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Infants and Young Children
Vol. 16, No. 2, pp. 120–142
c 2003 Lippincott Williams & Wilkins, Inc.
Emotional Expressions of
Young Infants and Children
A Practitioner’s Primer
Margaret Wolan Sullivan, PhD; Michael Lewis, PhD
Research on emotional development in infancy has benefited greatly from the use of videotape technology and coding systems that allow detailed coding of facial movements. Today we
know that a core set of human facial expressions, composed of specific movements in the brow,
eye/cheek, and mouth regions of the face, are probably innate. Theorists continue to debate the
meaning of these expressions as well as how they are organized and become regulated over the
first several years of life. Despite continuing debate and research on these issues, early facial expressions have practical, signal value for caregivers and practitioners alike. This article surveys
what is known about the appearance and early normative, developmental course of emotional
expressions, noting similarities and differences in special populations when available. Its goal is
to provide practitioners with basic information to help them and the parents they serve become
better able to recognize the expressive signals of the infants and young children in their care.
Key words: emotion, emotional development, facial expressions, infants, nonverbal communication
S
YSTEMS for deciphering the facial expressions of infants and young children were
developed in the 1980s. These systems represent important and needed tools for promoting more accurate, empirical study of
early emotional development. With them, researchers are beginning to understand when
infants first express particular emotion signals facially, the organization of these signals,
and their relation to other aspects of motivated behavior. While many important questions about the meaning and developmental
course of early expressions continue to be researched and debated, it is now recognized
that most, if not all, of the facial components
of the human expression repertoire can be observed shortly after birth (Camras, Holland,
& Patterson, 1993; Izard & Malatesta, 1987;
From the Institute for the Study of Child
Development, UMDNJ-Robert Wood Johnson Medical
School, New Brunswick, NJ.
Corresponding author: Margaret Wolan Sullivan, Institute for the Study of Child Development, UMDNJRobert Wood Johnson Medical School (e-mail: sullivan@
umdnj.edu).
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Lewis & Michalson, 1983). Despite this finding, facial coding systems have only just begun to move out of the laboratory into clinical
settings (Gilbert et al., 1999). This is unfortunate, because information about facial expressions potentially has practical import for
those working with infants, older, nonverbal
children, and their caregivers.
For practitioners, facial expressions are informative in 2 ways. First and foremost, they
are social signals to others. Crying, vocalizing, and bodily movements combine with facial expression to provide cues to an infant’s
status. Savvy caregivers no doubt make use
of all of these cues in interpreting infant behavior. Although psychologists may be reluctant to assign a specific emotion value to
infant facial expressions, parents have no
problem doing so. In fact, they routinely use
facial expressions to attribute personality and
intellectual characteristics to a young baby
(Haviland, 1983). They also use facial expressions to gauge their own responses, thus helping to regulate their infants’ arousal and teaching them display rules (Malatesta & Haviland,
1982). Parents’ reading and interpretation of
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the infant’s expressive cues in daily interaction are key to the child’s social development,
emotion regulation, and early language learning (Mundy & Willoughby, 1996; Walden &
Knieps, 1996). Consequently, whether parents observe and are having difficulty interpreting the expressive signals of their infant
should be an important screening question for
the practitioner.
Although some adults seem to have “natural” skills at reading emotional expressions,
others will need some training to recognize
the facial signals of young infants whose expressions are often fleeting, subtle, and perhaps less well organized than those of older
children. This problem can be compounded
when there is neurological impairment or
developmental delay. Expressive behaviors
of infants and children with various forms
of disability have been described as muted,
hard-to-read, or excessively labile and incongruous, depending on the population under study (Mundy, Yirmiya, & Sigman, 1990;
Kasari & Sigman, 1996; Sigman, Kasari, Kwon,
& Yirmiya, 1992). When parents are unable to recognize and interpret emotional signals from their infants, they will be uncertain about their child’s needs and less able
to share positive affect. Consequently, parents may become less expressive themselves
(Dawson, Hill, Spencer, Galpert, & Waton,
1990), further degrading the quality of interaction. Learning to recognize facial expressions
and how they evolve is a worthwhile effort
because these and other nonverbal cues of
emotion offer another channel of communication when children’s behavior or vocal utterances are absent, or unclear. This channel
signals the infant’s arousal level, something
about the quality of the infant’s positive or
negative response to concurrent stimulation,
and may help explain other aspects of motor,
postural, and behavioral responses. In short,
the ability to interpret infants’ expressive signals is extremely important to parents personally and to promoting mutually satisfying interactions.
Another way expressions can be helpful to
practitioners is that they offer clues to the
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neurological and cognitive status of the child.
Facial expressions are controlled through the
facial cranial nerves but are also intimately
linked to cognitive development (Lewis &
Michalson, 1983). Consequently, young children’s facial expressions have some clinical
significance. Although their initial appearance
is organized at the brain’s subcortical level,
changes in their form or developmental pattern over time reveals that the child’s higher
cognitive and motivational systems are becoming integrated as brain maturation proceeds. Appropriate developmental changes in
facial signals imply that certain cognitive functions are preserved in neurologically damaged children, for example. This fact has
long been recognized for smiling (McCall,
1972), but is likely to be true for other
expressions as well.
Data on individual differences in facial expressions, their developmental trajectory in
normally developing populations, and specific information about facial expressions in
atypical populations is growing. This article
surveys the expressions of which infants and
young children are capable as revealed by facial coding systems such as MAX (Maximally
Discriminative Facial Coding System), its companion, whole-face scoring system, AFFEX
(Affective Expressions Scoring System; Izard,
1982), and Baby FACS (Facial Action Coding
System; Oster, 1978) and will cover typical expressions. The article will not treat related and
important topics such as arousal, physiological reactivity, or emotion regulation. Rather,
the focus is a pragmatic one of how to recognize expressions—whether they are muted
or intense, prototypic or idiosyncratic. Likewise, we set aside the thorny theoretical question of whether the emotional experiences of
very young children are similar to or different
from those of older children and adults. Since
the discussion of expressions will make use
of the movements described in MAX, AFFEX,
and FACS, we briefly consider the nature of
these tools.
Although some of the assumptions underlying MAX and AFFEX, as opposed to the Baby
FACS coding systems, remain controversial,
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research using these systems shows that most
of the facial movements comprising adult
emotion expressions are present and map
onto positive and negative reactions to stimulation during the first months of life. MAX,
AFFEX, and Baby FACS also share many features. For example, all observe movements
of the facial musculature in the forehead,
eye/cheek, and mouth regions of the face.
They also agree, for the most part, on those
facial movements that constitute emotion
signals. The major differences between the
systems are their theoretical orientation and
comprehensiveness in scoring facial movements.
