Early, Middle & Late Childhood
Context
What happens to children in their earliest years can have a significant impact on
their adult life
The early years of life are crucial in influencing a range of health and social outcomes across
the life-course. Research now shows that many challenges in adult society — mental health
problems, obesity/stunted growth, heart disease, criminality, competence in literacy and
numeracy — have their roots in early childhood.
In Scotland the Early Years Framework was published in 2008, outlining the importance of
giving children the best start in life and the need to tackle the significant inequalities faced by
children in the most deprived settings (NHS Scotland, 2008). Two years later Education
Scotland published Pre-Birth to Three: Positive Outcomes for Scotland’s Children and
Families (Education Scotland, 2010). This national guidance is aimed at those working with
our youngest children and their families and forms part of a shared vision for Getting it Right
for Every Child (GIRFEC) in Scotland and in supporting parents through a National Parenting
Strategy (The Scottish Government, 2012).
Key Legislation: Children and Young People (Scotland) Act 2014
Key Concepts
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Classic developmental theories
Contemporary concepts in child development
Characteristics of human growth and development
Foetal, Newborn, Infant, Toddler, Pre-school, school
developmental milestones
Importance of relationships and attachments
Parenting - styles and cultural variances
Impact of risk and adversity
Protective factors and the development of resilience
Mental health and wellbeing
Supporting / enabling parents to develop resilience
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&
pre-adolescent
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Revision
The Role of the Nurse in Prevention, Protection and Health Promotion
Consider each element of the illustration below. The headings at the top
indicate a continuum, with the 'absence of disease' on the left moving through different clinical
phases to the presence of 'chronic disease' on the right.
Below each phase of the continuum is a corresponding 'Level of Prevention'. Each Level of
Prevention highlights key stages in the prevention of disease, and the potential consequences
should disease occur.
Activity: Using your notes from Part 1, and your own research, identify the type of nurse that
would work mainly in each of the areas of prevention listed?
Level of Prevention
Type of Nurse
Example of the role of the Nurse
Primordial
Primary
Secondary
Tertiary
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Classic Developmental Theories
This illustration outlines four, of possibly the best known, theories of human development.
Each theorist providing an explanation, based on their observations, for the process of
human development across the lifespan.
Activity: Write a short description of the key concepts of the following developmental
theorists in relation to early childhood.
Theorist
Key Concepts
Jean Piaget
Erik Erikson
Lawrence
Kohlberg
Sigmund Freud
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Contemporary Concepts in Child Development
Research now shows that children’s early environment has a vital impact on the way their
brains develop. A baby is born with billions of brain cells that represent lifelong potential, but,
to develop, these brain cells need to connect with each other. During the first few weeks of a
pregnancy the foetus's brain produces 50,000 brain cells every second. At birth a baby
has 100 billion brain cells (or neurons) and by the age of 24 weeks the baby will have all of
its brain cells.
By the end of a baby's first year the brain cells will have developed their specific functions and
connections (synapses). By the end of the first year the baby's brain will have developed 1,000
trillion connections and this will continue until about 8 to 10 years of age.
The more stimulating the early environment (social interaction), the more positive connections
are formed in the brain and the better the child thrives in all aspects of his or her life, in terms
of physical development, emotional and social development, and the ability to express
themselves and acquire knowledge.
Activity: Click on the links and view the videos. Make notes of the key learning points.
Education Scotland
Pre-Birth to Three: Positive Outcomes for Scotland’s Children and Families.
Harvard University - Center on the developing child
1. Experiences Build Brain Architecture
2. Serve and Return Interaction Shapes Brain Circuitry
3. Toxic Stress Derails Healthy Development
Three Core Concepts in Early Development
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Risk and Adversity
A risk factor is usually defined as a factor that increases the likelihood of a future negative
outcome.
"Health risk factors are attributes, characteristics or exposures that increase the likelihood of
a person developing a disease or health disorder. Behavioural risk factors are those that
individuals have the most ability to modify. Biomedical risk factors are bodily states that are
often influenced by behavioural risk factors" (Australian Government, 2016).
"Major adversity, such as extreme poverty, abuse, or neglect can weaken developing brain
architecture and permanently set the body’s stress response system on high alert. Science
also shows that providing stable, responsive, nurturing relationships in the earliest years of life
can prevent or even reverse the damaging effects of early life stress, with lifelong benefits for
learning, behavior, and health" (Center on the Developing Child, 2007).
While our understanding of risk and protective factors is not complete, research shows that it
is the presence of a number of risk factors, 'cumulative risk', rather than the presence of a
single risk factor that affects health outcomes.
