3 Infancy, Toddlerhood, and Preschool 67ratings at age 5, and decreased social acceptance when entering school
(Maughan, Cicchetti, Toth, & Rogosch, 2007). Most women’s depressive
symptoms include an externalized locus of control and more difficulty man-
aging parenting stress. These symptoms may act as mediators to either lax or
over-reactive parenting that meets attachment and attunement needs
inconsistently. In turn, this places children at risk for poor attachment, a
sense of mistrust, and a defensive detachment (Gerdes, et al., 2007). There is
strong and consistent evidence that the caregiver’s attunement and emotional
care assist the infant to develop the neurobiological substrate that enables
him or her to develop attachments and the ability to learn self-soothing and
affect regulation (Applegate & Shapiro, 2005; Siegel, 2012). Put the other way
around, when care is unavailable, these neurobiological substrates in the
brain have less opportunity to develop and this negatively affects the infant’s
ability to engage fully in other attachments and to develop affect regulation
(Shapiro, Shapiro, & Paret, 2001).
When an infant or preschooler experiences the loss of a caregiver due
to parental depression, removal from parental care, or hospitalization, they
experience loss that we do not view as normal maturational developmental
loss. However, the challenges of such loss are rarely recognized. While the
youngster receives care for basic needs such as nutrition, shelter, and hygiene,
often little attention is paid to the need for an attuned and consistent caregiver.
In highlighting the ramifications of such loss, we aim to validate it so that
remediation may become customary.
Loss of a Child’s Own Health
Finally, young children may experience the loss of their own health. Young
children with life-threatening illnesses often have such intense medical care
experiences that they and their families are caught in the moment–to-moment
experiences of treatment. Hospitals that provide care for infants soon after
birth and in toddlerhood are now much more attuned to the needs of children
this age to maintain and continue to develop attachment relationships with
their caregivers. They have embraced family-centered care models that
encourage parents to be at the baby’s bedside (www.ipfcc.org/faq.html).
Nevertheless, babies in institutional care or in foster care experience a separa-
tion from their primary caregiver. Under such circumstances, it is important for
social workers and others to promote attachments to consistent and available
caregivers.
Families often want to avoid discussion of their toddler’s possible death,
and the uncomprehending child is focused on the pain, separation from
family, and/or reactions to their perceptions of their caregivers’ stress. Few
studies delineate the experience of children coping with life-threatening ill-
ness at this young age (Bluebond-Langner, 1978; Schwartz & Drotar, 2006).
With more awareness of the need for open discussion and the fact that
more children experience chronic, life-threatening illness, even the resource
WebMD has advice for parents about how to handle children’s questions
when they have life-threatening illness (www.webmd.com/palliative-care/
talking_to_children_about_death).