If you recall from our previous discussions, infants and mothers are uniquely predisposed to interact. A mother’s pattern of talking to her baby and the child’s response patterns reflect a unique developmental predisposition that is designed to initiate the process of acquiring the amazing gift of speech and language. We will now continue our exploration of how children learn to communicate, and in doing so let’s now turn our attention to the “conversational” side of communication.

I think you would agree that turn-taking is an integral part of having a conversation. As adults, when we engage in conversational interactions, we have learned to employ the social rules for conversational exchanges. These rules simply imply that one partner listens as the other speaks. When one is done speaking, it is then the turn of the other partner to interact. Thus a conversation is largely comprised of language-based turn-taking consisting, of back and forth exchanges on a single topic. Can you agree, in that light, that language-based turn-taking and topic maintenance are prerequisites for a meaningful conversation to take place? But, and this is important, children are not initially equipped to take turns, nor remain on a single topic. Turn-taking and topic maintenance is learned. Each is not a natural skill. With that in mind let’s consider how mothers can assist their infants in acquiring these basic skills.

As noted previously, babies are initially wired to gaze at faces, with their interest shifting to objects at 4-7 months of age. Thus when a baby initiates face to face joint focus, or later when he reaches and grasps for an object, it is helpful for the adult to do all that is possible to maintain joint interest as well as establish some form of turn-taking. This can be as simple as gently taking an object from the child and then handing it back repeatedly. During the early months, mothers can watch for their child’s responses to the adult’s vocal initiations and then determine how the child is indicating their desire to keep the turns going. One of the most important things for mothers to gauge is the number and variety of ways their child sends signals, indicating that they are seeking turn-taking, as well as how the child indicates that they want the turn-taking to continue. In this light, it barely matters what is said to the child. Remember, they are responding to the inflectional patterns and cadence of your speech. As noted previously, 4-7 word utterances, spoken with a wide inflectional pattern and an even cadence is best suited to catch and maintain your child’s interest. The easiest way to summarize these thoughts is in this manner; follow your child’s lead and do all that is possible to keep the turns going. These are the skills that translate into conversational ability as the child develops his vocabulary and begins to use words. In the 7-10 month range, typically developing children will display 2-4 turns on a single topic, before seeking something else or losing interest. When the child indicates a desire to transition to another “topic” follow their lead and repeat the process.

The suggestions provided above are important precursors to the development of a child becoming a conversational partner. Remember that topic maintenance and turn-taking lie at the core of social language. Before the acquisition of these two skills, learning words is secondary. For the most part, word usage will emerge as your child possesses the conversational skills described above.
Regardless of the age of your child, let me encourage you to frequently engage in “conversational exchanges”. Go slow, learn to “read” your child, take turns, stay on topic, and most importantly, enjoy every minute of it!

​TEACHING CHILDREN TO BE SAFE
As we all live through this pandemic of Covid-19, we need to be wise about our continuing need to protect ourselves and our children from exposure. We can do this by simply following the CDC Protection Guidelines when away from home:

• Wear a mask
• Physically distance yourself 6 feet away from those you do not live with
• Wash your hands frequently

However, gaining the cooperation of our children to do those 3 protective steps may be difficult, especially wearing a mask. To gain a child’s compliance, the child will need to be taught these behaviors with continuing reinforcement until they become habit.
Here are some suggestions for teaching children to wear a mask:

• Whenever your children leave the house, have them wear a mask. At first they may resist keeping it on because they are not accustomed to wearing it and their sense of touch will alert them to the mask being on their face. However, if consistently worn, they will become desensitized and will adjust to wearing it just like they did to wearing a hat
• Role model wearing a mask and following all other recommended safety guidelines
• Try not to call attention to the fact your children are wearing masks. The object is for them to not notice the mask
• Use distraction to help your children not to think about the mask
• If they remove the mask, gently and positively put it back on them and then distract their attention on to something fun or interesting. Do not use a bribe in the moment because your children will then learn to take off their masks to receive a bribe.
• Speak only positively about wearing a mask even though you would prefer not to wear one
• At the end of each day, give a little prize, special treat, or do a fun activity with your children as positive reinforcement for wearing their masks even if it was difficult for them to keep it on
• Be consistent and recognize that wearing a mask does not feel natural and will take a month for the habit to form.

