Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Interventions for Toddlers

1. Early childhood programs - For toddlers who have been receiving early intervention services and whose behavior and development are within normal limits, interventions would include quality, developmentally based early childhood programs like Head Start (modified for younger children with appropriate staffing and curriculum), preschool programs, and parent-child groups.
   Quality early childhood programs offer children and their parents the opportunity to be exposed to other adults who have different approaches to childrearing, to try out new activities and learning experiences within a supportive environment, to participate as part of a group, to interact with peers, to receive feedback from others about their behavior, and to experience success and a sense of accomplishment. Children at risk for school failure because of their drug exposure or drug-using home environment can master these critical tasks within an integrated early childhood program.
2. Individual Therapy - Some children may not have received early intervention, or may still need individual therapy. Interventions, including speech and language services and physical and play therapy should be based on individual profiles of abilities and weaknesses. Low child: teacher ratios (1:1 being optimal) are recommended to allow for quality programming and an individualized focus.
3. Self-Regulation - Early childhood marks the beginning of self-regulation. Specific strategies to support self-regulation include (Appendix A, Section V):
   • An orderly, consistent, child-appropriate environment.
   • Predictable routines and consistent schedules.
   • Clear expectations and rules.
   • Clear patterns for transitions (such as a daily routine, warning signals, and signals to move to next activity).
   • Offering choices to children.
   • Praising a child's efforts, not just successes, each day.
   • Using anticipatory guidance to avoid difficult situations.
   • Explaining how a child's actions affect others.
4. Relationships - Strategies to support secure relationships with ongoing caregivers include:
   • Individual attention, encouragement of mutual respect, and celebration of each person to build healthy self-esteem.
   • Activities that foster self-esteem in both mother and child.
   • Labeling of feelings, so the child can learn to identify and express a range of emotions.
   • Clear boundaries within adult-child relationships.