By the end of this chapter, you should be able to:
Discuss what mental health is and what that looks like during early childhood.
Explain how mental health practices should begin during infancy.
Describe mental health problems that young children may experience.
Examine the impact of adverse childhood experiences, trauma, and stress on your children.
Reflect on how to support young children’s resilience and social and emotional competence.
Outline ways early care and education programs should be supporting young children’s mental health (including engaging families).
Explain what trauma-informed care is.
Caution
Warning: This chapter contains information about childhood trauma that may be triggering for some readers.
WI Department of Children and Families Licensing Rules for Group Child Care Centers
DCF 251 Administrative Code regulations that relate to this chapter include:
DCF 251.07 (1)a Program
Social Emotional Development
Each group child care center shall have a written program of activities which are suitable for the developmental level of each child and each group of children. The program shall provide each child with experiences which will promote all of the following
Wisconsin Early Childhood Collaborating Partners website at
http://www.collaboratingpartners.com/
or through the Child Care Information Center at 1-800-362-7353.
Self-esteem and positive self-image.
Social interaction.
Self-expression and communication skills.
Creative expression.
Large and small muscle development.
Intellectual growth.
Literacy
Introduction
Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in early care and education programs and school, and in their communities.
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Mental health is an important part of overall health and well-being. Mental health includes emotional, psychological, and social well-being. It affects how people think, feel, and act. It also helps determine how people handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.
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When early educators and families know more about early childhood mental health, they are better able to support children’s learning and development.
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Foundation for Mental Health
Beginning at birth, children need positive relationships with the adults who care for them. When children learn to recognize and share their feelings with trusted adults, they feel good about themselves. These relationships help them develop the confidence to learn new skills. Children thrive when adults support their strengths and needs. Responsive adults help children feel safe and valued and learn how to get along well with others.
Children who can manage their feelings can learn and play with peers. They are better able to plan, monitor and control their behavior. They can also adjust to changes in schedules and routines. Children who get along with adults learn to work together and follow rules. They can also show concern for, and share, take turns and compromise with other children.
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Mental Health from the Beginning
Infant mental health practice applies knowledge of relationships to support and enhance healthy social and emotional development and to prevent and treat mental health disorders. The following definition of infant mental health was developed by a group of experts with the common understanding that observing young children’s interactions with parents and other significant people is key for the assessment of emotional well-being.
In addition, experts also suggest keeping in mind the infants’ underlying biology that could include temperament and compromises to resilience from early trauma. Infant mental health is the developing capacity of the child from birth to three to: experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn—all in the context of family, community, and cultural expectations for young children. Infant mental health is synonymous with healthy social and emotional development. (ZERO TO THREE Infant Mental Health Task Force, December, 2001) The mental and physical health of infants and toddlers is critically influenced by the daily behaviors of their caregivers.
The following sections describe key concepts related to the mental health of infants. These concepts enhance what is included in the previous definition:
“Developing capacity” highlights the extraordinarily rapid pace of growth and change in the first 3 years. Although newborns experience intense feelings and are active partners in their relationships with adults, the differentiation and complexity of a young child’s emotional and social development increases markedly over time.
Infants and toddlers initially depend heavily on adults to help them experience, regulate, and express emotions. Infants’ cries and coos evoke strong reactions in their caregivers. An infant’s ability to master feelings develops through give and take.
Through relationships with parents and other caregivers, infants and toddlers learn what people expect of them and what they can expect of other people. Infants and toddlers learn through what they experience within relationships and what they observe in adult’s interactions with one another.
Infants and toddlers share and communicate feelings and experiences with significant caregivers and other children. Infants and toddlers interact with one another in emotionally meaningful ways. Parents and caregivers help young children name the feelings and understand their effect on others.
The drive to explore and master one’s environment is inborn in humans. An essential component of infants’ and toddlers’ well-being is the self-esteem that grows out of mastering their bodies and the environment as well as sharing that mastery with parents and significant caregivers.
Every child is a unique blend of characteristics; infants’ and toddlers’ developmental pathways will reflect not only their individual constitutional differences but also the contributions of their caregiving environments. Temperament, or the way an individual approaches the world, influences how tentatively or vigorously an infant might engage with a new person, toy, or situation.
The state of adults’ emotional well-being and life circumstances profoundly affects the quality of infant-caregiver relationships as well as infant and toddler mental health. Parents and other significant caregivers bring their own temperament and past experiences to relationships.
Culture influences every aspect of human development. This broad influence affects the way that infant mental health is understood; the goals and expectations adults have for young children’s development; and the childrearing practices that parents and caregivers use to promote, protect, or restore infants’ and toddlers’ mental health.
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Pause to Reflect
How does this toddler’s exploration relate to his self-esteem?
Mental Health in Early Childhood
Early childhood mental health (birth to 5 years) is a child’s growing capacity to do these things, all in the cultural context of family and community (adapted from ZERO TO THREE):
Experience, regulate, and express emotions
Develop close, secure, relationships
Explore the surroundings and learn.
Early childhood mental health is the same as social emotional development.
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Social and emotional development is important to early learning. Many social-emotional qualities—such as curiosity; self-confidence as a learner; self-control of attention, thinking, and impulses; and initiative in developing new ideas—are essential to learning at any age. Learning, problem solving, and creativity rely on these social-emotional and motivational qualities as well as basic cognitive skills.
When learning occurs in groups, such as in preschool classrooms or family child care programs, the social environment significantly influences how learning occurs. When young children enjoy interacting with adults and other children, they are more enthusiastic about activities and participate more. Furthermore, the interest and enthusiasm of others fuels the child’s own excitement about learning, and children are also motivated by others’ acknowledgment of the child’s accomplishments.
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It is important because it affects a child’s ability to:
Express their needs
Pay attention
Solve problems
Get along with others
Follow directions
Persist when challenged
Manage their emotions
Take initiative
Be curious and interested in learning
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Interviews with preschool and kindergarten teachers indicate that children who have the greatest difficulties in learning are hindered by the lack of these social-emotional qualities more than by the inability to identify letters or numbers. Children who are delayed or impaired in developing these social-emotional and motivational qualities:
may have difficulty controlling their emotions or behavior,
may not readily work independently or in a group,
often appear to lack curiosity or be uninterested in learning, and
may have difficulties getting along with others, which may undermine the learning environment for all children
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Children’s mental health is critical to their later school success as well. Children who
are able to follow directions and pay attention are able to focus on learning.
can express their feelings are able to get help when they need it.
learn to persist when frustrated can overcome challenges.
feel good about themselves are able to work on their own.
can control their behavior are able to stay on task.
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Finally, the importance of social-emotional development to early learning is consistent with the research on brain science. The developing brain is not neatly divided into separate areas governing learning, thinking, and emotions. Instead, it is a highly interconnected organ with different regions influencing, and being affected by, the others. This means, for example, that young children who experience emotional challenges (perhaps because of stress) are less ready for learning because brain regions related to memory are being affected by other regions governing emotion. This conclusion from brain research is, of course, consistent with the everyday experience of teachers of children whose stressful lives often lead to emotional, behavioral, and learning difficulties.
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Childhoods Mental Health Issues
There are two types of mental health issues this chapter is going to address. The first is diagnosable mental problems. The second is the result of Adverse Childhood Experiences and childhood trauma.
Mental Health Problems
Mental health problems, which the CDC refers to as mental disorders, among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day.
Among the more common mental health problems that can be diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD, which has already been addressed in Chapter 10), anxiety, and behavior disorders.
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Anxiety and Depression
Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders.
Anxiety
When children do not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include
Being very afraid when away from parents (separation anxiety)
Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
Being very afraid of school and other places where there are people (social anxiety)
Being very worried about the future and about bad things happening (general anxiety)
Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)
Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.
Depression
Occasionally being sad or feeling hopeless is a part of every child’s life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.
Examples of behaviors often seen in children with depression include
Feeling sad, hopeless, or irritable a lot of the time
Not wanting to do or enjoy doing fun things
Showing changes in eating patterns – eating a lot more or a lot less than usual
Showing changes in sleep patterns – sleeping a lot more or a lot less than normal
Showing changes in energy – being tired and sluggish or tense and restless a lot of the time
Having a hard time paying attention
Feeling worthless, useless, or guilty
Showing self-injury and self-destructive behavior
Extreme depression can lead a child to think about suicide or plan for suicide. While less common in early childhood, for youth ages 10-24 years, suicide is among the leading causes of death.
Some children may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a trouble-maker or lazy.
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Behavior or Conduct Problems
Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child’s age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are often called externalizing disorders.
Oppositional Defiant Disorder
When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.
Examples of ODD behaviors include:
Often being angry or losing one’s temper
Often arguing with adults or refusing to comply with adults’ rules or requests
Often resentful or spiteful
Deliberately annoying others or becoming annoyed with others
Often blaming other people for one’s own mistakes or misbehavior
Conduct Disorder
Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. In older children, these rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.
