Child Development

and identify a viewpoint for the doll specified by a pic-
ture of the display. Some children around age four
did not distinguish between their own view and that
of the doll, a tendency interpreted by Piaget as evi-
dence of egocentrism. Egocentrism was considered
an indication of the preoperational period, a stage
that preceded logical thinking. Research since the
1970s has shown young children’s perspective-taking
ability to be affected by a variety of situational vari-
ables.

See also: CONSERVATION; PIAGET, JEAN

Bibliography
Piaget, Jean, and Bärbel Inhelder. The Child’s Conception of Space.
New York: Norton, 1967.
Gary L. Allen

TITLE V (MATERNAL AND CHILD

HEALTH SERVICES BLOCK GRANT)

In the United States the provisions of Title V of the
Social Security Act (SSA) have their origins in the First
Maternity and Infant Act (or Sheppard-Towner Act)
of 1921, a grant-in-aid program that provided federal
funds to states for the establishment of maternal and
infant welfare and hygiene agencies. Passed in 1935,
Title V extended new funding to states to provide ma-
ternal and child health services, specifically for early
detection, treatment and rehabilitation for ‘‘condi-
tions which lead to crippling,’’ child welfare services,
and vocational rehabilitation. Among the more im-
portant changes that have occurred to Title V since
it was passed are the establishment of special projects
in 1963, the consolidation of categorical MCH ser-
vices into the Maternal and Child Health Block Grant
in 1981, and the move toward greater accountability
in 1989. By the end of the twentieth century, Title V,
a $870-million program, remained the statutory basis
of maternal and child health services in state and local
health departments across the United States.

See also: POVERTY

Bibliography
Lesser, Arthur. ‘‘The Origin and Development of Maternal and
Child Health Programs in the United States.’’ American Jour-
nal of Public Health 75 (1985):590–598.
Margolis, Lewis, George Cole, and Jonathan Kotch. ‘‘Historical
Foundations of Maternal and Child Health.’’ In Jonathan
Kotch ed., Maternal and Child Health: Programs, Problems, and
Policy in Public Health. Gaithersburg, MD: Aspen Publishers,
1997.
Schmidt, William, and Helen Wallace. ‘‘The Development of
Health Services for Mothers and Children in the United
States.’’ In Helen Wallace, Richard Nelson, and Patrick
Sweeney eds., Maternal and Child Health Practices, 4th edition.
Oakland, CA: Third Party Publishing, 1994.

VanLandighem, Karen, and Catherine Hess. ‘‘Maternal and Child

Health at a Critical Crossroads.’’ In Helen Wallace, Gordon

Green, Kenneth Jaros, Lisa Paine, and Mary Story eds., Health

and Welfare for Families in the Twenty-First Century. Sudbury,

MA: Jones and Bartlett, 1999.

Jonathan Kotch

TOUCH

Touch typically refers to the provision of tactile/

kinesthetic stimulation to the newborn and young in-

fant with the intended goal of facilitating early growth

and development. Also known as ‘‘massage therapy,’’

sensory experiences include stroking, holding, and

passive movements. When applied to preterm infants

who suffer from a lack of responsive, developmentally

appropriate stimulation, positive effects include less

need for ventilatory support, better orienting to the

social environment, healthier changes between sleep

and wake states, and shorter hospitalization. Benefi-

cial effects depend on the duration, amount, and tim-

ing of stimulation—including the infant’s stress level.

Evidence suggests that massage therapy is an effective

intervention with infants of depressed mothers and

children suffering from painful procedures and neu-

romuscular and immune disorders. Research sup-

ports suggestions that stimulation increases nervous

system components, which lower physiological arous-

al and production of stress hormones. These changes

may then lead to better infant interactions with the so-

cial and nonsocial environments, and efficient meta-

bolization of nutrients and enhanced immune

function, all of which are essential for optimal growth

and development.

See also: INFANCY; PREMATURE INFANTS

Bibliography

Field, Tiffany M. ‘‘Massage Therapy Effects.’’ American Psychologist

53 (1998):1270–1281.

Lester, Barry M., and Edward Z. Tronick, eds. ‘‘Stimulation and

the Preterm Infant’’ (special issue). Clinics in Perinatology 17,

no. 1 (1990).

Philip Sanford Zeskind

TOYS

Toys, or objects whose main intended use is for play,

have the potential to enhance development (creative

building blocks) or to alter or hinder development

(violent video games). Toys are the primary tools of

childhood that allow children to extend their play be-

yond what can be done through imagination, voice,

or action alone. The careful selection of toys by adults,

as well as mediation of their use, is an important way

418 TITLE V (MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT)