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Family guide to early childhood development

Your companion for ages 1 - 4

Early childhood is an exciting time, full of rapid change and discovery.  It can also be a challenging time, as little ones assert their independence and experiment with new skills. 

When your young child has a CHD, early childhood can be especially challenging. 

As caregivers, you want to do the right thing for your child and your family.  This guide can help you to navigate these wonderful and bewildering years with confidence.   

Starting with the basics

What to do right now

Do you want to support your young child’s development, but aren’t sure where to start?  

Don’t worry: we can help.  We’ve highlighted the most important things you can do right now to support your young child’s healthy development.   

Domains of child development

Understanding domains of development

As children grow up, they develop in multiple skill area at the same time. We call these skill areas “domains of development.”   

Some children develop pretty evenly across domains. Other children develop quickly in some domains, and more slowly in others.   

When you think about your child’s development, you may find it helpful to think about how they are doing in each domain.  

Then, you can use this knowledge to nurture your child’s strengths, and support their weaknesses.   

Think includes understanding, recognizing patterns, solving problems, learning. It is also called “cognitive development.” 

Move includes using arms and legs, using hands, balance, coordination, strength. It is also called “motor development.”  

Talk includes talking or signing, listening, understanding, communicating.  It is also called “language development.”

Connect includes understanding other people, social skills, relationships.  It is also called “social development.” 

Feel includes self-regulation, understanding emotions, managing feelings.  It is also called “emotional development.”  

Exploring your child’s development

 Cognition is how a child learns, thinks, solves problems, and understands. During early childhood, the brain grows quickly, and children discover new ways to make sense of what is around them. 

Toddlers and preschools learn an enormous amount about how the world works:  They recognize objects, places, people and animals. They learn routines. They discover how to solve simple problems. 

However, toddlers and preschools are not limited to the real world.  They usually have a good imagination, and can make up characters, objects, and storylines.  Sometimes, they are not be sure what is real, and what is pretend.  

Typical skills most young children learn

Every child learns at their own pace, and there is a wide range of healthy development. Delays are not always a sign of a problem, and intervention can always help children to make progress.

However, most children reach certain milestones some time during early childhood.

Some time when they are 1 or 2, most toddlers learn to: 

  • Point to interesting things 

  • Look at something when someone else points 

  • Use some words 

  • Use gestures like waving and nodding 

  • Understand many words and sentences 

  • Solve simple puzzles 

  • Match shapes 

  • Put objects inside a container 

  • Look for a hidden toy or person 

  • Sing familiar songs 

  • Play simple pretend games 

  • Play with a variety of toys, like cars, dolls, and blocks 

  • Scribble with crayons or markers 

  • Follow one-step directions 

  • Look at and name familiar things 

  • Look at and name pictures of familiar things 

Some time when they are 3 or 4, most children learn to:

  • Have back-and-forth conversations using full sentences 

  • Understand a picture book 

  • Pretend an object is something else (example: a banana is a phone) 

  • Act out scenes and stories when they play 

  • Answer questions about things they did 

  • Describe a picture 

  • Say how they are feeling (example: thirsty, sleepy, mad) 

  • Follow directions with 2 or 3 parts 

  • Ask a lot of “why” questions 

  • Solve a simple jigsaw puzzle 

  • Fill and empty containers 

  • Look at small sets of objects, and know which are “more” or “less” 

  • Remember and recite a song or rhyme 

  • Make up a story 

Cognitive challenges, delays, and differences

Children with CHDs face a lot of challenges, and sometimes they have delays or disabilities in their development. When you know what to look for, you can find and target appropriate interventions.

Remember: every child develops at their own pace. If your child behaves more like a younger child, you may want to explore the 0-12 month parent guide for ideas.

Young children are naturally curious.  They are eager to explore, and hungry to learn. 

However, sometimes children with CHDs face obstacles to their learning.

 Children may have a harder time learning if they: 

  • often feel sick 

  • often feel very tired 

  • are often in the hospital 

  • cannot go to daycare or school 

  • cannot be around many people 

  • have a genetic syndrome that affects brain development 

  • have a brain injury 

Sometimes, young children with CHD’s develop more slowly than other children.   

With intervention, most children with CHDs can catch up with their peers.  Other children do not catch up, but intervention can help them to make progress, and to feel accomplished.  

When a young child has a cognitive delay, they might: 

  • show little interest in people or objects 

  • not speak, or speak very little 

  • not understand what people say 

  • not understand or use gestures 

  • not show people things 

  • not play pretend 

  • not pay attention to books or pictures 

  • play with the same toy the same way for longer than is typical 

  • not seem to understand the effect of common actions 

  • not know how to play with toys like dolls and cars 

  • behave in a way that is more typical of a baby 

If you notice that your child is struggling in any of these ways, tell your doctor. Remember: every child can learn, and help is always available. 

Understanding Global Developmental Delay

Have you heard this term, and are wondering what it means?

Doctors sometimes give young children a diagnosis to describe their delay or disability.  A diagnosis can help to capture what a child is experiencing, and it can help the family to get the services they need.


Supporting Your child's thinking and learning

Young children (ages 1-4) learn from playing, and from interacting with other people.  Any time you are playing or talking with your child, they are learning.  Here are some more specific ideas to help you feel confident that you are doing the very best for your child. 


Services to support thinking and learning

As a parent, you doubtless want to do everything you can to help your child develop their thinking, learning, and understanding.  Experts are available to support you, and to teach your child important skills.

You do not need to do this alone. 

The Power Of Intervention

Interventions for development

Children' brains are still developing, and are astonishingly "plastic," meaning they can change, grow, and heal. Developmental interventions can literally build and rewire a child's brain.

Early, appropriate intervention can help children to learn new skills and concepts, and meet developmental milestones.

Explore the selected interventions below, or visit our Power of Intervention page. Help is always available.

A heart story

Share your heart story!

Do you have a young child with a CHD who has overcome a developmental challenge? We want to hear about it and see their smiling face! We may be able to feature their story here.

Email CNPschedulingandquestions@childrens.harvard.edu to tell YOUR heart story.

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