MAX and AFFEX focus on a theoretically limited set of “prototypic” expressions of adults. In contrast, Baby FACS
does not, and is comprehensive in scoring all possible movement combinations. Because MAX (Izard, 1983/1995) concentrates
on those facial movements that are maximally discriminative of 9 specific human
emotion expressions, it lends itself more
readily to applied situations. Besides the
9 facially expressed emotions (ie, Interest,
Surprise, Enjoyment, Anger, Sadness, Fear,
Disgust, Contempt, and Shame), several control or regulatory movements are also included in MAX. Blended expressions, describing combinations of specific facial movements
in the face, also are deciphered (for example,
Anger/Sad is a common expression blend in
infants). In MAX, single component expressions are thought to reflect a lower intensity
of expression than are signals occurring in all
3 facial regions (Abe & Izard, 1999). MAX, like
Baby FACS, is designed for use with videotape
or still photographs, but AFFEX can be used
as a live observational system. If you are interested in what facial expression or expressions
can be “read” as emotional signals, MAX or
AFFEX is the best application. We use it here
to present the facial expressions of infancy,
describing specific expressions, their development, and what is currently known about
them in specific disabling conditions. The expressions are described as related sets or families because of the well-established finding
that infants’ expressions to any given context
vary across individuals. Even within individuals, multiple expressions seen in rapid succession are common. Expressions are also seldom pure and may blend 2 emotion signals.
Since blended expression may persist in some
children (Yirmiya, Kasari, Sigman & Mundy,
1989), the developmental course of and
individual differences in blends are of some
interest.
THE INTEREST FAMILY
Some do not consider interest is an emotional expression, but since it is a sign of positive approach and receptivity to people and
objects, it is coded in MAX/AFFEX as a family
of expressions distinct from a neutral, awake,
but nonexpressive face. Figure 1 illustrates
3 varieties of interest occurring in young infants. Notice that in all of the photographs,
the infants appear alert and attentive. However, there are subtle differences in their expressions, signaling differing qualities of that
attention.
Figure 1a has been characterized as
the “open” or relaxed interest expression
(Sullivan & Lewis, 1989; Sullivan, Lewis,
& Alessandri, 1992). The brows are raised
slightly, eyes wide open. The mouth is relaxed and open, taking a bow-shape as shown
here. The mouth may be closed in some
variants, but the key is that there is no sign
of tension. This expression occurs in environments that offer the infant low intensity,
nonthreatening stimulation. Also described
as “curious” and “wide-eyed wonder” in the
nonscientific literature, open interest is by
far the most common expression of young
infants. Adults, on the other hand, typically
maintain a neutral/awake expression as our
modal expression. This is not the case for
infants, whose faces are rarely still and whose
expressions change rapidly (Malatesta &
Haviland, 1982). In fact, a “neutral” or sober
face is rare in awake, attentive infants much
before about 9 months of age (Lewis &
Sullivan, 1988). The common occurrence of
open interest reflects the “positivity offset”
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Fig 1. Three forms of interest: (a) open interest, (b)
knit brow interest, and (c) interest with lip roll.
of the central nervous system (Cacioppo
& Gardner, 1999). That is, humans show
a mild bias toward positive emotion and a
motivation to approach novel objects, stimuli,
or contexts. Very young infants showing the
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relaxed, open interest expression are ready to
explore—if only visually—the environment
around them.
Figure 1b shows a form of interest suggesting greater intensity. It is “excited” or
“knit-brow” interest (Camras, 1992; Sullivan
& Lewis, 1989). The major difference from
Fig 1a is the upper face region. The brows
stand out more prominently because the forehead muscles have been contracted. They
are pulled together, sometimes slightly as
shown here, sometimes more strongly, making central bulges. The eyes appear slightly
narrowed, resulting in crinkling or furrowing
of the outer eye muscles known as crow’s feet.
Infants showing this expression appear to be
intensely interested. They may vocalize while
showing this expression or momentarily become still. They have a concentrated or even
a quizzical look, as if they are actively studying what they are looking at. Knit brow interest is observed during young infants’ social interactions, marking periods of gazing
at mother or father (Malatesta & Haviland,
1982; Oster, 1978). It persists as much as
10 seconds, thereafter either resolving into a
smile or, in some cases, fussing, if the interaction has been overwhelming (Oster, 1978).
This expression has a specific developmental trajectory (Lewis, Sullivan, & Alessandri,
1990; Malatesta & Haviland, 1982). Seen frequently in young infants, it decreases between
2 and 8 months, appearing again regularly by
10–12 months (Malatesta & Haviland, 1982;
Malatesta, Culver, Tesman & Shipard, 1989;
Sullivan and Lewis, 1988). Knit-brow interest
at these ages typically occurs in situations that
challenge infants or requires problem-solving.
It has also been referred to as a wary face
in studies of response to novel objects. In
such contexts, this expression is coupled with
the inhibition of motor behavior (Bronson,
1972; Lewis & Michalson, 1983). Wariness
suggests a state of heightened vigilance or
uncertainty. Collectively, the findings suggest that knit brow interest is a form of
highly focused, effortful attention associated with active information processing. The
age change in its occurrence may mark a
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developmental shift in the type and quality
of stimulation that infants must “work” to
assimilate.
Figure 1c shows an interest expression that
includes one of MAX’s regulatory movements,
a thinning and rolling inward of one or both
lips. This expression was seen widely some
years ago as the whimsical expression of
Cabbage Patch@ baby dolls. This lip movement seems to be regulatory because it frequently suppresses smiling; however, its exact signal value in infants remains unclear. In
older infants and children however, it tends
to be combined with or precede gaze aversion. After about 12 months, coordination
of this mouth expression with head and eye
movements signals the child’s awareness of
the other’s unwanted attention in social situations. Head lowering and gaze aversion function to withdraw from or reduce undesired
social interaction, and when combined with
this lip movement may signal either embarrassment or shyness toward a social partner, depending on the context and presence
of other bodily cues (Lewis & Brooks-Gunn,
1979; Lewis, Sullivan, Stanger, & Weiss, 1989).
After the onset of self-cognition at about 18
months of age, this lip expression may occur in evaluative settings. When coupled with
body collapse, mouth components suggesting sadness, and/or withdrawal from a task,
it signals shame or evaluative embarrassment
(Lewis, Alessandri, & Sullivan, 1992; Lewis,
2000).
Infants with neurological impairment and
various disabling conditions are frequently
reported to have difficulties attending. These
difficulties are often noted during infancy or
are detected as learning disabilities as children reach school age. Differences in the form
or patterning of interest expressions may
appear as well and may offer early markers.
