Altan is a happy little boy who spends his days at school, playing with friends, learning new skills and thoroughly enjoying mealtimes. But just a few years ago, Altan’s life — and future — looked quite different.

When Altan was born to his family in Mongolia, he had a twin sibling. But shortly after birth, Altan’s twin passed away, and his father abandoned his mother — leaving her to care for her infant son alone. Enduring loss and abandonment, Altan’s mother faced yet another challenge: Altan was born at just 4.8 pounds and was diagnosed with cerebral palsy, a condition that has impaired his muscular growth and development. By the time he was 18 months old, Altan could not sit up on his own, roll over or crawl, and he needed support to eat. Ultimately, his delays affected his ability to receive the nutrition he needed to stay healthy and grow.

Altan’s mother tried everything she could to help her little boy, but he was constantly sick and severely malnourished. With little support, she began to feel physically and emotionally exhausted. The demands of being a single mother caring for a young child with a disability were adding up. Feeling ill-equipped to meet his needs, Altan’s mother considered placing her son in an orphanage. But with a final ounce of strength, she continued to search for help.

Finding Help — and Hope

One day, Altan’s mother discovered a daycare center in her community that cared for children with disabilities. Partnering with Holt Mongolia, the daycare staff had received Holt’s innovative Child Nutrition Program (CNP) training, through which they had learned how to properly feed and nourish children with disabilities. Because of this training, the daycare center was able to welcome Altan and recognize the window of opportunity and interventions he needed to grow and thrive.

Like Altan, many of the children who enter Holt’s CNP are malnourished, anemic or struggling with feeding difficulties. Many have disabilities or chronic conditions, putting their health and development in jeopardy. But since it began in 2014, Holt’s child nutrition program has reached thousands of children with holistic nutrition and feeding interventions uniquely designed to meet their needs.

“Our targeted approach focuses on reaching the most vulnerable children early in life,” says Emily DeLacey, PhD, RDN, LDN, Holt’s director of nutrition and health services. “About 25% of the children we serve have a disability, and more than 60% are under the age of 5 — a crucial developmental period for growth.” Unless they receive the essential nutrition they need during this critical period, children face irreversible consequences to their development and overall wellbeing.

The CNP embraces the philosophy that how children eat is just as important as what they eat. While eating may seem intuitive to many, it can be far more complex for infants and children with disabilities. Through CNP training, our feeding specialists empower caregivers with safe feeding techniques tailored to children of different ages and abilities. This approach encourages caregivers to consider key factors, such as positioning, sensory needs and the feeding environment. Additionally, caregivers learn to conduct nutrition and health assessments, enabling them to monitor each child’s unique nutritional needs, track growth and provide personalized support.

Caregivers at the Holt-supported daycare center in Mongolia used these skills to assess Altan. They realized that every time he ate, he was experiencing aspiration as bits of food and fluid entered his lungs. Unsafe feeding practices can have many severe consequences, from aspiration and poor nutrient absorption to pneumonia, choking, emotional trauma and other psychological and developmental ailments. That’s why improving feeding practices — or changing how children are fed — is critically important. Like many children with disabilities, Altan became chronically ill due to being fed in unsafe positions. But with hands-on training, ongoing expert support and resources like Holt’s Feeding and Positioning Manual, teachers and caregivers knew that they could help Altan — and empower his mom with training and support to help her son thrive.

Recognizing that Altan needed immediate care, the CNP team in Mongolia quickly took action. They helped him sit upright in supportive seating and introduced safe feeding techniques to prevent choking or aspiration. Ensuring he had access to nutritious foods, including plenty of fruits and vegetables, they provided the foundation for his growth. With the right support and therapy, Altan gradually developed essential skills like chewing, swallowing, crawling and walking. Over time, with the dedication of his care team, he grew stronger. Eventually, he could sit up on his own, stand independently and even communicate with his mother, caregivers and friends, marking incredible progress on his journey.

About 25% of the children we serve have a disability, and more than 60% are under the age of 5 — a crucial developmental period for growth.

Emily DeLacey, PhD, RDN, LDN, Holt’s director of nutrition and health services

Altan also was able to thrive thanks to the generous support that Holt donors have provided to the Molly Holt Fund. The Molly Holt Fund is named in honor of Molly Holt, daughter of Holt’s founders and a nurse who dedicated her life to caring and advocating for children and adults with disabilities and special needs around the world. Donations to the fund go toward everything from life-changing surgeries and medical care to rehabilitative therapies and special education to Holt’s innovative child nutrition program trainings for children in orphanages, foster families or living with their birth families in the countries and communities where Holt works. In short, your generosity has made a world of difference to children like Altan.

