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Pride
in Parenting: Training Curriculum for Lay Home Visitors
Linda
T. Diamond, M.S. and Marion H. Jarrett, Ed.D., editors.
Unit 16
Child Growth and Development: One to Four Months
In this unit, participants will review developmental milestones of 1-4 months, learn how to help parents understand stages of development and interpret infant behavior, share activities that both parents and their babies will enjoy, recognize possible problems in infant growth and development and identify available resources for babies and parenting families.
| Objectives |
By the end of this unit, participants will be able to:
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| Time | 23 hours |
| Outline | A. Developmental
Milestones |
| Materials |
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| Advance Preparation |
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A. Introduction (1-3/4 hours)
| Rationale: | It is important for the PSSs to have a clear understanding of what successful parenting is about in order to support and encourage this. As a beginning to the next step of growth and development, some factors related to positive parenting will be discussed. |
| Procedure: | 1. Review the following descriptors involved in successful parenting:
Ask the participants for examples from their own experiences that may have led to these feelings/situations. 2. Discuss how, as PSSs, they can facilitate this positive parenting. Have the participants share thoughts on how each of the above situations can be encouraged. Possible responses:
To introduce another strategy in positive parenting, have the group discuss:
Discuss how they can encourage families to do this. Ask what they do or did as children. Possible responses:
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B. Developmental Milestones (7 hours)
| Rationale: | Give the Parenting Support Specialists a framework into which to fit the detailed information which is to follow by introducing the 1 to 4 month old baby based on information in Caring for Your Baby and Young Child, pp. 165-187. Be sure to include these points:
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1. Appearance
| Rationale: | Mothers will continue to notice changes in their baby's physical appearance during these early months. Parenting Support Specialists can help mothers know what to expect. |
| Procedure: | Mini-lecture. Babies should continue to grow at the same rate established during the first few weeks of life. On the average, they:
Review growth charts and graph the growth of 2 different babies Head: The soft spot on the baby's head should be soft and flat at two months. By four months, the soft spot at the back should be closed. The head may look big and out of proportion because it is growing faster than the rest of his body. Do not worry about this. It is normal. His body will catch up over time. Body: At two months, he will look round and chubby. He will begin to loose some of his fat as he moves his arms and legs and begins to develop muscles. His arms and legs begin to "loosen up" and seem to stretch out. This will make him look taller and thinner. |
2. Skill Areas
| Rationale: | Understanding normal growth and development will help PSS’s interpret the baby’s behavior to parents. |
| Procedure: | a. Mini-lecture and demonstration. Show a typical 1-4 month old baby using the video, "Your Baby and You: Understanding Your Baby's Behavior". Review the developmental milestones presented in Caring for Your Baby and Child, pp. 167-179. Give each participant a copy of the Developmental Milestones, Handout #1. Write the categories on a flip chart and tape this paper to the wall in the front of the room. b. Live demonstration. Invite two or three mothers to play with their babies before the group. After a few minutes, ask the trainees what skills they observe. Process their responses by writing them on the flip chart. Next ask trainees to tell which developmental area ( movement, vision, hearing and making sounds, and emotional and social development) each skill represents. Write the name of the area after each skill. Participants may discover that some observed skills can represent more than one area. Stress the inter-relatedness of skills at the 1 to 4 month age. c. Activity: Elicitation of skills. Write the following developmental milestones/skills on index cards:
Have trainees draw one card. Ask them to demonstrate that skill with one of the babies. Facilitate the demonstration by giving suggestions as necessary. Have appropriate materials available.
