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“Despite economic recovery and rising employment, lack of health insurance has become a rising social and economic problem in the United States By the mid-1980s, more than 37 million Americans were completely uninsured. The women that are most likely to be uninsured are the most likely to be poor—those who are black or Hispanic, poorly educated, working in low-paying jobs or unemployed. Women with no insurance face many problems when trying to obtain prenatal care. Their options are limited to charity care at the hands of willing providers or care in public health clinics and other settings usually financed by public funds. Unfortunately, the amount of women aged 15 to 44 who have no health insurance is likely to increase.. Women that work in industries are least likely to be offered health insurance (such as service and retail jobs). They are also more  likely to work part-time, which usually carries no health insurance benefits. Other reasons include growing gaps in the employer-based insurance system and the decreasing number of the poor covered by Medicaid. Although expansions of Medicaid will help finance care for some portion of uninsured women, the problem of absent health insurance has outnumbered the steps taken so far. Women with limited financial resources, frequently seek prenatal care in so-called “organized settings,” as distinct from private physicians in office-based practices. These settings include hospital outpatient departments, Community Health Centers and Migrant Health Centers, public health departments, Maternity and Infant Care projects, and school-based prenatal services (Institute of Medicine (US) Committee to Study Outreach for Prenatal Care, 1988).”

“Preterm birth and other growth restrictions have been commonly associated with lower socioeconomic status, in particular within poor urban populations in Canada . By combining both of these outcomes, Spencer et al estimated that 30% of low birth weights could be the result of  a mother’s lower social class. Explanations for these  birth outcomes include higher rates of maternal smoking, poorer nutrition and a higher number of tract  infections among lower income pregnant women. Kramer et al and Seguin et al have hypothesized that premature birth and/or intrauterine growth restriction may be explained by the greater exposure of poor pregnant women to accumulated chronic stressors, including crowded home environments, unemployment, single-parent households, less social support and financial problems . Looking at this from a social and physical environment perspective, it is clear  that children living in poverty also  gather a wide range of  unfortunate risk exposures that therefore explain why childhood poverty is so pathogenic (Larson, 2007).”

“Parents are  an important part of the pediatric care team.  They are in a unique position to report on the care their children receive. These differences signify  the sometimes vast social and cultural gaps that separate parents and health care professionals. Professionals are  used to the world of health care, while parents experience this world as a new and different culture. Understanding the way that parents perceive things is the key to developing programs and interventions to minimize barriers and is central to the provision of patient-centered care.  If you visit the website https://www.wiaap.org/education-programs/resources-for-parents/ , parents can find many resources for keeping their children healthy, including educational programs and resources (Resources for Parents 2020).”

“Communication between caregivers and families occurs during daily hellos and goodbyes, as well as in more formal activities such as a planned home visit or family meetings. All of these opportunities require you to be aware of many of the family’s characteristics, including tone, choice of words, and nonverbal communication, such as facial expressions and body language. When you are aware of these characteristics, you can better communicate in ways that are most supportive and respectful of families while keeping in mind this may be the family’s first experience with early care and learning programs. Families will be eager to know how their infant or toddler is doing, and you can support comfortable communication by offering encouraging responses and asking for clarification if something is not understood. Communication is the basis for any strong relationship and it is especially important concerning family engagement in early childhood education programs (Baker & Manfredi-Petitt, 2004). Communicating with families is about listening, sharing information, and working toward common understanding. When families communicate with you openly and effectively, you can better understand what is happening at home, as well as what goals, hopes, and dreams families have for their infants and toddlers. When you communicate effectively, families are better able to understand what is happening during their infant’s or toddler’s day and how they are developing and learning. Make a point of communicating with parents both when they drop off and pick up their infant or toddler. If you speak with a family in the morning but are not in the room during pick up, communicate to another caregiver what you were told by the family and what should be relayed to them about the child’s day. When you and your families communicate and share information, you can become even more aware of the infant or toddler’s strengths and possible areas of need to work together and support ongoing development. Programs must use communication practices that are sensitive to the diverse language and cultural backgrounds of the families they serve. Each family is teaching their young children how to be successful within their own culture (Promoting family engagement: Communicating with families: Vls, 2021).”

