Infant Mental Health: The First 12 Months

1. Infant Mental Health:The First 12 Months Angela M. Tomlin, Ph.D., HSPP Riley Child Development Center IU School of Medicine

2. IMH: Key topics • Relationships/Attachment • Regulation (sleeping; eating; emotions) • Temperament • Cognitive Skills • Special needs • Family Issues

3. IMH: Key Points • Socio-emotional competence develops within and because of relationships • Socio-emotional development affects all other areas of development • Socio-emotional development has long lasting impact • Research in early brain development may provide basis for these phenomena

4. Overview: Social Milestones • Newborn: Scans parent’s face; increasing eye contact • 6 weeks: begins to smile and coo responsively • 4 months: learns about others/ begins to be aware of strangers • 7 months: stranger anxiety • 9 months: separation anxiety; turns to caregiver for comfort when distressed

5. Attachment • the bond that develops between a child and important caregivers • develops through repeated interactions between child and caregiver • is a strong influence on many areas of development

6. Attachment • Gradually develops over the first several months • Is firmly established by about 9 months • Is a scaffold on which future relationships are developed

7. Attachment • Secure attachments develop when the caregiver is loving, consistent and reliable. • Insecure attachments occur when the caregiver’s behavior is unpredictable or even hurtful.

8. Attachment: Secure Pattern • Comforts the child • Accepts the child’s feelings • Is not intrusive • Allows independence • Show positive feelings • Sensitively responds to the child’s cues

9. Attachment:Signaling Behaviors • Engaging cues • Disengaging cues • Hungry cues • Full cues

10. Attachment: Secure Pattern • Child does well in child care • Positive social interactions with peers and adults • Liked better by others/more friendships • Easily comforted when upset • Can problem-solve • Asks for help appropriately • Manages conflict

11. Attachment: Insecure Patterns • Avoidant • Ambivalent • Disorganized

12. Avoidant Pattern • Parent consistently ignores negative emotions and fails to respond when child is upset and crying • Child manages separation, but may hide own feelings and have trouble handling other people’s feelings

13. Ambivalent Pattern • Parent is anxious, overprotective, interfering, and inconsistent • Child is upset when left, hard to settle, and often whiney, impulsive, attention seeking, has high levels of conflict with others, and cannot solve problems when frustrated

14. Disorganized Pattern • Parent shows unpredictable behavior; appears frightened and unable to cope; or is frightening and hostile. • Child may have seem frightened, sad, or anxious, and have behavior problems; may want closeness, then strike out

15. Brain Research and Attachment • Brain develops more neurons than needed • Experience helps determine the pathways that will be maintained • Brain is described to be “experience expectant” • Social transactions may be of primary importance for brain development and function

16. Regulation • Refers to an infant’s ability to regulate her own biological and behavioral rhythms, using environmental cues • Parents support the child’s developing regulation system through caregiving actions

17. Regulation: Feeding Birth to 3 monthsmay be unpredictablebreast fed babies eat 8-12 x/24 hoursbottle fed babies eat 6-8 x/24 hours

18. Regulation: Feeding • 3-6 monthsbreast fed babies still need several night feedingsbottle fed babies may sleep through the night

19. Regulation: Feeding • 6-12 monthsIntroduce solid foods • 12-36 monthsWork toward 3 meals/3 planned snacks

20. Regulation: Feeding • Encourage breastfeeding • Hold infants 0-6 months while feeding • Encourage eye gaze during feeding • Provide routines • Watch for “full” signals • Relate feeding schedule to sleep schedule

21. Regulation: Sleep • Birth to 3 months5 sleep periods/24 hourstotal sleep 10-16 hrs8-10 hrs should be at nightFamily routines affect sleep patterns

22. Regulation: Sleep • 3-6 months14 hours of sleep/24 hoursMore sleep at night2-3 naps per day

23. Regulation: Sleep • 6-12 months12-14 hours of sleep /24 hoursMore sleep at night 1-2 naps

24. Regulation: Sleep • 13-26 months10-12 hours of sleep/24 hoursMore sleep at nightafternoon nap continues

25. Regulation: Sleep • Self-soothing behaviors may be used to fall asleep • Back to sleep position is preferred • A regular feeding and sleep schedule can promote feelings of security • Safety, especially with co-sleeping

26. Regulation: Emotions • Babies begin to recognize emotional expressions of others starting about 6 months • Basic emotional states of infants are contentment and distress • Helping babies out of distress shows affection and concern

