Who is keeping the baby in mind?
By Clair Rees - PIP UK Executive Director
Yesterday on BBC 5Live the poignant question that was poised to me was Can babies be depressed? I was struck by the power of the question in the week that the BBC are facilitating #In the Mind to highlight mental health and the need for further significant investment - it is a question that needs unpacking further. Thanks to the Institute of Health Visiting (IHV) who yesterday called on further investment for infant mental health, this was highlighted within the BBC focus on mental health.
It is not the first thing that springs to mind for most as we continue to unpack the levels of mental health being experienced in our country today. The Duchess of Cambridge speaking within the context of children’s mental health this week stated that we need to be thinking about young children too.
#In the mind for Infant Mental Health in light of the question poised I want to focus on the following:
- The importance of holding in mind the baby and their relationships
- Infant mental health as a professional field and preventative strategy
- Solutions for increasing life chances in the first 1001 days of a child’s life
The World Health Organisation states that depression results from a complex interaction of social, psychological and biological factors and often experienced by people who have gone through adverse life events.
- Depression is a common mental disorder. Globally, an estimated 350 million people of all ages suffer from depression.
- Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
- More women are affected by depression than men.
As we assess the lifespan perspectives of living with mental illness including depression there has been some profound illuminations of what it is like to live with mental illness this week. The documentary about perinatal mental illness on the mother and baby unit (MBU) that Dr Alain Gregoire runs was particularly moving and brought back memories of my own experiences working as a clinician in a MBU. It was very clear that such depth and profoundness of suffering is experienced and that you wouldn’t wish it upon anyone you love.
And yet such hope distilled any fears that might have been born out of watching that documentary with the compassion and care illustrated by the wrap around team journeying with these families. It was clear that the husbands supporting their wives in sickness or in health were a pivotal part of this care and highlighted the important role that fathers play – sadly many other mothers do not have a partner alongside them.
The importance of holding in mind the baby and their relationships
As someone who thinks about the developing mind of the baby and their earliest experiences I was also looking out for the baby’s story within the wider narrative being told. What was highlighted to me was how important it was to keep mother and baby together and the vital role of mother and baby units in doing so, another component was nursery workers who look after the baby whilst mothers have an opportunity for sleep as an important part of her recovery.
In the wider context of babies and their relationships in society how are babies being held in mind? How do we think about the 26% of babies according to the NSPCC in the UK who have a parent affected by domestic violence, mental health or substance misuse. That is 39,000 of them living in a home where domestic violence is taking place, 144,000 babies who have parents with mental illness and 109,000 babies who will be witness to an environment where substance misuse is an issue. It is far from thinking about the ideal scenario we would all want for our own baby to begin their life in.
If we are thinking about holding the baby in mind from the antenatal period, where one of the earliest experiences for some is a felt presence of violence, according to statistics which reveal that 40% of women who are at the receiving end of domestic violence are impacted for the first time in pregnancy. In thinking about the baby’s experience early on, this is not an easy thing to hold in one’s mind that a vulnerable unborn baby could be so profoundly impacted.
The baby in context of their earliest relationships is intrinsically connected to their primary carer (predominantly mum) and yet their own separate personhood at the same time. It is this relationship that begins to shape their person hood right at the point of entry into the world in their earliest form of baby hood in the womb. Depression and anxiety affect 10-15 out of every 100 pregnant women.
If we believe this to be so, is it true to say that those first earliest relationships babies are interacting within and in the context of their environment have some impact upon the baby? If so, intergenerational difficulties that provide some of the fuel of the emotional world within the family context need to be thought about and its impact upon the baby’s relationships and forming a secure bond.
Can babies be depressed?
9 Month old Jacinta is a very quiet and still baby. She is not very playful, and she doesn’t reach out to engage the grown-ups around her. In fact, no-one seems to notice Jacinta very much. She shows little interest in exploring the toys around her playmat. She sits by herself with little movement – the odd kick of her leg at times. She doesn’t cry out for much and gets very little attention from those caring for her. Jacinta is the 2nd child in her family. Her parents are relieved that she is an “easy baby” because they have their hands full with their other child who is seven years old and has been recently diagnosed with ADHD. Jacinta seems rather sad and withdrawn. She does not really engage with her parents or anyone else. Jacinta’s parents are not concerned about her. They see her as a good girl good who is happy being on her own.
Is Jacinta depressed? Not yet. But she is highly likely to develop depression a few months down the line according to international observational studies in the field of infant mental health. Parent-infant mental health services suggest that depression can only really occur after the age of about 18 months.
Younger children are not diagnosed with depression as they do not yet have the mental capacity to experience depression in the way that we understand it with older children, teenagers and adults. But young babies do show signs of being unhappy, and this can and does develop into depression later on where they are not being held in mind.
Some of the early signs of an unhappy baby are withdrawal and a lack of interest in being in relationships. Withdrawn, unhappy babies look objectively sad. They don’t smile or laugh much. They might have a faraway or glazed look in their eyes, and they don’t easily play or engage with other people. They are the babies that get neglected and ignored because of a complex world around them where relationships are difficult because of the impact of mental health, substance misuse and domestic violence and which so often can lead to neglect and maltreatment.
This is quite the opposite experience in which psychologically healthy babies are quite easily tempted to play games like peek a boo, sticking your tongue out or when you pull funny faces at them. A withdrawn baby might be unable to participate in these games, or she might even start crying when there is an attempt to interact with her. But strangely enough, unhappy babies sometimes do not cry much at all. This is confusing and misleading because one might think that if a baby is unhappy you would know about it by his crying.
