Active role played by the young child in family relationship must be acknowledged Cork is experiencing two pilot psychological health projects for toddlers, writes Fiona Tyrrell
Milestones in a child's physical development, such as rolling over, sitting up unaided or taking the first step, are always a priority for parents. However, the social and emotional milestones of children in the under-three age group are less well-understood.
Two new pilot services in the Southern Health Board (SHB) hope to pave the way for the development of Ireland's first dedicated mental health service for infants.
The "dance between parents and their child" in the first two years of life provides the foundation stone for the development of positive health and well-being in childhood and adulthood, according to clinical psychologists Catherine Maguire and Rochelle Matacz, who work with the SHB's north Cork community services.
Until recently, a baby or toddler was viewed as the passive recipient in the parent-child relationship. It was believed that just meeting the physical needs of a baby, like changing its nappy or feeding it, was enough, they explained.
"We now know differently," says Matacz, "and it is becoming widely accepted that the baby or toddler is in fact an active participant in the caregiver-child relationship, showing initiatives from very early on."
During the 0-to-12 month age bracket, a child gives out a lot of cues and signals. The better a parent understands them, the more secure the child-parent relationship will be. How a baby is held, the eye contact between mother and child, the range and tone of voice used by a parent, how a baby is touched and how a caregiver expresses emotion to a child, all impact enormously on the emotional, social and cognitive development of an infant.
Ideally, it is during these months that a child develops a secure and healthy attachment to their caregiver. The attachment formed will have huge implications on how a child will relate to everybody in their life and how they form adult relationships.
Ultimately, the most important ingredient in infant care is a warm, responsive, consistent and dependable adult caregiver, who nurtures their baby through holding, cuddling and playing.
A caregiver responding to their baby's cues and signals in a way that meets their baby's needs is a crucial part of developing a secure attachment, according to Maguire and Matacz. Conversely, early problems in the parent-child relationship will place the baby or toddler's emotional, social and cognitive development at risk.
Much work has been done in this field in Australia, Europe, Britain and the US, and there is international evidence suggesting that one in five children will develop social and emotional difficulties before they reach the age of 18, they point out.
Early intervention will help prevent early childhood problems developing into late childhood psychological problems, which are much more difficult to solve. Although this knowledge is widely accepted in psychological circles, it is not being passed on to primary care workers and parents. Services targeting the social and emotional needs of infants require a lot of development in Ireland, according to Maguire.
This month, two pilot services, both based in the north Cork area, were established to promote secure and healthy relationships in families, and avoid problems in the parent-child relationship that might place the baby or toddler's emotional, social and cognitive development at risk. It is hoped they will provide a foundation for setting up a formal consultation and intervention service.
"We saw a gap in the service when we noticed we were getting referrals to our services for children as young as 15 months of age presenting with social and emotional difficulties," she explained.
The kind of difficulties exhibited by these infants include head banging, biting, severe tantrums lasting for a couple of hours, sleep difficulties and feeding problems.
In one of the pilot studies, Maguire and Matacz will work with four families whose babies or toddlers are showing signs of emotional or social difficulties. The study will take the form of 12 therapeutic videotaping sessions where the interaction between the parent and child is recorded and played back to give the parent more insight into the child's social and emotional needs.
This technique is called "seeing is believing" and is used in the US and Australia. The idea is that the video, along with guidance from the psychologists, will increase the caregiver's "sensitivity and responsiveness to their baby's cues, signals and needs". This will lead to an overall improvement in the mental health of the caregiver and their baby or toddler, according to Maguire.
Simple techniques such as improving child-parent eye contact and letting the child rather than the parent take the lead in play activities will help improve the child-parent relationship, she explained.
The second pilot study involves pregnant women and their partners in an antenatal group setting where parents with emotional concerns during pregnancy will be followed-up closely after the birth.
Most women experience three distinct psychological phases in pregnancy. First they must come to terms with having another being in their body. Then the merging phase takes place, where mother and baby come together as one and the woman has to manage mixed feelings of joy and anxiety. Finally, in the last trimester, the mother becomes maternally preoccupied and prepares for the birth.
This range of emotions a mother experiences is very useful, and parents need to be aware of it, according to Maguire.
Unfortunately not everybody is blessed with these feelings at the time of birth, particularly women who experience great stress during their pregnancy. "The idea is to bring the psychological knowledge to the parents rather than just focus on the physical developmental phases," she says.
Women targeted in the service will be expectant mothers showing risk factors, including a lack of supports or with histories of drug use, being placed in care or with social and emotional difficulties.
Public health nurses and physiotherapists who provide antenatal care will be trained to identify emotional concerns at the earliest point and offer emotional support to improve the social and emotional development of the parent-child relationship.
"It might be as simple as helping a parent feel more comfortable and confident in holding their baby in a way that maximises the infant feeling safe and secure," Matacz notes.
Through the two six-month pilot studies, they hope to reduce the rate of referrals to existing child, adolescent and adult services by intervening at the earliest point to provide a "foundation stone for the development of positive health and well-being throughout a child's life".