Helping Caregivers Provide Nurturing Care
Foreword
Infant mental health is often ignored, mostly because it is an unfamiliar or
uncomfortable topic (Reschke, 2021). At the same time, many believe that infants’ and
young children’s mental health problems are not real, as children are resilient and will
bounce back (HCA Virginia, 2021). Worse yet, there is a myth that infants and toddlers’
brains are “a blank slate”, that they will successfully overcome any adverse situation
they will encounter (such as maltreatment, neglect, abuse, abandonment, and trauma,
just to name a few). Because infant and early childhood mental health (IECMH) is
paramount for the healthy emotional, physical, and psychological development of all
individuals, this paper aims to bring greater attention to the topic, as well as to increase
awareness of the potentially destructive consequences of disregarding the importance of
IECMH for our individual wellbeing, as well as our society’s future health, creativity, and
productivity.
Brain Development and The Nature-Nurture Dilemma
Early prenatal brain development begins at about two weeks of gestation when
the embryo begins to form a “C-shaped” neural tube, a structure that will eventually
become the hindbrain, midbrain, and forebrain (Broderick & Blewitt, 2015). From about
the 40th day, or 5th week of gestation, the neurons in the fetal brain begin to increase at
an astonishing rate; one-quarter of a million per minute for 9 months, and by birth, the
baby’s brain will contain roughly 100 billion neurons (Broderick & Blewitt, 2015). After
birth, the neurons in the baby’s brain continue to form new connections and reproduce
at a rapid pace, slowing down at around 12 months of age; however, this process of
growth is shown to take place throughout the lifespan, through processes that involve
the generation of new synapses (new connections among neurons) and pruning
(elimination of extra, unused synapses; Broderick & Blewitt, 2015).
As seen above, neurodevelopment (a term referring to the brain’s development of
neurological pathways that influence performance or functioning, such as emotional
regulation, intellectual functioning, reading ability, social skills, memory, attention, or
focus skills) begins early in the prenatal period, “explodes” during the first 12 months of
an infant’s life, and continues, though at a much slower rate, throughout the lifespan
(Brighton Center for Pediatric Neurodevelopment, 2021; Broderick & Blewitt, 2015).
Brain development takes place sequentially, that is, it organizes itself in a hierarchical
manner, from least (brainstem) to most complex (cortical areas). These different parts
develop, organize, and become fully functional at different times during childhood
(perry, 2007). At birth, for example, the lower brain areas (or brainstem) are responsible
for regulating the cardiovascular and respiratory functions. (If these are damaged, the
infant will not survive). In comparison, the cortical areas that are responsible for
abstract thinking and executive function are not fully developed and functional until
later in life, usually around the age of 25 (Broderick & Blewitt, 2015; Perry, 2207).
Additionally, there is also a debate over which is more important, Nature or
Nurture; in this respect, studies show that both genes and environment influence
human development, but how exactly and in what ways they interact and influence
each other, remains unclear. (Broderick & Blewitt, 2015). What is certain, however, is
that genes and environment are in constant communication, always working together,
with recent literature showing that neurodevelopment takes place within the context of
relationships, as “children’s brains grow and are molded by the people around them”
(Broderick & Blewitt, 2015; Perry & Szalavitz, 2017, p. xxviii). In other words, everyone’s
personal history- the people, places, and events in their life, influences their brain
development, thus the way each person sees and understands the world is unique
(Perry & Winfrey, 2021).
Infant and Early Childhood Mental Health and Stress
The Centers for Disease Control and Prevention (CDC) defines mental health as
our emotional, psychological, and social well-being; our mental health, in turn, affects
how we think, act, and feel about ourselves, others, and the world (CDC, 2021). Infant
and Early Childhood Mental Health (IECMH), at its basis, refers to “the developing
capacity of the child from birth to 5 years old to form close and secure adult and peer
relationships; experience, manage, and express a full range of emotions; and explore
the environment and learn—all in the context of family, community, and culture”
(Reschke, 2021, p. 36). To reach optimal mental health, each infant needs a nurturing,
warm, and responsive environment, where they can learn through patterned, repetitive
experiences that they are safe, secure, and loved. When these experiences occur, the
infant’s brain makes certain associations, as well as a model of him/herself and the
world around: he/she begins to see him/herself as loved and worthy, and the world as
trustworthy and safe (Broderick & Blewitt, 2017; Perry, 2017).
