4.1 What Are Prenatal and Neonatal Stages of Development? When considering theimportance of child development, it is common to think of contexts that begin during infancy and continue through toddlerhood, including nutrition, learning, and building relationships. However, a child’s developmental journey truly begins at conception. Chapter 2 explored the importance of genetics and experiences during the time before birth. The period from conception through birth is called the prenatal stage. During this time, the mother and her support team are ultimately responsible for providing the child with everything needed to grow physically and mentally. They are equally as responsible for protecting the child from harm during this period. The prenatal period is crucial for preparing the child for exposure to the outside world. The next developmental stage in this journey begins immediately after birth and continues through the first 4 weeks of life. This is called the neonatal stage. Babies are especially vulnerable during this time period. Every detail about how they eat, sleep, and interact with other people can have huge implications for their future development. These implications are important for early childhood caregivers to recognize, regardless of the age at which the child begins receiving care. Discussions Your avatar Top of Form 350  of 350 characters left Bottom of Form Previous section 4.1 What Are Prenatal and Neonatal Stage… Next section 4.2 Prenatal Development What occurs from conception to birth is a complex and intricate process. In discussing this process, we focus first on how conception occurs, the distinction between gestational age and fetal age, and the phases of prenatal development. Conception Each month in the female body, an egg is released from the ovary as part of the reproductive cycle. The process of releasing the egg, or ovum, is called ovulation. Ovulation typically occurs halfway through a woman’s menstrual cycle, approximately 14 days after menstruation begins. After ovulation, the ovum travels down the fallopian tube toward the uterus (see Figure 4.1). On a typical month, the ovum continues its journey to the uterus alone and is flushed out along with the uterine lining in the menstruation process. However, if the woman has recently had intercourse, or has intercourse after the ovum is released and before it is flushed out of the body, the process can potentially be altered. The male reproductive cell, called the sperm, is designed to penetrate the wall of the recently released ovum. If a sperm successfully penetrates the ovum wall, it results in fertilization. Sperm can live in the female body for roughly 3–5 days, and a released ovum is viable for fertilization for anywhere from 24 to 48 hours after it is released. This means that every month there is a small, but significant, window of time in which a woman can become pregnant. Even if intercourse occurs days before ovulation takes place, fertilization i ...

1. 4.1 What Are Prenatal and Neonatal Stages of Development?
When considering theimportance of child development, it is
common to think of contexts that begin during infancy and
continue through toddlerhood, including nutrition, learning, and
building relationships. However, a child’s developmental
journey truly begins at conception. Chapter 2 explored the
importance of genetics and experiences during the time before
birth. The period from conception through birth is called the
prenatal stage. During this time, the mother and her support
team are ultimately responsible for providing the child with
everything needed to grow physically and mentally. They are
equally as responsible for protecting the child from harm during
this period. The prenatal period is crucial for preparing the
child for exposure to the outside world.
The next developmental stage in this journey begins
immediately after birth and continues through the first 4 weeks
of life. This is called the neonatal stage. Babies are especially
vulnerable during this time period. Every detail about how they
eat, sleep, and interact with other people can have huge
implications for their future development. These implications
are important for early childhood caregivers to recognize,
regardless of the age at which the child begins receiving care.
Discussions
Your avatar
Top of Form
350 of 350 characters left
Bottom of Form
Previous section 4.1 What Are Prenatal and Neonatal Stage…
Next section
4.2 Prenatal Development
What occurs from conception to birth is a complex and intricate

2. process. In discussing this process, we focus first on how
conception occurs, the distinction between gestational age and
fetal age, and the phases of prenatal development.
Conception
Each month in the female body, an egg is released from the
ovary as part of the reproductive cycle. The process of releasing
the egg, or ovum, is called ovulation. Ovulation typically occurs
halfway through a woman’s menstrual cycle, approximately 14
days after menstruation begins. After ovulation, the ovum
travels down the fallopian tube toward the uterus (see Figure
4.1). On a typical month, the ovum continues its journey to the
uterus alone and is flushed out along with the uterine lining in
the menstruation process. However, if the woman has recently
had intercourse, or has intercourse after the ovum is released
and before it is flushed out of the body, the process can
potentially be altered. The male reproductive cell, called the
sperm, is designed to penetrate the wall of the recently released
ovum. If a sperm successfully penetrates the ovum wall, it
results in fertilization. Sperm can live in the female body for
roughly 3–5 days, and a released ovum is viable for fertilization
for anywhere from 24 to 48 hours after it is released. This
means that every month there is a small, but significant,
window of time in which a woman can become pregnant. Even
if intercourse occurs days before ovulation takes place,
fertilization is still possible.
Figure 4.1: Female reproductive system
An ovum is released by the ovary and fertilized in the fallopian
tube. After completing the journey through the fallopian tube
and into the uterus, the fertilized egg implants in the uterine
wall, where it will begin to grow.
Once fertilized, the egg is called a zygote. However,
fertilization alone does not mark the beginning of a pregnancy,
only the start of a new process. The zygote begins to multiply
cells rapidly while continuing to travel down the fallopian tube
toward the uterus. The traveling ball of cells is called a

3. blastocyst. Once the blastocyst reaches the uterus it should
attach itself to the thick uterine wall and begin to burrow into
the lining. If achieved, this step is called implantation. If
implantation is successful, it triggers the body to begin
producing human chorionic gonadotropin, or hCG (this is the
same hormone that home pregnancy tests detect). Production of
hCG signals the body not to shed the uterine lining this month,
but instead to switch into pregnancy mode.
Following successful implementation, a woman typically
recognizes her missed period and soon after discovers that she
is pregnant. In addition to a missed period, a number of
symptoms indicate that a woman is pregnant. Early pregnancy
symptoms include the following (Womenshealth.gov, 2010a):
Sore, heavy breasts
Nausea, vomiting, or just the feeling of needing to vomit
(commonly referred to as “morning sickness,” although the
sensation can occur at any time of the day)
Darkening and/or widening of the area around the nipples
Mood swings
Sensitivity to smells
Aversion to food (sometimes even favorite foods) or cravings
Fatigue
Frequent urination
Headaches
Cramping
Backaches
Bloating and/or constipation
Dizziness and/or fainting
Spotting (sometimes as a result of implantation, called
implantation bleeding)
Keep in mind that every pregnancy is as unique as the mother
carrying the child and as the child who is developing. Some
women may experience very few or all of these symptoms, and
symptoms may come and go throughout the pregnancy. Early
symptoms from a woman’s first pregnancy may also differ
greatly from her experiences in subsequent ones.

4. Gestational Age Versus Fetal Age
Women are advised to visit a doctor as soon as they suspect
they are pregnant; the doctor can confirm the pregnancy and
provide the woman with a wellness check. Some medical testing
may be needed as well as confirmation that the expectant
mother’s immunizations are up-to-date (Womenshealth.gov,
2010a).
The doctor will want to know how far the pregnancy has already
progressed. Because women discover their pregnancies in
different ways, and at different times during the course of their
pregnancies, calculating the progression of the pregnancy is not
always easy. Most doctors calculate the age starting with the
first date of the woman’s last menstrual period. This method is
used to calculate the gestational age. For example, if Amanda’s
last menstrual period began on January 16 and her doctor
confirmed her pregnancy on March 22, the gestational age
would be 9 weeks and 2 days. This is the most common method
used by doctors and expectant mothers to calculate the
progression of the pregnancy because it does not rely on
knowing the exact date of conception. When speaking in terms
of gestational age, an average full-term pregnancy is 40 weeks.
A more accurate method for calculating the progression of a
pregnancy assumes that the exact date of fertilization is known,
and begins from that date. The exact age of a growing embryo
or fetus is called fetal age. In some cases, especially with
alternate methods of conception such as in vitro fertilization,
this type of calculation is possible. If Amanda’s last menstrual
period began on January 16, but Amanda underwent a successful
in vitro fertilization procedure on February 4, then her doctor
would know that the fetal age on March 22 is 6 weeks and 4
days. Because this method does not account for the 2 weeks
following the last menstrual period, prior to fertilization, fetal
age is usually approximately 2 weeks less than gestational age.
Phases of Prenatal Development
The development of the fetus during prenatal development can
be separated into certain phases. Commonly, the phases that

5. occur during a woman’s pregnancy are discussed as trimesters,
which segment the pregnancy into three phases. However, an
alternative way of discussing the phases of a pregnancy is based
on what is occurring in fetal development. These are called the
germinal, embryonic, and fetal phases.
Trimesters
A typical, healthy pregnancy lasting 40 weeks consists of three
phases referred to as trimesters. Trimesters are the most
commonly discussed breakdown of phases in a pregnancy.
Trimesters are three approximately equal segments of time
during pregnancy. This is a useful grouping of time periods,
typically referred to by gestational age, because each trimester
seems to hold its own distinctive symptoms, risks, and
developmental progression. The first trimester (weeks 1–12)
begins the development of all of the major organs (including the
sex organs), the spinal cord, the placenta, and the umbilical
cord. At the end of the first trimester, the nerves and muscles
begin functioning and the eyelids close over the eyes. The
second trimester (weeks 13–28) progresses through the
formation of the skeleton and skin. More physical detail
develops, including fingernails, eyelashes, eyebrows,
fingerprints, and a covering of fine hairs all over the body. By
the end of the second trimester, the baby can swallow, hear, and
sleep. In the beginning few weeks of the third trimester (weeks
29–40), the baby moves around quite a bit and works to store
important nutrients and body fat. As the third trimester comes to
a close, the baby may reposition with its head down to prepare
for birth (Womenshealth.gov, 2010a). See Table 4.1 for a more
detailed description of these core fetal developments during
each trimester (by gestational age).
Table 4.1: The developing fetus by trimester
First trimester (weeks 1–12)

6. At 4 weeks:
The baby’s brain and spinal cord have begun to form.
The heart begins to form.
Arm and leg buds appear. The baby is now an embryo and one-
twenty-fifth-inch long.
At 8 weeks:
All major organs and external body structures have begun to
form.
The baby’s heart beats with a regular rhythm.
The arms and legs grow longer, and fingers and toes have begun
to form.
The sex organs begin to form.
The eyes have moved forward on the face and eyelids have
formed.
The umbilical cord is clearly visible.
At the end of 8 weeks, the baby is a fetus and looks more like a
human. The baby is nearly 1 inch long and weighs less than
one-eighth ounce.
At 12 weeks:
The nerves and muscles begin to work together. The baby can
make a fist.
The external sex organs show if the baby is a boy or girl. A
woman who has an ultrasound in the second trimester or later
might be able to find out the baby’s sex.
Eyelids close to protect the developing eyes. They will not open
again until the 28th week.
Head growth has slowed, and the baby is much longer. Now, at
about 3 inches long, the baby weighs almost an ounce.
Second trimester (weeks 13–28)
At 16 weeks:
Muscle tissue and bone continue to form, creating a more
complete skeleton.
Skin begins to form. One can nearly see through it.

