By Dr Nicole Milburn, Infant Mental Health Consultant & Jen Willis, Communications Consultant, Berry Street – Take Two
As a community we often discuss the poor mental health of adults and young people, but rarely do we really look at the mental health of babies. This is unfortunate because it is the relationships and environment a baby experiences during infancy that often set the conditions for that baby’s mental health during later adolescence and adulthood.
What is mental health for a baby?
There are three key factors that define early mental health and wellbeing. These refer to the baby’s capacity to:
- Form and maintain trusting relationships.
- Feel, express and tolerate a range of feelings and behaviour.
- Learn the culturally expected skills considered appropriate for the child’s age.
These things are developed from birth through the interaction between the baby and their physical and relational environment. Good mental health in a child’s first three years is intrinsically linked to all future brain development and making sure they meet their developmental milestones.
A baby’s mental health needs to be nurtured
It’s just like a plant. The genetic material in the seed grows in response to the nutrients in the soil when it’s provided with water and sunlight. Just like the developing roots, stems and leaves of a plant, in this way, the skills learned in the first years of life form the essential building block to the rest of their healthy development. And just as if there are problems for the plant, such as drought or storm in the early development of a tree that may cause compromised growth or damage, problems in infancy can become life-long issues.
Mental health problems in babies are often completely overlooked because babies don’t tell you they’re hurting using words. Instead, they show you in lots of different ways that can sometimes be really obvious (such as crying when they are hungry or soiled), and sometimes can be really hard to detect. Relationships are crucial for the development of good infant mental health, because it’s within relationships that babies exist and communicate. The good news is that because of the rapid growth in the early years, there are many ways you can help set a baby on a better path towards good mental health and development.
We know an important aspect of a baby’s mental wellbeing is influenced by the care they receive while they are still in their mother’s womb and from the second they are born, as babies are born ready to connect and have many skills that they use to interact. Babies brains are growing directly in response to the physical and relational stimulation they receive.
How can a baby develop mental health problems?
Babies are completely dependent on their parent from when they are conceived. But as we know, many babies don’t receive the loving attention and nurture they need. Their parents might be facing their own challenges; they might be suffering family violence and be scared, they might be living with addictions or mental health problems and scare the baby, or they might even be deliberately hurting their baby.
Babies brains are really adaptable. This means that when a baby doesn’t feel safe and have their physical and emotional needs consistently met by a responsive parent or caregiver (the most important person in their life), their brain will adapt to suit these conditions. We call this ‘developmental trauma’ and it will impact their mental wellbeing and can have ramifications for later situations that are also different or stressful, such as school and friendship groups.
When a baby comes into out of home care (‘care’) – even if they are very young – they will likely have already suffered some developmental trauma. They may be grieving the loss of their caregiver (even if they have had terrible experiences with their caregiver at times) and be suffering mental health problems. We might know very little about their life before they came into care, but we can still help them heal. The baby will often show its new carer in lots of different ways what their experience has been. It can however be challenging to be tuned in to that communication .
Advice for the baby’s carers
How can I understand what this baby is trying to tell me?
Just like older children and adults, no two babies are the same. Depending on their experiences and their personality, every baby will react differently to each situation. The baby you are caring for has already suffered a traumatic experience just by being removed from their parent and placed with strangers.
Getting to know the baby in your care is critical. Pay attention and watch how the baby responds to different people and situations. Be open to what the baby might be expecting of caregivers. Do they want cuddles? Food? To be left alone? Are they angry? All of the above?
Their early experiences may mean they are particularly scared of some people or situations, loud noises or being left in a room on their own. Many babies who come into care have problems with feeding and sleeping. You’ll need to learn to read the baby’s individual behaviours and needs. The best way to do this is to spend as much time as possible with them, providing daily care and comfort. The baby may seem irrationally scared of some things, but there will be a reason behind that fear. Be patient and caring even if you don’t understand why they are scared.
How can I tell if the baby I’m caring for has poor mental health?
Some babies will cry and scream incessantly – more than a healthy baby. They may become hyper-aroused very easily. They may overreact to what seem like inconsequential or little things – sounds, smells, other people.
A very fast heart rate is a common sign and often they can’t lower their heart rate even when they aren’t otherwise visibly distressed. Some babies will continually vomit when they get distressed, even if they are not crying. Others may look visibly sickly and underweight. Some babies will be very hard to settle. Others will not feed or sleep properly. They may avoid eye contact with you or seem to not want to interact with other people or children.