On the contrary, when the infant’s needs are not met, or the care is sporadic,
inconsistent, or absent, the infant’s brain makes associations that reflect these
experiences and his/her model of him/ herself and the world is that he/she is not
important and the world cannot be trusted (Broderick & Blewitt, 2017; Perry, 2017).
These associations made in the brain early in life will have a far greater impact on the
individual’s wellbeing than any other later ones because as they grow and develop,
infants’ and toddlers’ brains also create a “personal catalog” of experiences or
templates, which is then used for the rest of their life to make sense of the world
around them (Perry & Winfrey, 2021, p. 38).
Additionally, depending on the type of care
received, the stress-response systems in the infants’ brains will develop accordingly:
they will be in balance (or regulated) when the care is timely and adequate, and they
will be dysregulated (or sensitized) when the care is chaotic or unpredictable (Perry,
2007). Stated otherwise, because infants and very young children are dependent on
their caregivers for survival, having but limited ways of signaling their distress (i.e.,
crying), it is the adult caregivers that provide the infant with external regulation (Perry &
Winfrey, 2021). Thus, when the caregiver is consistent, predictable, and nurturing, the
stress-response systems in the brain become resilient, but if the stress-response
systems are activated in unpredictable or chaotic ways, they become sensitized and
dysfunctional (Perry, 2007; Perry & Winfrey, 2021). This is exactly what happens to the
infants’ and toddlers’ brains when they are exposed to extreme stress, maltreatment,
neglect, abuse, abandonment, or trauma.
Extreme Stress and Trauma
Stress is a fact of life. Evolutionarily speaking, some degree of stress can be
adaptive, as it strengthens our capacity to adapt to challenges to thrive. That is why,
when stress is predictable, controllable, and moderate in severity, it may lead to
resilience, but when it is unpredictable, rapid, threatening, and severe, it may lead to
vulnerability (Perry, 2007; Perry & Pollard, 1998). When stress is manageable, the stress-
response systems in the brain can regulate themselves and achieve balance, also called
homeostasis. But when stress is severe, extreme, unpredictable, or prolonged, the
brain’s capacity to compensate or balance the stress can become overactivated or
fatigued, thus incapable of restoring the previous state of equilibrium or homeostasis
(Perry, 2007; Perry & Pollard, 1998, Perry & Winfrey, 2021).
Two major forms of maltreatment that are most often encountered and have
the most deleterious impact on the infant’s/toddler’s brain development, are neglect
and trauma. Neglect is defined as the absence of an experience or patterns of
experiences required for the development of one’s genetic potential, while trauma is an
event that is frightening, dangerous, or violent, and poses a threat to an infant’s/child’s
life or bodily integrity (Perry, 2008; The National Child Traumatic Stress Network, n.d.).
Because the brain goes through various sensitive developmental periods in the first five
years of life, exposure to high levels of stress leads to key systems in the brain to
become more reactive and supersensitive, and the stress-response system can be
activated whenever anything new takes place (Perry & Winfrey, 2021; Teicher et al.,
2003). That is why, for most people, the unknown is one of the major causes of feeling
anxious overwhelmed (Perry & Winfrey, 2021). Moreover, infants and children who are
exposed to unpredictable or extreme stress (e.g., maltreatment, trauma) will become
dysregulated, and the normal progression of brain development will be altered, often
leading to psychiatric illness and behavioral dysfunction later in life (Teicher et al.,
2003).
Fortunately, the field of IECMH has made great strides over the past decades and
today there is abundant research that can help us understand how early experiences
(both positive, but especially negative ones, such as those mentioned above) can put
babies’ and toddlers’ social and emotional wellbeing in danger. Moreover, such studies
are a wonderful avenue we can use to educate us (and the society at large) on the early
signals in very young children’s behavior that can inform us they are suffering or in need
of help. Lastly, these resources can provide us with supports and interventions that
protect babies’ and toddlers’ mental health during stressful times so that we can look
for ways to restore their emotional and social well-being and help them flourish
(Reschke, 2021).
Afterword
Despite the great strides in neuroscience and other related domains, the field of
Infant and Early Childhood Mental Health (IECMH) is still lagging in putting this
information into daily practice. Countless infants and young children are suffering
because they are not getting the adequate care necessary to fulfill their true potential
and thrive. From a neurodevelopmental perspective, it is the human brain that mediates
all emotional, social, cognitive, and behavioral functioning, and this lack of care may
have tremendous negative outcomes for our society’s future, its productivity, well-
being, and creativity (Perry, 2007).
