Opportunity and Vulnerability

For all young children, the rapidity of early brain development creates both opportunity and vulnerability. Most babies and young children are well cared for, experiencing the responsive, nurturing relationships that wire their brains for healthy development and promote their well-being. Early experiences with caregiving relationships that are harsh, traumatic, or neglectful can have lifelong negative impacts.

Rapid Early Brain Development

Young children’s brains create up to 2 million new synapses (or connections between neurons) per second. By the time a child is three years old, the brain has reached almost 80% of its adult size. Early experiences get built into the developing brain and growing body, powerfully influencing cognitive, physical, social, and emotional well-being throughout life. Adverse childhood experiences (ACEs), which are severe or ongoing events such as abuse and neglect, can have immediate as well as long term negative impacts on health and well-being.

The Power of Early Relationships

Early relationships form the context for babies and young children’s healthy social and emotional development, or their capacity to “…experience, regulate and express emotions, form close and secure interpersonal relationships, and explore the environment and learn – all in the context of family community, and cultural expectations for young children¹. ” Safe, stable, nurturing relationships and environments (SSNRs) can buffer young children from the toxic stress of maltreatment and other traumatic experiences.

Most parents can read and respond to their young children’s cues and form the satisfying “serve and return” relationships that help young children thrive. Very stressed parents and those who experienced ACES in their childhood may need help in building responsive relationships with their young children. Providers can support healthy parent-child relationships by creating responsive relationships with parents. This, along with other needed supports, enhances parents’ capacity to nurture their young children.

Culturally Responsive Care

Recognizing and respecting cultural influences on parents’ views and understanding of the world is vital in encouraging SSNRs. Culture is an integral part of identity and often serves to maintain connections across generations. Culture is “…a shared system of meaning, which includes values, beliefs, and assumptions…²” . Some cultures tend to be more individualistic in their values, while others promote interdependence. Individualistic cultures emphasize individual fulfillment, and interdependent cultures emphasize the group’s well-being ³. These fundamental cultural values shape parenting beliefs and practices.

An individualistic culture, such as the mainstream U.S. culture, might emphasize practices like encouraging children to make decisions or choices, training babies to sleep alone and to dress and feed themselves as early as possible. Many U.S. immigrant and minority groups emphasize interdependence, which might lead to parenting practices such as co-sleeping, weaning at older ages, and obedience to adults ⁴. Child-rearing practices support cultural goals and values for children. Practitioners can support SSNRs by seeking to understand and support the goals of parents’ culturally-based child-rearing practices.

The Centers for Disease Control (CDC) found that parents across diverse cultural groups share many values and norms about desired goals and behaviors for children, as well as strategies for handling misbehavior. Disciplinary strategies used across cultural groups ranged from time out, taking away privileges, and physical punishment. These strategies had different meanings for the different cultural groups studied. Discussing how child-rearing strategies fit with parents’ cultural beliefs, and reframing effective strategies to increase their consistency with parental cultural values are two approaches for supporting healthy parenting practices.

¹ Parlakian, R. & Seibel, N.L. (2002). Building strong foundations: Practical guidance for promoting the social-emotional development of infants and toddlers. Washington, D.C.: ZERO TO THREE, p. 2.

² Christensen, Emde & Fleming (2004) and Emde (2006) cited in Maschinot, B. (2008). The changing face of the United States: The influence of culture on early child development, p. 2. Available at http://main.zerotothree.org/site/DocServer/Culture_book.pdf?docID=6921)

³ Maschinot, op cit.

⁴ Maschinot, op cit.

A decade-long emphasis on building protective factors has reshaped the way policymakers, practitioners, and parents view the prevention of child maltreatment. Rather than focusing on risk and deficits, a protective factors approach promotes well-being for children and families by recognizing and building family strengths. The emphasis is on partnership, collaboration, engaging all areas of the social ecology, and working across traditional professional and service system boundaries to fully meet families’ needs.

A presentation at the 2013 Children’s Bureau’s Network for Action meeting highlighted three protective factors frameworks as they relate to the individual, family, and societal areas of the social ecology.

Protective Factors Resources

Center for the Study of Social Policy
Strengthening Families

Child Welfare Information Gateway
Preventing Child Abuse and Neglect

FRIENDS National Center
Protective Factors Survey

Online Learning Center

National Alliance of Children’s Trust and Prevention Funds
Online Training Course

Families’ needs are more significant than the boundaries of any one profession or service system. Collaborations across professions and service sectors create comprehensive approaches to meeting these needs and promoting child and family well-being. Engaging informal sources of support via friends, family, community groups, and religious and spiritual organizations further increases supports for children’s and families’ well-being.

For a detailed listing of programs that can collaborate on families’ behalf, see the CBCAP Program Instruction.

