Aspen Pub.

/IYC AS160-03 March 5, 2003 18:35 Char Count= 0

Infants and Young Children

Vol. 16, No. 2, pp. 120–142

c 2003 Lippincott Williams & Wilkins, Inc.

Emotional Expressions of
Young Infants and Children
A Practitioner’s Primer
Margaret Wolan Sullivan, PhD; Michael Lewis, PhD
Research on emotional development in infancy has benefited greatly from the use of video-
tape technology and coding systems that allow detailed coding of facial movements. Today we
know that a core set of human facial expressions, composed of specific movements in the brow,
eye/cheek, and mouth regions of the face, are probably innate. Theorists continue to debate the
meaning of these expressions as well as how they are organized and become regulated over the
first several years of life. Despite continuing debate and research on these issues, early facial ex-
pressions have practical, signal value for caregivers and practitioners alike. This article surveys
what is known about the appearance and early normative, developmental course of emotional
expressions, noting similarities and differences in special populations when available. Its goal is
to provide practitioners with basic information to help them and the parents they serve become
better able to recognize the expressive signals of the infants and young children in their care.
Key words: emotion, emotional development, facial expressions, infants, nonverbal commu-
nication

S YSTEMS for deciphering the facial expres-

sions of infants and young children were
developed in the 1980s. These systems rep-
resent important and needed tools for pro-
moting more accurate, empirical study of
early emotional development. With them, re-
searchers are beginning to understand when
infants first express particular emotion sig-
nals facially, the organization of these signals,
and their relation to other aspects of moti-
vated behavior. While many important ques-
tions about the meaning and developmental
course of early expressions continue to be re-
searched and debated, it is now recognized
that most, if not all, of the facial components
of the human expression repertoire can be ob-
served shortly after birth (Camras, Holland,
& Patterson, 1993; Izard & Malatesta, 1987;
From the Institute for the Study of Child
Development, UMDNJ-Robert Wood Johnson Medical
School, New Brunswick, NJ.
Corresponding author: Margaret Wolan Sullivan, In-
stitute for the Study of Child Development, UMDNJ-
Robert Wood Johnson Medical School (e-mail: sullivan@
umdnj.edu).
120
Lewis & Michalson, 1983). Despite this find-
ing, facial coding systems have only just be-
gun to move out of the laboratory into clinical
settings (Gilbert et al., 1999). This is unfor-
tunate, because information about facial ex-
pressions potentially has practical import for
those working with infants, older, nonverbal
children, and their caregivers.
For practitioners, facial expressions are in-
formative in 2 ways. First and foremost, they
are social signals to others. Crying, vocaliz-
ing, and bodily movements combine with fa-
cial expression to provide cues to an infant’s
status. Savvy caregivers no doubt make use
of all of these cues in interpreting infant be-
havior. Although psychologists may be reluc-
tant to assign a specific emotion value to
infant facial expressions, parents have no
problem doing so. In fact, they routinely use
facial expressions to attribute personality and
intellectual characteristics to a young baby
(Haviland, 1983). They also use facial expres-
sions to gauge their own responses, thus help-
ing to regulate their infants’ arousal and teach-
ing them display rules (Malatesta & Haviland,
1982). Parents’ reading and interpretation of
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
the infant’s expressive cues in daily interac-
tion are key to the child’s social development,
emotion regulation, and early language learn-
ing (Mundy & Willoughby, 1996; Walden &
Knieps, 1996). Consequently, whether par-
ents observe and are having difficulty inter-
preting the expressive signals of their infant
should be an important screening question for
the practitioner.
Although some adults seem to have “nat-
ural” skills at reading emotional expressions,
others will need some training to recognize
the facial signals of young infants whose ex-
pressions are often fleeting, subtle, and per-
haps less well organized than those of older
children. This problem can be compounded
when there is neurological impairment or
developmental delay. Expressive behaviors
of infants and children with various forms
of disability have been described as muted,
hard-to-read, or excessively labile and incon-
gruous, depending on the population un-
der study (Mundy, Yirmiya, & Sigman, 1990;
Kasari & Sigman, 1996; Sigman, Kasari, Kwon,
& Yirmiya, 1992). When parents are un-
able to recognize and interpret emotional sig-
nals from their infants, they will be uncer-
tain about their child’s needs and less able
to share positive affect. Consequently, par-
ents may become less expressive themselves
(Dawson, Hill, Spencer, Galpert, & Waton,
1990), further degrading the quality of interac-
tion. Learning to recognize facial expressions
and how they evolve is a worthwhile effort
because these and other nonverbal cues of
emotion offer another channel of communi-
cation when children’s behavior or vocal ut-
terances are absent, or unclear. This channel
signals the infant’s arousal level, something
about the quality of the infant’s positive or
negative response to concurrent stimulation,
and may help explain other aspects of motor,
postural, and behavioral responses. In short,
the ability to interpret infants’ expressive sig-
nals is extremely important to parents person-
ally and to promoting mutually satisfying inter-
actions.
Another way expressions can be helpful to
practitioners is that they offer clues to the
Emotional Expressions 121
neurological and cognitive status of the child.
Facial expressions are controlled through the
facial cranial nerves but are also intimately
linked to cognitive development (Lewis &
Michalson, 1983). Consequently, young chil-
dren’s facial expressions have some clinical
significance. Although their initial appearance
is organized at the brain’s subcortical level,
changes in their form or developmental pat-
tern over time reveals that the child’s higher
cognitive and motivational systems are be-
coming integrated as brain maturation pro-
ceeds. Appropriate developmental changes in
facial signals imply that certain cognitive func-
tions are preserved in neurologically dam-
aged children, for example. This fact has
long been recognized for smiling (McCall,
1972), but is likely to be true for other
expressions as well.
Data on individual differences in facial ex-
pressions, their developmental trajectory in
normally developing populations, and spe-
cific information about facial expressions in
atypical populations is growing. This article
surveys the expressions of which infants and
young children are capable as revealed by fa-
cial coding systems such as MAX (Maximally
Discriminative Facial Coding System), its com-
panion, whole-face scoring system, AFFEX
(Affective Expressions Scoring System; Izard,
1982), and Baby FACS (Facial Action Coding
System; Oster, 1978) and will cover typical ex-
pressions. The article will not treat related and
important topics such as arousal, physiologi-
cal reactivity, or emotion regulation. Rather,
the focus is a pragmatic one of how to rec-
ognize expressions—whether they are muted
or intense, prototypic or idiosyncratic. Like-
wise, we set aside the thorny theoretical ques-
tion of whether the emotional experiences of
very young children are similar to or different
from those of older children and adults. Since
the discussion of expressions will make use
of the movements described in MAX, AFFEX,
and FACS, we briefly consider the nature of
these tools.
Although some of the assumptions underly-
ing MAX and AFFEX, as opposed to the Baby
FACS coding systems, remain controversial,
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
122 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
research using these systems shows that most
of the facial movements comprising adult
emotion expressions are present and map
onto positive and negative reactions to stim-
ulation during the first months of life. MAX,
AFFEX, and Baby FACS also share many fea-
tures. For example, all observe movements
of the facial musculature in the forehead,
eye/cheek, and mouth regions of the face.
