Infant Mental Health: The First 12 Months

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Infant Mental HealthThe First 12 Months

• Angela M. Tomlin, Ph.D., HSPP
• Riley Child Development Center
• IU School of Medicine

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IMH Key topics

• Relationships/Attachment
• Regulation (sleeping eating emotions)
• Temperament
• Cognitive Skills
• Special needs
• Family Issues

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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

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Overview Social Milestones

• Newborn Scans parents 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

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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

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Attachment

• Gradually 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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Attachment

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

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Attachment Secure Pattern

• Comforts the child
• Accepts the childs feelings
• Is not intrusive
• Allows independence
• Show positive feelings
• Sensitively responds to the childs cues

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AttachmentSignaling Behaviors

• Engaging cues
• Disengaging cues
• Hungry cues
• Full cues

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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

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Attachment Insecure Patterns

• Avoidant
• Ambivalent
• Disorganized

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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 peoples
  feelings

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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

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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

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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

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Regulation

• Refers to an infants ability to regulate her own
  biological and behavioral rhythms, using
  environmental cues
• Parents support the childs 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 Feeding

• 3-6 monthsbreast fed babies still need several
  night feedingsbottle fed babies may sleep
  through the night

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Regulation Feeding

• 6-12 monthsIntroduce solid foods
• 12-36 monthsWork toward 3 meals/3 planned snacks

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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

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Regulation Sleep

• Birth to 3 months5 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 months14 hours of sleep/24 hoursMore sleep
  at night2-3 naps per day

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Regulation Sleep

• 6-12 months12-14 hours of sleep /24 hoursMore
  sleep at night 1-2 naps

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Regulation Sleep

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

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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

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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

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Regulation Emotions

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

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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

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Regulation Infant Cues

• Looking away
• Diffuse movements
• Frowning and pouting
• Crying

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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

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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

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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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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

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Temperament

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

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Temperament Easy

• Regularity
• Positive approach to new things
• Adapts to change
• Mild to moderateintense mood
• Usually 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 Difficult

• Irregular
• Negative/withdraw from new things
• Trouble adapting to change
• Intense mood
• Often negative mood

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Temperament

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

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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

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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

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Cognitive Skills Causality

• Birth to 3 monthsbeings to observe connection
  between actions and outcomes
• 4-6 monthsattends to objects and tries to make
  something happen
• 7-8 months-repeats action that results in
  interesting outcome
• 9-11 monthsunderstand cause and effect and tries
  to imitate
• 12 monthspurposeful actions

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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

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Cognitive SkillsObject Permanence

• Newborn to 3 monthsobjects out of sight no
  longer exist
• 4-6 monthsstops feeding to search for source of
  sound
• 7-8 monthsvisually tracks object moving out of
  sight
• 9-11 monthssearches for partially hidden object
• 12 monthssearch for object after seeing it hidden

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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

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Cognitive Skills Imitation

• Birth to 3 monthssticks out tongue after another
• 4 to 6 monthsimitates sounds
• 7 to 8 monthsimitates symbolic gestures
• 9 to 11 monthsimitates actions on objects
• 12 monthsimitates social actions

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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

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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
• Parents family history can also impact current
  relationship

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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

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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

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Discussion
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Infant Mental HealthThe First 12 Months

• Angela M. Tomlin, Ph.D., HSPP
• Riley Child Development Center
• IU School of Medicine