Wearing masks, washing hands, and physically distancing will be with us for the months ahead and will play an important role in controlling this crisis and returning us to work and our children to school and child care. Until there is a proven vaccine, what other options do we have? Our job as parents is to teach our children how to survive. They will then have the opportunity to live a happy and productive life!

​       If you recall, last week we described several behaviors that are present in newborn infants and their mothers from the earliest of their shared experiences. For example, newborn infants and their mothers are driven to initiate and sustain face to face contact. A mothers’ request to “see the baby” is concurrent with the infants’ primary interest in gazing at faces above than anything else. It is only later that the infant’s principle interest transitions from gazing at faces to gazing at objects. With those considerations in mind, let’s take a look at several additional developmental activities that mothers and infants engage in, from the earliest of their interactions.
       Prior to 4-7 months of age, the infant is the primary initiator of face to face contact. If you doubt that, simply try to get an infant to gaze at you if he does not want to. However, although the baby is the primary initiator of face to face contact, the adult can prolong it by responding to and encouraging the lengthening of mutual gaze. After 4-7 months of age, the child and the adult can both initiate and sustain interactions. This is an important development because it is at the 4-7 month mark when the infant’s primary interest shifts from faces to objects. This shift is generally observed as soon as the child develops independent reach and grasp.  So, once the child is interested more in “things” than “faces” adults are encouraged to facilitate mutual interest in objects that are familiar to the child and which will likely become part of his future play activities and routines. 
       In addition, if we carefully study the content and manner of how mothers speak to their children, we will find several interesting characteristics. The first to note is that a mother’s vocalizations with her baby consist primarily of 3-5 words, spoken in a very even cadence and characterized by a wide inflectional pattern. 
Thus, statements such as, “pretty baby” or “ma-ma loves you” or “you’re a good girl” or “time for bed” are quite common. As a side note, no one instructed mothers to use 3-5 word utterances spoken with an even cadence and wide inflectional pattern. This is something mothers are naturally “wired” to do, and it is something your child is naturally “wired to respond to. 
       As a way of demonstrating the reality of this, let me encourage you to pay particular attention to your child’s eyes, hands, and breathing patterns as you speak to them in this manner. It would not be at all unusual for your child to synchronize her eye, hand, or finger movements in cadence with your speech. She may even demonstrate awareness of your rate of speech via breathing patterns. The consistency of her responses will amaze you and make you particularly aware of how social infants are from their earliest of weeks. And although his response patterns may be limited by a lack of understanding of what is said, the rate and pattern of your speech catches the child’s interest and is accompanied by wonderful responses on her part. 
These thoughts represent just a few of the things adult caregivers can be alert to during the early months of a child’s life. As we continue, additional patterns of interaction will be discussed. 
I never tire of watching mothers and infants learn to interact during the early months. I trust that you will come to be as amazed as I am at the incredible process our children engage in as new members of our world.

Over the past three weeks, we have laid the groundwork for understanding how important early experience is relative to a child's cognitive development. We have stressed the importance of opportunity and ability as foundational for a child to begin and sustain the process of making sense of the world. With those considerations in mind, in the weeks ahead we will discuss the developmental milestones that suggest typical skill development and mastery, with particular emphasis on the emergence of communication skills.
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Now as it relates to communication skills, it is important to note that a child's communication skills are highly related to his success in the early elementary grades. Said differently, children that possess and utilize age-appropriate communication skills, by school age, generally do well in kindergarten and beyond. Conversely, if a child does not possess age-appropriate speech and language skills, the risk for school difficulties is increased. Thus, our awareness and promotion of speech and language development is an important component for school success. Please keep those considerations in mind as we describe some of the earliest milestones of communication development in infants and toddlers.

There are two things worth considering as it relates to the earliest of experiences a newborn has. First is the response of the mother, almost immediately following the birth of her child. Now it is worth noting that mothers throughout the world say virtually the same thing after delivering their child. Once they know that their child is healthy and have asked the appropriate questions, mothers universally utter a simple request. This is their first utterance directed toward the child as opposed to statements about the child. Further, not only does the professional literature support this but I have witnessed this as part of my professional activities in birth contexts throughout the world, even though I did not know the language that was being spoken.

