Infancy chapter 3: Birth to 24 Months

Introduction

• Dr. Carl Menager's statement highlights the significant influence and responsibility of parenthood.
• Parenthood often occurs without formal training, education, or credentialing.
• It's insufficient to rely solely on how one was parented because of advancements in understanding human development.
• Counselors should use current knowledge to guide interventions and prevention services.
• This chapter reviews typical human development during infancy, exploring physical, cognitive, social, and emotional changes.
• Learning Objectives:
  • Describe typical physical, cognitive, and social/emotional development during infancy.
  • Apply various developmental theories related to infancy.
  • Evaluate common risks to healthy infant development.
  • Distinguish areas of counseling needed for parents, including prevention and intervention strategies.
  • Demonstrate areas of consultation with other healthcare providers.

Healthy Infant Development

• Healthy nutrition and a supportive environment are crucial.
• Breastfeeding is highly recommended; delay solid foods until 4-6 months.
• AAP (2019a) recommends breast milk as the sole nutrient until 4-6 months.
• Infant formula is an alternative for mothers who cannot or choose not to breastfeed.
• Human breast milk contains lactose (energy) and lipids (healthy fats).
• AAP recommends breastfeeding for at least one year; WHO (2019) recommends two years.
• Benefits of breastfeeding:
  • Less diarrhea.
  • Fewer ear and urinary tract infections.
  • Fewer infectious diseases.
  • Lower obesity rates.
  • Lower incidence of SIDS (Sudden Infant Death Syndrome) in the first year.
• Benefits for mothers:
  • Decreased postpartum bleeding.
  • More rapid uterine involution.
  • Decreased menstrual blood during cycles.
• Fruit juice offers no nutritional benefits to infants under one year; should be introduced after 12 months (AAP, 2017; Hayman & Abrams, 2017).
  • Limit juice to 4 oz/day for children under 4, 4-6 oz/day for ages 4-6, and 8 oz/day thereafter.
  • Whole fruit is preferred over juice.
  • Excessive juice consumption can lead to malnutrition, short stature, and dental cavities.
  • Serve juice in a cup, not a bottle.
• Solids should be introduced around six months when the infant can sit alone and grab items (AAP, 2019c).
• Introduce basic foods one at a time.
• Infant cereal mixed with breast milk or formula is a popular first food.
• AAP recommends iron-enriched infant cereals due to depleted iron stores around six months.
• Introduce new foods every 2-3 days to identify sensitivities or allergies.
• Within 2-3 months of starting solids, the daily diet can include breast milk/formula, cereal, vegetables, fruits, and meats, spread throughout the day.
• Around 8-9 months, infants can begin eating finger foods.
• Avoid raisins, nuts, popcorn, or other small, hard foods due to aspiration risk.
• Follow an immunization schedule to prevent illnesses and diseases (Advisory Committee on Immunization Practices, CDC, 2019; AAP, 2019b; AAFP, 2019; ACOG, 2019).

Immunization Concerns

• A 1998 study (Wakefield et al.) claimed a link between the MMR vaccine and autism but was later retracted due to flaws.
• Numerous studies found no scientific evidence of a link between autism and vaccination (e.g., Astudy, Salimo, & Pamuncassari, 2018; Godlee, Couchul et al., 2016; Hviid, Hansen, Frisch, & Melbye, 2019; Wu et al., 2018).
• Thimerosal, a preservative in some vaccines, was also linked to autism.
• Some studies indicated a possible link (Dorea, 2017; Geier, Kern, Omer, & Geier, 2017; Kern et al., 2017; Nammourpour, Nasli, Amini, & Sarindest, 2018).
• The CDC (2019) maintains that thimerosal in vaccines shows no connection to autism.
• Thimerosal was removed from childhood vaccines in February 2001.
• Concerns arose regarding the DTaP vaccine and SIDS, possibly due to the timing of vaccinations coinciding with the age range when SIDS is most common.
• Controlled studies in the 1980s and current studies show no association between SIDS and the DTaP vaccine (Huang, Chen, Hsu, Glasser, & Rhodes, 2017; Moro et al., 2018).
• All vaccines can have side effects, but most are minor (e.g., low-grade fever, sore arm).
• Counselors should be aware of vaccination benefits and risks, staying updated with current research.

