For the large swath of our country that views mental health as something that implies a personality deficit, considering infant mental health must sound ludicrous. Physical health problems are medically treated and usually not the object of scorn (but even that is changing in our divisive society). Mental health problems are seemingly less tangible and are viewed in less-than-charitable ways. Treated by psychiatrists, psychologists, therapists and counselors, mental health issues are often swept to the side in our health care system that views diagnoses, treatments and cures as the sole goal of health care. Yet physical well-being is so inextricably tied to mental well-being that to ignore those connections is to do so at our own personal and greater social perils.
I would liken the concept of overall well-being to the concept of freedom as espoused by Professor Timothy Snyder in his recent book On Freedom.1,2 He eloquently notes that freedom is not just the absence of evil, oppression, artificial restrictions and other factors. For people to be truly free there must the presence of good also. We need structures, both moral and political, that are good.
In the same way, the pursuit of overall well-being needs ways to address both the physical and mental wellness simultaneously and interwoven for each of us, for our families and for our communities. It is not just sufficient to be physically healthy if our mental health is tenuous or deteriorating. And conversely, robust mental health can often assist with the recovery from physical health issues. The parts of our health spectrum, physical and mental, are not separate but fused in a sometimes precarious way. When nurtured appropriately, they can be strong “partners” in the journey of life so dependent on our health and well-being. So, well-being (like freedom) only truly can occur in the absence of preventable things and the presence of positive nurturing things.
That gets me to the point of infant mental health. No, it does not entail asking an infant how does that make them feel. I suspect that some critics of the concept would giggle at that comment and argue that the idea of infant mental health is ludicrous. Yet of all the things that we do in society, infant mental health is the most crucial of all.
I have oftentimes stated with parents and in talks with medical learners that the book of life is written in the first three years of life and that we just add appendices after that. I recognize that is bit of hyperbole but not far off the point. Those first three years set the stage for the life to come. The developing brain in size, connections, and nerve transmission speeds are undergoing unbelievable changes. It is estimated that over 80 billion neurons (nerve cells) are present at birth and that by 18 months of age the connections for those cells number in the hundreds of trillions.3 It is interesting that one of the most significant activities that occurs after birth and early life is the “pruning” of the connections (in all of the different neural networks) in the brain. This pruning solidifies certain connections and alters others.
The brain is “built” from the bottom up with the basic functions of the nervous system (breathing, heart rate, BP, body temperature) controlled by the brain stem and then other functions integrated over time as the maturation process proceeds. Movement, sleeping, arousal, and appetite activities are quickly enhanced by bonding, memory, emotions, and rewards – then hopefully leading to higher brain functions like thinking, language, values, time and hope. The purposely simplified hierarchical structure of the brain, as outlined by Dr. Bruce Perry, emphasizes the “flow” of information to be processed and the “maturity process” necessary for human development.4
Once we understand how the brain develops, it becomes incumbent on us to use this information wisely. Yes, the brain is a physical organ that needs blood supply with oxygen and nutrients. But most of all, it needs the nurturing that allows for solid connections that can be further enhanced in the years ahead. So, the development of the brain is primal initially to the mental health of our infants and later to our overall mental health.
I have previously emphasized the critical role that safe, stable nurturing relationships (SSNRs) have for children.5 It is these SSNRs that can determine how the brain develops and the connections occur. To talk about the physical health of infants without being concerned about the mental health is to neglect the elements of child rearing that matter. In point of fact, those elements initially are almost all in the nurturing category – warmth, nutrition, comforting, diaper changing. Those actions provide the basis for early care that too many people take for granted.
The connection of these actions to the mental health of our infants is too often undervalued. It is assumed that everyone does all those things, but the significant challenges that too many people and families face in our society are overlooked. The challenges of substandard housing, unequal education, poverty and racial bias at times pose impediments to seemingly simple tasks. And to think that other families of means do not face challenges is to ignore the fact everyone needs help in this difficult time of multiple tasks, responsibilities, and emotions.
Deficiencies in infant mental health often lead to trauma that is accidental or unintentional, and this trauma can have long term consequences. The primary prevention to avoid the long-term consequences is to provide the SSNRs in spades. The next blog will address how to address infant mental health in tangible ways but let me finish this blog with a frequent query from the thousands of parents that I saw over the years.
“Doc, I worry about rushing to my baby every time they cry. I worry that I will spoil them.” My answer was an emphatic NO. Infantile responses to needs (soiled diaper, hunger, temperature, arousal, sleep, overall discomfort) are crying and crying. And the appropriate response for caregivers is to take care of their needs and supply comfort. The love that is supplied by this nurturing is all-important and is not spoiling the infant.6 I would argue that you cannot spoil an infant and to think so is to deny the biology of early development and its long-term effects on advancing the health of children.
Infant mental health is so much more than what most folks think. It involves knowing how infants develop and then how they prosper with the assistance of the parents, caregivers and society as a whole. We have so much work to do and will discuss more in Part II next week.
- Snyder T. On Freedom. Crown, New York; 2024. 345 pp.
- https://mychildrenschildren.com/freedom-and-children/
- Garner A, Saul R. Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health. American Academy of Pediatrics; 2018. 175 pp.
- Perry B, Winfrey O. What Happened to You? Conversations on Trauma, Resilience, and Healing. Flatiron Books; 2021. 301 pp.
- https://mychildrenschildren.com/ssnrs-and-mr-rogers/
- https://mychildrenschildren.com/spoiled-or-nurtured/