Attention, unfortunately, has been studied
almost exclusively as motor behavior, ie,
visual, auditory, or even cardiac orienting to
stimuli, not as facial expressions. Exceptions
are studies of emotion during joint attention
primarily in children with autism and mental
retardation. In this work, children with these
disabilities are compared to each other
and with an MA-matched group to observe
differences in MAX-coded positive, negative,
interest (all forms) versus neutral expressions
(e.g. Kasari et al, 1992; Yirmiya et al., 1992).
This work finds that autistic children display
primarily neutral and interest expressions
for somewhat longer periods than do other
groups. Increased interest in autistic children
appears at the expense of less enjoyment
expressions (Yirmiya et al., 1989). No published study has examined developmental
trajectories or examined differences in
interest expressions in any atypical population. Knowledge about the range, distribution, and pattern of these expressions may
be of some clinical use in identifying those in
need of further assessment.
SURPRISE
The Surprise expression is rarely seen in
young infants, especially in the full form
shown in Fig 2. In surprise expressions, the
brows are raised and prominently arched. The
eyes are widened so that the white of the
sclera is more evident than in relaxed interest. The mouth gapes with jaw slackened,
Fig 2. Surprise in a 5-month-old.
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assuming an “o” shape, and may be accompanied by abrupt, momentary stilling
of other ongoing behavior. The expression
in Fig 2 occurred when a 5-month-old accidentally turned on slides and taped music by tugging on a ribbon attached to her
wrist (Sullivan & Lewis, in press). Surprise
is an appropriate expression in this context
of sudden, unexpected exposure to an audiovisual event. Yet, investigators have been
stymied in their study of surprise because
it does not consistently occur in situations
that adults imagine would surprise babies.
A jack-in-the-box does not produce surprise
expressions in a majority of babies, for example. Occasionally, surprise occurs in situations where the experimenter did not anticipate observing it (Bennett, Bendersky, &
Lewis, 2002; Camras, 1992). When surprise
does occur, it appears briefly before resolving into some other expression—either interest, smiling, or a negative expression. Most
researchers accept that infants show at least
mild surprise expressions to novel events by 6
months, and some may do so sooner (Bennett
et al., 2002; Charlesworth & Kreutzer, 1973).
But, there are wide individual differences in
whether babies display this expression even
within the standard laboratory situations, suggesting that surprise may occur only in the
most emotionally reactive infants. Besides the
suddenness of the stimulus onset and its intensity, a key factor in surprise seems to be
whether the stimulus event was expected. For
instance, infants who learned that pulling a
string turned on a slide with music expressed
surprise at this contingent event only when
first learning this response. Once learning
had occurred, surprise expressions were no
longer observed, suggesting that the infants
now expected something when they pulled
(Sullivan & Lewis, 1989). Surprise expressions
in very young infants also appear to grow
more intense across the first several repeated,
sudden stimulus presentations. This is less
characteristic of surprise in adults, who if surprised by a stimulus more than once, rapidly
show an attenuated response.
Like interest expressions, information
about surprise expressions is lacking for
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various populations of infants and children
likely to be seen in clinical practice. Given its
relation to arousal modulation in response to
unexpected events and its tendency to habituate with familiarization, information about
surprise expressions in various groups is of
considerable interest in assessing children’s
emotion regulation and emerging cognitive
skills.
ENJOYMENT
Because they are so readily recognized and
such widely acknowledged milestones of social behavior, smiling and laughter, the 2
major facial expressions of enjoyment, have
been the most intensely studied expressions
in infants. Their developmental trajectory
and links to cognitive processing in infants
have been extremely well documented in
full-term and preterm infants, as well as in
infants with Down Syndrome, autism, and
blindness (Calhoun & Kuczera, 1996; Carvajal
& Iglesias, 1997; Cicchetti & Sroufe, 1978;
Kasari, Mundy, et al, 1990; Kasari, Sigman,
et al., 1992; McCall, 1972; Sroufe & Waters,
1976; Sroufe & Wunsch, 1972; Vine, 1973).
While smiling appears universally, cultural
and environmental differences also have been
described (Camras et al., 1998; Gerwirtz,
1965; Kisilevsky, et al., 1998). Some have argued that additional enjoyment forms are detectable in older infants (Fogel et al., 2000;
Scanlon-Jones et al., 1990). In fact, the developmental course of enjoyment provides a
model for comparison with the development
of other expressions, although not all expressions will follow enjoyment’s pattern.
Smiling, like interest, is present from the
opening days of life and is state-dependent
during the neonatal period. Unlike the interest expressions, which presume an awake,
alert infant, the first signals of enjoyment appear during the newborn’s sleep. Even at this
early stage, newborn smiles include the 2
most recognizable components of this expression: narrowed eyes, widened mouth, with
corners raised. These same features consistently appear in the smiles of older infants
(see Fig 3a–c), although later smiles are more
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Fig 3. Four examples of enjoyment from 2- to 9-month-olds in various contexts. (a) Response to tactile
teasing at 8 weeks, (b) response to audiovisual contingency at 4.5 months, (c) response to play in an older
infant, and (d) response to audiovisual contingency in an older infant with Down syndrome.
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intense and may include other components.
Originally thought to be related to digestion
(older literature may refer to them as “vegetative” or “gas” smiles), sleepy smiles are probably related to the discharge of pleasant stimulation of some kind by the infant’s immature
central nervous system (CNS) during rapid
eye movement sleep. The source of this stimulation need not be internal, but can be linked
to the external environment through whatever attention and perceptual processing systems are functional at birth. For example, one
of the author’s newborn daughter slept in a
room with a musical, chiming clock on her
first day at home from the hospital. Two days
later, when she was again sleeping nearby, the
clock chimes elicited smiling. This incident
in a healthy newborn shows that the CNS is
primed to recognize familiar external auditory
information and to signal this recognition to
others. Repetition alone may be enough to
promote positive emotional responses to nonthreatening stimulation through simple associative learning (Zajonc, 2001).
Between 6 and 8 weeks, smiles of enjoyment can be observed during waking to
both visual and auditory stimulation. Visual
stimuli alone elicit smiling in young infants
but must have a face-like quality. For example, a gently bobbing oval with 2 small
black circles, suggesting the eyes of a human face, are sufficient to make a 2- to 3-
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month-old smile (Ambrose, 1963; Vine, 1973).
Figure 3a shows that gentle tactile stimulation also successfully elicits enjoyment in an
8-week-old. Such demonstrations show that
expressions of enjoyment in early life are
closely tied to the physical quality of stimulation, which can be auditory, tactile, or visual,
but is usually multisensory in quality. Very
soon, however, enjoyment begins to occur to
social events.