Some babies react by completely shutting down emotionally. In the past if they were scared and they weren’t comforted, the baby learnt to be quiet and go to sleep. Sometimes this was the safest and most adaptive thing to do. Now when they get upset it’s so overwhelming for them, that they may use this same coping strategy and withdraw and go silent. They may have also taught themselves to completely disconnect and dissociate from their feelings as a way of trying to keep themselves safe. They may underreact, or just go quiet when they are hurt or scared instead of crying like other babies do. This can seem confusing or strange for carers. Often, this behaviour can be mistaken for ‘they are such a good baby, no trouble at all!’
Some babies and young children will also rock, suck objects incessantly, bang their heads or masturbate. These are ways that they can soothe themselves. They are coping mechanisms that can be respected whilst transitioning to more relational means. The aim is to build trust and reliance through predictable and attuned care so that the baby can come to caregivers for comfort rather than having to find ways to comfort themselves.
What can a carer do to help them heal?
Children – especially babies – can’t improve their own mental health by themselves. They need to feel safe, loved and nurtured, and they need consistent care from their caregiver.
Here’s some tips for supporting an infant who has suffered developmental trauma:
- Help them develop an age appropriate routine which includes feeding, sleeping, and playing. The importance of predictability cannot be overstated for feelings of safety and security.
- Play with them. You don’t need fancy toys, babies will often be delighted playing a gentle game of peek-a-boo with your hands over your eyes or by you pulling funny faces or blowing raspberries. There are heaps of other great ideas here
- Encourage their curiosity and imagination by exploring, looking at, touching and describing things you see in your home or neighbourhood together.
- Comfort them when they get upset. They may resist this because they may never have experienced this type of nurturing, so don’t force it. In the beginning it’s important to notice what your baby finds helpful for comfort. Over time as your baby feels safer and more settled they will be able to use age appropriate comfort and nurture.
- Calm environments are important.
- Make eye contact and show you are interested in their needs.
- Talk, sing and read to the baby. Talking to the baby about what is happening can promote connection and help prepare the baby when care tasks are about to happen and at times of change and transition. Talking with the baby will teach them communication skills and support their language development.
- Repetitive songs, dancing together and stories are great for helping children learn to regulate themselves and can be a time for being with and connecting with one another. Watching Play School together and doing the actions to the songs can be a great activity.
A carer can’t undo the trauma a child has suffered, but they can help them learn that they are now safe and being looked after. You can do that by spending time with them and being there for them.
What if I’m worried things aren’t getting better?
It’s very important that you act upon any concerns you have about a baby in your care as soon as possible. Babies can’t wait. Keep your Maternal and Child Health Nurse and foster or kinship care worker updated about any changes you notice in the baby, or concerns you have, particularly if you’re worried about the baby not developing. You can also speak to your doctor or contact an Early Parenting Centre (Tweddle, QEC or O’Connell Family Centre). All Child and Adolescent Mental Health Services see infants as well.
Further useful resources
Royal Children’s Hospital: Why infant mental health is so important
Center on the Developing Child at Harvard University – InBrief: Early Childhood Mental Health (video).
Zero to Three: Infant and childhood mental health.
Raising Children Network has information and resources for newborns, toddlers, pre-schoolers to the teen years.
App: The Wonder Weeks (also a book) that can support you to track the baby’s development and their changing needs as they learn, grow and develop. The app is free and can be downloaded to your phone.
Book: Your Baby is Speaking to You. A Visual Guide to the Amazing Behaviours of Your Newborn and Growing Baby, by Kevin Nugent. This book uses pictures to illustrates the full range of behaviours: from early smiling to startling, feeding to sleeping, listening to your voice and recognising your face as a means of illuminating the meaning of the things babies do and how to understand their meanings and what they signify.
Take Two clinicians are currently working with about 60 babies and toddlers who are suffering infant mental health problems.
Take Two is a Victoria-wide outreach service provided by Berry Street on behalf of the Victorian Department of Health and Human Services. The service is recognised all over the world as a leading model of how best to support children and young people who have experienced complex developmental trauma.
Take Two can provide specialist clinical consultancy services to organisations. Contact us for more information.
This article includes expertise provided by Dr Nicole Milburn, Berry Street’s Take Two Infant Mental Health Internal Consultant. Nicole is a Clinical Psychologist and also runs her own private practice.
She regularly presents papers at both national and international Infant Mental Health conferences.