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3. Developmental Alerts
| Rationale: | Since PSS’s will be seeing mothers and babies weekly, their knowledge of developmental alerts can help them identify potential problems that may result in needed intervention. |
| Procedure: | a. Discussion. Remind participants that each baby is an individual and will develop at his own rate. However, there may be times when the Parent Support Specialist is concerned about a baby during this time of 1 to 4 months. Ask participants to tell you what they would consider warning signs for medical or developmental problems during this period. Process their answers by writing them on the flip chart. b. Activity. Give each participant a copy of the Developmental Alerts Handout from Resource Mothers Unit 12, Handout #2, and the Developmental Health Watch, Handout #3, from p. 180 of Caring for Your Baby and Child. Ask them to incorporate the Alerts from Resource Mothers into the longer Developmental Health Watch List, then match any warning signs that were listed by the trainees to the ones included on the charts. Discuss each alert thoroughly, making sure everyone understands. Answer any questions they have about what is normal or typical development and when they should be concerned. Give each participant "Safety Check" and "Immunization Alert" (Handout #4). Review each point carefully. |
C. Site Visit (7 hours)
| Rationale: | Observing infants and caregivers at this stage will make the information more meaningful to PSSs. |
| Procedure: | 1. Trainees will visit an infant care or early intervention site to observe infants one to four months of age to complete a structured observation following the format for Pride in Parenting Training Site Visit Protocol, Handout #7. 2. After the site visit, in the whole group, discuss what PSSs observed. Ask each trainee to discuss the ways babies played and interacted with their parents/caregivers. What milestones did they observe? How did parents/caregivers facilitate development? |
D. Providing Guidance and Support (7 hours)
| Rationale: | In this part of the training, participants will examine ways to interact with parents around child development issues. As pointed out in the PSS's training, it is important for Parent Support Specialists to learn how to support and encourage without undermining the self-esteem of the parents. |
| Procedure: | 1. Group Discussion. Remind the group of the exercises they practiced in Unit 2 on using praise and encouragement. Parenting is a difficult and sometimes unrewarding job. It is an area where PSS's need to give lots of praise and encouragement. Everyone needs to feel they are valued and cared for, and that is particularly true of new parents. PSS's can help to build their clients' self-esteem by acknowledging and commending them for positive attempts at parenting, like keeping their infants clean, talking and playing with them, etc. Remind the trainees that encouragement of any positive and nurturing behavior will serve to empower their clients. 2. Ask participants to name some benefits of providing positive rather than negative feedback when talking with parents. Possible responses might be:
3. Distribute Handout #5, Helping Parents to be Parents. Go around the room and have the PSS's take turns reading paragraphs. After each section is read, discuss it. For example, in the first section, make sure everyone understands what is meant by an "indirect comment." What additional examples can trainees give? Continue in this fashion, asking your own questions at the end of each section to make sure all the messages are understood. Then ask trainees to think up additional statements that exemplify each of the guidelines. Distribute Handout #6, Working with Parents. Ask participants if they agree with each statement, what is their role in each instance. 4. Evaluation of teaching materials. Distribute any books, curriculum guides, kits and other materials available to Parenting Support Specialists to use with mothers and babies. Ask participants to review the materials focusing specifically on activities for infants one to four months. Allow participants fifteen minutes to review the materials. ASK: Were the materials easy to understand? Which ones did you like best and why? (Overhead #1). 5. Mini-discussion. Sometimes parents have a hard time knowing how to play with their babies. This is especially true for young parents and parents who are isolated from family and friends. It is also difficult for parents to think of playing with a baby who is so young (1 to 4 months). Ask who knows ways to play and have fun with a young baby. Let participants share their ideas with one another. Make several suggestions and show where these techniques are presented in the curricular materials previously reviewed. 6. Activity: Role Play Scenarios. Ask each participant to select a partner or assign partners. One will play the Parenting Support Specialist and the other the mother. Then they will change: Take slips of folded paper with child development role play scenarios which have been written prior to training (Handout #8). Place them in a container and ask each "mother" to pick one child development scenario. Give each team 15 minutes to jot down responses to the question asked at the end of the scenario. They may use the books and materials just reviewed. Ask them to incorporate suggestions from Handout #5, Helping Parents to be Parents. Then let them take turns practicing things the Parenting Support Specialists can say and do. Bring everyone back together and ask each team to play out its scenario with the mother introducing the scenario to the Parenting Support Specialist. The PSS should talk to and demonstrate to the mother as she would on a home visit. Following each scenario, process the activity by asking first the participants doing the role play, then the rest of the participants the questions in Overhead #1. Write the questions, but not the answers, on the flip chart to help structure the discussion. After all pairs have had an opportunity to role play the scenarios, take a break, then repeat the entire role play scenarios activity with the partners switching roles. (Note: make written notes about each trainee's performance as part of the Trainee Evaluation.)
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E. Summary and Review (15 minutes)
| Procedure: |
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Unit
16 Handout #1
Developmental Milestones
One to Four Months
- Holds self up on forearms when on stomach
- Stretches legs out and kicks when on stomach or back
- Takes some weight on legs when held in standing position
- Holds head steady
- Swipes at objects with hands
- Watches faces intently
- Looks at hand and object when grasping
- Follows moving objects
- Looks from one object to another
- Recognizes mother and other familiar adults
- Smiles in response to familiar voices
- Anticipates sounds associated with feeding
- Cries differently to express hunger, irritation, pain
- Expresses pleasure by cooing, squealing, gurgling
- Calls for attention
- Takes turns vocalizing with a familiar adult
- Smiles in response to familiar voices
- Enjoys playing with people; may cry when play stops
- Imitates some movements and facial expressions
Unit 16 Handout #2
Developmental
Alerts
This is a checklist that the PSS can use when observing a client's child on her 3 month visit. Remember that all children are different, so it's not essential that each baby is able to do everything on this list at a given month. But if the PSS observes children who cannot do many of the things suitable for their age, she should encourage her clients to talk to their health care providers about their babies' development.