“Communication preferences may be related to cultural or community values, priorities, and commitments. For example, Sohn and Wang (2006) found that Korean-born mothers, even those who spoke English well, had difficulty communicating with teachers face-to-face. Their preference was to communicate with teachers through email or program letters (Promoting family engagement: Communicating with families: Vls, 2021).”  When communicating with families, it is also important to understand and consider:

• Different forms of greetings and use of titles that may be preferred (Promoting family engagement: Communicating with families: Vls, 2021)
• Male and female roles defined within various cultures(Promoting family engagement: Communicating with families: Vls, 2021)
• Non-verbal communication and body language (e.g. eye contact, use of touching, use of physical space) (Promoting family engagement: Communicating with families: Vls, 2021)

“You can ask questions to learn how families would like to communicate about their infant’s or toddler’s day. Some families may prefer face-to-face conversations while others prefer to telephone or regular (daily) notes (Promoting family engagement: Communicating with families: Vls, 2021).”  Other ways of communicating with families include:

• Program website (Promoting family engagement: Communicating with families: Vls, 2021)
• Email (Promoting family engagement: Communicating with families: Vls, 2021)
• Family meetings or conferences (Promoting family engagement: Communicating with families: Vls, 2021)
• Newsletters (Promoting family engagement: Communicating with families: Vls, 2021)
• Articles of interest (Promoting family engagement: Communicating with families: Vls, 2021)

“Families will also help set the pace for their communication with you. It is important to acknowledge it can take time for families to feel safe, comfortable, and friendly. Different forms of communication can play an important role in easing the process. Using a combination of communication styles with families might work best for their needs to be met. Other ideas may be to translate written communication into the home languages of the families supported in the program and consider having translators that are regularly available for face-to-face or phone communication (Promoting family engagement: Communicating with families: Vls, 2021).”

How will caregivers impact children in years to come?

“The study, by researchers at the University of Minnesota, the University of Delaware, and the University of Illinois at Urbana-Champaign, appears in the journal Child Development. It was carried out to replicate and expand on findings from the NICHD Study of Early Child Care and Youth Development, which showed that early maternal sensitivity has lasting associations with children’s social and cognitive development at least through adolescence.” The study indicates that the quality of children’s early caregiving experiences has an enduring and ongoing role in promoting successful social and academic development into the years of maturity,” notes Lee Raby, a postdoctoral researcher at the University of Delaware, who led the study. Sensitive caregiving is defined as the extent to which a parent responds to a child’s signals appropriately and promptly, is positively involved during interactions with the child, and provides a secure base for the child’s exploration of the environment. The researchers used information from 243 individuals who were born into poverty, came from a range of racial/ethnic backgrounds, and had been followed from birth into adulthood (age 32) as part of the Minnesota Longitudinal Study of Risk and Adaptation. Observations of interactions between mothers and their children were collected four times during the children’s first three years of life. At multiple ages during childhood and adolescence, teachers reported on children’s functioning in their peer groups and children completed standardized tests of academic achievement. During their 20s and early 30s, participants completed interviews in which they discussed their experiences with romantic relationships and reported their educational attainment. Individuals who experienced more sensitive caregiving early in life consistently functioned better socially and academically during the first three decades of life, the study found. The associations were larger for individuals’ academic outcomes than for their functioning in peer and romantic relationships. Moreover, early caregiving experiences continued to predict individuals’ academic, but not social, functioning after accounting for early socioeconomic factors as well as children’s gender and ethnicity. Although families’ economic resources were important predictors of children’s development, these variables didn’t fully account for the persistent and long-term influence of early caregiving experiences on individuals’ academic success. “Altogether, the study suggests that children’s experiences with parents during the first few years of life have a unique role in promoting social and academic functioning–not merely during the first two decades of life, but also adulthood,” according to Raby. “This suggests that investments in early parent-child relationships may result in long-term returns that accumulate across individuals’ lives. Because individuals’ success in relationships and academics represents the foundation for a healthy society, programs, and initiatives that equip parents to interact with their children sensitively during the first few years of their children’s life can have long-term benefits for individuals, families, and society at large (Early caregiving experiences have long-term effects on social relationships, achievement 2014)”

“In healthy children, social-emotional stages develop on an expected trajectory and monitoring these milestones is an imperative part of preventative health supervision visits. The caregiver’s sensitive and available supportive role is imperative to establish attachment and the skill set that follows (Malik, 2020).”

“Three distinct emotions are present from birth; anger, joy, and fear, revealed by universal facial expressions. Cognitive input is not required for emotional response at this stage. During the brief periods of alertness in the newborn period, the newborn may return a mother’s gaze. Soon the infant explores her face. The first measurable social milestone is around one-two months of age, and it is the infant’s social smile in response to parental high pitched vocalizations or smile. She recognizes the caregiver’s smell and voice and responds to gentle touch. Infants can use a distinct facial expression to express emotions in an appropriate context after 2 months of age. In the first 2 to 3 months infant learns to regulate physiologically and need smooth routines. She progressively learns to calm herself, gives a responsive smile and responds to gentle calming (Malik, 2020).”