They also agree, for the most part, on those
facial movements that constitute emotion
signals. The major differences between the
systems are their theoretical orientation and
comprehensiveness in scoring facial move-
ments.
MAX and AFFEX focus on a theoret-
ically limited set of “prototypic” expres-
sions of adults. In contrast, Baby FACS
does not, and is comprehensive in scor-
ing all possible movement combinations. Be-
cause MAX (Izard, 1983/1995) concentrates
on those facial movements that are max-
imally discriminative of 9 specific human
emotion expressions, it lends itself more
readily to applied situations. Besides the
9 facially expressed emotions (ie, Interest,
Surprise, Enjoyment, Anger, Sadness, Fear,
Disgust, Contempt, and Shame), several con-
trol or regulatory movements are also in-
cluded in MAX. Blended expressions, describ-
ing combinations of specific facial movements
in the face, also are deciphered (for example,
Anger/Sad is a common expression blend in
infants). In MAX, single component expres-
sions are thought to reflect a lower intensity
of expression than are signals occurring in all
3 facial regions (Abe & Izard, 1999). MAX, like
Baby FACS, is designed for use with videotape
or still photographs, but AFFEX can be used
as a live observational system. If you are inter-
ested in what facial expression or expressions
can be “read” as emotional signals, MAX or
AFFEX is the best application. We use it here
to present the facial expressions of infancy,
describing specific expressions, their devel-
opment, and what is currently known about
them in specific disabling conditions. The ex-
pressions are described as related sets or fam-
ilies because of the well-established finding
that infants’ expressions to any given context
vary across individuals. Even within individ-
uals, multiple expressions seen in rapid suc-
cession are common. Expressions are also sel-
dom pure and may blend 2 emotion signals.
Since blended expression may persist in some
children (Yirmiya, Kasari, Sigman & Mundy,
1989), the developmental course of and
individual differences in blends are of some
interest.
THE INTEREST FAMILY
Some do not consider interest is an emo-
tional expression, but since it is a sign of pos-
itive approach and receptivity to people and
objects, it is coded in MAX/AFFEX as a family
of expressions distinct from a neutral, awake,
but nonexpressive face. Figure 1 illustrates
3 varieties of interest occurring in young in-
fants. Notice that in all of the photographs,
the infants appear alert and attentive. How-
ever, there are subtle differences in their ex-
pressions, signaling differing qualities of that
attention.
Figure 1a has been characterized as
the “open” or relaxed interest expression
(Sullivan & Lewis, 1989; Sullivan, Lewis,
& Alessandri, 1992). The brows are raised
slightly, eyes wide open. The mouth is re-
laxed and open, taking a bow-shape as shown
here. The mouth may be closed in some
variants, but the key is that there is no sign
of tension. This expression occurs in envi-
ronments that offer the infant low intensity,
nonthreatening stimulation. Also described
as “curious” and “wide-eyed wonder” in the
nonscientific literature, open interest is by
far the most common expression of young
infants. Adults, on the other hand, typically
maintain a neutral/awake expression as our
modal expression. This is not the case for
infants, whose faces are rarely still and whose
expressions change rapidly (Malatesta &
Haviland, 1982). In fact, a “neutral” or sober
face is rare in awake, attentive infants much
before about 9 months of age (Lewis &
Sullivan, 1988). The common occurrence of
open interest reflects the “positivity offset”
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
Fig 1. Three forms of interest: (a) open interest, (b)
knit brow interest, and (c) interest with lip roll.
of the central nervous system (Cacioppo
& Gardner, 1999). That is, humans show
a mild bias toward positive emotion and a
motivation to approach novel objects, stimuli,
or contexts. Very young infants showing the
Emotional Expressions 123
relaxed, open interest expression are ready to
explore—if only visually—the environment
around them.
Figure 1b shows a form of interest sug-
gesting greater intensity. It is “excited” or
“knit-brow” interest (Camras, 1992; Sullivan
& Lewis, 1989). The major difference from
Fig 1a is the upper face region. The brows
stand out more prominently because the fore-
head muscles have been contracted. They
are pulled together, sometimes slightly as
shown here, sometimes more strongly, mak-
ing central bulges. The eyes appear slightly
narrowed, resulting in crinkling or furrowing
of the outer eye muscles known as crow’s feet.
Infants showing this expression appear to be
intensely interested. They may vocalize while
showing this expression or momentarily be-
come still. They have a concentrated or even
a quizzical look, as if they are actively study-
ing what they are looking at. Knit brow in-
terest is observed during young infants’ so-
cial interactions, marking periods of gazing
at mother or father (Malatesta & Haviland,
1982; Oster, 1978). It persists as much as
10 seconds, thereafter either resolving into a
smile or, in some cases, fussing, if the inter-
action has been overwhelming (Oster, 1978).
This expression has a specific developmen-
tal trajectory (Lewis, Sullivan, & Alessandri,
1990; Malatesta & Haviland, 1982). Seen fre-
quently in young infants, it decreases between
2 and 8 months, appearing again regularly by
10–12 months (Malatesta & Haviland, 1982;
Malatesta, Culver, Tesman & Shipard, 1989;
Sullivan and Lewis, 1988). Knit-brow interest
at these ages typically occurs in situations that
challenge infants or requires problem-solving.
It has also been referred to as a wary face
in studies of response to novel objects. In
such contexts, this expression is coupled with
the inhibition of motor behavior (Bronson,
1972; Lewis & Michalson, 1983). Wariness
suggests a state of heightened vigilance or
uncertainty. Collectively, the findings sug-
gest that knit brow interest is a form of
highly focused, effortful attention associ-
ated with active information processing. The
age change in its occurrence may mark a
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124 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003

developmental shift in the type and quality and with an MA-matched group to observe
of stimulation that infants must “work” to differences in MAX-coded positive, negative,
assimilate. interest (all forms) versus neutral expressions
Figure 1c shows an interest expression that (e.g. Kasari et al, 1992; Yirmiya et al., 1992).
includes one of MAX’s regulatory movements, This work finds that autistic children display
a thinning and rolling inward of one or both primarily neutral and interest expressions
lips. This expression was seen widely some for somewhat longer periods than do other
years ago as the whimsical expression of groups. Increased interest in autistic children
Cabbage Patch@ baby dolls. This lip move- appears at the expense of less enjoyment
ment seems to be regulatory because it fre- expressions (Yirmiya et al., 1989). No pub-
quently suppresses smiling; however, its ex- lished study has examined developmental
act signal value in infants remains unclear. In trajectories or examined differences in
older infants and children however, it tends interest expressions in any atypical popula-
to be combined with or precede gaze aver- tion. Knowledge about the range, distribu-
sion. After about 12 months, coordination tion, and pattern of these expressions may
of this mouth expression with head and eye be of some clinical use in identifying those in
movements signals the child’s awareness of need of further assessment.
the other’s unwanted attention in social situa-
tions. Head lowering and gaze aversion func- SURPRISE
tion to withdraw from or reduce undesired
social interaction, and when combined with The Surprise expression is rarely seen in
this lip movement may signal either embar- young infants, especially in the full form
rassment or shyness toward a social part- shown in Fig 2. In surprise expressions, the
ner, depending on the context and presence brows are raised and prominently arched. The
of other bodily cues (Lewis & Brooks-Gunn, eyes are widened so that the white of the
1979; Lewis, Sullivan, Stanger, & Weiss, 1989). sclera is more evident than in relaxed inter-
After the onset of self-cognition at about 18 est. The mouth gapes with jaw slackened,
months of age, this lip expression may oc-
cur in evaluative settings. When coupled with
body collapse, mouth components suggest-
ing sadness, and/or withdrawal from a task,
it signals shame or evaluative embarrassment
(Lewis, Alessandri, & Sullivan, 1992; Lewis,
2000).
