MODULE 1

Objectives

Overview

• Goals and Concerns
• Parent/Infant Interactions
• Developmental Surveillance
• Screening

Key Components

• Temperament
• "Goodness of Fit"
• Self-Regulation
  • Feeding
  • Sleep/Waking
  • Emotions
  • Distress
• Family Formation
• Families at Risk
• Attachment
• Cognitive Development
• Communication
• Play
• Mastery
• Stimulating Environments
• Child Care

Developmental Checklist

Office Practices

Community Practices

Developmental Surveillance in Infancy

Through developmental surveillance, primary care providers and families observe the infant's abilities and skills over time. The process is continuous and collaborative as both the provider and the family note the infant's progress and share concerns. At each visit, the concerns of the family are the highest priority. Providers should listen carefully to parental concerns and observations.

Developmental Surveillance Components

Providers can integrate developmental surveillance into each infancy visit by:

• Asking parents if they have any specific concerns about their infant's development, learning, or behavior
• Obtaining or updating a developmental history
• Observing the interactions between parents and infant
• Identifying risk and protective factors
• Screening with a validated developmental screening tool at 9 months and any other time concerns are raised by parents or others involved in the care of the infant.
• Sharing observations and concerns with other relevant professionals, as needed
• Documenting both the process and the findings

Mental Health Risk Factors in Infancy

As part of developmental surveillance, providers should assess for risk factors for infant mental health problems, including:

Infant Factors

• Genetic and biological factors
• Prematurity and low birth weight
• Serious and chronic medical problems
• Insecure attachment
• Difficult temperament

Family Factors

• Parental mental/emotional illness
• Severe maternal depression or social isolation
• Prenatal and parental substance abuse
• Lack of parenting knowledge and skills
• Educational level and age of mother
• Absence of a parent

Environmental Factors

• Poverty or homelessness
• Family stress, including separation and divorce
• Exposure to domestic violence or early trauma
• Infant abuse and neglect
• Persistent fear and stress

Protective Mental Health Factors in Infancy

Providers can promote and advocate for the following strengths, skills, and assets that foster healthy mental development in infancy:

Infant Factors

• Loving, secure attachment between infant and parent or primary caregiver
• Easy temperament
• Adequate nutrition
• Self-regulation skills

Family Factors

• Family harmony
• Secure, stable family
• Supportive relationships

Environmental Factors

• Positive learning environment
• Economic security
• Good housing
• Healthy and safe neighborhood
• Access to support services

Developmental Surveillance at Specific Visits

Surveillance occurs at each visit and takes place over time to allow for assessment of the infant's achievements and developmental milestones:

Newborn Social-emotional Has periods of wakefulness Responsive to parental voice and touch Communicative Able to be calmed when picked up Cognitive Looks at parents when awake	First Week Social-emotional Is able to sustain periods of wakefulness for feeding Will gradually become able to establish longer stretch of sleep (4 to 5 hours at night) Has indefinite regard of surroundings Communicative Turns and calms to parent’s voice Communicates needs through his behaviors Has an undifferentiated cry Cognitive Is able to fix briefly on faces or objects Follows face to midline
1 Month Social-emotional Is responsive to calming actions when upset Communicative Is able to follow parents with his eyes Recognizes parents’ voices Cognitive Has started to smile	2 Months Social-emotional Attempts to look at parent Smiles Is able to console and comfort self (brings hands to midline and mouth) Communicative Begins to demonstrate differentiated types of crying (hunger, discomfort, fatigue) Coos Has clearer behaviors to indicate needs for food, sleep, play, comforting Cognitive Indicates boredom (crying/fussiness) when no changes in activity occur
4 Months Social-emotional Smiles spontaneously Elicits social interactions Shows solidified self-consolation skills Communicative Cries in a differentiated manner to express hunger, fatigue, pain Babbles more expressively and spontaneously Cognitive Responds to affection, changes in environment Indicates pleasure and displeasure	6 Months Social-emotional Is socially interactive with parent Recognizes familiar faces and is beginning to recognize whether a person is a stranger Communicative Uses a string of vowels together (babbling “ah,” “eh,” “oh”) and enjoys vocal turn taking Is beginning to recognize own name Will begin to use consonant sounds (“m,” “b”) and then combine together (“ah,” ”ba,”) as jargon Cognitive Continues to use visual exploration to learn about the environment but is also beginning to use oral exploration for learning
9 Months Social-emotional Has developed apprehension with strangers Seeks parent for play and comfort, and as a resource Communicative Uses wide variety of repetitive consonants and vowel sounds Starts to point out objects Cognitive Develops object permanence Learns interactive games, such as “peek-a-boo” and “so big” Looks at books and explores environment, physically and visually

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Source

For the areas of developmental surveillance: American Academy of Pediatrics, Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition.