In an ever-changing world, that runs at a crazy fast pace, emerging from a pandemic that has reshaped our world – many are taking the time to pause and reflect. It has made us all rethink our lives, to think more about our work, our health, the future, the future for our children and the desire for both a positive future and outcomes.
What we have learned about an adult who has suffered trauma or poor mental health in later life, is that it generally stems from both the internal and external influences, plus environment from very early childhood.
Let’s talk about Infant Mental Health.
Have you ever heard the expression that it “takes a village to raise a child”?
Is there truth that the environment and adversity experienced in the early years can have an impact on an Infant's Mental Health?
The simple answer is YES.
Why is that? and what is the infant health period I am referring to?
It refers to the development period from being in the womb to 3 years old.
Infants and toddlers can experience mental health issues that shape their brain and ultimately shape their future. It can be more difficult to recognise and more difficult to diagnose, however these very early experiences may affect lifelong health, behaviours and learning.
Have you ever heard of the term ‘bonding’? and the impact bonding has to social, emotional, physical, cognitive and mental health development?
Bonding is essential for normal infant development.
Bonding and attachment occur when a caregiver can provide love, warmth and care. When a caregiver provides a nurturing environment, it allows a child to have future healthy relationships with other people throughout life and to experience/express a full range of emotions.
I am relating experiences here from my own team members' life experiences, that have made a visible impact to an infant or toddler’s mental health and in some cases additionally their physical well-being due to the external environment for growth and development.
If there is one thing that is universal in terms of an infant needs – it is the opportunity to feel safe and loved, and to receive ‘predictable’ caregiver relationships.
Sometimes it can be difficult for a caregiver to provide ‘predictable’ care and in some cases beyond their ability to change the outcomes.
There might be a range of reasons why this is difficult such as:
The mother experiencing post-natal depression after giving birth. Dee (our marketing coordinator) saw her very close friend go through an incredibly traumatic time both before birth and after the birth of her child. For anyone who has become a mum, it is such a life changing event and even more complicated if the experience isn’t quite as euphoric like everyone has you believing. For some, it brings on mental health challenges. This may have an impact to the ability to bond and form a healthy attachment with your new-born child. It is important to note here that with the right interventions, it can change the outcomes for both mum and infant. In the case of Dee's friend, she was very heavily medicated at the time and really has little recollection of this period of time in her life.
The infant having a severe medical condition preventing much needed physical touch to bond with the baby/infant (such as severe eczema). This was the case for Dee's own brother. She grew up in a small country town, with limited access to medical treatment and to medical specialists. He suffered from eczema, which was so severe, that as a baby he was unable to wear clothing for a majority of his early life. His little body was swathed instead in cotton sheets so he could be placed into a bath to help the material ‘soak’ off his weeping skin, so as not to rip his skin off. There was minimal physical contact or attachment. Her mum commented that as he grew older, it became evident of this lack of bonding impact – notably being difficult for him to both show and receive affection. This created lifelong challenges to his physical well-being and social relationships, which in turn also impacted his emotional well-being. None of which was within the scope of her mother’s ability to influence or change at that precious time. She found this very upsetting, and Dee's brother has spoken often of the challenges his life has presented.
Exposure to domestic violence (in the early years this can have a significant impact on brain development). Domestic violence being represented in many forms which includes emotional, psychological, or physical, all affecting a young infant’s well-being. Being able to remove yourself as caregiver from a domestic violent situation is not always easy nor simple, so often there are often complexities to these situations.
Lack of social supports, particularly to those who may be single parents or in the lower socio-economic group, whereby financial stressors are more significant. This may impact a caregiver to reach out or seek support or interventions.
The caregiver may have a substance abuse or dependency problem with drugs (or prescription drugs) and/or alcohol affecting their ability to provide a suitable, nurturing environment for their infant. I attended a Positive Parenting program when our kids were young and shocked to learn the largest demographic dependent on prescription drugs in an effort to cope with life was our middle aged mums!
I grew up in the 70's and upon reflection, there were some questionable practices as to what equated as positive parenting. It was quite the norm in this era to be physical towards your child. In fact, in the 1970's Positive parenting program, the strategy to help your child who was not overly attentive, was to deliver a hard strike to the side of the head. The video even showed you how to deliver such a blow! (Just above the ear!). Quite unfathomable really. It extended into the classrooms, whereby your teachers were able to administer physical punishment with canes. There was a lot of those types of behaviours and equally unhealthy emotional behaviours. In essence bullying behaviours. I personally have seen the impact of this in adult years.
There is a general misconception that infant mental health problems won’t occur for a child younger than 3 years old. Organisations such as Emerging Minds are educators in this field and actively support the community and professionals to help people understand the importance of Infant Mental Health and the very real impacts to well-being.
One of our trainers, Kellee, is a breastfeeding educator with Australian Breastfeeding Association. She personally found both breastfeeding and babywearing as a way to help connect with and soothe her babies, especially as her family were all overseas so had a lack of 'local village' able to help through those early years.