Infants with neurological impairment and
various disabling conditions are frequently
reported to have difficulties attending. These
difficulties are often noted during infancy or
are detected as learning disabilities as chil-
dren reach school age. Differences in the form
or patterning of interest expressions may
appear as well and may offer early markers.
Attention, unfortunately, has been studied
almost exclusively as motor behavior, ie,
visual, auditory, or even cardiac orienting to
stimuli, not as facial expressions. Exceptions
are studies of emotion during joint attention
primarily in children with autism and mental
retardation. In this work, children with these
disabilities are compared to each other Fig 2. Surprise in a 5-month-old.
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
assuming an “o” shape, and may be ac-
companied by abrupt, momentary stilling
of other ongoing behavior. The expression
in Fig 2 occurred when a 5-month-old ac-
cidentally turned on slides and taped mu-
sic by tugging on a ribbon attached to her
wrist (Sullivan & Lewis, in press). Surprise
is an appropriate expression in this context
of sudden, unexpected exposure to an au-
diovisual event. Yet, investigators have been
stymied in their study of surprise because
it does not consistently occur in situations
that adults imagine would surprise babies.
A jack-in-the-box does not produce surprise
expressions in a majority of babies, for ex-
ample. Occasionally, surprise occurs in situ-
ations where the experimenter did not an-
ticipate observing it (Bennett, Bendersky, &
Lewis, 2002; Camras, 1992). When surprise
does occur, it appears briefly before resolv-
ing into some other expression—either inter-
est, smiling, or a negative expression. Most
researchers accept that infants show at least
mild surprise expressions to novel events by 6
months, and some may do so sooner (Bennett
et al., 2002; Charlesworth & Kreutzer, 1973).
But, there are wide individual differences in
whether babies display this expression even
within the standard laboratory situations, sug-
gesting that surprise may occur only in the
most emotionally reactive infants. Besides the
suddenness of the stimulus onset and its in-
tensity, a key factor in surprise seems to be
whether the stimulus event was expected. For
instance, infants who learned that pulling a
string turned on a slide with music expressed
surprise at this contingent event only when
first learning this response. Once learning
had occurred, surprise expressions were no
longer observed, suggesting that the infants
now expected something when they pulled
(Sullivan & Lewis, 1989). Surprise expressions
in very young infants also appear to grow
more intense across the first several repeated,
sudden stimulus presentations. This is less
characteristic of surprise in adults, who if sur-
prised by a stimulus more than once, rapidly
show an attenuated response.
Like interest expressions, information
about surprise expressions is lacking for
Emotional Expressions 125
various populations of infants and children
likely to be seen in clinical practice. Given its
relation to arousal modulation in response to
unexpected events and its tendency to habit-
uate with familiarization, information about
surprise expressions in various groups is of
considerable interest in assessing children’s
emotion regulation and emerging cognitive
skills.
ENJOYMENT
Because they are so readily recognized and
such widely acknowledged milestones of so-
cial behavior, smiling and laughter, the 2
major facial expressions of enjoyment, have
been the most intensely studied expressions
in infants. Their developmental trajectory
and links to cognitive processing in infants
have been extremely well documented in
full-term and preterm infants, as well as in
infants with Down Syndrome, autism, and
blindness (Calhoun & Kuczera, 1996; Carvajal
& Iglesias, 1997; Cicchetti & Sroufe, 1978;
Kasari, Mundy, et al, 1990; Kasari, Sigman,
et al., 1992; McCall, 1972; Sroufe & Waters,
1976; Sroufe & Wunsch, 1972; Vine, 1973).
While smiling appears universally, cultural
and environmental differences also have been
described (Camras et al., 1998; Gerwirtz,
1965; Kisilevsky, et al., 1998). Some have ar-
gued that additional enjoyment forms are de-
tectable in older infants (Fogel et al., 2000;
Scanlon-Jones et al., 1990). In fact, the de-
velopmental course of enjoyment provides a
model for comparison with the development
of other expressions, although not all expres-
sions will follow enjoyment’s pattern.
Smiling, like interest, is present from the
opening days of life and is state-dependent
during the neonatal period. Unlike the inter-
est expressions, which presume an awake,
alert infant, the first signals of enjoyment ap-
pear during the newborn’s sleep. Even at this
early stage, newborn smiles include the 2
most recognizable components of this expres-
sion: narrowed eyes, widened mouth, with
corners raised. These same features consis-
tently appear in the smiles of older infants
(see Fig 3a–c), although later smiles are more
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126 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003

Fig 3. Four examples of enjoyment from 2- to 9-month-olds in various contexts. (a) Response to tactile
teasing at 8 weeks, (b) response to audiovisual contingency at 4.5 months, (c) response to play in an older
infant, and (d) response to audiovisual contingency in an older infant with Down syndrome.
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
intense and may include other components.
Originally thought to be related to digestion
(older literature may refer to them as “vegeta-
tive” or “gas” smiles), sleepy smiles are proba-
bly related to the discharge of pleasant stimu-
lation of some kind by the infant’s immature
central nervous system (CNS) during rapid
eye movement sleep. The source of this stim-
ulation need not be internal, but can be linked
to the external environment through what-
ever attention and perceptual processing sys-
tems are functional at birth. For example, one
of the author’s newborn daughter slept in a
room with a musical, chiming clock on her
first day at home from the hospital. Two days
later, when she was again sleeping nearby, the
clock chimes elicited smiling. This incident
in a healthy newborn shows that the CNS is
primed to recognize familiar external auditory
information and to signal this recognition to
others. Repetition alone may be enough to
promote positive emotional responses to non-
threatening stimulation through simple asso-
ciative learning (Zajonc, 2001).
Between 6 and 8 weeks, smiles of en-
joyment can be observed during waking to
both visual and auditory stimulation. Visual
stimuli alone elicit smiling in young infants
but must have a face-like quality. For ex-
ample, a gently bobbing oval with 2 small
black circles, suggesting the eyes of a hu-
man face, are sufficient to make a 2- to 3-
Table 1. Variants of enjoyment
MAX/AFFEX
Facial actions codes
Closed-mouth, simple smile 0-0-52 CL
(ie, grin)
Enjoyment
“Duchenne” smile (with 0-33-52
cheek raise/eye crinkle)
Enjoyment
Bared-teeth play or 0-0-52/50∗
open-mouth Enjoyment
Duplay (play + cheek 0-33-52/50
raise/eye crinkle) Enjoyment
∗The combination of codes 52/50 can be used to designate a smile with jaw drop.
Emotional Expressions 127
month-old smile (Ambrose, 1963; Vine, 1973).
Figure 3a shows that gentle tactile stimula-
tion also successfully elicits enjoyment in an
8-week-old. Such demonstrations show that
expressions of enjoyment in early life are
closely tied to the physical quality of stimula-
tion, which can be auditory, tactile, or visual,
but is usually multisensory in quality. Very
soon, however, enjoyment begins to occur to
social events.
Expressions of enjoyment to social stimula-
tion increase dramatically by 16 weeks. Social
smiling peaks between 12–14 weeks of age
in home-reared infants in Western culture. In-
fants at this age clearly seem to enjoy people
and will smile readily at most adults who in-
teract pleasantly with them. After 16 weeks,
however, many infants become more discrim-
inating about whom they will smile for. The
familiarity and the behavioral style of the in-
teractive partner become important factors.
In this way, an emotional signal provides an
index of the infant’s growing social-cognitive
development.
In 12- to 17- month-old infants, variants
of social smiling have been described (Fogel
et al., 2000; Scanlon-Jones et al., 1990). These
appear to signal somewhat different quali-
ties of enjoyment within social situations but
more work is needed to determine if they
are actually different expressions or just dif-
fering intensities of enjoyment (see Table 1).
Context
Social and Toy play (Scalon-Jones, Raag,
& Collins, 1990)
Readiness to engage, peekaboo game (Fogel,
Nelson-Jones, & Hsu, 2002)
Social interactiona (Fogel et al., 2000;
Scalon-Jones et al., 1990)
Play with mother, tickle game (Fogel et al., 2002)
Social and Toy play (Scalon-Jones et al., 1990)
Social Play (Scalon-Jones et al., 1990)
Game resolution, peek-a-boo and
tickle (Fogel et al., 2000)
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128 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
None are treated as unique emotions in
MAX/AFFEX, but are simply coded as enjoy-
ment. All of these expressions were more fre-
quent during interaction with mother than
with toys. The play face, however, has special
meaning.
The laughing or play face
Wide-open mouthed, gaping enjoyment ex-
pressions occur with characteristic vocaliza-
tions known as laughter. In intense forms of
this expression, the lips may be rolled in-
ward as the jaw gapes. Either form signals
high excitement and positive arousal. Such ex-
pressions haven been called “play face” be-
cause they appear to be the human equiv-
alent of a primate expression of the same
quality (Blurton-Jones, 1972; Preuschoft & van
Hoof, 1997). The play face makes its appear-
ance by 5 months of age in normally devel-
oping infants (Sroufe & Waters, 1976). It oc-
curs at first to vigorous, auditory, and tactile
stimulation, ie, tickling as did smiling a few
weeks previously. After 7 months, visual stim-
ulation becomes more effective in eliciting
this expression. By about 12 months, incon-
gruity and novelty, especially if it involves the
infant’s own participation, will elicit laugh-
ter and the play face, immediately or in an-
ticipation of game-like interaction with a so-
cial partner, such as peek-a-boo (Fogel et al.,
2000).
Enjoyment of mastery
During the second half of the first year, in-
fants continue to smile and laugh at nonsocial
events but infrequently compared to social
situations. Smiling occurs in nonsocial con-
texts especially when infants learn that inter-
esting, familiar, and therefore, nonthreaten-
ing stimulation is under their own control.
Figure 3b shows a 4-month-old expressing en-
joyment of a slide and music that she has
learned to expect when she tugs a ribbon
attached to her wrist (Lewis et al., 1990;
Sullivan & Lewis, 1989). This is the beginning
of playful enjoyment of mastery of the physi-
cal environment that will continue to develop
as infants learn to play and explore. Compar-
ing this expression to one of the 9-month-old
at play with something novel (Fig 3c), one can
see that the crinkled eyes, widened mouth,
and raised, dimpled cheeks are very similar,
despite the fact that motor and cognitive skills
have grown considerably in the intervening
5 months. Thus, it seems that the form of
the enjoyment expression does not change,
only the contexts and qualities of stimula-
tion required to elicit it. Enjoyment of mas-
tery of an object or task becomes especially
common after 12 months and has been stud-
ied as one measure of “mastery motivation”
(Busch-Rossnagel, 1997). Once the infant is
capable of self-referential and self-evaluative
behavior, the integration of enjoyment of
mastery and postural and gestural signals
will lead to more elaborated expressions of
pride.
Because of the connection of enjoyment
with management of arousal and emerging
cognitive competencies, smiling and laughter
have been the most studied expressions of in-
fants and children with disabilities. Much is
known, for example, about the emergence of
enjoyment in infants with Down syndrome
(DS) (DS; Cicchetti & Sroufe, 1978; Sroufe &
Wunsch, 1972). As can be seen in Fig 3d, the
characteristic expressive components of mas-
tery enjoyment are present in this 8-month-
old child. Research shows that the general
course of both smiling and the play face is
the same in infants with DS, although delayed
compared to infants without this syndrome.
For example, social smiling peaks at the
same mental age (ie, 4–5 months) and smiles
are directed appropriately to social partners
(Carvajal & Iglesias, 1997). The intensity of
enjoyment is less, however, and infants with
DS may not sustain social enjoyment in spon-
taneous interaction to the same degree as do
infants without the syndrome and may be less
likely to initiate smiling (Carvajal & Iglesias,
2000; Kasari & Sigman, 1996). Such differ-
ences can have important effects on social
interaction. Smiling to auditory stimulation
also may be more limited in some children
with DS, but can be increased with interven-
tion (Calhoun & Kuczera, 1996). In fact, by
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
preschool age, children with DS are usually
reported to be highly positive in their social
interactions. One study finds however that
they are uniformly high in expression enjoy-
ment across situations whereas MA-matched
peers displayed more enjoyment only in those
situations involving joint attention and affect
sharing (Kasari, Mundy, et al., 1990; Kasari,
Sigman, et al., 1992). Thus the child with
DS seems to display enjoyment more indis-
criminately, suggesting a need to focus on
emotion regulation in some contexts. Finally,
enjoyment of mastery may be affected in
some children with DS because motor lim-
itations restrict early forms of object play,
but this also can be improved by interven-
tion (Brinker & Lewis, 1982; Sullivan & Lewis,
1990).
In severe cerebral palsy (CP), enjoyment ex-
pressions, especially in the mouth region, may
be less well modulated or appear asymmetri-
cal. If motor impairment is severe, the play
face may be the only form of smiling available
to these children because subcortical centers
modulating enjoyment are activated.