Full of Smiles and Laughter

Today, after two years in the child nutrition program, Altan is healthier and stronger than ever before. Not only is he getting the proper nutrition to stay healthy, but he is also enjoying mealtimes! Full of smiles and laughter, he eagerly exclaims, “Let’s eat!” before digging into his favorite dishes. Fueled with good nutrition and stronger than ever, Altan enjoys being an active 3-year-old, going to school and playing with his friends.

Thanks to Holt’s generous donors who support the CNP, Altan’s life has been forever changed, and he’s not alone. Each year, thousands of children benefit from this life-changing program. From simple, cost-effective changes to improve the position of children during mealtimes to caregivers using our growth and health monitoring system to accurately meet each child’s needs, these interventions dramatically impact the health and wellbeing of children across the globe. Over the past 10 years, Holt’s innovative child nutrition program has expanded its reach to more than 110 sites in eight countries.

For a child like Altan, the entire trajectory of his life has changed, allowing him to soar beyond his limited beginnings and experience all of the joys that life can bring. Not only that, but his improved health has contributed to a stronger, more stable family. His mother is no longer fearful and stressed about Altan’s health and her ability to care for him. Instead, she is proud of the progress her son has made —and confident in their future together!  

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In the past two decades, rapid development in China’s urban centers have lifted millions of people out of poverty. Today China — a nation of 1.4 billion people — boasts the world’s second-largest economy. But the nation’s wealth is not distributed equally. In fact, many children and families in rural communities struggle to get by. Out of desperation, young people living in these communities often migrate to cities in search of work, many of them leaving their children behind in the care of elderly grandparents or relatives. Often, these relatives struggle to provide for them on their own meager resources, placing children at risk for malnutrition, poor growth and impaired development. Infants and children with disabilities are among the most vulnerable to these conditions.  

But with the support of Holt donors, one global program is empowering families in China to safeguard children in their care.

Holt Targets Nearly 3,000 Children and Their Families

In 2014, we developed the Holt International Child Nutrition Program (CNP), an innovative nutrition and feeding program that helps children living in orphanages, foster homes and impoverished communities become healthier and experience a better quality of life. This donor-funded program has since been implemented in eight countries, including China, and offers education and community outreach among its many services.

“I think the flipbook is very interesting and innovative. There are pictures and words in it, [and it is] very visual.”

Social Worker in China

In 2021, the CNP team created the Child Nutrition Program Community Flipbook as one of its community outreach tools. The flipbook is just that — a book that social workers can flip through when visiting with families to teach proper nutrition and health practices. It provides answers to questions and engages families in activities on topics such as general nutrition, health conditions, women and infants, nutrition by age, feeding support and mealtimes, and hygiene and sanitation. Using simple pictures and storylines, the flipbook is geared toward the participatory engagement of audiences of various literacy levels.

Although initially produced in English, in 2022 Holt’s U.S.-based CNP team worked closely with our team in China and in strong partnership with the Chinese government to create a Chinese version of the flipbook. This past April, 357 flipbooks were distributed to social workers in Xinxiang, a city in Henan province with nearly 3,000 vulnerable children. Holt’s CNP team trained the social workers in how to use the flipbooks when they visit children and their families in their homes to learn more about their needs, help them gain access to essential services and offer fundamental nutrition and health education. “I think the flipbook is very interesting and innovative,” shared one social worker who attended a training. “There are pictures and words in it, [and it is] very visual.”

Holt China plans to reach nearly 3,000 children and their families in Xinxiang with education and support. Once the initial program is implemented and assessed, the team will extend its reach to other provinces. “We are so happy to see that the CNP program can go into Chinese communities, especially in rural areas,” says Kate, a staff member at Holt China. “Scientific nurturing is not only a kind of skill, but also a mindset, and we hope that such a good mindset will reach the hearts and minds of more vulnerable and ‘left-behind’ children and their parents.”

Nutrition and health education strengthens families and improves lives. Thanks to the generous support of Holt donors, the CNP and its Child Nutrition Program Community Flipbook are reaching those who need it most — and making this dream a reality.  

