Infant Mental Health 101

At the end of September 2017, I attended a seminar on infant mental health delivered by the Infant Mental Health Promotion at SickKids Hospital. The lessons I learned confirmed those I have learned in school as well as my own personal values when it comes to children’s emotional development.

To begin with, infant mental health is defined as “the developing capacity of the child from birth to five years of age to (1) form close and secure adult and peer relationships; (2) experience, manage, and express a full range of emotions; and (3) explore the environment and learn in context of family, community, and culture” (Dr. Chaya Kulkarni, 2017). Positive early mental health supports the capacity for self-regulation, leading to resilience, and promoting optimal brain development. Secure attachment is essential in the child’s developing self-regulation skills and in the likelihood of positive physical and mental health outcomes across the lifespan. Aside from primary caregivers, practitioners in the field of infant mental health come from diverse educational backgrounds such as medicine, nursing, social work, early childhood education, occupational therapy, etc.

It is important to remember that early experiences–from preconception to pregnancy to the early years of life–influence children’s brain development greatly. Moreover, children’s growth is dependent on the relationships they have in their daily life. The absence of relationships in a child’s life is as detrimental as not feeding the child. This makes attachment a huge influencer in infant mental health.

Note, however, that attachment is not necessarily related to good or bad parenting. It is simply the earliest relationship between an infant and his/her caregiver. It is initiated by the child, which cues the caregiver to respond to his/her needs. (On the contrary, bonding is initiated by the caregiver to show affection, to play with him/her, or to meet his/her basic needs.) A secure attachment is formed when the caregiver responds consistently and appropriately to the child’s distress.

In fostering a secure attachment, the primary caregiver also acts as an external regulation system. This helps the child develop his/her own regulation skills as his/her caregiver responds to his/her cues to calm or energize him/her. In the absence of this external regulation during the early years, the child learns to act in certain ways, being mislabeled with having behaviour problems rather than mental health problems caused by neglect and an insecure attachment.

The good news is that we can recognize the risk factors and poor mental health during infancy. Unfortunately, services vary tremendously within provinces and across Canada. For services that do exist, most communities experience significant waiting lists. There is no formal system for recognizing when development is derailed, making it a challenge to help these children cope and recover.

Furthermore, there is the challenge of recognizing when behaviour is typical or when it is something else. Difficult behaviours such as aggression, whining, and tantrums may be examples of strategies that the child uses to help regulate him/herself. We often focus on the behaviour, trying different strategies to “correct” it. Often, this does not solve the problem. So instead, we should ask “why this behaviour” and “why now”. In answering these questions, we delve deeper into the root cause and look more closely at the child’s attachment relationships. Understanding this will help us help the child approach things differently and re-wire his/her brain with a more positive mental health outcome.

Responding early to signs of neglect, toxic stress, and other forms of trauma is essential in developing positive mental health. We need to be proactive and monitor children’s development. We need to work with families and support them in building secure attachments with their children. And we need to continue to build on our knowledge and understanding of infant mental health so that we may support it better.

The Power of Silence

In college, we are taught to observe, listen to the child, and scaffold their learning through observational comments and open-ended questions. Unfortunately, many of us go out in the field remembering only the latter: We ask too many questions, give too many comments, and offer suggestions without pause.

I have worked with educators who were so passionate about playing with children, they led most of the activities.

They jumped too quickly on each little movement that the children made, not taking the time to figure out what the children were really doing or what they were really interested in during that moment.

For instance, a child laid down on his side and said, “I’m tired,” as he reached his hand out toward the educator (who was surrounded with toy food). The educator answered, “Pardon? You want a midnight snack?” and picked up a toy food to hand to him. He put his arm under his body as he turned over on his stomach and said again, “I’m tired.” She replied, “Oh, you want the lasagna? Here you go.” He got up and took the lasagna offered to him, forgetting that he wanted to pretend to sleep.

Another time, a child stacked some building blocks. I asked, “What are you building?” She said she was building a castle. Later, an educator walked by and said, “I like how tall your tower is.”

What happened to following the child’s interests and letting them lead their play?

What happened to letting children come up with their own ideas?

Sometimes we get too preoccupied thinking about how we could keep the children playing that we forget they are autonomous and are creative in their own respects. Sometimes we overthink the idea of scaffolding and take over the children’s play by dictating to them what they are doing.

This week at placement, I heard the frustration in a child’s voice when I asked her what she’s making in the home area and she said, “[Someone] thought I was making pancakes, but I’m not.” (I did not hear who it was that thought she was making pancakes, but it sounded like somebody’s name). So I asked her again what she is making without offering a suggestion and I listened to every detail she has thought of about cooking: adding salt, pepper, waiting for two minutes before it’s ready, adding more salt and pepper, mixing the pot, etc. She had such a rich understanding of what it is like to cook beyond making pancakes. She even knew that salt and pepper are tiny particles; so she scraped small pieces off a chunk of play dough. Whoever that someone was who assumed she was making pancakes made a mistake of glossing over the child’s imagination and not listening to what she has to say.