The course of smiling in blind children also
has been studied to understand the degree
of visual input that is necessary to produce
recognizable expressions of happiness. Visual
input does not appear to be necessary for
blind children to produce recognizable, spon-
taneous expressions of enjoyment. Instead, it
is their negative expressions that are more
difficult to recognize compared to those of
sighted children (Galati, Sini, Tinit, & Miceli,
2001). However, blind children may be less
skillful at management of social expressions,
contributing to the social inhibition that is fre-
quently reported in these children (Castanho
& Otta, 1999). Lower rates and poorer qual-
ity of enjoyment expressions may prompt the
perception of inhibition in children with dis-
abilities generally.
Enjoyment expressions in autistic children
have been studied around the issue of shared
affect between child and adult partners. Less
enjoyment is expressed by these children
when compared with MA-matched controls
in semistructured interactions. Autistic chil-
Emotional Expressions 129
dren also fail to share enjoyment with social
partners by coordinating their enjoyment
expressions with eye contact (Dawson
et al., 1990; Sigman et al., 1992). During toy
play, autistic children are as likely to express
enjoyment, a finding that underscores the
nonsocial nature of their expressions (Sigman
et al, 1992). Finally, autistic children
are likely to display incongruous blends
expressions that combine positive and nega-
tive facial elements (Yirmiya et al., 1989). It
is unclear if this occurs because of problems
in regulating expressions themselves, or be-
cause of ambivalent or competing emotional
arousal in these children. However, incongru-
ous expressions provide unclear, conflicting
signals to caregivers who rely much on
context or trial and error in responding to
them.
PHYSICAL PAIN
Some argue that pain is not an emotion.
Yet, painful stimulation clearly causes a strong
negative emotional response and promotes
other negative expressions. The developmen-
tal course of pain expression has been stud-
ied in some detail because of its theoretical
interest and the very practical need for as-
sessment and management of pain in pedi-
atric procedures (Grunau, Oberlander, Holsti,
& Whitfield, 1998; Oberlander, 2001). Pain
expressions can be also observed in situa-
tions of distress that are not physically painful
(Oster, Hegley, & Nagel, 1992). Thus, the pain
expression and those that follow it provide
clues to emotional and regulatory responses
to all forms of aversive stimulation.
Acute pain in response to tissue damage
during standard pediatric procedures (eg, cir-
cumcision, heel lance, or inoculation) pro-
vides a naturalistic and ethical way to observe
how facially and behaviorally expressed pain
responses change with the developmental
and neurological status of the infant. Pain in
response to such procedures is signaled by
distinctive and intense facial actions includ-
ing the drawing together and lowering of the
brows to create a midbrow bulge, a deepened
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
130 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
Fig 4. Pain in response to DPT inoculation in 4-month-olds showing (a) cupped tongue and (b) lateral
retraction of the mouth.
nasolabial furrow, and tight squeezing of
the eye orbit muscles, resulting in a strong
squint. From the newborn period through 18
months, few changes occur in the pain ex-
pression’s appearance or components (Craig,
1992; Craig & Grunau, 1993; Izard, Hem-
bree, Dougherty, & Spizziri, 1983; Johnston,
Stevens, Craig, & Granan, 1993; Lilley, Craig,
& Grunau,1997). Throughout this time, the fa-
cial response to acute pain reliably includes
all of the upper face movements listed. Mouth
movements are more variable but include lat-
eral stretching of lips, especially in older in-
fants and children. In young infants, one of
two common mouth variations can be ob-
served. Prominent especially in newborns is
a dropped jaw with taut or ”cupped” tongue
within an angular, wide mouth (see Fig 4a;
Lilley et al., 1997). From 1 to 5 years, these
facial movements cohere to form pain expres-
sions in pediatric patients. A greater number
of components shown is related to higher
pain ratings by clinicians (Gilbert et al., 1999).
The laterally stretched mouth also occurs
commonly at these ages (see Fig 4b). Since
few longitudinal investigations of pain have
followed infants’ pain expressions from the
newborn period, the meaning of these vari-
ations and age changes in the mouth compo-
nents of pain are unknown. We do not know if
they reflect individual differences in pain sen-
sitivity or in regulatory responses to pain.
Surprisingly, increased crying in preterms
and newborns is not a reliable marker for
pain in response to a heel lance (Grunau
& Craig, 1987). Young babies vary in their
irritability and many will cry in response
to handling prior to the actual procedure
(Grunau, Johnston, & Craig, 1990; Owens
& Todt, 1985). Very low birth weight pre-
mature infants between 26–31 weeks gesta-
tional age, show the upper face pain actions
when their heels are lanced to obtain blood.
The upper facial response is specific to the
piercing of the skin, rather than other po-
tentially stressful aspects of handling that oc-
cur as part of the medical procedure, and is
accompanied by the maximum increase in
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
heart rate. Noxious stimulation and the high
negative arousal they produce appear to si-
multaneously activate many different nega-
tively toned neurological systems in the young
baby. Pain expressions are associated with a
rise in cortisol levels in newborns, also sug-
gesting that heel lancing is a highly stressful
procedure for the young baby (Oberlander,
Gilbert, Chambers, O’Donnell, & Craig, 1999;
Owens & Todt, 1985; Ramsay & Lewis, 1994).
The pain expression and its accompanying
physiological response are related to the de-
velopmental age of the preterms, appearing
more consistent and robust in older babies
(Johnston, Stevens, Yang, & Horton, 1995).
It is unclear if this age change reflects bet-
ter neurological regulation of the pain re-
sponse, or the gradual recovery from illness
and trauma experienced by many of these sick
babies.
Although the expression of pain appears
relatively invariant over the first 2 years of
life, a number of important changes occur
that possibly reflect a combination of neuro-
physiological maturation, life experience, and
a growing ability to remember prior painful
experiences. In contrast to newborns, in
2-month-olds, the expressive components of
pain occur at low frequency during a preinoc-
ulation or baseline period. This observation
suggests that pain expressions, occurring as
nonspecific generalized distress reactions to
handling, decrease with age. However, be-
cause a significant and dramatic increase in
all pain components is observed in response
to inoculation, infants’ pain response shows
some specificity to skin trauma at every age
studied (Lilley et al., 1997). Healthy term in-
fants between 2 and 4 months of age have
the most robust response to pain (Lewis &
Thomas, 1990; Maikler, 1991). By 4 months,
pain expressions are highly specific to in-
oculation, with very few pain signals occur-
ring during the baseline period. Likewise,
4 month-olds have quicker recovery from
pain (Lilley et al., 1997; Lewis & Thomas,
1990; Ramsay & Lewis, 1994), suggesting
that CNS mechanisms inhibiting the trans-
Emotional Expressions 131
mission of pain become functional at this
age. Following this important transition point,
6-month-olds show a shorter duration of pain
response and less of a rise in cortisol in re-
sponse to immunizations, suggesting better
internal physiological regulation in response
to pain (Lewis & Thomas, 1990; Ramsay &
Lewis, 1994).
Although the appearance of the pain ex-
pression may change little with age, older in-
fants have more complex responses to pain.
