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8 – Milestones in Child Development

Milestones in Child Development

Eulalia Juan Pastor

summarizes how the development of a child aged between 0 – 3 years is proceeding in general, which differences in time and scale of development are “normal” and how observation of behaviour can help to assess the progress of the child.


During this phase, the child will undergo major changes and progress in all development areas: mental, motor, social-affective and language. Each child has his/her own growth and development pace. This is written in general terms. Both the family and education environments will determine the child’s development. It is fundamental to know each phase—a child’s possibilities and needs—in order to establish goals and activities during the early attention education programming from zero to three years old.
This phase is essential for the child’s ulterior development as a person in society, with values, rules and attitudes to be respected and in which one must live.

Objectives of the Module
The objectives of this module are:
To give an overview of child development (from zero to three years old) and different aspects of it: cognition, motor development, affection and communication.
To know and interpret tools to evaluate development during the period studied.
To apply this knowledge while interacting with children and be able to detect and apply elements that encourage development in specific situations.

The program offers two types of reading material, one compulsory, one optional. The first one aims at providing the student with basic curricular content, as included in the program (this module). The second one aims at studying compulsory content in depth, be it as supporting material or critique (basic reading, articles, links, etc. as suggested in the references) or promoting reading original texts by most relevant authors.

Bibliographic references and links to documents or websites will be used. References will be written in footnotes or at the end of each subject.

Basic links

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Chapter1 – Concept of development

This is an introduction to the remaining content in the program. Knowledge and contributions by main authors working on this discipline will be reviewed. These changes happen to people in life and can be explained through coupled factors: continuity versus discontinuity, inheritance versus environment, rules versus ideography. Understanding the context in which individuals develop is helpful to understand their evolution better. It is therefore necessary to highlight the historic, socio-economic, cultural and even ethnic context, just to cite the most important ones. Finally, it must be highlighted that development must be understood as a continuous, global, very flexible process.

After reading and understanding the chapter, the student will be able to:
understand the concept of “development”
know which factors and contexts can influence in development.
know the theoretical models that explain development.

People change with age in many ways and aspects. This chain of changes is known as development. At this point, it is advisable to explain several concepts that are similar but nonetheless different:
Growth: It refers to quantitative changes related to the increase in body mass.
Maturing: It refers to morphological and behavior changes that are biologically determined.
Learning: It refers to changes in a person’s behavior produced as a result of practice and acquisition of a technique.
Development: It would be the highest concept, the one covering the previous ones. It refers to quantitative and qualitative behavior changes that integrate psychical and biological structures with skills an individual learns overtime.
Critical or sensitive periods occur during a person’s development. These are moments where there is a special predisposition to learning certain things. Early attention is very important during childhood to palliate and remedy possible recoverable deficiencies. This is possible thanks to the child’s nervous system plasticity.

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Factors that explain change

Three main factors explain psychological change.
They are related in the following way:
A) Inheritance versus environment
B) Continuity versus discontinuity
C) Rules versus ideography
There is not a definite agreement on the level of implication these factors have in development, nor which factor plays a bigger role on a subject’s development. However, it is true that each of them somehow influences human development.

A) Inheritance versus environment
Since antiquity, there is controversy over what is the reason for change: inheritance or environment. To a certain point, this is a futile debate, since both play a role in change.
Innatists defended biology as a fundamental factor for change in individuals. Information found in the genetic code passes down from parents to children, and therefore inheritance plays a fundamental role. Inherited information exists since birth for them. This information “starts up” as the “maturation calendar” progresses, and this is the only reason for subjects to change.
On the contrary, environmentalists thought just the opposite. The reason for change—and therefore development—is the environment’s influence. The child evolves because of his/her relationship with the vital context in which he/she develops. Influences such as family, school, culture, friend, etc and each person’s vital circumstances modify radically their own development.
B) Continuity versus discontinuity
Another factor largely discussed through history is continuity vs. discontinuity.
Champions of continuous development consider development harmonic and stable. Therefore, change is quantitative. This model is mainly defended by environmentalists.
Change for those working from discontinuous perspectives is understood as something sudden, sometimes unpredictable. Changes take place in “leaps.” Changes are qualitative and often are significant. Proponents of this model usually are innatist authors.
C) Rules versus ideography
Authors proposing change as a rule consider change universal. It happens within all children in the world, regardless of culture or environment. These changes are usually related to biologic development aspects, and therefore are inherited. Proponents of ideography believe that each “subject is a world” of own experiences determined by his/her environment. In this case, change is individual and encouraged by context, although there can also be internal influences from the individual.

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Context of development

The context in which the subject develops influences his/her own development. This is why different types of context may have an impact—and this is actually the case—on the way humans evolve. There are several kinds of contexts, but only four are the most significant ones: historic, cultural, socio-economic and ethnic contexts.


BERGER, K.S. (2004) Chapter 2. Theories of Development. p. 35-56 from BERGER, K.S. (2004) Psicología del desarrollo: infancia y adolescencia. Madrid: Médica-Panamericana

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Chapter 2 – Motor development


During first and second childhood most physical and psychomotor skills that we will have for life are developed. During these years, the body undergoes the biggest evolution of life. We owe the term “motor development” to Wernicke. By consensus, it is framed within the two first years of life.
Each of us has a different genetic charge. Inheritance is very important. However, the environment in which we grow and are educated is also different.

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Know the basics of infant development and warning signs in motor development.
Know the physical and motor characteristics of a child between zero and three years.

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Birth and first months

After childbirth, the infant needs to adapt to a new situation. This must be done fast.
The child has gained independence from the mother, and all functions—respiratory, circulatory, digestive and temperature regulation—are performed independently from the mother.

In 1953, Virginia Apgar created a test to measure the child’s degree of adaptation to the new situation. Ever since, this test is used everywhere around the world when an infant is born. This test is performed a minute after the child is born and repeated five minutes afterwards.