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3 Months:
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Unit 16 Handout #3
Developmental
Health Watch
One to Four Months
Although each baby develops in his own individual way and at his own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.
- Still has Moro reflex after four months
- Doesn't seem to respond to loud sounds
- Doesn't notice his hands by two months
- Doesn't smile at the sound of your voice by two months
- Doesn't follow moving objects with his eyes by two to three months
- Doesn't grasp and hold objects by three months
- Doesn't smile at people by three months
- Cannot support his head well at three months
- Doesn't reach for and grasp toys by three to four months
- Doesn't bring objects to his mouth by four months
- Doesn't push down with his legs when his feet are placed on a firm surface by four months
- Has trouble moving one or both eyes in all directions
- Crosses his eyes most of the time. (Occasional crossing of the eyes is normal in these first months.)
- Doesn't pay attention to new faces, or seems very frightened by new faces or surroundings
- Still has the tonic neck reflex at four to five months
Unit 16 Handout #4
Safety
Check
One to Four Months
Falls
- Never place the baby in an infant seat on a table, chair, or any other surface above floor level.
- Never leave your baby unattended on a bed, couch, table, or chair.
Burns
- Never hold your baby while smoking, drinking a hot liquid, or cooking by a hot stove or oven.
- Never allow anyone to smoke around your baby.
- Before placing your baby in the bath, always test the water temperature with the inside of your wrist or forearm.
- Never heat your baby's milk (or, later on, food), in a microwave oven.
Choking
- Routinely check all toys for sharp edges or small parts that could be pulled or broken off.
- If you use a crib gym or other suspended toys for the crib, make sure they are fastened securely and tightly so the baby cannot pull them down or entangle himself in them.
Immunization Alert
- At two months, and again at four months, your baby should receive:
- DTP vaccine
- Oral polio vaccine
- HBCV (previously called Hib). (This may cause a slight fever and some soreness where it's injected. The vaccine helps prevents meningitis, pneumonia, and joint infection caused by Haemophilus influenza bacteria.
Unit 16 Handout #5
Helping Parents to Be Parents
The following guidelines illustrate some ways that PSS's can help their clients become more successful parents.
1. Give the idea of being a mother or father positive meaning and identity.
Help parents feel like parents -- admire them. Give them credit for what they do, have fun together with the infant, and reassure them that their infant is doing well.
Indirect comments are useful. Don't just admire the baby. As you say something positive about the baby, credit the parents. For example:
- "Mommy dressed you so warmly today. She knows exactly what you need in this cold weather."
- "You are so big; Mommy knows exactly how to feed you to make you grow."
- "You are so nice and clean; Daddy knows exactly how to give you a bath."
- Other examples?
2. Make the mother and father feel special.
Support and encourage the attachment between parent and child. For example:
- As the baby smiles at the parent you might say, "Mommy gets the best smiles from you! I know how much she loves you!"
- When the baby looks at your new or strange face say, "You sure know your Mommy best of all. I can see you staring at me. You don't know me at all!"
- When the baby fusses you can say, "Mommy knows how to comfort you best of all," as you guide and support her response to calm the infant.
- Other examples?
3. Focus on the infant or parent's experience and not on right or wrong.
Communicate to your clients the fact that babies have feelings by "talking through the baby." This means that the PSS talks as though she were the infant. For example:
- "Hold me tight. I like to be wrapped up tightly too."
- "Don't turn me so fast. It's scary and I'm afraid I'll fall."
- "Lunch was delicious. I really love your milk, Mommy."
- Other examples?
4. Focus on issues relevant to the baby's specific stage of development.
To help parents learn to read the baby's cues and signals you might say:
- "You want to tell Daddy something, don't you?"
- "Look how he turns around to look for you just after he crawled away. He's making sure you're still there."
- "You need your Mommy's help, don't you?"
- Other examples?
5. Focus on how the present behavior of a client's baby will impact on the future.
- If you see the baby with a book you can say, "When you grow up you're going to be so smart because Mommy is already getting you ready!" By saying this, you can encourage the reading of books to the baby.
- If the baby pounds on a toy, "Mommy is so good with tools and you are following in her foot steps."
- Other examples?
6. Build the parents' self-esteem by selecting and admiring success.
- Every time a child is doing well, point it out and paint a picture of the child as a successful learner and the mother (or father) as a successful parent.
- "You really got him to listen when you got his attention first, before asking him to do something."
- "You really taught her how to put away her toys when she's done playing."
- Other examples?
In Summary:
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Unit 16 Handout #6
Working with Parents
- Parents usually want the best for their children. The parent and the family are the constants in the child’s life, whereas the service providers and systems fluctuate (National Center For Family-Centered Care, 1990).
- Most parents want to be better parents (Curran, 1989).
- The professional’s ability to listen and hear the parent is equally or more important than teaching, telling, or advising.
