The present doctoral thesis focuses mainly on the experiences of 20 women and men of becoming and being parents of a prematurely born child and on their perceptions of their contacts with health and medical care services. An additional aim was to investigate the utilisation of health care during the first year of life and its relation to high-risk diagnoses in the neonatal period. Data were obtained by interviews of the 20 sets of parents to infants born at a gestational age of <34 weeks with no serious congenital defects. These parents were interviewed 1-2 weeks after the infant’s birth and at 2, 6 and 18 months of age. The interview texts were subjected to phenomenological and content analysis. Data was also obtained from the records of 36 infants born at a gestational age of <31 weeks and with a birth weight of <1500 g and 36 full-term infants. The records included information regarding contact with health care services including the child health centres (CHCs) and the outpatient clinics of the paediatric and ophthalmic clinics. Finally data from the other two quantitative studies were obtained from three questionnaires: Quality of Care from The Patient’s Perspective, The Swedish Parenthood Stress Questionnaire and The Toddler Behaviour Questionnaire. The result of the studies showed that the utilisation of health care by the very low birth weight infants was higher than that by the fullterm infants in paediatric and ophthalmic outpatient clinics. High-risk diagnoses in the neonatal period did not correlate with utilisation of care except for visits to the paediatric outpatient clinic, especially planned visits. The internalisation of parenthood was described by the parents as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity. The development and construction of the mothers’ and fathers’ parental identity followed a pattern that could be summarised into three themes: Unexpected start of parenthood, integration of parenthood into the sense of identity and recognition of parental identity. Important turning points in experiences of parenthood often occurred when the infant could be removed from the incubator, when it was discharged from the ward, and when the infant appeared normal compared to full-term infants. The quality of care was judged, from the parents’ and nurses’ perspective. In general the subjective importance of the given care was rated higher than the care actual given in both neonatal care and care at the CHCs. Higher ratings were given to neonatal care compared with the care at CHSs for medico-technical competence. It was also of importance, of both parents, to receive an optimal identity-oriented approach and socio-cultural atmosphere in the neonatal care and the care at the CHSs. High-risk diagnoses in the newborn did not affect the answers. Parental stress of very preterm children, at 18 months of age, did not differ notably from those parents of children born somewhat less premature, but they assessed their children as being rather later in the development of social behaviours. Parents of children who had had a difficult neonatal period were not more stressed when the child was 18 months old than those who had no problems in the neonatal period. In sum, this research project showed that the parents’ expectations and experiences of becoming mothers and fathers in preterm birth was a process of integrating the unexpected start of parenthood into the parents’ sense of identity and their way of being. When the parents developed a relationship with the infant, actively participated in its care on the basis of their own preferences, and received recognition as parents, this process was strengthened. It is therefore important that the professional caring of the staff should meet and involve the natural caring of the parents.

The purpose of the study is to investigate the toddlers’ communicative strategies to the teachers in their way to reach influence in the preschool. The purpose is to make further investigations how teachers’ common experiences and interpretations of toddlers’ communicative signals to reach influence. The questions are: How the toddlers communicate to the teachers, their wish to take part of influence in the preschool? How do the toddlers reveal their intersubjective ability, in the communication with the teachers? How can teachers’ experiences help us to interpret the toddlers’ communicative strategies to their influence? We’ve used a qualitative research, with a phenomenological base, to carry out our study. The 1st step was to observe 1-2 years old toddlers, in two different units in a preschool. The 2nd step was to implement focus group discussionswith the teachers in the two different units. This two-combined steps gave us a lot of empiric material. Our theoretical approach is based on the theory of phenomenology of perception (Maurice Merleau-Ponty) and the theory of intersubjectivity (Daniel Stern). With the concepts: life-world, the sense of a subjective self and the sense of a verbal self, we seek the essence of how the toddlers use the body language to think, perceive and experience themselves in their communication to the teachers to reach influence. Investigations show that when the toddlers capture the teachers’ confirmation to influence, the body language changes to a proud straight posture, with belly up, and shoulders backwards. Their eyes get bigger. Their body language also changes when they want to show their dissatisfaction, in these situations where the confirmation from the teachers did not work. They turn their body and face away, from the teachers. The research also shows that the toddlers’ noise gets more intense when they want to clarify their communication to the teachers. Even the body movement’s strengths by making the body longer, and they also repeat the movement again. The toddlers also imitate a body movement between the child and the teacher, in a shared common experience, that they had done together in the past. The research also shows that even if the toddlers don’t have a well-developed verbal language yet, they are qualified to share their intentions to the teachers, through their body language. When these communications work out well, the toddlers’ sense of the intersubjective self grows and develops. This way opens up for the way when the toddlers’ sense of verbal self, starts. When the teachers are present and empathetic, and the toddlers are confirmed, they continue to develop as self-sensing individuals, which strengthens their belief in their own skills. This allows the children to learn that they have rights to influence over their daily lives and themselves, even in the age of the toddler and further.

