Infants have mental health needs, too

When it comes to mental health, we may think mainly of a man struggling with depression after losing his job, a woman anxious about her relationship with her partner or a rebellious teenager. We rarely think of infants and young children. These little bundles of joy seem to have uncomplicated and happy lives.  Sadly, many mental health difficulties have their roots in challenges occurring in infancy and early childhood. Early intervention is essential to preventing mental health disorders.

Infant mental health refers to the well-being of infants and children up to age 3 and includes the child's emotional and social growth and development. Many new caregivers (moms, dads, grandparents and foster parents) can experience normal challenges with their infants. When challenges become persistent or apparently unchangeable, caregivers may experience anxiety and frustration. Seeking supportive counsel with an expert in infant and early childhood development can provide helpful strategies to reduce stress. 

Warning signs

Indicators of infant mental health difficulties may be:

• Poor sleep patterns
• Difficulties with feeding
• Persistent and/or unremitting crying
• Restlessness 
• Gastric disturbance
• Anxiety and tension
• Distress and fear 
• Lack of weight gain/failure to thrive
• Failure to meet expected developmental milestones 

Central to an infant's mental health is his/her relationship with primary caregivers. Newborns come into the world with a highly underdeveloped neurological system. They are vulnerable and unable to regulate their physical and emotional states independently.  Infants initially have four identifiable biological states of deep sleep, light sleep, active alert and quiet alert (Brazelton), and rely on their caregivers to help them remain in a comfortable state. Each of these states performs an essential function for growth and development. It is through predictable, sensitive and responsive care that infants are able to regulate their states and feel safe in their environment. State regulation creates an optimal biophysical environment for brain development. Feeling safe builds secure attachment — a connection that sets the stage for social emotional learning. Without healthy social emotional connections, living comfortably can be challenging.

Infants don't have words; however, they are biologically programmed to seek closeness to their caregivers. Infants employ cues, such as crying, hiccoughs, gaze aversion and even changes in skin color, to attract a caregiver’s attention when they are in distress and need help.  Imagine for a moment that you are cold or hungry and unable to help yourself. You flush red (sign of distress) and then fuss. Someone who notices these cues comes to help warm you or provides you nourishment. How do you feel when that person relieves you of your discomfort? What do you learn about the world and relationships? These first sensitive and caring responses to infant cues teach us that we can trust that our needs will be met and we will be safe.  

When infants are comforted and their basic needs are met, they have been given the first building blocks of mental health — trust and safety. These gifts are the fertile ground for healthy social emotional growth.

Healthy social emotional growth

Let's think about the impact of healthy social emotional growth in infants.  Social emotional growth is the first learning priority for infants and can be defined as an infant’s experience, expression and management of emotions, and the ability to establish positive and rewarding relationships with others. (Cohen, et al., 2005).

Core features of healthy social emotional growth are:

• Understanding one’s own emotional states
• Reading and understanding emotional states in others
• Managing strong emotions and expressing these in a constructive manner
• Regulating own behavior
• Developing empathy for others
• Establishing and maintaining relationships 

An infant’s future abilities to pay attention, adapt in flexible ways, learn in school and in life situations, make friends, and manage anger, anxiety and other emotions in healthy ways all depend on healthy social emotional development and the connection of secure attachment which leads to the ability to trust in others and self. When infants and young children struggle to develop these essential abilities, mental illness can follow.

Barriers

There are many things that can interfere with a caregiver’s ability to provide sensitive responsive care including:

• Parental mental illnesses, such as depression and anxiety 
• Parental history of neglect and abuse
• Single parenthood without support
• Temperament mismatches between infant and caregiver
• Poverty/financial stress 
• Marital conflict 
• Alcohol/drug abuse

A caregiver’s most important goals are to provide a loving, safe environment for their infants. When a caregiver experiences personal health concerns or life events that interfere with caring for their infant or young child, they may experience guilt and worry that others will judge them as being an incompetent caregiver. As caregivers, we may even judge ourselves negatively. It is important to understand that most caregivers experience some or many challenges and that support is available to help caregivers achieve their goals for their infant.

Caregivers who would like more information or have questions about preventive infant mental health may like to meet with a professional trained in newborn behavior observation (NBO). NBO is conducted with infants who are 3 months or younger and their caregivers. NBO is a great way to receive support in learning about your infant’s unique cues and to ask questions with the goal of increasing connection and overall mental health.

When symptoms are present for either the infant or caregiving system, caregivers should seek professional help. Infants and their caregivers can be supported through dyadic therapy. This treatment focuses on strengthening the recognition of and response to infant cues within the infant/caregiver relationship to foster brain development and social emotional growth.