In this module, you will learn to differentiate among infant states and recognize a wide range of infant cues. You’ll also learn how to support caregivers’ ability to recognize cues.

By the end of this module, you will be able to:

  • Describe the connection between caregiver interpretation of infant behavior and feeding practices
  • Differentiate among six infant states
  • List risk factors for poor state control in infants
  • Differentiate between engagement and disengagement cues
  • List risk factors for infants who may have a limited ability to use cues
  • Describe the connection between caregiver response to cues and infant crying


  • Click on each of the 3 links in order to complete the steps below.
  • Be sure to complete each step before moving on to the next link.

Step 1. Click on the image or link below (Part Two – Infant States and Cues) to begin:

Part Two - Infant States and Cues

Link to view Part TWO presentation

Step 2. Click on the image or link below for a self-assessment to test your ability to differentiate infant cues.

Self-Assessment - Cues

Link to begin Self-Assessment- Cues

Step 3. Click on the link below for a self-assessment to test your ability to apply the knowledge and skills learned in this module.


Relevant Resources

Barnard KE.  Keys to Developing Early Parent-Child Relationships. In: Barry M Lester and Joshua D. Sparrow, eds. Nurturing Children and Families. Building on the Legacy of T Berry Brazelton. Oxford, UK: Wiley-Blackwell; 2010: 53-63.

Nugent et al. Understanding Newborn Behavior and Early Relationships: The Newborn Behavioral Observations (NBO) System Handbook.  Baltimore, MA: Paul H Brookes Pub Co; 2007.

Hodges, EA, Wasser HM, Bolgan BK, Bentley, ME.  Development of feeding cues during infancy and toddlerhood. MCN Am J Matern Child Nurs. 2011; 41:244-251.

DiSantis KI, Hodges EA, Johnson SL, Fisher JO. The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. Int J Obes. 2011; 35: 480-492.

Heinig MJ, Banuelos J. Normal Infant Behavior. In: Campbell SH, Lauwers J, Mannel R, and Spencer B, eds. Interdisciplinary Lactation Care. Burlington, MA: Jones and Bartlett, 2019: 57-66.

White, C., Simon, M., & Bryan, A. (2002). Using evidence to educate birthing center nursing staff about infant states, cues, and behaviors. MCN: The American Journal of Maternal/Child Nursing, 27, 294–298.

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Go to Next: Module 3: Crying and Sleep Patterns