A brief overview of these formal sources of support follows:

Early Intervention Programs:

For young children with special needs, early intervention programs implement Part C of the Individuals with Disabilities Act and are responsible for assessment and treatment of children from birth to three who have or are at risk of having significant developmental delays. Early intervention professionals come from an array of professions, including speech-language pathology, occupational therapy, physical therapy, child development, social work and mental health, and early education. The U.S. Department of Education provides additional information about federally funded programs for infants, toddlers, and young children with disabilities. The Early Childhood Technical Assistance Center offers a range of TA and online resources to states and programs implementing services for young children with disabilities and their families.

Early Care and Education Programs (ECE):

Most children under age 3 spend some portion of their week in non-parental care. Research demonstrates that quality ECE programs support social-emotional development and promote readiness to learn. ECE staff may include professionals with certificates, licenses, associate degrees, undergraduate or graduate degrees in early childhood education, child development, and other human service professionals depending upon services provided.

The U.S. Department of Health and Human Services, Administration for Children and Families’ (ACF) Office of Child Care provides access to quality early care and education programs for low-income families. The Child Care Technical Assistance Network (CCTAN) provides TA to states, territories, tribes, and local communities. 

Early Head Start (EHS) and Head Start (HS) programs are federally-funded ECE programs that offer comprehensive child and family services for young children in low-income families. The ACF Office of Head Start provides information about and resources for Early Head Start and Head Start programs, and there are six national centers provide T/TA to EHS and HS programs.

Child Welfare Programs:

Child welfare agencies are charged with assuring the safety, permanency, and well-being of children identified as victims of maltreatment, or at very high risk of maltreatment. They are typically staffed by social workers who may have bachelor’s or graduate degrees, certificates, or licenses. State and federal laws define the parameters for abuse, and they can vary across jurisdictions.

ACF’s Children’s Bureau partners with federal, state, tribal, and local agencies to improve children’s and families’ overall health and well-being. It’s Training and Technical Assistance Network, which includes the FRIENDS National Resource Center, works with states, tribes, courts, and other facets of the child welfare system in meeting desired Federal outcomes and promoting children’s and families’ safety, permanency and well-being. The Child Welfare Information Gateway offers an array of resources related to child welfare, promoting child and family well-being, and preventing child maltreatment.

Physical Health Providers:

Primary care pediatricians, pediatric dentists, nurses, nurse practitioners, and physicians’ assistants provide routine well-child care, offer information to parents, and diagnose and treat illness. Primary health care providers refer to specialists when specific expertise is needed. Like their children, parents and caregiving adults need health and dental care, as ill-health causes distress for the adult and can impair responsive parent-child interactions. The U.S. Department of Health and Human Services offers an array of physical health-related information.

Mental Health Providers: 

Infant mental health and early childhood mental health clinicians diagnose and treat mental health disorders in very young children. They may have graduate degrees, certificates, or licenses in psychology, counseling, social work, psychiatric nursing or marriage, and family therapy, with additional training in infant and early childhood development, assessment, diagnosis, and treatment. Treatment approaches engage the child’s parents or parental figures, as young children’s healthy development is dependent on their caregiving relationships. SAMHSA, the Substance Abuse and Mental Health Services Administration, offers a range of mental health resources, including those focused on very young children and their families.

Family Support:

An array of programs, including family resource centers, parent support groups, parent education, home visiting, and others, and multi-disciplinary professional and paraprofessional human service providers support families in building protective factors that promote well-being. As examples, these services include family resource centers, home visiting programs, parent education, parent support groups, and parent warmlines. The Child Welfare Information Gateway offers information about family support programs.

Why focus prevention efforts on babies, toddlers, and preschoolers?

While it may seem that infants, toddlers, and preschoolers are “too young to remember” early adversity, in reality, early trauma and neglect can become embedded in the brain and body, with lifelong consequences. Maltreatment of young children disrupts attachment relationships that young children depend on, and can result in out of home placements for very young children. The changes in caregiving relationships that come with foster care placement are themselves disruptive to the formation of secure attachment, a critical developmental task for young children. The absence of secure attachment can have long term and serious developmental consequences ¹.

A foundation is laid during the early years for all that comes later. When care is taken to support safe, stable, and nurturing families and environments, that foundation is sturdy and promotes lifelong health, well-being, and success. This benefits individuals, communities, and society. Economic studies indicate that society sees a return of at least $7 for every $1 spent on quality early childhood programs.

Are very young children likely to be victims of abuse and neglect?

Children under age 3 are the age group most likely to be victims of child maltreatment and account for the majority of child maltreatment deaths. Young children who come into contact with the child welfare system have high rates of developmental, mental health, and physical health problems ². Maltreatment is associated with high personal and societal costs. These costs can be averted when parents and communities are supported in safe, stable, nurturing relationships and environments for young children.

What has the Adverse Childhood Experiences (ACE) Study learned about the outcomes of ACEs?