7. Meconium (mih-KOH-nee-uhm) develops in the baby’s
intestinal tract. This will be the baby’s first bowel movement.
The baby makes sucking motions with the mouth (sucking
reflex).
The baby reaches a length of about 4–5 inches and weighs
almost 3 ounces.
At 20 weeks:
The baby is more active. The mother might feel slight
fluttering.
The baby is covered by fine, downy hair called lanugo (luh-
NOO-goh) and a waxy coating called vernix. This protects the
forming skin underneath.
Eyebrows, eyelashes, fingernails, and toenails have formed. The
baby can even scratch itself.
The baby can hear and swallow.
Now halfway through the pregnancy, the baby is about 6 inches
long and weighs about 9 ounces.
At 24 weeks:
Bone marrow begins to make blood cells.
Taste buds form on the baby’s tongue.
Footprints and fingerprints have formed.
Real hair begins to grow on the baby’s head.
The lungs are formed, but do not work.
The hand and startle reflex develop.
The baby sleeps and wakes regularly.
If the baby is a boy, his testicles begin to move from the
abdomen into the scrotum. If the baby is a girl, her uterus and
ovaries are in place, and a lifetime supply of eggs have formed
in the ovaries.
The baby stores fat and has gained quite a bit of weight. Now at
about 12 inches long, the baby weighs about 1.5 pounds.
Third trimester (weeks 29–40)
At 32 weeks:

8. The baby’s bones are fully formed, but still soft.
The baby’s kicks and jabs are forceful.
The eyes can open and close and sense changes in light.
Lungs are not fully formed, but practice “breathing” movements
occur.
The baby’s body begins to store vital minerals, such as iron and
calcium.
Lanugo begins to fall off. The baby is gaining weight quickly,
about a half-pound a week. Now, the baby is about 15–17 inches
long and weighs about 4–4.5 pounds.
At 36 weeks:
The protective waxy coating called vernix gets thicker.
Body fat increases. The baby is getting bigger and bigger and
has less space to move around. Movements are less forceful, but
the mother will feel stretches and wiggles.
The baby is about 16–19 inches long and weighs about 6–6.5
pounds.
Weeks 37–40:
By the end of 37 weeks, the baby is considered full term. The
baby’s organs are ready to function on their own.
As the mother nears her due date, the baby may turn into a
head-down position for birth. Most babies “present” head down.
At birth, the average full-term baby weighs somewhere between
6 pounds 2 ounces and 9 pounds 2 ounces and is 19–21 inches
long. Most full-term babies fall within these ranges. But healthy
babies come in many different sizes.
Source: Womenshealth.gov. (2010a). Stages of pregnancy.
Retrieved from http://womenshealth.gov/pregnancy/you-are-
pregnant /stages-of-pregnancy.html.
Science Photo Library/SuperStock
Germinal, Embryonic, and Fetal Phases
An alternative breakdown of the phases of pregnancy gives
more weight to the importance of the type of development
taking place and less to the amount of time that passes in each

9. phase. See Figure 4.2 for more detail on these phases. The
following time frames for each phase are given in fetal age:
The germinal phase consists of the first 14 days (2 weeks)
following fertilization. As discussed previously, this period of
time follows the zygote through many repetitions of cell
multiplication resulting in a blastocyst, migration of the
blastocyst into the uterus, and implantation of the blastocyst in
the uterine wall.
The Life of the Embryo
The first three months of pregnancy are called "embryonic life"
and start in the fallopian tubes. Watch the stages of embryo
growth and its transformation into a small fetus. For the rest of
the pregnancy, the fetus will grow considerably, becoming 10
times larger and almost 1,000 times heavier.
Critical Thinking Questions
Why might it be important for a women to lead a healthy
lifestyle before conception?
What would happen if the fertilized egg did not attach?
Upon implantation of the blastocyst, the embryonic phase
begins (weeks 3–8), and the placenta starts to develop. The
placenta, which connects the growing embryo to the uterine wall
by means of the umbilical cord, provides for the absorption of
nutrients and oxygen as well as the removal of waste from the
intrauterine environment. The placenta also filters out harmful
substances that can negatively affect the growing baby. The
placenta will continue to grow throughout the pregnancy. The
embryonic phase also marks the beginning of the development
of the baby’s spinal cord, brain, heart, and other organs.
The fetal phase (weeks 9–38) includes the complete
development of the eyes, head, arms, legs, neck, toes, fingers,
fingernails, and bones. The baby’s genitals also form during this
stage and are visible for the identification of the baby’s sex by
ultrasound by the 14th week.
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10. Bottom of Form
·
4.3 A Healthy Pregnancy Lifestyle
Healthy development of a child begins at conception. As the
fetus grows and develops senses, organs, and brain function, the
mother’s lifestyle controls the quality of development in all of
the important areas. As discussed in previous chapters, child
development consists of critical periods when progress can be
crucially hindered or helped. Critical periods of development
also occur as a fetus matures. However, it is not possible to
pinpoint exactly when these critical periods will occur because
all pregnancies and developmental timelines are slightly
different. For this reason, it is important for women to make
smart choices throughout their entire pregnancies. Proper
nutrition, rest, exercise, and avoidance of harmful substances
are the first and most important lines of defense for a healthy
start to a child’s life.
Poor eating habits, exposure to harmful substances during
pregnancy, and lack of sufficient activity and rest can lead to
low birth weight, prematurity, and babies who are small for
gestational age (Kaiser & Allen, 2008). Children born in these
contexts may have certain problems that caregivers need to be
aware of when caring for them. These characteristics and
behaviors can include delays and disorders in any one or all of
the developmental domains in neurological functioning
(Aylward, 2005). Resultant behaviors include learning
difficulties, hyperactivity, attention problems, poor executive
functioning (see Chapter 2), and others.
Nutrition
During pregnancy, it is essential for a woman to receive proper
nutrition in order to support the growing fetus’s development.
When identifying nutritional needs, one must consider what a
woman should eat, as well as what she should avoid.
What to Eat
Just as children, teens, and adults need a well-balanced diet to

11. stay healthy, a fetus needs a variety of nutrients to develop
properly. A mother’s body is also doing a considerable amount
of extra work during pregnancy, and pregnant women need the
right kinds of nutrition to sustain energy and avoid illness. A
diet rich in vitamins, proteins, and other nutrients is
recommended. Pregnant women are encouraged to eat foods
across the major food groups to ensure that all of the necessary
nutrients are obtained (visit this website for more information).
Natural and fresh foods typically offer more nutrition than
processed boxed or canned foods. A variety of fruits and
vegetables is also important to diversify the types of nutrients
and allow them to work together to be absorbed into the
woman’s body. Eating a rainbow of different-colored fruits and
vegetables is an easy way to ensure that a woman is getting the
nutritional variety that a growing fetus needs.
Pregnant women need more specific types of nutrients because
of their importance in aiding fetal development and protecting
against birth defects. Women are encouraged to take prenatal
vitamins to help ensure that the proper nutrients are absorbed
daily. Pregnant women specifically need iron, calcium, vitamins
A and B12, and folic acid. Folic acid is an especially important
nutrient during pregnancy. Diets low in folic acid have been
linked to preterm delivery, low birth weight, neural tube
defects, and slow fetal growth (Scholl & Johnson, 2000). Table
4.2 describes these five important nutrients for pregnancy and
how much a pregnant woman should consume daily.
Table 4.2: Nutrients and pregnancy (daily dose)
Nutrient
Daily Requirements During Pregnancy
Folic acid
400–800 micrograms (mcg) (0.4 to 0.8 milligrams [mg]) in the
early stages of pregnancy, which is why all women who are
capable of pregnancy should take a daily multivitamin that

12. contains 400–800 mcg of folic acid. Pregnant women should
continue taking folic acid throughout pregnancy.
Iron
27 mg
Calcium
1,000 mg; 1,300 mg if 18 or younger
Vitamin A
770 mcg; 750 mcg if 18 or younger
Vitamin B12
2.6 mcg
Source: Womenshealth.gov. (2010b). Pregnancy: Staying
healthy and safe. Retrieved from
http://womenshealth.gov/pregnancy /you-are-pregnant/staying-
healthy-safe.cfm.
What to Avoid
Just as eating the right foods is critical to proper growth of the
fetus, avoiding the wrong foods is equally as important (see
Table 4.3). Some foods that do not pose a threat to a well-
developed adult digestive and immune system can be extremely
harmful to a vulnerable fetus. Many unpasteurized cheeses,
dairy products, and juices, and deli-styles meats, including hot
dogs, may contain harmful bacteria and should be avoided (U.S.
Food and Drug Administration, 2013). Some fish contain high
levels of mercury and should be eaten only in small quantities,
or not at all. Food preparation is also very important. Making
sure that food is cooked thoroughly and that cold food has been
refrigerated properly is essential in keeping food safe.
Table 4.3: Food safety in pregnancy
Don’t Eat These Foods
Why
What to Do
Soft CHEESES made from unpasteurized milk, including Brie,

13. feta, Camembert, Roquefort, queso blanco, and queso fresco
May contain E. coli or Listeria.
Eat hard cheeses, such as cheddar or Swiss. Or, check the label
and make sure that the cheese is made from pasteurized milk.
Raw COOKIE DOUGH or CAKE BATTER
May contain Salmonella.
Bake the cookies and cake. Don’t lick the spoon!
Certain kinds of FISH, such as shark, swordfish, king mackerel,
and tilefish (golden or white snapper)
Contains high levels of mercury.
Eat up to 12 ounces a week of fish and shellfish that are lower
in mercury, such as shrimp, salmon, pollock, and catfish. Limit
consumption of albacore tuna to 6 ounces per week.
Raw or undercooked FISH (sushi)
May contain parasites or bacteria.
Cook fish to 1458 F.
Unpasteurized JUICE or cider (including fresh squeezed)
May contain E. coli.
Drink pasteurized juice. Bring unpasteurized juice or cider to a
rolling boil and boil for at least 1 minute before drinking.
Unpasteurized MILK
May contain bacteria such as Campylobacter, E. coli, Listeria,
or Salmonella.
Drink pasteurized milk.
SALADS made in a store, such as ham salad, chicken salad, and
seafood salad
May contain Listeria.
Make salads at home, following the food safety basics: clean,
separate, cook, and chill.
Raw SHELLFISH, such as oysters and clams
May contain Vibrio bacteria.
Cook shellfish to 1458 F.
Raw or undercooked SPROUTS, such as alfalfa, clover, mung
bean, and radish
May contain E. coli or Salmonella.
Cook sprouts thoroughly.

