Tutorial 6 · Recognizing and Supporting
the Social and Emotional Health of Young Children Birth to Age Five

Eleven month old Kate came to child care six months ago and very slowly built a relationship with her caregiver at the daycare. Kate will not make eye contact with anyone else, and she insists on being held all of the time.

10 month old Adam frequently has difficulties being separated by his mother Jenna. When Jenna drops Adam off at child care, Adam screams. Jenna usually leaves the classroom very fast because of her busy schedule. Adam has frequent temper tantrums throughout the day and refuses to participate in any activities with his teachers. Adam’s teacher is anxious about the whole situation.

Nine month old Carrie was born at 29 weeks. Her caregiver reports most infants are usually calm yet responsive during the diaper changing routine, but Carrie whines, does not make eye contact, and pushes away when being touched by her caregiver.

Eleven month old Kate came to child care six months ago and very slowly built a relationship with her caregiver at the daycare. Kate will not make eye contact with anyone else, and she insists on being held all of the time.

Kate seems to have formed a close bond with one particular caregiver. Her behavior could be communicating her comfort with this caregiver and her anxiety about other adults. Kate’s desire to be held by the caregiver could be another way to communicate the sense of security that Kate associates with that caregiver. It is not uncommon for 11 month olds to experience some “stranger anxiety.” This is not a problem, but helping Kate broaden her opportunities for social interactions could be beneficial.

The mental health consultant could observe how Kate responds to different adults. The mental health consultant could encourage the preferred caregiver to slowly begin to support interactions between the caregiver, Kate, and another familiar adult.

10 month old Adam frequently has difficulties being separated by his mother Jenna. When Jenna drops Adam off at child care, Adam screams. Jenna usually leaves the classroom very fast because of her busy schedule. Adam has frequent temper tantrums throughout the day and refuses to participate in any activities with his teachers. Adam’s teacher is anxious about the whole situation.

Adam has difficulties transitioning from home to school. His screaming and temper tantrums may be communicating that he does not understand the transition, that he feels insecure, and that he does not know what to do.

First, the mental health consultant will need to talk to Adam’s mother as well to the teacher about how to support the transition into the care setting. Jenna might be able to arrive a little earlier and spend some time in the classroom. During this time, Adam, the teacher, and Jenna could develop a few transition routines with Adam. Jenna and Adam could spend a few minutes playing together before Jenna says a brief goodbye and leaves the classroom. The teacher could continue this routine by comforting Adam, telling him that it is okay to be sad when Mommy leaves, and reassuring him that Mommy will be back. Perhaps waving to mom from the window or reading a story that mom brought from home could be another part of the routine. The teacher can also learn more about what Adam likes and help him get engaged in activities he enjoys.

Nine month old Carrie was born at 29 weeks. Her caregiver reports most infants are usually calm yet responsive during the diaper changing routine, but Carrie whines, does not make eye contact, and pushes away when being touched by her caregiver.

Carrie’s behavior could be communicating a number of things. Perhaps she does not yet feel secure with the caregiver. Carrie seems to have difficulties regulating emotions.

First it will be important to rule out physical reasons that Carrie may react negatively to the diaper change routine: Is the changing table too cold? Does she have diaper rash or some other skin condition that might make diaper changing uncomfortable? Are wipes or creams (or the caregiver’s hands) cold? Are there any underlying conditions (such as abdominal pain, constipation, etc.) that touching her causes pain? Are changing materials often unprepared so Carrie spends a relatively long time lying on the changing table? Next, the mental health consultant can try to discern whether Carrie shows the same behavior every time she gets changed (i.e., by all different caregivers in all settings). Additionally, it would help to talk to Carrie’s parents to find out if there are soothing strategies she uses such as letting her play with a toy during the diaper changing routine. The caregiver can help Carrie engage in the diaper routine by: (a) letting her know a minute or two in advance that it’s time for a diaper change, (b) making sure the process of being picked up and put on the changing table is secure and comfortable (holding her and talking for a few seconds, laying her down gently, engaging together in making silly faces, gentle tickles, etc. before the change), (c) making the routine more engaging by giving her something to hold and/or placing mirrors or colorful pictures at her eye level, (d) playing simple games like Peek-a-boo during the change, and (e) talking or singing soothingly to Carrie during the routine.