Support Holt’s Child Nutrition Program

Your gift to Holt’s child nutrition program will provide life-changing nutrition and feeding support to children living in poverty and in orphanages around the world.

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The Child Nutrition Program Training Model

We started our days with a van ride through the busy streets of Addis Ababa. As we pulled in through the gates of the rehabilitation center, we were ready for a day of interacting with physical therapists, parents and the children in their care. Families and children were already lined up outside the therapy room. They were waiting for the opportunity to learn new skills to support and feed their child. Child nutrition program (CNP) training in Ethiopia had begun!

For many low-income families who have children with disabilities in Ethiopia’s capital city, mealtimes can be stressful. Diverse and nutrient-filled ingredients are often too expensive and out of reach, despite being so important. Most days, these families will feed their children the Ethiopian staple food, injera (sourdough flat bread) and shiro (a chickpea stew). Other fruits (papayas, mangos, avocados) and vegetables will sometimes be incorporated into their diet if finances allow. On top of limited resources, feeding a child with disabilities like cerebral palsy involves extra challenges in terms of safety and optimal nutrient intake.

These were the children and families we were here to help.

We were providing CNP training for physical therapists at a rehabilitation center in Addis Ababa. These physical therapists work closely with children who have severe disabilities and their parents or caregivers to improve everyday physical function. Our role was to share with these professionals the skills necessary to support safe feeding practices and optimal nutritional status of the caregivers and children they work with. In addition to four days of interactive classroom training, we arranged a hands-on practicum at the site and worked with over 20 families. This allowed us to find solutions to feeding challenges and conduct nutrition and health screenings.

The CNP brings nutrition, feeding and health education to caregivers and families all around the world. We know that proper nutrition and safe feeding greatly improve children’s health and quality of life. And the most efficient way to do this? Train the professionals who work with these children and families every day. By following this “Training of Trainers” (ToT) model, those trained in the CNP can pass their knowledge on to others. Then, they share with others, creating lasting change in nutrition and feeding practices for children!

Training Therapists and Parents

It was primarily mothers who brought their children to the center. But we also saw some fathers and grandmothers make the journey to the rehab center with their child to work with the team of therapists. We saw firsthand the love and dedication they all had for their children, as they made the extra effort for them to get the care and support they needed. As each session passed, it became evident that the trusting relationship between the physical therapist, caregiver and child was the main contributor to the success of each session. Therapists worked on providing individually tailored guidance for each parent, based on the child’s specific needs. They always collaborated with each other to improve their instructions. There was never a dull moment! We worked through frustrations, laughs, tears and the oh-so rewarding “ah-ha” moments as children and parents experienced breakthroughs with eating and feeding.

As if the weather was our timekeeper, each afternoon as we were wrapping up our long day of sessions, the clouds would roll in above us and let out a heavy rain. During our end-of-day meetings, we had to speak loudly over the roar of the raindrops on the therapy room’s metal roof. We learned two things that week: the rainy season came early this year, and no matter where you are in the world, the weather is always something to talk about.

Group Training

To finish up the four days of practicum, we held a half-day group caregiver training session. There we shared nutrition and feeding information with families who were just beginning their journey at the rehabilitation center. The day started with Holt Ethiopia staff members teaching about nutrition, health and meal planning. Parents showed what they had learned through an activity where they chose key foods and ingredients available in their communities to prepare a week’s worth of meals. It was clear to see that the families were excited to show what they knew and learned, choosing meals based on their personal food preferences.

The day concluded with feeding and positioning training led by the physical therapists. Along with the support of our feeding specialist, the physical therapists showcased their new knowledge by demonstrating and talking through the feeding practices. This was a true testament to the ToT model. Like the prior sessions, each parent’s deep desire to help their child be the healthiest they could be and reach their greatest potential was undeniable. Families also looked to each other for comfort and advice on the challenges they faced during mealtimes with their children.

A Lasting Impact

As we packed up our bags and prepared for our journey back to the United States, we took some time to reflect on the experience. Many of our nutrition and health programs were built to support families in rural areas. So, learning more about challenges for families in Ethiopia’s urban setting helps us strengthen the CNP training overall in Ethiopia. This, in turn, will allow us to reach more families in need of support. We look forward to seeing the impact of this training through the regular health screenings children at this center will receive. As more parents learn and practice improved nutrition and feeding practices for their children through our newly trained CNP trainers, more and more children will grow and thrive!