To be fair, I was like that someone: I asked children, “What are you making? Are you cooking lunch?” I did not even let the child tell me if he/she was cooking lunch or dinner, or maybe he/she was not cooking at all. I jumped into conclusion because I knew it was almost lunch time. But do young children know that? Not unless they are told by an adult that it’s almost lunch time. And, sometimes, even then, they still go on their merry way making and cooking whatever they feel like.

I believe that I listen enough to children, but I’ve always felt I should talk and interact more. The manager’s words at my placement site changed my understanding and approach to children.

I told her about my trepidations at the centre: how I’m afraid of speaking to parents and caregivers who come in to our centre, how I have no idea what to talk to them about, and how I feel scared to play with the children when the parents are nearby. She told me that I should use the children as vehicles for conversation and that I should never force any conversation with the children or caregivers. She said, “Mirror what the children are doing. Follow their lead. Do what they do. If they hand you an item to add to your creation, ask them what they would like you to do with it. Let them know that they are in charge of their play.” She explained that the children would eventually communicate to me as we move from parallel play to associative or cooperative play.

I realized: When we start with parallel play and allow the children to lead the play, we show the children our interest to be a play partner and that we mean no harm to them. Similarly, the caregivers get to know us and learn to trust us with their child. That’s when authentic conversations start.

I followed the manager’s advice the next week I was in.

The awkwardness has not left me yet, but working at the early years centre has become easier for me to do. I have had long conversations with some caregivers. I have also played longer with some children. And I did not feel compelled to ask questions or provide observational comments all the time.

I also applied this new understanding at work. I spent more time watching, listening, and observing than telling children what I think they are doing. I learned so much more about the children.

What do you think of this message?

Be still long enough to notice how the children play or interpret the materials.

Conquering My Fears: Working Beside Caregivers

Last week, I started my field placement at an early years centre. It was a very different experience compared to working in the traditional child care centre: caregivers are present with their child(ren) for the duration of their stay at the centre.

I felt awkward.

How was I going to hold decent conversations with caregivers? I’m not a small-talk person, so I had no idea what to say to them after the initial “How are you?” greetings. I also did not feel confident about my knowledge of child development to be saying anything to parents at this time. After all, they are the experts on their own children. What do I know? It was my first couple of days and I don’t even know anyone there.

I felt intimidated.

How was I going to interact with children while their caregivers are watching? It’s not like they’re in another part of the world watching us through a screen. Oh, no, not at all. They are physically nearby and could react (positively or negatively) to every little thing you do right then and there–intimidating. Some of them played with their own children (which they have a right to, of course); I did not want to interfere with their bonding moments. Others, I felt were watching me standing awkwardly or walking around the play area aimlessly, sticking out like a sore thumb.

I was afraid and anxious.

I did my best to observe and get to know the centre and the program. I tried to approach children who were not playing right beside their caregiver so that I did not feel intimidated, but there were few of them. I attempted to make conversations with parents and ask them about their children, but they may not have been ready to share anything with me. On my second day at the centre, I felt so anxious that I had to take a break and cry in the washroom for a moment before recomposing myself and going back out again.

My first week at the early years centre made me want to drop my field course.

The staff at the centre are all wonderful people. They also tried to reassure me that every one of them had had the same initial experience of trepidation. They told me that, in time, I will get used to it and feel more comfortable working alongside caregivers (literally).

Still, I felt super awkward, intimidated, and afraid.

On my third day (the next week), I got so anxious in the morning about the prospect of facing caregivers again, in a setting I was not comfortable with, that I missed that placement day.

So that evening I went up to one of my professors and asked for advice.

She was very understanding of my situation, but instead of giving me her perspective on the situation as an educator, she told me what caregivers may be thinking or feeling when they go to an early years centre. As a parent who has brought her child(ren) there, she told me that most caregivers do not want to be lectured, but that they are there to unwind while their children play. She said that most caregivers will not mind if an educator (or student-educator) played with their children. She also reassured me that the caregivers who drop in at early years centres are not there to be critical of me, especially when they know I am a student.

It really helped a lot to hear the perspective of a parent.

The next day, I gathered up my courage and pushed myself to attend Day 4 of placement.

It is said that “courage is not the absence of fear“. Rather, courage is doing something regardless of how much it may be frightening for one. And most often than not, courage pays off.

I felt much more at ease on Day 4. I still felt awkward and intimidated, but I felt brave enough to power through the day and interact with the families visiting the centre.

I am still in the process of conquering my fears, but I am beginning to like working in an early years centre and now look forward to my next days at placement. Will I improve? Will I feel better and better each day? Only time will tell.

How would you feel working alongside caregivers (geographically, literally) throughout the day?

Would you have felt the same as I did? Or would you welcome such an arrangement and thrive in this kind of environment right from the start?

What would you have done?