Examples of CD behaviors include:
Breaking serious rules, such as running away, or for older children staying out at night when told not to or skipping school
Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals
Lying, stealing, or damaging other people’s property on purpose
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Obsessive-Compulsive Disorder (OCD)
Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don’t actually make sense. For example, they might worry about having bad luck if they don’t wear a favorite piece of clothing. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away. Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset. The thoughts are called obsessions. The behaviors are called compulsions.
Having OCD means having obsessions, compulsions, or both.
Examples of obsessive or compulsive behaviors include:
Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress.
Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud)
Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)
Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away.
Children do these behaviors because they have the feeling that the behaviors will prevent bad things from happening or will make them feel better. However, the behavior is not typically connected to actual danger of something bad happening, or the behavior is extreme, such as washing hands multiple times per hour.
A common myth is that OCD means being really neat and orderly. Sometimes, OCD behaviors may involve cleaning, but many times someone with OCD is too focused on one thing that must be done over and over, rather than on being organized. Obsessions and compulsions can also change over time.
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Post-Traumatic Stress Disorder (PTSD)
All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD).
Examples of PTSD symptoms include:
Reliving the event over and over in thought or in play
Nightmares and sleep problems
Becoming very upset when something causes memories of the event
Lack of positive emotions
Intense ongoing fear or sadness
Irritability and angry outbursts
Constantly looking for possible threats, being easily startled
Acting helpless, hopeless or withdrawn
Denying that the event happened or feeling numb
Avoiding places or people associated with the event
Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).
Examples of events that could cause PTSD include:
Physical, sexual, or emotional maltreatment
Being a victim or witness to violence or crime
Serious illness or death of a close family member or friend
Natural or manmade disasters
Severe car accidents
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Diagnosis and Treatment of Mental Health Problems in Childhood
Symptoms of mental health problems change over time as a child grows, and may include difficulties with how a child plays, learns, speaks, and acts or how the child handles their emotions. Symptoms often start in early childhood, although some disorders may develop during the teenage years. The diagnosis is often made in the school years and sometimes earlier. However, some children with a mental disorder may not be recognized or diagnosed as having one.
Childhood mental health problems can, and should, be treated and managed. There are many treatment options based on the best and most current medical evidence, so families and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other service providers. Taking advantage of all the resources available will help parents, health professionals, and educators guide the child towards success. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders and their families.
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The childhood years, from the prenatal period to late adolescence, are the “building block” years that help set the stage for adult relationships, behaviors, health, and social outcomes.
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The occurrence of Adverse Childhood Experiences and childhood trauma can damage those building blocks. Early care and education programs can help children develop resilience to combat the negative effects of those.
Adverse Childhood Experiences
Adverse Childhood Experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years) such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration of a parent, sibling or other member of the household.
Traumatic events in childhood can be emotionally painful or distressing and can have effects that persist for years. Factors such as the nature, frequency and seriousness of the traumatic event, prior history of trauma, and available family and community supports can shape a child’s response to trauma.
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Adverse Childhood Experiences and associated conditions such as living in under-resourced or racially segregated neighborhoods, frequently moving, experiencing food insecurity, and other instability can cause toxic stress (i.e., prolonged activation of the stress-response system). Some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of multigenerational poverty resulting from limited educational and economic opportunities.
A large and growing body of research indicates that toxic stress during childhood can harm the most basic levels of the nervous, endocrine, and immune systems, and that such exposures can even alter the physical structure of DNA (epigenetic effects). Changes to the brain from toxic stress can affect such things as attention, impulsive behavior, decision-making, learning, emotion, and response to stress. Absent factors that can prevent or reduce toxic stress, children growing up under these conditions often struggle to learn and complete schooling. They are at increased risk of becoming involved in crime and violence, using alcohol or drugs, and engaging in other health-risk behaviors (e.g., early initiation of sexual activity; unprotected sex; and suicide attempts). They are susceptible to disease, illness, and mental health challenges over their lifetime. Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, family, jobs, and depression throughout life—the effects of which can be passed on to their own children.
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Childhood trauma occurs when a child experiences an actual or threatened negative event, series of events, or set of circumstances that cause emotional pain and overwhelm the child’s ability to cope. Childhood trauma is widespread and can take many forms. Common types of childhood trauma include:
Abuse and neglect
Family violence
Community violence
School violence
Life-threatening accidents and injuries
Frightening or painful medical procedures
Serious and untreated parental mental illness
Loss of or separation from a parent or other loved one
Natural or manmade disasters
War or terrorist attack
Forced displacement or refugee status
Discrimination
Extreme poverty
Trauma exposure often begins early in life. Young children are at the highest risk for exposure to trauma and are most vulnerable to its adverse effects. An estimated half of all children in the United States—approximately 35 million—are exposed to at least one type of trauma prior to their eighth birthday. For example, child abuse and neglect are most common among children younger than age 3. Children under age 5 are most likely to incur injuries from falls, choking, and poisoning, and represent the majority of children who witness domestic violence. Children from certain racial and ethnic groups also are more likely to experience adversities that can cause trauma. For example, exposure to childhood adversity is more common among black and Hispanic children than among white children, even when accounting for the role of income.
Childhood trauma is strongly linked to mental and physical health problems over the lifespan. It negatively impacts brain development, cognitive development, learning, social-emotional development, the ability to develop secure attachments to others, and physical health; it is also associated with a shortened lifespan. A considerable body of research demonstrates that children suffer the most severe, long-lasting, and harmful effects when trauma exposure begins early in life, takes multiple forms, is severe and pervasive, and involves harm by a parent or other primary caregiver—often referred to as
complex trauma
.
Childhood trauma is more likely to lead to post-traumatic stress disorder (PTSD) than trauma that occurs in adulthood. Children exposed to several different forms of trauma are more likely to exhibit PTSD (e.g., anxiety, depression, anger, aggression, dissociation) than children with chronic exposure to a single type of trauma. Children and youth with PTSD may re-experience the traumatic event through intrusive memories, nightmares, and flashbacks; avoid situations or people that remind them of the trauma; and feel intense anxiety that disrupts their everyday lives. In addition, they may engage in aggressive, self-destructive, or reckless behavior; have trouble sleeping; or remain in a state of hypervigilance, an exaggerated state of awareness and reactivity to their environments. However, there is no typical reaction to trauma. The vast majority of children show distress immediately following a traumatic event, but most return to their prior level of functioning.
Generally, children’s reactions to trauma differ based on the nature of the trauma; the child’s individual, family, and neighborhood characteristics; and the overall balance of risk and protective factors in their lives. It also depends on their age and developmental stage.
Young children who experience trauma may:
Have difficulties forming an attachment to caregivers
Experience excessive fear of strangers or separation anxiety
Have trouble eating and sleeping
Be especially fussy
Show regression after reaching a developmental milestone (e.g., sleeping through the night, toilet training)
School-age
children
who experience trauma may:
Engage in aggressive behavior
Become withdrawn
Fixate on their own safety or the safety of others
Re-enact the traumatic event through play
Have frequent nightmares
Exhibit difficulty concentrating in school
Table 11.9 – Childhood trauma has many effects
.
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Domain
Impacts
Brain Development
Smaller brain size
Less efficient processing
Impaired stress response
Changes in gene expression
Cognition
Impaired readiness to learn
Difficulty problem-solving
Language delays
Problems with concentration
Poor academic achievement
Physical Health
Sleep disorders
Eating disorders
Poor immune system functioning
Cardiovascular disease
Shorter life span
Emotions
Difficulty controlling emotions
Trouble recognizing emotions
Limited coping skills
Increased sensitivity to stress
Shame and guilt
Excessive worry, hopelessness
Feelings of helplessness/lack of self-efficacy
Relationships
Attachment problems/disorders
Poor understanding of social interactions
Difficulty forming relationships with peers
Problems in romantic relationships
Intergenerational cycles of abuse and neglect
Mental Health
Depression
Anxiety
Negative self-image/low self-esteem
Post Traumatic Stress Disorder (PTSD)
Suicidality
Behavior
Poor self-regulation
Social withdrawal
Aggression
Poor impulse control
Risk-taking/illegal activity
Sexual acting out
Adolescent pregnancy
Drug and alcohol misuse
Resilience to Childhood Trauma
When parents, service providers, and programs employ a
resilience
framework to childhood trauma, they understand there are always opportunities to support positive developmental trajectories among children, even if they have experienced trauma. Resilience has been defined as “a
dynamic process encompassing positive adaptation within the context of significant adversity.
” Resilience is not a personal trait that individuals do or do not possess (thus, the term “resiliency” is best avoided because it connotes an individual characteristic), but rather a product of interacting factors—biological, psychological, social, and cultural—that determine how a child responds to traumatic events.
Resilience to trauma can be defined in several ways: positive child outcomes despite exposure to trauma, prevention of trauma recurrence despite high risk for further exposure, or avoidance of traumatic experiences altogether in the face of significant risk. All three of these conceptualizations of resilience are based on an ecological approach.
Using an
ecological approach
to promote resilience in development among children who experience trauma is useful because it assumes that there are multiple levels of influence on a child’s development—the individual, parent, family, school, community, and culture—which may increase or decrease a child’s risk for and response to experiencing trauma. These various influences are often referred to as risk and protective factors.
Risk factors
are circumstances, characteristics, conditions, events, or traits at the individual, family, community, or cultural level that may increase the likelihood a person will experience adversity (e.g., childhood trauma, re-traumatization, or negative outcomes due to trauma). Risk factors for specific types of trauma may vary, but commonly include living in poverty, a lack of social supports, and prior history of trauma.  However, the presence of risk factors or membership in a high-risk group does not necessarily mean that a child will experience trauma or its most adverse effects. Protective factors can buffer children from risk and improve the odds of resilient functioning.
Protective factors
are characteristics, conditions, or events that promote healthy development and minimize the risk or likelihood a person will experience a particular illness or event, or its related negative outcomes. Research shows that the strongest protective factor linked with resilience to childhood trauma is the reliable presence of a sensitive, nurturing, and responsive adult. The presence of such a figure can help children by restoring a sense of safety, predictability, and control; giving them the feeling of safety; providing them a way to process traumatic events; protecting them from re-traumatization; supporting their development of self-regulation; and helping them heal.
In addition, the National Child Traumatic Stress Network highlights the following protective factors that promote resilience to childhood trauma:
Support from family, friends, people at school, and members of the community
A sense of safety at home, at school, and in the community
High self-esteem and positive sense of self-worth
Self-efficacy
Spiritual or cultural beliefs, goals, or dreams for the future that provide a sense of meaning to a child’s life
A talent or skill in a particular area (e.g., excelling in school or in a sport)
Coping skills that can be applied to varying situations
Finally, resilience to childhood trauma depends largely on the supports available to a child and his or her family. Family members, teachers, mental health providers, child welfare workers, and other community service providers can work together to ensure that children and families receive the emotional and concrete supports (e.g., food, shelter, financial stability) they need. This system of care approach is also a cornerstone of TIC.
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Pause to Reflect
What risk factors did you encounter in your own childhood? What protective factors did you experience? How did/does this effect your resilience?
Early Care and Education’s Role in Children’s Mental Health
Many practices of high-quality early care and education programs promote mental health and well-being including:
Screening and assessment of infants’ and toddlers’ social and emotional well-being support the functions of promotion, prevention, and intervention.
integrating curriculum and individualization.
A well-designed space is comfortable for infants and toddlers with different temperaments as well as for their teachers and parents.
Poorly designed environments are stressful. Teachers are concerned about the safety and well-being of children, and their saying “no” occupies a great deal of teacher energy and attention. The time teachers spend monitoring keeps them from interacting with an infant or toddler in ways that build self-esteem.
Having partnerships with community resources that families can be referred to.
Reciprocal communication with families.
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Mental health services in early care and education programs can address:
Promotion—helping all children to feel good about themselves, to get along with others and to manage their behavior.

Early Identification—paying attention to mental health problems early on.
Treatment—helping connect families with appropriate help for children with mental health problems.
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Table 11.1 – Nine Things Early Care and Education Programs Should Know
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Nine Things Early Care and Education Programs Should Know
Mental health is an essential part of health.
The mental health of young children is linked to the wellbeing of the people who care for them.
Promoting the mental health of infants and young children can make a positive difference for years to come.
Positive relationships support positive mental health.
Culture plays an important role in young children’s mental health and in how families view mental health and behavior.
The more staff and families know about mental health the better they are able to support it.
Addressing mental health concerns when children are young is more effective than waiting until they are older.
Mental health must be an integral part of early care and education programs.
Programs that focus on mental health are able to design services that improve children’s behavior.
Note
Infant and Early Childhood Mental Health Consultation
Infant and Early Childhood Mental Health Consultation (IECMHC) a prevention-based service that pairs a mental health consultant with families and adults who work with infants and young children in the different settings where they learn and grow, such as child care, preschool, and their home. The aim is to build adults’ capacity to strengthen and support the healthy social and emotional development of children―early and before intervention is needed.
IECMHC has been shown to improve children’s social skills and emotional functioning, promote healthy relationships, reduce challenging behaviors, reduce the number of suspensions and expulsions, improve classroom quality, and reduce provider stress, burnout, and turnover.
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Increasing Children’s Opportunities to Practice Social Skills and Emotional Competencies
Everyday activities in the classroom can be planned and implemented to help children’s social and emotional development (which, as mentioned, is the same as their mental health).
Teaching Children About Emotions
There are many things that teachers can do to help support children’s understanding emotions. Here are some ideas:
Make faces expressing different emotions and have children guess what you might be feeling.
Throughout the day, help children learn to label their own emotions (e.g., "It looks like you are feeling mad that we can't go outside; what can we do to help you feel better?").
While reading stories to children, have children guess how the characters in the story are feeling. Ask questions like, "How can you tell that the character is feeling that way? Can you make a face that shows that feeling?"
Use puppets to act out different situations; for example, one puppet takes a toy from another puppet. Ask the children what emotion(s) the puppets might be feeling.
Frequently direct children to look at each other's faces and think about how they are feeling.
Listen to some different types of music, such as rock or classical, and let the children dance to the music. Ask children how the song made the children feel.
Teaching Children about Friendship
Being in an environment with many same-aged peers that are all learning about how to express themselves, work with others, and regulate their behaviors provides a great place to help children learn about friendships. Here are some ideas:
Model asking others for help. If you have a task to do in the classroom, involve another child.

Have children help during routines such as putting out cots or mats for naptime.
Talk about your own social behaviors. You can say things like, "I said 'thank you' to Ms. Tanya because she passed me the milk," or "I think I'll hold the door open for Jamal because his hands are full."
Identify certain items in centers that require children to help each other, like taking a dollhouse off a shelf, moving the car garage, or feeding the class pet. Explain to children that it takes two friends to do these things.
Provide toys and play games that require two or more people, like a wagon or toss and catch game.
Make a "Friendship Board" on a bulletin board in your classroom. Take pictures when children are working together on something or playing together and put them on the wall.
Teaching Children about Problem-Solving
Everyday life presents many opportunities for children to engage in identifying problems and generating and trying out solutions. Here are some ideas for in the classroom:
Use naturally occurring opportunities to work problem-solving words into the classroom vocabulary. When there aren't enough glue sticks or too many people wanting to go in a certain center, say things like, "We have a problem. What can we do to fix it?"
Use naturally occurring problems in small groups to brainstorm possible solutions. Talk about that problem and come up with some ideas that could work to solve the problem.
Use puppets to act out problem situations during group time. Ask the children to come up with a solution for the problem.
When a child asks for help, take the opportunity to involve another child in solving the problem. You can say, "Let's look and see if one of your friends can help you. Marne, Sheila needs a glue stick and there are no more. Can you help her solve her problem?"
Encourage the children while they are working through a problem and provide them with recognition when they solve it. You can use a situation that ended well as an example to discuss in large group.
Discuss the problems that characters are having in the books you are reading. Brainstorm some possible solutions and guess what they are going to do.
Make up a song about what to do when children have a problem. For example, to the
Row, Row, Row Your Boat
tune: "Problem, problem, problem, oh what can we do? Stop and think of something new. I'll try it out with you."
If similar solutions keep coming up during discussions of problem-solving, start a "Solution Board" that shows the different solutions with an image to represent it. Children can use it to help think of solutions as problems arise, and the teacher can prompt a child to go look at it.
Teaching Children about Handling Disappointment and Difficult Emotions
Handling intense emotions and the disappointment when things don’t go their way are challenging for young children (and even adults!) to navigate. But teachers can help children develop techniques to handle difficult emotions. Here are some ideas:
Throughout the day, model labeling your own emotions. For example, "I feel frustrated because I cannot open this jar of paint."
Help children learn to label their emotions when they have conflict with other children: "Bobby, it looks like you are feeling angry because Terrence took away your toy. Can you tell Terrence how it makes you feel when he takes your toy away?"
When children cry, identify their feelings, and yours too. "I know that was really scary falling off the slide. I was worried about you. I am glad you are okay. Is there something I can do to help you until you feel better?"
Help children learn how to take deep breaths by "smelling the flowers" and "blowing out the birthday candles." Knowing how to breathe deeply is an important part of learning how to calm down when angry or upset.