Support Holt’s Child Nutrition Program

Your gift to Holt’s child nutrition program will provide life-changing nutrition and feeding support to children living in poverty and in orphanages around the world.

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It is important to remember that, new or seasoned, biological or adoptive, single or co-parent, you as a parent have people and resources you can rely on. Parents deserve to feel supported as they raise and support their children. Parent support includes empowering parents through reminders of their own greatness but also includes encouraging parents to reach out and find external support when needed. Whatever parent support looks like for you, it is important that it is prioritized and honored.

3 important reminders for you, as a parent, today: 

1. You are not alone. Sometimes, parenting can feel isolating. You work hard to keep your kids happy and healthy, and it’s not always easy. It is important to recognize there are many other parents out there who feel or have felt the same way. Sharing your experiences and feelings with others is a great way to break free of some of those feelings. When you begin to share, it opens the door for others to share as well and relate to your experiences. You can do this through conversation with family or friends or support groups online or in person. Building relationships with others who understand your position is a great way to grow your support system. 

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2. There is no one way to parent. In today’s world, we have access to read about, listen to and watch the everyday happenings of other peoples’ lives through social media. This new norm can help us connect with family and friends across the world and has brought many people together. On the flip side, we become a fly on the wall in dozens of other families’ homes which can lead to comparison and questioning. First, it is important to remember that social media is just a highlight reel. What you see might not always be what is actually happening. Second, there is no ONE right way to parent. Although someone else’s parenting choices might work for them, it does not mean that your choices should be the same. Trust yourself and recognize that you are doing a great job.  

3. Give yourself grace. Every person deserves to care for their well-being and being a parent doesn’t change that. It is important to realize self-care doesn’t have to take up time or require finding a babysitter and planning ahead. Self-care can mean acknowledging your own feelings and allowing yourself to express them. It can mean using the voice in your head to praise small wins instead of reprimanding silly mistakes. It can even mean letting go of a small responsibility or two for once. Giving yourself grace allows you to be the best version of yourself so you can be the best parent you can be. Above all, when you prioritize your well-being, the whole family wins.  

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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Like every child, children with disabilities need and deserve plenty of opportunities to learn, play and grow. Children with disabilities or medical needs can do a lot more than most people have come to expect. Yet, it’s hard to grow and learn when you aren’t given the chance. This can be especially true for children with disabilities who have been adopted but may have spent the early parts of their lives with limited opportunities to try new things. Caregivers must provide activities for children with disabilities to allow them to play, interact, learn and try new things. This includes mealtime experiences, so try offering new foods and let your child practice feeding themselves. Set your expectations high and watch your child flourish!  

Caregivers must give children lots of opportunities to play, interact, learn and try new things. Set your expectations high and watch your child flourish!

When considering activities for your child, you want to be realistic about their abilities. Choose activities your child is already interested in and ones with simple rules that may provide more structure. Holding in mind your child’s sensory needs will also help identify fun activities that will keep them engaged. If it is a group activity or an activity with an instructor, it may be beneficial to discuss with the instructor your child’s strengths and potential areas of need and if there are any adjustments that can help your child positively participate.  

8 Fun Activities for Children With Disabilities or Medical Needs

1. Listening to and making music 

Music is fuel for a child’s growing brain. Listening to music and playing with musical toys strengthens brain function — and it can be a ton of fun! Grab real or toy instruments and start making up some tunes. Egg shakers, maracas, tambourines, drums and keyboards can be some of the easiest instruments for children to play and they offer sensory feedback for their bodies when they play them. No instruments? No problem! Try wooden spoons for your drumsticks and a tin can as your drum.

If your child or family enjoys listening or dancing to music, have fun exploring different types of music and/or dance movements together — and remember that this doesn’t just include “kid music.” Watch for signs that your child is experiencing joy, such as moving their body to the tunes, showing pleasure in their facial expressions or happily making sounds or talking.  

2. Playing with their senses  

Sensory play can be one of the most important components of a child’s development. There are also so many ways to engage in this type of play, which makes finding something that matches your child’s individual needs easier. Sensory boards include a variety of different textured objects, mounted to a board. They can be bought premade or you can make them yourself. Sensory bins can be made from many items in your home. Grab a box or bin and fill it with dry pasta, beans, rice or sand. Have fun hiding items in the bin and then using your hands or another object to excavate them! Don’t have a board or a box? No problem! Find other ways to stretch those sensory skills, such as playing with Play-Doh, clay, shaving cream or even bubbles! With all of these tasks, just be sure that they are created with items that are safe for children and used with appropriate supervision.  