“Sensitive cooperative interaction with the caregiver helps the infant to learn how to manage tension. Around 4 months of age turn-taking conversation (vocalizations) begin. The infant learns to manipulate his environment. He lets his caregiver know taking away his toy upsets him or he is happy when held. A sensitive but firm response from the caregiver helps infants manage emotional stress. She can recognize the primary caregiver by sight around 5 months of age. In between 6 to 12 months effective attachment relationships establish with a responsive caregiver. Stranger anxiety emerges as an infant distinguishes between the familiar and unfamiliar. The infant becomes mutually engaged in her interactions with the caregiver. The infant seeks caregiver for comfort, help, and play. He shows distress upon separation (Malik, 2020).”

“Between 12 to 18 months, the infant learns to explore his environment by support from a caregiver. By 12 months of age, proto-imperative pointing emerges, in other words, the infant requests by pointing at the object of interest and integrates it with eye contact between the object and the caregiver. Proto-declarative pointing follows at 16 months of age when the child points with eye gaze coordination to show interest. Around 18 months of age, the child brings the object to show or give it to the caregiver (Malik, 2020).”

“Around 12 months of age, the child takes part in interactive play like peek-a-boo and pat-a-cake. He uses gestures to wave bye-bye and communicate his interests and needs. At around 15 months of age empathy and self- conscious emotions emerge. A child will react by looking upset when he sees someone cry or feel pride when applauded for doing a task. The child imitates his environment, helps in simple household tasks and explores the environment more independently (Malik, 2020).”

“Between 18 and 30 months, individuation (autonomy) emerges. The confidence in the child-parent relationship and continued firm parenting helps the child face environmental challenges on his own more persistently and enthusiastically. The child’s temperament manifests itself more, and he is aggressive and reserved or friendly and cooperating. Around 18 to 24 months he learns to pretend-play such as talking on a toy phone or feeding a doll and plays next to or in parallel with another child. He may imitate other child’s play and look at him but he cannot play in a cooperative, imaginative way with another child yet. During preschool years he learns to manipulate his subjective emotions into a more socially accepted gesture. He uses a “poker face”, exaggerate or minimizes emotions for social etiquette. For example, he will say thank you for a present he didn’t like. The child refers to himself as “I” or “me” and possessiveness “mine” and negativism “no” emerge (Malik, 2020).”

“Between 30 and 54 months, impulse control, gender roles, and peer relationship issues emerge. A caregiver plays a major role in helping preschoolers define values and learn flexible self-control. Testing limits on what behaviors are acceptable and how much autonomy they can exert is an expected phenomenon. Thoughtful parenting with a balance between setting limits and giving choices will successfully establish a child’s sense of initiative and decrease anxiety from guilt or loss of control. At 30 months pretend play skills emerge and the child shows evidence of symbolic play, using an object as something different like pretending a block to be a telephone or a bottle to feed a doll. The play scenarios become more complex with themes and story-lines. By 3 years of age, the child engages more in interactive play, masters his aggression and learns cooperation and sharing skills. He can play with 1 or 2 peers, with turn-taking play and joint goals. Imaginative and fantasy play begin like pretending to be a cat and role-play skills develop. The child, however, cannot yet distinguish between reality and imagination and it is common to be afraid of imaginary things. They master this skill to differentiate between real and imaginary around 4 years of age. They enjoy playing tricks on others and are worried about being tricked themselves. Imaginary scenarios and play skills are developing and become more complex. They can play with 3 to 4 peers, with more complex themes and pretend skills (Malik, 2020).”

“At 5 and 6 years of age, the child can follow simple rules and directions. He learns adult social skills like giving praise and apologizing for unintentional mistakes. He likes to spend more time in peer groups and relates to a group of friends. Imaginative play gets more complex, and he likes to play dress and act out his fantasies (Malik, 2020).”

“At 7 and 8 years of age, the child fully understands rules and regulations. He shows a deeper understanding of relationships and responsibilities and can take charge of simple chores. Moral development furthers, and he learns more complex coping skills. At this age, a child explores new ideas and activities and peers may test his beliefs. Children identify more with other children of similar gender and finding a best friend in common (Malik, 2020).”