Expressions of enjoyment to social stimulation increase dramatically by 16 weeks. Social
smiling peaks between 12–14 weeks of age
in home-reared infants in Western culture. Infants at this age clearly seem to enjoy people
and will smile readily at most adults who interact pleasantly with them. After 16 weeks,
however, many infants become more discriminating about whom they will smile for. The
familiarity and the behavioral style of the interactive partner become important factors.
In this way, an emotional signal provides an
index of the infant’s growing social-cognitive
development.
In 12- to 17- month-old infants, variants
of social smiling have been described (Fogel
et al., 2000; Scanlon-Jones et al., 1990). These
appear to signal somewhat different qualities of enjoyment within social situations but
more work is needed to determine if they
are actually different expressions or just differing intensities of enjoyment (see Table 1).
Table 1. Variants of enjoyment
Facial actions
Closed-mouth, simple smile
(ie, grin)
MAX/AFFEX
codes
0-0-52 CL
Enjoyment
“Duchenne” smile (with
cheek raise/eye crinkle)
Bared-teeth play or
open-mouth
Duplay (play + cheek
raise/eye crinkle)
0-33-52
Enjoyment
0-0-52/50∗
Enjoyment
0-33-52/50
Enjoyment
Context
Social and Toy play (Scalon-Jones, Raag,
& Collins, 1990)
Readiness to engage, peekaboo game (Fogel,
Nelson-Jones, & Hsu, 2002)
Social interactiona (Fogel et al., 2000;
Scalon-Jones et al., 1990)
Play with mother, tickle game (Fogel et al., 2002)
Social and Toy play (Scalon-Jones et al., 1990)
Social Play (Scalon-Jones et al., 1990)
Game resolution, peek-a-boo and
tickle (Fogel et al., 2000)
∗The combination of codes 52/50 can be used to designate a smile with jaw drop.
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None are treated as unique emotions in
MAX/AFFEX, but are simply coded as enjoyment. All of these expressions were more frequent during interaction with mother than
with toys. The play face, however, has special
meaning.
The laughing or play face
Wide-open mouthed, gaping enjoyment expressions occur with characteristic vocalizations known as laughter. In intense forms of
this expression, the lips may be rolled inward as the jaw gapes. Either form signals
high excitement and positive arousal. Such expressions haven been called “play face” because they appear to be the human equivalent of a primate expression of the same
quality (Blurton-Jones, 1972; Preuschoft & van
Hoof, 1997). The play face makes its appearance by 5 months of age in normally developing infants (Sroufe & Waters, 1976). It occurs at first to vigorous, auditory, and tactile
stimulation, ie, tickling as did smiling a few
weeks previously. After 7 months, visual stimulation becomes more effective in eliciting
this expression. By about 12 months, incongruity and novelty, especially if it involves the
infant’s own participation, will elicit laughter and the play face, immediately or in anticipation of game-like interaction with a social partner, such as peek-a-boo (Fogel et al.,
2000).
Enjoyment of mastery
During the second half of the first year, infants continue to smile and laugh at nonsocial
events but infrequently compared to social
situations. Smiling occurs in nonsocial contexts especially when infants learn that interesting, familiar, and therefore, nonthreatening stimulation is under their own control.
Figure 3b shows a 4-month-old expressing enjoyment of a slide and music that she has
learned to expect when she tugs a ribbon
attached to her wrist (Lewis et al., 1990;
Sullivan & Lewis, 1989). This is the beginning
of playful enjoyment of mastery of the physical environment that will continue to develop
as infants learn to play and explore. Compar-
ing this expression to one of the 9-month-old
at play with something novel (Fig 3c), one can
see that the crinkled eyes, widened mouth,
and raised, dimpled cheeks are very similar,
despite the fact that motor and cognitive skills
have grown considerably in the intervening
5 months. Thus, it seems that the form of
the enjoyment expression does not change,
only the contexts and qualities of stimulation required to elicit it. Enjoyment of mastery of an object or task becomes especially
common after 12 months and has been studied as one measure of “mastery motivation”
(Busch-Rossnagel, 1997). Once the infant is
capable of self-referential and self-evaluative
behavior, the integration of enjoyment of
mastery and postural and gestural signals
will lead to more elaborated expressions of
pride.
Because of the connection of enjoyment
with management of arousal and emerging
cognitive competencies, smiling and laughter
have been the most studied expressions of infants and children with disabilities. Much is
known, for example, about the emergence of
enjoyment in infants with Down syndrome
(DS) (DS; Cicchetti & Sroufe, 1978; Sroufe &
Wunsch, 1972). As can be seen in Fig 3d, the
characteristic expressive components of mastery enjoyment are present in this 8-monthold child. Research shows that the general
course of both smiling and the play face is
the same in infants with DS, although delayed
compared to infants without this syndrome.
For example, social smiling peaks at the
same mental age (ie, 4–5 months) and smiles
are directed appropriately to social partners
(Carvajal & Iglesias, 1997). The intensity of
enjoyment is less, however, and infants with
DS may not sustain social enjoyment in spontaneous interaction to the same degree as do
infants without the syndrome and may be less
likely to initiate smiling (Carvajal & Iglesias,
2000; Kasari & Sigman, 1996). Such differences can have important effects on social
interaction. Smiling to auditory stimulation
also may be more limited in some children
with DS, but can be increased with intervention (Calhoun & Kuczera, 1996). In fact, by
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preschool age, children with DS are usually
reported to be highly positive in their social
interactions. One study finds however that
they are uniformly high in expression enjoyment across situations whereas MA-matched
peers displayed more enjoyment only in those
situations involving joint attention and affect
sharing (Kasari, Mundy, et al., 1990; Kasari,
Sigman, et al., 1992). Thus the child with
DS seems to display enjoyment more indiscriminately, suggesting a need to focus on
emotion regulation in some contexts. Finally,
enjoyment of mastery may be affected in
some children with DS because motor limitations restrict early forms of object play,
but this also can be improved by intervention (Brinker & Lewis, 1982; Sullivan & Lewis,
1990).
In severe cerebral palsy (CP), enjoyment expressions, especially in the mouth region, may
be less well modulated or appear asymmetrical. If motor impairment is severe, the play
face may be the only form of smiling available
to these children because subcortical centers
modulating enjoyment are activated.
The course of smiling in blind children also
has been studied to understand the degree
of visual input that is necessary to produce
recognizable expressions of happiness. Visual
input does not appear to be necessary for
blind children to produce recognizable, spontaneous expressions of enjoyment. Instead, it
is their negative expressions that are more
difficult to recognize compared to those of
sighted children (Galati, Sini, Tinit, & Miceli,
2001). However, blind children may be less
skillful at management of social expressions,
contributing to the social inhibition that is frequently reported in these children (Castanho
& Otta, 1999). Lower rates and poorer quality of enjoyment expressions may prompt the
perception of inhibition in children with disabilities generally.