3. Playing outside 

Time outside for all individuals is nourishing for the body and the mind. Even 10 minutes of fresh air can be just what a child’s system needs in their day. Furthermore, there is so much to do and see outdoors! Help your child develop their big motor skills while playing tag or Simon Says outside. Take a walk, go for a bike ride or simply find a nice place to sit together. When it’s warm, bring out the water balloons, and when it’s chilly, have fun in the piles of leaves, puddles or snow. No matter a child’s abilities, regular time outside is essential to a balanced body and mind.  

4. Creating art 

Letting a child’s creative juices flow is not only valuable, but it can also be incredibly fun. Art can be anything or anywhere, which means any avenue you choose that works best for your child is perfect. Whether it’s paint or markers, crayons or chalk, glue and paper or shaving cream and a mirror, art is art and it’s powerful for the development of every child. Through tasks such as scribbling, coloring or painting, children grow their fine motor skills and expand their creativity. Set up an easel or table with paper and let your child’s inner artist take over. Bring out the coloring books or blank paper and let them scribble away! Don’t like as much of a mess? Use plastic bags to cover surfaces, wear smocks or old clothing (or no clothing), or take your art outside.  

5. Building a pillow fort 

Looking for an indoor activity on that rainier or colder day? Ignite your child’s imagination and use pillows and blankets to form an indoor fort that they can crawl through, play in and snuggle inside. It’s an ideal activity that works both motor and cognitive skills, while also supporting sensory systems. Your fort can be as big and elaborate as you and your child choose. Try including your child’s favorite books, toys and stuffed animals to make it the perfect and cozy place for connecting with one another.  

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6. Playing pretend 

Playing pretend is not only engaging for many children but it’s also filled with developmental benefits, especially for their early play, learning and social-emotional development. Have fun pretending to be your favorite animals by making their sounds and moving the way they move. Level up by trying to guess the animal! Look at books or shows with animals or listen to their sounds on an electronic device (“Hey Google: What sound does a duck make?”). Imitate what you see and hear, and encourage your child to play along if possible. These types of physical, language and intellectual development activities can be fun for the whole family! 

7. Playing “I Spy” 

Develop your child’s visual and cognitive skills through the classic game of “I Spy.” There’s great versatility in this activity as it can be accomplished anywhere — at home, the park, while in the grocery store or in the car. Wherever you can “spy,” you can play! You can also make this activity as easy or challenging as your child desires. For the child experiencing a visual impairment, try adding modifications to the game, such as offering a listening or feeling guessing game instead. Choose objects and items that are closer and larger. Offer different sounds or textured items for a child to feel and explore at a level that resonates best for their system. When we can spice up the game to match individual needs, everyone wins!  

8. Getting physical 

Movement is powerful! Furthermore, exercise can help stimulate your child’s brain and support their overall physical and mental development. There are so many different ways to encourage movement for any child, with or without disabilities. Want to try something new? Try out yoga with your child. Yoga can not only be physically engaging, but it can also help children learn self-soothing and self-regulation skills. Dance is another movement-based activity that can be easily individualized. Pop on the tunes and strike up a dance party in your home! Have contests to determine who can dance best in their chair or while lying on the floor! Even simply offering movements such as rocking in a chair, bouncing on a lap, patting a child’s back repetitively or pushing them in a stroller or wheelchair are wonderful forms of movement that provide essential input to a child’s body and mind.  

Activities that support a child’s growth will also support their confidence and help them positively engage with the world. No matter a child’s abilities, there is always a pathway toward finding fun, exciting and rewarding playtime activities.  

Spending intentional time playing and engaging in skill-building activities for children with disabilities will help them to learn and also strengthen your relationship. Children diagnosed with disabilities or medical needs can grow and thrive with the support of a caring and engaged caregiver. Create an environment that allows the child to lead in positive play activities. Activities that support a child’s growth will also support their confidence and help them positively engage with the world. No matter a child’s abilities, there is always a pathway toward finding fun, exciting and rewarding playtime activities.  

The potential activities don’t stop there! Check out UNICEF’s ideas and resources for children with disabilities.