“At 9 and 10 years of age, peer and friend groups take precedence over family. Children at this age will show increasing independent decision-making and a growing need for independence from family. Parents can use responsibilities and chores to earn time with friends. A positive nurturing relationship with a caregiver with praise and affection and setting up a reasonable balance between independence and house rules builds self-confidence and self-assurance. Promoting supportive adult relationships and increasing opportunities to take part in positive community activities increases resilience (Malik, 2020).”

“Greater independence and commitment to peer groups drive the transition to adolescence. This will include indulging in risky behavior to explore uncertain emotions and impress peer groups. Social interactions include complex relationships, disagreements, breakups, new friendships, and long-lasting relations. Normally the adolescent will learn to cope with these stresses with healthy adult relationships and guidance to make independent decisions. As young adulthood approaches, school success and work-related activities become important. For a healthy transition to adulthood positive and supportive adult guidance and opportunities to take part constructively in the community play a pivotal role (Malik, 2020).”

“Children grow and develop rapidly in their first five years across the four main areas of development. These areas are motor (physical), language and communication, cognitive and social/emotional. Cognitive development means how children think, explore and figure things out. It is the development of knowledge, skills, problem solving and dispositions, which help children to think about and understand the world around them. Brain development is part of cognitive development (Help me grow 2021).”

“As a parent, it is important to foster your child’s cognitive development as soon as he/she is born because doing so provides the foundation for your child’s success in school and later in life. For example, research shows that children who can distinguish sounds at six months of age are better at acquiring the skills for learning to read at four and five years of age. To promote your child’s cognitive development, it is important that you actively engage in quality interactions on a daily basis (Help me grow 2021).” Examples include:

• Talking with your baby and naming commonly used objects.
• Letting your baby explore toys and move about.
• Singing and reading to your baby.
• Exposing your toddler to books and puzzles.
• Expanding on your child’s interests in specific learning activities. For example, your toddler might show an early interest in dinosaurs, so you can take him/her on a trip to the natural history museum to learn more about the time that these creatures roamed the earth.
• Answering your child’s “why” questions.

  “Another way that you can foster your child’s cognitive development is to provide him/her with choices and prompt him/her to make thoughtful decisions. You should also allow your child to explore different ways of solving problems. While you may want to provide some gentle guidance and encouragement, allow your child some time to figure out things, like a new puzzle. This may require some patience on your part, but it will ultimately help him/her to learn (Help me grow 2021).”

“Remember that gross motor skills are voluntary movements involving the use of large muscle groups while fine motor skills are more exact movements of the hands and fingers and include the ability to reach and grasp an object. Early childhood is a time of development of both gross and fine motor skills. Early childhood is a time when children are especially attracted to motion and song. Days are filled with moving, jumping, running, swinging and clapping, and every place becomes a playground. Even the booth at a restaurant affords the opportunity to slide around in the seat or disappear underneath and imagine being a sea creature in a cave! Of course, this can be frustrating to a caregiver, but it’s the business of early childhood. Children may frequently ask their caregivers to “look at me” while they hop or roll down a hill. Children’s songs are often accompanied by arm and leg movements or cues to turn around or move from left to right. Running, jumping, dancing movements, etc. all afford children the ability to improve their gross motor skills. Fine motor skills are also being refined in activities such as pouring water into a container, drawing, coloring, and using scissors. Some children’s songs promote fine motor skills as well (have you ever heard of the song “itsy, bitsy, spider”?). Mastering the fine art of cutting one’s own fingernails or tying their shoes will take a lot of practice and maturation. Fine motor skills continue to develop in middle childhood, but for preschoolers, the type of play that deliberately involves these skills is emphasized (Learning, Lifespan development 2021).”

Watch this video below to see some examples of physical development in early childhood.

“Did you know one in five children live in a home with parental substance abuse? As a result, many of these children suffer psychologically, physically, and emotionally for years. Drug abuse interferes with a parent’s ability to care for their children and provide a safe, nurturing environment in which they can thrive. Children with a family history of substance abuse are at high risk of developing physical and emotional issues, as well as suffering from addiction later in life. If left untreated, parental drug use has the potential to destroy a family, disrupt communication, create financial problems, fuel physical altercations, and disturb healthy family roles (Center, How to help children with addicted parents: Tips and advice 2020).”

The American Academy of Experts in Traumatic Stress offers several examples of the harmful effects of parental drug use on child development.