Enjoyment expressions in autistic children
have been studied around the issue of shared
affect between child and adult partners. Less
enjoyment is expressed by these children
when compared with MA-matched controls
in semistructured interactions. Autistic chil-
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dren also fail to share enjoyment with social
partners by coordinating their enjoyment
expressions with eye contact (Dawson
et al., 1990; Sigman et al., 1992). During toy
play, autistic children are as likely to express
enjoyment, a finding that underscores the
nonsocial nature of their expressions (Sigman
et al, 1992). Finally, autistic children
are likely to display incongruous blends
expressions that combine positive and negative facial elements (Yirmiya et al., 1989). It
is unclear if this occurs because of problems
in regulating expressions themselves, or because of ambivalent or competing emotional
arousal in these children. However, incongruous expressions provide unclear, conflicting
signals to caregivers who rely much on
context or trial and error in responding to
them.
PHYSICAL PAIN
Some argue that pain is not an emotion.
Yet, painful stimulation clearly causes a strong
negative emotional response and promotes
other negative expressions. The developmental course of pain expression has been studied in some detail because of its theoretical
interest and the very practical need for assessment and management of pain in pediatric procedures (Grunau, Oberlander, Holsti,
& Whitfield, 1998; Oberlander, 2001). Pain
expressions can be also observed in situations of distress that are not physically painful
(Oster, Hegley, & Nagel, 1992). Thus, the pain
expression and those that follow it provide
clues to emotional and regulatory responses
to all forms of aversive stimulation.
Acute pain in response to tissue damage
during standard pediatric procedures (eg, circumcision, heel lance, or inoculation) provides a naturalistic and ethical way to observe
how facially and behaviorally expressed pain
responses change with the developmental
and neurological status of the infant. Pain in
response to such procedures is signaled by
distinctive and intense facial actions including the drawing together and lowering of the
brows to create a midbrow bulge, a deepened
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Fig 4. Pain in response to DPT inoculation in 4-month-olds showing (a) cupped tongue and (b) lateral
retraction of the mouth.
nasolabial furrow, and tight squeezing of
the eye orbit muscles, resulting in a strong
squint. From the newborn period through 18
months, few changes occur in the pain expression’s appearance or components (Craig,
1992; Craig & Grunau, 1993; Izard, Hembree, Dougherty, & Spizziri, 1983; Johnston,
Stevens, Craig, & Granan, 1993; Lilley, Craig,
& Grunau,1997). Throughout this time, the facial response to acute pain reliably includes
all of the upper face movements listed. Mouth
movements are more variable but include lateral stretching of lips, especially in older infants and children. In young infants, one of
two common mouth variations can be observed. Prominent especially in newborns is
a dropped jaw with taut or ”cupped” tongue
within an angular, wide mouth (see Fig 4a;
Lilley et al., 1997). From 1 to 5 years, these
facial movements cohere to form pain expressions in pediatric patients. A greater number
of components shown is related to higher
pain ratings by clinicians (Gilbert et al., 1999).
The laterally stretched mouth also occurs
commonly at these ages (see Fig 4b). Since
few longitudinal investigations of pain have
followed infants’ pain expressions from the
newborn period, the meaning of these variations and age changes in the mouth components of pain are unknown. We do not know if
they reflect individual differences in pain sensitivity or in regulatory responses to pain.
Surprisingly, increased crying in preterms
and newborns is not a reliable marker for
pain in response to a heel lance (Grunau
& Craig, 1987). Young babies vary in their
irritability and many will cry in response
to handling prior to the actual procedure
(Grunau, Johnston, & Craig, 1990; Owens
& Todt, 1985). Very low birth weight premature infants between 26–31 weeks gestational age, show the upper face pain actions
when their heels are lanced to obtain blood.
The upper facial response is specific to the
piercing of the skin, rather than other potentially stressful aspects of handling that occur as part of the medical procedure, and is
accompanied by the maximum increase in
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heart rate. Noxious stimulation and the high
negative arousal they produce appear to simultaneously activate many different negatively toned neurological systems in the young
baby. Pain expressions are associated with a
rise in cortisol levels in newborns, also suggesting that heel lancing is a highly stressful
procedure for the young baby (Oberlander,
Gilbert, Chambers, O’Donnell, & Craig, 1999;
Owens & Todt, 1985; Ramsay & Lewis, 1994).
The pain expression and its accompanying
physiological response are related to the developmental age of the preterms, appearing
more consistent and robust in older babies
(Johnston, Stevens, Yang, & Horton, 1995).
It is unclear if this age change reflects better neurological regulation of the pain response, or the gradual recovery from illness
and trauma experienced by many of these sick
babies.
Although the expression of pain appears
relatively invariant over the first 2 years of
life, a number of important changes occur
that possibly reflect a combination of neurophysiological maturation, life experience, and
a growing ability to remember prior painful
experiences. In contrast to newborns, in
2-month-olds, the expressive components of
pain occur at low frequency during a preinoculation or baseline period. This observation
suggests that pain expressions, occurring as
nonspecific generalized distress reactions to
handling, decrease with age. However, because a significant and dramatic increase in
all pain components is observed in response
to inoculation, infants’ pain response shows
some specificity to skin trauma at every age
studied (Lilley et al., 1997). Healthy term infants between 2 and 4 months of age have
the most robust response to pain (Lewis &
Thomas, 1990; Maikler, 1991). By 4 months,
pain expressions are highly specific to inoculation, with very few pain signals occurring during the baseline period. Likewise,
4 month-olds have quicker recovery from
pain (Lilley et al., 1997; Lewis & Thomas,
1990; Ramsay & Lewis, 1994), suggesting
that CNS mechanisms inhibiting the trans-
131
mission of pain become functional at this
age. Following this important transition point,
6-month-olds show a shorter duration of pain
response and less of a rise in cortisol in response to immunizations, suggesting better
internal physiological regulation in response
to pain (Lewis & Thomas, 1990; Ramsay &
Lewis, 1994).
Although the appearance of the pain expression may change little with age, older infants have more complex responses to pain.
Typically, they display facial pain for a smaller
proportion of time prior to quieting, displaying anger and blended expressions instead (Izard et al., 1983; Izard, Hembree,
& Heubner, 1987). By 18 months, painspecific expressions comprised only 10% of
the postinoculation distress (Izard et al.,
1987). Thus, anger and other negative expressions become rapid after-reactions to the
initial pain response. This pain after-reaction
is most likely to influence the appropriate soothing strategy and might also be stable across individuals. For example, these
postpain facial signals likely reflect some
combination of differences in pain sensitivity and social experience among individuals.