Typically, they display facial pain for a smaller
proportion of time prior to quieting, dis-
playing anger and blended expressions in-
stead (Izard et al., 1983; Izard, Hembree,
& Heubner, 1987). By 18 months, pain-
specific expressions comprised only 10% of
the postinoculation distress (Izard et al.,
1987). Thus, anger and other negative ex-
pressions become rapid after-reactions to the
initial pain response. This pain after-reaction
is most likely to influence the appropri-
ate soothing strategy and might also be sta-
ble across individuals. For example, these
postpain facial signals likely reflect some
combination of differences in pain sensitiv-
ity and social experience among individuals.
For, example, Japanese infants seem to have
less pain sensitivity and qualitatively different
emotional responses to inoculation than do
American infants; pain expressions are less
intense and are not typically followed by
anger and crying, but by surprise (Lewis,
Ramsay, & Kawakami, 1993). Differences be-
tween Chinese infants and other groups are
even more pronounced for a variety of expres-
sions (Camras et al., 1998).
Greater behavioral coordination and mat-
uration of motor skills also lead to elabora-
tion of responses to pain in older infants.
Infants over 12 months of age are more
likely to show goal-focused behaviors fol-
lowing immunizations (withdrawing, avoid-
ing), compared to younger infants who dis-
play more unorganized distress responses
(Craig & Grunau, 1993). Between 12 and 18
months, pain responses become anticipatory.
Lilley et al (1997) reported that baseline
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
132 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
pain expressions were low between 4 and
12 months, but rose again between 12 and
18 months to a level similar to that of 2-month-
olds! These differences in the baseline or pre-
inoculation period suggest that the older in-
fants anticipated the painful procedures in
store for them. If so, pediatricians may be-
gin to encounter anticipatory emotional re-
sponses to pain, cued by the environment
and salient memories of prior procedures by
12 months, perhaps even earlier. Collectively,
these changes suggest that the pain expres-
sion is stable over the first 2 years of life and
there is a close link between facially signaled
pain and neurophysiological development.
Significant neurological impairment ap-
pears to dampen the pain response, but the
basis for dampened or atypical pain responses
is unclear (Oberlander et al., 1999). Signif-
icant neurological, motor, and/or cognitive
impairment can produce a decreased pain
response for any number of reasons, lead-
ing to underrecognition and poor manage-
ment of pain in children with disabilities or
neurological impairment. The development
of expression-based pain scales for pediatric
practice is a relatively recent application di-
rected toward addressing this problem and
discovering methods to assess pain based on
facial responses (Oberlander, 2001). Hope-
fully, better quantification of pain will lead to
better recognition and effective management.
DISGUST AND ITS VARIANTS
The disgust expression is another that has
been studied in some detail in newborns. The
newborn’s response to bitter and sour sub-
stances is distinct from responses to water
and sweet solutions (Granchow, Steiner, &
Daher, 1983; Rosenstein & Oster, 1988;
Steiner, 1979). Saltiness does not trigger dis-
gust expressions, with less than half of in-
fants showing any negative response to it
(Rosenstein & Oster, 1988). However, quinine
and other bitter tastes are potent and rapid
elicitors of disgust responses regardless of in-
fant state. The intensity of the disgust expres-
sions as well as the pattern of components
expressed appear to index increasing concen-
trations of the solutions presented (Granchow
et al., 1983; Rosenstein & Oster, 1988; Steiner,
1979). The response to a bitter taste typically
involves turning away from the source of the
stimulus and gaping of the mouth and lower
lip, as shown in Fig 5a. Sometimes, the gag
reflex is observed (Steiner, 1979). Nose wrin-
kling and upper lip raising are components of
the full disgust reaction, but occur alone as
observed in about half of the newborns as a
less intense form of the reaction (Rosenstein
& Oster, 1988). A flattened tongue and drool-
ing may also be visible, depending on the state
of the child and the concentration of the fluid
(Steiner, 1979). These responses signal strong
distaste on the part of the infant. They are a
defensive reflex helping the infant to rid itself
of the unappealing taste. Similar responses are
observed to odors that most adults would find
objectionable, such as fishy and “rotten egg”
smells (Steiner, 1979).
Responses to a sour taste, such as citric
acid solution, are more variable, seem to be
milder, and evolve over several seconds in
contrast to disgust. Lip pursing is the com-
monly observed initial response, accompa-
nied by nose wrinkling, narrowed eyes, and
blinking (Rosenstein & Oster, 1988; Steiner,
1979). Figure 5b shows this response in a 4-
month-old. A closed mouth, either with cor-
ners down or retracted lips, is a feature as-
sociated with milder aversive reactions. This
“sour grimace,” signaling dislike, occurs as the
response develops (Granchow et al., 1983;
Steiner, 1979).
The variability of sour expressions in re-
sponse to sour tastes is even more pro-
nounced in 4-month-olds than in newborns.
The most common response to a natural
sour taste (lemon juice) at this age is in-
terest, following the initial puckering and
rapid lip movements associated with tasting
or mouthing of the flavor. In some infants,
however, negative expressions indicating dis-
like (sad frown or lip retraction movements)
appear, as observed in newborns (see Fig 5c).
However, a few infants actually smile, the next
most common response to this taste (Bennett,
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0

Emotional Expressions 133

Fig 5. Disgust (a) and sour (b, c) responses of 4-month-old infants elicited by a lemon juice swab.

et al, 2000). This finding shows that early in-
dividual differences in taste preferences and
rapid resolution of initial mild disgust reac-
tions into either enjoyment or dislike emerge
early in life.
The developmental course of the disgust
family of expressions has not been traced
further, but it appears that the disgust re-
sponse is so well-developed in infants and
specific to both the quality of olfactory and
gustatory stimulation, that its form changes
little. Steiner (1979) undertook extensive
study of disgust and enjoyment taste re-
actions in various populations of infants
and children with various forms of disabil-
ity, including newborns with hydrocephaly,
anencephaly, the congenitally blind, children
with craniofacial malformations, and mentally
retarded adults. Disgust and sour grimace ex-
pressions were recognizable in all popula-
tions studied, despite the considerable vari-
ation in the cognitive and motor control
(Steiner, 1979). He argued that the preser-
vation of disgust responses across this wide
range of cognitive and motor functioning
means that disgust expressions are controlled
by the brainstem and so undergoes little mor-
phological change. However, the emergence
of the positive or negative reactions to sour
also points to 4 months as an important
developmental milestone in organization of
expressions.
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134 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
Perhaps the most interesting aspect of dis-
gust expressions, and the one about which
little is known, is how the subtle variations
in responsiveness observed even in newborns
are related to individual differences in ner-
vous system functioning or other factors, such
as temperament. A second unanswered ques-
tion is when these expressions begin to occur
in response to non-taste stimuli, and espe-
cially social stimulation. Like smiling, dis-
gust expressions are elicited initially to phys-
ical rather than social-psychological elicitors.
