11/16/2020

Children’s Development:
Infancy to Age 5
Child Development for District Court Judges
November 16, 2020
Katelyn Donisch, PhD, MSPH
Center for Child and Family Health
Duke University School of Medicine

Today’s Objectives
• Define development and early childhood.
• Describe typical development in early childhood
across physical, cognitive, and socioemotional
domains.
• Identify common reactions to change and the
impact of divorce during early childhood.
• Apply information and learning to case vignettes.

Defining
Development
and Early
Childhood

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Guiding Principles of Development

• Results from constant interplay

of biology and the environment
• Occurs in a multilayered context
• Dynamic, reciprocal process (i.e.,
children are not passive
recipients of environmental
influence)
• Cumulative in that development
builds on itself
• Occurs throughout the lifespan

(Steinberg, Lowe Vandell, & Bornstein, 2011)

Setting the Stage

• What comes to mind when you think of the
early childhood years (i.e., birth to five)?
• What developmental tasks do children face
during the early childhood years?
• What would you like to learn about early
childhood and how it applies to your work?

Group Discussion

Why Is Early Childhood So Important?

A child’s brain size in the first year of life.

a. Stays the same
b. Doubles in
c. Triples in

By age 3, the brain reaches % of it’s adult volume.

a. 20%
b. 50%
(Gilmore et al., 2007; Nowakowski, 2006)
c. 80%

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Defining Early Childhood

Preschool

Toddlerhood Age
(1-3) (3-5)

Infancy
(0-1)

Developmental Milestones in Early

Childhood
• Developmental milestones: Set of functional skills or age-specific
tasks that most children can do at a certain age.
• Physical development (e.g., gross and fine motor skills)
• Social-emotional development (e.g., relationships with others, managing
emotions)
• Cognitive and language development (e.g., memory, reasoning, language)
• Milestones can be delayed when young children experience:
• Inadequate caregiving (e.g., abuse and neglect)
• Environmental deprivation and stressors
• Other negative risk factors

(Office of Disease Prevention and Health Promotion, 2018)

Resources: CDC’s Act Early Initiative

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Resources: Zero to Three

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Resources:
National Child Traumatic Stress Network (NCTSN)

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Physical
Typical
Development in
Early Childhood Social-
Emotional
Cognitive

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Physical
Typical
Development in
Early Childhood Social-
Emotional
Cognitive

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Physical Development

• Types of Motor Skills

• Gross motor skills: movements related to
large muscles such as arms, legs, and trunk.
• Fine motor skills: movements involving
smaller muscle groups such as those in the
hand and wrist.
• Importance of Motor Skills
• To be able to move and complete tasks
independently.
• To be able to explore world around them,
promoting cognitive, speech, and sensory
development.
(Pathways, 2020)

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Physical Development

[Link]
development-of-physical-skills-supports-learning

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Physical Development Milestones

Age Gross Motor Fine Motor
6 mo • Rolls both ways • Transfers objects from hand to hand
• Sits with and without support of hands
1 yr • Walks by holding onto objects • Explores objects in multiple ways (e.g., hand, mouth,
• Takes first steps smell)
2 yr • Kicks a ball • Uses spoon and fork well
• Walks up and down stairs, two feet at a time • Turns pages of a book one at a time
2.5 yr • Jumps with both feet • Holds pencil or crayon between fingers (instead of fist)
• Can walk on tiptoe
3 yr • Climbs stairs using alternate feet • Puts on shoes and socks
• Rides tricycle and runs well • Carries a container without spilling
4 yr • Skips on one foot • Cuts with scissors (not well)
• Throws ball overhand • Can dress self (not tying shoes)
5 yr • Hops and skips • Dresses without help, ties shoes
• Has good balance (e.g., skate) • Prints simple letters

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Physical
Typical
Development in
Early Childhood -
Social
Emotional Cognitive

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Social-Emotional Development
• Important for:
• Understanding thoughts and feelings to help communicate and act
appropriately.
• Developing healthy relationships with friends and family.
• Allows children to express themselves appropriately in different
environments and with different people to:

• Succeed in preschool and school • Make appropriate decisions

• Make friends and maintain • Resist negative social pressure
friendships • Learn strengths and weaknesses
• Resolve conflicts • Gain awareness of what others
• Learn social norms are feeling and develop empathy
(Zero to Three, 2020)

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Social-Emotional Development

[Link]
healthy-social-emotional-development-in-the-early-years

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Developing Attachment Relationships

Phase 1
(1-2 mo) • Indiscriminate Social Responsiveness

Phase 2
(2-7 mo) • Discriminating Sociability
Phase 3
(7-24 mo) • Attachments

Phase 4
(Bowlby, 1969)
(36+ mo) • Goal-Corrected Partnerships

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Social-Emotional Development