For, example, Japanese infants seem to have
less pain sensitivity and qualitatively different
emotional responses to inoculation than do
American infants; pain expressions are less
intense and are not typically followed by
anger and crying, but by surprise (Lewis,
Ramsay, & Kawakami, 1993). Differences between Chinese infants and other groups are
even more pronounced for a variety of expressions (Camras et al., 1998).
Greater behavioral coordination and maturation of motor skills also lead to elaboration of responses to pain in older infants.
Infants over 12 months of age are more
likely to show goal-focused behaviors following immunizations (withdrawing, avoiding), compared to younger infants who display more unorganized distress responses
(Craig & Grunau, 1993). Between 12 and 18
months, pain responses become anticipatory.
Lilley et al (1997) reported that baseline
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pain expressions were low between 4 and
12 months, but rose again between 12 and
18 months to a level similar to that of 2-montholds! These differences in the baseline or preinoculation period suggest that the older infants anticipated the painful procedures in
store for them. If so, pediatricians may begin to encounter anticipatory emotional responses to pain, cued by the environment
and salient memories of prior procedures by
12 months, perhaps even earlier. Collectively,
these changes suggest that the pain expression is stable over the first 2 years of life and
there is a close link between facially signaled
pain and neurophysiological development.
Significant neurological impairment appears to dampen the pain response, but the
basis for dampened or atypical pain responses
is unclear (Oberlander et al., 1999). Significant neurological, motor, and/or cognitive
impairment can produce a decreased pain
response for any number of reasons, leading to underrecognition and poor management of pain in children with disabilities or
neurological impairment. The development
of expression-based pain scales for pediatric
practice is a relatively recent application directed toward addressing this problem and
discovering methods to assess pain based on
facial responses (Oberlander, 2001). Hopefully, better quantification of pain will lead to
better recognition and effective management.
DISGUST AND ITS VARIANTS
The disgust expression is another that has
been studied in some detail in newborns. The
newborn’s response to bitter and sour substances is distinct from responses to water
and sweet solutions (Granchow, Steiner, &
Daher, 1983; Rosenstein & Oster, 1988;
Steiner, 1979). Saltiness does not trigger disgust expressions, with less than half of infants showing any negative response to it
(Rosenstein & Oster, 1988). However, quinine
and other bitter tastes are potent and rapid
elicitors of disgust responses regardless of infant state. The intensity of the disgust expressions as well as the pattern of components
expressed appear to index increasing concentrations of the solutions presented (Granchow
et al., 1983; Rosenstein & Oster, 1988; Steiner,
1979). The response to a bitter taste typically
involves turning away from the source of the
stimulus and gaping of the mouth and lower
lip, as shown in Fig 5a. Sometimes, the gag
reflex is observed (Steiner, 1979). Nose wrinkling and upper lip raising are components of
the full disgust reaction, but occur alone as
observed in about half of the newborns as a
less intense form of the reaction (Rosenstein
& Oster, 1988). A flattened tongue and drooling may also be visible, depending on the state
of the child and the concentration of the fluid
(Steiner, 1979). These responses signal strong
distaste on the part of the infant. They are a
defensive reflex helping the infant to rid itself
of the unappealing taste. Similar responses are
observed to odors that most adults would find
objectionable, such as fishy and “rotten egg”
smells (Steiner, 1979).
Responses to a sour taste, such as citric
acid solution, are more variable, seem to be
milder, and evolve over several seconds in
contrast to disgust. Lip pursing is the commonly observed initial response, accompanied by nose wrinkling, narrowed eyes, and
blinking (Rosenstein & Oster, 1988; Steiner,
1979). Figure 5b shows this response in a 4month-old. A closed mouth, either with corners down or retracted lips, is a feature associated with milder aversive reactions. This
“sour grimace,” signaling dislike, occurs as the
response develops (Granchow et al., 1983;
Steiner, 1979).
The variability of sour expressions in response to sour tastes is even more pronounced in 4-month-olds than in newborns.
The most common response to a natural
sour taste (lemon juice) at this age is interest, following the initial puckering and
rapid lip movements associated with tasting
or mouthing of the flavor. In some infants,
however, negative expressions indicating dislike (sad frown or lip retraction movements)
appear, as observed in newborns (see Fig 5c).
However, a few infants actually smile, the next
most common response to this taste (Bennett,
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Fig 5. Disgust (a) and sour (b, c) responses of 4-month-old infants elicited by a lemon juice swab.
et al, 2000). This finding shows that early individual differences in taste preferences and
rapid resolution of initial mild disgust reactions into either enjoyment or dislike emerge
early in life.
The developmental course of the disgust
family of expressions has not been traced
further, but it appears that the disgust response is so well-developed in infants and
specific to both the quality of olfactory and
gustatory stimulation, that its form changes
little. Steiner (1979) undertook extensive
study of disgust and enjoyment taste reactions in various populations of infants
and children with various forms of disability, including newborns with hydrocephaly,
anencephaly, the congenitally blind, children
with craniofacial malformations, and mentally
retarded adults. Disgust and sour grimace expressions were recognizable in all populations studied, despite the considerable variation in the cognitive and motor control
(Steiner, 1979). He argued that the preservation of disgust responses across this wide
range of cognitive and motor functioning
means that disgust expressions are controlled
by the brainstem and so undergoes little morphological change. However, the emergence
of the positive or negative reactions to sour
also points to 4 months as an important
developmental milestone in organization of
expressions.
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Perhaps the most interesting aspect of disgust expressions, and the one about which
little is known, is how the subtle variations
in responsiveness observed even in newborns
are related to individual differences in nervous system functioning or other factors, such
as temperament. A second unanswered question is when these expressions begin to occur
in response to non-taste stimuli, and especially social stimulation. Like smiling, disgust expressions are elicited initially to physical rather than social-psychological elicitors.
Non-taste stimuli that might be sufficient to
produce disgust in infants have not yet been
reported, but can be imagined. Disgust signals stimulus rejection. Therefore, too rapid
or sudden occurrence of a stimulus might
elicit disgust expressions if the stimulus overwhelms infants’ ability to process it. We have
observed this on some occasions in the infant
learning lab: sometimes an infant pulls sufficiently rapidly that the slide and music appears within a second of its previous appearance and before the infant’s reaction to the
first appearance has subsided. When this occurs, the infant may display nose wrinkling, or
asymmetrical mouth and lip movements in response, suggesting a kind of recoil reaction to
the overwhelming, too rapid reoccurrence of
the stimulus. While clearly not yet an instance
of “psychological disgust,” such observations
suggest that prior to 6 months of age, components of disgust may occur in response to visual and auditory stimulation, setting the stage
for their later function in social situations.
