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Infant Mental Health:The First 12 Months

Angela M. Tomlin, Ph.D., HSPPRiley Child Development

CenterIU School of Medicine

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IMH: Key topicsRelationships/AttachmentRegulation (sleeping; eating; emotions)TemperamentCognitive SkillsSpecial needsFamily Issues

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IMH: Key PointsSocio-emotional competence develops within and because of relationshipsSocio-emotional development affects all other areas of developmentSocio-emotional development has long lasting impactResearch in early brain development may provide basis for these phenomena

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Overview: Social Milestones

Newborn: Scans parent’s face; increasing eye contact6 weeks: begins to smile and coo responsively4 months: learns about others/ begins to be aware of strangers7 months: stranger anxiety9 months: separation anxiety; turns to caregiver for comfort when distressed

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Attachmentthe 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

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AttachmentGradually develops over the first several months

Is firmly established by about 9 months

Is a scaffold on which future relationships are developed

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AttachmentSecure attachments develop when the caregiver is loving, consistent and reliable.

Insecure attachments occur when the caregiver’s behavior is unpredictable or even hurtful.

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Attachment: Secure Pattern

Comforts the childAccepts the child’s feelingsIs not intrusiveAllows independenceShow positive feelings Sensitively responds to the child’s cues

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Attachment:Signaling Behaviors

Engaging cuesDisengaging cuesHungry cuesFull cues

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Attachment: Secure Pattern

Child does well in child carePositive social interactions with peers and adultsLiked better by others/more friendshipsEasily comforted when upsetCan problem-solveAsks for help appropriatelyManages conflict

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Attachment: Insecure Patterns

Avoidant

Ambivalent

Disorganized

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Avoidant PatternParent 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

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Ambivalent PatternParent 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

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Disorganized PatternParent 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

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Brain Research and Attachment

Brain develops more neurons than neededExperience helps determine the pathways that will be maintainedBrain is described to be “experience expectant”Social transactions may be of primary importance for brain development and function

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RegulationRefers 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

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Regulation: Feeding

Birth to 3 monthsmay be unpredictablebreast fed babies eat 8-12 x/24 hoursbottle fed babies eat 6-8 x/24 hours

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Regulation: Feeding3-6 monthsbreast fed babies still need several night feedingsbottle fed babies may sleep through the night

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Regulation: Feeding6-12 monthsIntroduce solid foods12-36 monthsWork toward 3 meals/3 planned snacks

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Regulation: FeedingEncourage breastfeedingHold infants 0-6 months while feedingEncourage eye gaze during feedingProvide routinesWatch for “full” signalsRelate feeding schedule to sleep schedule

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Regulation: Sleep Birth to 3 months

5 sleep periods/24 hourstotal sleep 10-16 hrs8-10 hrs should be at nightFamily routines affect sleep patterns

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Regulation: Sleep 3-6 months

14 hours of sleep/24 hoursMore sleep at night2-3 naps per day

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Regulation: Sleep 6-12 months

12-14 hours of sleep /24 hoursMore sleep at night 1-2 naps

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Regulation: Sleep 13-26 months

10-12 hours of sleep/24 hoursMore sleep at nightafternoon nap continues

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Regulation: SleepSelf-soothing behaviors may be used to fall asleepBack to sleep position is preferredA regular feeding and sleep schedule can promote feelings of securitySafety, especially with co-sleeping

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Regulation: EmotionsBabies 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

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Regulation: EmotionsPredominant mood of babies is contentment

Eye contact, cooing, and smiling show emotional connection

Social games can enhance emotional connections

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Regulation: EmotionsFrom 0-9 months babiesare increasingly able to express needs and self-sootheAfter 9 months babiesare more anxious about strangers, new situations, and transitions

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Regulation: Infant CuesLooking away

Diffuse movements

Frowning and pouting

Crying

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Regulation: Caregiver Responses