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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One of the greatest ways a parent can support their adopted child is by understanding some of the cultural practices they grew up with. Food and mealtime customs are important components to cultural identity.

It is also useful to familiarize yourself with common nutrition-related health concerns that might be helpful in conversations with your child’s pediatrician and in tailoring your child’s nutrition to best fit their needs. Find a country below to learn more about country-specific traditional foods, mealtime customs, malnutrition indicators and general nutrition recommendations. 

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Malnourishment can result in long-term impacts on growth and development, so early identification is important! Some physical symptoms of malnutrition include the following:    

Stunting When children are too short for their age, this can be an indicator of chronic malnutrition.  

Wasting When children are underweight for their height, this is often considered an indicator of acute malnutrition.   

Underweight This indicates that children are underweight for their age.    

Overweight This indicates that children are heavier than they should be for their age.   

Micronutrient deficiencies Key micronutrient deficiencies such as vitamin A, vitamin D, calcium, iron and others can be due to a number of influences including dietary intake, environmental factors, parasites or even a child’s disability.    

Growth Charts 

Often, growth charts are used to track and monitor children’s growth in addition to regular health screenings. Growth charts allow you to track children’s progress over time in relation to normal growth patterns. If a child falls outside of these growth patterns, it may indicate that some follow-up is needed to support healthy and full development.   

Here are two sets of growth charts from the World Health Organization (WHO):

• WHO Child Growth Standards growth charts for children up to 5 years old 
• WHO Growth Reference Data growth charts for children 5 to 19 years old 

For the most accurate assessment of your child’s growth and development, consult your pediatrician. 

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Vitamin and Mineral Deficiencies 

Having low levels or a deficiency of certain micronutrients at a young age can negatively impact a child’s developmental potential.   

It is important to recognize that deficiency and low levels of some micronutrients can cause more than just what the eye can see. A lack of certain vitamins or minerals can contribute to behavioral challenges, anxiety and depression. The best ways to avoid such deficiencies are to optimize your child’s diet by including a variety of foods from different food groups and consulting your child’s dietitian or pediatrician at regular checkups.  

Here are just a few examples of some nutrient deficiencies. 

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While every child is unique in their growth and development, understanding the key areas of preschooler development can help parents identify milestones. Because all areas of development are connected and influenced by one another, it is important to view a child’s development holistically.

Here are the 7 key areas of preschooler development:

• Adaptive skills. Adaptive skills are a child’s daily routine functions such as eating, sleeping and cleaning. When a preschooler serves themselves at meals, makes requests for foods, puts dirty dishes into the sink or dishwasher and cleans up spills and messes, they are showing adaptive skills. 

• Communication skills. Communication is connecting by sharing thoughts and feelings. Between 3 and 5 years, this can look like stating their full name, answering questions when told a short story or idea, using facial expressions and body language to express emotions and using more complex sentences made up of multiple words. 

• Fine and gross motor skills. Fine and gross motor skills include the physical movement of a child. For a child between 3 and 5 years, fine motor skills look like feeding themselves with utensils, drinking from an open cup and drawing some letters and basic shapes. Gross motor skills look like balancing on one foot and walking up and down stairs using alternating feet. 

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• Cognitive skills. Cognitive skills exemplify a child’s brain working on reasoning and awareness of themselves and the world around them. When a preschooler is able to count to 20, understand “more” and “less, and recount familiar stories, they are using their cognitive skills. 

• Social-emotional skills. Social-emotional skills are learned through interaction and relationships. In children between 3 to 5 years, this can look like sharing items with occasional support, returning objects to appropriate locations, showing pride in accomplishments and showing empathy for others. 

• Vision skills. A child can show their vision skills by copying or making different shapes, identifying different colors, recognizing letters and print, and showing a readiness to begin reading as they turn 5 years old. 

• Hearing skills. A child can show their hearing skills by distinguishing differences in speech sounds, repeating more complex words and lengthier sentences, marking sounds at the beginning, middle and end of words, and talking clearly so that others understand the majority of their statement. 

Holistic View of Preschooler Development

To look at something holistically means to not only see the individual parts but how they work together. Skills that children acquire must be viewed holistically. All areas of development are connected and influenced by one another. By understanding these basic milestones of development and how they work together, caregivers can more easily identify when development is going well and when there may be a problem.