But, the forms of disgust observed in this case
do not involve the intense, gaping reactions
observed in response to bitter tastes.
Toilet training and introduction of solid
foods when the child is able to eat independently are thought to be important contexts for parent-child socialization of disgust
(Rozen, Hadt, & McCauley, 2000). It is also
possible that disgust, signaling stimulus rejection, is more common in neurologically damaged infants and children in whom inhibitory
control is slow to develop or absent. This response would be an important clue to caregivers to reduce the intensity or pacing of
stimulation.
ANGER OR ‘‘CRY FACE” EXPRESSIONS
The prototypic anger or cry face appears
in Fig 6a. It is characterized by brows drawn
together and lowered, sometimes strongly as
seen in this view. Deep nasolabial folds frame
a wide-opened square mouth. Anger expressions of this intensity are almost always accompanied by a rolling cry in infants, but
milder versions are observed without any vocalization. This expression is the infant’s most
common negative expression.
A major quandary for theorists is that the
anger/cry face rarely occurs in young infants
without the co-occurrence of other negative
expressions or blends. Blended anger and sadness, as seen in Fig 5b, is commonly seen. In
this expression, knit, lowered brows and narrowed eyes of the upper face region are accompanied by a sad ”pout” in the lower face.
This particular blend (upper face anger with
lower face sadness) is often observed during
social interaction with the mother and it tends
to decrease with age in this setting (Izard
et al., 1995). This might not be so in all situations that recruit anger expressions, but more
information is needed. The co-occurrence of
multiple negative and blended expressions
with the anger/cry face has led some to argue
that these negative expressions collectively reflect general distress or unhappiness instead
of a specific facial signal of anger or other
negative emotions (Camras, 1992). However,
the co-occurrence of multiple negative expressions in the early months can also be
explained by the well-known quality of the
CNS to respond more intensely to negative
than to positive stimuli (Peters & Czapinski,
1990). Although the CNS idles in a mildly positive mode (positivity offset), when a threatening stimulus is encountered, a vigorous negative response is observed. This phenomenon,
known as the negativity bias, may be especially evident in young infants, in whom inhibitory control is still limited and arousal is
poorly regulated. The negativity bias could
result in an initially unmodulated negative
response that simultaneously activates several
competing systems when an aversive event
is initially perceived. It is not that there is
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135
Fig 6. Anger (a) and upper face anger blended with sad (b) expressions in 5-month-olds.
one “undifferentiated” distress state, but that
all negative emotion systems are primed. The
strongest response tendency is an energizing response to action in order to resist or
overcome the aversive stimulus. It is signaled
by increased motor activity and crying as
well as by the prototypical anger or cry face
expressions.
Although anger expressions may not appear exclusively when infants encounter certain types of negative events, by 3–4 months
of age, a number of situations seem to result in anger expressions predominantly. Restraining an infant’s arms, for example, produces a variety of facial expressions, not
all of them negative. Anger, however, is the
predominant negative expression (Bennett
et al., 2002; Braungart-Reiker & Stifter, 1996;
Stenberg, Campos, & Emde, 1983; but see
Camras et al., 1998, regarding ethnic differences). An even more powerful example is
the response of infants to loss of a contingent
event (Lewis et al, 1990; Sullivan, Lewis, &
Alessandri, 1992). Infants who learn to control a pleasant event by pulling a ribbon show
anger expressions and increase pulling when
that action abruptly fails to produce the event.
Anger expressions increase, but other negative expressions do not. The increase is therefore specific to infants’ having learned a relation between action and outcome (Lewis
et al., 1990; Sullivan & Lewis, in press). Situations that produce anger expressions before
6 months of age are those in which access to desired objects or goals is blocked
or thwarted in some way (Bennett et al.,
2002; Lewis et al., 1990; Stenberg et al., 1983;
Sullivan et al, 1992) or, those causing pain after about 4 months (Izard et al., 1983). There
is stability in individuals’ expressions of anger
in these contexts as well (Izard et al., 1995;
Sullivan et al, 1992).
Crying and fussing are widely recognized
vocal signals of negative emotion in infants,
but no any one quality of crying appears
to be specific to the “cry face” or to any
other negative expression. Negative facial
expressions can precede negative vocal behavior, suggesting that greater or increasing arousal is needed for vocal crying. Cries
can be differentiated by frequency and tonal
quality but it is difficult for observers to
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discriminate these features reliably and experience is an important factor when differentiating vocal crying in the mild to moderate
range (Papousek, 1989). Facial expressions
probably provide more graded information
about the onset, quality, and intensity of negative reactivity, making such discriminations
possible.
The form, development, and regulation of
anger expressions and their relation to vocal crying in atypical development has not
been addressed in any significant detail. Like
smiling, negative vocalizations undergo an important developmental transition in the first
4 months (Hopkins, 2001). Presumably this
change parallels changes in the patterning
of anger and other negative expressions, although this has not been studied. Much available work has focused on the clinical utility
of vocal cry behavior and unexplained infant
irritability (Barr, Hopkins, & Green, 2000). Because adults rely on vocal and facial information before correctly identifying that infants
are indeed upset (Greene & Gustafson, 2001),
the lack of information about the coordination
of expression and voice in the development of
typical and atypical children is frustrating. Dis-
abling conditions significantly affect adult perceptions of young children. For example, infants and children with DS are reportedly less
irritable than the norm and those with CP and
auditory and visual handicaps even more so
(Field, 1996). Autistic children are also sometimes found to be more negative (Yirmiya
et al., 1989). Greater attention to the quality of
expressive behavior of children with disabilities might provide more clinically useful information and suggest possible interventions.
Given their physical limitations, it is reasonable to expect greater frustration on the part
of these children. Whether it is expressed as
anger, other negative expressions, or undifferentiated distress is not known
SAD OR ‘‘POUT FACE” EXPRESSIONS
Figure 7a shows the sad frown or “pout
face” expression. The brows are raised and angular in appearance over narrowed eyes. The
nasolabial folds appear prominent, as they
do in all negative expressions. The mouth
corners are down-turned in a “horseshoe”
shape (Oster, 1978). The chin is raised, sometimes prominently as in Fig 7b. The latter
Fig 7. Sad expressions without (a) and with (b) lower lip protrusion in infants under 6 months of age.