Supportive Environment

• Parents and caregivers should create a safe and conducive environment.
• Safety measures:
  • Cover electrical outlets.
  • Put away breakable items.
  • Secure movable, top-heavy furniture.
• Provide a nurturing environment with activities encouraging large motor development (e.g., small steps, stools) and fine motor skills (e.g., grasping and carrying).
• Safety and nurturance aren't automatic, especially for those in poverty or facing daily threats.
• Counselors should advocate for those whose life conditions challenge their ability to provide safe and nurturing environments.

Physical Development

• Physical growth during infancy is rapid, often occurring in spurts.
• WHO growth charts describe optimal growth for children up to age 19.
• CDC provides growth charts for children up to age 20 in the U.S.

Sensory and Perceptual Development

• Sensory systems function at a higher level than the motor system in early months.
• Vision, hearing, taste, smell, and touch are more developed at birth.
• Vision:
  • Newborns can see about 8 inches in front of their face.
  • See the world in black and white initially; can see blue, green, yellow, and red by three months.
  • Prefer to look at faces (Choi, Mao, & Loe, 2018; Simpson, Suomi, & Puner, 2016; Xiaoyi et al., 2015).
  • Can distinguish between genders (Prober, 2017; Ramsey, Reynolds, & Langlois, 2006) and different races (Vogtle, Monesson, & Scott, 2012).
• Hearing:
  • Begins around 20 weeks prenatally.
  • Fetuses turn towards sound sources; loud noises can increase movement for 30 minutes.
  • At birth, infants distinguish between the mother's voice and a stranger's voice, calming down when hearing their mother.
  • By six months, infants follow sounds with their eyes and babble when excited.
  • By 12 months, children listen when spoken to and respond to requests.
  • NIDCD offers a checklist to assess hearing and communication development up to age five.
  • https://www.nidcd.nih.gov/health/your-babys-hearing-and-communicative-development-checklist
• Taste and Smell:
  • Taste buds form at 12 weeks prenatally.
  • Newborns show smell preferences, indicating a highly developed sense of smell (Adamczyk et al., 2018; Loos et al., 2017).
  • Breast milk scent has a calming, painkilling effect (Botsong de Chanville et al., 2017; Nesset et al., 2016; Nishitani et al., 2009).
  • Newborns distinguish between flavors, preferring sweet, savory, and salty, rejecting bitter and sour.
  • Infant taste preferences are influenced by the mother's diet during pregnancy and breastfeeding (Spahn et al., 2019).
• Touch:
  • A powerful sense often overlooked.
  • Numerous studies highlight its importance in infant development (Condagello & Diaz Rossello, 2016; Johnston et al., 2017; Tuilleries et al., 2019).
  • Parent/caregiver touch can reverse stress effects and protect at-risk infants (McEntroy, Quinn, Sharp, Pickles, & Hill, 2015).
  • Babies receiving lots of touch show less emotional negativity and develop fewer anxiety and depression symptoms (Pickles, Sharp, Hellier, & Hill, 2017).
  • Premature and high-risk newborns gain more weight when held skin-to-skin against their parents' chests (Shahnazoei & Al Ali, 2019; Sousa, Tavares, Carvalho, & Araujo, 2018).
  • Massage is effective in nurturing healthy development and increasing weight gain (Pados & McLaughlin Bell, 2019; Taheri, Ghodszai, Charatie, Nariman, & Madahian, 2018).

Motor Development

• Infants have poor muscle control at birth but are born with reflexes like Moro, rooting, and grasp reflexes.
• Moro Reflex (Startle Reflex): In response to loud noises or sudden movements, the baby throws out arms, lengthens the neck, and draws arms back to the chest.
• Rooting Reflex (Sucking Reflex): Instinct to search for and suckle the breast for nutrition.
• Grasp Reflex: Fingers tightly wrap around anything touching the palm.
• Over time, reflexes lead to more muscle control and voluntary actions through repeated discovery, exploration, and practice.
• Motor skills develop as bones, muscles, and the nervous system mature.
• Typical motor skill development in the first year:
  1. Hold chest and head up while lying on the stomach.
  2. Roll over.
  3. Sit with support.
  4. Sit alone.
  5. Crawl.
  6. Stand holding onto something or someone.
  7. Walk when led.
  8. Stand alone.
  9. Walk alone.