27. Regulation: Emotions • Predominant mood of babies is contentment • Eye contact, cooing, and smiling show emotional connection • Social games can enhance emotional connections

28. Regulation: Emotions • From 0-9 months babiesare increasingly able to express needs and self-soothe • After 9 months babiesare more anxious about strangers, new situations, and transitions

29. Regulation: Infant Cues • Looking away • Diffuse movements • Frowning and pouting • Crying

30. Regulation: Caregiver Responses • Babies cannot be “spoiled” • Respond to distressed crying • Allow child to self-comfort with mild protest crying • Physical contact helps soothe baby • Promote self-comfort skills • Manage normal adult feelings with fussy baby

31. Regulation: Caregiver Responses • Expect child to prefer parents, especially when tired or ill • Provide physical, visual, and verbal reassurance • Expect difficulty with routine changes • Expect child to continue to need adult help to calm • Encourage transitional objects

32. Stress and Brain Development • Adverse experiences may result in changes in the way the brain functions • Both severe and mild experiences can have an impact

33. Temperament • Refers to typical ways of responding to the environment and other people • Includes features such as mood, activity level, and reactions • Underlies many behaviors and interactions with others • Understood to be genetically derived and to develop over time

34. Temperament • Easy/Flexible (40%) • Slow to Warm/Fearful/Cautious (15%) • Difficult/Feisty/Spirited (10%)percents from Chess and Thomas NYLS sample

35. Temperament: Easy • Regularity • Positive approach to new things • Adapts to change • Mild to moderateintense mood • Usually positive mood

36. Temperament: Slow to Warm • Negative response of mild intensity to new things • Gradual adaptation with repeated tries

37. Temperament: Difficult • Irregular • Negative/withdraw from new things • Trouble adapting to change • Intense mood • Often negative mood

38. Temperament • Be aware of child’s unique style • Protect sensitive infants • Consider ways to manage challenging styles • Recognize own temperament style • Think about fit between child and adult style

39. Cognitive Skills • Through relationships, exploration of the environment, and play infants gradually begin to feel effective and competent • Several important cognitive processes contribute: causality, object permanence, imitation

40. Cognitive skills: Causality • Babies understanding of cause and effect grows from experience with others and objects • Actions graduallybecome more purposeful • Eventually babiesdo things to gain information

41. Cognitive Skills: Causality • Birth to 3 months—beings to observe connection between actions and outcomes • 4-6 months—attends to objects and tries to make something happen • 7-8 months-repeats action that results in interesting outcome • 9-11 months—understand cause and effect and tries to imitate • 12 months—purposeful actions

42. Cognitive Skills: Object Permanence • At first babies believe that objects do not exist when out of sight • By 6-9 months, babies realize that an object hidden under a cover still exists • Separation anxiety results from this knowledge • Mobile babies will search for a person who has moved away

43. Cognitive Skills:Object Permanence • Newborn to 3 months—objects out of sight no longer exist • 4-6 months—stops feeding to search for source of sound • 7-8 months—visually tracks object moving out of sight • 9-11 months—searches for partially hidden object • 12 months—search for object after seeing it hidden

44. Cognitive Skills: Imitation • Imitation gives babies more ideas about how to act on objects and to explore • Imitation is immediate at first • Delayed imitation occurs when older infants can hold behavior sequences in mind for a time • Great autonomy and independence result from imitation skills

45. Cognitive Skills: Imitation • Birth to 3 months—sticks out tongue after another • 4 to 6 months—imitates sounds • 7 to 8 months—imitates symbolic gestures • 9 to 11 months—imitates actions on objects • 12 months—imitates social actions

46. Infants with Special Needs • May develop skills at slower pace • May express needs and preferences less clearly • Caregivers may need help to recognize more subtle signals • More effort may be needed for soothing

47. Family Issues • Infant period can be stressful for families • Look for signs of post-partum depression • SES risk factors important impact on child outcomes • Parent problems, such as addiction, mental illness, and mental handicap may compromise attachment and child outcomes • Parent’s family history can also impact current relationship

48. Summary • Babies’ social and emotional development occurs and must be understood within relationships • Environmental, family, and personal traits impact social and emotional development • Social and emotional development provides a scaffold for development of skills in other areas

49. References • Jellinek, M, Patel, BP, Froehle, MC (eds) (2002). Bright Futures in Practice: Mental Health • Landy, S. (2002). Pathways to Competence • Gowen, JW & Nebrig, JB (2002). Enhancing Early Emotional Development

50. Discussion