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movement, especially when combined with
forward projection of the lower lip, as in
Fig 7b, gives it the pouting quality. In both
examples of this expression, the mouth is
closed, although open-mouthed sad pouts are
also possible. Sad pouts are equally likely to
appear as an upper face signal or as a full expression in young infants (Izard et al., 1995;
Sullivan & Lewis, in press). When blended
with another expression, sad brows are especially likely to combine with anger or, less often, with interest in the lower face. In either
case, such blends are interpreted as a signal of
dislike or unhappiness.
Sad pouts have never been observed to
be specific to any stimulus or context. For
this reason, little is known about them. They
are not a dominant negative expression in
any context that has been studied, except for
pouts associated with the after-sour response
(Bennett et al., 2002). Sad pouts occur at relatively low but stable levels during both social
interaction and learning/frustration episodes
(Izard et al., 1995; Sullivan et al., 1992).
Some have suggested that this expression
occurs as an infant or young child either
arouses to an anger expression or as a regulatory movement inhibiting anger (Camras,
1992; Oster, 1978). It is possible that sad
expressions are never completely independent of anger expressions even in adults
(Barr-Zisowitz, 2000). Caregiver intervention
in response to sad expressions may forestall
or more effectively help dampen more intense negative response, but this has not been
demonstrated.
FEAR EXPRESSIONS
Fear expressions are notoriously difficult
to observe in infants. In adults and children,
this expression involves raised and straightened brows, widened eyes with tense lower
eyelids, and horizontally retracted lips. Less
intense versions feature brow movements
alone, possibly blended with interest or other
facial movements in the lower face, such as
anger or sadness. Situations that could conceivably frighten infants (eg, a visual cliff, the
137
approach of a stranger, highly novel masks,
and startling mechanical toys) do not elicit
fear expressions (Bennett et al., 2002; Camras,
1992; Izard et al., 1995; Lewis & Michalson,
1983). Therefore, some suggest that infants
may not be able to display fear until sometime after 7–12 months because greater experience and cognitive abilities are needed for
appraisal of strange and dangerous environmental events (Izard & Malatesta, 1987). Both
independent locomotion and ability to inhibit
behavior may also be prerequisites of fear. For
example, wariness of strangers, a mild form of
fear, is not observed in a majority of children
until after 7 months of age (Bronson, 1972).
By 11 months, the brow components of fear
do occur to a variety of aversive stimuli, but
are not specific to fear-inducing toys, such as
a growling mechanical gorilla (Camras et al.,
1998). Fear systems in the brain do have a
high degree of plasticity (LeDoux & Phelps,
2000), supporting the view that learning and
experience are very important to this emotion. The question remains how little experience is needed for fear expressions to occur.
Figure 8a shows the response of a 6-monthold infant to the return of a nurse for the
second of 2 inoculations administered at this
well-child visit. This observation suggests that
a single salient experience may be sufficient. By 2 years of age, fear can be rapidly
learned, resulting in phobic reactions that
may spread readily to previously nonfeared
objects through learning (Watson & Rayner,
1920).
Even in young infants, fear blends are observed on occasion in situations that are aversive. For example, fear blends occurred in
8% of infants in response to arm restraint
(Camras, Oster, Campos, Miyake, & Bradshaw,
1997). This raises the possibility that most
stimulus situations studied thus far are not
adequate to elicit fear expressions and that
blends are observed because milder stimulation results in less intense reactions. As with
disgust, very specific and intense stimulation
may be necessary to elicit fear expressions.
Looming objects, very loud sounds, and the
loss of support are good candidates. However,
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Fig 8. A fear expression in response to approach of a nurse following inoculation (a) and a fear blend in
response to the sudden appearance of a stimulus (b).
some of these are impossible to study experimentally because of ethical considerations.
Alternatively, aversive situations may produce
fear only in the most temperamentally fearful
children. In our studies of infant conditioning, fear blends appear as negatively toned surprise expressions (see Fig 7b). These surprisefear blends appear early in the conditioning
session, before infants realize that their own
movements cause the sudden onset of slides
and music. While most infants are surprised
and interested in these first appearances of
slides and music, others show surprise reactions that grow more extreme across several
presentations, ultimately developing a negative quality including fear components (brow
straightening, tensed lower eyelid, and/or lateral movement of the mouth corners). In most
cases, fear-surprise responses subside quickly
as infants learn the relation between their
own movements and the slide’s appearance
(Lewis, Sullivan, & Michalson, 1984; Sullivan
& Lewis, 1989). But, some infants begin to
fuss and are unable to complete the procedure. These infants are reported by mothers
to have more fearful temperaments (Sullivan,
Ramsay, & Lewis, 1992). It seems reasonable
to infer that infants with fearful temperaments
may be expressing fear.
Because so few negative situations elicit
fear and the percentage of children for whom
fear expressions have been observed is so
low (Bennett et al., 2002), the developmental course of fear expressions has not been
studied extensively. The dependence of fear
on cognitive skills and appraisal of danger
in the environment may mean that most
infants must learn to fear. Hence, fear expressions will vary greatly across individuals. Some infants may express excessive
amounts of fear, either because neurological damage has interfered with the normal
buffering of the fear expression, or because
prolonged experience with invasive medical
procedures have resulted in conditioning of
fearfulness.
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SUMMARY
Despite differing approaches to measurement, considerable evidence shows that
context-appropriate emotion expressions occur in infants and young children from birth
or shortly thereafter. No matter what system is used, interest, enjoyment, anger, pain,
and disgust have been shown to signal behavioral dispositions congruent with these
emotions in young infants. This is also true
for fear and sad expressions in older infants.
Pain, enjoyment, interest, and possibly anger
and disgust show little change over the first
2 years. Instead, the contexts that elicit
these emotions shift at several major transitions in cognitive development and cerebral
maturation, ie, 4 months, 7–9 months, and
18–24 months. At these developmental ages,
expressions can be particularly informative
about the developmental status of children.
At all ages, individual differences in expressive behavior can provide clues to children’s
preferences and style of response. Although
a number of interesting and important questions remain about expressive development,
139
it seems clear that facial expressions provide
important information to caregivers and practitioners alike. Expressions, especially when
combined with vocal and postural behaviors,
provide important clues to the motivational
state of infants who cannot otherwise report what they feel. Ability to read the facial
behavior of children with disabilities gives
parents an important tool for promoting positive emotion, better management of their children’s negative behavior, and preventing frustration or helpless withdrawal of the parents.
It is also clear that social environments have
substantial influence on the emotional behaviors of children with disabilities as well
(Field, 1996), suggesting that well-designed
interventions may help parents who have difficulty in understanding their children’s expression become better attuned to subtle, incongruous, or ambiguous signals. Awareness
of these expressions and their developmental trajectories by the practitioner can assist in assigning meaning to infant behavior,
skills that parents are especially concerned
about in day to day commerce with their
children.
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