Apgar test.
How does the test work?
It scores newborn’s vitality. It is rated 1 and 5 minutes after birth, and sometimes, 10 minutes afterwards.
Five parameters are examined:
heart rate (determining heart beat frequency)
breathing (difficulty when breathing)
muscular tone (strength of movement)
reflexes (inducing the sneezing reflex)
color (rosy, bluish or pale).
The maximum score is 10. When the score at one of the times is very low, some kind of medical intervention may be indicated.

APGAR test criteria

0 points
1 point
2 points
Skin color
all blue
blue limbs
Heart rate
Reflexes and irritability
no response to stimulus
Mock / weak crying when stimulated
Sneezing / coughing / kicking when stimulated
Muscular tone
Some flexion
active movement
Weak or irregular

When a child is born, he/she interacts with the environment mainly through unconditioned reflexes, which are:

Reflexes of a newborn
The following reflexes are normal in a newborn:
Moro reflex. This reflex occurs when the infant’s head moves quickly or falls back, or when a strong noise scares the infant. The infant reacts by stretching out arms, legs and neck. Then he/she quickly joins his/her arms together. He/she may cry when doing so. This reflex must disappear after two months.
Sucking reflex. It is the reflex of looking for his/her mother’s breast. When you touch the infant’s cheek gently with your finger, the infant will turn his/her head towards the finger. This reflex lasts three to four months.
Grasping reflex. The infant will grasp anything in the palm of his/her hand and will close the fist. This reflex lasts five to six months.
Walking reflex. When you hold the infant underneath the arms and on a hard surface, he/she will take little steps. This reflex normally lasts a couple of months.
During the first year of age, under regular development and natural stimulation conditions, essential movements will appear every three months during the breastfeeding phase. Only when a notorious delay in the apparition of movements is observed must specialists be consulted to pay specialized attention through directed stimulation programs.
The emergence of essential movements on each stage of the child’s life depends largely on the Maturation of the Nervous System, and the myelinization process. It also depends on the influence of life and education.
Apgar, Virginia (1953). “A proposal for a new method of evaluation of the newborn infant”. Curr. Res. Anesth. Analg. 32 (4): 260–26

Calendar of acquisition of some of the main postures
Control of the head
Holding the head straight in line with trunk
3-4 months
Eye-hand coordination
Coordination between eye and hand to precisely grab objects
3-4 months
Sitting position
With support
Without support
4-5 months
6-7 months
Moving on hands and knees
At around 8 months
Standing up
With support
Without support
9-10 months
12 months
With support
Without support
11-12 months
12-14 months

Figure 1. Calendar of acquisition of main postures. ©Josep A. Pérez CastellóUIB.

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Motor development up to three years of age

When a child is born, he/she measures some 50 cm. and weights 3.5 kg. The regular, continuous development (development curve) starts now.
The first four weeks are the neonatal period, the transition from intrauterine life to an independent living.
The infant’s features at birth are distinctive: big head, big sleepy eyes, small nose, sunken chin (breastfeed) and fatty cheeks.
The newborn’s head is ¼ of the body’s length. Skull bones will not close completely until 18 months of age.
Physical growth is faster during the first three years of life than during the rest of life.
The first tooth appears between five and nine months of age. At one year of age, the infant has between six and eight teeth, and at two and a half years, he/she has 20 teeth.
The ability to move freely and accurately is progressive. The acquisition of motor skills progresses following a specific order.
The ability to walk and accurately grasp with hands are the two most distinctive motor abilities for humans. Neither of them is present at birth.
Development laws:
Cephalo-Caudal Law: Body parts closer to the head, from top to bottom (arms before legs), are controlled first.
Proximo-Distal Law: Body parts closer to the body axis are controlled first (arm, wrist, hand.)
Progression of posture control (according to these laws.)
3 months: control of the head
3 months: rolling over him/herself.
3 ½ months: grasping big objects.
4 months: hand-eye coordination. No arm shacking or slaps.
6 months: sitting without support.
7 months: accurate grasping and groping.
8 months: crawling and dragging.
10 months: standing up and moving with support.
12−14 months: start to walk without support.

Discovering stairs. First, helped, then, gradually by his/her own. 14 months: builds a two-cube tower.
Pushing an infant-walker to walk.
Playing ball with hands and feet.
Doodling and matching pieces, throwing and collecting.
Tireless to play once and again.
Starting to eat by him/herself.
At two, he/she grabs a cup by the handle and drinks on his/her own.

Pedaling a tricycle.
Going up the stairs with one foot at a time, and then going down.
Dressing and undressing (simple clothes, no buttons or zippers.)
Eating by his/her own without (barely) getting dirty.
Drawing, doodling, drawing lines and circles.
Controlling the sphincter (first during the day, then during the night.)

Psychomotor development of the child and its evaluation in primary
Care A. Iceta1, M.E. Yoldi2. ANALES Sis San Navarra 2002, Vol. 25, Suplemento 2
1 month of age
– Persistent irritability.
– Sucking disorder.
– Unable to fix his/her eyes shortly.
– No reaction to noises.
2 months of age
– Irritability persists.
– Exaggerated startling at noises.
– Adduction to thumb.
– Lack of social smile.
3 months of age
– Moving his/her hands asymmetrically.
– Unable to follow with his/her eyes.
– Unable to hold his/her head.
4 months of age
– Excessively passive attitude.
– Closed fists.
– Adductor hypertonia (angle under 90º.)
6 months of age
– Hypertonia in limbs and hypotonia in neck and trunk.
– Unable to roll over him/herself.
– Moro reflex persists.
– Unable to sit down with support.
– Lack of voluntary grasping and groping.
9 months of age
– Lack of autonomous moving.
– Hypotonia in trunk.
– Unable to stay sit.
– Lack of grasping and groping to handle things
\12 months of age
– Unable to stand up.
– Abnormal reflexes.
15 months of age
– Unable to walk on his/her own.
– Lack of upper grasping and groping.
– He/She does not throw objects.
– Constantly changing from one activity to the other.
18 months of age
– Unable to go up the stairs.
– He/She does not doodle spontaneously.
– Unable to drink from a cup.
– Unable to build a two-cube tower.
24 months of age
– He/She does not run.
– Unable to build three to six-cube towers
– Unable to participate in symbolic games.
Warning signs at any age
– Abnormal mobility, tone or posture.
– Involuntary movements (dystonic positioning of hands, hyperextension of head…)
– Abnormal eye movement.
– Delay in acquiring maturation items.
Note. Those items referring to language development have been deleted from the list of signs of alarm. They have been included in chapter 4 of the present Module 8.