Non-taste stimuli that might be sufficient to
produce disgust in infants have not yet been
reported, but can be imagined. Disgust sig-
nals stimulus rejection. Therefore, too rapid
or sudden occurrence of a stimulus might
elicit disgust expressions if the stimulus over-
whelms infants’ ability to process it. We have
observed this on some occasions in the infant
learning lab: sometimes an infant pulls suffi-
ciently rapidly that the slide and music ap-
pears within a second of its previous appear-
ance and before the infant’s reaction to the
first appearance has subsided. When this oc-
curs, the infant may display nose wrinkling, or
asymmetrical mouth and lip movements in re-
sponse, suggesting a kind of recoil reaction to
the overwhelming, too rapid reoccurrence of
the stimulus. While clearly not yet an instance
of “psychological disgust,” such observations
suggest that prior to 6 months of age, compo-
nents of disgust may occur in response to vi-
sual and auditory stimulation, setting the stage
for their later function in social situations.
But, the forms of disgust observed in this case
do not involve the intense, gaping reactions
observed in response to bitter tastes.
Toilet training and introduction of solid
foods when the child is able to eat inde-
pendently are thought to be important con-
texts for parent-child socialization of disgust
(Rozen, Hadt, & McCauley, 2000). It is also
possible that disgust, signaling stimulus rejec-
tion, is more common in neurologically dam-
aged infants and children in whom inhibitory
control is slow to develop or absent. This re-
sponse would be an important clue to care-
givers to reduce the intensity or pacing of
stimulation.
ANGER OR ‘‘CRY FACE” EXPRESSIONS
The prototypic anger or cry face appears
in Fig 6a. It is characterized by brows drawn
together and lowered, sometimes strongly as
seen in this view. Deep nasolabial folds frame
a wide-opened square mouth. Anger expres-
sions of this intensity are almost always ac-
companied by a rolling cry in infants, but
milder versions are observed without any vo-
calization. This expression is the infant’s most
common negative expression.
A major quandary for theorists is that the
anger/cry face rarely occurs in young infants
without the co-occurrence of other negative
expressions or blends. Blended anger and sad-
ness, as seen in Fig 5b, is commonly seen. In
this expression, knit, lowered brows and nar-
rowed eyes of the upper face region are ac-
companied by a sad ”pout” in the lower face.
This particular blend (upper face anger with
lower face sadness) is often observed during
social interaction with the mother and it tends
to decrease with age in this setting (Izard
et al., 1995). This might not be so in all situa-
tions that recruit anger expressions, but more
information is needed. The co-occurrence of
multiple negative and blended expressions
with the anger/cry face has led some to argue
that these negative expressions collectively re-
flect general distress or unhappiness instead
of a specific facial signal of anger or other
negative emotions (Camras, 1992). However,
the co-occurrence of multiple negative ex-
pressions in the early months can also be
explained by the well-known quality of the
CNS to respond more intensely to negative
than to positive stimuli (Peters & Czapinski,
1990). Although the CNS idles in a mildly pos-
itive mode (positivity offset), when a threaten-
ing stimulus is encountered, a vigorous nega-
tive response is observed. This phenomenon,
known as the negativity bias, may be espe-
cially evident in young infants, in whom in-
hibitory control is still limited and arousal is
poorly regulated. The negativity bias could
result in an initially unmodulated negative
response that simultaneously activates several
competing systems when an aversive event
is initially perceived. It is not that there is
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
Fig 6. Anger (a) and upper face anger blended with sad (b) expressions in 5-month-olds.
one “undifferentiated” distress state, but that
all negative emotion systems are primed. The
strongest response tendency is an energiz-
ing response to action in order to resist or
overcome the aversive stimulus. It is signaled
by increased motor activity and crying as
well as by the prototypical anger or cry face
expressions.
Although anger expressions may not ap-
pear exclusively when infants encounter cer-
tain types of negative events, by 3–4 months
of age, a number of situations seem to re-
sult in anger expressions predominantly. Re-
straining an infant’s arms, for example, pro-
duces a variety of facial expressions, not
all of them negative. Anger, however, is the
predominant negative expression (Bennett
et al., 2002; Braungart-Reiker & Stifter, 1996;
Stenberg, Campos, & Emde, 1983; but see
Camras et al., 1998, regarding ethnic differ-
ences). An even more powerful example is
the response of infants to loss of a contingent
event (Lewis et al, 1990; Sullivan, Lewis, &
Alessandri, 1992). Infants who learn to con-
trol a pleasant event by pulling a ribbon show
anger expressions and increase pulling when
Emotional Expressions 135
that action abruptly fails to produce the event.
Anger expressions increase, but other nega-
tive expressions do not. The increase is there-
fore specific to infants’ having learned a re-
lation between action and outcome (Lewis
et al., 1990; Sullivan & Lewis, in press). Situa-
tions that produce anger expressions before
6 months of age are those in which ac-
cess to desired objects or goals is blocked
or thwarted in some way (Bennett et al.,
2002; Lewis et al., 1990; Stenberg et al., 1983;
Sullivan et al, 1992) or, those causing pain af-
ter about 4 months (Izard et al., 1983). There
is stability in individuals’ expressions of anger
in these contexts as well (Izard et al., 1995;
Sullivan et al, 1992).
Crying and fussing are widely recognized
vocal signals of negative emotion in infants,
but no any one quality of crying appears
to be specific to the “cry face” or to any
other negative expression. Negative facial
expressions can precede negative vocal be-
havior, suggesting that greater or increas-
ing arousal is needed for vocal crying. Cries
can be differentiated by frequency and tonal
quality but it is difficult for observers to
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
136 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
discriminate these features reliably and expe-
rience is an important factor when differen-
tiating vocal crying in the mild to moderate
range (Papousek, 1989). Facial expressions
probably provide more graded information
about the onset, quality, and intensity of neg-
ative reactivity, making such discriminations
possible.
The form, development, and regulation of
anger expressions and their relation to vo-
cal crying in atypical development has not
been addressed in any significant detail. Like
smiling, negative vocalizations undergo an im-
portant developmental transition in the first
4 months (Hopkins, 2001). Presumably this
change parallels changes in the patterning
of anger and other negative expressions, al-
though this has not been studied. Much avail-
able work has focused on the clinical utility
of vocal cry behavior and unexplained infant
irritability (Barr, Hopkins, & Green, 2000). Be-
cause adults rely on vocal and facial informa-
tion before correctly identifying that infants
are indeed upset (Greene & Gustafson, 2001),
the lack of information about the coordination
of expression and voice in the development of
typical and atypical children is frustrating. Dis-
Fig 7. Sad expressions without (a) and with (b) lower lip protrusion in infants under 6 months of age.
abling conditions significantly affect adult per-
ceptions of young children. For example, in-
fants and children with DS are reportedly less
irritable than the norm and those with CP and
auditory and visual handicaps even more so
(Field, 1996). Autistic children are also some-
times found to be more negative (Yirmiya
et al., 1989). Greater attention to the quality of
expressive behavior of children with disabil-
ities might provide more clinically useful in-
formation and suggest possible interventions.
