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.