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.

Reflective Task 2: Learning Styles

Identify your top Learning Style(s) and some characteristics of the style.

Reflector

I like to take some time to observe, collect information, and reflect on this information before acting upon it. I prefer to do a thorough job rather than rushing through an activity for the sake of expediency.

Theorist

I like having the time to explore and probe through ideas and concepts to fully understand them. I prefer a systematic way of approaching situations by analysing it from different points of view.

Using the handouts provided as a guide, reflect on whether you agree with the assessment. Any new learning or insights? Surprises?

I agree with the assessment and see how I am equally a reflector and a theorist. In particular, the results explain why I take time to create activity plans for my field placement. Considering that I visit my kindergarten class only twice a week, I needed several weeks of observation and experience with the children before understanding what types of activity may or may not interest them. Additionally, I needed to thoroughly understand the Full-Day Kindergarten Curriculum, from which I base the activity’s anticipated learning, before completing my planning forms.

Although most of the characteristics of a reflector and a theorist apply to my learning style, I am surprised to see that my tendency to lead discussions and group assignments lies within an activist’s learning style (my lowest preference). At the same time, it is interesting to note that amidst leading the group, I take a step back and allow each member to put their ideas forth before sharing mine or before coming to a conclusion about the subject at hand.

Knowing your preferences is a first step to becoming an ‘all-around learner’. Identify which styles you are under-utilising and what you may do to strengthen them.

My preference to the pragmatist learning style (14 points) comes to a close second with the reflector and theorist styles (15 points). However, my preference for the activist learning style falls way behind the three with eight points. This makes sense in that the activist learning style seems to be a direct opposite of the reflector and theorist styles. For that reason, I believe that I need to be more spontaneous and open to new experiences. Moreover, acting on instinct once in a while may help me strengthen my activist learning style as I become skilled at thinking on my feet.

Joining the Girl Guides of Canada as a Unit Leader supports this practice. As a new Guider, I am thrust into unfamiliar situations that I have no background in. Thus, to practice learning as an activist, I need to speak up more in the meetings and take on the role I signed up for—a leader who generates ideas on the spot most of the time.