Positive Relationships: Ask the expert ... Separate ways

One of our mums went abroad for specialist medical treatment. While she was away, her daughter, then aged ten months, was looked after by her husband and his parents. The little girl settled fairly easily, as the grandparents are part of the extended family and share the family home. Her mother is now back but after a ten-week separation, the little girl doesn't recognise her mother, which is causing real anxiety. What can we do to help?

Prolonged absences such as these raise several questions. I wonder whether the treatment has caused the mother, first, to change appearance, perhaps through weight loss, and second, to smell differently on the first reunion.

This may sound strange, but the identity we form in our memories - especially our unconscious, implicit memory - of people is a combination of how they look, sound, smell, what they feel like and how they touch and hug us. In other words, it is a sensory and emotional mixture, which makes up the image we form of a particular person.

Interestingly, at around ten months, which is when this mother had to go away, the memory for remembering where something might be hidden and that something, or someone, out of sight still exists, is developing.

Memory

Many practitioners will be familiar with the child aged around eight to ten months who suddenly starts to look for a dropped item. It is obviously very difficult to know whether this understanding of the continuing existence of the little girl's mother was emerging. However, it is certainly possible that the mother may have left just when her daughter was realising that her mother was still there even when she could not see her.

Ten months is also within a phase when a range of developmental shifts are occurring, including increasing mobility, a greater awareness of being able to share experiences, strong preferences for familiar people - including the ongoing formation of very specific attachments to carers - and a parallel development of wariness to strangers.

This means that about this time, separations begin to be more difficult. All these changes make particular demands on parents, as the child often wants to be wherever their parent is and also requires extra reassurance when in unfamiliar situations or with unfamiliar people. So, this was the time when the child was undergoing significant developmental change, including shifts in her emotional needs and fearfulness at separations.

Atmosphere

It is also likely that the mother was unwell for some time before seeking treatment elsewhere. During that time, the mother, her husband and his parents were probably very worried, which will have potentially affected the emotional atmosphere in the home. Babies are extremely sensitive to atmosphere and while they cannot understand what words are being said, they can certainly be aware of the emotional tone of conversations. It is certainly possible that her mother's illness disrupted this child's relationship with her mother.

The child is described as settling 'fairly easily', which could cover a range of reactions, including becoming quiet and withdrawn - behaviour that may have been interpreted as being 'settled'.

Sharing the family home meant the grandparents were familiar to the child, but we don't really know just how much involvement they, or the child's father, had with her day-to-day care before the mother left. The father, for example, could have been totally immersed in the care of his wife and his worries about her.

Strategy

What this little girl had to do and still is doing now is to develop a strategy to manage her relationships with all the adults around her.

I wonder what sort of preparation the child had for the separation and indeed, how the actual leave-taking occurred? For example, seeing the mother leave by ambulance could have been traumatic for all concerned.

Berry Brazelton (2006) points out that children need ongoing, sympathetic help in dealing with separation. However, in this situation, there may not have been opportunities for any kind of transition phase where the child could begin to trust that Mummy would come back.

Felicity de Zulueta, quoted in Wingfield (2009), states that psychological trauma has been defined as 'the sudden cessation of human interaction'. Therefore, this child has had to cope with the trauma of the initial separation and the 'sudden cessation' of her mother's presence.

Another consideration is whether the child was helped in being comforted that her mother would return and if she had access to familiar items linked with her mother that she could look at and hold.

While her mother was away, this child has had ten weeks in which she had to adapt to yet another change in circumstances and to get used to the ways in which these other adults fed, changed, bathed, held and played with her. Again, we don't know the level of their interaction beforehand, but the key issue is that adult carers are not interchangeable.

We all have our ways of doing things, including how we talk to, interact and play with a child. We all look, sound and feel different, and this child is going through a developmental phase where her awareness of others, their difference, their continuing existence and her need for their guidance on her extending external world is at a peak.

As stated earlier, this period is also one when separations become harder, and the child may be very stressed at the return of her mother after such a long time. The child's screaming at seeing her mother may be a way of alleviating the stress and confusion she may feel - after all, she has few other options, as she can neither fight nor flee!

Schofield and Beek (2007) remind us just how painful separations are, and if long-term, her reactions at the separation will have included protest, denial, anger, despair in one form or another - and the child may still be in one of these phases.

Finally, in this situation, it is the adults who must show sympathy and compassion for this little girl. She does not understand why her mother left or that it is possibly 'all right now'. She only knows that she felt desolation and now this person is back again.

The mother must re-establish the child's trust and faith in her by being consistent, caring, available and gently persistent in her approaches to the child and responsive to the child's cues. It may seem very unfair that the child is responding like this, and the mother most likely feels terribly hurt at her reaction. However, if mother and family can be helped to see what it might have been like from the child's point of view, then perhaps they can begin to rediscover their relationship.

- Maria Robinson is an early years consultant and author of From Birth to One and Child Development from Birth to Eight: A journey through the early years (Open University Press). Her Nursery World series on child development can be bought online at: www.nurseryworld.co.uk/Books

REFERENCES

- Berry Brazelton, T, (2006) Touchpoints Birth to Three (2nd edition) Da Capo Lifelong Books

- Schofield G, Beek, M, (2007) Attachment Handbook for Fostering and Adoption. London, BAAF

- Wingfield, R, (2009) 'Struggling with Abandonment and Attachment in Relational Psychotherapy', in Journal of Attachment, vol 3, no 3, November