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Playing is much more than simply having fun. Playing is an essential part of an infant’s and child’s life. Playing is a child’s “daily work”: It helps him to learn and grow. Parents are the child’s first and prime educators.

The importance of playing:
Learning about his/her world.
Learning to do things.
Solving problems.
Learning about feelings.
Gaining confidence.
Becoming stronger.
Socializing (sharing and taking turns to do things.)

Game and age
Play is all about learning – A guide to play for parents of children zero-2 ½ years

0-9 months
Talking and singing to the infant. It helps him/her to learn how to talk and understand words.
The child learns by touching and feeling objects. You should give him/her safe toys and objects: stuffed animals, rattles, spoons. When an infant produces noise with a rattle, he/she is learning that he/she can cause an effect.
Let the infant play on his/her stomach for a while every day. This is how he/she will learn to hold his/her head. It will make him/her stronger, and he/she will be able to look around. Look for a safe place on the floor and put him on a blanket or carpet. Stay with the infant; do not let him/her fall asleep on his/her stomach.

9-18 months
Tell tales or read simple tale books. Alternatively, create a notebook with clippings. Point to pictures. Say what is happening in the pictures.
Doodle. Let the infant doodle on paper with non-toxic wax crayons.
Songs and rhymes.
Water toys: floating toys, filling and emptying containers.
Piling up cubes.
Fill a box with different (safe) objects and fabric bits. Make sure to include different shapes and colors. Let the infant explore the content of the box. Say the names of the objects aloud.

18 months to two ½ years
Dressing up.
Painting with his/her fingers.
Cardboard boxes to build up towers or little houses to play.
Word games.
Balls to throw, bounce and kick.

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APGAR, Virginia (1953). “A proposal for a new method of evaluation of the newborn infant”. Curr. Res. Anesth. Analg. 32 (4): 260–267
BERGER, K.S. (2004) Chapter 2. Theories of Development. p. 35-56 from BERGER, K.S. (2004) Psicología del desarrollo: infancia y adolescencia. Madrid: Médica-Panamericana.
STASSEN BERGER, K i THOMPSON, R.A. (1997) Chapter 12. “School Years: Biosocial Development.” From STASSEN BERGER, K i THOMPSON, R.A.: Psicología del Desarrollo: Infancia y Adolescencia. Madrid: Editorial Médica – Panamericana

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Chapter 3 – Cognitive development

A few days after being born, the infant already is an active explorer of his/her environment. He/She will start making sense out of it very soon. How does a child explore and organize such environment throughout childhood? We will try to answer this question in this chapter.

Know the basics of cognitive development in a child from zero to three years.
Know what cognitive processes a child uses to discover his/her environment.

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How does a newborn understand the world into which he/she is born? Through information. In order to do so, two processes are needed: sensation and perception.

Differences between Sensation and Perception
There is a big difference between sensation and perception. According to Stassen and Thompson, sensation is produced when a sensor (sense) detects a specific stimulus. Whereas perception takes place when the brain tries to integrate these stimuli in such a way that the individual becomes aware of them.
Let us see the development of each sense individually from the first days:

A) Sight is the least developed sense in an infant. However, the infant can see significantly better than we thought some years ago.

Babies can focus at an approximate distance of 20 to 70 cm.
Their sight at a distance is bad and blurry.
It can be said that babies are programmed to see at a distance where mother-child exchanges take place.
After a year, an infant can focus on the same distances an adult can. Two reasons explain this improvement: The eye structures that enable a correct focus (lens and ciliary body) have improved, and the brain structures in charge of sight have matured.
Babies have no sense of depth during the first months. Binocular sight is not developed until the third month. This skill matures when the infant starts crawling.
By 8-12 weeks they should start following with their eyes people or moving objects. At first, infants have to move their whole head to move their eyes, but by 2-4 months they should start moving their eyes independently with much less head movement.
Colors are present since birth. At four or five months, they can tell apart most of the usual colors.
Babies prefer stimuli with a contrast rather than plain stimuli. They prefer to look at shiny, moving, noisy objects. It must be highlighted that the infant is not only looking for complexity. He/She also enjoys observing all those things that can stimulate him/her in ways different from the usual ones. It is important to add that you also prefer to look at new things.
Babies have a favorite: the human face. Babies can spend many minutes looking at their mother’s face while they are playing with her.
B) Hearing The quality of hearing is better than seeing. It can be said that babies’ hearing is similar to that of adults, although it improves during development.
Babies show special interest in human voice. From the first weeks, they can recognize voices from their family, and tell them apart from other people’s voices. They can even tell whether those people are using their parents’ language or a different one.