Key modifiable areas of risk in early childhood
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Child competencies, skills and behaviour (such as reading, behavioural problems,
problem-solving skills, assertiveness, resisting peer pressure)
Parenting attitudes or behaviours (such as attributions, discipline strategies, warmth
and responsiveness, provision of cognitive stimulation, family communication)
The school environment (such as class sizes, school policies, rule enforcement,
opportunity for involvement in activities, teachers’ behavioural management)
Community or neighbourhood factors (such as social networks, availability of services).
Activity: Using the resources provided, the in-text links and your own research provide
examples of how the following risks/adversities can impact on the health and development of
a child.
RISKS / ADVERSITIES
HEALTH / DEVELOPMENTAL IMPACT
Abuse and Neglect
Physical
Emotional
Sexual
Household Dysfunction
Mother treated violently
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Substance abuse
Mental illness / chronic
illness / intellectual disability
Parental separation, divorce or
incarceration
Overcrowding
Poverty - income, employment
Level of education
Other Factors
Prematurity
Developmental disorders
Chronic or congenital problems
Sensory or regulatory problems
Poor nutrition
Infection/infectious disease
Oral health issues
Unintentional accidental injury
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Protective Factors
Protective factors are those variables that act as 'buffers' against the effects of risk factors and
adversity. Research has shown that protective factors are linked to a lower incidence of child
abuse and neglect.
"Protective factors are conditions or attributes in individuals, families, communities, or the
larger society that, when present, mitigate or eliminate risk" (Child Welfare Information
Gateway).
Key Protective Factors for Parents
Protective Factor
Parental Resilience
What it looks like
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Managing stress and
functioning well when
faced with challenges,
adversity and trauma
Resilience to general life
stress:
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Hope, optimism, self
confidence
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Problem solving
skills
o
o
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Social Connections
Positive relationships that
provide emotional,
informational, instrumental
and spiritual support
Knowledge of Parenting
and Child Development
Understanding child
development and
parenting strategies that
support physical, cognitive,
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Self care and
willingness to ask for
help
Role of the nurse
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Demonstrate in multiple
ways that parents are valued
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Honour each family’s race,
language, culture, history
and approach to parenting
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Encourage parents to
manage stress effectively
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Support parents as decisionmakers and help build
decision-making and
leadership skills
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Help parents understand
how to buffer their child
during stressful time
Ability to manage
negative emotions
Resilience to parenting
stress:
o
Not allowing stress
to interfere with
nurturing
o
Positive attitude
about parenting and
child
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Multiple friendships and
supportive relationships with
others
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Help families value, build,
sustain and use social
connections
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Feeling respected and
appreciated
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Create an inclusive
environment
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Accepting help from others,
and giving help to others
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Facilitate mutual support
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Skills for establishing and
maintaining connections
Promote engagement in the
community and participation
in community activities
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Nurturing parenting behavior
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Appropriate developmental
expectations
Model developmentally
appropriate interactions with
children
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Provide information and
resources on parenting and
child development
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language, social and
emotional development
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Ability to create a
developmentally supportive
environment for child
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Positive discipline
techniques; ability to
effectively manage child
behavior
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Encourage parents to
observe, ask questions,
explore parenting issues and
try out new strategies
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Address parenting issues
from a strength-based
perspective
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Recognizing and responding
to your child’s specific needs
Concrete Support in
Times of Need
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Seeking and receiving
support when needed
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Respond immediately when
families are in crisis
Access to concrete
support and services that
address a family’s needs
and help minimize stress
caused by challenges
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Knowing what services are
available and how to access
them
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Provide information and
connections to services in
the community
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Adequate financial security;
basic needs being met
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Persistence
Help families to develop
skills and tools they need to
identify their needs and
connect to supports
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Advocating effectively for self
and child to receive
necessary help
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For the parent:
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Help parents foster their
child’s social emotional
development
Model nurturing care to
children
Include children’s social and
emotional development
activities in programming
Help children develop a
positive cultural identity and
interact in a diverse society
Respond proactively when
social or emotional
development needs extra
support
Social and Emotional
Competence of Children
o
Family and child
interactions that help
children develop the ability
to communicate clearly,
recognize and regulate
their emotions and
establish and maintain
relationships
o
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Warm and consistent
responses that foster
a strong and secure
attachment with the
child
Encouraging and
reinforcing social
skills; setting limits
For the child:
o
Age appropriate selfregulation
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Ability to form and
maintain
relationships with
others
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Positive interactions
with others
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Effective
communication
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Protective Factors to Promote Well-Being (Child Welfare Information Gateway).
1.
2.
3.
4.
Nurturing and attachment
Knowledge of parenting and of child and youth development
Parental resilience
Social connections
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5. Concrete supports for parents
6. Social and emotional competence of children
Resilience
What is resilience? Why do some children do well in the face of adversity.