The purpose of this single-case study was to pilot a developmentally sensitive adaptation of an evidence-based intervention aimed at improving nutrition in children with cystic fibrosis (CF). Children with CF must adhere to a high-calorie diet to prevent malnutrition and maintain health. Toddler and preschool age children present a unique feeding challenge to parents as they begin to exert independence and exhibit a variety of challenging behaviors. Parents trying to adhere to CF nutrition guidelines often use ineffective strategies that inadvertently encourage children not to eat. This six-week group parent-training intervention combined nutrition and behavior elements to provide parents with the nutrition and child behavior management strategies necessary to improve children’s intake and ensure adequate nutrition. Parents of four children (one girl) between the ages of 21 and 30 months of age participated in two groups; all children were Caucasian, and all parents were married. Two children were malnourished and had primary goals of increasing intake and weight; two were adequately nourished and had primary goals of improving diet quality. Primary and secondary treatment outcomes were established individually for each child. Families completed three-day diet diaries and video recorded mealtime interactions across two baseline weeks, six weeks of intervention, and a twelve-week post-intervention follow-up. Children’s weights were measured at baseline, post-treatment, and follow-up. Caloric intake was calculated for all meals, and video taped meals were coded using a behavioral coding system. Treatment fidelity was also assessed. The two malnourished children increased caloric intake throughout the intervention and demonstrated clinically significant weight gains at post-treatment. Further, these gains were maintained at follow-up. One of the two adequately nourished children demonstrated improved diet quality. Findings support the efficacy of this developmentally-sensitive adaptation to increase weight in toddler children with CF, and findings provide partial support for the efficacy of this intervention in improving diet quality in adequately nourished children. A parent group intervention provides training in CF-specific child management skills to multiple families and may provide significant benefits to parents who often struggle with the demands of nutrition requirements and toddler behavior.

The present study investigated the direct and interactional effects of neighborhood disadvantage and harsh parenting on concurrent assessments and change in externalizing and internalizing behavior in toddlerhood. The study included 55 mothers and their children; families completed in-home assessments when children were 2 and 3 years of age. Mothers' reports were used to measure neighborhood disadvantage and children's problem behaviors. Observer ratings derived from a clean up task were used to measure harsh parenting. Four hierarchical regression equations were computed to test each study hypothesis. Results indicated marginally significant effects of harsh parenting on externalizing problems at age 2. Surprisingly, harsh parenting and exposure to neighborhood risk did not significantly predict increases in externalizing behavior problems from age 2 to 3. Harsh parenting was marginally related to children's internalizing problems under conditions of high levels of neighborhood disadvantage and predicted increases in internalizing over time. The theoretical implications of the results are discussed.

