Caring for Our Children (CFOC)

Chapter 2: Program Activities for Healthy Development

2.1 Program of Developmental Activities

2.1.2 Program Activities for Infants and Toddlers from Three Months to Less Than Thirty-Six Months Personal Caregiver/Teacher Relationships for Infants and Toddlers

Content in the STANDARD was modified on 05/30/2018.

The facility should practice a relationship-based philosophy that promotes consistency and continuity of caregivers/teachers for infants and toddlers (1-3). Facilities should implement continuity of care practices into established policies and procedures as a means to foster strong, positive relationships that will act as a secure basis for exploration and learning in the classroom (1-4). Child–caregiver relationships based on high-quality care are central to brain development, emotional regulation, and overall learning (5). The facility should encourage practices of continuity of care that give infants and toddlers the added benefit of the same caregiver for the first three years of life of the child or during the time of enrollment (6). The facility should limit the number of caregivers/teachers who interact with any one infant or toddler (1).

The caregiver/teacher should:

  1. Use a variety of safe and appropriate individualized soothing methods of holding and comforting infants and toddlers who are upset (7).
  2. Engage in frequent, multiple, and rich social interchanges, such as smiling, talking, appropriate forms of touch, singing, and eating.
  3. Be play partners as well as protectors.
  4. Be attuned to infants’ and toddlers’ feelings and reflect them back.
  5. Communicate consistently with parents/guardians.
  6. Interact with infants and toddlers and develop a relationship in the context of everyday routines (eg, diapering, feeding).

Opportunities should be provided for each infant and toddler to develop meaningful relationships with caregivers.

The facility’s touch policy should be direct in addressing that children may be touched when it is appropriate for, respectful to, and safe for the child. Caregivers/teachers should respect the wishes of children, regardless of their age, for physical contact and their comfort or discomfort with it. Caregivers/teachers should avoid even “friendly” contact (eg, touching the shoulder or arm) with a child if the child expresses that he or she is uncomfortable.


When children trust caregivers and are comfortable in the environment that surrounds them, they are allowed to focus on educational discoveries in their physical, social, and emotional development.

Holding, and hugging, in a positive, respectful, and safe manner is an essential part of providing care for infants and toddlers.

Quality caregivers/teachers provide care and learning experiences that play a key role in a child’s development as an active, self-knowing, self-respecting, thinking, feeling, and loving person (8). Limiting the number of adults with whom an infant or a toddler interacts fosters reciprocal understanding of communication cues that are unique to each infant or toddler. This leads to a sense of trust of the adult by the infant or toddler that the infant’s or toddler’s needs will be understood and met promptly (5,6). Studies of infant behavior show that infants have difficulty forming trusting relationships in settings where many adults interact with infants (eg, in hospitalization of infants when shifts of adults provide care) (9).

Sexual abuse in the form of inappropriate touching is an act that induces or coerces children in a sexually suggestive manner or for the sexual gratification of the adult, such as sexual penetration and/or overall inappropriate touching or kissing (10).

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation Immunity for Reporters of Child Abuse and Neglect Preventing and Identifying Shaken Baby Syndrome/Abusive Head Trauma Care for Children Who Have Experienced Abuse/Neglect
Appendix M: Recognizing Child Abuse and Neglect
Appendix N: Protective Factors Regarding Child Abuse and Neglect
  1. Zero to Three. Primary caregiving and continuity of care. Published February 8, 2010. Accessed January 11, 2018

  2. National Scientific Council on the Developing Child. The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain: Working Paper 12. Published December 2012. Accessed January 11, 2018

  3. Harvard University Center on the Developing Child. Three principles to improve outcomes for children and families. Accessed January 11, 2018

  4. Recchia SL. Caregiver–child relationships as a context for continuity in child care. Early Years. 2012;32(2):143–157

  5. US Department of Health and Human Services, Child Care State Capacity Building Center. Six essential program practices. Program for infant/toddler care. Published January 2017. Accessed January 11, 2018

  6. Ruprecht K, Elicker J, Choi J. Continuity of care, caregiver–child interactions, toddler social competence and problem behaviors. Early Educ Dev. 2015;27:221–239

  7. Kim Y. Relationship-based developmentally supportive approach to infant childcare practice. Early Child Dev Care. 2015:734-749

  8. Understanding children’s behavior. In: Miller DF. Positive Child Guidance. 8th ed. Boston, MA: Cengage Learning; 2016

  9. Sandstrom H, Huerta S. The negative effects of instability on child development: a research synthesis. Urban Institute Web site. Published September 18, 2013. Accessed January 11, 2018

  10. Al Odhayani A, Watson WJ, Watson L. Behavioural consequences of child abuse. Can Fam Physician. 2013;59(8):831–836


Content in the STANDARD was modified on 05/30/2018.