Give children materials to use to get out their anger. They can use a toy hammer, squeeze playdough, or run laps at recess. Let them know that it is okay to be angry and that there are safe ways to express anger.
Act out the difference between feeling tense (like a robot or statue) and relaxed (like a rag doll or stuffed animal). Have children act it out, too, so they begin to learn to identify when they are becoming wound up.
Help children learn to label their own emotions. You can say, "It looks like you are really frustrated over here. What is the problem?"
Give children different situations, such as "A child is very sad because he misses his mom," and let them act it out. Talk about the emotion and some things the child might do to feel better.
Children's storybooks have lots of opportunities to talk about dealing with certain emotions. Point out characters' simple emotions like happy, sad, mad, and excited, and look for opportunities to label more complex ones like disappointed, frustrated, surprised, and embarrassed. See what the characters do to deal with those emotions and whether or not the children think it was a good way. Brainstorm other things that could have been done when the characters were feeling that way.
If children are feeling sad at drop-off, have them "write" a letter or draw a picture to show their caregivers at pick-up time. Talk about how it is ok to feel sad, but that their caregiver will come back at the end of the day.
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Engaging Families in Supporting Children’s Social-Emotional Development
There are many things you can do to give families ideas of how to support their children’s social and emotional development at home too. You can
Incorporate the emotion words the children have been practicing or have identified during the day into notes or newsletters for parents. This may help to encourage discussion of emotion words in the home setting as well.
Include a note about a situation that arose at school and how it was solved when reporting to parents. Encourage the parents to ask the children about it.
Encourage families to use meals and end of day routes to discuss the day with their children.
Share some of the things you do throughout the day. Many of those things can be done at home too.
Some specific ideas you can give parents include the following:
During bathroom routines, have children look in the mirror and practice making mad, sad, and happy faces.
In the morning, discuss things you are excited about for the upcoming day.
When leaving the house, ask the child to help you carry things. Afterward, thank them for helping.
Throughout daily routines outside of the house, talk about the different ways the people you see help (police officers, bus drivers, cashiers). Emphasize the helping nature of these jobs.
Use meal preparation as a chance to practice and talk about social skills. Have children get out ingredients, set the table, or stir food. Discuss how important it is to help and how much the help is appreciated.
Create a solution kit that can be used at home when your child has a problem. Add solutions such as asking a sibling or parent for help, choosing a different toy, or going outside to play. Post them on the fridge for easy access!
Model techniques to use when dealing with anger and frustration. Show breathing techniques, counting, or whatever works to calm you down.
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Supporting Children Under Stress
Supporting children’s mental health also extends to helping children deal with the stress that they may encounter. One of the most important things teachers can do is provide the child with a predictable, safe haven where children can feel secure. Teachers can create a comfortable and comforting everyday routine that is child-centered, individualized, responsive, and helpfully structured to give young children a sense of control and predictability that may be lacking in other aspects of the child’s life. Central to these efforts is providing children with supportive adult relationships that are reliable and helpful. This may be more difficult than one would expect because young children under stress often test these relationships to see whether teachers and other adults will remain responsive to them even when children act defiantly or negatively.
In some circumstances, it can be helpful for teachers to obtain the advice of an early childhood mental health consultant who can observe the child in the classroom, talk with the teacher about the child’s behavior, and suggest strategies for providing supportive assistance. Early childhood mental health consultants can be valuable resources to an early childhood education program. They can help teachers provide much-needed support to young children who may not have other such sources of support elsewhere in their lives.
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Trauma-Informed Care
As mentioned, children who are exposed to traumatic life events are at significant risk for developing serious and long-lasting problems across multiple areas of development. However, children are far more likely to exhibit resilience to childhood trauma when child-serving programs, institutions, and service systems understand the impact of childhood trauma, share common ways to talk and think about trauma, and thoroughly integrate effective practices and policies to address it—an approach often referred to as
trauma-informed care (TIC)
.
The context in which children live, learn, and grow shapes both their immediate and long-term well-being. Accordingly, children who experience trauma are more likely to exhibit resilience when their environments are responsive to their specific needs. Families, schools, community-based programs and services, and the individuals caring for children can increase the chances of resilience following childhood trauma when they become aware of the impact of childhood trauma, provide a sense of safety and predictability, protect children from further adversity, and offer pathways for their recovery. In other words, children benefit when these entities provide them with trauma-informed care (TIC).
Despite its focus on trauma, TIC is inherently a strengths-based perspective that emphasizes resilience instead of pathology. TIC has been defined and implemented in a number of ways, but the Substance Abuse and Mental Health Services Administration has identified four key elements—the Four Rs (see Figure 11.12)
Applying TIC to real-world settings begins with a child’s first contact with a program, institution, or service system. It requires a comprehensive and multi-pronged effort involving the many adults in children’s lives. For example, in a school or afterschool program, TIC means increasing trauma-related knowledge and skills among program facilitators, school administrators, bus drivers, food service workers, classroom assistants, administrative staff, volunteers, teachers, leadership, special education professionals, school social workers and psychologists, families, and anyone else who comes into contact with children. However, increasing trauma knowledge is only one aspect of TIC, which also means that the individuals who care for children must be able to:
Realize
the widespread nature of childhood trauma and how it impacts the child’s emotional, social, behavioral, cognitive, brain, and physical development, as well as their mental health. In addition, adults must be aware of the influence of trauma on family members, first responders, service providers, and others who may experience secondary stress (trauma-related reactions to exposure to another person’s traumatic experience). In some instances, adults endure the same traumatic events or circumstances as the child (e.g., a natural disaster, community violence, death of a community member) and may benefit from similar supports.
Recognize
the symptoms of trauma, including how trauma reactions (i.e., symptoms of posttraumatic stress) vary by gender, age, type of trauma, or setting. In addition, the adults in children’s lives must understand that a child’s challenging behaviors are normal, self-protective, and adaptive reactions to highly stressful situations, rather than viewing that child as intentionally misbehaving. Children’s trauma reactions are understood to be adaptive efforts to protect themselves in response to traumatic events. For example, a child may be hypervigilant to an adult’s anger or disapproval because, in the past, he or she experienced physical abuse by a parent. Or, a child may disassociate or daydream as a learned response that enables them to avoid feeling or thinking about a traumatic experience. In addition, TIC means recognizing that trauma may influence a child’s engagement in activities and services, interactions with peers and adults, and responsiveness to rules and guidelines.
Respond
by making necessary adjustments, in their own language and behavior, to the child’s environment; and to policies, procedures, and practices to support the child’s recovery and resilience to trauma.
Resist re-traumatization
by actively shaping children’s environments to avoid triggers (sounds, sights, smells, objects, places, or people that remind an individual of the original trauma) and protect children from further trauma, which can exacerbate the negative impacts of trauma and interfere with the healing process.
Training and Professional Development on Child Trauma
Providing adults (staff, leadership, families, and community partners) with training and professional development on childhood trauma is an important component of implementing TIC. It is essential that adults become aware of the prevalence and impact of trauma, and learn to apply a “trauma lens” (i.e., gain the capacity to view children’s difficulties in behavior, learning, and relationships as natural reactions to trauma that warrant understanding and sensitive care). In addition, adults can learn key strategies to manage trauma-related problems in childhood. These include:
creating environments that feel physically and emotionally safe.
teaching children self-regulation, language and communication skills, and how to build healthy relationships.
learning each child’s trauma triggers and how both the child and adults can limit, anticipate, and cope with them.
supporting the development of healthy attachments with parents and other caregivers, as well as positive relationships with peers.
Evaluations of TIC initiatives also indicate that when parents, service providers, and programs share a common language and view of trauma, they are better able to work together to meet children’s needs.
Training and professional development opportunities are also important for increasing the capacity of adults to attend to other aspects of TIC, including:
family engagement.
practices that are responsive to culture, gender, and sexual orientation.
collaboration with community service providers (e.g., mental health providers who can screen for childhood trauma and provide evidence-based treatment).
developing and integrating emergency and crisis response protocols.
and establishing trauma-informed policies that support positive youth development despite exposure to trauma.
Building capacity and maintaining an ongoing commitment to TIC efforts are critical to sustainability. However, although it is a critical component of TIC, training staff and parents on the impact of childhood trauma is not sufficient and does not in and of itself constitute TIC. TIC must also include comprehensive, ongoing professional development and education for parents, families, school staff, out-of-school program staff, and community service providers on jointly addressing childhood trauma.
Secondary Traumatic Stress
TIC also means attending to the psychological and physical safety and well-being of the adults who care for children who have experienced trauma. Professionals, parents, and other caregiving adults may suffer
secondary traumatic stress
(trauma-related reactions to exposure to another person’s traumatic experience). The National Child Traumatic Stress Network recommends the following strategies to combat secondary traumatic stress and reduce related staff burnout and turnover:
Provide high-quality, reflective supervision
Maintain trauma workload balance
Support workplace self-care groups
Enhance the physical safety of staff
Provide training to both staff and leadership to increase awareness about secondary traumatic stress and how to address it effectively
Develop opportunities for staff and leadership to learn about and engage in self-care practices.
