Tag Archives: attachment

Interventions in Infancy

Important Note: The image in this post and in all the previous ones are not images of the children discussed in the posting. They are simply children whose photos I have collected throughout my travels. 

Now we are ready to look at infancy. As a matter of a fact, this topic may be relevant to parents of preschool children, since these parents are often having second or third children when their first is in preschool. What we are talking about is showing parents what they can do to help their babies feel secure. If babies feel secure and safe in the infant-parent relationship, they are creating the expectation that reunion with their parent will bring comfort and safety. That expectation is correlated with a “secure attachment strategy”. When the baby is upset and cannot manage to comfort himself, he anticipates that his mother (or other primary caregiver) will comfort him, so when his mother approaches, he already begins to calm down.

The infant mental health mini-course that the nonprofit organization, Supporting Child Caregivers (SCC), teaches emphasizes the three tasks of parents – to protect, nurture, and enjoy their children. We believe that parents deserve the support of the community in raising their children. That support begins with ensuring the physical and emotional support of the pregnant mother and continuing to support the parents of the growing child. The more parents can be protected from stress, or the more they can be helped to deal with the stress in their lives, the more they can help their babies feel secure. Of course, stress can come in different packages. Most of the work SCC does is in developing countries, where there is a high incidence of chronic poverty, domestic violence, and serious illness.

However, my work in the U.S. has taught me that the stress on parents of infants even in affluent communities can be great. One important source of stress is isolation. In contrast with collectivist societies, our society does not offer new mothers easy access to alternative caregivers such as family members or neighbors. In the Indian villages I visit, mothers congregate around the village square. In the U.S., new mothers often do not have a natural way of connecting with other mothers with whom to share their worries and complaints and to gain useful information. I want to emphasize that I am not suggesting it is easier to bring up an infant in a poor country, but only that in addition to similar stresses, there are also different ones.

For example, parents of newborns in the U.S. are often burdened by the cultural demand to “multi-task”. In order to feel productive and organized they believe they must be getting many things done. It is hard to do that when you have a newborn. In order to be available to respond to the baby, it is necessary to let go of most other agendas. This can be stressful to some parents. Also, in the age of technology, parents are often “plugged in”. It is painful to observe mothers pushing their babies in strollers while they talk on their mobile phones to some distant friend, and to imagine what their sense their babies are making of the relationship.

Another big stress in Western culture is the responsibility given to parents to produce a perfect child. The expectation that good parenting produces a good child is a relatively recent one in the history of humankind. The corollary can lead to relentless self criticism- if your child has problems, then you are not a good parent. Let me clarify an important point. Whereas I have been emphasizing sensitive and responsive caregiving as a building block of healthy development, I do not mean to say that good caregiving ensures a healthy child. This is part of what I was referring to in the previous post as “uniqueness” of the child and the family.

Children are different. Infants are different. Ask any parent of more than one child whether this is true. One of my criticisms of Attachment Theory is that it does not account for the uniqueness of infants and the active role they have in making meanings about safety in the infant-parent relationship. Do we doubt that a premature infant makes the same meanings about comfort and safety as a full term baby, or that a baby with high reactive temperament can be made to feel secure as easily as a baby with an easy temperament?

Let me talk about interventions in the next posting.

Preschool, Day Care: Attachment and Separation

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I have promised to discuss interventions for childhood constipation and soiling, but I received a great comment that I would like to address first.

A reader of the blog commented:

As the director of a Montessori school in Colorado, I have a few questions:
1) What are your thoughts about early child care and its effects on attachment? I am aware of Belsky’s study and the NIHCD studies. Do you believe that early child care (before 3) undermines security of attachment? Do you believe this is irrespective of the type or quality of care? Is there other research on this issue that you would recommend?

2) I know there have been a lot of studies (some even specific to child care) which show that infants/young children separated from their parents show abnormally high cortisol levels and lower growth hormone levels. Given these studies, do you have a recommendation as to an optimal way to transition a young child into a child care setting (to minimize their distress)? Is there an optimal way for children to separate from their parents each day (we have tried many things over the years- parents walking their child into the school, children leaving their parents in a car line- a teacher comes out to get the child, etc)? If a child appeared to be highly stressed (how would you quantify this?), what would you recommend? Is there any research as to how specific practices might increase or decrease a child’s experience of separation?

In response to this important comment, I contacted recent graduates of the Infant Parent Mental Health course in Boston and Napa, of which I am on the faculty – http://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health. I value the knowledge and expertise of this group of clinicians and wanted to start a discussion about the issues of childcare, security of attachment, and separation from parents. I will also request comments from another group of valued colleagues – preschool teachers.

My first response came from an IPMH graduate who also has extensive experience directing and administrating early child care programs, Alayne Stieglitz. Here is her thoughtful response:

When I read these questions I thought of Ed Tronick on the first day of the IPMH Program introducing us to the caregiving practices of several cultures around the world: The village in the Andes where infants are bundled in blankets and strapped upside down on their mothers backs for the first year of their lives and the tribal group in Africa where children have an average of seven caregivers before their first birthday. These are not what we would consider ” best practices” but the children there are reaching their developmental milestones, forming healthy, robust attachments, and thriving in their societies. He said, “Different patterns of care taking and parenting may violate norms we hold as vital, yet children are still developing and learning. Those differences work for their culture. The point is to raise a child who can be competent and successful in the culture they live in.”

In this day and age, the culture that an increasing number of families are living in includes childcare. Single parent households and households where both parents work in order to provide what’s needed for their family do not have the option of whether or not to put their children in someone else’s care. There are many choices; in home care by a relative, in home care by a nanny, small family day care, and center based care. I think the question to ask is not, “Which type of care is best?” But, “Which type of care will be best for my child and my family?” And, of course, “Which is the highest quality of care that I can afford?” This last question limits the options for many families. Continue reading