Development of hearing
(M.P.Downs. Hearing in children. Salvat.BCN.1981)
a) Phases of development in the location of sound
1. Left to Right Eye movement 12 weeks

2. Left to Right Head movement 16 weeks

Up to the 36th week, the infant keeps improving at locating the source of sound. After the initial eye movement comes the cervical tonic reflex by which movement of the head is developed. Head movement, as a response to sound stimuli, is performed at a straight angle from the ear or slightly downwards. Head movement will follow the sound stimulus if produced at shoulder’s height.
In general, it can be said that 60% of children locate sound first on the right side, then on the left side.
In all cases and phases, sound is located first downwards and then upwards.

b) Hearing stages

0 to 14 days
1. Infant startles at a sudden, loud noise.
2. Infant blinks at a sudden, loud noise.
3. Infant stops shouting when mother starts talking to him.
4. Infant moves when asleep if he/she hears noise nearby.
5. Infant stops sucking noises when he/she hears sound or mother speaks to him.
1 month
1. Infant changes his/her behavior because of a loud noise.
2. Infant calms down when mother comforts him/her.
3. First differences in the use of voice.
2 mo.
1. Infant listens to a little bell’s tone.
2. Infant looks for the source of familiar sound with his/her eyes.
4-6 mo.
1. Infant locates a lateral, downwards source of sound (5m.)
2. Infant listens to a tuning fork’s tone.
3. Infant stops crying when he/she listens to music.
7 to 9 mo.
1. Infant reacts to name.
2. Infant consciously locates sound laterally and upwards.
3. Infant observes adults talking.
4. Infant carefully listens to a clock’s tic-tac nearby (9 meters.)
3 semester. At 10 m.
1. Infant stops shouting when mother starts talking to him.
2. Infant seems aware of his/her mother’s voice.
3. Infant sleeps regardless of noise.
4. Infant wakes up when you touch his/her bed.
10 mo. to one year
1. Infant understands “No” prohibitions (10 m.)
2. Infant listens to a soft song at one meter and looks for it.
3. Vocal reaction when he/she listens to music.
4. Infant reacts to name with low voice.
2.5 mo. to 6 mo.
1. Infant looks towards the speaker.
2. Infant is happy when there is music.
3. Infant stops moving when he/she hears something interesting.
4. Infant knows his/her name and smiles when called.
5. Infant makes searching movements as long as there is sound.
6. Infant hears the rattle when lying on his/her stomach.
18 mo to 36 mo
1. Infant distinguishes between normal and angry speech.
2. Infant understands the meaning of “here,” “look,” “listen.”
3. Infant points at people and related actions (3 to 5.)
4. Infant understands “on top, underneath, inside, outside.”

C) The other senses
Feeling, tasting and smelling have not been studied as in-depth as seeing and hearing. Feeling is extremely developed in babies. But taste is not perfect in an infant, although it is known to work roughly. Smelling is slightly better than tasting, especially when the infant is used to a smell. Taste and smell improve during the first months and will continue to do so during the first year of life.

Warning signs for hearing loss
(Adapted from S. Burdo.Varese CI Center)
From birth to three months of age:
No reaction to loud noises.
Loud noises and voices do not wake him/her up.
No reaction to his/her own voice.
His/Her own voice does not sooth him/her.
No smiling when you talk to him/her.

From three to six months of age:
No turning of his/her head or looking towards the source of sound.
Noisy toys do not attract him/her.
No emission of guttural sounds to call for attention.
A loud voice does not startle him/her.

From six to 12 months of age:
No response to his/her own name or to people’s voices.
No babbling, not even when alone.
No playing with vocalizations or imitating the adult’s vocalizations.
Unable to locate daily sounds or familiar words.
No understanding of a negation or farewell unless an indicative gesture is used.

From 12 to 18 months of age:
Unable to follow simple instructions.
No frequent use of words he/she knows.
Vocabulary under 10 to 15 words.
He/She does not say “Dad” or “Mom.”
No pointing to familiar objects and people when mentioned.
No naming of familiar objects.

From 18 to 24 months of age:
No understanding of simple questions and is unable to answer “yes” or “no.”
No understanding of simple sentences.
No pointing to images when asked.
No paying attention to tales.
No understanding of simple orders when no gestures are used.
Unable to identify his/her name.
Unable to make two-word sentences.
Unable to identify the parts of the body.

From 24 to 36 months of age:
He/She understands “not now” and “enough.”
He/She chooses objects by their size “big,” “small.”
He/She understands many verbs meaning action.
His/her words are unintelligible.
He/She does not repeat sentences.
He/She does not answer to simple questions.

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Chapter 4 – Communication and language development

Language acquisition and development are important milestones in human development. The most important milestones in language development for a child up to three years old will be identified in this chapter. We have an interest in studying in depth what encourages this development the most: the relationship between hearing and language and family-infant interactions.

Know the basics of language development in a child between zero and three years old.
Know the warning signs in communicative development

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Preverbal language evolution

Acquiring and developing verbal language requires the child to have contact and relationships with people around him/her. The child will learn language prerequisites through these contacts. Through history, several authors have written about these prerequisites, such as Schaeffer (1989), who talks about the way this relationship between children and close people develops through the first years of life.
For Schaeffer, the mother’s role is essential. Schaeffer divides the appearance of prelinguistic language in different phases.

a) From birth.
During this period, the goal of mother-child encounters is to regulate biological aspects essential for the infant’s survival. During the first weeks, this translates in regulating eating, sleeping and activity processes.
It is thanks to the social interaction between mother and child that the infant can regulate and stabilize these biological aspects. The mother somehow imposes some habits on to the infant: when to eat, when to sleep and so on. Although it is also true that the mother must in turn adapt to the infant’s pace and states and learn to interpret them. Therefore, it is a phase of mutual adaptation.
The first months are quite complicated for parents: they have to adapt their lifestyle entirely to the pace the infant needs. Contact during these routines is extremely important for both parents and caretakers, since they are the infant’s first socialization steps: you talk to the infant when you feed him, bathe him, rock him and so on. There are many opportunities to communicate present.
Many authors have researched innate perception mechanisms that enable the infant to be especially endowed for interaction with adults. Therefore, the mother looks to maintain such contacts with her children. It can be said that the same way an infant is predetermined to network with adults, mothers are especially endowed to network with their children.

b) From two to five months
According to several authors, at around two months of age babies discover social mates. During the following months, they show special interest to interact with other people, namely parents, siblings or other people. In this way, infant-adult “face-to-face” relationships are established. Truly, these are the first relationships. The adult is the main character in these interactions. The adult is in charge of keeping the infant’s attention and inducing exchange.