Language Development

• Newborns can discriminate speech sounds.
• Prefer to hear their mother's voice over a stranger's voice, indicating prenatal listening.
• Infants begin with cooing and progress to babbling around five months.
• Babbling includes well-formed syllables, essential for later speech development.
• Parents and caregivers should encourage, imitate, and respond to babbling.
• By nine months, babies may intentionally say "dada" or "mama."
• Infants are born ready to learn any language, but by 12 months, they lose the ability to discriminate sounds in different languages.
• By 7-12 months, infants focus on sounds of their most commonly heard language.
• Language heard through television or radio is not internalized (Linguistic Society of America, 2019).
• Parents and caregivers should constantly talk to their child because infants learn language best when adults talk directly to them.

Cognitive Development

• The brain grows rapidly during prenatal development and continues in the first three years.
• Experiences shape neural connections in the brain.
• Synapses are overproduced in the cerebral cortex and then pruned based on experiences.
• Active synapses become thicker and stronger, while unused synapses are deleted.
• Pruning enables the brain to become more finely tuned and functional.
• Almost half of the neurons created during infant development survive to function in adults.
• The child's brain is immature at birth.
• Physical maturation and experience both positively influence optimal brain development.
• Parents and caregivers play a critical role.
• Being sensitive to an infant's distress, emotionally available, and responsive to cues are critical parenting skills.
• Infants learn to regulate emotions and behaviors by watching caregivers.
• Responding to infant cues (crying, cooing) increases language and cognitive development.

Social and Emotional Development

• Identity is a person's self-definition focusing on enduring traits.
• Infants learn who they are and how they are perceived by how they are treated.
• Loving, caring relationships with caregivers are critical for healthy social-emotional development.
• Early experiences shape skills to form friendships, communicate emotions, and respond positively to challenges.
• Supportive relationships develop trust, compassion, and empathy.
• Key aspects of identity development:
  • Emotional development: ability to recognize, express, and regulate emotions.
  • Influenced by culture, adult-child interactions, and context.
  • Researchers consider social referencing, temperament, self-regulation, and attachment.

Constructs of Emotional Development

• Social Referencing:
  • Ability to observe and understand emotional cues of others to guide behavior.
  • E.g., A child crawls towards a toy if the mother smiles, but stops if the mother looks fearful.
  • Begins around seven months.
• Temperament:
  • Individual personality, disposition, and tendencies.
  • Each child has a unique personality (relaxed, energetic, irritable).
  • Thomas, Chess, Birch, Herzig, and Korn (1963) identified nine dimensions: activity level, biological rhythms, approach/withdrawal, mood, intensity of reaction, sensitivity, adaptability, distractibility, and persistence.
  • Three temperament types: easy, difficult, and slow-to-warm.
    • Easy: Cheerful, recover quickly from changes, regular rhythms, moderately active.
    • Difficult: Fussy, intense emotional reactions, fearful of new situations.
    • Slow-to-Warm: Passive, needs time to adjust, withdraws from new situations.
  • Goodness of fit: The match between caregiver and child temperament, and the caregiver's understanding and acceptance of the child's temperament is crucial.
  • Caregiver's view impacts parenting behaviors influencing the caregiver-child relationship.
• Self-Regulation:
  • Ability to regulate and attend to emotions and behaviors.
  • Begins with reciprocal, sensitive interactions between adult and child, continuing throughout life.
  • Positive, empathetic support helps children learn how to express emotions in culturally acceptable ways.
  • Mistreated, abused, or neglected children struggle with emotional control, resorting to aggression or maladaptive behaviors.
• Attachment:
  • The emotional bond between child and caregivers (Bowlby, 1979; Ainsworth, Waters, & Wall, 1978).
  • An affectional bond that is persistent and emotionally significant.
  • Produces a desire to maintain closeness, seek security and comfort, and results in distress upon involuntary separation.
  • Attachment Styles:
    • Securely Attached: Feel safe and protected, seek parent after separation, go to the parent for comfort, explore their environment, socially competent.
    • Anxious-Resistant: Fearful to explore, stay close due to inconsistent parental responses to distress, limited exploration, feelings of incompetence, intrusive and negatively controlling parents.
    • Avoidant Attached: See caregivers as unavailable, suppress negative emotions, avoid the adult (look away, arch backs), prefer playing with objects, struggle socially.
    • Disorganized-Disoriented: Appear dazed and confused when with the caregiver, typically a result of abuse or neglect.