[Link]
emotional-development

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Factors that Influence Attachment

Characteristic Description
Sensitivity Responding promptly and appropriately to the infant’s signals

Positive Attitude Expressing positive affect and affection for the infant

Synchrony Structuring smooth, reciprocal interactions with the infant

Mutuality Structuring interactions in which parents and infant attend

to the same thing

Support Attending closely to and providing emotional support for the

infant’s activities
(De Wolff & van Ijzendoorn, 1997)
Stimulation Frequently directing actions toward the infant

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Factors that Influence Attachment Security

• Mothers and fathers have somewhat
distinctive, yet similar styles of parent-child
interaction.
• Benefits of maintaining contact with both
parents exceed any special need for
relationships with male or female parents.
• Literature demonstrates that infants and
toddlers need regular interaction with both
parents to foster and maintain attachments.
• E.g.: feeding, playing, diapering, soothing, putting
to bed.

(Lamb, 1997; Kelly & Lamb, 2000)

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Social-Emotional Milestones
Age Developmental Tasks
6 mo • Able to display emotions (e.g., joy and sadness at 2.5 months, fear and anger between 3
and 6 months)
• Responds to expressions of emotions
1 yr • Shy or anxious with strangers
• Cries when parents leave
• Enjoys imitating people in play
• Prefers certain people and toys
Toddlerhood • Imitates behavior of others, especially adults and older children
• Aware of himself/herself as separate from others leading to increased independence (and defiant
behaviors)
• Enthusiastic about company of other children
• Learning how to regulate emotions
Preschool • Imitates adults and playmates
Age • Shows affection for familiar playmates
• Can take turns in games
• Continuing to learn how to regulate emotions

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Period of Purple Crying

(National Center on Shaken Baby Syndrome, n.d.)

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Physical
Typical
Development in
Early Childhood Social-
Emotional
Cognitive

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Cognitive Development
• Process of growth and change in intellectual abilities, such as
acquiring knowledge, thinking, reasoning, and understanding.

“ What we see in the crib is the

greatest mind that has ever
existed, the most powerful learning
machine in the universe.”
-Gopnik, Meltzoff, & Kuhn (1999)

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Cognitive Development
Piaget’s Stage Theory

• Piaget held that mental development unfolds in a

fixed sequence of developmental stages:
• Sensorimotor Stage (0-2 yrs)
• Preoperational Stage (2-7 yrs)
• Concrete Operational Stage (7-11 yrs)
• Formal Operational Stage (11+ yrs)
• Research now suggests that:
• Development does not always progress in a smooth manner
• Sociocultural environment plays an important role
• Domain-specific knowledge and skills constructed in a dynamic way (i.e., not
simply driven by brain development; impacted by relational interaction)
(Piaget, 1976)

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Cognitive Development

[Link]

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Sensorimotor Stage (0-2 Yrs)

• General Tenets
• “Thinking” consists of coordinating sensory information with motor activity
• Infants learn through looking, sucking, listening, touching, mouthing,
grasping.

• Stage Accomplishments
• Certain actions produce certain results (causality)
• Object permanence
• Mental representation

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Preoperational Stage (2-7 Yrs)

• General Tenets
• Children are able to represent previous experiences to themselves mentally.
• Children acquire a storehouse of images and symbols, especially spoken and
written words.

• Stage Accomplishments
• Pretend play
• Deferred imitation
• Egocentrism

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Cognitive Development Milestones

Age Developmental Tasks
6 mo • Coos and babbles in first month
• Finds partially hidden objects
• Explores with hands and mouth
• Struggles to get objects that are out of reach
1 yr • Explores objects in different ways (e.g., touches, shakes)
• Finds hidden objects easily
• Looks at correct picture when the image is named
• Begins to use objects correctly
• Begins using words (first word between 11 and 14 months)
Toddlerhood • Uses grammatically correct sentences by 24 months
• Finds objects even when hidden 2 or 3 levels deep
• Sorts by shape and color
• Engages in pretend play
Preschool
• Understands “mine” and “his/hers”
Age
• Sorts objects by shape and color
• Completes 3-4 piece puzzles
• Draws a person with 2 to 4 body parts

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Common
Reactions to
Change

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Common Reactions to Change

• Many children show emotional and behavioral

changes in the first year after parental
separation, with most problems resolving in 2-3
years.
• Sense of loss may last for years (exacerbation on
holidays, birthdays, other special events)
• Adjustment to a new living situation, continuing
parental tensions cause ongoing distress.
• Reactions depend on: stage of development, parents’
ability to focus on child’s needs and feelings, child’s
temperament, and parents’ pre- and post-separation
psychosocial functioning.