Exchanges take place on many occasions during the day, from feeding to bathing and playing. The infant’s role is passive during the first exchanges, since he/she depends completely on the adult’s actions. The infant just looks, smiles, and vocalizes occasionally. Therefore, this kind of interaction takes place thanks to the adult’s contribution.
First interactions follow clear rules, the adult’s speech bears specific characteristics that some authors call infant-talk: slowness, intonation and many repetitions, in such a way that the infant can follow verbal and gestural evolutions by the adult.
The direction of communication is not only verbal; it comprises tactile contacts as well. When the child does not respond, adults must readjust the dialogue so that the child intervenes. At the end of this period, face-to-face interactions are more symmetrical. The child participates much more and takes the communication initiative. Children become more independent, that is, they become an active participant. However, at five months, they still depend on adults.

c) From five to eight months
At around five months, children become interested in the world of objects. They enjoy exploring the world, and they do it through handling and looking.
Adults see how the child becomes interested in objects. During these months, the best way of interacting with the child is by helping him to interact with the world of objects. During this period, mother and child start sharing things from the real world: playing ball, playing with a stuffed animal, or big, soft objects, such as colored cubes. In this way, the physical world of objects shortly becomes an agent of social exchange. During this time, the child is still unable to focus adults’ attention on an object. The child is normally interested in objects, but the adult must turn solitary exploration into social exploration.
In such cases, adults mostly use the following resources: pointing, looking, and handling objects and referential language. At the beginning of this period, the adult handles objects directly to establish contact with the child. Then, he uses referential gestures (pointing) to refer to objects. After that, the adult labels such objects verbally. The adult uses these resources as he/she observes the child’s ability at communication and social interaction. Besides, adults frequently use several of these resources at the same time, since redundancy is very effective for children
this age. This is how first interpersonal relationships are created. According to Vigotski, these are the first inter-psychological relationships, whereby an adult and a child share real physical contexts through social exchange. The adult is not just a model for the child to imitate. He is not a passive actor observing and reinforcing the child either. He is an active agent through the process. He adapts to and helps the child when needed.

d) From eight to eighteen months
An essential change in child’s behavior takes place between eight and eighteen months of age. Child-adult interactions are more symmetrical. What Schaeffer (1989) calls “the concept of dialogue” appears now. The child is now able to combine what he/she has learnt during the two previous phases. This means the child can talk to an adult about things of the world. He/She can do so more independently and initiating conversation him/herself. This is the reason why it is said that dialogue has appeared.
First dialogues start along with the first signs of symbolic ability, at around eighteen months. For dialogue to be established, two things are needed. First, the child must understand that dialogue is a two-people activity, where speakers can exchange their roles (speaker versus recipient.) So the child knows he/she is required to participate actively, same as the other person. In short, the child has to understand that it is a reciprocal activity. Second, the child must understand that communicating means having the intention to communicate. The child knows now that when he/she is communicating he/she is doing so for a reason.
Obviously, such a recent skill is limited by the child’s poor language at that age. It will not be until the next phase, with the appearance of the symbolic function, that the child can have real conversations.

e) From eighteen months to three years
To this point, all communication exchange on the child’s side can be considered preverbal, since the child did not have yet sufficient linguistic ability to use verbal language. At eighteen months, symbolic function appears. This new acquisition enables the child to use verbal language.
The ability to use language puts the child squarely in the so-called “conversational period.” This period is a step further towards symmetry. The child is still a long way from reaching full communication capacity. In fact, it could be said that communication skills defining good quality communication do not appear until approximately seven years of age. However, the base of communication skills is set at this point.
Interactions with other people become much less physical and more symbolic. This new verbal communication system does not plainly substitute non-verbal communication. Rather, they co-exist. In fact, adults continue to present non-verbal communication behaviors as well as verbal ones. The appearance of language, however, modifies the child’s thinking.

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Language up to three years of age

The first mother-child interactions mentioned above enable the apparition and evolution of the so-called preverbal language. As Stassen Berger and Thompson (1997) propose, children are equipped to learn language since birth. This is so due to an innate aptitude and their experience with the world of language and the others. The infant is exposed to language even during the last months of pregnancy. Shortly after birth, children can recognize their parent’s language and distinguish their language from a foreign one. This means the child has the skill to process some aspects of language at a very early stage. This also means that the child needs contact with others to start such skills. The speed at which a child learns to talk shows the efficacy of these skills.
Language evolution through the first years is impressive. Changes happen gradually through several phases. Obviously, the child learns to understand a language before learning how to talk. And he/she does so perfectly during the first year.
A short summary of the main milestones achieved by a child during the first two years is presented below.

a) From birth to two months of age
Since birth, children are predisposed to perceive speech. Thanks to this, they are able to differentiate sounds making words—except for those children presenting congenital hearing losses. Children can tell apart syllables, intonation and so on. The ability to perceive speech at such an early age allows language to develop fast.
Children can understand most phonemes in their language from a very early age. In spite of not comprehending the meaning behind sounds, children start producing them very soon. During the first two years, children just cry, shout, moan and sometimes laugh. However, these sounds are not characteristic of speech. They are only physiological productions. Still, they are the first sounds a child produces.

b) From two to six months
From three to six months of age, new sounds appear. Old sounds must be strengthened and broadened: new shouts, murmuring, vocal sounds, etc. These sounds normally are true vocalizations mainly made up of vocals. These new sounds are the step previous to what is known as “babbling.” During this period there seem to be no differences between productions from a normal hearing infant and an infant with a hearing loss.