14. Be Careful with These Foods
Why
What to Do
Hot dogs, luncheon meats, cold cuts, fermented or dry sausage,
and other deli-style meat and poultry
May contain Listeria.
Even if the label says that the meat is precooked, reheat the
meat to steaming hot or 1658 F before eating.
Eggs and pasteurized egg products
Undercooked eggs may contain Salmonella.
Cook eggs until yolks are firm. Cook casseroles and other
dishes containing eggs or egg products to 1608 F.
Eggnog
Homemade eggnog may contain uncooked eggs, which may
contain Salmonella.
Make eggnog with a pasteurized egg product or buy pasteurized
eggnog. When you make eggnog or other egg-fortified
beverages, cook to 1608F.
Fish
May contain parasites or bacteria.
Cook fish to 1458 F.
Ice cream
Homemade ice cream may contain uncooked eggs, which may
contain Salmonella.
Make ice cream with a pasteurized egg product; add the eggs to
the amount of liquid called for in the recipe, and then heat the
mixture thoroughly.
Meat: beef, veal, lamb, and pork (including ground meat)
Undercooked meat may contain E. coli.
Cook beef, veal, and lamb steaks and roasts to 1458 F. Cook
pork to 1608 F. Cook all ground meats to 1608 F.
Meat spreads or pate
Unpasteurized refrigerated meat spreads or pate may contain
Listeria.
Eat canned versions, which are safe.
Poultry and stuffing (including ground poultry)

15. Undercooked meat may contain bacteria such as Campylobacter
or Salmonella.
Cook poultry to 1658 F. If the poultry is stuffed, cook the
stuffing to 1658 F. Better yet, cook the stuffing separately.
Smoked seafood
Refrigerated versions are not safe, unless they have been
cooked to 1658 F.
Eat canned versions, which are safe, or cook to 1658 F.
Source: Foodsafety.gov. (n.d.). Checklist of foods to avoid
during pregnancy. Retrieved from
http://www.foodsafety.gov/poisoning
/risk/pregnant/chklist_pregnancy.html.
Highly processed foods, fried food, and other foods that are
high in unhealthy fats and refined sugars are unhealthy for a
growing baby and pregnant mother. In many cases, unhealthy
foods like these can exacerbate unpleasant pregnancy symptoms
for the mother, causing undue stress on the baby. They also
provide calories without proper nutrition.
Teratogens
Other substances besides unhealthy foods and bacteria can be
extremely harmful for a developing fetus, especially in brain
development. Harmful substances that may cause adverse
effects during prenatal development are called teratogens.
Exposure to teratogens before or soon after birth can have
extremely negative effects on the developing brain or on other
developing areas of the embryo and fetus (see Figure 4.2). Brain
development during the prenatal period is crucial for later years
in a child’s life. The brain is the center of the nervous system,
and it develops over time, beginning before birth in the
mother’s womb and continuing into young adulthood. Although
brain development is not completed until adulthood, the
immature brain is much more susceptible to negative exposures
than is the adult brain. This happens because the brain of a fetus
or an infant has not yet developed the barrier of protective cells
that is part of the mature brain. These cells keep toxic
chemicals from entering the bloodstream and having negative

16. effects on brain tissues. Many factors can have an effect on the
fetal brain, but the intensity of that effect depends on the type
of factor (positive or negative), dose, duration, and timing of
interaction.
Figure 4.2: Sensitivity to teratogens during periods of prenatal
development
During fetal development, the degree of sensitivity to teratogens
and the physical components most susceptible are dependent on
the timing of exposure.
Source: Moore, K. L., & Persaud, T. V. N. (2008). Before we
are born: Essentials of embryology and birth defects (7th ed., p.
313). Philadelphia: Saunders Elsevier
For example, toxic substances can weaken the brain’s structure
in a way that creates permanent and lifelong damage, with
consequences on academic achievements and physical and
mental health. This poisonous effect is called neurotoxicity
because it affects brain structures of the neural circuits and
neurons. Illnesses such as rubella occurring during the prenatal
period can have the same effect. The National Scientific
Council on the Developing Child (2006) divides harmful
chemical substances into three categories: environmental
chemicals such as lead and mercury; recreational drugs such as
alcohol, nicotine, and cocaine; and prescription medications
such as anticonvulsants and some drugs used for treatment of
severe acne. Table 4.4 distinguishes scientific facts about toxins
in the prenatal environment from long-held misperceptions of
science on this topic.
Note, in particular, that smoking during pregnancy exposes the
fetus to the harmful substance nicotine. This exposure to
nicotine affects both the structural development of the brain and
the way the developing brain functions (National Scientific
Council on the Developing Child, 2006). Additionally, when a
pregnant mother smokes, a decreased amount of oxygen reaches
the fetus, which reduces fetal growth and can lead to low birth
weight (Centers for Disease Control and Prevention, 2013;

17. National Scientific Council on the Developing Child, 2006).
Smoking can also cause certain complications during a woman’s
pregnancy, can lead to a premature birth, and has been
associated with certain birth defects (Centers for Disease
Control and Prevention, 2013).
Similarly, the harmful effects of fetal exposure to alcohol
during the pregnancy (and particularly higher levels of
exposure) can lead to a number of problems that are
characterized collectively as fetal alcohol syndrome (FAS).
Features of FAS have been identified as reduced growth (both
before and after birth), facial features characteristic of the
syndrome (including a thin upper lip, the lack of a vertical
groove between the lip and nose, and a smaller length from one
corner of the eye to the other), and abnormalities within the
central nervous system leading to delays in development and
often significant impairment in the cognitive development
domain (O’Leary, 2004). These features can differ based on
race and ethnicity and can present differently over time;
however, the cognitive delays and impairments have been
shown to persist across developmental stages (O’Leary, 2004).
Table 4.4: Popular misperceptions of science: toxins and
prenatal development
Popular beliefs about which chemical substances are more or
less toxic to the developing embryo, fetus, infant, and child are
most commonly related to their relative abundance and legal
status in society. In this context, it is essential that we
distinguish scientific facts from widespread misperceptions.
Myth:
Illegal recreational drugs have the most damaging impact on
brain development and function for the growing fetus.
Fact:
Although illegal recreational drugs and alcohol are both
damaging to the developing fetus, extensive research indicates

18. that alcohol, while legal, is one of the most dangerous
neurotoxins that can affect the brain during the period between
conception and birth.
Myth:
The adverse impact of toxic substances on the developing
architecture of the brain is an all-or-none phenomenon.
Fact:
Neurotoxins can produce a range of outcomes, from mild to
severe impairment, which often lead to confusing conclusions
about the linkage between exposure to a specific substance and
its consequences.
Myth:
The absence of cognitive or behavioral problems in childhood
indicates that an early exposure to a neurotoxin had no adverse
effect on brain development.
Fact:
Studies in both animals and humans have demonstrated that
some substances cause damage to the brain that is manifested in
the delayed onset of learning problems, attention deficits, and
changes in emotional regulation, which can have long-term
consequences into the teenage and adult years.
Myth:
The determination of a dangerous level of exposure to a
potentially neurotoxic substance is a straightforward scientific
question.
Fact:
The determination of a dangerous level of exposure to a
potentially neurotoxic substance can present a complicated
challenge because the developing brain of a young child is
typically more susceptible to damage than the mature brain of
an adult, and the immature nervous system of an embryo or
fetus is even more vulnerable to toxic exposures than is that of
an infant. Therefore, there is no credible way to determine a
safe level of exposure to a potentially toxic substance without
explicit research that differentiates its impact on adults from the
greater likelihood of its adverse influences on the developing

19. brain during pregnancy and early childhood.
Myth:
Vaccines containing thimerosal (which has been added as a
preservative) are linked to the development of autism in
susceptible children.
Fact:
Extensive and repeated studies by highly reputable scientific
groups have failed to confirm the claim that there is a link
between vaccines containing thimerosal and the development of
autism in susceptible children.
Source: National Scientific Council on the Developing Child.
Early Exposure to Toxic Substances Damages Brain
Architecture. Copyright © 2006 National Scientific Council on
the Developing Child and the Center on the Developing Child.
Reprinted by permission.
Activity and Rest
Just as staying fit and active is an important part of any healthy
lifestyle, it is also a fundamental ingredient in the recipe for a
healthy pregnancy. Daily physical activity helps to improve
blood flow through the body, improves mood, builds stronger
muscles and bones, improves immune health, aids in digestion
(which is not at its best during pregnancy), and even combats
stress and improves sleep (HealthyFamilies BC, 2013a). The
growing baby benefits from all of these perks, too. It is best
practice for expectant mothers to talk to their doctors before
starting any new exercise routine, but medical professionals
agree that women who exercise regularly before becoming
pregnant can continue their normal exercise routines into
pregnancy as long as it does not cause injury or cause them to
feel fatigued. Note, however, that with some high-risk
pregnancies, doctors may recommend limiting, or even ceasing,
activity as a precaution.
Rest is equally important for the healthy development of the
fetus (National Sleep Foundation, 2013b). With pregnant bodies
working overtime to manufacture a perfectly healthy baby in 38
short weeks, it is no wonder that ample rest is crucial for a

20. successful outcome. When the body shuts down in rest, it
rejuvenates energy sources and allows a mother’s body to
concentrate on the growing fetus. It also helps to regulate the
bodies’ systems and counteracts the effects of daily stress on
the body.
Figure 4.3: Components of weight gain in pregnancy
Only a fraction of a woman’s weight gain in pregnancy is due to
the growing baby. Fluids and other supplies stored in the breasts
and uterus account for the majority of extra weight.
Weight Gain
Gaining weight is an inevitable and important component of
pregnancy. However, the concept of “eating for two” is outdated
and misleading. A pregnant mother needs only an additional 300
calories per day to properly nourish the growing baby. A woman
in the normal weight range entering into pregnancy is expected
to gain approximately 30 pounds throughout the pregnancy. Of
course, this weight isn’t all contained in the baby. Other
components in the intrauterine environment, fluids, and even
extra blood contribute to the overall weight gain during
pregnancy. Women who are overweight or obese need to gain
slightly less, and women who are underweight should gain
slightly more (HealthyFamilies BC, 2013b). Figure 4.3 shows
where weight is gained in a women’s body during a healthy
pregnancy.
Pregnancy Complications
Even with appropriate attention to the mother’s health prior to
and during pregnancy, complications are possible.
Understanding these complications is the best way to prevent
them or to recognize symptoms early enough to receive proper
treatment. Although there are many possible complications
during pregnancy, some of the most common include gestational
diabetes, a baby being small for gestational age, and various
infections.
Gestational diabetes is glucose intolerance that presents for the
first time during pregnancy. Its symptoms can mimic typical