(Cohen & Weitzman for AAP, 2016)

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Common Reactions to Change

• Infants
• Reactive to changes in routine and caregivers
• May be fussier, irritable, or listless and have feeding or sleep disturbances
• Normal separation anxiety may increase between 6-9 months of age
• Toddlers
• Separation anxiety (i.e., may be reluctant to separate from parents even in
familiar settings)
• Developmental regression (e.g., loss of toileting or language skills)
• Eating and sleeping disturbances are common

(Cohen & Weitzman for AAP, 2016)

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Common Reactions to Change

• Preschool-Age Children
• Do not understand the permanence of the separation and will repeatedly ask for
the absent parent
• May be demanding and defiant (e.g., tantrums, acting out)
• Developmental regression (e.g., loss of toileting and self-help skills)
• Eating and sleeping disturbances common
• Test and manipulate differences in limit setting by the two parents
• By 4 or 5, may blame themselves for the separation, begin acting out, have
nightmares, have more reluctance to separate, and fear they may be
abandoned

(Cohen & Weitzman, 2016)

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Separation Anxiety
• Infants
• Develops after a child gains an understanding of object permanence (i.e., as
early as 4-5 months, generally by 9 months).
• Toddlers
• Some toddlers may not demonstrate separation anxiety in
infancy, and begin demonstrating challenges at 15-18
months.
• Preschoolers
• By the time children are 36 months, most clearly
understand the effect their anxiety or pleas at
separation have on parents

(AAP, 2015)

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General Considerations
• Young children’s routines (e.g., feeling/eating,
napping/sleeping) should ideally remain as
unchanged as possible.
• For infants, this may include a daily communication log
• The quality of parenting the child receives is more
important than the type of custody arrangement.
• When children are attached to both parents,
helpful to support continuity of both relationships.

(Cohen & Weitzman for AAP, 2016)

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Implications for Custody and Access

Arrangements
• Parents lived together prior to separation and relationship with both
parents is of adequate quality and supportiveness
• Maintainance both parent-infant attachments
• Concerns about child maltreatment, substance abuse, mental illness, or
domestic violence
• Evaluations of parental adequacy recommended; supervised or restricted
visiting may be required to ensure safety
• Parents have never lived together and infant has had no opportunity to
attach to one of the parents (common when paternity is being
established legally)
• Efforts needed to support development of attachment relationship

(Lamb, 1997; Kelly & Lamb, 2000)

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Overnights and Breastfeeding

• “Fourth” Trimester Theory
• Evidence that treating newborns as if they were still “in utero” for first three months can make
life easier for baby and parents.
• Postpartum care should be an ongoing process, rather than a single encounter (e.g.,
comprehensive postpartum visit at 12 weeks).
• Feeding is better when it is baby-led, not led by routine (e.g., some babies may want a quick
snack or some comfort sucking).
• Breastfeeding Recommendations
• Infants should be fed breastmilk exclusively for the first 6 months after birth to achieve optimal
growth, development, and health.
• Breastfeeding should continue with the addition of complementary foods throughout the first
year; should continue as long as mutually desired.
• Protects against a variety of diseases and conditions in the infant (e.g., bacteremia, otitis
media, late-onset sepsis, type I and II diabetes, leukemia and lymphoma,
childhood obesity).
(American Academy of Pediatrics, 2020; American Academy of Family Physicians, 2020; American College of Obstetricians and Gynecologists, 2018; World Health Organization, 2020)

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Overnights and Breastfeeding

• Some considerations:
• Exclusively breastfed infants under 6 month of age
nurse every 1.5-3 hours (i.e., 20-60 minutes for
each feeding).
• Women can produce the same amount of milk
from breastfeeding or pumping (depends on how
often and long the nipple is stimulated).
• At 6 months of age, most infants begin eating
some solid food.

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American Academy of Pediatrics Family and Conciliation Courts Review

Resources: Divorce, Separation, Custody

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• Please spend 10-15 minutes in your

breakout groups.
• Review your assigned case scenario,
noticing concerns related to early
childhood development.
• Answer the questions provided.
Case Scenarios

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Case Scenario #1
• Child Age: 9-months-old
• Context: Parents of baby stayed home from work the first 4 weeks of
baby’s life and were both involved in meeting baby’s needs. Mother
stayed home another 6 weeks after the father returned to work. Baby is
now in a day care while parents work full-time. When baby was 6-
months-old, father moved out, but still sees baby every day at
mother’s home.
• Legal Details: Father files a custody action seeking primary custody
because mother is a “workaholic” and he seeks a temporary custody
order because mother won’t let him have overnights. Mother states
that overnights are harmful, as they disrupt the baby’s routine.

