcrowding in housing, the mother's level of education,
followed by habitual maternal depression, and aspects related to the role of the
woman in society and with a gender perspective (type of work, satisfaction with it)
what she achieves as a woman and macho practices in upbringing.
But to understand its impact on the child's development, more important than
to consider a list is to understand how they interrelate and empower each other. The Group
Interdisciplinary Studies of Psychosocial Issues, using statistical analysis
multivariate, factor analysis, logistic regression, and correlation matrices confirm the
complexity of these phenomena and their interrelation, obtaining a psychosocial profile of
families in poverty. When this profile is present in the family, the
children or some of the children have a higher probability of suffering developmental damage
psychomotor. Below are the obtained profiles:
The psychosocial profile of families living in poverty with children aged 2
at 5 years old, and which explained the greater presence of children with risk and delay in their
psychomotor development was characterized by the presence of:
"Depression, demoralization and/or maternal dissatisfaction in the face of multiple
deprivations of daily life.
Triply absent father (in his parental role, as a member of the couple
or devalued by the woman in her discourse.
Non-enabling social macrocontext, in which social supports
(health, education, other) institutions do not operate as resources of
"valuation and support." (GIEP, 1996)

56
Canetti, A., Roba, O., Navarrete, C., Álvarez, M., Hoffnung, C., Cavalleri, F, Schwartzmann, L. GIEP
(2009) "Descriptive study and impact on children and their families of the program 'Our Children' -
Intendancy of Montevideo. Montevideo. ODM/ UNDP
57
Survey on Growth, Development, and Maternal Health in Canelones/Isabel Bove.–Montevideo:
UNICEF, Canary Commune, UNDP, 2012. 104p.
In 2004, eight years later, in the study to establish the baseline of
the Infamilia program (IPES / UCUDAL, 2004) shows once again that children
whose families presented this profile are the ones with the highest likelihood of
present damage in their development.
Meanwhile, the psychosocial profile of families living in poverty
with children under 2 years old, (GIEP, 1999)58was characterized by the presence of:
Difficulties in the relationship: Restriction in verbal and playful communication.
Absence of rituals and maintenance of rhythms in parenting practices.
Sadness, nervousness, exhaustion in mothers.
Low availability of the man in his parental role.
Restriction of cognitive stimuli (no singing, playing, telling stories with the child)
In families that presented the previously mentioned profile, their children under 2 years old,
they were 2 times more likely to show damage in their psychomotor development than
those who lived under the same conditions but did not present this profile (GIEP,
1999).
The environmental risk factors, as has already been mentioned, can also be
present in families from other socio-economic backgrounds, but in a situation of poverty
they are amplified and enhanced, becoming powerful conditioning factors in the
children's mental health (GIEP, 1997; Sameroff 1998)

1.3.4.2) Regarding protective factors, these include both aspects

materials like humans. Different investigations59made in this regard, coincide
What are the most significant protective factors for child development?
a) At the community level: “social wealth” understood as: (i) A strong
presence of quality collective institutions, recreational spaces in the neighborhoods
and decent housing; (ii) Perception by families of good social support
(positive link with health institutions, education, others); (iii) Networks of
support, that is to say, feeling that there are people who help, who collaborate with them in the
parenting of children (support for parenting) and positive connections with other families
close.
b) Within families, the following stands out: (i) The construction of attachment bonds.
on a secure base (Fonagy, 1994, 1996; Kreisler, 1996, 2000). (ii) The importance
of playful exchanges and the game between the child and their caregivers (Cramer, 1999).
Positive parenting practices in the education of children and less abuse
negligence. (Leventhel and Alt, 2000)

From national studies, the following protective factors emerge as the most significant.
weight, for child development to: (i) An educational climate at home with an average of

58
Canetti, A., Cerutti, A., Schwartzmann, L., Roba, O., Zubillaga, B., Navarrette, C. (GIEP/Dept of
Medical Psychology/Faculty of Medicine/UdelaR) "Child-rearing practices, beliefs, parental availability,"
family organization and psychomotor development" (1999). In Cerutti, A. and Pérez Castells, M. "A place for
grow and learn through play. Promoting the development of girls and boys from birth to 2
years. Montevideo. INAME/Plan CAIF/UNICEF/PNUD. I. Rosgal S.A.
59
Mancieux, M. compiler (2003) “Resilience: to resist and to rebuild”. Barcelona. Gedisa
schooling of the family group of 9 or more years. (ii) Ownership of the child's own books
and the presence of written material at home. (iii) Opportunity to experience experiences
positive everyday interactions (verbal and playful interactions with adults and other children;
stories, songs, clear routines, a variety of games displayed.
Characteristics of the child that facilitate; (v) Self-perception of the woman
satisfactions in life (as a mother and as a woman). (vi) Father's participation in the
raising the child (GIEP60, 1996, 1999, 200961; Mara et al., 199962Assistance to
Quality early childhood care and education centers (Mori Teams/CAIF, 2011; Bove, I.,
2012
Reinforce the above presented, the findings of a study conducted in Canada,
applying the National Longitudinal Survey of Children and Youth (NLSCY)
mentioned by Fraser Mustar, J (2005)63In this work, it has been found that there is
a clear socio-economic gradient among vulnerable children in their development, in the
moment of their school start and the socio-economic position of families. Thus, by the
criterion used in this study, approximately 40% of the children from the socio-
the lowest economic bracket, they were vulnerable, and the 10% of the highest socio-economic class.
Analyzing this data, it was possible to examine the gradient in relation to the influence.
of reading a book to a child or with the degree of support from the community to their children. It
it was found that if the child was read to / or there was good social support, regardless of their class
Socially, there was no socio-economic gradient for cognition or behavior. This
indicates that the gradient is not caused solely by purely economic factors, but that
it is the result of the quality of interaction with the small child without taking into account the
socio-economic position. This has greater implications for policies
public.” (Fraser Mustard, J., 2005: 21)64

60
As cited.
61
As cited.
62
Mara, S., Gutiérrez, R., González, M., Mara, G. (1999) "Study of language in 4-year-old children"
Uruguay Montevideo. ANEP, MECAEP Project
63
As cited.
64
Op. Cit.