About the author:
Dr. Aimee Ketchum is a pediatric occupational therapist with over 24 years of experience working in pediatrics. She currently practices in the neonatal intensive care unit at UPMC hospital in Lititz where she founded the NICU retired nurse cuddler program. Ketchum is also academic fieldwork coordinator and assistant professor of early childhood development in the occupational therapy doctorate department of Cedar Crest College. Ketchum creates and teaches workshops on early child development through PA Quality Assurance System for pre-school teachers and early intervention practitioners. Ketchum is the founding director of Aimee’s Babies, LLC and creator of STEM Starts Now digital parenting program. She aims to create a next generation of innovators and problem solvers who are all afforded the ability to start kindergarten on an equitable playing field, giving all children everywhere the best start possible. Ketchum recently had her book “See Occupational Therapists Run” published by See Us Run Publishing. This is a workbook to help fellow occupational therapists practice self-care to avoid burnout. Her baby development DVDs and apps have been featured on the Rachael Ray show, iPhone Essentials Magazine and the United Kingdom’s Baby and You Initiative. She was the winner of the 2017 Fine Living Lancaster Innovator Award, and the 2018 Social Enterprise Pitch and her work has been recognized with the prestigious Word Gap Challenge Finalist award from the U.S. Department of Health and Human Services.
When we realize that one event occurs after another event, we are likely to conclude that the first event caused the second event to happen. We draw these causal conclusions all day long and they greatly affect how we learn. If we get blisters every time we wear ill-fitting shoes, we learn to stop wearing ill-fitting shoes. Babies begin to draw conclusions to learn about their world as early as three months of age (Gopnik, 1999). Studies show that babies are remarkably able to make inferences and learn new information without prior knowledge (Shultz et al., 2008).
When scientists tied a ribbon to a mobile and to the foot of a three-month-old-baby, the baby quickly learned that the physical action of kicking their foot made the mobile move and they are apt to try this trick over and over again (Rovee-Collier, 1990). Very young babies also learn important social lessons through cause and effect. They learn that when they cry, their needs are met by doting parents and caregivers who quickly respond to comfort them (Hyunjoo, Dale, & Kimbrough, 2018).
By the time babies are eight months old, they are usually intentionally throwing items over the edge of the high-chair tray to see if we will pick them up, splashing the bath water to watch it slosh over the edge of the tub, and banging blocks together to hear the loud sound.
Babies also use communication to learn cause and effect by making sounds to get parents attention and even babbling in back-and-forth conversations with parents.
Babies learn cause and effect by performing an action, then using all of their senses to observe the results. What happens when a baby has a disability or a delay? It is important that all children have access and can participate in learning experiences to practice manipulating their world and observing the effects. For children with disabilities, adaptations to the environment, materials, and/or instruction can provide opportunities to fully participating in learning experiences.
Let’s begin by considering the baby’s positioning and asking ourselves: Are babies positioned so they can see and touch their toys? Tummy time or supported sitting are great positions for babies to visually observe their world. If babies are unable to hold their head up in tummy time, they can be positioned on their side with both arms in front of them and simple toys within reach.
Next, present developmentally appropriate and stimulating toys or objects. Some babies with disabilities may have a sensory delay making it important to engage as many senses as possible. Toys and objects should be visually stimulating, textured for tactile input, make noises for auditory input, and can even be scented. Adaptations can also be made to toys/objects so that children with disabilities can engage with them.
In addition to proper positioning and providing developmentally appropriate and stimulating toys, families and caregivers can take an active role in helping babies learn cause and effect by talking with babies and engaging in interactive play. If children are unable to grasp a toy, it can be placed into their hand, or the hand-over-hand technique can be used so babies feel the tactile sensation. Some studies show that babies can learn cause and effect from observing other people interacting with an object and causing that object to change (Saxe, Tenenbaum, & Carey, 2007; Meltzoff, Waismeyer, & Gopnik, 2012). Families can encourage babies to watch them stack blocks, then bring the baby’s hand to the blocks to knock them down, so the baby observes the action and takes part in the effect.
Strategies to explore and develop concepts of cause and effect with children at all ages and abilities. Note that the ages are estimates:
- Respond to baby’s cries in a timely manner to teach them that their needs will be met.
- Wrist and bootie rattles are great for body awareness and learning that simple actions produce a noise.
- Talk to babies all day to provide a foundation for language and pause for baby’s response after a question even before babies can talk and respond.
- Hold baby and turn light switches on and off, narrating what you are doing and why. *Do not do this if baby has epilepsy. Point out that the light is controlled by the switch. Encourage baby to try.
- Provide toys or objects that stimulate all of the senses.
- If babies are unable to hold and manipulate toys, do it hand-over-hand or adapt the materials to support exploration. Visit STEMIE’s Guide to Adaptations here
- Water play or bathtime is a great sensory activity that teaches cause and effect because water reacts to movement. Use language as you play such as “full”, “empty”, “dump”, and “splash”.
- Allow babies a lot of floor time with a variety of toys and household objects at their level to explore.
- Respond to baby’s utterances and other forms of communication, begin to have back and forth conversations.
- Allow babies to learn to walk barefoot on different surfaces (e.g., grass, carpet) so they experience the textures on the bottom of their feet and learn how foot movements affect balance.
- Explore sounds and music using musical instruments, household objects or loose parts (e.g., pots, ladles, plastic containers, cardboard boxes) because movement and sound are a fun way to learn cause and effect. Children who are deaf can also feel sounds and music and explore rhythms, pulses, and vibrations.
- Mirrors are great for babies to see how their body moves and what their funny faces look like.
- As baby’s vocabulary grows, continue to have back and forth interactions and communication, ask and answer questions.
- Outdoor play offers opportunities to engage different senses and use larger muscle groups to manipulate the world and learn from it. Perhaps children can skip a rock in a pond to watch the ripples form or walk on a path with muddy footprints and observe the footprints being formed.
- Interactive play with other children teaches social cause and effect skills for all children.
Interactive and guided play, vast sensory experiences, back-and-forth conversations and communication, and lots of floor time with developmentally appropriate and safe toys and household objects within reach will help children start to understand concepts of cause and effect before they even have their second birthday.
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