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Case Scenario #1
Discussion Questions
• What should the court consider to
support the baby’s positive physical,
cognitive, and psychological
development?

• How would you resolve the temporary

custody request? Does it matter that
mother is or is not breastfeeding?

• What other information do you want

before making a permanent custody
decision?

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Case Scenario #2
• Child Age: 6-8 weeks
• Context: Unwed mother gives birth to child 2 weeks before her due date.
Father and mother broke up before baby was born and mother does not
tell him when she has the baby. He finds out 1 week after the baby is born and tries
to communicate with mother so he can see his son, but she
avoids his calls for a while. When baby is 5 weeks old, mother allows dad to see the
baby at her home for an hour and agrees he can visit the baby at
her home for one-hour visits when she is there to supervise. He shows up for every
visit mom agrees to. Mother won’t let him have any unsupervised time with the
baby.
• Legal Details: Father files a paternity and child custody action and is
seeking joint custody. He has filed a motion for a temporary order for
overnight visitation arguing that mom is interfering with his ability to form a
relationship with his child.

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Case Scenario #2
Discussion Questions

• What should the court consider to support

baby’s positive physical, cognitive, and
psychological development?

• How would you resolve the temporary

custody request? Does it matter that mom is
or is not breast feeding?

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Case Scenario #3
• Child Age: 3 years of age
• Legal Details:
• A permanent custody order for baby awarded joint legal and physical custody
between mom and dad. Things worked well until girlfriend (GF) moved into
dad’s home when toddler was 2.5 years of age. GF is actively involved with
the child and dad reports the child has a positive relationship with her.
• Six months after GF moves in, mom has filed a motion to modify, arguing that
since GF moved in, the child now has temper tantrums, cries when going to
dad’s, and is having more nighttime potty accidents than before. Dad says
child’s behavior is normal for the child’s age and that the child settles down
and is happy once at his house and cries when leaving his house to go to
mom’s. Assume there is a substantial change in circumstances affecting the
child’s welfare.

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Case Scenario #3
Discussion Questions
• What child development issues related to
the best interests of the child are raised
in this scenario?

• What additional information would you

like to know before deciding?

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• Local Children’s Developmental Services Agencies (CDSAs,

developmental assessments):
[Link]
• UNC Carolina Institute for Developmental Disabilities
(developmental assessments):
[Link]
• Duke Children’s Evaluation Center (general mental health
assessment and informed referral):
[Link]
evaluation-
center?utm_source=google&utm_medium=organic&utm_ca
mpaign=Directory+Management
Resources • Duke Child and Family Study Center (variety of treatment
and assessment for children):
[Link]
center?utm_source=google&utm_medium=organic&utm_ca
family-study-
mpaign=Directory+Management
• Duke Family Studies Program and Clinic (family therapy to
address conflict):

[Link]
clinic?utm_source=google&utm_medium=organic&utm_cam
paign=Directory+Management
program-and-

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References
American Academy of Pediatrics. (2020). Breastfeeding. Accessed from [Link]
initiatives/Breastfeeding/Pages/[Link].
American College of Obstetricians and Gynecologists. (2018). Optimizing support for breastfeeding as part of obstetric practice.

Committee Opinion, Number 765. Accessed from [Link]

Cohen, G. J., & Committee on Psychosocial Aspects of Child and Family Health. (2002). Helping children and families deal with divorce and separation. Pediatrics,
opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice.
110(5), 1019-1023.
Fox, S.E., Levitt, P., & Nelson, C.A., III. (2010). How the timing and quality of early experiences influence the development of brain architecture. Child
Development, 81(1), 28–40 .
Gilmore, J.H., Lin, W., Prastawa, M.W., Looney, C.B., Sampath, Y., Vetsa, K., et al. (2007). Regional gray matter growth, sexual dimorphism, and cerebral
asymmetry in the neonatal brain. Journal of Neuroscience, 27(6), 1255–1260 .
Kelly, J. B., & Lamb, M. E. (2000). Using child development research to make appropriate custody and access decisions for young children. Family Court
Review, 38(3), 297-311.
National Scientific Council on the Developing Child. (2007). The timing and quality of early experiences combine to shape brain architecture. Working Paper
No. 5.
Nowakowski, R.S. (2006). Stable neuron numbers from cradle to grave. Proceedings of the National Academy of Sciences, 103(33), 12219–12220.
Piaget, J. (1976). Piaget’s theory. In Piaget and his school (pp. 11-23). Springer, Berlin, Heidelberg.

World Health Organization. (2020). Breastfeeding. Accessed from [Link]

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