12th June 2017
A reflective blog written by Catherine Lowenhoff, one of our Fellows, to kick off the start of Infant Mental Health Awareness Week (#IMHAW17) by thinking about babies’ earliest nurturing environments – ie. in the womb.
As we begin Infant Mental Health Week thinking about the impact of the earliest nurturing environment on the developing baby, I am reminded of Winnicott’s words “there is no such thing as a baby…A baby cannot exist alone but is essentially part of a relationship’’ (Winnicott, 1947/1957, p.137).
Just as there is no health without mental health, there is no child health without maternal health. Of course, the mother-baby relationship is not the only relationship that matters with respect to promoting infant mental health. Shonkoff and Phillips in their book ‘From neurons to neighbourhoods’ stated that “Human relationships, and the effects of relationships on relationships, are the building blocks of healthy development.” (2000 p.4).
Whilst the mother holds the primary responsibility for providing an environment that fosters the health, growth and development of the baby in the womb, she also depends on a network of supportive relationships to help her to cope with the enormous changes that are happening to her body, her life, her circumstances and her relationships. Pregnancy can be a very stressful time.
Impact of maternal distress
Maternal physiological responses to stress can influence the development of biological processes and neural pathways in the developing foetus. Whilst exposure to stress and individual reactions to stressful experiences may differ, there appears to be a dose-response relationship between prenatal maternal distress and the subsequent development of a range of adverse outcomes for the child including difficulties in regulating arousal, emotion and attention (Field 2011); delayed cognitive and language development; behavioural problems; immune and neuroendocrine dysfunction and digestive and respiratory system conditions (Connor, Monk and Fitelson 2014).
As well as any kind of experience of maternal distress, stressors that compromise the foetal environment can take many forms. For example, a range of lifestyle factors, such as maternal antenatal diet, pre-pregnancy and pregnancy obesity and physical inactivity, have all been implicated in the ‘biological embedding’ of increased susceptibility to a range of emotional and behavioural problems in children (Lewis et al 2014).
Antenatal exposure to neurodevelopmental toxicants such as alcohol, cigarettes, medications and lead have also been linked to adverse child mental health outcomes (Lewis et al 2014). Although the exact mechanisms of transmission are not always known, the interesting point here is that different exposures seem to culminate, not only in similar emotional, behavioural and attentional deficits for the child, but also in an increased predisposition to multiple health problems (such as heart disease and diabetes) across the lifespan (Schlotz and Phillips 2009).
There is, therefore, clear evidence of the potential benefits to be gained for the child from enhancing maternal antenatal wellbeing and protecting the foetus from exposure to modifiable risk factors.
Opportunities for health visitors to make a difference
Sensitive, responsive antenatal support from health visitors is, therefore, potentially one of the most important opportunities for health visitors to make a difference to maternal and child health outcomes. If health visitors are able to establish a relationship with expectant mothers, they can provide anticipatory guidance and information to reduce the amount of distress experienced.
Health visitors can also explore possible sources of distress and facilitate access to timely and appropriate support to address underlying issues, reduce symptoms and prevent the escalation of distress to more serious mental health problems. This, in turn, will protect the growing foetus and reduce the chances of compromised physiological processes and consequent negative mental health outcomes.
Health visitors can also proactively promote the health and wellbeing of all members of the family, and facilitate supportive relationships and responsive parenting, thereby providing the foundations for optimal infant mental health. There are compelling reasons for the mandated antenatal visit to be offered earlier in pregnancy and to be the most important health visiting contact. It is a shame that in many areas, due to capacity issues or conflicting priorities, this visit is sometimes demoted to the status of an optional extra!
Infant Mental Health
Infant mental health has been defined as ‘the developing capacity of the child from birth to 3 to experience, regulate and express emotions; form close and secure interpersonal relationships; and explore and master the environment and learn – all in the context of family, community, and cultural expectations for young children.’ (Zero to Three 2001). This definition should be amended to include the developing processes and pathways that are established during foetal development that provide the foundation for physiological and emotional regulation, as well as readiness to engage and respond to human interaction.
Catherine Lowenhoff, FiHV
Connor TG, Monk C, Fitelson EM (2014) Practitioner Review : maternal mood in pregnancy and child development: implications for child psychology and psychiatry. J Child Psychol Psychiatry 55 (2): 99-111
Field T (2011) Prenatal depression effects on early development: a review. Infant Behaviour and Development 34 : 1-14
Lewis AJ, Galbally M, Gannon T, Symeonides C (2014) Early life programming as a target for prevention of child and adolescent mental disorders. BMC Medicine 12: 33 http://www.biomedcentral.com/1741-7015/12/33 (accessed May 25th 2017)
Schlotz W, Phillips D (2009) Fetal origins of mental health: evidence and mechanisms. Brain Behav Immun 23: 905 – 916
Shonkoff JP, Phillips DA (Eds.) National Research Council and Institute of Medicine (2000) From neurons to neighborhoods: The science of early childhood development. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press
Winnicott DW (1957) Further thoughts on babies as persons. In J. Hardenberg (Ed.),
The child and the outside world: Studies in developing relationships. London: Tavistock Publications Ltd. (Original work published 1947)
Zero to Three (2001). Infant Mental Health Task Force: Definition of infant mental health.cited in Research synthesis produced by The Centre on the Social and Emotional Foundations of Learning. Retrieved from: http://csefel.vanderbilt.edu/documents/rs_infant_mental_health.pdf
(accessed May 31st 2017)