21. pregnancy symptoms, such as hunger and fatigue, or it may
present with no symptoms at all. Therefore, it is difficult to
diagnose without testing for sugar levels in the blood.
Gestational diabetes can be controlled with diet, exercise, and
even insulin injections. Untreated, gestational diabetes can
result in a large baby with added delivery complications, babies
with low blood sugar, or even fetal death; it may also cause
later complications for the mother after pregnancy (American
Diabetes Association, 2004).
Babies who do not grow at the rate they should for their age
during the prenatal period are considered small for gestational
age, or SGA. SGA babies have a higher risk of complications
during the first 4 weeks of life. Later in life, those who were
small for gestational age as babies may experience diabetes,
cardiovascular disease, and hypertension (Karlberg &
Albertsson-Wikland, 1995). Strauss (2000) found that although
individuals who were SGA at birth had decreased academic and
professional achievement, they did not present with long-term
deficits in the social-emotional realm, based on employment,
marriage, and life satisfaction.
Infections may occur during pregnancy from a variety of causes.
Some infections may be identified from discolored or odorous
discharge, burning or itching, muscle aches, or diarrhea or other
flu-like symptoms. Some infections during pregnancy can be
dangerous, resulting in miscarriage, preterm birth, or low birth
weight (Schieve, Handler, Hershow, Persky, & Davis, 1994).
Practicing safe sex, a healthy diet, good personal hygiene, and
an overall healthy lifestyle are the best ways to prevent
infections.
Tips on Recognizing Prenatal Depression
Prenatal depression can have many adverse effects on a
developing baby. Learn to recognize the following signs and
symptoms of prenatal depression in pregnant woman:
Dramatic increase or decrease in typical eating patterns

22. Disturbed sleeping patterns
Difficulty concentrating
Extreme mood swings
Excessive crying
Easily angered or agitated
Feelings of emptiness or worthlessness
Unjustified feelings of guilt
Lack of interest in previously enjoyed activities
Withdrawn behavior, especially from friends and family
Incessant anxiety or worrying
Severe lethargy
Frequent headaches or other body aches and pain
4.4 Genetics
Every child has a unique genetic code that influences the child’s
appearance, behavior, preferences, special talents, and any
physical or mental limitations. No two children, or adults,
throughout history have ever been the same. The encoded
instructions for creating all of the cells in our body are carried
on sections of our DNA called genes (genes were also discussed
in Chapter 2). A collection of many genes make up long DNA
molecules, which are packaged tightly into chromosomes (see
Figure 4.4). Every cell in the human body, with the exception of
sperm and ovum cells, houses 46 chromosomes (23 pairs) in the
control center of the cell called the nucleus. Sperm and ovum
cells contain only 23 chromosomes each. In the Conception
section, we discussed the process of the sperm and ovum joining
to create new life. When this occurs, the sperm brings its 23
chromosomes and the ovum brings its 23 chromosomes.
Combined, they form 23 sets of chromosomes, or 46
chromosomes in total. The complete set of all genes in a child is
called the structural genome. Each child’s genome contains
approximately 23,000 genes.
Figure 4.4: Cells, chromosomes, and DNA
A collection of many genes make up DNA molecules, which are
packaged tightly into chromosomes. A cell’s nucleus contains
these chromosomes.

23. One very important pair of chromosomes determines the baby’s
gender. Every female carries two X chromosomes, making an
XX chromosome pair. Every male carries one X and one Y
chromosome, making an XY chromosome pair. Because an
ovum carries only one of its chromosomal pair, it has no choice
but to carry an X, every time. However, each sperm may carry
either an X chromosome or a Y chromosome. If an X-carrying
sperm fertilizes the X-carrying ovum, the result is an XX
chromosome pair . . . it’s a girl. Alternatively, if the ovum is
fertilized by a sperm carrying a Y chromosome, the result is an
XY pair, or a baby boy. Consider the irony of the often-told
story of King Henry VIII, who executed his wives because they
did not produce a male heir. The gender was determined by him
all along!
Sometimes the process of manufacturing, pairing, or replicating
chromosomes does not occur as it should. When an irregularity
occurs in a set of chromosomes, it is known as a chromosome
abnormality. The National Human Genome Research Institute
(2011) categorizes chromosome abnormalities into two groups,
numerical abnormalities and structural abnormalities. Numerical
abnormalities are the result of missing a chromosome from a
pair or having more than two chromosomes present in a pair.
For example, Down syndrome occurs when an individual has
three copies of the 21st chromosome. Children with Down
syndrome may have physical and mental limitations within a
wide range of abilities. Early intervention is highly
recommended to lessen the impact of these limitations. If a
female is born with only one X chromosome, she is diagnosed
with Turner syndrome. Females with Turner syndrome may have
a variety of symptoms that involve atypical growth and atypical
physical sexual characteristics. However, with medical care and
monitoring by a doctor, most children with Turner syndrome
lead a normal life. Klinefelter syndrome is the presence of more
than one X chromosome with a Y chromosome in a male baby.
Babies born with this syndrome have an atypical hormone level

24. and may be affected in their physical and cognitive
development. Yet, many males with this syndrome live normal
lives and discover they have it only during or after puberty.
Medical treatments are available.
Structural abnormalities occur when the chromosome takes on
an atypical form. There are five possible structural
abnormalities. They include missing or deleted parts of
chromosomes, extra genetic material, parts of a chromosome or
complete chromosomes exchanging places, genetic material that
is inverted, and rings or parts of a chromosome that fall off
(National Human Genome Research Institute, 2011). The most
common examples of these abnormalities include Cri du Chat
syndrome and Pallister Killian syndrome, both of which often
include a variety and range of physical and mental disabilities.
A set of a child’s gene codes is called a genotype. The
observable characteristic that is physically shown as a result of
the genotype is called the phenotype. However, genotypes and
their phenotypes are not the only elements at play in
determining how a person looks, thinks, and acts. The
epigenome controls the unique expression of the gene. The
epigenome is made up of chemical compounds that mark the
genome with proteins and enzymes in a way that turns genes
“on” and “off.” The epigenome is the link between the genome
and the environment (National Human Genome Research
Institute, 2011). The epigenome is built over time and is
influenced by experiences, relationships, nutrition, physical
activity, drugs and medications, and toxins in the environment.
Epigenomes can temporarily or permanently modify genes and
thus influence brain structures, which in turn influences the
child’s behavior. This can happen in a fetus and be passed on to
later generations. For example, recurring, highly stressful
experiences can cause epigenetic changes that have been
observed to cause persistent stress responses (National
Scientific Council on the Developing Child, 2010). Persistent
stress responses have been associated with detrimental changes
in brain structure and function, and thus can have a detrimental

25. effect on a child’s growth and development (National Scientific
Council on the Developing Child, 2010). By contrast, positive,
supportive relationships can leave marks that switch on positive
genetic potential. This recently discovered biological activity of
epigenetics explains why early experiences can have long-term
impacts and why siblings, even twins, may achieve more or less
in school and behave very differently from each other (National
Scientific Council on the Developing Child, 2010).
At Issue: Genetic Testing
Parents who are at particularly high risk of carrying genetic
diseases, due to family history or ethnicity, are able to undergo
genetic testing prior to or during pregnancy. Two of the most
common tests are chorionic villus sampling (CVS), in which a
piece of the placenta is taken, and amniocentesis, in which
amniotic fluid is drawn. These tests can reveal if the baby
inherited a genetic condition, including cystic fibrosis or Down
syndrome. When a particularly severe disease is identified,
parents may elect to terminate the pregnancy.
The ethics of genetic testing for these reasons has long been the
subject of debate. Professionals and parents in favor of genetic
testing argue the importance of preventing a lifetime of
suffering and hardship for the whole family. Those opposed to
genetic testing in general argue that genetic testing may not
remain in the realm of identifying disease, but eventually could
be used on a large scale to preselect traits like gender and hair
color, or even traits for intelligence, athleticism, or musical
talent, among other characteristics. Do the benefits of genetic
testing outweigh the potential risks of the tests being abused for
frivolous uses? Is it ethical to undergo genetic testing to
identify the inheritance of a disease?
4.5 The Birth Process
The labor and delivery process does not have an easily
recognizable onset. In fact, the birth process may occur
differently for every woman. It is a gradual process that

26. typically begins around 38–40 weeks of pregnancy. The baby’s
brain releases certain hormones, including oxytocin and
cortisone, which signal the mother’s body to prepare for labor
and delivery. As early as 2 weeks before delivery, the mother
may notice that she’s carrying the baby lower. This is because
the baby has repositioned so that the head is nestled at the
opening of the birth canal. A woman may notice bloody
discharge as a result of the mucus plug dislodging from the
opening of the cervix, and she may experience leaking amniotic
fluid, commonly referred to as “water breaking” (American
Pregnancy Association, 2007).
There are three commonly recognized stages of the birth
process, followed by a recovery stage. The first stage, referred
to as active labor, is the longest stage in the process (see Figure
4.5). Active labor usually lasts 12 hours or more for a woman
birthing her first child, and a significantly shorter period of
time for subsequent births (Mayo Clinic Staff, 2013). During
this stage, the cervix softens and opens, or dilates, in
preparation for transporting the baby through the birth canal.
Typically the cervix is dilated about 2.5 centimeters at the
beginning phase of labor. Throughout active labor the woman
will experience painful contractions of the uterine muscles.
Contractions during this phase will be intermittent and will
occur more frequently toward the completion of this stage.
When the cervix is dilated approximately 10 centimeters, the
second stage begins.
Figure 4.5: Stage one: active labor
During active labor the cervix, at the opening of the uterus,
proceeds from no dilation (before labor begins) through full
dilation at 10 centimeters.
The second stage can last anywhere from 30 minutes to almost 3
hours, but is typically longer for the first birth. This stage
begins with a fully dilated cervix and ends with the birth of the
baby. During this stage the contractions become much more
painful and frequent. The woman may experience a feeling of

27. pressure, the need to defecate, and a desire to push along with
the contractions. In a typical vaginal birth, the baby will emerge
head-first.
The third and final stage lasts only minutes. During this stage
the placenta detaches from the uterine wall and is carried out
through the birth canal. The baby no longer needs the placenta
for nutrients and oxygen, so the umbilical cord attaching the
baby to the placenta is cut. In most settings, after the birth
process is complete, the mother’s vital signs will be monitored
to ensure that she recovers appropriately. In particular, her
blood pressure and pulse, as well as bleeding, are monitored.
This is called the recovery stage.
In some cases, the birth process does not proceed as expected
and complications arise. Many medical interventions are now
available to help a mother through many of these common
complications. For example, if a vaginal birth is not possible
because of a small birth canal, improper positioning of the
baby, labor that is not progressing, or other medical problems,
the mother may have to undergo a surgical removal of the baby
through the abdomen (U.S. National Library of Medicine,
Medline Plus, 2013a). This surgery is called a cesarean section,
or C-section. C-sections have become much more common in
the United States in recent years (Martin, Hamilton, Ventura,
Osterman, & Mathews, 2013). Although the rate remained stable
from 2010 to 2011 (and decreased by one-tenth of a percent
from 2009 to 2010), the rate of C-sections in the United States
increased by close to 60 percent between 1996 and 2009. In
addition, based on certain characteristics of a vaginal delivery,
an episiotomy, or an incision made in the tissue between the
vaginal opening and the anus may be needed; however, this
procedure is no longer routinely recommended as it had been
previously, based on problems with maternal recovery.
If a baby is able to be delivered vaginally, but needs some
assistance on the way out, doctors may use forceps placed on
the baby’s head or a vacuum device to help gently move the
baby through the birth canal. In addition, many medications are

