Babies may not have ‘mental health’ in the way that we understand it for older children and adults, but they do have strong feelings and need support with them.
Dr Matt Price, strategic lead for clinical psychology and psychotherapy at Barnardo’s, says it is easy for the mental health needs of babies to be overlooked. ‘We struggle to think about babies in terms of their feelings and social and emotional development,’ he says. ‘The focus for babies is often much more on recording physical development, how they are feeding and how they are sleeping.’
Dr Abi Miranda, head of early years and prevention at Anna Freud, agrees that despite a lot of work in the past few years to champion the mental health needs of babies, there can still be a lack of awareness. ‘Babies’ mental health is very different to the mental health of older children, in that positive mental health is relianton having parents and caregivers who are mentally healthy and have their basic needs met,’ she explains.
‘Another barrier to awareness is that it can be hard to differentiate between developmentally appropriate behaviours and signs that a young child’s mental health is in decline. A misconception can be that quiet babies are happy babies. However, babies cry to communicate their needs.’
Miranda adds that parent-infant relationships are key to creating the foundation for positive mental health in babies.
EARLY EXPERIENCES
Miranda and Price both emphasise how the first two years of a child’s life are important for a child’s mental health development. ‘About a million new connections are made in a baby’s brain in those first few years of life. So it is a rapid time for development,’ says Price. ‘What connects those brain cells are experiences, so the experiences that babies have from conception to their second birthday shape their developing brain. If those experiences are warm, sensitive and responsive then the baby’s brain will wire up to expect warmth, sensitive and responsive care whenever they have a need.’
He adds that if babies do not experience these warm interactions, their brain can be flooded with stress. ‘Hormones, including cortisol, make it more difficult for those brain cells to connect together. The stress response system becomes on high alert or becomes really dampened down,’ Price explains. ‘The baby is ready for a very stressful world, which serves a good purpose in terms of survival. But what you might see is that when that baby becomes a child entering school, that stress response system sets them up not to be able to engage in that learning environment and with the world around them in an optimal way. So the strategies they learn in childhood become less helpful as they become older children, young people and ultimately adults.’
Babies lacking these positive experiences can be helped through early support and intervention, but Miranda says it can take far more effort and be costly in terms of time and resources to remediate issues. ‘It is far better to promote positive mental health than to intervene when a child’s mental health starts to deteriorate,’ she explains.
Price warns that the easiest babies to care for – the ‘good baby’ that doesn’t cry – could be a cause for concern because it is not typical infant development; just as babies that present with what he refers to as ‘a persistent picture of distress’ are also a concern.
EARLY ATTACHMENT
‘Early years practitioners need to recognise how important they are in the world of that baby,’ says Price. ‘We know early attachment relationships really start to get solidified when babies are nine to 12 months of age, which is often where they are starting childcare. So practitioners are going to play a key role in what the baby expects from relationships. Investing in a nurturing relationship will have a long-term impact.’
Price adds, ‘Good attachment relationships between babies and the people that look after them are so important for future development and mental health.’
He emphasises it is important for staff to ‘hold babies in mind’ and to slow down, tune in to the babies in their care and understand what they are trying to communicate. Then they can respond quickly and with as much warmth as possible.
Although babies are not able to articulate how they are feeling, practitioners should look for their body language, facial expressions, vocalisations and gestures.
‘It is important for practitioners to remember that we are biased to feel happier when babies we care for are happier, and we might feel like we have failed as a caregiver when it is hard to comfort a baby,’ adds Miranda. ‘Being mindful of how the baby’s mood makes us feel can help us to be more present and to support them through a range of different emotional states.’ (See box).
Babies need consistent, attuned care and they need opportunities for interaction and stimulation. ‘The adult keyworker is the most important resource in the baby room, as it is through being spoken to, being picked up and held, being soothed and being fed and changed that the baby feels secure that someone is there who can meet not only their physical needs but also notice their changing emotional states,’ says Miranda.
‘Through narrating how thebaby might be feeling and matching facial expressions to mimic the expressions of the baby, they learn to recognise the baby’s emotional states, attach language to their emotional states, and [the baby] knows someone is there to care for them no matter how they feel.’
Price adds that practitioners should ‘strive to respond with warmth, empathy and as much “professional love” as they can muster to meet the needs of babies and young children’.
supporting adults
Early years practitioners: Working in a baby room is a physically and mentally demanding role. This can become greater in areas of deprivation where there may be higher levels of distress. Dr Price emphasises how important it is for practitioners to also look after themselves: ‘It could be easy to slip into responding to babies and children from a place of frustration or exhaustion, which isn’t good for the practitioner or the children.’
‘The worst thing we can do is to pretend feeling frustrated never happens. Some of the strongest feelings we have as grown-ups are in response to the big feelings a baby has. Anyone who’s tried to soothe a crying baby for a really long time knows it gets your blood pressure going. Cortisol levels are going as you try and regulate this child, so you need help to be regulated as well,’ he says.
He recommends nursery managers acknowledge the pressure of the role and have an open-door policy where staff are encouraged to talk honestly about their feelings.
He also recommends creating a ‘culture of compassion and understanding’ where staff look out for each other and regularly discuss difficult issues
Parents: ‘Early years staff are likely to have interacted with hundreds of babies over their careers, whereas a parent or carer will have experience of fewer children,’ says Dr Miranda.
‘Building a positive relationship with the parent or carer is the first step. This will enable them to talk to the practitioner openly and honestly about any challenges.’ She recommends staff share books and resources aimed at developing the emotional awareness of children. By encouraging parents to talk to children using the same concepts as they do at nursery, it strengthens links between home and nursery.
FURTHER INFORMATION
- Early Years in Mind is a free learning network run by Anna Freud that offers termly updates on the latest resources: https://bit.ly/3xSBb3b.
- Barnardos: https://www.barnardos.org.uk