Pensar a educação para bebês é considerar como favorecer práticas docentes que possam garantir o acesso às crianças muito pequenas ao mundo da cultura e da sociedade. Quando o foco da prática docente se direciona para as crianças e suas relações, a qualidade do ambiente educativo depende de escolhas de concepções de educação, infância e criança, para que se possa redefinir os trajetos e as ações de uma educação participativa, que não se faz sozinho, mas em colaboração com a criança, seus familiares e a equipe da creche. Na presente pesquisa, os critérios de qualidade para a educação de bebês e crianças pequenas e suas implicações na formação de educadores em contexto, constituíram os objetos de estudo. Duas grandes questões conduziram o estudo: O que se entende por qualidade na educação de bebês e crianças pequenas? Seria a escala ITERS-R um instrumento fidedigno para avaliação de creches? O problema se desdobrou na relação entre a qualidade na educação da infância e a formação de educadores em contexto para a Educação Infantil. Esta questão tornou possível considerar se uma escala de avaliação do ambiente educativo seria um instrumento que poderia auxiliar o grupo de professores a refletir sobre a sua prática docente favorecendo o desenvolvimento das necessidades individuais e do grupo das crianças. O intuito foi investigar se a escala norte-americana Infant/Toddler Environment Rating Scale - ITERS (HARMS, CRYER e CLIFFORD, 1990) - que avalia o ambiente para crianças de zero a trinta meses em instituições infantis, constituía-se como instrumento de avaliação da qualidade do atendimento infantil em creches. Para a realização do estudo foi selecionada uma creche na região sul da cidade de São Paulo. Trata-se de uma creche direta, pertencente à diretoria regional do Ipiranga e que atende uma ampla região da Vila Clementino. A creche foi selecionada para este estudo por ser tratar de um campo de pesquisas do grupo Contextos Integrados em Educação Infantil da Faculdade de Educação da Universidade de São Paulo. Adotou-se o estudo de caso como modalidade qualitativa de pesquisa. Os dados foram colhidos e analisados seguindo alguns critérios da abordagem fenomenológica, tendo como base os trinta e nove itens da escala, e o referencial teórico apresentado na própria escala. Entende-se que reflexão sobre os diversos itens que compõem a escala do ambiente educativo em um processo colaborativo, entre o pesquisador e as educadoras, possa contribuir para o que se entende como formação em contexto, formação partilhada, que respeita a autonomia do educador para avaliar a sua prática educativa a partir de uma pedagogia da infância que torne a criança visível. Para tal, buscou-se apoio nas pedagogias da infância, com interesse maior em Dewey, que sugere uma educação democrática, a qual valoriza os interesses e necessidades das crianças, e a mediação da cultura para discutir ambientes educativos para bebês e crianças bem pequenas. / To think of education for babies is to consider how to favor teaching practices that can guarantee very young children the access to the world of culture and society. When the focus of the teaching practice turns to children and their relationships, the quality of the educational environment depends upon the choices of conceptions on education, infancy and children, so that is possible to redefine the paths and actions of a participatory education, which cannot be done alone, but in collaboration with the child, their families and daycare staff. In the current research the quality criteria for education of infants and toddlers and their implications on educators formation in context, constituted the objects of this study. Two great questions conducted the study: What is meant by education quality for babies and toddlers? Would the ITERSR scale be a reliable instrument to evaluate daycare centers? The problem was unfolded in the relationship between the quality of early childhood education and the formation of educators in context for Early Childhood Education. This question has made it possible to consider if an educational environment assessment scale would be an instrument that could help a group of teachers reflect on their teaching practice, promoting the development of individual needs and that of children groups. The purpose was to investigate if the North American Infant/Toddler Environment Rating Scale - ITERS (HARMS, CRYER e CLIFFORD, 1990) which evaluates the environment for children from zero to thirty months old in child institutions, was constituted as an evaluation instrument of child care quality in daycares. In order to conduct the study, a daycare center located in the southern region of the city of São Paulo was selected. It is a direct daycare center, belonging to the regional board of Ipiranga and serving a wide region of Vila Clementino. The daycare center was selected for this study for it is the research field of the Integrated Contexts in Early Childhood Education group of the School of Education at the University of São Paulo. The case study was adopted as a qualitative research method. The data were collected and analyzed following some phenomenological approach criteria, based on the thirty-nine scale items and the theoretical referential presented in the scale itself. It is understood that the contemplation of the various items which constitute the educational environment scale in a collaborative process, between the researcher and the educators, may contribute to what is meant by formation in context, shared training, which respects the educators autonomy to evaluate his/her educational practice from an early childhood pedagogy that renders the child visible. For such, support from early childhood pedagogies was sought, with a higher interest in Dewey, who suggests a democratic education, which values the interests and needs of children and the mediation of culture to discuss educational environments for babies and toddlers.