28. now available to mothers to help ease the pain of labor. The
most common pain medication given during labor is epidural
anesthesia. This medication is inserted into the back, near the
spine, and serves to block pain to the lower region of the body.
These stages describe the process of a typical birth, but the
process may vary greatly among different women, including the
presence and severity of symptoms, length of each stage, and
levels of pain. Even the same mother may experience
differences in the birth process with different children. In the
vignettes that follow, three mothers give their accounts:
I went into labor and was admitted to the hospital. I slept for
hours, waking occasionally because of the contractions. Then
the contractions stopped, so they induced me but I didn’t want
the epidural. The induction without an epidural caused
horrendous pain. It was not worth trying to do without the pain
medication. Once I got the epidural, I couldn’t feel anything
and it was smooth sailing! I’m currently pregnant and passed
my due date. I’m scheduled to be induced in 1 week.—Crysta
My son was almost 2 weeks past his due date. I had planned his
birth at a local birthing center with a midwife and doula. I went
for a checkup and was told he was totally fine, but in order for
me to have him at the birthing center (versus the hospital), I
would have to go into labor the next day. Fortunately, I began
enough contractions within the time limit to go to the birthing
center. I laid in the Jacuzzi the majority of the time with soft
music playing, was able to eat food (English muffin with peanut
butter, fruit, water) for energy, and my support system was
around me. There were no complications, and no medication.
The contractions were painful, but I just breathed through it,
and focused. I went into labor at about 10:00 p.m., and 3-1/2
hours later, he was here, at 1:30 a.m. . . . 3 hours of “hard
labor” with 30 minutes of pushing.—Medina
With my first child, I woke up at 2:00 a.m. in labor and 3 weeks
before my due date. Once at the hospital they gave me an
epidural. I started pushing at 5:00 a.m., and I gave birth at 7:00
a.m. Only 5 hours of labor. My second was faster and 4 weeks

29. early. My contractions started at 6:00 a.m., and we left for the
hospital 30 minutes later. I gave birth at 7:05 a.m. in the
hospital waiting room.—Julie
4.6 The Neonatal Period
© Michael Blackburn/iStock/Thinkstock
The first 4 weeks (or 28 days) of life are referred to as the
neonatal period, beginning immediately after birth.
The neonatal period begins immediately after birth and lasts for
the first 4 weeks of life. This is another critical time in the
development of a child, and the most vulnerable in the lifetime
of a human. During this time, a child learns how to survive
outside of the womb for the first time, transitioning from its
protection and resources.
An average newborn weighs 7–7.5 pounds and is approximately
20 inches in length. Even for newborns at a healthy size, the
first few minutes are crucial to survival and sometimes require
intervention. To gauge a newborn’s health status, a test is given
at 1 minute after birth and 5 minutes after birth. This test,
called the Apgar scale, assesses the baby’s breathing, heart rate,
muscle tone, reflexes, and skin color (Apgar, 1953). Table 4.5
describes the scoring process for the Apgar scale.
Table 4.5: Apgar scale scoring
Category
0
1
2
Breathing effort
Not breathing
Slow or irregular
Cries well

30. Heart rate
No heartbeat
Less than 100 beats per minute
Greater than 100 beats per minute
Muscle tone
Loose and floppy
Some muscle tone
Active motion
Grimace/reflex
No reaction
Grimacing
Grimacing, plus cough, sneeze, or cry
Skin color
Pale blue
Body is pink, extremities are blue
Entire body is pink
Source: Adapted from U.S. National Library of Medicine,
Medline Plus. (2013b). APGAR. Retrieved from
http://www.nlm.nih.gov /medlineplus/ency/article/003402.htm.
Most healthy babies will receive an Apgar score of between 7
and 9. Any score under 7 requires medical attention for the
child. However, a low score at 1 minute after birth will
typically increase by the 5-minute time point (Apgar, 1953).
Sensory Abilities and Reflexes
© Philippa Banks/iStock/Thinkstock
Placing a finger on the open palm of an infant will elicit the
grasping reflex.
A newborn’s sensory abilities and natural reflexes set the stage
for the critical physical and cognitive developments to follow
like building blocks. Sight, hearing, smell, touch, and taste are
all natural senses that should begin to function within minutes
after birth. Almost immediately an infant shows a preference for
looking at human faces, and other stimuli with face-like
characteristics, more than any other stimuli (Johnson,
Dziurawiec, Hadyn, & Morton, 1991). In fact, newborns show a

31. preference for their mother’s face and their mother’s smell over
any other faces or scents (Mills & Melhuish, 1974; Pascalis, de
Schonen, Morton, Deruelle, & Fabre-Grenet, 1995; Porter &
Winberg, 1999). A newborn’s sense of hearing is very
sophisticated. Newborns are able to distinguish variations in a
sound’s frequency, duration, and volume, and can even separate
vowel sounds (Huotilainen, 2010).
Observation of a newborn’s reactions to certain senses at work
is a good way to gauge healthy development during this period.
A natural response to an external stimulus is called a reflex. A
variety of reflexes can be observed in newborns. Table 4.6
describes the stimuli for some of these reflexes and the
appropriate responses that can be observed if the senses are
developing properly.
Table 4.6: Neonatal reflexes
Reflex
Stimulus
Response
Moro (startle) reflex
A loud sound or a sudden movement imitating a fall
The newborn’s extremities extend quickly and the head jerks
back and then the newborn pulls the extremities back in, often
gasping in air and crying out.
Rooting reflex
Gently stroking the cheek or area near the mouth
The newborn turns toward and searches for the object.
Sucking reflex
Placing an object (usually a nipple or fingertip) gently in the
newborn’s mouth
The newborn sucks rhythmically.
Babinski (step) reflex
Lightly touching the bottom of the foot to a flat, hard surface

32. The newborn’s feet move in a stepping or walking motion.
Tonic neck reflex
Turning the head of a newborn who is lying on his or her back
to one side
The arm on the same side as the newborn’s turned head
straightens and stretches away from the body. The opposite arm
is pulled into the body, fist clenched.
Grasp reflex
Placing a finger on the newborn’s open palm
The newborn’s hand will close tightly around the object or
finger.
Truncal incurvation
Stroking or tapping along the spine while the newborn is lying
on his or her stomach
The newborn’s hips twitch in the direction of the sensation.
Source: Adapted from U.S. National Library of Medicine,
Medline Plus. (2013c). Infant reflexes. Retrieved from
http://www.nlm .nih.gov/medlineplus/ency/article/003292.htm.
All of these reflexes should be observable in the neonatal period
following birth but will fade at various stages during the first
year. Some additional reflexes seen in infancy actually last into
adulthood, such as sneezing, blinking, and gagging.
The work of T. Berry Brazelton was greatly influential for
establishing the perspective that newborns, even hours old, are
competent and organized in their behavior, with a unique
personality from the beginning (Nugent, 2013). He developed
the Neonatal Behavioral Assessment Scale (Brazelton, 1973), an
assessment tool to examine a newborn’s individual differences,
strengths, and difficulties (Nugent, 2013). By observing the
newborn’s behavioral responses through reflexes and
interactions, professionals can identify the child’s neurological
status and unique functioning (Nugent, 2013). This assessment
tool has shown individual differences in neonatal behavior to be
influenced by prenatal and birth circumstances (such as
prematurity or fetal drug exposure), as well as by cultural
environments (Nugent, 2013). Today, Brazelton’s contributions

33. continue to influence the perceptions and perspectives of child
development (Brandt, 2013).
Feeding and Sleeping
Newborns need to be fed around the clock, which means as
many as 8–12 times a day or every 2–3 hours (Mayo Clinic
Staff, 2012b). However, all babies eat differently, in different
amounts, and on different schedules. What they do have in
common is that they all show obvious interest in eating and
sucking. Poor sucking, no interest, or inadequate weight gain
are reasons to call the doctor. Sucking that is ineffective or a
baby who cannot latch on to a nipple can lead to problems such
as poor weight gain. Prematurity, labor and delivery mediations,
and poor health conditions at birth may cause a newborn to be
unable to suck and remove milk from the breast or a bottle
(Robert Wood Johnson University Hospital, n.d.). See Table 4.7
for signs of ineffective sucking.
Table 4.7: Signs of ineffective sucking
The baby may be sucking ineffectively if he or she regularly:
Prompts the mother to breastfeed fewer than 8 times, or more
than 14 times, within a 24-hour day.
Resists, pushes away from, or recurrently latches on and off
during a breastfeeding.
Falls asleep within the first several minutes of feeding, or does
not awaken on his or her own to prompt feedings.
Fails to suck consistently during the first 7–10 minutes of
feeding, or does not act satisfied after feeding for 45 minutes or
more.
Remains latched on to the same breast for more than 30–40
minutes.
Resists milk by alternate feeding methods.
Acts as if he or she has gas, produces frothy, green stools after
the first week, or produces fewer than 3 stools within a 24-hour
day during the first week.
Soaks through fewer than 6 diapers within a 24-hour day after

34. the first week.
Source: Adapted from Robert Wood Johnson University
Hospital. (n.d.). Ineffective latch-on or sucking. Retrieved from
http://www.rwjuh.edu/health_information/centers_pregnancy_di
ffltch.html.
© Getty Images/Jupiterimages/Photos.com/Thinkstock
Newborns must be fed around the clock every 2–3 hours, both
night and day.
If the baby has difficulties in sucking during feedings, the
mother should consult the child’s pediatrician to receive
personalized information and suggestions based on the unique
circumstances of that mother and child. Burping the baby after
feedings can eliminate some of the air the baby may swallow
while feeding, which can decrease a baby’s gas and spitting up.
Babies should be content between feedings and have several wet
diapers and bowel movements a day. Whether babies are breast-
fed or bottle-fed formula makes little difference in these feeding
and elimination behaviors. Chapter 5 provides additional
information regarding feeding (including breast-feeding and
bottle-feeding), diaper changing, and other infant care.
Newborn sleep is different from that of an older infant.
Newborns wake up frequently during the night and are expected
to wake for feedings every few hours. They also fluctuate
between deep sleep and active sleep but with irregular patterns.
According to the National Sleep Foundation (2013a), newborns
sleep 10–18 hours a day, in a restless sleep, with only 1–3 hours
spent awake at a time. Too little sleep for a newborn may result
in poor development and deficient physical growth. Sudden
infant death syndrome (SIDS) and other issues regarding sleep
are described in Chapter 5.
Bonding
Neonates and parents, usually the mother, generally experience
attachment and intense emotions. This experience is called
bonding. Some professionals believe bonding continues the
intense feelings of devotion and attachment that often are

