Ten things to know about baby and toddler mental health

It’s the physical needs we tend to obsess over with newborn babies. Are they hungry? Are they too hot or too cold? Does their nappy need changing? How often should we bathe them?

But infant mental health specialists are encouraging parents to give similar consideration to emotional needs. While we might think mental health isn’t really a “thing” until late childhood or adolescence and into adulthood, in fact it is an equally important aspect of nurturing from birth.

“The emotional health and wellbeing of these early stages of childhood has not been on a par with what’s understood with physical development,” says clinical psychologist Catherine Maguire, a specialist in infant mental health. It is still a relatively new and emerging area of science and only in recent times has the early development of emotional and social capabilities been classed as infant and early childhood mental health.

“It needs the same dedicated attention, understanding and care that parents would give to the physical development of their child,” she says. We now know that 20-30 per cent of the brain is developed at birth and that by the age of three about 90 per cent of brain development has taken place. What happens during these first three years is a foundation for lifelong emotional and social wellbeing and could prevent mental health problems later in life.

“The nature and quality of this social and emotional development can determine whether newborns, babies and toddlers will have a sturdy start or a fragile start,” says Maguire, who works with Childhood Matters at the Tusla-funded Bessborough Centre in Cork.

Here are 10 things to know about baby and toddler mental health:

1) Babies are ready to communicate with their parents as soon as they are born and they expect their parents to be ready to respond. “We often say the job of parents is to be a signal detector, interpreting the cues, signals and communication of their baby,” says Maguire.

Initially babies use eye contact, the gaze, to build relationship with parents. By seven to nine weeks, their babble is advancing and they are communicating with their voice, reaching out with their arms and legs and hands, and touch becomes an essential communication tool. Ideally this will all be reciprocated by parents.

2) Many parents talk about the surge of love they feel at first sight of their newborn, so those who don’t experience that can feel guilty and wonder if there’s something wrong with them. But bonding is a relationship-based process that takes place over time, not an instant feeling that must always be present at birth. Maguire says there isn’t nearly enough talk about the impact of a traumatic birth, which may hamper early bonding experiences, as can prematurity, neo-natal care, and maternal ante-natal or post-natal depression. Whatever the cause for the interruption in bonding, parents shouldn’t worry unduly.

What builds that bond is everyday, predictable, nurturing experiences, through touch, eye contact and breastfeeding or, if that is not possible, bottle feeding. Imitation of facial expressions and gestures also promote bonding and babies love the sound of their parents’ voices.

Any new parent who is struggling with ambivalent feelings is urged to seek support, whether from their public health nurse, the maternity hospital or their GP. With support and care for parents, “they will fall in love [with their baby] and that bonding will take place”, she says.

3) Emotional and social development in early childhood happens in the context of their relationship with parents and caregivers. Babies and toddlers start to learn how to manage their own emotions and feelings through secure and steady support.

Maguire believes that parents don’t always realise how much babies or young children learn about themselves through the expressions on a parent’s face or tone of voice. That’s why it’s a good idea to try to take charge of your own emotions before responding to a fussing baby or toddler.

Faces that are cross, or sad, or blank, can be very upsetting to a baby and toddler. If these expressions are unpredictable, it can be very confusing.

4) Signs that all is not well with an infant’s mental health include being very hard to settle or soothe; a baby that is sad and not very expressive; a baby that is very quiet and unresponsive; babies from whom it is very difficult to establish a routine. These symptoms are seen where babies are exposed to adverse situations or toxic relationships in, for example, cases of domestic violence.

“We have to recognise that behaviour has meaning,” she explains. Infants’ development takes place in the context of their relationship with their parents. In clinical practice, this relationship is often regarded as “the client”, because that is what the professionals focus on to establish what is going on and how it can be addressed.

5) Parents shouldn’t be overawed by a sense of responsibility because simply focusing on ordinary actions around the home sets the stage for social and emotional development. Babies and toddlers thrive with consistent and predictable responses by their parents in everyday matters. It’s unsettling for a child if daily life is chaotic but very rigid routines don’t always work either.

Maguire recommends adopting a “flexible routine” that suits the family situation and the baby’s temperament style. Be mindful that you are trying to create a sense of safety for an infant who is yet to understand that their needs will be met.

6) Set aside time to communicate through play and storytelling with your baby and toddler – just as you do to feed them, change them, bathe them. Of course focusing on communication through all those tasks is important too – without a screen in sight.

“Sometimes technology becomes the ‘third person’ in the relationship and gets in the way,” says Maguire. “It’s important for parents not to be doing feeding time with the phone beside them.” Thrusting a digital device into the hand of a tantruming toddler in an effort to distract is not recommended either. “Better to think of the relationship as the regulator.”

7) The myth that you can spoil a baby with too much attention needs to be dispelled. Newborns and infants need predictable responses to all their cues and signals, to promote inner security, trust, attachment and sense of themselves.

Maguire warns against leaving a baby to “cry it out”. By responding to their cries, you are enabling the infant to experience that they matter and are loved. They are learning that when they are distressed, somebody in their world can soothe them.

8) Toddlers, who are rapidly acquiring independent mobility and language, get a bad press over tantrums. Meltdowns are “just part of that developmental stage, which is so exciting and engaging for toddlers”, says Maguire.

Tantrums need to be understood as a time when a toddler’s emotional state becomes unregulated. “It is their way of letting parents know ‘I need help, I need you to sort me out’.”

Sometimes a parent and/or toddler needs a quiet period but this is not about “time out”, she stresses, but rather “time in” where the parent and toddler are together. They both need to try to understand what is happening and try to sort out what is distressing the toddler. Whereas isolating a toddler fosters a sense of shame.

