Supporting The Mental Health Of Infants In Care During The Pandemic

Supporting the mental health of infants in care during the pandemic

Author Paula Gow, Dr. Bea Anderson and Rosie Simpson

By supporting caregivers to navigate this challenging time, we can help them provide a safe and secure environment for the infants in their care.

Glasgow Infant and Family Team (GIFT) is a multidisciplinary infant mental health team in Scotland, with a sister site in London. We work with infants aged 0-60 months in foster or kinship care as a result of maltreatment. Our involvement comes at a time of critical decision-making about where children should spend the rest of their childhood. We work with families to build on strengths and address areas of need and risk, through relationship-focused therapeutic and systemic interventions. We liaise closely with other professionals to promote child-centred practice in wider systems, monitor children and families’ progress, and make recommendations about permanence planning and what infants need to support their mental health.

In practice and everyday life, it is often perceived that infants are too young to understand or remember events in their lives, or are less affected than older children by what is going on around them. This belief emerges from infants’ lack of maturity and cognitive ability (Zeanah and Zeanah, 2009) and is reinforced because infants cannot verbalise or verbally recall their early experiences (Treisman, 2017). However, young children are shaped by their experiences, and influence their environment actively by communicating their needs through behaviours and non-verbal communication from birth (Gerhardt, 2015; Rosenblum et al, 2019). They learn to express their intentions and expectations as they grow and develop (Rosenblum et al, 2019); for example, a healthy infant will learn to cry intentionally at approximately nine months, signalling needs and expecting a response from caregivers, where this has been their experience (Doherty-Sneddon, 2003).

During the coronavirus (COVID-19) pandemic, our team has been considering the experience of the infants with whom we work, and how to collaborate with caregivers and parents to support their wellbeing. The impact of COVID-19 and governmental restrictions is universal; for many, it has been accompanied by worry and discomfort in uncertainty. For families with young children in care, often facing high levels of stress and adversity already, these circumstances are especially challenging. 

Infants in care may experience additional changes in their lives compared with peers, currently, for example seeing parents via video call rather than spending time together. Depending on their situation, infants might have a range of feelings such as worry or sadness when not seeing parents, relief if time with parents has been stressful, or happiness about spending more time with current caregivers. When infants have not experienced safe and responsive care, they can behave in ways that conceal or obscure their needs (Powell et al, 2014). Notwithstanding individual capacities and unique contextual resources (Ungar, 2013); these children often need additional support, having had previous experiences of stress, loss and change when living at home and coming in to care (Furnivall and Grant, 2014).

All young children need help to feel safe, during times of stress, from the important adults in their lives, and particularly primary caregivers (Zeanah and Lieberman, 2016). Although very young infants may not yet understand words, they connect with their caregiver’s voice and face from birth (Doherty-Sneddon, 2003). Behaviours of pre-verbal and verbal children can tell us they need extra help: tears, over-excitement, tantrums and disrupted sleep or appetite can all be indicators, as can seeming unusually ‘okay’ when this wouldn’t be expected, or seeking additional closeness. Infants learn to understand and process their feelings when their caregivers notice, understand and name their child’s feelings, while offering comfort. When children experience this reliably enough with caregivers, they experience that all feelings are safe to share (Powell et al, 2014).

Given the current demands for all of us, including caregivers, it is critically important that helping professionals seek to promote caregivers’ wellbeing and coping, so they are better able to support children in their care. From a compassionate stance, helping professionals can best support caregivers to consider the world from their infants’ perspective, with this informing understanding of the infant’s cues and needs (Coyne et al, 2019).

Young children are acutely sensitive to the feelings and responses of their caregivers, and this guides how they make sense of themselves and their world (Treisman, 2017; Rosenblum et al, 2019). Caregivers may wish to protect young children, but should be encouraged to speak openly and to provide honest, age-sensitive information about COVID-19. This is important for children of all ages to help them make sense of events and feel safe. There might not be answers to all their questions, like when things will be back to normal, or when they might start seeing family members again. It is okay to tell children that adults do not know the answers to everything. Caregivers should resist the urge to guess or make promises that cannot be guaranteed, like saying everyone they know will be okay. Honest dialogue and containing acceptance of feelings are both key in supporting the child’s understanding and sense of security (Fahlberg, 2012; Dalton, Rapa, and Stein, 2020).

By supporting caregivers to navigate this challenging time, we can help them provide a safe and secure environment for the infants in their care. The infant and family team in Glasgow has developed more detailed resources, which can be used to support children, parents and caregivers within the current context. Please email glasgow.servicecentremailbox@nspcc.org.uk if you would like to find out more.

If you’d like to find out more about the NSPCC Infant Family Teams, visit the website, or email learning@nspcc.org.uk with any questions.

Paula Gow, Dr. Bea Anderson and Rosie Simpson

This article was written by Paula Gow, Social Worker; Dr. Bea Anderson, Clinical Psychologist; and Rosie Simpson, Team Manager, from the Glasgow team.

References

Coyne, J., Powell, B., Hoffman, K. and Cooper, G. (2019) ‘The Circle of Security’, in Zeanah, C. H. Jr. (Ed) Handbook of Infant Mental Health 4th Edition, New York: Guilford Press.

Dalton, L., Rapa, E., and Stein, A. (2020) ‘Protecting the psychological health of children through effective communication about COVID-19’. The Lancet, Vol 4, (5), pp.346-347.

Doherty-Sneddon, G. (2003) Children’s Unspoken Language. London: Jessica Kingsley.

Fahlberg, V. (2012) A Child’s Journey through Placement, London: Jessica Kingsley.

Furnivall, J. and Grant, E. (2014) Trauma Sensitive Practice with Children in Care: Insight 27. [online]: IRISS. [accessed 29th May 2020].

Gerhardt, S. (2015) Why Love Matters: How Affection Shapes a Baby’s Brain, East Sussex: Routledge.

Powell, B., Cooper, G., Hoffman, K., and Marvin, B. (2014) The Circle of Security Intervention: Enhancing Attachment in Early Parent-Child Relationships, New York: Guilford Press.

Rosenblum, K. L., Dayton, C. J., and Muzik, M. (2019) ‘Infant Social and Emotional Development: Emerging Competence in a Relational Context’, in Zeanah, C. H. Jr. (Ed) Handbook of Infant Mental Health 4th Edition, New York: Guilford Press.

Treisman, K. (2017) Working with Relational and Developmental Trauma in Children and Adolescents. Oxon: Routledge.

Zeanah, C. H. Jr. and Zeanah, P. (2009) The Scope of Infant Mental Health. In Zeanah, C. H., Jr. (Ed) Handbook of Infant Mental Health (3rd Edition) New York: Guilford Press.

Zeanah, C. H. Jr. and Lieberman, A. (2016) ‘Defining Relational Pathology in Early Childhood: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood’, Infant Mental Health Journal, Vol 37, (5), pp.509‐520.

Ungar, M. (2013) ‘Resilience, Trauma, Context and Culture’. Trauma, Violence and Abuse, Vol. 14, pp. 255 – 266.