35. evident during pregnancy. Yet in the 1980s it was thought to
emerge primarily during the sensitive period beginning
immediately after birth during the recovery stage (Klaus &
Kennell, 1983). Later studies found that bonding can start later
and even develop over time for many parents.
Bonding is a natural and complicated emotion. It is the feeling
of strong affection and tenderness for the baby and generally
results from performing everyday activities like touching,
talking to, and gazing at the infant, and by providing care
routines like feeding, changing, and cuddling the baby. The
neonate is stimulated to bond by hormones that are released
during labor and by the sound and smells of the mother.
Bonding can be hampered by postpartum maternal depression,
parental substance abuse (see Chapter 2), and even by the
removal of a neonate from the parents for care in the neonatal
unit of the hospital. Parents with an infant in the neonatal unit
have been found to experience depression, stress, and anxiety
(Obeidat, Bond, & Callister, 2009), which can make bonding
with the baby more challenging. However, bonding is a process
that grows and changes over time, as parents become more
comfortable and confident caring for the baby, as well as with
appropriate care of the parents’ unique needs. The timing and
characteristics of bonding are unique to each mother and baby,
and can occur at different times and in different ways. Any
concerns about the bonding process should be discussed with
the child’s doctor, in order to gain personalized information and
care for both mother and child.
Summary and Resources
A child’s optimal development depends on an understanding of
how important it is—before, during, and immediately after
birth—to avoid harmful substances and behaviors and promote
those that lead to healthy, happy children. This understanding
starts with the parents’ health as early as the time of conception
and through the prenatal phase. For example, it is important that
the mother receive proper nutrition, avoid harmful substances,

36. and get healthy levels of activity and rest. The embryo and fetus
develop in several phases, and exposure to negative substances
and experiences can affect growth at any time during a
pregnancy.
Just as a pregnant mother needs proper care, a newborn also
needs proper care. The level of care needed will be based
largely on whether the birth proceeded without issue, or
whether complications arose. It is crucially important that the
parents be prepared for the birth and know where to access
supports afterward. Recognizing typical newborn characteristics
immediately after birth and over the first 4 weeks of life is
critical, to ensure that healthy growth and development are
occurring. The neonatal period may be perhaps the most
vulnerable period of a child’s life, and identifying
complications early allows the newborn to receive necessary
care as quickly as possible.
Key Terms and Concepts
active labor
amniocentesis
Apgar scale
blastocyst
bonding
cesarean section
chorionic villus sampling (CVS)
chromosome abnormality
chromosomes
embryonic phase
epidural anesthesia
epigenome
fertilization
fetal age
fetal phase
genes
genome
genotype
germinal phase

37. gestational age
implantation
neonatal
neurotoxicity
nucleus
ovulation
phenotype
placenta
prenatal
reflex
small for gestational age
sperm
teratogen
trimesters
zygote
Discussion Questions
Why is it important to understand the stages of prenatal
development?
What are some lifestyle changes a mother may need to make
when she learns that she is pregnant?
Is it more appropriate to refer to stages of prenatal development
by trimesters or by germinal, embryotic, and fetal phases? Why?
Why might a chaotic home environment be harmful to a baby’s
prenatal development?
What types of birthing methods do you know of that aim to
reduce the amount of stress the baby encounters upon birth? Do
you agree with these methods?
What might you suspect if a newborn does not want to be fed
regularly? Should you seek medical help?
Can bonding still occur between parents and adoptive children?
Please describe.
Web Resources
Womenshealth.gov
www.womenshealth.gov
This website offers information on all areas of women’s and
girls’ health.

38. HealthyFamilies BC
www.healthyfamiliesbc.ca
This website offers to families resources on issues related to
pregnancy through the first 3 years of life.
Foodsafety.gov
www.foodsafety.gov
This website provides information on food safety in the United
States, including food recalls, food poisoning, tips for eating
safely, and additional resources.
National Human Genome Research Institute
www.genome.gov
This website offers information about genetic health, research,
and other issues in genetics.
MedlinePlus
www.nlm.nih.gov/medlineplus
This U.S.-government-sponsored resource offers information on
a variety of health topics for all ages.
5.2 Physical Growth and Brain Development in Infancy
An infant’s physical growth is quite impressive, and shows a
wide range of what is considered “normal.” An infant’s physical
growth is a composite of three measurements: weight, height (or
length), and head circumference. Each of these measures is
discussed in this section. In addition, because so much brain
growth and development takes place during this period, that
topic is addressed here as well.
Weight
As noted in Chapter 4, the typical neonate weighs 7–7.5 pounds
at birth. Most newborns lose weight in the first few days after
birth. An average weight loss is about 5 percent of the infant’s
birth weight. But after this loss, the typical infant gains about
5–7 ounces every week in the first month, doubles birth weight
by 5 months, and typically triples birth weight by the first
birthday (Hoecker, 2011). As pointed out in one of the early
books on infant development, Infants, if this growth rate
continued at the same rate as it does in the first 6 months, a 10

39. year old would be 100 feet tall and weigh about 240,000 tons
(McCall, 1979). This certainly puts an infant’s early growth rate
into perspective.
Infant weight gain is generally monitored regularly through
well-child or pediatric visits. Clinical charts for infants are
published in various forms. The U.S. Centers for Disease
Control and Prevention (CDC) provides a commonly used set of
10 charts (5 for boys and 5 for girls), with the 5th, 10th, 25th,
50th, 75th, 90th, and 95th smoothed percentile lines shown on
all charts, and the 85th percentile line shown for body-mass-
index-for-age and weight-for-stature (see Figure 5.1). These
charts are available in English, Spanish, and French and cover
not only weight but also head circumference.
Figure 5.1: Clinical charts, birth–36 months
Clinical charts can be used to monitor infants’ weight gain. The
U.S. Centers for Disease Control and Prevention publishes a
series of such charts. The child’s age and sex determine which
version of the chart should be used.
Source: Adapted from Kuczmarski, R. J., Ogden, C. L., Guo, S.
S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., Wei, R.,
Curtin, L. R., Roche A. F., Johnson, C. L. (2002).. 2000 CDC
growth charts for the United States: Methods and development.
National Center for Health Statistics. Vital and Health Statistics
11(246).
Failure to thrive refers to infants whose weight or rate of weight
gain is significantly lower than that of other infants, at times
presenting with diminished growth after typical growth patterns
had been observed previously (MedlinePlus, 2011). Failure to
thrive can be due to a medical problem or the result of
environmental issues such as abuse or neglect, poverty, poor
eating habits, or parents’ lack of understanding about proper
infant nutrition. Often, however, the cause of failure to thrive
cannot be specifically identified. Children who are
characterized by failure to thrive may show delays in their
milestone skill development, and severe and prolonged failure

40. to thrive may have long-term effects on a child’s developmental
growth. However, if a cause can be determined and/or treatment
can be provided quickly, a child’s developmental growth may
not be severely affected (MedlinePlus, 2011).
Length
Along with weight, measurement of an infant’s length is needed
to assess physical growth at this stage. Recumbent length is a
measure of an infant’s physical growth (analogous to the height
of older children and adults), and refers to the length of the
infant while lying down. The CDC and the American Academy
of Pediatrics recommend the use of the 2006 World Health
Organization (WHO) international growth charts to monitor
growth in children in the United States under age 24 months
(WHO, n.d.). Growth curves are graphed by these growth charts
from birth to age 2, by gender. (For one example of a growth
chart, see Figure 5.2.)
Figure 5.2: Length-for-age and height-for-age, for boys, birth–5
years
This chart is a standard growth chart showing that the precise
point where an infant lies on the chart is not as important as the
overall trend of growth.
Source: WHO Child Growth Standards (2014). Length/height-
for-age: Birth to 5 years. Retrieved from
http://www.who.int/childgrowth/standards/cht
_lhfa_boys_p_0_5.pdf?ua=1.
There are general patterns that are considered typical for an
infant’s growth. If an infant is determined to be far off the
pattern for several routine pediatrician visits, a red flag should
be raised to identify the cause and to decide whether an
intervention is needed. For instance, extreme chronic
malnutrition may produce stunted growth in children. The term
stunted growth is generally used for children who fall below the
5th percentile of the reference population in height for age. This
is where culture comes into play. The reference population for
Asian children is different than that for children from the

41. United States. Stunting is commonly found where poverty is
extreme (including in the United States), with the conditions of
poverty affecting how children are fed. Children below the
poverty threshold experience stunting at much higher rates (7–
13 percent) than do those living above the poverty threshold (4–
5 percent), as shown in Figure 5.3 (Lewit & Kerrebrock, 1997).
Figure 5.3: Stunting and the effects of poverty
Depending on age, children living below the official federal
poverty threshold varied widely in the percentage falling in the
range of stunting, whereas children in families over the poverty
threshold have a much lower percentage of stunting.
Source: Lewit, E. M., & Kerrebrock, N. (1997). Population-
based growth stunting. The Future of Children, 7(2), 149–156.
Important relationships have been identified between the
number of years of malnutrition early in life and lower scores
on tests of cognitive development (Korenman, Miller, &
Sjaastad, 1995). However, research over the past three decades
has shown that good nutrition after age 2 years can restore
cognitive development (Brown & Pollitt, 1996; Bryan,
Osendarp, Hughes, Calvaresi, Baghurst, & van Klinken, 2004).
Head Circumference
The third measurement of physical growth in infants is that of
head circumference. Head circumference is indicative of brain
volume and is measured by a tape around the forehead. An
unusually shaped head is common immediately after birth due to
the birthing process through the birth canal, but it lasts only
hours or a few days. The infant head is large in proportion to
the rest of the infant’s body, usually about one-fourth the size
of the infant’s body length (Gairdner & Pearson, 1971). The
skull also may appear large for the face and has parts that are
soft because the bones have not fused yet. These soft spots are
known as fontanels. The anterior fontanel can be found at the
front top part of the head, a smaller one (the posterior fontanel)
can be found at the back of the head, and smaller soft areas also
may be found in other areas of the skull (Children’s Hospital of