c) From six to ten months
From six to ten months, the infant starts babbling. Babbling are vocal and consonant sounds repeated in syllables (ma-ma-ma, pa- pa- pa, da- da- da.) The first babbles are called “reduplicated babbling,” since the child just repeats the same syllable. This is an essential phase: as babbling progresses, parents are motivated by their first interactions with their infant. They imitate his/her productions and give them a meaning. In short, a certain “dialogue” is produced.
It seems children from all over the world share the same babbling. This means that—at its initial stage—babbling is universal, that is, children babble the same in any language. However, sounds produced are gradually limited to those of their own language. This phenomenon is obviously linked to hearing functionality. A child needs hearing feedback to correctly discriminate speech sounds. Hence, the great importance of neonatal hearing triage programs. They allow us to detect hearing loss during the first days of life, provide a diagnosis within the first three months and establish a treatment before the infant is 6 months old. Because of this, severe consequences induced by hearing loss in the process of acquiring and developing language are avoided. First gestures start appearing at this point as well. The first gesture is pointing. It appears at around seven or eight months of age. However, it is used involuntarily. Actually, what the child wants is to grab an object, but he/she does not reach, so he/she stretches out his/her arms. Adults interpret the child is pointing out to something, but not yet. Therefore, this gesture has no meaning for the infant in the beginning, although it does have a meaning for the adult observing the child.

d) From ten to twelve months
At around one year old, the child starts understanding most of what adults say to him/her. He/She understands simple and short sentences. At the same time, children start producing sounds in simple intonations. They usually go along with simple gestures with some meaning.
Reduplicated babbling undergoes some changes. Afterwards, the child can put different syllables together (pa-da-ba, pa-ta-ba, etc.) The new babbling is known as “canonical babbling.” At this point children can use meaningful gestures. In fact, the child does it intentionally so that the adult will give him/her an object he/she cannot reach. What used to be an attempt at grasping an object now becomes a true gesture. He/She uses some social gestures like “hello” and “goodbye,” puts his/her face forward when asked for a kiss, and so on.

e) From twelve to eighteen months
Once the child is one year old, he/she can say one or two words, although he/she does not pronounce them perfectly. From now on, his/her vocabulary increases gradually every month until it reaches 50 words. However, the child understands much more than he/she can produce. Most of these words are people’s names or objects that are very familiar to him/her. There are also some verbs. Although the child can pronounce some words, “canonical babbling” still continues.

f) From eighteen to twenty-one months
Once the 50-word threshold is reached, a remarkable explosion in language learning takes place, specially from a vocabulary point of view. From now on, a child can learn 100 words a month. At six years of age, he/she may master 8,000 to 10,000 words (bear in mind that this calculation is approximate.) Heibeck and Markman (1987) have named “fast mapping stage” the process by which children learn vocabulary so fast. Children learn nouns easier than verbs, and verbs easier than adjectives, conjunctions, adverbs or other particles. This phase is also known as “holosentence,” since children often use one word as a sentence. This phase may be delayed in children with hearing losses. They may need more time to acquire “basic vocabulary” to create the first ones with two words.

g) From twenty months to three years
From 21 months to three years of age children leave the “holophrase” or word-sentence stage and start using two-word sentences. For example, “give bread,” “Mom, water,” and so on. This kind of sentences is very simple, and almost always made up of very familiar words for the child. During this phase, vocabulary continues to expand.

Benchmarks for Deaf or Hard of Hearing Children with Early Amplification
by Betsy Moog Brooks, M.S. Coordinator of the Family School Program
at the Moog Center for Deaf Education. Adapted to the HICEN Project

Children who have received a cochlear implant under 2 years of age have been able to develop speech and language skills sufficient to be successfully mainstreamed by the age of 7. The benchmarks listed below are a guide to that achievement. Children who are implanted at one year old may be expected to reach the same benchmarks, except at 4-6 months post-activation (18 months old), they may produce fewer words. Hearing aid users are expected to perform equally as well.

Almost Immediately after Activation
* Demonstrates detection of sounds across all frequencies
* Demonstrates detection of the Ling 6 sounds: ee (feet), -o- (hot), oo (shoe), s, sh, m
* Demonstrates detection of a variety of environmental sounds

0-4 Months Post Activation
* This seems to be a “listening” time. Since the children are very young, it is difficult to assess what they are truly understanding.

4-6 Months Post Activation
* Identifies known words, in closed sets in lessons. These words include nouns, verbs
* Can name most of the items or actions they understand
* Uses some single words to express their wants and needs

1 Year Post Activation
* Identifies 75 to 100 words, consisting of nouns, verbs, some early developing adjectives and early developing prepositions, when pictures or objects representing those words.
* Develops understanding of some early developing two-word combinations (noun-noun, noun-verb, verb-noun)
* Produces some early developing two-word combinations
* Produces some early developing two-word combinations in a lesson setting
* Uses single words and some common phrases and expressions.

15 Months to 18 Months Post Activation:
* A language explosion seems to occur
* Learns vocabulary outside of the classroom or therapy environment
* Uses a variety of two-word combinations spontaneously

2 Years Post Activation
* Uses so many words that you do not count them
* Comprehends of a variety of simple sentences and questions
* Uses of simple sentences of 4-6 words when speaking spontaneously

Factors which may affect the child’s potential to reach such high goals:
* Normal intelligence
* Be a consistent wearer of her implant
* No concerns in relation to speech or oral motor skills
* Appropriate amplification, specifically well-fitted hearing aids and/or an appropriate MAP if a cochlear implant user


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M.P.Downs. Hearing in children. Salvat.BCN.1981
OWENS, J. (2003) Language Development. Madrid: Prentice Hall. Chap. 2. “Models of Language Development.