In other words, if the infant’s brain receives the proper stimulation at the right
time (i.e., all its senses are stimulated at each sensitive developmental stage- touch,
smell, hearing, taste, and sight), and key systems in its brain will organize and function
properly; however, if the brain is not provided with the necessary patterned, repetitive
stimulation, the stress-response systems will be negatively impacted, resulting in
dysfunction and psychopathology (Perry, 2007; Perry & Winfrey, 2021). In this respect,
infants and young children exposed to maltreatment, abuse, and trauma during a
sensitive developmental period will have the greatest difficulties in relating to others,
themselves, and the world around, as their stress-response systems become altered,
impacting their capacity to regulate and function adequately (Perry, 2007).
Fortunately, there is abundant research in the field of IECMH that can be used to
help caregivers and families to better cater to the needs of their infants and very young
children. However, it is the responsibility of various health care professionals (e.g.,
health care personnel, school administrators, mental health providers, welfare, and
children’s agencies) and community leaders in different capacities to make this
information available to the greater public, as well as increase their efforts to shine a
spotlight on early development. Nurturing care is essential for the emotional wellbeing
of infants and very young children, but to achieve this goal, we need to join efforts to
work on behalf of children and families everywhere (ZERO TO THREE, 2018).
References
Brighton Center for Pediatric Neurodevelopment. (2021). Neurodevelopment. Retrieved
from https://www.bcpn.org/what-is-neurodevelopment-.html
Broderick, P. C., & Blewitt, P. (2015). The life span: Human development for helping
professionals (4th ed.). Upper Saddle River, NJ: Pearson Education.
HCA Virginia. (2021). 5 myths about children’s mental health that all parents need to
read. Retrieved November 8, 2021, from https://hcavirginia.com/blog/entry/5-
myths-about-childrens-mental-health-that-all-parents-need-to-read.
Nuyts, T., Van Haeken, S., Crombag, N., Singh, B., Ayers, S., Garthus-Niegel, S., Braeken,
M. A. K. A., & Bogaerts, A. (2021). “Nobody Listened”. Mothers’ Experiences and
Needs Regarding Professional Support Prior to Their Admission to an Infant
Mental Health Day Clinic. International Journal of Environmental Research and
Public Health, 18(20). https://doi-
org.ezp.waldenulibrary.org/10.3390/ijerph182010917
Perry, B. D. (2008). Child Maltreatment: A Neurodevelopmental Perspective on the Role
of Trauma and Neglect in Psychopathology. Retrieved from https://7079168e-
705a-4dc7-be05-
2218087aa989.filesusr.com/ugd/aa51c7_6b493f28b1b74a95aae35bcd4fe807a5.
pdf
Perry, B. D. (2007). Stress, Trauma and Post-traumatic Stress Disorders in Children.
Retrieved from chrome-
extension://efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=https%3A%
2F%2Fwww.complextrauma.ca%2Fwp-content%2Fuploads%2FC9-PTSD-in-
Children-An-Introduction-.pdf&clen=192075&chunk=true
Perry, B.D., & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation: A
neurodevelopmental view of childhood trauma. Child and Adolescent
Psychiatric Clinics of North America, 7, 33-51.
Perry, B. D., & Szalavitz, M. (2017). The boy who was raised as a dog. Basic Books.
Perry, B. D., & Winfrey, O. (2021). What happened to you? Conversations on trauma,
resilience, and healing. Flatiron Books.
Reschke, K. L. (2021). Caring for the Mental Health of Infants and Toddlers. YC: Young
Children, 76(1), 35–38.
Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M.
(2003). The neurobiological consequences of early stress and childhood
maltreatment. Neuroscience and Biobehavioral Reviews, 27(1–2), 33–44.
https://doi-org.ezp.waldenulibrary.org/10.1016/S0149-7634(03)00007-1
The Centers for Disease Control and Prevention (CDC). (2021). Mental Health. Retrieved
from https://www.cdc.gov/mentalhealth/learn/
The National Child Traumatic Stress Network. (n.d.). About Child Trauma. Retrieved
from https://www.nctsn.org/what-is-child-trauma/about-child-trauma
ZERO TO THREE. (2018). Supporting Parents to Provide Nurturing Care for Young
Children. Retrieved from ZTT_journal_global.issue-3.pdf
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