42. Wisconsin, 2013). The anterior fontanel is the one generally
referred to when identifying the soft spot. The posterior
fontanel will close within the first few months, while the
anterior fontanel will close at around 2 years (Children’s
Hospital of Wisconsin, 2013). The American Academy of
Pediatrics (2013d) describes fontanels as being fairly durable
but cautions against applying extreme pressure anywhere on a
newborn, including the fontanels.
Brain Development
The architecture of an infant’s brain is constructed from genetic
information, with successive brain development shaped largely
by experiences. During early gestation, brain cells called
neurons are developing by the millions. These neurons then
travel to sites determined by genetics and form the layers of the
brain. Neurons cluster together by the function they perform.
The clusters are connected to each other through a system of
synapses, which are gaps between the clusters of neurons
through which messages are sent.
All functioning, whether sensory or cognitive, is determined by
this connecting of neurons. At the end of neurons are chemical
messengers, such as adrenaline and serotonin, called
neurotransmitters. Neurotransmitters activate areas of the brain
at different times so that it can produce thoughts, emotions, and
behaviors. The critical connections of groups of neurons are
strengthened and become denser by being used, and are
eliminated by not being used. The elimination of these unneeded
connections or synapses is called pruning (Webb, Monk, &
Nelson, 2001).
Before birth and into early infancy, the less complex parts of
the brain are developed. These parts include the brain stem and
the midbrain, which control bodily functions such as breathing,
blood pressure, heart rate, and sleeping. Over the rest of the
first year and through the next 2 years, the more complex parts
of the brain in the limbic system are shaped and developed (see
Figure 5.4).
Figure 5.4: The limbic system

43. This lateral view of an adult brain illustrates the prefrontal
cortex, amygdala (emotions), and hippocampus (memory).
The limbic system is responsible for processing experiences and
developing controls for emotions. Not until adolescence are the
prefrontal cortex and the rest of the cortical areas that control
abstract thinking and executive functioning (see Chapter 2)
fully developed. Therefore, early experiences teach the brain
how to react and also continue to influence development of the
brain through adolescence. It is quite clear that early childhood
caregivers have a huge influence in shaping the brain and,
hence, the child’s future abilities and behaviors.
Although a critical amount of brain development occurs early
and is influenced immensely by experiences, for young children
who have difficult beginnings, researchers have identified the
brain’s ability to change, and its ability to change in a positive
way. As described in Chapter 1, the brain’s natural ability to
change is called plasticity. Researchers have found that in the
early stages of brain development there is a great deal of
plasticity. Plasticity can compensate for areas in the brain that
have been damaged or did not develop typically. Because of this
plasticity, experiences in the early years have a substantial
influence on the brain’s development and functioning. Although
negative experiences can have a detrimental influence on brain
development in early childhood, later experiences also have a
significant influence because of plasticity, which means that
care from responsive and nurturing caregivers can compensate
for earlier problems.
A group of infants to consider when examining brain
development are those born prematurely. With every additional
week of gestation, the fetus’s brain is more developed. Risks to
fetuses born prematurely include future problems with language,
learning, coordination, and behavior (e.g., attention-
deficit/hyperactivity disorder); the more premature the birth, the
greater the risks (Black et al., 2008). In addition, extremely
premature infants may have brain hemorrhages, which can cause

44. a variety of deficits in cognitive and motor functioning
(Shonkoff & Phillips, 2000).
5.3 Motor Development in Infancy
Infants are born with protective reflexes in the motor domain.
Most reflexes disappear within the first year, but some play a
protective function for survival and remain throughout life.
Reflexes specific to the period of infancy are identified in Table
4.5 of Chapter 4. These reflexes will be observed following
birth but fade over the first year of life. Reflexes that serve a
protective function during infancy and that remain throughout
life include the gag reflex, which protects an infant from
choking while sucking and drinking; the blink reflex, which
protects the infant’s eyes from foreign particles; and the shiver
reflex, which signals to caregivers that the infant is
experiencing uncomfortable temperatures (Muller et al., 2013).
Although sucking is considered a reflex at birth, it becomes
voluntary at about 2 months and becomes permanent. In
coordination with the suck reflex, the swallowing reflex is
established at birth. Voluntary swallowing develops sometime
in the middle of the first year in time for solid foods to be
introduced into the infant’s diet.
© 2009 Daniel MacDonald/www.dmacphoto.com/Flickr
Select/Getty Images
The Moro reflex can be a response to a loud noise or sudden
loss of support. It includes rapid extension of arms followed by
bringing them back to midline.
Other infant reflexes disappear within the first year as
maturation of the central nervous system allows voluntary
movements to take their place (Zafeiriou, 2004). The palmar
grasp reflex is produced by putting pressure on an infant’s
palm. The fingers will curl and grasp the pressure-producing
object. This reflex weakens in the third month and disappears
by the end of the first year. The stepping reflex is observed
immediately after birth in full-term infants and disappears at
around 2 months. It is elicited when the child is held upright

45. with toes touching a surface and reciprocal “walking”
movements of the legs are observed. This pattern of movement
is a precursor to independent walking later in life (Bradley,
2003).
Even more reflexes disappear at around 4–5 months. One such
reflex is the rooting reflex. This reflex occurs when an infant’s
cheek is stroked lightly. The head turns in the direction of that
cheek; the infant opens his or her mouth, and attempts to suck.
The asymmetrical tonic neck reflex is sometimes referred to as
the fencing position because the infant’s head turns to one side,
while the arm and leg on that side extend and the limbs on the
other side flex, making the infant look like a fencer (Clopton,
2000). The Moro reflex, also called the startle reflex, is a
reaction to a startling stimulus such as a sudden loud noise.
This stimulus causes the infant’s arms to extend and rapidly
come back to midline while the fingers close and release in a
grasping motion (Ronnqvist, 1995).
Newborns’ skills in the fine and gross motor domains are
limited, as is seen in the uncoordinated movements of the legs
and arms. However, their motor development follows two
patterns that, once understood, make infant motor development
seem very orderly and logical. These two patterns—
cephalocaudal and proximodistal development—take motor
development from the simple to the advanced.
Cephalocaudal development refers to how body growth and
muscular control proceeds from top down or from the head to
the legs. The infant smiles, gains head control, and is able to
lift the upper trunk, in that order. This is followed by arm
control, which comes before sitting up (which requires trunk or
core control), followed by the gaining of strength and
coordination in the legs.
Proximodistal development is motor development progressing
from the center of the body to the extremities. The infant must
first gain proximal stability in the musculature of the trunk
before mastering more refined distal movements. An infant’s
muscle strength follows the same pattern. In the first month, an

46. infant attains good muscle strength in the upper body. Control
of the upper trunk and shoulders will be followed by reaching,
which is then followed by grasping or object manipulation. This
pattern is also observed in the motor sequence of crawling: As
core control improves, the child will begin to rock on all fours
until proximal extremity strength is achieved, allowing
progression of strength development to the limbs. Based on this
proximodistal motor development, it makes sense that,
depending on the progressive development of strength and
stability of musculature, the infant smiles at 2 months, then lifts
the shoulders and chest at 3 months. At 3–5 months, the infant
is able to hold the head steady and can roll over, bear weight on
legs, reach out for toys, and play with hands and feet.
Finally, the infant is able to sit independently at about 5 months
and can creep, crawl, and cruise along furniture by the second
half of the first year. Walking is a milestone that parents often
anticipate with special joy. As with other motor milestones, the
ability to walk varies in its precise age of onset, but it typically
appears at approximately 12 months.
These cephalocaudal and proximodistal growth patterns explain
why fine motor skills develop after many of the gross motor
skills are achieved. Different from the innate palmar grasp
reflex discussed previously, infants develop the voluntary motor
skill of grasping objects with the palm, called the palmar grasp.
This palmar grasp typically develops before the more advanced
pincer grasp, in which infants use the index finger and thumb to
pick up objects. At about 3 months, infants typically can bring
their hands toward midline. Midline refers to the center of the
body if a line were to be drawn from head to toe with left and
right sides of the body equivalent. At about 6–9 months, infants
are able to use this skill to transfer toys from one hand to the
other. From 9 to 12 months, infants develop the ability to
isolate the index finger to point and to push buttons, and many
motor skills combine to enable infants to feed themselves finger
foods at this time.

47. Tips on Promoting Motor Development in Infancy
Engage an infant in play.Present toys that stimulate the infant’s
senses to encourage the infant to move eyes, head, and neck to
see what you have. This can also encourage older infants to
reach and grab for toys, promoting fine motor skills.
Without causing frustration, place a toy just out of the infant’s
reach to encourage the development of skills used to move
toward and grasp objects.
Use tummy time (occasionally placing a supervised infant on
his or her stomach during awake time) to help strengthen
muscles and improve motor skills. Provide interesting toys and
interact with the infant during this activity.
Before an infant begins to stand and cruise, make sure furniture
and items low to the floor are safe and stable for the infant to
hold onto and walk around.
Allow an infant to self-feed (when ready) with finger foods.
This helps the child to develop fine motor skills.
Source: Harding, S. (2013). Activities to encourage the motor
development of a baby. Retrieved from http://www.livestrong
.com/article/82666-activities-encourage-motor-development-
baby/.
5.4 Cognitive Development in Infancy
Cognitive development in newborns and infants is interrelated
with each of the other developmental domains. However, this
cognitive development initially is based in the five senses of
hearing, vision, touch, smell, and taste. Each of the senses is
functional at birth and becomes refined in the first year (see
Table 5.1).
Developmental Milestones: Infancy
During this time infants progress toward developmental
milestones in areas of motor skills, cognition, communication,
social emotional, and self-help.