Babies cannot be “spoiled”Respond to distressed cryingAllow child to self-comfort with mild protest cryingPhysical contact helps soothe babyPromote self-comfort skillsManage normal adult feelings with fussy baby

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Regulation: Caregiver Responses

Expect child to prefer parents, especially when tired or illProvide physical, visual, and verbal reassuranceExpect difficulty with routine changesExpect child to continue to need adult help to calmEncourage transitional objects

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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

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TemperamentRefers to typical ways of responding to the environment and other peopleIncludes features such as mood, activity level, and reactionsUnderlies many behaviors and interactions with othersUnderstood to be genetically derived and to develop over time

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TemperamentEasy/Flexible (40%)

Slow to Warm/Fearful/Cautious (15%)

Difficult/Feisty/Spirited (10%)

percents from Chess and Thomas NYLS sample

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Temperament: EasyRegularityPositive approach to new thingsAdapts to changeMild to moderateintense moodUsually positive mood

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Temperament: Slow to Warm

Negative response of mild intensity to new things

Gradual adaptation with repeated tries

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Temperament: DifficultIrregularNegative/withdraw from new thingsTrouble adapting to changeIntense moodOften negative mood

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TemperamentBe aware of child’s unique styleProtect sensitive infantsConsider ways to manage challenging stylesRecognize own temperament styleThink about fit between child and adult style

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Cognitive SkillsThrough relationships, exploration of the environment, and play infants gradually begin to feel effective and competent

Several important cognitive processes contribute: causality, object permanence, imitation

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Cognitive skills: CausalityBabies understanding of cause and effect grows from experience with others and objectsActions graduallybecome more purposefulEventually babiesdo things to gain information

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Cognitive Skills: CausalityBirth to 3 months—beings to observe connection between actions and outcomes4-6 months—attends to objects and tries to make something happen7-8 months-repeats action that results in interesting outcome9-11 months—understand cause and effect and tries to imitate12 months—purposeful actions

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Cognitive Skills: Object Permanence

At first babies believe that objects do not exist when out of sightBy 6-9 months, babies realize that an object hidden under a cover still existsSeparation anxiety results from this knowledgeMobile babies will search for a person who has moved away

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Cognitive Skills:Object Permanence

Newborn to 3 months—objects out of sight no longer exist4-6 months—stops feeding to search for source of sound7-8 months—visually tracks object moving out of sight9-11 months—searches for partially hidden object12 months—search for object after seeing it hidden

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Cognitive Skills: ImitationImitation gives babies more ideas about how to act on objects and to exploreImitation is immediate at firstDelayed imitation occurs when older infants can hold behavior sequences in mind for a timeGreat autonomy and independence result from imitation skills

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Cognitive Skills: ImitationBirth to 3 months—sticks out tongue after another4 to 6 months—imitates sounds 7 to 8 months—imitates symbolic gestures9 to 11 months—imitates actions on objects12 months—imitates social actions

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Infants with Special NeedsMay develop skills at slower pace May express needs and preferences less clearlyCaregivers may need help to recognize more subtle signalsMore effort may be needed for soothing

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Family IssuesInfant period can be stressful for familiesLook for signs of post-partum depressionSES risk factors important impact on child outcomesParent problems, such as addiction, mental illness, and mental handicap may compromise attachment and child outcomesParent’s family history can also impact current relationship

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SummaryBabies’ social and emotional development occurs and must be understood within relationshipsEnvironmental, family, and personal traits impact social and emotional developmentSocial and emotional development provides a scaffold for development of skills in other areas

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ReferencesJellinek, M, Patel, BP, Froehle, MC (eds) (2002). Bright Futures in Practice: Mental HealthLandy, S. (2002). Pathways to CompetenceGowen, JW & Nebrig, JB (2002). Enhancing Early Emotional Development

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Discussion

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Infant Mental Health:The First 12 Months

Angela M. Tomlin, Ph.D., HSPPRiley Child Development

CenterIU School of Medicine