Create external partnerships with secondary traumatic stress experts.
Regularly assess the vulnerability and resilience of staff and leadership to second traumatic stress
Create a buddy system for self-care accountability.
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Pause to Reflect
What are key take-aways for you about how teachers can support children’s mental health? What are some ways that you can stay mentally healthy as well?
Summary
Children’s mental health (their social and emotional development) must be intentionally supported from the beginning. Children with mental health problems (both diagnosed and that may go undiagnosed) and children who experience adverse childhood experiences, trauma, and stress may need additional mental health support. Early care and education programs should practice trauma informed care and recognize their role in helping children, and their families, to develop resilience.
Resources for Further Exploration
Georgetown University Center for the Early Childhood Mental Health Consultant:
https://www.ecmhc.org/


1.1: Why It Matters- ¿Qué haces todos los días?
-
- Last updated
- Save as PDF
Based on the song titles below, what do you think the vocabulary in the module will be about?
Zoé –
Labios Rotos
Zoé is a Grammy Award and Latin Grammy Award-winning Mexican rock band.
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La Dame Blanche –
Dos Caras
(feat. Celso Piña & Serko Fu)
With her explosive mix of hip hop, cumbia, dancehall and reggae, the Cuban singer, flautist and percussionist Yaite Ramos Rodriguez, aka La Dame Blanche delivers a powerful and compelling sound which summons the spirits. (
More about La Dame Blanche
)
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T3R Elemento —
En boca de todos
T3R Elemento Pay Homage to their Humble Beginnings in the Music Video for their New Single, “En Boca De Todos”. Regional Mexican band, T3R Elemento have captured the attention and admiration of fans and industry alike with their alternative take on the traditional since they exploded onto the scene a little over a year ago. (youtube description) (
More about T3R Elemento
)
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Cable Head –
Cierro Los Ojos
Cable Head is a performing artist and activist. As a modern superhero, its superpower is to change consciousness through sound & technology and the cables around its head are a representation of human interconnections. The music is Electro-Pop produced with advanced and vintage technology, featuring the trademarked vocals of Cable Head singing in different languages. (
Spotify description
)
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Devendra Banhart –
Abre Las Manos
Devendra Obi Banhart is a Venezuelan American singer-songwriter and visual artist. Banhart was born in Houston, Texas and was raised by his mother in Venezuela, until he moved to California as a teenager. Banhart’s music is often associated with the New Weird America genre, along with Vetiver and Joanna Newsom. (
More about Devendra Banhart at Wikipedia
)
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Juan Luis Guerra —
Lámpara Pa’ Mis Pies
Juan Luis Guerra Seijas is a Dominican musician, singer, composer, and record producer. Guerra is one of the most internationally recognized Latin artists of recent decades. His popular style of merengue and Afro-Latin fusion has garnered him considerable success throughout Latin America. He is also credited for popularizing bachata music on a global level and is often associated with the genre, although his distinct style of bachata features a more traditional bolero rhythm and aesthetic mixed with bossa-nova influenced melodies and harmony in some of his songs. (
Wikipedia entry on Juan Luis Guerra
)
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In this module, we’ll also be working on reflexive verbs. Here are a few:
Julieta Venegas –
Me Voy
Julieta Venegas is an American-born Mexican singer, songwriter, instrumentalist and producer who sings pop-rock in Spanish.
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Sech, Ozuna –
Si Te Vas
Carlos Isaías Morales Williams, better known as Sech, is a Panamanian singer. Juan Carlos Ozuna Rosado, known simply by his surname Ozuna, is a Puerto Rican Latin trap and reggaeton singer.
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Debi Nova, Pedro Capó –
Quédate
Deborah Nowalski Kader, better known by her stage name Debi Nova, is a Costa Rican singer-songwriter who resides in Los Angeles. Pedro Capó is a Puerto Rican musician, singer, songwriter and actor.
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Fania All Stars ft Oscar D’Leon, Milly Quezada, El Canario and others –
Quítate Tu
(Yo Soy La Salsa)
The Fania All-Stars is a musical group formed in 1968 as a showcase for the musicians on Fania Records, the leading salsa music record label of the time.
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The Delirians –
Quitate Tu
The Delirians are the heavy hitters of Californias ever growing traditional ska and reggae scene. (
from the Delirians website
).
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12.7A: Cervical Plexus
The cervical plexus is the plexus of the ventral rami of the first four cervical spinal nerves.
- Describe the cervical plexus and its function
Key Points
- The cervical plexus describes the plexus of the ventral rami of the first four cervical spinal nerves that arise from the cervical spinal column in the neck.
- The cervical spinal nerves that form the cervical plexus are located laterally (farther from the median line) to the transverse processes of the prevertebral skeletal muscles of the neck from the medial side, and vertebral (closer to the vertebral column) to these muscles from the lateral side.
- The cervical plexus forms an anastomosis, a connection, with the accessory nerve, the hypoglossal nerve, and the sympathetic trunk.
- The cervical plexus is located in the neck, internal to the sternocleidomastoid, an anterior neck muscle.
Key Terms
- sympathetic trunk : Also called the sympathetic chain or gangliated cord, these are a paired bundle of nerve fibers that run from the base of the skull to the coccyx.
- plexus : A network or interwoven mass, especially of nerves, blood vessels, or lymphatic vessels.
- platysma : A superficial muscle that overlaps the sternocleidomastoid.
- cervical plexus : A plexus of the ventral rami of the first four cervical spinal nerves that are located from the C1 to C4 cervical segment in the neck. They are located laterally to the transverse processes of the prevertebral muscles from the medial side and vertebral (scalenus, levator scapulae, splenius cervicis muscles) from the lateral side.
Structure and Distribution
The cervical plexus is a plexus of the ventral rami of the first four cervical spinal nerves located from the C1 to C4 cervical segment in the neck. They are located laterally to the transverse processes between prevertebral muscles from the medial side and anteriolateral to the m. scalenus and m. levator scapulae.
There is anastomosis with the accessory nerve, hypoglossal nerve, and sympathetic trunk. It is located deep in the neck, near the sternocleidomastoid muscle.
Nerves formed from the cervical plexus innervate the back of the head, as well as some neck muscles. The branches of the cervical plexus emerge from the posterior triangle at the nerve point, a point that lies midway on the posterior border of the sternocleidomastoid.
Branches and Their Functions
The cervical plexus has two types of branches: cutaneous and muscular.
Cutaneous branches include:
- The lesser occipital nerve, or small occipital nerve, is a cutaneous spinal nerve that arises between the second and third cervical vertebrae, along with the greater occipital nerve. It innervates the scalp in the lateral area of the head posterior to the ear.
- The great auricular nerve originates from the cervical plexus and is composed of branches from spinal nerves C2 and C3. It provides sensory innervation for the skin over the parotid gland and mastoid process, and both surfaces of the outer ear.
- The transverse cervical nerve (superficial cervical or cutaneous cervical) arises from the second and third cervical nerves, turns around the posterior border of the sternocleidomastoideus about its middle, then passes obliquely forward beneath the external jugular vein to the anterior border of the muscle, where it perforates the deep cervical fascia and divides beneath the platysma into ascending and descending branches that are distributed to the antero-lateral parts of the neck.
- The supraclavicular nerves (descending branches) arise from the third and fourth cervical nerves. They emerge beneath the posterior border of the sternocleidomastoideus, and descend in the posterior triangle of the neck beneath the platysma and deep cervical fascia.
Muscular branches include:
- Ansa cervicalis (loop formed from C1–C3), geniohyoid (C1 only), thyrohyoid (C1 only), sternothyroid, sternohyoid, omohyoid: The ansa cervicalis is a loop of nerves that are part of the cervical plexus.
- The phrenic nerve (C3–C5, but primarily C4) is a nerve that originates in the neck and passes down between the lung and heart to reach the diaphragm.
- Segmental branches (C1–C4) innervate the anterior and middle scalenes.
There are two additional branches that are formed by the posterior roots of the spinal nerves:
- Preauricular nerve (from the posterior roots of C2–C3).
- Postauricular nerve (from the posterior roots of C3–C4).
Cervical plexus : Diagram of the cervical plexus.