For example, feeding is a complex process and all areas of development are involved. Even when just one area is not working well, it can create challenges for babies and their caregivers. Therefore, it is critical to look at babies broadly to understand their full range of capacities and needs.

Example of a Holisitic View of Feeding (3 to 5 Years)

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It is vital that all areas of development are supported. Giving a child simple support during their everyday activities and routines encourages development in an efficient and effective way.

5 Ways to Support Children With Disabilities or Medical Needs 

1. Set high expectations. Children with disabilities or medical needs can do a lot more than we might expect. Yet it’s hard to grow and learn when you aren’t given the chance. Families can support their children through lots of opportunities to play, interact, learn and try new things. 

2. Find their strengths. Every child with a disability or medical need has her own unique strengths. It’s important for caregivers to identify these strengths and use them to help a child continue to develop. 

3. Provide individualized care. Every child is different. Despite having a similar condition, children do not always have similar abilities and needs. Therefore, the care provided for each child must be individualized. Identifying and understanding the unique needs of the child is one of the best ways you can support children with disabilities.

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4. Make the most of mealtimes. Providing positive interactions to a child with a disability or medical need during mealtimes is one of the best way to support their development. Mealtimes are an opportunity for learning and building relationships.  

5. Create positive relationships. Children learn best in the context of positive relationships. Set aside time to be present and engage in small activities with your child. Practicing new skills or helping with household chores provides children with the opportunity to learn while feeling cared for and supported.  Positive interactions and healthy relationships between children and their caregivers support the growth and development of a child’s brain, body and mind. This is important because children with disabilities can have difficulties eating and engaging socially. 

Children with disabilities or medical needs are children who have unique differences and may require extra care and patience from their caregivers. It is valuable for caregivers to understand and anticipate which children may have needs requiring extra care, what those needs might be and how best to support them. 

For more information on how you can support your child with disabilities visit Childcare.gov or see Holt’s list of recommended parenting resources.

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Toddler development can vary, including for those children who have been adopted. While every child is unique in their growth and development, it is important to understand the key areas and view development during the toddler years holistically to best support the child.

Here are the 7 key areas of toddler development: 

• Adaptive skills. Adaptive skills are a child’s daily, routine functions such as eating and sleeping. When a child drinks from a cup or straw and eats using fingers and utensils with greater ease, washes their own hands and face with support, and starts to clean up spills and messes with support, they are showing adaptive skills.

• Communication skills. Communication is connecting by sharing thoughts and feelings. Between 24 and 36 months, this can look like understanding different sizes (“big” and “little”), asking for help with personal needs using words, responding to multistep directions and identifying objects by function (for example, you eat with a ____, drink from a ___). 

• Fine and gross motor skills. Fine and gross motor skills include the physical movement of a child. For a child between 24 and 36 months, fine motor skills look like cutting with scissors and using their hand to hold paper in place when drawing. Gross motor skills look like throwing a ball with some accuracy, walking or running longer distances, and walking up and down stairs with support from a rail, wall or person. 

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• Cognitive skills. Cognitive skills exemplify a child’s brain working on reasoning and awareness of themselves and the world around them. This looks like telling their own age, understanding quantity language such as “one,” “one more” and “all,” counting to at least 5 and putting graduated-sized objects in order. 

• Social-emotional skills. Social-emotional skills are learned through interaction and relationships. In children between 24 and 36 months, this can look like claiming objects as their own (using “mine”), taking turns occasionally with support, showing affection toward other children and participating in small groups with greater ease. 

• Vision skills. A child can show their vision skills by copying lines and circles, recognizing familiar adults in pictures, matching objects and sorting at least four colors as they turn 36 months old. 

• Hearing skills. A child can show their hearing skills by repeating more words and lengthier phrases, using more speech sounds correctly in words and responding to more complex directions with greater ease as they near 36 months old. 

Holistic View of Toddler Development

To look at something holistically means to not only see the individual parts but how they work together. Skills that babies acquire must be viewed holistically. All areas of development are connected and influenced by one another. By understanding these basic milestones of development and how they work together, caregivers can more easily identify when development is going well and when there may be a problem.

For example, feeding is a complex process and all areas of development are involved. Even when just one area is not working well, it can create challenges for babies and their caregivers. Therefore, it is critical to look at babies broadly to understand their full range of capacities and needs.

Example of a Holistic View of Feeding for Toddler Development (24 to 36 Months)

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