Mothers throughout the world say something like; "come see me, let me look at you, let me see your eyes, let me see your face." Hence from a biological standpoint, mothers appear driven to facilitate face to face contact with their newborns shortly after birth. Thus it is reasonable to assume that a mother's requests to make face to face contact with her newborn are part of her biological makeup.

Now combine that with another significant fact regarding newborns. It is a developmental reality that infants under four months of age are primarily interested in gazing at faces above anything else. When given a choice, a child will voluntarily direct his visual attention toward faces as opposed to objects. This preference is noted from the earliest of newborn experiences, and is present in infants throughout the world, regardless of the birthing practices into which they are born.

Can you see the connection? Both mothers and infants are biologically driven and drawn to initiate and mutually engage in face to face interactions. This behavioral pattern is where the earliest communication development begins? And further, if anything impedes such interactions, the risk for communication delay increases?
Indeed, mothers and infant are compelled to make and sustain face to face contact, thus initiating the process of communication development. Quite amazing, don't you think?
As we continue this discussion in the weeks ahead, we will explore several of the common events that characterize how mothers and infants interact. The process is incredible and complex. It has a significant impact on how our children make sense of and become important participants in their world.
 

Week 3
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 Based on our discussion over the previous two weeks, it is instructive to recall that there are two things that are essential for a child to begin the process of making sense of the world. Certainly, one of these relates to the child's ability to do so. As we noted, anything that restricts a child's ability can serve as a contributing factor to the presence of developmental delay. Several of these factors were discussed last week.

        The second issue relates to a child’s early exposure to the world. In that light, if a child has a limited or deficient early experience or is not afforded ample environmental exposure, the potential for developmental delays is increased. This relates to several things, not the least of which is the actual caregiving environment and routine the child is exposed to.

       It should be kept in mind that children come into the world uniquely predisposed to begin the process of making sense of it. In order for the process to unfold, a child needs auditory, visual, and tactile experiences that are provided in the context of a stable and nurturing caregiving routine. During the early weeks of life, the child's system is geared toward his basic survival needs. The infant's earliest behaviors and responses are biologically driven, thus reflecting her need for nutrition, sleep, physical comfort, and contact with caregivers. Any undue or prolonged deprivation in one or more of these basic areas predisposes a child to less than optimal opportunities. At this stage of development, a child has very limited intentional means to express their needs. Yet as the child grows and becomes a greater participant in its world, his ability to make an increasing sense of it improves. Thus, in many ways, these early weeks serve as a developmental foundation thereby enabling the child to put his world together in an increasingly purposeful manner over time.

    Neglect, lack of routine, limited face to face time with caregivers, social deprivation, minimal nurturing touch, or an over stimulating daily routine can further the risk of the child's withdrawal into a "survival" mode and reduce its benefit from exposure to the world.
In the presence of adequate environmental exposure and opportunity, it is truly a wondrous thing to note, from week to week, the subtle changes that take place as visible proof that a child has begun and will sustain a rapidly expanding set of skills that equips him/her for optimal success during the infant, toddler, preschool years and beyond. I encourage parents to be intentional about keeping a record of developmental changes, some quite subtle, that are constantly taking place. You will be amazed at how perfectly ready your child is to grow, learn, and change. 

          Last week, if you recall, we began this discussion by emphasizing the unbelievable process whereby children enter the world and immediately begin making sense of it. I made the point that children learn more in the first five years of their lives than they do for the rest of their lives. It is an incredibly complex process, and it is dependent on two primary things; first, the opportunities provided for the child; and second, normal ability, from birth, to begin and sustain cognitive development. As such, anything that impedes the child's ability or inhibits their exposure to the world presents an increased risk for developmental delay. Keep those thoughts in mind as we consider some of the "ability" factors that can impact, in a negative manner, a child's developmental progress.