1.10.15: Gibbs Energies- Salt Solutions- Electric Neutrality
The solid crystalline salt \(\mathrm{NaCl}\) comprises a lattice of sodium \(\mathrm{Na}^{+}\) and chloride \(\mathrm{Cl}^{-}\) ions. The charge number on each sodium ion, \(\mathrm{z}_{+}\), is \(+ 1\); the charge number on each chloride ion, \(\mathrm{z}_{-}\), is \(- 1\). The amount of sodium ions \(\mathrm{ν}_{+}\) produced by one mole of sodium chloride is 1 mol. The amount of chloride ions \(\mathrm{ν}_{-}\) produced by one mole of sodium chloride is 1 mol. The electric charge on the sodium ions in one mole of sodium chloride is \(\left(\mathrm{v}_{+} \, \mathrm{z}_{+} \, \mathrm{N}_{\mathrm{A}} \, \mathrm{e} \right) \mathrm{~C}\) where \(\mathrm{e}\) is the unit charge and \(\mathrm{N}_{\mathrm{A}}\) is the Avogadro constant. The product \(\left(\mathrm{N}_{\mathrm{A}} \, \mathrm{e}\right) \quad\left\{=[\mathrm{C}] .[\mathrm{mol}]^{-1}\right\}\) is the Faraday constant \(\left{=\left[\mathrm{C} \mathrm{mol}^{-1}\right]\right\}\). Similarly the electric charge on the chloride ions in 1 mol of sodium chloride equals, \(\left(\mathrm{v}_{-} \, \mathrm{z}_{-} \, \mathrm{N}_{\mathrm{A}} \, \mathrm{e} \right) \mathrm{~C}\). The total electric charge on one mole of solid sodium chloride equals \(\left[\left(\mathrm{v}_{+} \, \mathrm{z}_{+} \, \mathrm{N}_{\mathrm{A}} \, \mathrm{e}\right)+\left(\mathrm{v}_{-} \, \mathrm{z}_{-} \, \mathrm{N}_{\mathrm{A}} \, \mathrm{e}\right)\right] C\) which equals zero.
We make these points in order to highlight the fact that the total electric charge on 1 mol of sodium cations (in for example 53 g of common salt) is enormous, being 96 500 C. Very few laboratories can handle such enormous electric charges. Chemists cope because the electric neutrality condition always operates [1]. When we set down equations describing the properties of salt solutions we ensure that the electric neutrality condition is not violated. However when we turn to the task of developing molecular models for these systems we recognize the magnitude of the forces involved.
Footnotes
[1] One model of Utopia is a society when there are equal number of men and women. It is interesting to note that from the perspective of each male, the Utopian society has a majority of women. Similarly each woman lives in a male dominated society. Life is the same for ions.


Learning Objectives
After this chapter, you should be able to:
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Compare and contrast different methods of childbirth preparation.
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Describe the stages of vaginal delivery.
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Explain why induction or Caesarean section may be necessary.
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Differentiate the common procedures for assessing the condition of the newborn.
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Examine problems newborns experience before, during, and after birth.
After around 266 days of developing inside the womb (for a full-term pregnancy), comes the arduous process of childbirth. After birth, newborns have to regulate their own body temperature, breathe for themselves, and take in all of their nutrition through feeding. Let’s look at both the process of birth and some attributes of the newborn.
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3.1: Preparing for Childbirth
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Prepared childbirth refers to being not only in good physical condition to help provide a healthy environment for the baby to develop, but also helping individuals to prepare to accept their new roles as parents. Additionally, parents can receive information and training that will assist them for delivery and life with the baby. The more future parents can learn about childbirth and the newborn, the better prepared they will be for the adjustment they must make to a new life.
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3.2: Childbirth
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Childbirth typically occurs within a week of a woman’s due date, unless the woman is pregnant with more than one fetus, which usually causes her to go into labor early. As a pregnancy progresses into its final weeks, several physiological changes occur in response to hormones that trigger labor.
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3.3: The Newborn
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3.S: Summary
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Thumbnail: pixabay.com/photos/baby-slee...y-girl-784608/


3.5: Case Study- Red Bull Wins the “Extreme” Niche
Background
Red Bull is an Austria-based company started in 1987 by Dietrich Mateschitz that sells one product: an energy drink containing taurine (an amino acid) that’s sold in a slim, silver-colored 8.3-ounce can. The drink has been an enormous hit with the company’s target youth segment around the globe. In the year 2018, Red Bull boasted sales of $1.06 billion USD in the United States alone [1] , and has held the majority of the energy-drink market share for years, with a 35.3% market share in 2019 (Monster Energy, their closest competitor, held 25.4%). [2] From Stanford University in California to the beaches of Australia and Thailand, Red Bull has managed to maintain its hip, cool image, with virtually no mass-market advertising.
Red Bull’s Targeted Approach to Marketing
“Red Bull. It gives you wings.” Over the years, Red Bull has organized extreme sports events (like cliff diving in Hawaii and skateboarding in San Francisco), parties, and even music festivals to reinforce the brand’s extreme, on-the-edge image. In 2012, they sponsored Felix Baumgartner’s record-setting freefall from 128,000 feet:
(Note that the following video has limited narration. Access audio description using the widget below the video.)
You can view the transcript for “Felix Baumgartner’s supersonic freefall from 128k’ – Mission Highlights” here (opens in new window) or the text alternative for “Felix Baumgartner’s supersonic freefall from 128k’ – Mission Highlights” (opens in new window).
Their grass-roots approach to reaching the youth market worked: “In terms of attracting new customers and enhancing consumer loyalty, Red Bull has a more effective branding campaign than Coke or Pepsi,” said Nancy F. Koehn, author of Brand New: How Entrepreneurs Earned Consumers’ Trust from Wedgwood to Dell . Red Bull’s success has also gained attention (and concern) among beverage-industry giants, and some have tried to follow its lead: For a time Coke ran a stealth marketing campaign, packaging its cola in a slim can reminiscent of Red Bull and offering it to customers in trendy bars and clubs in New York City.
- “Red Bull Energy Drink Sales U.S., 2015–2018.” Statista. Accessed September 25, 2019. https://www.statista.com/statistics/558082/us-sales-of-red-bull-energy-drinks/ . ↵
- “Energy Drink Market Share in the US in 2019.” Statista. Accessed September 25, 2019. https://www.statista.com/statistics/306864/market-share-of-leading-energy-drink-brands-in-the-us-based-on-case-volume-sales/ . ↵
Contributors and Attributions
- Revision and adaptation. Provided by : Lumen Learning. License : CC BY-SA: Attribution-ShareAlike
- Marketing. Provided by : Boundless. Located at : https://courses.lumenlearning.com/boundless-marketing/ . License : CC BY-SA: Attribution-ShareAlike
- Red Bull Gives you Strobes. Authored by : Aurimas. Located at : www.flickr.com/photos/needoptic/3828156829/. License : CC BY-ND: Attribution-NoDerivatives
- Felix Baumgartner's supersonic freefall from 128k' - Mission Highlights. Provided by : Red Bull. Located at : https://youtu.be/FHtvDA0W34I . License : All Rights Reserved . License Terms : Standard YouTube License


1.1.3: Conversación
Preparación comunicativa 1
Paso 1. Have a look at the following situations, and decide whether you would use a formal or informal register. Justify your answers. In some case, both registers would be appropriate. Explain why.
- Two strangers holding a conversation on the street.
- A patient talking with their doctor.
- You are being interviewed for a new job by your future employer.
- A young boy is having a conversation with his best friend.
- A father is talking with his daughter/son.
- Two neighbors are talking to each other.
Paso 2. With a classmate, create short dialogues for each of the situations in Paso 1 . Use Situations 1-3 and the information in tu vocabulario as guidance (e.g., imagine that people are greeting each other and/or introducing themselves for the first time).
Preparación comunicativa 2
Paso 1. Look at the image below and, with a classmate, create two different dialogues: Introductions (meeting for the first time) and greetings (having already met and seeing each other again). Use Situations 1-3 and the information in the vocabulario as guidance.
By Informedmag, licensed under CC BY 2.0.
Paso 2. What register did you choose for your conversation? Why? Is this the same way you greet your friends? What other expressions can you use in Spanish? Are your classmates’ dialogues similar to yours?
Preparación comunicativa 3
In this section, you will apply what you’ve learned so far to communicate with your peers.
Conversación 1. Imagine that you and your classmate meet on campus. Greet each other using the informal forms. Ask each other how you are doing. Conclude the conversation with a goodbye.
Conversación 2. You are meeting your instructor on the first day of class. Estudiante 1 ( Student 1 ) will play the role of the student and Estudiante 2 ( Student 2 ) will be the instructor. Greet each other using formal and/or informal forms, depending on your role. Make sure you:
- ask the other person how they are doing;
- introduce yourself;
- say where you are from and answer each other’s questions.


6: Periodic Functions
In the previous chapter, the trigonometric functions were introduced as ratios of sides of a right triangle, and related to points on a circle. We noticed how the x and y values of the points did not change with repeated revolutions around the circle by finding coterminal angles. In this chapter, we will take a closer look at the important characteristics and applications of these types of functions, and begin solving equations involving them.