The purpose of this study is to investigate toddlers’ responses when they are listening to a biology story with special focus on ants. The method used was a teaching attempt that was supplemented by a video recording of the activi- ty. Four children in the age of about three years participated. The analysis was conducted based on a phenomenological approach. The results show that children's interest in ants during the storytelling activities varied over time. All the children showed interest at some parts during the activities. They showed this affective response through facial expressions, being focused, listening and being active. It seemed as if the pictures that were shown during the storytelling were of importance. To be able to be active was another factor identified having an impact on the outcome. Finally, some of the content in the story that surprised the children also seemed to have an effect. / Syftet med den här studien är att se vilken respons små barn visar när de får en saga berättad för sig i ämnet biologi med inriktning på myran. Metoden som användes var ett undervisningsförsök, som kompletterades med en videoinspelning av aktiviteten. Fyra barn i treårsåldern deltog. En fenomeno- logisk ansats användes för att analysera data. Resultatet visar att barnens intresse för myror varierade under sagoberättandet. Samtliga barn visade intresse under vissa delar av aktiviteterna. De visade sitt intresse genom olika ansiktsuttryck, genom att vara fokuserade, lyssnade och var aktiva. Det verkade som att bilderna som visades under sagoberättandet var betydelse- fulla. Möjligheten att få vara aktiv var en annan viktig faktor. Det verkade även som om delar av innehållet i sagan som skapade förvåning påverkade barnen.

Two testing conditions (immediate and delayed) were used to test for the presence of imitation and emulation in typically developing and developmentally delayed children, including children with autism spectrum disorder, ranging in age from 2.8-years old and 4.0-years old, in two experiments, Experiment I (n=20), Experiment II (n=30). Using a mixed within-between design, I compared the performance of the two groups across various tasks in two testing conditions and analyzed their performance. The participants were selected because they fit the criteria of 1) being between the age of 2.5 and 4 years of age at the onset of the study, 2) had gross motor and generalized imitation in repertoire, and 3) observational learning was present. The independent variable was the test interval in both experiments across both testing conditions, immediate and delayed. The dependent variables were the unconsequated responses during the test interval (Experiment I and II). The embedded dependent variable in Experiment II was the number of 5s intervals participants interacted with a puzzle box in the free play setting. Responses were defined as imitation (copy the specific actions with point-to-point correspondence), or emulation (bring about the model’s goal by the observer’s own methods and means, no point-to-point correspondence but same end result). In the first experiment I found that although typically developing preschoolers often imitate in the short term, they were more likely to emulate in the long term when not shown again how to use the items. In contrast the participants with autism spectrum disorder were more likely to imitate across both testing conditions. My findings support evidence that typically developing children naturally shift from imitation to emulation and that children are in fact emulators in contrast to research that suggests otherwise. For those children with autism, Experiment I, supports evidence that they are potentially missing a developmental cusp (emulation). Experiment II sought to replicate the findings in Experiment I and differed in that 1) more tasks were added, 2) more participants were used, and 2) a free play observation session was added. The results from Experiment II supported the results from Experiment I, in that, all participants (typically developing and those with autism) were more likely to imitate in the short-term immediate testing condition; however, typically developing children naturally shifted to an emulative response given a delay, whereas, those children with autism continued to emit imitative behaviors given a delay, signifying that children with autism are missing the developmental cusp of emulation. The findings support the notion that emulation is a developmental cusp and that children with autism often are missing this developmental cusp.