- It is important to elicit the parent’s views about their child and their experience with the child. "Tell me what life is like for you and the baby." (Trout, 1987).
- We often need to restrain our impulse to criticize and correct the parents’ handling of their baby (Arnold, 1978).
- Parents find criticism painful and are apt to react negatively to it (Curran, 1989).
- Most parents know their own children better than anyone else does (Curran, 1989).
- Parents want support more than information (Curran, 1989).
- "It is important . . . to be aware of the goals and priorities that parents have established for their own infant, " (Bronwich, 1984). Offer help in response to family-identified needs (Dunst et al., 1988).
- "Parents should participate as much as possible in the planning of activities for their infant," (Bromwich, 1984).
- "Recognition of parents’ strengths . . . are paramount in intervention that purports to help parents feel and be more competent," (Bromwich, 1984).
- The individual style of each parent-infant dyad should be recognized and respected so that intervention can support as well as be in harmony with the style (Bromwich, 1984).
- "Parents should become aware of their own actions and behaviors that are particularly beneficial to the infant," (Bromwich, 1984).
- "Parents should not feel a sense of failure as a result of a staff suggestion that may not work in a particular family," (Bromwich, 1984).
- "We may need to recognize that the best hope of fulfillment of our educational or medical goals may lie in attending to the psychology of the family first—in our willingness to get up off the floor (where we are more comfortable with the child) and onto a chair (where we must look right into the eyes of the parent), where we ask, "How has it been for you? Teach me about your life with this child?" ("Trout, 1987).
Unit 16 Handout #7
Child Development Scenarios
How can the PSS help in the following situations?
- . Sara has a 2 month old baby. She complains that while feeding the baby she looks away from Sara. She seems very upset when she tells you this.
- Susan is the mother of a 6 week old baby. In the past 2 weeks he has been crying for 2-3 hours at the end of each day. She has tried to feed him, rock him and sing to him but nothing seems to help.
- Adeena is worried that 3 month old David doesn’t keep his head up when she sits him up. She makes him sit a lot to practice.
- Talia hasn’t put any toys or pictures around Michael’s crib or room. She reads a magazine while she feeds him.
- Deanne has had her baby Donnie sleeping in bed with her. Now that he is 3 months old she thought he was ready to sleep in his crib. Now he cries until she brings him in bed with her and then he goes to sleep. She wonders what she should do.
- Toya finds that 3 month old Lakeisha will play with a rattle for a few minutes but then starts to fuss to be picked up. Toya is trying to get some housework done. Toya is frustrated and doesn’t know what to do.
- Angela would like to give the baby a chance to play on his tummy on the floor. She gets out an old crib quilt to lay on the floor for a mat. Her mother says that the floor is too drafty and that the baby will catch a cold. Angela asks you how to handle this.
- 3 year old Darnell is fascinated by his baby brother Juwan. When Darnell talks to Juwan, he puts his face right up close to his brother’s. The baby starts to cry. This makes their mother angry. What might you suggest?
Unit 16 Handout #8
PIP Training
Site Visit
Observation
Name of Setting:
Age of Child Observing:
Number of Children:
Number of Adults:
a. Children’s
play and interaction:
b. Daily
caretaking:
c. Safety:
a. Children’s
play and interaction:
b. Daily
caretaking:
c. Safety:
a. Motor:
b. Cognitive:
c. Emotional:
d. Social:
e. Communication:
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What the Child Prefers |
How Do You Know |
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For Toys or People? |
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For Specific Toys?
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Unit 16 Overhead #1
Evaluation of Teaching Materials
- Were the materials easy to understand?
- Which ones did you like best and why?
Unit 16 Overhead #2
Role Play Feedback
- What do you think you the Parenting Support Specialist did well?
- What could the Parenting Support Specialist have changed or done differently?
- What other things do you think the Parenting Support Specialist might say or do to help a mother in this situation?
Unit 16 Post-Unit Test
Child
Growth and Development
One Month to Four
Months
- List 5 major developmental milestones during the 1-4 month period.
- How can parents and caregivers help infants develop optimally at this stage?
- What changes occur in the baby at this stage that require changes in parenting?
- Describe 3 specific ways a parent can help her baby’s development during this period.
- How can a PSS work with parents to encourage their growing attachment to their baby?
- List 3 developmental observations about which a PSS should be concerned.
Unit 16 Handout for use at end of each Unit
Post-Unit
Evaluation
Unit Covered: _____
Date: _____
- Do you feel we covered all the information in this unit that we said we were going to?
- What did you like best about the unit?
- What did you like least about the unit?
- Was the information in this unit presented clearly? If not, please explain.
- In which skill areas do you feel you need more practice or help?
- How can we make this unit better?
- Any additional comments?
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View Description for this Item
University of Illinois at Urbana-Champaign