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- 6.3: Inverse Trigonometric Functions
- In previous sections, we have evaluated the trigonometric functions at various angles, but at times we need to know what angle would yield a specific sine, cosine, or tangent value. For this, we need inverse functions. Recall that for a one-to-one function, if f(a)=b, then an inverse function would satisfy f⁻¹(b)=a .
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5.8: Research Starts with Answers
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- Cheryl E. Ball & Drew M. Loewe ed.
- West Virginia University via Digital Publishing Institute and West Virginia University Libraries
Author: Alison Witte,Trine University, Angola, Indiana
The research paper has become a rite of passage where students choose a topic (or are assigned one) about which they present a claim, and then look for ways to confirm it with evidence located through some ambiguous thing or process called research . One of the primary problems with the research paper is that it teaches students that to do research is to look things up—to use the library or the Internet. Skills for locating information are essential to being a successful researcher, as is familiarity with the library and the rich variety of sources available, but it represents only a small part of the research process.
So, what does it really mean to do research ? Research is a threestage process: (1) seeking information that is new to the researcher, (2) interpreting, evaluating, and organizing that information, and (3) reporting that information to others to affect some action. Richard Larson emphasizes that the nature of research is active. The researcher—whether student, academic, or professional— takes an active role in seeking . Seeking is not limited to locating what exists, but also extends to creating new data or information in service of answering a question or solving a problem.
Perhaps some of the confusion over the role of research in writing, and the writing process, comes from the structure of classical argument that is often included as part of the organizational pattern for the research paper. When argument is taught, it’s frequently connected to the historical practices of Greek and Roman rhetoric. Rhetoric, the study of the ways to use language to persuade a listener, was one of the core subjects of formalized education in Greek and Roman times and was seen as a necessary component of democratic citizenship. The study of rhetoric focused on argument as an oral practice of making clear claims in an effort to persuade. Speakers would present their positions, respond to
challenges to their positions, listen to speakers presenting opposing positions, challenge those positions, and adjust their own claims and approaches. Argument was the primary means of conducting governing and legal activities, so participants were expected to be knowledgeable in both the conventions of arguing and in possession of acceptable, logical evidence to support their claims. The process was messy, time-consuming, and in some cases, not the most efficient way to conduct business or legal proceedings. It was viewed as a dynamic interaction that involved speakers going back and forth, and sometimes round and round, in an effort to come to a conclusion. Classical argument, in its basic principles, was meant to be a continual process rather than strictly a completed product.
Oral argument was a cornerstone of university curricula through the Middle Ages, the Renaissance, and into the 18th century. Written forms of argumentation did not take precedence in university settings until the 1800s, and coinciding with increasing specialization found both within and outside of the university. The research paper replaced oral exams and public speaking as a measure of intellect; and it was initially successful at fostering and promoting the creation of knowledge in local communities. The use of the research paper proliferated until it became the primary genre students write—a genre less about creating knowledge and more about compiling it.
Subsequently, the research paper became a tool for teaching students how to use the library, find the right words, and skillfully search through the words of others. Such a task eliminates the writer’s voice from the conversation—as they are not required to participate in the discussion of the subject at hand, but simply to report what others have said about it. Because they are not active participants in the conversation, when students are taught by their textbooks and teachers to make a claim supported by reasons at an early stage of developing their argument, they have no real stake in the claim they make, nor any real grounds for making such a claim. Their choices are often arbitrary and rote, based in what they believe they know, in what they are comfortable with, or in what they believe will lead to many easy-to-find, readily accessible sources. They see no purpose for their claim other than completing the assignment. Nonetheless, this claim becomes the thesis statement of the paper and is to be the foundation of the work that follows.
Teaching students the purpose of doing research is supporting an idea or belief one already holds is not teaching students about research. In fact, the name research paper is, in itself, misleading, as it implies that research is a practice only used in a particular genre or instance, rather than as a fundamental element of nearly all forms of academic, workplace, or personal writing. Researching isn’t meant to be a narrow task of looking up information, but of creating and discovering new information in response to problems. Describing research in these limited terms does not prepare students to participate in actual research in their courses of study and in their professional fields.
A more useful approach to teaching students about research, and how to do research, begins with re-thinking how we define research and research skills. If research is the process by which a researcher seeks new information, makes sense of that information, and then reports that information to someone else, then research ought to begin with a question, not an answer. Students need to be taught not to look for answers, but to look for problems that need solving and for questions that need to be answered.
Rather than limiting the conception of research to a search for certain facts or pieces of evidence or to a trip to the library, it needs to include the processes of primary research—research collected directly by the researcher using tools he or she has designed to find the information needed to answer a particular question. I am not suggesting that secondary research—the locating of previously published materials—be eliminated, but that it not be presented as the paramount form of research, as is often done in the research paper. Secondary research is a key part of the research process and usually precedes any primary research. Once a researcher has a question, it’s logical to see if and how others might have answered the same question. To be successful, students, and any researchers, must have a working knowledge of the question they are investigating. However, that information serves as a starting point for researchers, who then ask further questions to spur and design their own primary research.
Primary research provides students with opportunities to engage with people around them, to work collaboratively, to think critically about the best way to accomplish the task of getting the information they need to answer their questions, to learn how to manage and organize data, and to learn to interpret data. Because students need to work with people around them to develop ideas and locate problems to research and solve, primary research encourages students to see the ways in which research might help or benefit the people around them in their local communities.
Additionally, working on primary research as a component of a class engages students with one another as they share their struggles, progress, and successes. They have the opportunity to learn both from their own experiences and each other. Students engaged in primary research also have to design their own tools (surveys, interview questions, experiments, etc.) to accomplish their particular goals. They can test versions and make modifications, adapting to changes in their research question, or problems that arise during the process. The need for such adaptability breaks students of the conception that there is a way to get the answers that they need, preparing them to be adaptable in situations beyond the classroom.
Once the definition of research shifts from information locating and idea confirmation to information generating and problem solving, the ways students write about research needs to change. The genre of the academic research report requires students to present the findings of their research in a clear, logical fashion, while also documenting their processes and opening their work to be critically examined by others. The research report also typically necessitates a literature review—a collection of published and cited research related to the topic at hand—that provides the impetus for the student’s project and to show how the project extends what has already been done and provides new insight or knowledge. Thus, the research report gives students practice at both primary and secondary research, while allowing them to pursue genuine research questions.
Having students design and pursue genuine research projects that generate rather than simply locate information teaches them that research is about innovation—about doing what hasn’t been done. It also demonstrates to them that research is a useful tool not only for learning, but also for action. Information gained from research can be used to impact their schools, homes, workplaces, and communities. Then, much as the ancient Greeks viewed classical argument as an essential part of citizenship, participating in genuine research and research writing becomes a key part of engaged and productive citizenship in the 21st century.
Further Reading
For further information about the historical understandings and practices of rhetoric, see Aristotle’s On Rhetoric . Additionally, Walter Ong’s Orality and Literacy (Routledge) and David Russell’s Writing in the Academic Disciplines 1870–1990: A Curricular History
(Southern Illinois University Press) discuss the shift from oral to literate culture and how the introduction of writing affected the ways people thought about and communicated about the world around them.
For more on the prevalence and use of the research paper, see James Ford and Dennis Perry’s “Research Paper Instruction in Undergraduate Writing Programs: National Survey” ( College English ) . Richard Larson’s “The ‘Research Paper’ in the Writing Course: A Form of Non-Writing” ( College English ), Robert Connors’s Composition-Rhetoric: Backgrounds, Theory, and Pedagogy (U of Pittsburgh Press), and Audrey Roth’s The Research Paper: Process, Form, and Content . (Cengage Learning) look at the pedagogy of the research paper, while Robert Davis and Mark Shadle’s “‘Building a Mystery’: Alternative Research Writing and the Academic Act of Seeking” ( College Composition and Communication ) offer some mixed/ multi-genre alternatives to the traditional research paper.
Keywords
argument, claim-based writing, classical argument, data-driven writing, research paper, research writing, rhetoric
Author Bio
Alison Witte is an associate professor of humanities and communication at Trine University in Angola, Indiana. She has been teaching research writing to college students for 10 years. She regularly teaches courses in research writing, research methods, technical writing, and advanced composition, and has co-developed curriculum for teaching research writing to international graduate students. She also chairs her university’s Institutional Review Board, which reviews and approves all campus research projects with human participants. Her research interests include student research practices, digital pedagogy, digital pedagogy preparation, and non-classroom writing. Her twitter handle is @acwitte82.


28.5: Relativistic Momentum
Learning Objectives
By the end of this section, you will be able to:
- Calculate relativistic momentum.
