Most people, on the street, when asked ‘Do you know about infant mental health?’ say, 'What? A baby could have a mental health problem?' Then they look at you like you have a ridiculous 'first world problem' such as 'What kind of fleece coat shall my labradoodle wear in winter?' Or 'Why doesn't Mulberry's stock quinoa?' This is not a very validating response for infant mental health professionals....!
I am so thankful that now the 1001 Critical Days APPG have tasked PIP UK with helping create a shared narrative about Infant Mental Health. This is essential https://fnp.nhs.uk/blogs/uniting-behind-the-first-1001-days/
It’s been #children’smentalhealthweek this week (4-10th February 2019) and we have a whopping child mental health epidemic in the UK with at least 1 in 10 children having a diagnosed mental health condition https://youngminds.org.uk/about-us/media-centre/mental-health-stats/ and 56% of children saying they worry about something all the time. https://www.childrensmentalhealthweek.org.uk/research
This week I found myself questioning:
Where and when do people think child mental health starts? Do they think it’s like an physical illness that comes on all of a sudden in year 6? Why do many people (including informed and engaged commissioners) think child mental health only begins at age 5?
Some statements: 1. Babies as young as 2 months old can be observed as depressed, anxious and developing attachment disorders.
2. A child’s brain undergoes an amazing period of development in the first few years of life producing more than 1 million connections per second. http://www.zerotothree.org
3. Infant mental health is PREVENTION of ongoing and further trauma to a tiny little person who cannot tell us what s/he is feeling or thinking and is born without defenses.
The smaller and less formed we are the more malleable (and therefore vulnerable) we are. We are born into thousands of different possible cultures, traditions, and languages. The only way we could survive as a species is to have offspring who can adapt to this. A human infant is born ‘prematurely’ and unable to walk or survive at all compared to any other mammal.
This enables us to download our entire cultural (and social and emotional repertoire). It is known by neuroscientists that the brain is literally shaped by each environmental influence…. moment by precious.. moment.
So What is Infant Mental Health?
Infant mental health is not maternal or paternal mental health.
Recently, there has been a big increase in understanding the impact of maternal mental health. In 2014 Bauer et al highlighted the cost and implications of perinatal mental health at £8.1 billion per year with 72% of this relating to impact on the baby. https://www.nationalelfservice.net/populations-and-settings/perinatal-mental-health/ We are just catching up with this in the UK. NHS England is working to ensure maternal mental health is addressed and support accessible. But what about infant mental health in babies who do not have a parent with a mental health diagnosis? Just because a parent has a diagnosis of, for example, depression, anxiety or bi-polar disorder does not automatically mean that the baby is in danger of a later mental health problem. It is a risk factor but not essentially a cause.
Infant mental health is not the same as infant development. Some babies develop quickly, some are premature, some have a syndrome or a delay. This may or may not impact on that baby's mental health.
Infant mental health is not parenting support. While infant mental health can be played out in how a baby weans, sleeps or communicates, this is not in itself mental health, just a symptom This is not necessarily the only thing we need to target (via parenting or behavioural strategies) to address this little person's mental health.
Infant mental health is not just about parent infant attachment but this is getting closer to the core of the issue. In pregnancy we cannot separate a mum-to-be from the infant's state.
We also cannot separate the type of attachment patterns that develop from conception to aged 2 from a baby’s (and later that child and adult’s) mental health. It may be helpful to think of attachment as the mechanism that surrounds and protects each person.
In 1975, a ground breaking paper written by Selma Fraiberg et al, told the story of how a parent’s own history links with attachment and so shapes infant mental health. This speaks of 'ghosts in the nursery'. https://www.ncbi.nlm.nih.gov/pubmed/1141566
In considering infant mental health and working alongside parents we can ask: When you hear your baby cry what are you hearing? Pain? Sadness? Anger? Grumbling? Tiredness? Is it your baby’s real communication or is it your own 'stuff'? Did you experience being heard? Loved? Understood?
Our 'stuff' is the mist and fog that would prevent us seeing our baby for who they are and therefore can seriously get in the way of us acting in a sensitive, loving, protective way to ensure our parent infant relationship is healthy and secure and our baby stays mentally healthy. It was the analysts (Freud, Winnicot, Bion and more) who discovered infant mental health and they are the port from which we always set sail in addressing infant mental health in 2019 and beyond.
Infant mental health is impacted by a myriad of factors... too many to cover here but including a parent's own history of being cared for as well as social support and poverty, physical health, the parents relationship or witnessing domestic abuse, drug or alcohol misuse or the impact of birth trauma.
In the context of working with families in extreme situations and to state this strongly and clearly to get a point across: Traumatic events in a baby's life can cause him or her harm. If something happens to an adult they can talk about it, call Samaritans, talk to a friend.
If something happens to a child, they can play it out, adapt in some way, tell a teacher or their mum.
There is hope that the event can be processed.
If something is experienced by a baby who does not know where they end and the world begins - then they don't know where the event ended and they began. Without intention- this is not about blame- the event becomes part of them and who they are. It’s important to remember that babies are amazing at adapting and most babies, even when there is a fair amount of chaos around them, will actually be okay. However, the quality of the parent infant connection and later the parent child connection will dictate how well they recover. In this way, infant mental health is entirely formative in terms of mental health prognosis over the lifespan.
Developmental trauma and the way this shapes a vulnerable infant can be thought of as infant mental health. Our work is in PREVENTION of ongoing and further trauma to a tiny little person by developing security of their attachment to their carer.
Infant Mental Health is important and it’s not a luxury. Unlike how we dress our pet or what superfood is in fashion, it applies to everyone. It is I believe, a key to reversing our child mental health epidemic.
Does this make sense? Do you agree or disagree? Please post below, I would love to hear your ideas!