Pensar a educação para bebês é considerar como favorecer práticas docentes que possam garantir o acesso às crianças muito pequenas ao mundo da cultura e da sociedade. Quando o foco da prática docente se direciona para as crianças e suas relações, a qualidade do ambiente educativo depende de escolhas de concepções de educação, infância e criança, para que se possa redefinir os trajetos e as ações de uma educação participativa, que não se faz sozinho, mas em colaboração com a criança, seus familiares e a equipe da creche. Na presente pesquisa, os critérios de qualidade para a educação de bebês e crianças pequenas e suas implicações na formação de educadores em contexto, constituíram os objetos de estudo. Duas grandes questões conduziram o estudo: O que se entende por qualidade na educação de bebês e crianças pequenas? Seria a escala ITERS-R um instrumento fidedigno para avaliação de creches? O problema se desdobrou na relação entre a qualidade na educação da infância e a formação de educadores em contexto para a Educação Infantil. Esta questão tornou possível considerar se uma escala de avaliação do ambiente educativo seria um instrumento que poderia auxiliar o grupo de professores a refletir sobre a sua prática docente favorecendo o desenvolvimento das necessidades individuais e do grupo das crianças. O intuito foi investigar se a escala norte-americana Infant/Toddler Environment Rating Scale - ITERS (HARMS, CRYER e CLIFFORD, 1990) - que avalia o ambiente para crianças de zero a trinta meses em instituições infantis, constituía-se como instrumento de avaliação da qualidade do atendimento infantil em creches. Para a realização do estudo foi selecionada uma creche na região sul da cidade de São Paulo. Trata-se de uma creche direta, pertencente à diretoria regional do Ipiranga e que atende uma ampla região da Vila Clementino. A creche foi selecionada para este estudo por ser tratar de um campo de pesquisas do grupo Contextos Integrados em Educação Infantil da Faculdade de Educação da Universidade de São Paulo. Adotou-se o estudo de caso como modalidade qualitativa de pesquisa. Os dados foram colhidos e analisados seguindo alguns critérios da abordagem fenomenológica, tendo como base os trinta e nove itens da escala, e o referencial teórico apresentado na própria escala. Entende-se que reflexão sobre os diversos itens que compõem a escala do ambiente educativo em um processo colaborativo, entre o pesquisador e as educadoras, possa contribuir para o que se entende como formação em contexto, formação partilhada, que respeita a autonomia do educador para avaliar a sua prática educativa a partir de uma pedagogia da infância que torne a criança visível. Para tal, buscou-se apoio nas pedagogias da infância, com interesse maior em Dewey, que sugere uma educação democrática, a qual valoriza os interesses e necessidades das crianças, e a mediação da cultura para discutir ambientes educativos para bebês e crianças bem pequenas. / To think of education for babies is to consider how to favor teaching practices that can guarantee very young children the access to the world of culture and society. When the focus of the teaching practice turns to children and their relationships, the quality of the educational environment depends upon the choices of conceptions on education, infancy and children, so that is possible to redefine the paths and actions of a participatory education, which cannot be done alone, but in collaboration with the child, their families and daycare staff. In the current research the quality criteria for education of infants and toddlers and their implications on educators formation in context, constituted the objects of this study. Two great questions conducted the study: What is meant by education quality for babies and toddlers? Would the ITERSR scale be a reliable instrument to evaluate daycare centers? The problem was unfolded in the relationship between the quality of early childhood education and the formation of educators in context for Early Childhood Education. This question has made it possible to consider if an educational environment assessment scale would be an instrument that could help a group of teachers reflect on their teaching practice, promoting the development of individual needs and that of children groups. The purpose was to investigate if the North American Infant/Toddler Environment Rating Scale - ITERS (HARMS, CRYER e CLIFFORD, 1990) which evaluates the environment for children from zero to thirty months old in child institutions, was constituted as an evaluation instrument of child care quality in daycares. In order to conduct the study, a daycare center located in the southern region of the city of São Paulo was selected. It is a direct daycare center, belonging to the regional board of Ipiranga and serving a wide region of Vila Clementino. The daycare center was selected for this study for it is the research field of the Integrated Contexts in Early Childhood Education group of the School of Education at the University of São Paulo. The case study was adopted as a qualitative research method. The data were collected and analyzed following some phenomenological approach criteria, based on the thirty-nine scale items and the theoretical referential presented in the scale itself. It is understood that the contemplation of the various items which constitute the educational environment scale in a collaborative process, between the researcher and the educators, may contribute to what is meant by formation in context, shared training, which respects the educators autonomy to evaluate his/her educational practice from an early childhood pedagogy that renders the child visible. For such, support from early childhood pedagogies was sought, with a higher interest in Dewey, who suggests a democratic education, which values the interests and needs of children and the mediation of culture to discuss educational environments for babies and toddlers.

Research has shown that parents of children with autism report higher stress than parents of children with other developmental disabilities. It has been suggested that parent training programs, specifically naturalistic social-communication training, can reduce parental stress and enhance the quality of the parent-child relationship. Although the development of a multilevel assessment has been suggested, much of the research in this area has relied on measures of parent implementation fidelity and specific child target skills such as vocal communication, eye contact, and joint attention. Few have directly measured the parent-child interaction. The purpose of the current study is to examine the effects of an in-home parent training package for toddlers with autism on parent-child social interactions. Within this package, parents are taught to attend to contextual variables, to arrange the environment to set the occasion for child responding, to respond immediately to targeted child approximations, and to respond in ways that are mutually reinforcing, social, and fun. Data were collected during 5-min video-taped assessments, on the number of parent teaching episodes, child target skills (turn taking and social attending), engagement, and synchronous engagement. Results were evaluated in a multiple baseline design across two parent-child dyads and indicated increases in all measures. This study contributes to the current discussion on toddler parent-training programs and extends it in a way that highlights the benefits of using a multi-level assessment to measure the parent-child interaction.

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