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Chapter 5 – Development of emotional aspects and personality

A person’s socio-affective life starts much sooner than we thought some years ago. During the first month of life, an infant can express emotions. He/she can be aware of others even during the last trimester of pregnancy. Relationships with parents are especially significant in this sense.

1. Knowing how a child’s socio-affective interaction develops through the first years of life.
2. Knowing the role personality plays in the evolution of socio-affective aspects.

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Development of emotions

Attachment is a very special relationship between infants and close persons. Creating it is one of the main development points during the first two years.
The relationship between the infant and the others is very important at this point. The relationship with him/herself is also very important. The infant must discover him/herself. He/She does so through others. However, some sort of self-discovering also plays an important role. Self-discovery is very relevant between two and six years of age. A child that age has other types of relationships with others as well. His/Her relationships increase, especially once schooling starts. Family relationships change dramatically now. The role of parents is essential at this point.

Social and affective implications due to lack of communication because of hearing loss must also be taken into account. Isolation and difficulties a deaf child faces in his/her linguistic and cognitive development may have a negative influence in the process of social integration and relationships as well as on the person’s affective development. A deaf person’s social interaction will be affected by this. This includes school, since it is part of the teaching-learning process that takes place thanks to the joint action of several people.
Still, consequences depend mostly on the ability to communicate with family and at school. It must be taken into account that social exchanges and interpersonal relationships must be mostly based on linguistic exchanges. Besides, there are other factors, such as overprotecting families, integrated or non-integrated schooling, early acquisition of a language for communication (including sign language), experiences in contexts structured around oral language or education strategies parent use in relation with impulsiveness-self-control and dependence-independence.

All these difficulties at communication interaction and incorporation of social rules are going to generate a series of education needs in a deaf student. Some examples are the need to have more information on rules and social values, assert his/her identity and self-esteem, acquire and share a communication system that will allow him/her to structure his/her thinking, regulate his/her behavior and interact with the environment.

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Contact with others

An important aspect of sound is its capacity to induce and transmit emotions.
A child learns to distinguish affection, tenderness, stimulus or anger by perceiving, telling apart differences in intonation, volume, pace, and other. Simple imitation of these sounds will allow him/her to be initiated into communication.

An infant soothes to his/her mother’s voice and a month-old infant, even a toddler over
a year old feels safer in his/her mother’s voice-span. Sound
plays an important role during the individualization-separation process that takes place between
eight and 16 months of age.
Lack of hearing can isolate the child and hamper communication and comprehension of his/her affective and emotional world. It also hampers sound imitation and spontaneous learning of oral language. A deaf child will not understand correctly oral explanations
about other people’s emotions and feelings. If the child is not given information in advance, is not explained why things happen, he/she will end up misunderstanding other people’s intentions, the origin of events, the nuances that go along different concepts, the complexity of things, and so on. It is therefore normal for a hearing-impaired child to feel insecure, inflexible, egocentric, susceptible, not in control of him/herself and impulsive.

Adult-deaf child communication interactions usually are
more controlling and rule-oriented than those between adults and normal hearing children.
Normal-hearing adults usually do not explain enough the reason behind rules or
actions or facts happening in the future. As a consequence,
a deaf child will not know or understand rules correctly. His/her behavior, at times,
will not be adequate (Alonso and others, 1991.)

In general, parents have the initiative to command and limit the child’s field of action. The child is often given few options to respond with. Children are usually addressed closed questions with two options: Do you want this or that? Such limits make it hard for the child to understand time sequences, get away from specific concepts, think about possibilities and plan for events. (Clemente and Valmaseda, 1985).

Difficulty at explaining things may even influence parents’ permissiveness. Deaf children are allowed more whims and we are less hard
on them on areas such as going to bed routines, hygiene and so on. An early communication code encourages a higher level of information, an internal control of him/her own behavior and a correct external control through adequate interactions. Parents and educators must exert external control adequately and must teach children how to raise the bar and accept small frustrations.

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MORENO, C., i CUBERO, R. (1991). Relaciones sociales: familia, escuela, compañeros. Años preescolares. A: J. Palacios, A. Marchesi, i C.Coll Eds. Desarrollo psicológico y educación, I. Madrid: Alianza Psicología.
PALACIOS, J., i HIDALGO, V. (1991). Desarrollo de la personalidad en los años preescolares. A: J. Palacios, A. Marchesi, i C.Coll Eds. Desarrollo psicológico y educación, I. Madrid: Alianza Psicología.
SHAFFER, D.R. (2002). Social and Personality Development. Madrid: Thomson
Luterman, D., Counseling Persons with Communication Disorders and Their Families, Pro-Ed, 2001.
Meadow, K., «Burnout in Professionals Working with Deaf Children» en American Annals of the Deaf, nº 126(pp. 13-19), 1982.

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Chapter 6 – Development of musical perception
(by Damian Llopis)

Friedrich Nietzsche.

Music is defined as the artful sound of human voice, instruments, or both, taking into account melody, harmony and rhythm. Music, like language, is a form of communication based on acoustics. It follows certain rules to combine a limited number of sounds in an infinite number of forms. For both skills there is a genetic predisposition that enables subjects to acquire language and recognize musical variations from a very early age. During the first year of life, a baby exposed to sounds develops musical and verbal or linguistic perception abilities.

In music, as well as in language, common discrimination factors serve as starting point. Among these factors you may find tone and intensity. Children in the pre-lingual phase have a musical perception ability similar to that of older children. From 6 months of age onwards you can assess the ability to detect changes in melodies. This musical perception has an influence on personal relationship aspects. All mothers sing melodies to their babies, even though they cannot understand what is being said and, generally, a special, simple and acute, slow and emotionally expressive tone is used. It is common to all cultures.

