Module 1: Promoting Mental Health in Infancy

AttachmentFather Comforting Baby

Building Love and Trust

Beyond providing for the baby’s most basic needs such as food and shelter, a nurturing family helps the baby to feel safe and secure. The loving interaction between the baby and his parents forms the foundation for feelings of trust and attachment.

Questions to Ask

  • How are things going for you and your baby?
  • What do you find most rewarding about him?
  • How does he respond to you?
  • What do you think your baby is trying to tell you when he cries, looks at you, turns away, or smiles?
  • What have you found to be the best way to comfort your baby?
  • Are you reading to your baby? Singing to him? Talking to him?

Provider Tips

  • When social milestones occur, such as eye contact, smiles, cooing, or separation anxiety, point them out to parents and explain that these are ways their baby shows his growing attachment to them. Describe ways parents can help their baby achieve social milestones.
  • Using the guidance below, help parents understand their role in promoting a secure attachment.

Guidance for Parents

  • Your baby has his own way of letting you know how he is feeling and what he wants. Watch him to learn how to respond to him and take care of his needs. In a short time, you will understand what your baby is trying to tell you when he cries, smiles, puts his fingers in his mouth, reaches out, or turns away.
  • When you touch your baby, you make him feel secure and loved. Touch him often during the day - when you feed him, hold and carry him, cuddle with him, change his diapers, and rock with him.
  • Your baby enjoys looking at your face. You can “speak” to your baby through your facial expressions. Send him cheerful and loving messages by looking into his eyes and smiling during feedings and other activities. If you are feeling sad or stressed, try not to express these feelings when you are with your baby.
  • There are many ways that you can connect with your baby every day:
    • Hold, cuddle, and rock with him
    • Read to him, play music and sing to him
    • Talk to him while dressing, bathing, and feeding him
    • Imitate the sounds and movements he makes
    • Spend time playing simple games with him such as pat-a-cake and peek-a-boo
  • Always try to comfort your baby but understand that he may not always be consoled. It may help to:
    • Leave his fingers uncovered so he can suck them if he wants to
    • Touch or stroke him gently and speak to him in a soft voice
    • Rock with him and sing to him softly
    • Use a soft infant carrier to keep him in close physical contact with you
    • Be consistent and predictable in the way you respond to him
  • As your baby forms a strong attachment to you, he may begin to feel concerned or uneasy when he is separated from you. Give him a comfort item such as a blanket or favorite toy. This will help him feel secure and safe when you are away from him.
Resources for Providers and Families

For Providers

Helping Parents Read Infant’s Cues Information appears in a pop up window

Engaging cues: Infant turns toward parent, reaches up, opens eyes

Disengaging cues: Infant turns head away, begins to hiccup or drool, falls asleep (signals
need for less stimulation)

Hungry cues: Infant fusses, places fists in mouth, makes sucking noises, turns to parent with flexed posture

Full cues: Infant falls asleep while feeding, sucks less vigorously, relaxes and extends arms and legs

These observations are especially helpful with premature infants or infants with disabilities, who may be less clear in the cues they give.

Source: Bright Futures in Practice: Mental Health—Volume I, pg. 29.

Social Milestones Information appears in a pop up window

Newborn: Scans the parent’s face, increasingly sustains eye contact

6 weeks: Begins to smile and coo responsively

4 months: Learns about others/begins to become aware of strangers

7 months: Exhibits growing awareness of strangers (stranger anxiety)

9 months: Remembers when parent is absent, experiences separation anxiety, turns to parent after exploring or when in distress

Source: Bright Futures in Practice: Mental Health—Volume I, pg. 31.

Age-Specific Observations of the Parent–Child Interaction PDF

Area of Concern: Insecure Attachment more information

Attachment is a dynamic process that can be affected by infant and parental factors.

  • Infants who may have special considerations around attachment include:
    • Premature infants
    • Multiples
    • Infants with sensory difficulties or major medical illness
    • Abused infants
    • Foster and adopted infants
  • Parents who may face challenges include those who have:
    • Cognitive or emotional difficulties (depression, substance abuse)
    • History of maltreatment
    • Current family stress
  • Signs of insecure attachment include:
    • A withdrawn infant who ignores parents or does not seek comfort from them
    • An infant who is indiscriminately affectionate, showing little preference for her parents
    • An infant who has disturbance in appetite—either overeating or undereating
    • A parent who appears withdrawn, depressed, or intrusive with a child
    • A family dealing with stress, conflict, and/or instability
  • Assess for and address factors that may be contributing to attachment difficulties. Infant-related factors include:
    • Temperament difficulties
    • Illness
    • History of trauma or neglect
    • Parent-related factors include:
    • Mood disorders
    • Anxiety
    • Substance use
    • Inexperience
    • Family transitions
    • Stress
    • History of maltreatment
  • Refer parents as indicated to a mental health professional, parent support groups, and financial and respite services.

Promoting Attachment Between Parents and Infants with Special Health Care Needs Information appears in a pop up window

For infants with sensory difficulties or medical illnesses:

  • Help parents recognize their baby’s limits for stimulation and his signs of distress.
  • Suggest other ways of interacting with their baby such as moving his arms and legs, rocking him, and touching him often.
  • Consider a referral to other pediatric specialists such as an occupational therapist or developmental-behavioral pediatrician if needed to address the baby’s sensory or regulatory sensitivities.

For parents with premature infants:

  • Offer to make a home visit to provide support for the family.
  • Help parents understand that their baby may not give clear cues about his needs and may often place greater demands on them.

For adoptive and foster parents:

  • Point out signs of attachment to the parents whenever they appear.
  • Explain that their adopted or foster baby may need to mourn the loss of previous caregivers before attachment with their new parents can fully develop.
  • Discuss when and how parents plan to talk about adoption or foster care with their child when he gets older.

For parents of multiple births:

  • Suggest that parents get respite care and additional support from family and friends.
  • Help parents recognize the individual differences in their babies.

Source: Bright Futures in Practice: Mental Health—Volume I, pg. 32.

For Families

Separation Anxiety

Copyright Georgetown University Georgtown University Infancy