• It creates a chaotic home life. Homes in which substance abuse is prevalent are often unpredictable and chaotic. Inappropriate family roles are often assumed, such as children taking care of siblings like parents or assuming financial responsibilities of the household. Additionally, communication among leadership in the household is often unclear or nonexistent, leaving children in a living environment that lacks structure (Center, How to help children with addicted parents: Tips and advice 2020).
• It breeds violence. Substance abuse and domestic violence are closely tied. According to the American Society of Addiction Medicine, 40 to 60 percent of domestic violence incidents co-occur with substance abuse.3 Substance abuse and child abuse, sexual abuse, and neglect are also common within families with a history of addiction, and many children suffer from symptoms of PTSD as a result of the trauma (Center, How to help children with addicted parents: Tips and advice 2020).
• It contributes to mental health problems. Parents who abuse drugs and alcohol are more likely to deal with things like financial problems, divorce, physical abuse, unemployment, and legal problems, which can all cause stress at home. Children of alcoholics have a higher prevalence of suicide attempts, eating disorders, anxiety, and depression when compared with their peers (Center, How to help children with addicted parents: Tips and advice 2020).
• It contributes to physical health problems. The American Academy of Pediatrics states that almost a quarter of children of mothers with identified substance use disorders do not receive routine child health maintenance services in their first two years of life.4 Additionally, children of substance abusers may suffer from stress-related health issues such as migraines or gastrointestinal problems as a result of their parent’s alcohol and drug abuse. Used needles and other drug paraphernalia may also create an unsanitary living environment that is full of health hazards (Center, How to help children with addicted parents: Tips and advice 2020).
• It creates difficulties at school. Children whose parents abuse drugs and alcohol are more likely to be distracted at school due to emotional and psychological stress, lack of sleep, and worries or fears about things going on at home. They may also be reluctant to develop friendships with other kids at school because they are embarrassed by their home situation (Center, How to help children with addicted parents: Tips and advice 2020).
• It fuels emotional issues. Children of drug-abusing parents may harbor negative emotions such as shame, fear, insecurity, or mistrust as a result of their parents’ substance abuse. It may also create a lack of respect or trust for authority figures such as teachers (Center, How to help children with addicted parents: Tips and advice 2020).
• It increases their own risk of drug addiction. Children of substance abusing parents are more than twice as likely to have a drug and alcohol use disorder by young adulthood as compared to their peers (Center, How to help children with addicted parents: Tips and advice 2020).

How can we help children with addicted parents?

“As a close family member, such as a grandparent, an aunt, or an uncle, it can be very difficult to help children with addicted parents. Close family members may feel an urge to rescue the child or protect them from the situation by taking them away from it, but unless the child is being neglected or physically based, parental drug abuse is unlikely to qualify as child abuse.That said, close family friends or loved ones can support children with addicted parents by being a safe and supportive adult that is always available to talk about what is going on. Aside from being available regularly, these close family members can also step in during a family crisis if necessary. Whether you are the sober parent in the situation or a close relative, one of the best things you can do to help the child of an addict is to encourage his or her addicted parent to seek treatment. (Center, How to help children with addicted parents: Tips and advice 2020). “ Depending on your relationship with the addicted person, this may include doing things like:

• Planning and hosting an addiction intervention (Center, How to help children with addicted parents: Tips and advice 2020)
• Helping the addicted person research treatment options (Center, How to help children with addicted parents: Tips and advice 2020)
• Offering to pay for a portion of the treatment expenses (Center, How to help children with addicted parents: Tips and advice 2020)
• Offering to provide childcare so the addicted person can attend outpatient meetings (Center, How to help children with addicted parents: Tips and advice 2020)
• Providing emotional support throughout the treatment process (Center, How to help children with addicted parents: Tips and advice 2020)

“Although the addicted person may need help to overcome his or her substance use disorder, a child of an addict will need support too. As the sober parent, you can serve as a stable and nurturing adult for the child. Addiction often makes a household feel very chaotic, but by maintaining a sense of overall routine, establishing traditions, and regularly celebrating holidays like Christmas and Thanksgiving, you can establish a structured, normal life. It’s also important to talk to your child about what’s going on. Educate your child about addiction in an age-appropriate way and make sure to emphasize the fact that the illness is not their fault, as children of addicted parents often blame themselves and carry this unhealthy mindset into adulthood. As the sober parent, you will also need to take care of yourself to ensure that you can care for your child or children. This may mean attending regular counseling sessions and local recovery support groups for family members of addicts. Dealing with substance abuse in your family is never easy, but there are many ways you can support the child of an addict and the addicted person to help facilitate healing (Center, How to help children with addicted parents: Tips and advice 2020).”