Ericsson's Theory of Psychosocial Development

• Erik Erikson, a neo-Freudian psychologist, developed eight stages of psychosocial development (1959).
• Like Freud, Erickson focused on how personality and behavior were influenced after birth.
• The theory asserts that a person experiences internal struggles that he or she must negotiate to grow and develop.
• Each stage involves two opposing emotions; success involves achieving a healthy balance.
• Stage 1: Trust vs. Mistrust (infancy to 18 months)
  • Infants need to develop a healthy level of trust and understand when not to trust.
  • The quality of care is vital to the successful resolution of this stage.
  • Consistent responses to cries and provision of comfort build trust.
  • If needs are not met or inconsistently met, mistrust develops, and children may believe the world is inconsistent and unpredictable.
  • Infants who develop trust feel safe and secure, becoming adults who can hope.

Individual Differences in Infant Development

• Variations due to hereditary and environmental factors.
• Children of tall parents tend to be taller.
• Health and nutrition play important roles.
• Children in developed areas are taller than those in regions with food scarcity and infectious diseases.
• Chronic poverty leads to slower growth.
• Ethnic differences exist (e.g., African American children grow faster and taller than Caucasian peers in the U.S.).

Counseling Issues

• Counselors can make unique contributions in providing targeted interventions and prevention services.
• Emphasis on the counselor as educator and provider of support.

Postpartum Depression (PPD)

• Defined as moderate to severe depression after childbirth.
• Affects approximately 10-15% of women and 10% of men (Garfield et al., 2014; Ke, Rockhill, Tong, Morrow, & Farr, 2017).
• Most parents experience PPD within the first three months after birth, but symptoms can arise up to one year later.
• Risk peaks in winter months.
• Suicide is the leading maternal cause of death during the first year after birth after the first 42 postnatal days (Thornton, Schmidt, Dennis, Barnett, & Dolan, 2013).
• Risk Factors in rural settings:
  • Low socioeconomic status (SES), being single, history of abuse, low social support, past psychiatric history, depression during pregnancy, recent stressful events.
  • Lack of knowledge of infant care, struggles within loss, unemployed or uneducated husband, husband's psychopathology, years of marriage, gender of infant, more than five children, two or more children under seven (Kim, 2018).
• Living in a rural area may decrease access to mental health services.
• Screening for depression occurs infrequently in rural communities.
• Counselors may want to:
  • Develop improved screening tools and referral systems.
  • Offer group therapy, which has been found effective for women with PPD in rural settings.

Parent Education: Discipline for the Infant

• Parental beliefs about discipline are linked to parenting practices, which affect child outcomes.
• Beliefs are rooted in cultural and personal beliefs.
• Explore parental beliefs and cultures surrounding child discipline before suggesting strategies.
• Many parents believe infants can be spoiled, leading to conduct problems if not taught to respect authority.
• These parents are less likely to demonstrate responsive and stimulating parenting.
• Mothers using punitive styles justify teaching respect and avoiding spoiling, but this often results in the opposite effect.
• Loving responses increase independent behaviors.
• Counselor focus should be on eliminating physical punishment and removing the negative connotation of spoiling.
• Educating parents about typical infant behavior can prevent future child abuse.

Attachment Parenting

• Secure attachment, fostered by consistent, predictable relationships, is the foundation for healthy childhood development.
• Attachment parenting promotes autonomy and independence.
• Benefits of secure attachment:
  • More likely to explore their environment.
  • Possess a more developed conscience.
  • Exhibit more empathy and prosocial behaviors.
  • Promotes emotional availability, better moods, emotional regulation, reduced stress, and fewer behavior difficulties.
  • Higher intelligence and academic performance.
• Challenges to Bonding Experiences:
  • Babies with physical problems or environmental concerns (e.g., separation from the primary caretaker at birth) may struggle to bond.
  • Parents who are products of insecure attachment, grew up in abusive homes, or have negative memories may struggle with bonding.
  • Parents with emotional problems, drug/alcohol problems, or high stress may struggle to offer nurturing support.
• Helping new parents foster a positive attachment is critical.
• Addressing beliefs that being constantly available will spoil the child.
• Encouraging routines, responsiveness to cries, and following cues foster positive attachment.
• Attachment parenting encourages reciprocity, cooperativeness, and sensitivity, helping infants manage difficult feelings.
• Mothers of securely attached infants are more consistent, sensitive, and accepting.
• Criticisms of Attachment Parenting:
  • Causes mothers to subjugate themselves and sacrifice everything.
  • Concerns with bed-sharing linked to SIDS (Attachment Parenting International provides guidelines for safe bed-sharing).
  • Healthy attachments impacted by peer pressure and relationships during dating/marriage.
  • Can lead to over-dependent children or highly stressed parents.