48. 00:00
00:00
Critical Thinking Questions
How would you help support the development of an infant?
What do you think most influences infant development?
The infant is born with selective but good hearing. Many studies
have demonstrated infants’ ability to discriminate among
voices, especially responding to female voices with preference
for the mother’s voice (Fernald, 1985). Within a few months,
the infant can coordinate the behaviors of listening and looking,
and turning voluntarily toward sounds. Infants also seem to
enjoy musical sounds at this time.
Visually, newborns attend more readily to moving objects than
to static ones. They are able to follow moving objects if the
objects are close enough to see. Infants cannot yet distinguish
all colors, but they are able to see and focus on black-and-white
patterns. Acuity, or visual clarity, is weak in early infancy, and
two-dimensional visual skills likewise are poor. However,
acuity, visual tracking of a moving object in all directions, and
depth perception improve in the first 6–8 months so that by the

49. second half of the year vision is comparable to that of an adult.
This means that infants recognize color and shapes and see at a
distance.
Jean Piaget’s theory of cognitive development (see Chapter 3)
identifies four main stages. In the first year of life, children are
within what Piaget referred to as the sensorimotor stage. Object
permanence is an important part of Piaget’s sensorimotor stage.
Object permanence is the ability to know that objects exist even
when they cannot be seen, heard, or touched. It is thought to be
an important cognitive milestone that usually occurs after the
age of 4 months. Object permanence is connected to the senses
since the object first must be recognized through the senses,
usually by vision. It is a significant milestone because it also
signals that the infant is developing memory and some abstract
thinking.
The sense of touch is also not very sophisticated at birth, but it
is present. Newborns’ responses to touch often are by reflexes,
but gradually they begin to discriminate between touch that is
preferred and touch that is not. For instance, infants may like
being patted on the back to fall asleep and may enjoy skin-to-
skin cuddling. Mouthing is another way infants experience
touch and exploration. This behavior begins in the first half of
the year, but an infant needs more developed motor skills in
order to bring an object, whether a toy or body part, to the
mouth.
Researchers have found that neonates are able to discriminate
between odors by looking in the direction of the more pleasant
ones, with their favorite being their mothers’ (Cernoch &
Porter, 1985). Taste is also somewhat selective. Most infants
prefer sweet tastes to salty or tasteless ones.
Table 5.1: Senses in infancy
Sense
Characteristics

50. Hearing
Infants are born with selective but good hearing, as they have
been shown to discriminate among voices.
Within a few months, infants can coordinate the behaviors of
listening and looking, turning voluntarily toward sounds.
Vision
Newborns attend more readily to moving objects than to static
ones.
Newborns can follow moving objects if the objects are close
enough to see.
Infants cannot yet distinguish all colors, but they are able to see
and focus on black-and-white patterns.
Acuity (visual clarity) is weak in early infancy.
Two-dimensional visual skills are poor in early infancy.
Acuity, visual tracking of a moving object in all directions, and
depth perception improve in the first 6–8 months; by the second
half of the year vision is comparable to that of adults.
Touch
The sense of touch is also not very sophisticated at birth, but it
is present.
Often the newborn’s responses to touch are by reflexes, but
gradually they begin to discriminate between touch that is
preferred and touch that is not.
Smell
Neonates are able to discriminate between odors by looking in
the direction of the more pleasant ones, with their favorite being
their mothers’.
Taste
Most infants prefer sweet tastes to salty or tasteless ones.
Tips on Promoting Cognitive Development in Infancy
Provide infants with interesting toys and experiences.
Talk to infants. Respond to infants’ smiles and vocalizations.
Read and sing to infants.
Provide infants with adequate nutrition.

51. Provide infants with sensitive and responsive care.
PLAY!
Allow infants to touch and mouth objects that are safe. Infants
learn through all of their senses.
Provide toys that stimulate all of an infant’s senses.
Follow an infant’s cues for the need for more or less
stimulation.
A relatively recent debate among caregivers is the use of
technology and media with infants. The American Academy of
Pediatrics (2011a, 2011b), the National Association for the
Education of the Young Child and the Fred Rogers Center for
Early Learning and Children’s Media (2012), and the White
House Task Force on Childhood Obesity (2010) discourage the
use of screen media for children under 2 years of age in early
childhood programs. However, there is agreement that some
technology such as music and audio recordings, if used
intentionally and in an age-appropriate manner, can enhance the
quality of programs. Mixed messages about the use of
technology for infants has much to do with the use of passive
technology like television versus the use of interactive
technology that, when combined with adult involvement such as
modeling its use and partnering in play, can help build
relationships, feed curiosity, and improve communication and
social skills (Plowman & Stephen, 2005).
Media, Technology, and Early Childhood: Infants and
Technology: A Lost Opportunity
Nancy cares for two infants, Louise and Carol (9 and 11 months
old, respectively), in her home child care. Several times a day,
she needs to prepare food, change bedding, and complete other
chores related to their care. Nancy finds that leaving the infants
in safe seats to watch television during these times keeps them
quiet. In addition, when she returns to the room they are in, the
quiet suggests to her that she can leave them in front of the
television longer so that she can have some quiet reading time
for herself.

52. Screen time for children under 2 years old is discouraged by
experts in child development (National Association for the
Education of the Young Child and the Fred Rogers Center for
Early Learning and Children’s Media, 2012) for many reasons
but especially because children under age 2 need direct adult
interaction and relationship-building activities. Therefore, if
Nancy changes her use of technology for the infants in her care
from passive watching of television to interactive activities led
by her, she can supplement Louise’s and Carol’s opportunities
for improved development. For instance, Susie, another home
child caregiver, folds her children’s laundry in the same room in
which the children in her care are listening to soft music. She
talks with the infants about what she is doing and sings with the
music.
5.5 Communication Development in Infancy
Communication and language are key to social interactions,
building relationships, and other critical skills later in life. In
addition to being directly related to the social-emotional
domain, it is difficult to separate communication skills from the
cognitive domain since an infant’s communication is often seen
as the vehicle by which cognition and intelligence are assessed.
For example, if a baby cannot communicate with caregivers, the
caregiver could not know what the baby understands, or develop
a reciprocal relationship.
© R. Eko Bintoro/iStock/Thinkstock
Intentional communication occurs when infants use actions (like
pointing) or vocalizations to influence a caregiver.
Communication is typically separated into two categories:
receptive and expressive. Receptive communication skills are
generally apparent sooner than are expressive skills. Receptive
communication includes symbols like words, sounds, and
gestures that an infant understands. Receptive communication
skills are important for current and future learning; however, it
is sometimes difficult to recognize if the infant is having
challenges with these receptive skills. Expressive

53. communication includes how infants express themselves and
communicate to others. Expressive communication is an equally
important component of communication, and it signals to
caregivers that receptive skills are being used.
Infancy is a time when many communication skills are gained,
but researchers also recognize that infants are born with many
capabilities to communicate. For instance, infants communicate
specific needs early (Owens, 2001). The earliest forms of infant
communication are nonverbal or preverbal communication. The
typical infant often begins communication with crying. The
infant cries to signal the need for food, nurturance, and comfort,
including the need for a diaper change. Generally in the first 3
months, infants also coo and use other similar sounds of
pleasure as well as smiling to communicate contentment.
Infants also use early nonvocal communication through facial
expressions, head turning, and reaching. They react to loud
sounds, recognize familiar voices, and calm down to those
voices if they are upset. In the next 3 months, infants pay
attention to changes in voice tones and to music. They can
follow sounds with their eyes and are aware of toys that make
sounds. They express themselves with even more sounds than in
the first 3 months by adding babbling and gurgling sounds.
They begin to laugh out loud and babble in response to
emotions like being excited (American Speech-Language-
Hearing Association, 2013; National Institute on Deafness and
Other Communication Disorders [NIDCD], 2010).
Babbling and First Words
Babbling emerges from 3-12 months as babies experiment with
language sounds. Early language development is a maturation
process. The average age for first words is 13.6 months.
Critical Thinking Questions
Discuss why a baby’s babbling sounds the same regardless of
what language their parents speak?
Why is talking to a baby important for their language

54. development? Describe this importance in your own words.
During the second half of the first year, infants imitate speech
sounds and may say one or two simple words like “dada,” “up,”
and “mama.” This stage in communication development is
called the sound imitation period. One form of sound imitation
is echolalia. Echolalia is when infants imitate sounds, not real
words, they hear in their environments, including sounds from
people. It occurs at around 9 months.
At about this same time, infants begin to attend more carefully
when caregivers talk to them. Thus it becomes apparent through
the infant’s communication skills that infants understand some
words for common items like “milk” and “dog” and react to
simple phrases like “come here.” The use of gestures to
communicate desires, such as wanting to eat or wanting to be
picked up, begin at 7–12 months of age (NIDCD, 2010). This is
the beginning of intentional communication. Intentional
communication is demonstrated when infants deliberately
communicate by using either actions or vocalization to get
something (Owens, 2001). The difference in this type of
communication, as compared with other types, is in its use as
the means to get a response from another. See Table 5.2 for
distinctions among types of infant communication.
Table 5.2: Types of infant communication
Type of Communication
Description
Approximate Age
Nonverbal/preverbal
Cries to signal needs, including the need for food, nurturance,
and comfort.
Coos and uses other similar sounds of pleasure
Smiles to communicate contentment
Pays attention to music

55. Laughs
Understands basic sounds of native language
Obviously listens to words by turning and physically reacting
Birth–9 months
Simple words/intentional gestures
Waves, holds up arms to be picked up
Understands common words
Responds to simple requests
Imitates speech sounds
Has one or two words
9–12 months
Tips on Promoting Communication Development in Infancy
Be engaging when talking to infants; respond to their
vocalizations.
Engage in joint attention. Point to objects and talk about what
you and the infant see.
Describe to infants the objects they see, the activities in which
they take part, and events that occur.
Use a variety of words and grammar.
Label objects and actions.
Let infants take part in interesting activities.
Read books (and read them over and over!).
Introduce and talk about new and interesting objects.
Involve infants in musical activities; sing nursery rhymes and
children’s songs.
Use gestures or simple signs when talking.
Source: Gardner-Neblett, N., & Gallagher, K. C. (2013). More
than baby talk: 10 ways to promote the language and
communication skills of infants and toddlers. Chapel Hill:
University of North Carolina, FPG Child Development Institute.
Figure 5.5: Three components necessary for first words and
sentences
For infants to begin to use words and sentences, some language
specialists believe that they must have a conceptual framework

56. of their environment, which is made up of conceptual
development, speech/signal decoding, and intentionality.
Source: From De Villiers, J. G., & De Villiers, P. A. (1999).
Language development. In Developmental psychology: An
advanced textbook (4th ed.). Copyright © 1999 Lawrence
Erlbaum Associates, Inc. Reprinted by permission.
5.6 Social-Emotional Development in Infancy
Infant social-emotional development begins with the neonate’s
bonding experience described in Chapter 4, as well as all social
interactions and early relationships. Early behaviors that
demonstrate that infants have emotions include laughing and
smiling, showing anticipation and excitement (possibly through
arms and legs flailing), and switching from quiet to alert states
when paying attention to the environment.
The intense closeness an infant feels to the attachment figure is
part of social-emotional development. The infant sends out
signals that encourage relationships by mutual gazing, cooing,
cuddling when held, and smiling. Some researchers say the
grasp reflex is demonstrative of this innate desire, based on the
infant’s strong grasp of a parent’s fingers, but there is no
evidence for this interpretation.
According to attachment theory (see Chapter 3), attachment is
the basis for social-emotional well-being, which is the basis for
good future mental health. Attachment behaviors are observed
in all healthy infants. These behaviors include clinging to a
caregiver, crying when the attachment figure leaves the infant,
and in later infancy, clinging and crying when a stranger
approaches. In addition, infants use different strategies to seek
out a familiar person or object, at first visually and later with
locomotion, given that making eye contact and physical
touching are also behaviors that promote relationships. Those
individuals who most often become attachment figures are
caregivers who are responsive to the infant’s cues and signals,
are typically sensitive in their style of caregiving, and who are
stable in the infant’s life (Ainsworth, 1979).