Although toddlers strive for autonomy, issues of attachment remain important
developmental themes. Attachment refers to the bond that forms in time between an infant and a caregiver.A secure bond is important in both social and emotional development during infancy and the
preschool years. The toddler who seeks autonomy and independence relies on secure parental ties for the confidence to venture out and explore the environment. Although he or she may wander,
the toddler always is cognizant of the caregiver’s presence and intermittently returns for reassurance. If the care- giver cannot be found, the toddler likely will become distressed. Disorders of attachment may result from inconsistent caregiving and are more common in the presence of family stressors, such as poverty, drug use, or emotional illness. Affected toddlers may not show interest in exploring the environment, may display separation problems, or may distrust the primary caregiver. It should be
particularly worrisome when a 2-year-old does not seek out the primary caregiver for reassurance
in a stressful situation, such as during a physical examination or painful procedure.