Daycare, Quality Matters

• Parents often struggle with the decision to place their newborn in daycare.
• Counselors can help parents by being aware of childcare options, understanding advantages/disadvantages, and providing support.
• The need for daycare has risen due to more mothers entering the workforce.
• Childcare settings may include daycare centers or care from relatives/non-relatives.
• Overall quality of childcare settings is critical.
• Children in high-quality settings demonstrate high achievement and development, increased cognitive and psychosocial skills.
• Children in poor-quality settings develop psychosocial and emotional problems (e.g., separation anxiety, social struggles, poor nutrition, poor caretaker skills).
• Factors for Assessing Child Care Options:
  • Characteristics of the caregiver (warm, caring, attentive, positive discipline, active communication).
  • Staffing ratios and turnovers (low caregiver-student ratios, specialized training in early childhood development).
  • Environment of the setting (cleanliness, safety, organized activity centers, absence of hazards).
  • Services provided (healthy nutrition, preventative health care, child development monitoring, parent programs).
  • Personal interactions with the caregiver (positive relationship between caregiver, parent, and child, open communication).
  • Safety (CPR and first aid training, sanitary procedures, adequate lighting, temperature, and noise control).

Sleep Concerns

• Interaction between sleep and physical, emotional, and behavioral well-being.
• Infants require longer sleep periods than adults.
• Early establishment of normal sleep patterns is important for infants and caregivers.
• Factors Affecting Sleep:
  • Normal sleep cycles and sleep disturbances.
  • Infant temperament, attachment, physiological states.
  • Caregiver presence during the sleep routine, sleeping arrangements, and continuity of sleep disorders.
• Maintaining sleeping and waking periods is a major developmental milestone.
• Infant Sleep Patterns:
  • Awake: Eyes opening or opening and closing.
  • Active Sleep: Movements of arms and legs, irregular breathing, and eye movement.
  • Quiet Sleep: Regular breathing patterns, no limb or eye movement.
  • Transitional Sleep: Anything that does not fall into the previous categories.
• Wakefulness may be due to nursing/feeding needs, being overtired, soiled diapers, or attachment issues.
• Wakefulness Affects Caregivers:
  • Fatigue, poor maternal and paternal health, distress, depression, feeding difficulties, and problems in family life.
• Sleep disturbances increase with age if appropriate interventions and sleep management methods are not implemented.
• Problematic behaviors such as television, video games, and cell phone use can negatively influence sleep patterns.
• Sleep is important for caregivers' mental well-being and ability to care for their children.
• Parental stress is associated with infants with bedtime resistance and daytime sleepiness.
• Sleep Management Methods:
  • Education about infant sleep cycles through parent consultation.
  • Behavioral Approaches: Extinction, the Ferber method, self-soothing.
    • Extinction: Removing reinforcing stimulus (e.g., caregiver attention) to extinguish behavior (e.g., crying).
      • Unmodified Extinction (Cry-it-Out): Putting the infant to bed and not attending until the next day (not currently encouraged).
      • Modified/Graduated Extinction (Ferber Method): Brief caregiver comfort with slowly reducing attention by waiting longer periods.
      • Extinction with Parental Presence: Caregiver stays in the room until the child falls asleep.
    • Immediate Responding: Caregivers respond quickly to distress by rocking or nursing the infant until drowsy (gentler approach).
  • Positive Bedtime Routines: Relaxing activities intermingled with praise and encouragement.

Summary

• Infants have poor muscle control at birth but exhibit reflexes like Moro, rooting, and grasp reflexes.
• Newborns can discriminate speech sounds.
• The brain develops rapidly during prenatal development and in the first three years; experiences shape neural connections.
• Supportive relationships help children develop trust, compassion, and empathy.
• Infants express universal emotions influenced by culture, interactions, and context.
• Healthy nutrition and a supportive environment are critical for infant development.
• Breastfeeding is highly recommended, delaying solid foods until 4-6 months.
• Safety is a primary concern due to infants' natural exploration.
• Counselors can address issues such as:
  • Postpartum depression
  • Difficulties with discipline
  • Fostering a secure attachment
  • Childcare decisions
  • Establishing healthy sleep schedules