quirement for regular school attendance, which may both reflect current health and exert effects on a given child’s likelihood of future health.

Behavioral influences on children’s health are often reciprocal, both influencing and influenced by parents, peers, and others. For example, parenting style, family traditions, and peer influences affect not only fairly simple youth behaviors, such as compliance with behavioral requests or participation in health prevention programs (Patterson and Fisher, 2002), but also more complex behaviors, such as participation with disease management regimens. This section focuses on the internal psychological factors that underpin children’s behavior, with implications for subsequent health outcomes.

Emotions, Attitudes, and Beliefs

In addition to the influence of explicit behaviors on health, a child’s internal emotional, attitude motivation, or belief states may exert effects on health. For example, research on both adults and children has shown direct relationships between internal attitudinal and personality factors and health outcomes, perhaps through mechanisms that link internal emotions, attitudes, and beliefs with stress reactions and immune responses (Berry and Worthington, 2001; Herbert and Cohen, 1993; Kiecolt-Glaser, 1999, Lawler et al., 2000). Thus, external events perceived as stressful by a child may function as triggers for an asthma or inflammatory bowel disease flare, over and above any biological exposure or adherence to therapy (Rietveld and Prins, 1998; Santos et al., 2001). Presumably such effects are conveyed through a child’s emotional arousal states, which in turn result in physiological changes, such as increased pulse and elevated blood pressure, glycemic, and immune responses. This research has solid empirical support in both the adult human and animal research fields (McEwen, 1998; Seeman et al., 1997), but it is less firmly established for children.

Behavioral Adaptations

The hallmark of childhood is the constant exposure to new developmental challenges. As children acquire new physical and cognitive skills and experiences, their behaviors change. They explore, practice, and experiment and as a result they change and are changed. The resulting behaviors are both manifestations of their health and have significant implications for it. At each new exposure, the child may respond in a variety of ways that in turn unleash a variety of reactions in his or her caregiver and in others around him.

From birth, infants recognize, prefer, and are soothed preferentially by their mother’s voice (Mehler et al., 1978; DeCasper and Fifer, 1980). They suckle more in response to it (Mehler et al., 1978), and mothers in turn are gratified by their ability to sooth their children (Klaus et al., 1972). Thus the beginnings of attachment are initiated. As an infant continues his or her explorations and trials, which

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