The ACE Study of 17,000 Kaiser Permanente patients found that experiences of child maltreatment and other childhood trauma are common. Almost 2/3 of the study population reported at least one ACE, and more than 1 in 5 reported three or more ACEs. Exposure to ACEs can result in short and long-term health and behavioral problems. The more ACEs a person has been exposed to, the higher the likelihood of later life outcomes such as alcoholism, fetal death, chronic obstructive lung disease, depression, decreased health-related quality of life, heart disease, liver disease, intimate partner violence, illicit drug use, smoking, suicide attempts, and unwanted pregnancy. These findings highlight the importance of approaches to reducing ACEs.

Are there any promising or evidence-based approaches to promoting well-being and preventing maltreatment among infants, toddlers, and their families?

There are several promising and evidence-based approaches to promoting well-being and preventing the maltreatment of very young children. These include high-quality early care and education, home visiting, parent support, parent education, early childhood systems of care, and early childhood mental health consultation. For more information, see the next accordion on Characteristics of Effective Programs.

¹ Honig, A.S. (2002). Secure relationships. Nurturing infant/toddler attachment in early care settings. Washington, DC: National Association for Education of Young Children.

² Leslie, L.K., Premji, K., Peoples, J., & Gist, K. (2005). Addressing the developmental and mental health needs of young children in foster care. J Dev Behav Pediatr. 2005 April ; 26(2): 140–151.

Programs serving young children and their families are more likely to be effective in supporting child well-being and preventing maltreatment when they ¹:

Promote secure parent-child attachment by…

• Encouraging warm, supportive parent-child relationships
• Providing parents with the information, concrete help, emotional support, mental and physical health care, either directly or via coordination and collaboration with other providers
• Addressing the multiple risk and protective factors affecting the family, either directly or through coordination and collaboration with other providers
• Operating from a sound understanding of infant and early childhood development
• Understanding the importance of supporting the child in the context of essential caregiving relationships
• Respecting and responding to families’ culturally-based child-rearing values and practices

Purposefully use the parallel process, or the power of relationships to influence other relationships, throughout the program by…

• Building responsive parent-provider relationships that mirror and support responsive parent-child relationships
• Providing reflective supervision for staff that helps them in engaging effectively with very young children and their families

Have organizational support for young children’s well-being, including…

• Attention to comprehensively addressing children’s and families’ needs
• A culture that values support and nurturance as well as stability of and quality of provider-family relationships
• A culture that is both accountability based (results-oriented) and relationship-based (emphasize collegiality, teamwork and staff well-being)
• A climate of trust, cooperation, respect, openness, and inclusion
• Staff with personal characteristics of effective helpers (empathy flexibility and ability to develop positive relationships with families)
• Ongoing staff training and professional development

¹ Center on Social and Emotional Foundations of Early Learning (nd). Infant mental health and early care and education providers. Vanderbilt University, available online at http://csefel.vanderbilt.edu/documents/rs_infant_mental_health.pdf; Jones Harden, B. & Duchene, M. (2012) White, J. & Jones Harden, B (2012), in Understanding early childhood mental health: A practical guide for professionals. Janko Summers, S. & Chazan-Cohen, R., Eds. Baltimore: Paul H. Brookes Publishing Company.

The resources listed below include a) information related to the quality of programs serving infants, toddlers, preschoolers, and their families, and b) clearinghouses with information on evidence-based and promising programs that promote well-being for very young children and their families.

Early Care and Education

• Child Care and Early Education Research Connections – Research on quality in center-based and family home early care and education programs
• Center for the Social and Emotional Foundations of Early Learning – A national resource center funded by the Office of Head Start and Child Care Bureau for disseminating research and evidence-based practices to early childhood programs nationwide. Includes research briefs, decision-making guides, materials and resources

Home Visiting

• Maternal, Infant and Early Childhood Home Visiting Program – The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program facilitates collaboration and partnership at the federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs

Infant and Early Childhood Mental Health

• Early Childhood Mental Health Consultation – What Works? A Study of Effective Early Childhood Mental Health Consultation Programs
• Early Childhood Systems of Care – Project Launch: Promoting Wellness in Early Childhood (newsletter article)

Evidence-Based and Evidence-Informed Programs for Preventing Maltreatment and Promoting Well-Being of Very Young Children

• Evidence-Based and Evidence-Informed Programs: Prevention Program Descriptions Classified by CBCAP Evidence-Based and Evidence-Informed Categories – A FRIENDS publication identifying evidence-informed and evidence-based prevention programs, including those focused on very young children and their families
• California Evidence-Based Clearinghouse for Child Welfare – A listing of programs identified as promoting child and family well-being, which includes those focused on very young children and their families
• Home Visiting Evidence of Effectiveness – The Department of Health and Human Services launched Home Visiting Evidence of Effectiveness (HomVEE) to conduct a thorough and transparent review of the home visiting research literature and provide an assessment of the evidence of effectiveness for home visiting programs models that target families with pregnant women and children from birth to age 5