Mental health is more than the absence of mental illness; it also is a condition in which children and families can experience positive social and emotional development that creates the foundation for success and adjustment throughout life. Good mental health starts during infancy as their intimacy needs are met.

For example, when infants cry, a caring adult responds and tends to their needs and the babies begin to trust their caregivers. As they develop, mentally healthy infants increasingly demonstrate the ability to adapt to their environments; to form warm, trusting relationships with other children and adults; and to be comforted by adults.

The home and childcare environments are critically important in promoting good mental health. Infants need to feel secure and to bond with their parents or caregivers. Caregivers need to be aware of the needs and characteristics of each infant, particularly in reference to temperament, attachment, and emotional referencing.

Infants are born with a basic pattern of responses to stimuli and people. This is called temperament and there are three basic types--easy, slow-to-warm-up, and spirited. These temperament categories describe the child’s type of response pattern. They do not describe the personal characteristics of the child.

Most babies have easy temperaments. They are usually in good moods, adjust easily and quickly to new situations, and adapt well to routines like sleeping through the night or eating on a semi-regular schedule. Most babies can find ways to soothe or calm themselves, such as sucking their thumb or holding a blanket.

Babies who have slow-to-warm-up temperaments may seem shy and need more time than easy babies to warm up to new people and experiences. These babies approach life cautiously. They may withdraw from new things or people, they may quickly become over stimulated, and they may not cry or fuss much, even if hungry or wet.

Babies with spirited temperaments engage in almost constant physical activity. These babies may be very sensitive to environmental stimuli such as crowded spaces, noises, smells, how their clothing feels on their bodies, and even touch. They may be hard to console when fussy and may have a harder time adapting to changes, such as changes in caregivers.

It is important that parents and caregivers maintain consistency when caring for each and every infant, based on their individual needs. For example:

• Do not change caregivers unless absolutely necessary. If possible, train caregivers to care for different age groups, from infants to toddlers and older. For example, if six infants enroll in a childcare program, they will be placed in an infant nursery and will form attachments to their caregivers. As these babies grow and become toddlers, they may move into a new nursery set up with toddler toys and furniture. Optimally, their primary caregivers will be “promoted” along with them and will continue to be their primary caregivers.
• Do not change placement of infants’ cribs.
• Try to establish a routine for the children and stick to it. For example, be consistent in how you put each baby down for a nap--give a baby a bottle, then a burp, rock the baby and sing, and then lay her or him in the crib while still slightly awake.
• Allow children to keep security blankets, favorite toys, or pacifiers.

Attachment is an enduring emotional bond to a specific person, generally the parent or the primary caregiver. It is characterized by the infant’s tendency to seek and maintain closeness to this person, particularly during stressful situations. Caregivers need to be aware of the importance of their role in attachment.

For children who have healthy family environments, quality childcare promotes mental health primarily by reinforcing the child’s family experience. For children who do not have optimal home situations, the quality of the caregiving can help compensate for the lack of nurturing experiences in the home.

Early infant attachment is at the heart of healthy child development. Infant attachment can generally be observed at two points during the day--when the person who is the focus of the attachment leaves the child at the childcare setting and later when that person returns to pick up the child each day.

A securely attached infant will fuss for a few minutes when the parent leaves, but then quickly calm down. When the parent returns, the baby is demonstrably happy. Some infants react differently, however. A baby may cry when the parent leaves and be hard to console, yet act standoffish when the parent returns.

Caregivers and families should work together to help children feel secure, even in stressful situations. Be aware that each time the parent (or specific attachment person) leaves, this is a stressful situation for the infant.

• Do not let a parent leave the child without saying goodbye. Even if the child cries when the parent leaves, that is better than the feeling of abandonment the child experiences if the parent leaves without saying goodbye. Of course, a child who cries when the parent says goodbye should be consoled, and the caregiver should identify the cause of the crying—it may not be the parent leaving, but hunger or a wet diaper!
• Talk to infants. Smile and play games.
• Touch, hold, and cuddle infants. Always hold each infant when giving a bottle or feeding. Never prop a bottle!
• Focus on the routine needs of individual children. Each child has an individual rhythm of eating, sleeping, and playing.

Children react to what they see in adults; this is called “emotional referencing.” For example, if the caregiver is visibly angry when she enters the nursery, young children may sense this. Children do not understand why she is angry; they just sense the emotion and often will react with their own unhappy emotions (crying, fussing).

Caregivers should be calm and composed before being with the children. If necessary, ask another adult to tend to the child for a few minutes so you can breathe deeply, drink some water, and settle your emotions. Bring in your happy face as happiness promotes mental health for both you and the children.

Anarella Cellitti, PhD
University of Alabama at Birmingham