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Infant Mental Health: The First 12 Months

2. IMH: Key topics. Relationships/AttachmentRegulation (sleeping; eating; emotions)TemperamentCognitive SkillsSpecial needsFamily Issues. 3. IMH: Key Points. Socio-emotional competence develops within and because of relationshipsSocio-emotional development affects all other areas of developmentSocio-emotional development has long lasting impactResearch in early brain development may provide basis for these phenomena.

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Infant Mental Health: The First 12 Months

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    1. 1 Infant Mental Health: The First 12 Months Angela M. Tomlin, Ph.D., HSPP Riley Child Development Center IU School of Medicine

    2. 2 IMH: Key topics Relationships/Attachment Regulation (sleeping; eating; emotions) Temperament Cognitive Skills Special needs Family Issues Emotional development occurs within and because of relationships. Through repeated interactions in daily routines babies learn who they are and what they can expect from other people.   Important areas of social and emotional skills include attachment and self-regulation (feeding, sleeping).   Early relationships and experiences have long-lasting effects on all areas of development, including interpersonal outcomes, mental health, and a child’s later ability to learn. Cognitive development and the child’s temperament can also impact emotional development. Emotional development occurs within and because of relationships.

    3. 3 IMH: Key Points Socio-emotional competence develops within and because of relationships Socio-emotional development affects all other areas of development Socio-emotional development has long lasting impact Research in early brain development may provide basis for these phenomena

    4. 4 Overview: Social Milestones Newborn: Scans parent’s face; increasing eye contact 6 weeks: begins to smile and coo responsively 4 months: learns about others/ begins to be aware of strangers 7 months: stranger anxiety 9 months: separation anxiety; turns to caregiver for comfort when distressed

    5. 5 Attachment the bond that develops between a child and important caregivers develops through repeated interactions between child and caregiver is a strong influence on many areas of development

    6. 6 Attachment Gradually develops over the first several months Is firmly established by about 9 months Is a scaffold on which future relationships are developed

    7. 7 Attachment Secure attachments develop when the caregiver is loving, consistent and reliable. Insecure attachments occur when the caregiver’s behavior is unpredictable or even hurtful.

    8. 8 Attachment: Secure Pattern Comforts the child Accepts the child’s feelings Is not intrusive Allows independence Show positive feelings Sensitively responds to the child’s cues

    9. 9 Attachment:Signaling Behaviors Engaging cues Disengaging cues Hungry cues Full cues The caregiver’s ability to read infant cues is important in developing a secure attachment. Providers can help make sure that parents know the following behaviors: 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—infants 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 The caregiver’s ability to read infant cues is important in developing a secure attachment. Providers can help make sure that parents know the following behaviors: 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—infants 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

    10. 10 Attachment: Secure Pattern Child does well in child care Positive social interactions with peers and adults Liked better by others/more friendships Easily comforted when upset Can problem-solve Asks for help appropriately Manages conflict

    11. 11 Attachment: Insecure Patterns Avoidant Ambivalent Disorganized

    12. 12 Avoidant Pattern Parent consistently ignores negative emotions and fails to respond when child is upset and crying Child manages separation, but may hide own feelings and have trouble handling other people’s feelings

    13. 13 Ambivalent Pattern Parent is anxious, overprotective, interfering, and inconsistent Child is upset when left, hard to settle, and often whiney, impulsive, attention seeking, has high levels of conflict with others, and cannot solve problems when frustrated

    14. 14 Disorganized Pattern Parent shows unpredictable behavior; appears frightened and unable to cope; or is frightening and hostile. Child may have seem frightened, sad, or anxious, and have behavior problems; may want closeness, then strike out

    15. 15 Brain Research and Attachment Brain develops more neurons than needed Experience helps determine the pathways that will be maintained Brain is described to be “experience expectant” Social transactions may be of primary importance for brain development and function

    16. 16 Regulation Refers to an infant’s ability to regulate her own biological and behavioral rhythms, using environmental cues Parents support the child’s developing regulation system through caregiving actions

    17. 17 Regulation: Feeding Birth to 3 months may be unpredictable breast fed babies eat 8-12 x/24 hours bottle fed babies eat 6-8 x/24 hours

    18. 18 Regulation: Feeding 3-6 months breast fed babies still need several night feedings bottle fed babies may sleep through the night

    19. 19 Regulation: Feeding 6-12 months Introduce solid foods 12-36 months Work toward 3 meals/3 planned snacks

    20. 20 Regulation: Feeding Encourage breastfeeding Hold infants 0-6 months while feeding Encourage eye gaze during feeding Provide routines Watch for “full” signals Relate feeding schedule to sleep schedule

    21. 21 Regulation: Sleep Birth to 3 months 5 sleep periods/24 hours total sleep 10-16 hrs 8-10 hrs should be at night Family routines affect sleep patterns In the first 3 months babies should sleep about 10-16 hours per day, divided into about 5 sleep periods. We expect that 8-10 hours will be at night. Families with irregular routines may have babies with disrupted sleep.In the first 3 months babies should sleep about 10-16 hours per day, divided into about 5 sleep periods. We expect that 8-10 hours will be at night. Families with irregular routines may have babies with disrupted sleep.

