Counseling Schedule: Infancy

2. VISIT INTRODUCE 2 DAYS to 4 WEEKS • What Babies Do • Parental Frustration • Parent Mental Health • Parent Support 2 and 4 MONTHS • Child Care • Family • Safe Environment • Parenting Style • Bonding and Attachment 6 and 9 MONTHS • Establishing Routines • Discipline = Teaching • Firearms • Modeling Behavior Counseling Schedule: Infancy

3. Infancy1-7 • Early caregiver relationships set the stage for future relationships • Securely attached young children have an easier time developing positive, supportive relationships • Emerging evidence shows that securely attached young children are found to have more8-15: • Balanced self-concept • Advanced memory processes • Sophisticated grasp of emotion • Positive understanding of friendship

4. Infancy Counseling Is this what you expected? Be on the lookout for families who are socially isolated or experiencing family discord. Who helps you with your baby? How much time do you have off from work? If there is a gun in the home, how is it stored? Being a new parent can be exhausting. How are you doing?

5. Infancy Brochures

6. Welcome to the World of Parenting!Visit: 2 Days to 4 Weeks • Helps parents understand the normal development of newborns • Provides information about coping skills for parents • Discusses changes in the ways parents may now relate as a couple

7. How to Use this Tool • Whenever appropriate, include both parents in the conversation • Discuss infant crying and ways to handle it: • Crying is normal • Crying upsets parents • Sometimes, parents just need to let the baby cry Helpful Hint! I love the way your baby looks at you, soothes to your voice. You’re doing a great job! Support new parents with positive statements:

8. Parenting Your InfantVisit: 2 and 4 Months • Helps parents understand normal development of 4- to 9-month-old infants • Stresses importance of building family connections • Discusses 3 problems: • Colic • Trouble sleeping • Clinging to parents

9. How to Use this Tool • Reiterate messages about crying and parental frustration • Emphasize to parents the importance of having time together without their baby Helpful Hint! Support new parents with positive statements: Your infant is alert, growing well, and has a beautiful smile!

10. How Do Infants Learn?Visit: 6 and 9 months • Offers practical suggestions to parents based on a newborn’s brain development • Encourages activities like reading or singing to promote brain growth • Helps parents understand that exploration is a natural developmental need

11. How to Use this Tool • Ask parents about their social connections. Refer to sections “Others Who Care for Your Baby” and “Taking Care of Yourself” • Utilize the “Social Connections” worksheet from the Clinical Guide • Talk about child care arrangements Helpful Hint! Wow, your baby is really interested in my stethoscope! I like the way she lets me examine her, but she is always looking over at you for assurance. Notice infant’s new behaviors and parent-child interaction:

12. Your Child is on the Move: Reduce the Risk of Gun InjuryVisit: 6 and 9 months • Correlates childhood injuries/ deaths due to firearms and presence of handguns in the home • Emphasizes that a child’s curiosity about guns overwhelms any lessons learned about gun safety • Provides information needed to make informed decisions

13. How to Use this Tool • Discuss handguns in the context of other household hazards • Since some parents may not be in agreement concerning the presence of handguns in the home, encourage them to look at the brochure together to make an informed decision Helpful Hints! • In areas of country with high rates of gun ownership, some practices offer reduced price or free gun locks • Be aware of the potential lethality of domestic violence in homes with handguns

14. Counseling Schedule: Early Childhood VISIT INTRODUCE 12 and 15 MONTHS • Child Development and Behavior 18 MONTHS and 2 YEARS • Child’s Assets • Guided Participation • Media 3 and 4 YEARS • Peer Playing • Safety in Others’ Homes • Talking About Emotions • Promoting Independence

15. Early Childhood16-20 • Communication skills allow young children to sustain bouts of play • How young children learn to react is greatly influenced by: • Parental relationship • Parental behavior • Home environment

16. Early Childhood Counseling Normal toddler behavior may be especially difficult for families with little social support. Encourage alternatives to TV, such as outdoor activity or reading. “She really pays attention when we talk; does she understand when you speak to her?” “Does your child have opportunities to play with other children this age?” “Teach your child by providing positive reinforcement for desired behaviors.” “What do you think your child does best? What does he enjoy doing?”

17. Early Childhood Brochures

18. Teaching Good Behavior: Tips on How to DisciplineVisit: 12 and 15 Months • Describes the basics of a behavioral approach to parenting toddlers • Positive reinforcement for desired behaviors • Limit setting • Advises parents about effective alternatives to corporal punishment

19. How to Use this Tool • Start conversations about toddler behavior with gentle inquiries • “Your child is growing and developing well. Have tantrums started? How do you handle them?” • “What is your child doing new since last visit? What do you want to change?” • Endorse the core message: a simple approach for teaching toddlers how to behave well Be on the lookout for children with difficult temperaments, families who are socially isolated, and families experiencing discord Helpful Hint!

20. Playing is How Toddlers LearnVisit: 18 Months and 2 Years Helps parents understand normal toddler behavior and advises them how to • Provide a stimulating environment during this period of major brain development • Understand the natural curiosity and exploration of toddlers

21. How to Use this Tool • Discuss normal toddler play behavior • Provide parents with guidance on the types of toys that stimulate imagination • Help parents identify places where they can meet other toddlers and their parents Helpful Hints! • Check in with parents about how their family relationships are faring • Support toddler’s parents with positive statements: What a delightful child you have! He is really curious about the world. This is great to see!