Kellee found it even more important as she experienced post-natal depression after her third baby. By keeping baby close, she was able to meet her mental and emotional needs, while she was struggling and getting help. Research has shown that skin-to-skin contact helps to improve an infant’s physical and mental health. This type of contact is generally common in the early days and weeks of an infant’s life and continues with a breastfeeding relationship. In addition to skin-to-skin contact, a similar connection can be made regardless of how an infant is fed, by making eye contact and nurturing facial expressions, as well as gentle touch, such as holding their hand or stroking their foot.
If you understand that crying is a form of communication, it will help you to understand that a baby's cry is just simply a way for them to communicate that they need something.
Is it hunger, a need for a nappy change, is it wind, pain in their belly, are they feeding well, are they sick? As a parent it can be very distressing if your baby continues to cry and you are feel at a loss to know what to do. This can evoke all kinds of feelings for the mum, raising levels of anxiety. It is distressing for baby and for everyone. This heightened state can even raise feelings of anger and despair. It is important for your baby to feel safe and loved. It is okay to cuddle, pick up baby, breastfeed baby in an effort to soother baby. Find out more information from the Australian Breastfeeding Association on why babies cry and what you can do to help.
It is very important that you are focussed on self-care, take every opportunity to rest, eat well and reach out to your supports, be that friends, family or support groups. It is helpful to talk with others going through the same experience. You are not alone.
Kellee shares this insight:
A “good” baby who never cries, is often one who has learnt that no one comes when they do, so they learn to stop wasting their energy trying to ask for help. This is often seen in babies who have unfortunately experienced continued neglect by their caregivers.
The key is to be make observations of your young one, connect and look for any signs that may pose red flags.
It is true that mental disorders are not typically diagnosed in children younger than two years, largely due to it being quite difficult to interpret if there are mental health problems in this age group.
Some of the signs that may be related to indicators of mental health concerns are:
· Poor sleep patterns/restlessness
· Difficulties maintaining or making eye contact
· Gastric disturbance such as persistent reflux, bowel dysfunction.
· Difficulties with feeding
· Persistent crying
· Failure to thrive/lack of weight gain
· Failure to meet developmental milestones
· Heightened anxiety, tension, fears
Some of the above signs were evident for Dee's daughter, who was diagnosed with Autism Spectrum Disorder at 4 years old. Whilst Autism Spectrum Disorder is a lifelong disorder, she says it would have been helpful to have been directed to the right resources at the time. Dee felt the obvious signs were there as early as 17 months old, however at the time she says it was difficult finding a professional to make a diagnosis. I personally think it is very important for professionals and the community to be aware of the resources and programs on offer to families.
Emerging Minds develops mental health policy, services, interventions, training progams and some wonderful resources to support professionals, children and their families.
They advise that infant’s mental health is on a continuum, and it will flex over time. Infants are constantly developing, and it is up to caregivers and professionals to consistently check on an infant’s mental state and where they are sitting on that continuum.
Key developmental stages of an infant may also be normal behaviours for infants at certain developmental stages, so is important to understand where an infant is on the continuum and how long they remain in an unhealthy stage.
The continuum is presented as below: (This is sourced from Emerging Minds)
Healthy: A positive state of mental health.
Coping: The infant experiences challenges to their mental health but has the nurturing care and support they need to manage.
Struggling: The infant experiences challenges to their mental health but is not effectively managing these, so the infant and their family require support.
Unwell: The infant experiences significant challenges to their mental health. They and their family require extra support to manage these challenges and recover (adapted from National Mental Health Commission, 2021).
Red flags are raised when:-
· your infant is unable to pay attention (for e.g. returning a smile to their caregiver)
· being inflexible or the development of rigid routines
· they fail to engage or engage positively with other infants,
· to regulate emotions such as anger or anxiety
When infants struggle to develop these skills, the risks increase for mental illness to develop later in life. It is important for caregivers and professionals to recognise the early signs, to seek professional support for the child and importantly to also seek self-care strategies for themselves.
I am sure you have heard the saying about an emergency mid-flight ‘to apply the oxygen mask to you first’. The theory being that you need to care for you, so that you can care and connect with others.
This is critical for you, as will be difficult for you to show love, warmth and care when you yourself are in a sustained and heightened state of anxiety or stress. The key message is to reach out for support, intervention and seek out self-care strategies as a part of the solution.
Paeditrician Nadine Burke Harris presented a TED talk on "How childhood trauma affects health across a lifetime". She talks about the science behind how early adversity has direct correlation to both mental and physical outcomes in later life. She quotes the science behind this and I highly recommend watching this TED talk. She speaks of the physical health impacts, such as tripling of risks for heart disease and lung cancer. Nadine encourages routine screening and a multidisciplinary approach to focus on early intervention. So very obviously her beliefs are to put the spotlight on infant mental health and look at prevention from the earliest possible outset.
When parents and professionals work together early to understand development, identify the risk factors, adopt the right interventions, they can reduce the negative impact on an infant or toddler’s mental health. Paving the way for a positive future and outcomes that you have taken the time to step back and reflect on.
In Nadine's words:
"this is treatable, this is beatable".
Let's not put our heads in the sand and have the courage to work towards a brighter future for Infant Mental Health.
It starts with you.
