Infant mental health: a stronger start

22 July 2020

How has the NSPCC promoted infant mental health during lockdown? Dawn Hodson, Victoria Joel, Julia Mayes and Louise Harrington explain how their evidence-based services help build up young brains: from serve-and-return interactions to easing parental stress.

Covid-19 has had a huge impact on all our lives, but there are particular risks when it comes to the wellbeing of babies (born and unborn) and very young children. Infancy is a critical stage of development: infants are reliant on parents to respond to their needs. The current circumstances have increased stress for families and sometimes exacerbated adversity.

Babies and very young children are particularly vulnerable when anxious or stressed parents are unable to engage in a responsive way, especially if this is over a protracted period (Cuthbert et al, 2014). And exposure to significant stress in the womb or early life can impact on child development and long-term outcomes, including brain development (Buss et al, 2012).

However, secure attachments with a caregiver in touch with what their baby is communicating and able to respond can help build babies’ brains and support their emotional and behavioural development. Amid the disruption, parents and carers need the right support to give their baby the best start in life.

In lockdown, the NSPCC and the partners we work with to deliver services have transformed how we operate to ensure we’re still here for families and children. We’ve moved from a face-to-face operating model to a virtual model with staff home-working and remote contact with children and families. We’ve been able to continue to support caregivers and help them provide a safe and secure environment for the infants in their care.


Look, Say, Sing, Play: brain-building tips

Look at what your baby is focusing on and see how they react. Place your baby on their back and dangle a safe toy just out of their reach. Encourage them to follow the objects with their eyes and head or to reach for them. Comment on how hard they try: ‘You almost touched the toy!’

Say what you’re doing and copy the sound your child makes. Get on your baby’s level and look at the world through their eyes. What might they see while lying on their back or tummy? Notice where they’re looking, point at it, and use words to describe what they’re seeing, noticing any little responses they make. Talk about what you see too.

Sing along to your favourite tunes or make up your own. Pay attention to how they tell you they want more singing. Do they turn their head toward you? Smile? Move? What do they do to say ‘enough’? Cry? Turn away? Take note of how to respond to their cues now and in the future.

Play simple games and see what your baby enjoys. Put your baby on their back or tummy and shake something that makes a noise, such as keys. Do they follow the sound with their eyes or head? What do they do when you shake fast or slow? If they do something, copy that action or sound and have a conversation without words.


The parent-infant relationship

Parents interact with their babies all the time without always realising how those interactions shape the way their baby’s brain develops. For example, serve-and-return interactions – when a parent responds positively to their child by speaking, gesturing or touching – help shape brain architecture by building and strengthening the neural connections that babies need to develop communication and social skills.

To help all parents, we’ve developed ‘Look, Say, Sing, Play’ (see panel, left): weekly emails full of tips for parents to help build their baby’s brain, based on the work of Vroom, a US public health initiative that uses the science of early learning to help parents improve back-and-forth interactions with their children. Leaflets are also available from our NSPCC learning website for professionals to share with parents and carers (see Resources).

Look, Say, Sing, Play tips can help drive high-quality interactions between a parent and their baby and encourage parents to be more sensitive to cues, so they can identify and respond to their child’s needs. These everyday interactions can also help improve attunement of parents from an early age, setting up positive behaviours as their child grows. With parents spending more time at home, we hope there will be more opportunities for them to try out the tips over the coming months.

Increasing access to services

Pregnancy and the early weeks and months are a key time of change and development for babies and parents. Antenatal education offers a unique window of opportunity to help parents-to-be prepare for these changes. But preparing for parenthood is about more than just labour and birth. Focusing on the transition to parenthood, parents’ relationship with each other and their child can help improve outcomes for children. Unfortunately, this is often absent from traditional antenatal education, and families who could benefit from additional support are less likely to engage with antenatal education.

Baby Steps is a perinatal education and support programme designed to address these gaps. The programme is evidence-based, underpinned by attachment research and infant mental health, alongside traditional practical and medical information. The programme has been designed to be participatory rather than didactic, and content is delivered through a range of interactive approaches, to make it more accessible. Parents learn about the development of their growing baby. They are encouraged to talk and sing to their baby and to spend time imagining what he or she might be like. In the postnatal period, practitioners provide parents with information about how to interact with babies at different stages. Practitioners offer positive feedback about how parents are responding to their infants’ cues, and model the positive interactions they hope to see between parent and infant.

An evaluation has found that parents who attended Baby Steps…

  • Showed an improvement in the quality of their relationship with their babies
  • Showed a reduction in levels of parental anxiety and depression
  • Showed an increase in self-esteem
  • Did not show the reduced relationship satisfaction with their partners that is seen in the general population following the birth of a baby.

These findings suggest that parents who complete Baby Steps will be better equipped to provide sensitive, responsive care to their babies (Coster et al, 2015).

The NSPCC helps other organisations set up the programme in their local area and support ongoing implementation. The programme is then delivered jointly by someone in children’s services, and a health visitor or midwife. Ordinarily, Baby Steps is delivered face to face through group sessions and two home visits, but this has been paused since the beginning of the lockdown. Now the programme is being delivered over the phone, through video calls, and using video content and supporting resources to share the key messages.