Researchers have found that psychologically healthy babies react to discomfort by making their voice loudly heard through their cries. They are then easily comforted, often by their mother’s close physical holding, soothing voice and eye contact and this is demonstrated by a strong bond and secure attachment.
For some babies who will go on to experience psychological difficulties they do not necessarily cry (or not immediately) when they are subjected to a traumatic experience or it can be the opposite that there is excessive crying and they cannot be soothed. A baby who never cries is not necessarily psychologically healthy and robust. They might have learned that crying doesn’t help, or they might not have the energy to cry. Professionals who work with babies and their relationships all point out that they have been referred because of infant regulatory disturbances such as excessive crying, feeding, sleeping difficulties and bonding/attachment problems.
Possible early warning signs of depression in a baby include:
Withdrawal |Does not easily engage with adults |Unsociable |Difficult to soothe when distressed |Does not play easily |Does not smile or laugh much |Quiet, still and passive |Does not require much attention |Feeding problems (poor appetite) |Underweight |Developmental delay |Reluctance to explore the environment |Easily overlooked
In contrast, healthy babies are full of life, continually demanding and needing attention – born to be in relationship and to be loved in a warm and nurturing environment for them to thrive. This experience literally builds their brain which builds their mind, emotional and psychological wellbeing, cognitive abilities and ability to relate to others (the social brain), preparing them early on for peer relationships and school readiness which will all contribute to their life chances later on in life.
Parents who are able to understand their baby’s cues and tune into their baby’s needs are able to provide the responses and experiences that their baby needs at different points in their baby’s life, in order to support the establishment of appropriate neural pathways and optimal development of their baby’s brain.
As the Building Great Britons report argues that “Just as a positive environment can support optimal development for babies, so too can a negative environment disrupt development with potentially damaging effects on the developing brain which can predispose to mental health problems, risk taking behaviour, depression, anxiety and even violence throughout the life span”
When you as an adult become depressed, the chances that you will lose your appetite are high. Even if you previously loved your food, depression takes the joy of eating away. A loss of appetite and loss of weight are two very standard, common symptoms of depression. Besides this, depression also robs you of your energy, your zest for life and your ability to find pleasure in just about anything.
It takes away your motivation and usually leaves you feeling like you just don’t feel like doing anything. For a depressed person, just getting out of bed can be a major challenge. Being sociable, getting your work done and doing your chores when you are depressed can feel almost insurmountable and completely overwhelming. Depression flattens you and slows you down. It makes you look tired and defeated. In this way, the appearance of a withdrawn baby who will go on to become depressed later is uncannily similar to the experience and appearance of a depressed adult.
Infant mental health as a professional field and preventative strategy
The Association of Infant Mental Health (AIHM) Infant mental health who are currently offering a free online course ‘Babies in Mind: Why the Parent's Mind Matters’ highlight on their home page "Children are our most precious national resource; they are the living messages to a time we will not see, and new scientific advances are showing the crucial importance of the foundation years and especially the first 1001 days from conception until age 2 as a springboard for neuro-cognitive development, life-long health and well-being and socioeconomic success". National Scientific Council on the Developing Child, Harvard University.
The field of Infant Mental Health is defined as the healthy social and emotional development of a child from birth throughout their early years and a growing field of research and practice devoted to the:
•Promotion of healthy social and emotional development;
•Prevention of mental health problems; and
•Treatment of the mental health problems of very young children in the context of their families.
Solutions for increasing life chances in the first 1001 days of a child’s life
Early experiences matter and the message of the 1001 Critical Days Manifesto is to enable a universal, seamless and holistic pathway to ensure that every baby has the best possible start in life.
Key solutions to enable this to happen in our local communities are to ensure there is a 1001 days’ strategy which has all the components of a good local primary prevention approach which includes:
- Good universal services
- Central role of children’s centres
- Universal early identification of need for extra support
- Good antenatal services
- Good specialised perinatal mental health services
- Universal assessment and support for good attunement between parent and baby
- Prevention of child maltreatment
The 1001 Critical Days Manifesto and Building Great Britons report can be downloaded on www.1001criticaldays.co.uk.
Northamptonshire become the first locality to pledge their commitment to a 1001 days’ strategy which can be seen at http://www.itv.com/news/anglia/update/2016-01-26/1001-critical-days-giving-children-the-best-start-in-life/
It is essential for better public health outcomes in the UK we invest further with financial resources, human resources and educational resources. PIP UK is leading with its partners to continue highlighting such a worthy course on Infant Mental Health week 6-10 June 2016 which will enable a national calendar of events. If you are interested in registering to be part of that do get in touch firstname.lastname@example.org
Parent Infant Partnership (PIP) UK is a charity committed to upscaling infant mental health services across the UK. We offer three year start up packages for those where this type of service is lacking. If you are interested in finding out more do get in touch.
Perinatal and Infant Mental Health is being supported in policy strategy by the All Party Parliamentary Group (APPG) Conception to Age 2: first 1001 days. Its next evidence session is being held in Parliament on the 7th March. If you are interested in attending and want to find out more get in touch. The next session will focus on what is needed to implement the 1001 days’ strategy and why it is essential to the health and wellbeing of our communities.
Parent Infant Partnership (PIP) UK ©