Resilient children are those who achieve normal development despite their experience of past
or present adversity. For parents resilience is managing stress and functioning well when
faced with challenges, adversity and trauma.
Resilience is not just dependent on the characteristics of the individual or their developmental
level, but is also influenced by processes and interactions arising from the family and the wider
environment. Although as individuals we may be resilient to some kinds of risk experiences or
outcomes, we may not be resilient to others.
Resilience is more than just knowing about the risks to health and how they can be prevented
or minimised. In order to become resilient, an individual must have:
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the attributes and capabilities to put in place strategies to prevent or address adverse
situations;
the capacity to be able to learn from, adapt to and recover from difficult experiences;
and
in many cases the support of others, e.g. friends and family, to provide the essential
'back-up' needed to take action.
Activity: Using the resources provided, in-text links and your own research make notes on
resilience.
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Maternal Mental Health
During the perinatal period women have been shown to be at a higher risk for the onset or
recurrence of mental illnesses than at other times. It is estimated that maternal psychiatric
disorders occur during the perinatal period in at least 15 percent of pregnancies. Maternal
mental illness in this period has a detrimental effect on the emerging mother-infant relationship
and can result in delayed social and emotional development and/or significant behavioural
problems for the infant, potentially leading to a range of negative outcomes that may persist
into adulthood.
Activity: Complete these short courses and make notes of the key learning points.
1. Maternal Mental Health - The Woman's Journey
2. Understanding Maternal Mental Health
Attachment & Relationships
Babies totally dependent on others for survival. When they learn that they can depend on and
trust one person (usually, but not always, their mother) who is consistently responsive and
sensitive to their physical and emotional needs they have what is called a ‘secure attachment’.
Research indicates that securely-attached children develop more connections and have welldeveloped brains. However, no one person can provide everything a growing child needs and
children can form close attachments with several people.
These emotional bonds that children develop with their parents and other caregivers are
crucial for their personal, social and emotional development. A child with secure attachments
feels able to rely on their parents or caregivers for safety and comfort and uses these important
attachment relationships as bases from which to explore and learn about the world.
The Development of Attachment (adapted from Prior and Glaser 2006)
Phase 1: Birth to two–three months (pre-attachment)
The infant has a variety of signals and behaviours that are relational, including direct gaze,
smiling, gesturing, crying, and babbling. All of them may be directed to any adult although from
birth some discrimination is evident. For example, having heard their parents’ voices while in
the womb, babies will turn towards their parents’ voices preferentially from soon after birth.
Phase 2: Two to six months (attachment-in-the-making)
As development progresses the infant's ability to discriminate between parents/caregivers and
others increases. The infant has improving capacity for signalling and maintaining interaction
(closeness) to parents.
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Phase 3: Beginning between six–seven months and a year and continuing into the third
year (clear-cut attachment)
The infant's signals and mobility becomes more organised and is utilised when distressed or
fearful. So the infant is able to plan their behaviour. That behaviour is organised around the
attachment figure and there is a general increase in discrimination between adults; for
example, strangers become a source of alarm.
Phase 4: From the second–third year (the development of a goal corrected partnership)
Due to their cognitive development the child begins to understand their attachment figure has
their own goals. This causes the relationship to become more complex and, for the child, more
thinking is required. It is understood that the child is developing an 'internal working model' of
their relationship with their parent(s) based on the caregiving experiences over time. For
example, the child who has experienced their parent as protective and soothing when they are
anxious or distressed can take that repeated interaction and hold it in their mind so that if the
parent is not there when they fall at preschool they can allow themselves to be looked after by
another adult. The converse can be said where the child's experiences have not been positive.
Activity: Using the resources provided, in-text links and your own research make notes on
relationships and attachment in early childhood.
Parenting
Activity: Using the resources provided, in-text links and your own research briefly discuss:
Parenting styles – common theories
Cultural differences in parenting
Activity: From your own research identify examples of local and national interventions and
strategies in Scotland aimed at supporting/enabling parents in early child development.
Protective Factors
Local and National Strategies & Interventions in
Scotland
Nurturing and attachment
Knowledge of parenting and of child
development
Parental resilience
Social connections
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Concrete support for parents
Social and emotional competence of children
Developmental Stages & Milestones
Activity: Using the resources provided and your own research complete the following stages
of development.