        It is helpful to acknowledge that there are many factors, prior to a child’s birth, that equip a child for typical skill mastery. Now, keep in mind that for the most part, a healthy mother brings a healthy child into the world. However,  good prenatal care is not a 100% guarantee that a child will possess the ability to begin the process of skill mastery. There are numerous factors, some genetic, some related to problematic choices made by the mother and some as a result of a disease process in the mother and or the child, that enhance the potential for developmental problems.
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          The presence of a genetic anomaly, particularly one known to include developmental delay, must be kept in mind. Prenatal exposure to drugs and alcohol is surely on the list of risk factors for atypical development. Another important consideration is prematurity. Premature and low birth weight infants are at enhanced risk for developmental delay, pending the degree of prematurity, birth weight, and other complicating medical factors. Birth injuries that include any degree of cranial bleeding, lack of oxygen, or head trauma must likewise be considered as risk factors. Frankly, the list of potential factors that relate to impeding the child's ability to make sense of the world is extensive. However, please note that the presence of any of these factors increases risk. Their presence does not guarantee problems in development.

All of these considerations have a potential impact on a child’s ability to make sense of the world. 
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Should there be questions as it relates to these factors (and others) a developmental specialist should be consulted as soon as possible. Please feel free to contact the Achieve Center if you have any questions.

Week 1
         I think you would agree that there are few things more wondrous than observing a newborn child enter the world and soon thereafter begin the process of making sense of it. The simple reality is that our children learn more during the first five years of life than they do the rest of their lives. An amazing process, don’t you think?

        In that light a simple question arises. What factors contribute to a child’s ability to make sense of the world? Researchers have considered this question for many decades. Their research is consistent in demonstrating that there are two primary factors in considering how children progress from limited ability as a newborn to functioning preschoolers and beyond. These two factors are ability (nature) and opportunity (nurture). If a child possesses good health and is exposed in a profitable manner to the world around it, he will begin and sustain the process of making sense of the world. On the other hand, if anything gets in the way of opportunity or ability the potential for developmental delay increases.

        Now with those realities in mind, there is a simple scientific fact worth considering, and it is this: the more complicated something is the greater the risk that something may go wrong. When applied to child development, and in light of the amazing process of achieving developmental skills, there are many things that might impede a child’s ability to attain normal developmental milestones.  Would you agree?
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        As we consider this in the weeks ahead it is my intent to do three things. First, I want to alert parents to the factors that may contribute to less than optimal developmental skill development. Second, I want parents to understand what to look for in determining if their child is attaining appropriate skills. And third, I intend to provide an overview of what constitutes typical skill development (concentrating heavily on speech and language development) so that each child is equipped and ready to enter school and be successful. I trust this information will be both instructive and supportive as we marvel at how our children grow and develop.

Are meal times a source of tension and struggle for your family? Do you have a child who refuses to eat a variety of foods or eats a limited range of foods? Perhaps they struggle to chew or swallow certain textures? Your child may be a picky eater or a problem feeder. The process of trying to get your child to eat well can be frustrating and tiring. Thankfully, there are trained professionals who have tools and tips that can provide some assistance and relief.

The Achieve Center is hosting an informational meeting for parents of children with eating and feeding problems. This informational meeting will include: a presentation by a certified Speech Language Pathologist and a Registered Dietician, a question-answer session, and informational handouts. The presentation will discuss what makes a picky eater/problem feeder, methods to use at home to encourage positivity around new foods, nutritional information, and any red flags that would warrant therapy.

Presenters: Shannon Schield, MS CCC-SLP & Vernell Theisen, Registered Dietician
Where: The Achieve Center, 520 N. 28th Avenue, Wausau, WI 54401
When: Monday, March 16th from 6:30-8:00 PM
What to Bring: Informational handouts, notepads, and writing utensils will be provided. Light refreshments will also be provided.
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*Please note that childcare will not be provided

According to a recent study published in the February 11, 2020 issue of Lancet Psychiatry, declining physical activity starting at age 12 is associated with depressive symptoms at age 18, new research shows.

In the first study to objectively measure physical activity in teens, investigators found that every additional 60 minutes of sedentary behavior per day at age 12, 14, and 16 was linked to an increase in depression scores of 11.1%, 8%, and 10.7%, respectively at age 18.
Conversely, every additional hour of light activity per day at age 12, 14, and 16 was tied to a decrease in depression scores of 9.6%, 7.8%, and 11.1%, respectively, when measured at age 18.
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Recommendation: Children and adolescents need daily physical activity throughout the day. The good news from this study is the implication that light activity — which can include movements as simple as standing, stretching, or casual walking — might be an effective strategy for decreasing the burden of adolescent depression. Long periods of inactivity such as playing video games, watching movies, and even studying can contribute to the development of depression symptoms.