- Explain why the only mass it makes sense to talk about is rest mass.
In classical physics, momentum is a simple product of mass and velocity. However, we saw in the last section that when special relativity is taken into account, massive objects have a speed limit. What effect do you think mass and velocity have on the momentum of objects moving at relativistic speeds?
Momentum is one of the most important concepts in physics. The broadest form of Newton’s second law is stated in terms of momentum. Momentum is conserved whenever the net external force on a system is zero. This makes momentum conservation a fundamental tool for analyzing collisions. All of Work, Energy, and Energy Resources is devoted to momentum, and momentum has been important for many other topics as well, particularly where collisions were involved. We will see that momentum has the same importance in modern physics. Relativistic momentum is conserved, and much of what we know about subatomic structure comes from the analysis of collisions of accelerator-produced relativistic particles.
The first postulate of relativity states that the laws of physics are the same in all inertial frames. Does the law of conservation of momentum survive this requirement at high velocities? The answer is yes, provided that the momentum is defined as follows.
Definition: Relativistic Momentum
Relativistic momentum \(p\) is classical momentum multiplied by the relativistic factor \(\gamma\)
\[p = \gamma mu,\]
where \(m\) is the rest mass of the object, \(u\) is its velocity relative to an observer, and the relativistic factor
\[\gamma = \dfrac{1}{\sqrt{1 - \dfrac{u^2}{c^2}}}.\]
Note that we use \(u\) for velocity here to distinguish it from relative velocity \(v\) between observers. Only one observer is being considered here. With \(p\) defined in this way, total momentum \(p_{tot}\) is conserved whenever the net external force is zero, just as in classical physics. Again we see that the relativistic quantity becomes virtually the same as the classical at low velocities. That is, relativistic momentum \(\gamma mu\) becomes the classical \(mu\) at low velocities, because \(\gamma\) is very nearly equal to 1 at low velocities.
Relativistic momentum has the same intuitive feel as classical momentum. It is greatest for large masses moving at high velocities, but, because of the factor \(\gamma\), relativistic momentum approaches infinity as \(u\) approaches \(c\) (Figure \(\PageIndex{2}\)). This is another indication that an object with mass cannot reach the speed of light. If it did, its momentum would become infinite, an unreasonable value.
MISCONCEPTION ALERT: RELATIVISTIC MASS AND MOMENTUM
The relativistically correct definition of momentum as \(p = \gamma mu\), is sometimes taken to imply that mass varies with velocity: \(m_{var} = \gamma m\), particularly in older textbooks. However, note that \(m\) is the mass of the object as measured by a person at rest relative to the object. Thus, \(m\) is defined to be the rest mass, which could be measured at rest, perhaps using gravity. When a mass is moving relative to an observer, the only way that its mass can be determined is through collisions or other means in which momentum is involved. Since the mass of a moving object cannot be determined independently of momentum, the only meaningful mass is rest mass. Thus, when we use the term mass, assume it to be identical to rest mass.
Relativistic momentum is defined in such a way that the conservation of momentum will hold in all inertial frames. Whenever the net external force on a system is zero, relativistic momentum is conserved, just as is the case for classical momentum. This has been verified in numerous experiments.
In Section on Relativistic Energy , the relationship of relativistic momentum to energy is explored. That subject will produce our first inkling that objects without mass may also have momentum.
Exercise \(\PageIndex{1}\)
What is the momentum of an electron traveling at a speed \(0.985 c\)? The rest mass of the electron is \(9.11 \times 10^{-31} \, kg\).
- Answer
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\[ \begin{align*} p &= \gamma mu \\[5pt] &= \dfrac{mu}{\sqrt{1 - \frac{u^2}{c^2}}} \\[5pt] &= \dfrac{(9.11 \times 10^{-31} kg) (0.985 c)(3.00 \times 10^8 m/s)}{\sqrt{1 - \frac{(0.985 c)2}{c^2}}} \\[5pt] &= 1.56 \times 10^{-21} kg \cdot m/s \end{align*} \]
Summary
- The law of conservation of momentum is valid whenever the net external force is zero and for relativistic momentum. Relativistic momentum \(p\) is classical momentum multiplied by the relativistic factor \(\gamma\)
- \(p = \gamma mu\), where \(m\) is the rest mass of the object, \(u\) is its velocity relative to an observer, and the relativistic factor \(\gamma = \frac{1}{\sqrt{1 - \frac{u^2}{c^2}}}.\)
- At low velocities, relativistic momentum is equivalent to classical momentum.
- Relativistic momentum approaches infinity as \(u\) approaches \(c\). This implies that an object with mass cannot reach the speed of light.
- Relativistic momentum is conserved, just as classical momentum is conserved.
Glossary
- relativistic momentum
- \(p\), the momentum of an object moving at relativistic velocity; \(p = \gamma mu\), where \(m\) is the rest mass of the object, \(u\) is its velocity relative to an observer, and the relativistic factor \(\gamma = \frac{1}{\sqrt{1 - \frac{u^2}{c^2}}}\)
- rest mass
- the mass of an object as measured by a person at rest relative to the object


1.8: Other Types of Patents
After completing this section, you will be able to
- Explain the differences among utility, plant, and design patents.
- Describe common patent misconceptions.
Up to this point, we have focused only on the most common types of patents, called utility patents , which preclude others from making, using, or selling the invention during the term of the patent, which begins on the grant date and ends 20 years from the filing date (for an average of 17 to 18 years). But in addition to these, the Patent Act also provides for two other types of patents— plant patents and design patents .
Plant Patents
Plant patents were first created by the Patent Act of 1930 , which had been proposed by Luther Burbank to protect new species of asexually reproduced plants, mostly flowers. These are different than the utility patents granted to bioengineered plants used in agriculture. The United States was the first country in the world to grant plant patents, and even today many countries continue to deny protection for plants. Indeed, even some signatories to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) administered by the World Trade Organization (WTO) reserve the right to deny patents for plants.
Although the requirements for plant and design patents are substantially the same as those for utility patents, there are some crucial differences. The most important of these is the substitution of a different test for one of the three criteria for patentability discussed in the previous section.
Instead of novelty, utility, and non-obviousness, the criteria for plant patentability are novelty, distinctiveness , and non-obviousness. To be patentable, plants must be cultivated rather than found in the wild, and plant patents are granted only to protect a new, distinct, and non-obvious variety of asexually reproduced plant—i.e., those grown not with seeds but by grafting, budding, or cutting. A plant need not be useful to qualify for a patent, but it must be distinctive in its color, habit, soil, flavor, productivity, form, or other aspects.
Design Patents
Design patents are granted to protect new, original, and non-obvious ornamental designs for articles of manufacture. Examples include Apple’s 2009 and 2010 patents— No. D593087 and No. D618677 —which covered among other things the unique, rounded-corner design of the iPhone, as well as its 2005 design patent No. D504889 for the look and feel of the iPad. Design patents can be just as valuable as utility patents, as Apple discovered when a jury awarded it $1 billion in damages against Samsung in August 2012, for the latter’s infringement of Apple’s utility and design patents. The case is currently on appeal.
Like plant patents, design patents also substitute a different test than utility in their requirements for patentability. Instead of the novelty, utility, and non-obvious requirements for utility patents, the criteria for design patents are novelty, ornamentality , and non-obviousness.
It was on the subject of design patents that one example of media confusion appeared. The New York Times published an article November 16, 2012, declaring in a sensational headline that “ Apple Now Owns the Page Turn .” The article claimed that a new Apple design patent “gives Apple the exclusive rights to the page turn in an e-reader application.” According to the article’s author, this showed “just how broken the patent system is.”
Had the author of the article even read an obvious and easily-available source as the Wikipedia entry on design patents, however, he would have learned that design patents are granted only for nonfunctional ornamental designs. In fact, says Wikipedia, “design patents can be invalidated if the design has practical utility.”
What Apple actually “owns,” therefore, is not the “page turn” function itself but merely the particular ornamental design of the way a page turn is executed in their devices.
Another example of confused media reporting on patent matters was the February 6, 2013, Forbes article headlined: “ Is the Patent System Broken? Well, Amazon’s Just Patented the Sale of Second Hand Goods .” Amazon actually did no such thing, but the author of that article probably made this assumption after reading the abstract of the patent describing its general subject matter. Like many reporters new to patent issues, the author didn’t realize that the abstract tells you literally nothing about the exclusive rights conferred by a patent. Only the claims of the patent detail the specific exclusionary rights of the patent holder.
Indeed, when you read the claims of the Amazon patent in question, you discover that Amazon hasn’t claimed ownership of the idea of a “market in second-hand digital goods” at all. Instead, the claims involve merely a very specific and novel method of conducting such a market. Meanwhile, Apple, ReDigi, and other firms have patented their own alternative methods of conducting a secondary digital market.