Foetal Development
Identify critical stages in development
Trimester 1
(1-12 weeks)
Trimester 2
(13-26 weeks)
Trimester 3
(27 weeks-birth)
Neonatal / Newborn (0 to 4 weeks)
Physical
Reflexes
Gross Motor
Communication & Hearing
Socialisation & Behaviour
Emotional Needs &
Attachments
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Early Childhood (4 weeks to 5/6 Years)
Infant
(1-12 months)
Toddler
(1-3 years)
Pre-school
(3-5/6 years)
Cognitive
Physical & Gross Motor
Fine Motor & Vision
Communication & Hearing
Socialisation & Behaviour
Emotional Needs
& Attachments
Middle Childhood & Pre-adolescence (6/7 to 13 Years)
Middle Childhood
(6/7 - 10 years)
Pre-adolescence
(11 - 13 years)
Cognitive
Physical & Gross Motor
Fine Motor & Vision
Communication & Hearing
Socialisation & Behaviour
Emotional Needs
& Relationships
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Resources
Nurse as a health promoter
Kemppainen, V., Tossavainen, K. and Turunen, H. (2012) Nurses’ roles in health promotion
practice: An integrative review. Health Promotion International. [Online]
p.34.Available: http://heapro.oxfordjournals.org/content/28/4/490.full.pdf+html
McDowell, I. (2015) Concepts: Prevention [Online].
Available: http://www.med.uottawa.ca/sim/data/Prevention_e.htm[Accessed 23 Aug 2016].
Royal College of Nursing (2012) Going upstream: Nursing’s contribution to public health
prevent, promote and protect. RCN guidance for nurses [Online].
Available:https://www2.rcn.org.uk/__data/assets/pdf_file/0007/433699/004203.pdf [Accessed
29 Aug 2016].
The Open University (2016) Public health approaches to infectious disease [Online].
Available:http://www.open.edu/openlearn/science-maths-technology/science/public-healthapproaches-infectious-disease/content-section-3.1 [Accessed 23 Aug 2016].
The Scottish Government (2011) Improving maternal and infant nutrition: A framework for
action [Online]. Available:http://www.gov.scot/resource/doc/337658/0110855.pdf [Accessed
23 Aug 2016].
Child Development
Centre for Learning Innovation (2006) A basic introduction to child development
theories. New South Wales: Department of Education and Training [Download]
Deans, B. (2016) Prebirth to Preschool PowerPoint Presentation.
NHS Choices (2016) Birth-to-five development timeline [Online].
Available:http://www.nhs.uk/Tools/Pages/birthtofive.aspx [Accessed 29 Aug 2016].
NHS Scotland (2011) Developmental milestones - maternal and early years [Online].
Available: http://www.maternal-and-early-years.org.uk/developmental-milestones [Accessed
29 Aug 2016].
Nolan, A. and Raban, B. (2015) Theories into practice understanding and rethinking our work
with young children.Australia: Teaching Solutions [Download]
The Scottish Government (2015) Universal health visiting pathway in Scotland: Pre-Birth to
Pre-School [Online]. Available: http://www.gov.scot/Resource/0048/00487884.pdf [Accessed
29 Aug 2016].
ZERO to THREE (2016) Early development & well-being [Online].
Available: https://www.zerotothree.org/early-development [Accessed 23 Aug 2016].
Risk, Adversity and Resilience; Attachments and Relationships; Parenting
Calder, M. C., Mckinnon, M. and Sneddon, R. (2012) National risk framework to support the
assessment of children and young people. Edinburgh: The Scottish Government [Download]
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Daniel, B. and Wassell, S. (2007) Understanding resilience - introduction. Glasgow: The
Institute for Research and Innovation in Social Services [Online]
Hill, M., Stafford, A., Seaman, P., Ross, N. and Daniel, B. (2007) Parenting and
resilience. London: Joseph Rowntree Foundation [Download]
Howarth, J., Lees, J., Sidebotham, P., Higgins, J.and Imtiaz, A. (2008) Religion, beliefs and
parenting practices. Joseph Rowntree Foundation. [Online]
Kellet, J. and Apps, J. (2009) Assessments of parenting and parenting support need. Joseph
Rowntree Foundation. [Online]
Mitchell, F. (2011) Resilience: concept, factors and models for practice. Briefing. Stirling:
Scottish Child Care and Protection Network, University of Stirling [Download]
Newman, T. (2002.) Promoting resilience: A review of effective strategies for child care
services promoting resilience: A review of effective strategies for child care services. Exeter:
Centre for Evidence Based Social Services, University of Exeter, [Download]
O’Connor, T. G. and Scott, S. B. C. (2007) Parenting and outcomes for children. York:
Joseph Rowntree Foundation [Download]
Scott, E. (2011) Briefing on attachment. Edinburgh: NHS Scotland [Download]
Seaman, P., Turner, K., Hill, M., Stafford, A., and Walker, M. (2006) Parenting and children's
resilience in disadvantaged communities. Joseph Rowntree Foundation [Online]
Waylen, A. and Stewart-Brown, S. (2008) Diversity, complexity and change in
parenting. Joseph Rowntree Foundation [Online]
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