Such behavior on the side of the mothers generates a decrease in motor activity and long periods of focused attention in children. Music, just like language, has been studied by neuroscientists, musicians and therapists. Both types of sound stimuli share sensory aferences that transfer information to the cerebral cortex.

Language is made up of phoneme, morpheme, words and sentences. Music is made up of tone, timbre, rhythm and melody. Together, they produce musical perception. Besides, music and language relate to image creation (memories and memory), motor activity and affectivity.

Analyzing central processing of language has advanced greatly, whereas music analysis is more complex, since you need to isolate its various characteristics. Results from experimental studies related to musical processing are affected by the subject’s musical experience (musicians, non musicians or amateurs) and by the way elements of musical stimuli are presented. While one may be competent without training language-wise as far as comprehension and verbal expression go, and musical perception ability and melody recognition may be acquired spontaneously, playing an instrument must be learnt. In order to fulfill with the requirements of a harmonious production, there must be training.

Music plays a very important role in the learning process of a child in nursery school. It is essential that from the very first contact with music, a child feels and perceives that he/she is producing it. A child must be appealed by music so that he/she learns to listen to it, to know it and respect it. Musical activities are very beneficial: Listening ability as well as concentration increase, imagination is developed, creativity is encouraged, and so on.







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Musical transmission in the mother-baby relationship

Experimental psychology findings bring us interesting data on the benefits of rocking a baby and the efficiency of carrying the baby in their arms to sooth him/her. Korner (1965, 1970) considers vestibular stimuli produced by a change in position to have a soothing effect on the baby, even more so than mere skin contact. The very same stimuli, when brief and predominantly vertical, activate the baby’s visual sweep and attention capacity. Clark (1977) showed that vestibular stimuli have a positive effect on the child’s motor development.

Several authors indicate how important rhythm is in mother-baby interactions. Their work shows how repetitions through time as well as a regular mother-baby interaction schedule favor cognitive acquisition in the baby. Through what is known (rhythm), the mother prepares the baby to accept the unknown (changes in stimuli).

Other authors showed the effect rhyme and repetition provoked on the psyche. The pleasure given by rhymes in songs compensates for the detachment and separation feeling brought by sleep.

It is known that the mother-baby relationship is determined by an early diagnosis of hearing loss. Therefore, it is essential that early attention programs reinforce the importance of maintaining these behaviors to establish the first contact with music, in the form of rhymes, songs and lullabies that are so beneficial for babies.

Distressed mothers express that they must remove the baby’s hearing aid or cochlear implant to sleep. Because of this, the baby can no longer listen to them, so “what is the point of singing to a deaf baby”. First, it is not a must to remove the baby’s hearing aid or CI when he/she is falling asleep. Even if you do remove them, the baby benefits from the mother´s facial expression, the tenderness of the moment and vestibular stimuli from rocking and so on.

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Psychology of musical development

Several authors have proved and described different evolution phases to acquiring different musical parameters. They have proposed development steps for musical skills depending on a child’s response to different perception and creative and leisure production situations of sounds considered music.

Development milestones in musical ability from 0 to 6 years of age Shuter-Dyson and Gabriel (1981)

Reacts to sounds.
Makes music spontaneously.
Starts reproducing sentences of songs heard before.
Conceives a melody’s general plan. He/She could develop a comprehensive ear should he/she learn how to play an instrument.
Can discriminate pitch registers, can reproduce, through imitation, simple rhythms.
Understands loud/low, can tell apart “same” and “different” when talking about melody outlines or simple rhythms.

Characteristics of evolution and musical development in a child (0-3 years old)

8 months
The baby responds to music and to any other acoustic stimulus by changing positions and his/her regular resting position.
18 months
The baby reacts to music rhythmically with his/her entire body.
Hums or spontaneously sings syllables.
Imitates songs he/she listens to, humming out of tune.
2 years
He/She mostly sings, uses percussion and moves.
Discovery of rhythm (generally, the brain “discovers” the body; walking, dancing, sense of physical rhythm).
Interest in instruments. Encouraged to sing.
2 and a half years
Tells music and noise apart.
He/She is familiar with songs and easy lyrics.

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Music and Cochlear Implant

(from Music and Cochlear Implants. Professional series Cochlear Ltd.2008)

Up-to-date, little research has been undertaken on musical perception abilities of children with CI. Tara Vongpaisal, PhD student at the University of Toronto in Canada, has carried out a study series on music. The population was 10 implanted children and a control group of 10 children with regular hearing levels. The study consisted of recognizing some pop songs under three different forms: The original recording, the recording without the lyrics (karaoke style) and the melody on the piano. Children with regular hearing and children with CI obtained similar results when listening to the original version. However, without the lyrics, children with CI performed less well. Their performance decreased even more when they were asked to identify the melody on the piano, whereas children with regular hearing maintained a good performance.

In a second study, the children’s ability to differentiate the tone of some sequential sounds was measured. In a monotonous sequence, children with CI can differentiate a change in tone between one and two semi-tones. Their performance was worse than that of the children in the control group when they were given tones sequentially different and were asked to determine whether two sequences were the same or not. In this context, children with CI had trouble detecting changes of one semi-tone.

Another study consisted of repeating the lyrics of familiar melodies with or without musical accompaniment. Children with CI repeat 19% of words correctly, as opposed to 90% of children with regular hearing in the control group.

The last study assessed whether children with congenital hearing loss and a CI could reproduce information on tone and time from songs. 12 Japanese children with CI and 6 with regular hearing are included. Children with CI sang the rhythm of the songs in a similar way to children with regular hearing. However, their tone spectrum is reduced and tone patterns had no relation with the requested songs.

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1. http://www.phys.unsw.edu.au/jw/Cochlear.html
2. Music perception with cochlear implants: a review.McDermott HJ.Trends Amplif. 2004;8(2):49-82.
3. Music and Cochlear Implants. Professional series Cochlear Ltd.2008.pdf free to download. www.cochlear.com

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