Unlike the half-dozen other small participants struggling with the intricacies of speech, she doesn't attempt to join in. But when Zamora finally asks who wants a monkey and prompts the toddlers to answer "I do," Gretchen calls out, "I," with gusto.

Most children Gretchen's age can speak about 30 words; Gretchen utters only a few. The rosy-cheeked redhead has endured two heart surgeries that have left her at risk for developmental problems, including speech delay. She's one of many children encouraged to find their voices with the help of Arc of San Diego's Parent/Infant Program.

The San Diego County Parent/Infant Program is a local arm of the state's Early Start program for children who have or who are at risk of acquiring developmental problems. The early intervention services are free, thanks to federal and state funds. The Parent/Infant Program partnered with The Arc of San Diego, a nonprofit agency that helps people with developmental disabilities and their families.

In September alone, 70 1-to 3-year-olds took part in the Parent/Infant program in Chula Vista.

Although the Parent/Infant program offers in-home training and play groups in the Chula Vista classroom, the program also finds ways for the toddlers to mingle with their counterparts without developmental problems.

"Kids just aren't as interested in adults as they are in other children," said Becky Thaller, Parent/Infant Program director. "They learn from observing one another. And they accept one another's differences."

Thaller said that although everyone benefits when all types of children play together, help for at-risk infants begins by coaching parents and children.

When a baby is premature or is born with a medical problem such as Gretchen's heart defect, parents reel from the initial blow. Boosting their morale is key.

"They're so caught up in the medical issues," Thaller said. "We help parents see their babies as babies rather than as little medical things."

Once toddlers join the Parent/Infant Program, they are exposed to challenges disguised as fun, such as singing games to spur vocalization; artwork to improve fine motor skills, including holding a crayon; and outdoor play that stimulates gross motor skills such as climbing and pushing.

Parents are challenged as well – to step back gradually and let their children work.

These days, Gretchen's mother, Denise Nielson, waves goodbye in a matter-of-fact way to her daughter and reads in her car during the twice-a-week play sessions at the Arc of San Diego's Chula Vista office.

Parents learn more than how to let go, Thaller said. The Parent/Infant Program takes students and their parents on outings that many hesitate to embark upon alone.

"It's kind of difficult to take a child to McDonald's that can't hold their head up," Thaller said. "The high chair might not fit right. People might say things. We decided, let's do it together."

Now the group goes on field trips to parks, the zoo or a pumpkin patch. On these excursions parents can learn from one another, picking up tips about how others handle situations, Thaller said.

Nielson especially welcomed the outings and other family-oriented activities, such as the annual Christmas party. "The program provided support, like family," she said.

The support went beyond the occasional day out.

"During Gretchen's second open-heart surgery when she was a year old, not only did the program take care of her, but they took care of me," Nielson said.

Nielson said Zamora visited her, her husband and her daughter in the hospital and gave them advice, emotional support and an attentive ear.

The final frontier for a special needs family is the world outside the classroom. The Parent/Infant Program partners with church day-care centers, in-home day-care providers and other community play groups for toddlers without special needs.

"All kids are kids – if you can start when you're 2 on patience and acceptance, you can just go on with that," Thaller said.

The Chula Vista Parent/Infant Program is looking for additional groups for interaction.

"We would love to find more participating day cares and preschools here in South Bay," Thaller said.

In the next year, Gretchen will work toward transitioning to a regular preschool like her older brother Dane, 3, a graduate of the same Parent/Infant Program his sister attends. Dane was born with the same heart defect Gretchen suffers from, pulmonary atresia. He also experienced developmental delays.

Zamora said that any child who has a heart defect at birth is at risk for developmental delays. Heart malformations don't affect the fetus before it is born, when it receives oxygen through the placenta. But after birth, heart abnormalities can interfere with the oxygen supply to tissues and cause a disability.

Now Dane is getting along well at his new school, and Gretchen is making rapid strides.

"She was just this little floppy baby doll, but look at her now!," Thaller said. "She's our role model."

Zamora attests to Gretchen's improvement. "Her motor skills have caught up. Her cognitive development has improved 100 percent. She understands everything we say, follows directions, knows the routine."

As yet, Gretchen's actions speak louder than words.

Zamora tilts a toy microphone under Gretchen's nose and asks her to say, "Hi, Sissy."

Gretchen makes an attempt.

"Good job!" Zamora said, telling the group, "She said 'ssss.' "

On the playground, Gretchen waves her chubby arms, walking as if wading, then runs and buries her face in her mom's chest before venturing out again.

"It's not what we've done," Thaller said. "It's what the parent has done with the information we've given them."

For more information about The Arc of San Diego's Parent/Infant Program, call (619) 427-7524.