Forming strong, healthy attachments is the fundamental building block in reducing adverse childhood experiences

Impact of lockdown

The NSPCC’s multidisciplinary infant and family mental health teams in Glasgow and London work with infants aged 0 to 60 months in foster or kinship care because of maltreatment. The team help social workers and judges decide whether a child in care should be returned to their birth family or enter care permanently.

For these families and infants, the circumstances surrounding the pandemic are especially challenging. Infants in care may be experiencing additional changes in their lives compared with peers: for example seeing parents via video call rather than spending time together. Depending on their situation, they might feel worry or sadness when not seeing parents, relief if time with parents has been stressful, or happiness about spending more time with current caregivers. Notwithstanding individual capacities and unique contextual resources (Ungar, 2013), these children often need additional support, after previous experiences of stress, loss and change when living at home and coming in to care (Furnivall and Grant, 2014).

It is critically important to help professionals seek to promote caregivers’ wellbeing and coping, so they are better able to support children in their care. Helping professionals can best support caregivers to consider the world from the infant’s perspective, with this informing understanding of the infant’s cues and needs (Coyne et al, 2018). New resources designed by the team in Glasgow in response to the pandemic help caregivers support children through new experiences, such as video calls with parents in lieu of normal contact visits, while other resources explain to parents how their child might be feeling.

Parental mental health

Prior to the pandemic, up to one in five mums and one in 10 dads reported perinatal mental health difficulties during pregnancy and in the first year of their child’s life (NHS England, 2018; Bauer, 2016). We’ve seen a rise in contacts with the NSPCC helpline from people with concerns about parental mental health, with the total for May up 38% on the monthly average prior to lockdown. Investing to prepare and support new parents to care and interact with their babies, and to form strong, healthy attachments is the fundamental building block in reducing adverse childhood experiences. That’s why our Fight for a Fair Start campaign is calling for all families to get the support they need if they’re struggling with their mental health during the perinatal period (see page 34 for more on mental health in lockdown).

The NSPCC has also developed an evidence-based preventative mental health service for pregnant mums and partners called Pregnancy in Mind. It’s designed to protect against the impact of parental anxiety and build parents’ capacity to provide sensitive, responsive care to their babies. The programme is underpinned by six core evidence-based themes, including mindfulness meditation, psychoeducation, and awareness raising of fetal development.

Practitioners are currently running a virtual Pregnancy in Mind service, via videoconferencing and telephone calls with service users. Alongside these sessions, practitioners are supporting parents-to-be with literature, links and audio recordings, all of which are emailed weekly.    

Dawn Hodson is early years theme lead,  Victoria Joel is development support  officer, Julia Mayes is implementation  manager and Louise Harrington is development and impact manager,  all at the NSPCC. 


Resources  

  • To set up and deliver Baby Steps in your area, the NSPCC offers an implementation support package through their Scale-up Unit [email protected]  
  • Find out more about the NSPCC’s direct services nspcc.org.uk/familyservices  
  • Please also help the NSPCC campaign for all families to get the support they need if they’re struggling with mental health during the perinatal period by signing the Fight for a Fair Start campaign petition nspcc.org.uk/fair-start
  • Free tips and tools from Vroom vroom.org

References:

Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B. (2016) The costs of perinatal mental health problems. See: centreformentalhealth.org.uk/publications/costs-of-perinatal-mental-health-problems (accessed 19 June 2020).

Buss C, Entringer S, Swanson JM, Wadhwa PD. (2012) The role of stress in brain development: the gestational environment’s long-term effects on the brain. Cerebrum (online). See: ncbi.nlm.nih.gov/pmc/articles/PMC3574809 (accessed 21 June 2020).

Coster D, Brookes H, Sanger C. (2015) Evaluation of the Baby Steps programme: pre- and post-measures study. See: https://www.activematters.org/wp-content/uploads/pdfs/baby-steps-evaluation-pre-post-measures-study.pdf (accessed 21 June 2020).

Coyne J, Powell B, Hoffman K, Cooper G. The circle of security. In: Zeanah CH Jr (ed). (2018) Handbook of Infant Mental Health (4th edition). Guilford Press: New York. 

Cuthbert C, Rayns G, Stanley K. (2011) All Babies Count: prevention and protection for vulnerable babies. See: http://childhub.org/sites/default/files/library/attachments/1346_NSPCC-All-babies-count-research_original.pdf (accessed 21 June 2020).

Furnivall J, Grant E. (2014) Trauma sensitive practice with children in care. See: iriss.org.uk/resources/insights/trauma-sensitive-practice-children-care (accessed 21 June 2020).

NHS England (2018) Partners of new mums with mental illness set to get targeted support on the NHS. See: england.nhs.uk/2018/12/partners-of-new-mums-with-mental-illness-set-to-get-targeted-support-on-the-nhs (accessed 21 June 2020).

Ungar M. (2013) Resilience, trauma, context and culture. Trauma, Violence and Abuse 14(3): 255-66.

Picture Credit | iStock

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