Research shows that a small child’s capacity to manage fussy states, she says, is only beginning to develop between 3½ and four years. Up to that, the baby and toddler is dependent on parents and carers to make sense of what they are feeling and can need help to be soothed.

Parents may be stressed by their toddler’s meltdowns but, she advises, “because they are the wiser, stronger person in the relationship, we want the parent to try to stay calm and regulate their own emotions first” before trying to understand and respond to the toddler’s distress. Take a deep breath, pause or seek support if necessary.

9) A sleep routine begins only after a baby’s first year and there will be various cycles before that. “It is really important that parents are aware of that,” says Maguire, who acknowledges that it is a fraught area of parenting.

“It is hard to give prescriptive messages but it is about establishing a routine around the same time each day and making bedtime as predictable as possible.” Get to know your baby’s cues for tiredness; avoid carbohydrate-heavy meals or sugary drinks late on in the day; turn off screens and maybe have a night light in the room.

10) Think of infant mental health as giving a child an emotional tool kit that will help prepare them for all the ups and downs of life.

“We want young pre-schoolers to have the core skills to understand what they are thinking and feeling, so that they can manage small tasks on their own and, when the bigger challenges come, that they can seek help,” says Maguire.

Investing time in these three years pays big dividends, she adds, because once you get a small child off to a good start, the later developmental stages flow much more smoothly.

– During Infant Mental Health Awareness Week, June 13th-19th, the HSE, in partnership with Tusla, aims to promote and support the understanding of infant mental health among parents and childcare workers across Ireland. A series of 10 practical videos with HSE expert advice are now available on mychild.ie

‘Doing a class was so beneficial for my mental health and equally bonding for the baby as well’: First-time parents share their story

The birth of primary school teacher Anne Ryan’s first child, Billy, two years ago didn’t go as she had imagined. She had to be induced due to concerns about the placenta and there were some complications after that. “In my head I wanted to do the hypnobirthing; I wanted it all to go so smoothly and it was far from that,” she says. The following day Billy had to be taken into neonatal care due to jaundice and she found it “horrible” not to have him by her side, particularly as she was determined to breastfeed.

“I just wanted to be with him the whole time and he wasn’t there. It’s not what you imagine, when you think of this moment of your first baby being born; you think of all the happiness and love. I just felt that was kind of taken.”

However, she stresses how grateful she was that he wasn’t really sick in neo-natal care. But she had to go up and down to the unit to feed him while very sore from stitches.

“I remember being in so much pain and wondering how I was ever going to walk normally again. It is very vivid in my memory of feeling distraught at times. I remember my husband Michael coming in so many times and I would just be bawling.”

She thinks her distress stemmed from feeling the birth was out of her control. In contrast, the arrival of their second child, Róisín, 16 months later was the “polar opposite” and went very smoothly.

Anne struggled with the early breastfeeding of Billy and reckons she would not have got past day 10 without the support of a HSE lactation consultant and friends who had breastfed. But she is so glad she persevered as soon it proved to be “a lovely time” for connecting with him.

Even before Billy was born in January 2020, she had looked into mother-baby activities and at three weeks old she took him to baby massage classes. She recalls how her husband had just gone back to work after paternity leave the day before and it was a huge challenge to get out of their house in Nenagh, Co Tipperary.

“But the minute you are there, it is so worth it.” She found it very helpful as a first-time mother to hear others parents’ stories.

Anne enjoyed not just the socialisation – the first Covid lockdown was to hit soon afterwards – but being taught baby massage helped her to focus on Billy. She found this aspect even more helpful with Róisín, when she took her to baby sensory classes.

With a second child, “when they come home as a newborn, they sleep so much and you are so busy with a toddler that the day can pass and you haven’t really connected with them”, she says. “Those classes are brilliant because you’re focused solely on the baby; it’s such a good feeling when you see the smiles and the giggles and they’re loving it.

“I feel with both of them doing a class was so beneficial for my mental health and equally bonding for the baby as well.” However, she says she “probably didn’t” think about infant mental health as a concept, until she and Billy got involved in the shooting of mother-and-baby videos by the HSE to help parents in this aspect of child-rearing. The series of 10 practical videos is being launched on mychild.ie ahead of Infant Mental Health Awareness Week, June 13th-19th.

Right now, Anne is finding that two is a lovely age with Billy. “There is so much enjoyment and so much fun.”

Of course as a toddler he has his moments but “I feel it is very important not to dismiss any of it and that he knows he is listened to”. She allows him to go through his little meltdowns, to “let him feel whatever he feels”, while also making sure he knows she is there for him.

“At such a young age you might not think it’s that important,” she says. But she sees it as building trust, so that he “knows that you are always there, no matter what”. She feels she is more on the ball with the different stages of Billy’s development than with Roisin. “With her, things can pass,” she says, verbally wincing. She or Michael would have read books with Billy every night but; with Róisín, “it’s nearly ‘we need to get Róisín to bed and then we can do a few books with Billy’. It’s awful when I think about it,” Anne says guiltily. “I have been telling myself lately that we have to have more chat.”

Keeping up a running commentary to a baby who is not talking back rarely comes naturally. “You have to remind yourself to do it.” Using opportunities, she suggests, such as nappy changes, when you’re not distracted by anything else, are really important times for babble and chat and to point out nose and eyes etc.

In these first three years of their children’s lives, Anne is conscious of how their behaviour as parents is constantly watched. “It makes you think a lot more about the things that you do around them and the way you react, even the way my husband and I talk to each other, arguments and things like that. It definitely makes you more aware of modelling correct things, teaching them.

“You want to get it right as much as you possibly can,” she says, “but it’s never going to be perfect”.