    22. 22 Regulation: Sleep 3-6 months 14 hours of sleep/24 hours More sleep at night 2-3 naps per day

    23. 23 Regulation: Sleep 6-12 months 12-14 hours of sleep /24 hours More sleep at night 1-2 naps

    24. 24 Regulation: Sleep 13-26 months 10-12 hours of sleep/24 hours More sleep at night afternoon nap continues

    25. 25 Regulation: Sleep Self-soothing behaviors may be used to fall asleep Back to sleep position is preferred A regular feeding and sleep schedule can promote feelings of security Safety, especially with co-sleeping

    26. 26 Regulation: Emotions Babies begin to recognize emotional expressions of others starting about 6 months Basic emotional states of infants are contentment and distress Helping babies out of distress shows affection and concern

    27. 27 Regulation: Emotions Predominant mood of babies is contentment Eye contact, cooing, and smiling show emotional connection Social games can enhance emotional connections

    28. 28 Regulation: Emotions From 0-9 months babies are increasingly able to express needs and self-soothe After 9 months babies are more anxious about strangers, new situations, and transitions

    29. 29 Regulation: Infant Cues Looking away Diffuse movements Frowning and pouting Crying

    30. 30 Regulation: Caregiver Responses Babies cannot be “spoiled” Respond to distressed crying Allow child to self-comfort with mild protest crying Physical contact helps soothe baby Promote self-comfort skills Manage normal adult feelings with fussy baby These are 0-9 months suggestionsThese are 0-9 months suggestions

    31. 31 Regulation: Caregiver Responses Expect child to prefer parents, especially when tired or ill Provide physical, visual, and verbal reassurance Expect difficulty with routine changes Expect child to continue to need adult help to calm Encourage transitional objects These are 9+ month suggestionsThese are 9+ month suggestions

    32. 32 Stress and Brain Development Adverse experiences may result in changes in the way the brain functions Both severe and mild experiences can have an impact

    33. 33 Temperament Refers to typical ways of responding to the environment and other people Includes features such as mood, activity level, and reactions Underlies many behaviors and interactions with others Understood to be genetically derived and to develop over time

    34. 34 Temperament Easy/Flexible (40%) Slow to Warm/Fearful/Cautious (15%) Difficult/Feisty/Spirited (10%) percents from Chess and Thomas NYLS sample

    35. 35 Temperament: Easy Regularity Positive approach to new things Adapts to change Mild to moderate intense mood Usually positive mood

    36. 36 Temperament: Slow to Warm Negative response of mild intensity to new things Gradual adaptation with repeated tries

    37. 37 Temperament: Difficult Irregular Negative/withdraw from new things Trouble adapting to change Intense mood Often negative mood

    38. 38 Temperament Be aware of child’s unique style Protect sensitive infants Consider ways to manage challenging styles Recognize own temperament style Think about fit between child and adult style

    39. 39 Cognitive Skills Through relationships, exploration of the environment, and play infants gradually begin to feel effective and competent Several important cognitive processes contribute: causality, object permanence, imitation

    40. 40 Cognitive skills: Causality Babies understanding of cause and effect grows from experience with others and objects Actions gradually become more purposeful Eventually babies do things to gain information

    41. 41 Cognitive Skills: Causality Birth to 3 months—beings to observe connection between actions and outcomes 4-6 months—attends to objects and tries to make something happen 7-8 months-repeats action that results in interesting outcome 9-11 months—understand cause and effect and tries to imitate 12 months—purposeful actions

    42. 42 Cognitive Skills: Object Permanence At first babies believe that objects do not exist when out of sight By 6-9 months, babies realize that an object hidden under a cover still exists Separation anxiety results from this knowledge Mobile babies will search for a person who has moved away

    43. 43 Cognitive Skills:Object Permanence Newborn to 3 months—objects out of sight no longer exist 4-6 months—stops feeding to search for source of sound 7-8 months—visually tracks object moving out of sight 9-11 months—searches for partially hidden object 12 months—search for object after seeing it hidden

    44. 44 Cognitive Skills: Imitation Imitation gives babies more ideas about how to act on objects and to explore Imitation is immediate at first Delayed imitation occurs when older infants can hold behavior sequences in mind for a time Great autonomy and independence result from imitation skills

    45. 45 Cognitive Skills: Imitation Birth to 3 months—sticks out tongue after another 4 to 6 months—imitates sounds 7 to 8 months—imitates symbolic gestures 9 to 11 months—imitates actions on objects 12 months—imitates social actions

    46. 46 Infants with Special Needs May develop skills at slower pace May express needs and preferences less clearly Caregivers may need help to recognize more subtle signals More effort may be needed for soothing

    47. 47 Family Issues Infant period can be stressful for families Look for signs of post-partum depression SES risk factors important impact on child outcomes Parent problems, such as addiction, mental illness, and mental handicap may compromise attachment and child outcomes Parent’s family history can also impact current relationship

    48. 48 Summary Babies’ social and emotional development occurs and must be understood within relationships Environmental, family, and personal traits impact social and emotional development Social and emotional development provides a scaffold for development of skills in other areas

    49. 49 References Jellinek, M, Patel, BP, Froehle, MC (eds) (2002). Bright Futures in Practice: Mental Health Landy, S. (2002). Pathways to Competence Gowen, JW & Nebrig, JB (2002). Enhancing Early Emotional Development

    50. 50 Discussion

    51. 51 Infant Mental Health: The First 12 Months Angela M. Tomlin, Ph.D., HSPP Riley Child Development Center IU School of Medicine

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