Cognitive Development in Young Children with a CHD
Ages 1 - 4 Years
Young children are growing and changing rapidly, both in their bodies and in their brains. They tend to be curious, imaginative, and inquisitive, and eager to explore their world. Young children with heart defects are just as enthusiastic about learning as other children, but sometimes they face unique obstacles that can make learning hard. Intervention can help all children to make the best progress they can.
In this section
Cognitive development in early childhood
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 preschoolers generally learn an enormous amount about how the world works: They recognize objects, places, people and animals. They learn routines, and discover how to solve simple problems.
Toddlers’ and preschoolers’ thinking is usually no longer limited to the real world. They generally have a good imagination, and can make up characters, objects, and storylines. Sometimes, they are not sure what is real, and what is pretend, and they may invent magical explanations for events.
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Developmental milestones in context
Every child learns at their own pace, and there is a wide range of healthy development. Sometimes children make rapid progress in a particular skill, and at other times they seem to stall, or even lose skills. Delays are not always a sign of a bigger problem, and intervention can always help children to make progress.
Despite this natural unevenness and variability, most children reach certain cognitive milestones some time during early childhood. Awareness of typical development can help caregivers to know when to seek help if it is needed.
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Typical cognitive development, ages 1 - 2
Some time when they are 1 or 2, most toddlers learn to:
Point to interesting things
Look at something that someone else is pointing to
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
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Typical cognitive development, ages 3 - 4
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 that 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
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Challenges to typical cognitive development
Young children are naturally curious. They are eager to explore, and hungry to learn.
However, sometimes children with congenital heart defects face obstacles to their learning. For example, 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
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Differences in cognitive development
Sometimes, young children with heart defects develop more slowly than other children. With intervention, most children with heart defects can catch up with their peers. Other children do not catch up, but intervention can help them to make the best possible progress. 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 have any concerns about how your child is developing, tell your doctor. Your doctor can help to get your child an evaluation and appropriate services. Remember: every child can learn, and help is always available.
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Help for cognitive development
Each child follows their own path. Most children develop in an expected way, and some children develop in a more unusual way. All children can make progress with love, attention, and intervention, and all children can bring joy to those lucky enough to care for them.
If parents have questions or concerns about their child’s emotional development, help is always available. Families can seek help from their local doctor or cardiac neurodevelopmental program, and can get connected to services such as Early Intervention (EI), preschool Special Education, speech and language therapy, and occupational therapy (OT).
Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.
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