22. Pulling the Plug on TV ViolenceVisit: 18 Months and 2 Years • Provides information about the influence of TV violence on children • Offers tips for parents • Set limits on TV time • Know what children are watching • Watch programs with children • Do not put TV in a child’s room

23. How to Use this Tool • Identify alternatives to TV, such as toys that use imagination or outdoor play when possible • Recognize that alternatives can be challenging, as TV often provides free in-home child care for families who cannot afford organized activities or who live in unsafe areas Helpful Hint! What’s your favorite TV show? Ask the child: The child’s response often indicates the kind of TV programs being watched, which provides a topic to open discussion with parents

24. Young Children Learn A Lot When They PlayVisit: 18 Months and 2 Years • Introduces the importance of peer playing • Includes tips on how to make play opportunities successful • Assists parents in solving common difficulties, such as aggression and rejection

25. How to Use this Tool • Ask if child has opportunities to play with other children of the same age • Use parent’s answer to discuss how the child plays or how to find other children • Help parents problem solve any play or playmate issues Helpful Hint! I see you really like trucks. Do you and your friends play with trucks a lot? Try to notice something about what children are wearing, the toys they bring, or their behavior:

26. References 1. Bretherton I, Munholland KA. Internal working models in attachment relationships: a construct revisited. In: Cassidy J, Shaver PR, eds. Handbook of Attachment: Theory, Research, and Clinical Applications. New York: Guilford Press; 1999:89-111 2. Sroufe LA, Fleeson J. Attachment and the construction of relationships. In: Hartup WW, Rubin Z, eds. Relationships and Development. Hillside, NJ: Lawrence Erlbaum Associates; 1986:51-71 3. Sroufe LA, Fleeson J. The coherence of family relationships. In: Hinde RA, Stevenson-Hinde J, eds. Relationships Within Families: Mutual Influences. Oxford, UK: Clarendon; 1988:27-47 4. Thompson RA. Early sociopersonality development. In: Damon W, Eisenberg N, eds. Handbook of Child Psychology. Vol 3: Social, Emotional, and Personality Development. 5th ed. Hoboken, NJ: John Wiley & Sons; 1998:25-104 • Sroufe LA, Egeland B. Illustrations of person-environment interaction from a longitudinal study. In Wachs TD, Plomin R, eds. Conceptualization and Measurement of Organism-Environment Interaction. Washington, DC: American Psychological Association; 1991:68-84 6. Sroufe LA, Carlson E, Schulman S. Individuals in relationships: development from infancy through adolescence. In: Funder DC, Parke RD, Tomlinson-Keasey C, Widaman K, eds. Studying Lives Through Time: Personality and Development. Washington, DC: American Psychological Association; 1993:315-342

27. References 7. Thompson RA. Early attachment and later development. In: Cassidy J, Shaver PR, eds.Handbook of Attachment: Theory, Research, and Clinical Applications. New York: Guilford Press; 1999:265-286 8. Cassidy J. Child-mother attachment and the self in six-year-olds. Child Dev. 1988;59:121-134 9. Verschueren K, Marcoen A, Schoefs V. The internal working model of the self, attachment, and competence in five-year-olds. Child Dev. 1996;67:2493-2511 10. Belsky J, Spritz B, Crnic K. Infant attachment security and affective-cognitive information processing at age 3. Psychol Sci. 1996;7:111-114 11. Kirsh SJ, Cassidy J. Preschoolers’ attention to and memory for attachment-relevant information. Child Dev. 1997;68:1143-1153 12. Laible DJ, Thompson RA. Attachment and emotional understanding in preschool children. Dev Psychol. 1998;34:1038-1045 • Cassidy J, Kirsh SJ, Scolton KL, Parke RD. Attachment and representations of peer relationships. Dev Psychol. 1996;32:892-904 14. Kerns KA. Individual differences in friendship quality: links to child-mother attachment. In: Bukowski WM, Newcomb AF, Hartup WW, eds. The Company They Keep: Friendship in Childhood and Adolescence. New York: Cambridge University Press; 1996:137-157

28. References 15. Park KA, Waters E. Security of attachment and preschool friendships. Child Dev. 1989;60:1076-1081 16. Bradley RH, Caldwell BM, Rock SL. Home environment and school performance: a ten-year follow-up and examination of three models of environmental action. Child Dev. 1988;59:852-867 17. Collins WA, Laursen BP, Hartup WW. Relationships As Developmental Contexts. Minnesota Symposia on Child Psychology30. Mahwah, NJ: Lawrence Erlbaum Associates; 1999 18. Dunn J. Young Children’s Close Relationships. Newbury Park, CA: Sage; 1993 19. Hartup WW, Rubin Z, eds. Relationships and Development. Hillsdale, NJ: Lawrence Erlbaum Associates; 1986 20. Maccoby E, Martin J. Socialization in the context of the family: parent-child interaction. In: Mussen P, Hetherington E, eds. Handbook of Child Psychology, Volume 4: Socialization, Personality, and Social Development. 4th ed. New York: John Wiley & Sons; 1983:1-102

29. Acknowledgments Howard Spivak, MD Robert Sege, MD, PhD Elizabeth Hatmaker-Flanigan, MS Bonnie Kozial Vincent Licenziato Kimberly Bardy, MPH This project was supported by Grant No. 2001-JN-FX-0011 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.