Given their physical limitations, it is reason-
able to expect greater frustration on the part
of these children. Whether it is expressed as
anger, other negative expressions, or undiffer-
entiated distress is not known
SAD OR ‘‘POUT FACE” EXPRESSIONS
Figure 7a shows the sad frown or “pout
face” expression. The brows are raised and an-
gular in appearance over narrowed eyes. The
nasolabial folds appear prominent, as they
do in all negative expressions. The mouth
corners are down-turned in a “horseshoe”
shape (Oster, 1978). The chin is raised, some-
times prominently as in Fig 7b. The latter
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
movement, especially when combined with
forward projection of the lower lip, as in
Fig 7b, gives it the pouting quality. In both
examples of this expression, the mouth is
closed, although open-mouthed sad pouts are
also possible. Sad pouts are equally likely to
appear as an upper face signal or as a full ex-
pression in young infants (Izard et al., 1995;
Sullivan & Lewis, in press). When blended
with another expression, sad brows are espe-
cially likely to combine with anger or, less of-
ten, with interest in the lower face. In either
case, such blends are interpreted as a signal of
dislike or unhappiness.
Sad pouts have never been observed to
be specific to any stimulus or context. For
this reason, little is known about them. They
are not a dominant negative expression in
any context that has been studied, except for
pouts associated with the after-sour response
(Bennett et al., 2002). Sad pouts occur at rela-
tively low but stable levels during both social
interaction and learning/frustration episodes
(Izard et al., 1995; Sullivan et al., 1992).
Some have suggested that this expression
occurs as an infant or young child either
arouses to an anger expression or as a reg-
ulatory movement inhibiting anger (Camras,
1992; Oster, 1978). It is possible that sad
expressions are never completely indepen-
dent of anger expressions even in adults
(Barr-Zisowitz, 2000). Caregiver intervention
in response to sad expressions may forestall
or more effectively help dampen more in-
tense negative response, but this has not been
demonstrated.
FEAR EXPRESSIONS
Fear expressions are notoriously difficult
to observe in infants. In adults and children,
this expression involves raised and straight-
ened brows, widened eyes with tense lower
eyelids, and horizontally retracted lips. Less
intense versions feature brow movements
alone, possibly blended with interest or other
facial movements in the lower face, such as
anger or sadness. Situations that could con-
ceivably frighten infants (eg, a visual cliff, the
Emotional Expressions 137
approach of a stranger, highly novel masks,
and startling mechanical toys) do not elicit
fear expressions (Bennett et al., 2002; Camras,
1992; Izard et al., 1995; Lewis & Michalson,
1983). Therefore, some suggest that infants
may not be able to display fear until some-
time after 7–12 months because greater expe-
rience and cognitive abilities are needed for
appraisal of strange and dangerous environ-
mental events (Izard & Malatesta, 1987). Both
independent locomotion and ability to inhibit
behavior may also be prerequisites of fear. For
example, wariness of strangers, a mild form of
fear, is not observed in a majority of children
until after 7 months of age (Bronson, 1972).
By 11 months, the brow components of fear
do occur to a variety of aversive stimuli, but
are not specific to fear-inducing toys, such as
a growling mechanical gorilla (Camras et al.,
1998). Fear systems in the brain do have a
high degree of plasticity (LeDoux & Phelps,
2000), supporting the view that learning and
experience are very important to this emo-
tion. The question remains how little experi-
ence is needed for fear expressions to occur.
Figure 8a shows the response of a 6-month-
old infant to the return of a nurse for the
second of 2 inoculations administered at this
well-child visit. This observation suggests that
a single salient experience may be suffi-
cient. By 2 years of age, fear can be rapidly
learned, resulting in phobic reactions that
may spread readily to previously nonfeared
objects through learning (Watson & Rayner,
1920).
Even in young infants, fear blends are ob-
served on occasion in situations that are aver-
sive. For example, fear blends occurred in
8% of infants in response to arm restraint
(Camras, Oster, Campos, Miyake, & Bradshaw,
1997). This raises the possibility that most
stimulus situations studied thus far are not
adequate to elicit fear expressions and that
blends are observed because milder stimula-
tion results in less intense reactions. As with
disgust, very specific and intense stimulation
may be necessary to elicit fear expressions.
Looming objects, very loud sounds, and the
loss of support are good candidates. However,
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
138 INFANTS AND YOUNG CHILDREN/APRIL–JUNE 2003
Fig 8. A fear expression in response to approach of a nurse following inoculation (a) and a fear blend in
response to the sudden appearance of a stimulus (b).
some of these are impossible to study exper-
imentally because of ethical considerations.
Alternatively, aversive situations may produce
fear only in the most temperamentally fearful
children. In our studies of infant condition-
ing, fear blends appear as negatively toned sur-
prise expressions (see Fig 7b). These surprise-
fear blends appear early in the conditioning
session, before infants realize that their own
movements cause the sudden onset of slides
and music. While most infants are surprised
and interested in these first appearances of
slides and music, others show surprise reac-
tions that grow more extreme across several
presentations, ultimately developing a nega-
tive quality including fear components (brow
straightening, tensed lower eyelid, and/or lat-
eral movement of the mouth corners). In most
cases, fear-surprise responses subside quickly
as infants learn the relation between their
own movements and the slide’s appearance
(Lewis, Sullivan, & Michalson, 1984; Sullivan
& Lewis, 1989). But, some infants begin to
fuss and are unable to complete the proce-
dure. These infants are reported by mothers
to have more fearful temperaments (Sullivan,
Ramsay, & Lewis, 1992). It seems reasonable
to infer that infants with fearful temperaments
may be expressing fear.
Because so few negative situations elicit
fear and the percentage of children for whom
fear expressions have been observed is so
low (Bennett et al., 2002), the developmen-
tal course of fear expressions has not been
studied extensively. The dependence of fear
on cognitive skills and appraisal of danger
in the environment may mean that most
infants must learn to fear. Hence, fear ex-
pressions will vary greatly across individ-
uals. Some infants may express excessive
amounts of fear, either because neurologi-
cal damage has interfered with the normal
buffering of the fear expression, or because
prolonged experience with invasive medical
procedures have resulted in conditioning of
fearfulness.
Aspen Pub./IYC AS160-03 March 5, 2003 18:35 Char Count= 0
SUMMARY
Despite differing approaches to measure-
ment, considerable evidence shows that
context-appropriate emotion expressions oc-
cur in infants and young children from birth
or shortly thereafter. No matter what sys-
tem is used, interest, enjoyment, anger, pain,
and disgust have been shown to signal be-
havioral dispositions congruent with these
emotions in young infants. This is also true
for fear and sad expressions in older infants.
Pain, enjoyment, interest, and possibly anger
and disgust show little change over the first
2 years. Instead, the contexts that elicit
these emotions shift at several major transi-
tions in cognitive development and cerebral
maturation, ie, 4 months, 7–9 months, and
18–24 months. At these developmental ages,
expressions can be particularly informative
about the developmental status of children.
At all ages, individual differences in expres-
sive behavior can provide clues to children’s
preferences and style of response. Although
a number of interesting and important ques-
tions remain about expressive development,
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