Transforming Infant Wellbeing

Research, Policy and Practice for the First 1001 Critical Days

Penelope Leach

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138689534
• eBook ISBN: 9781315452876
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Transforming Infant Wellbeing brings together science and policy to highlight the critical importance of the first 1001 days of infancy: the period from conception to the second birthday. Introduced and edited by Penelope Leach, who uniquely combines academic knowledge of infant development with the ability to write about it for wide audiences, the book has at its heart 25 original articles by acknowledged experts in different aspects of infant health and development. Brought together, they showcase innovative science and best practices to a wide range of readers: to scientific colleagues in different disciplines; to politicians and policy makers; to local authority commissioners and specialist advisors, statutory and voluntary organisations and parents.

This book has a two-fold purpose in science and in social policy. First, to collect new papers by leading scientists in a single volume, which ensures they reach a broad audience. Second, by introducing and commenting on the significance of these new findings, the book highlights both the benefits that accrue to society when it acts accordingly, and the costs, financial and social, of our failure to do so.

In the last 50 years, interest in infant development and especially maternal and infant mental health has burgeoned. A large number of issues at the forefront of child development research mirror those of yesterday, but the research brought to bear upon them has transformed. Thanks largely to technological and statistical advances, we now know a great deal that researchers of earlier generations could only surmise. However, increasing knowledge of infancy has not been matched by an increasing impact on parents and professionals, politicians and policy makers. Bringing contemporary studies involving pregnancy, birth, infancy and toddlerhood together, along with the undisputed evidential findings that flow from them, large gaps between what is known and what is done become apparent. By focusing on what can be done to fill those gaps, Transforming Infant Wellbeing renders inescapable the need to rethink current priorities. It represents essential reading for researchers, parents and policy makers of infancy.

PART I
Issues in infant wellbeing

1
FIFTY YEARS OF CHILDHOOD

Penelope Leach

Starting at the beginning: Why the first 1001 days are critical

This millennium has seen the ‘early years’ attracting a great deal of interest among parents and professionals, policy makers and politicians, and therefore, of course, from media. Until recently, though, ‘the early years’ were usually taken to refer to ages 3–5; post-infancy and pre-school with most of the research work focusing on cognitive development, school readiness and nonparental child care. Children’s earliest years, the ones that matter most, do not start with birthdays or even births but with conception. The first 1001 days are critical because they take a person from potential to actual, from conception to the second birthday; and it is during that period of fetal development, infancy and toddlerhood that the brain is growing and developing with maximum (and astonishing) speed (Sheridan & Nelson, 2009) that renders it more open to and dependent on outside influence than it will ever be again. Optimal brain development throughout those days not only gives a new child the best possible start in life but also enables him or her to make the most of the lifetime which is to follow. The reverse is also true.

It has been and often still is assumed that how babies’ brains grow in size and complexity, forming the connections and interconnections that make them ‘work’, depends on infants’ physical maturation and the genetic inheritance passed on to them by their parents. But recent international research findings – counter-intuitive and therefore not widely recognised – have established that brain development depends principally on interactions between a baby’s genes and his environment (Szyf, 2009).

An infant’s first environment is the uterus. A developing fetus receives complex biochemical signals from the mother via the placenta; signals which can be affected not only by her diet and lifestyle, including her nutrition and consumption of alcohol and other drugs, but also by her emotional state. Extreme maternal stress, for example, can affect the function of the placenta in such a way that it allows more of the stress hormone, cortisol, to reach and affect the fetus’ brain and influence the way that brain is developing and which genes are turned on or off, when and by how much (p. 98 Glover) Talge et al., (2007). Such an infant is likely to have a lifelong increased risk of any of a range of problems from being anxious or depressed in his turn (p. 47 Pawlby), to being a slow learner, suffering conditions such as ADHD and even having some physical problems such as asthma (O’Connor et al., 2005).

Neurology meets attachment science: Why mothers matter

When a baby is born his environment is no longer the womb but is still almost entirely his mother (or whoever stands in for her as his ‘primary caregiver’) and the interactions that make up his relationship with her. The newborn’s brain is still an unfinished project (Tau, 2010) that can only be optimally completed by the social and emotional relationships within which attachment grows. Parents or people who stand in for parents actually build babies’ brains (Balbernie, 2001).

Nurture by caring adults is hard wired into children’s brains even before they are born. After birth, if a baby doesn’t have a loving special adult – being cared for perhaps by several different and changing people in an institution, or receiving minimal, inconsistent or inappropriate adult attention – the structure and chemistry of his brain will probably adapt defensively (Nelson, 2014). He may develop extra strong fear and anger reactions, or intense attack and defense impulses. He may become hyper-vigilant, his brain suffused with cortisol which floods his body until or unless someone turns it off by comforting him. Repeated episodes of acute stress, when nobody regulates his feelings, can damage his capacity to learn, possibly forever, and permanently affect his response system so that it becomes hyper-sensitive. Such an individual over-reacts to minor stress with major fear and anxiety, not only as a baby but as a child, an adolescent and an adult too. We all know such hypersensitive people although we seldom recognise that the source is in their earliest infancy.

People who lack nurture from one or more caring adults in these first critical days of their lives achieve less in education and in the world of work, are more likely to behave antisocially and are less healthy, physically as well as mentally, than individuals who were given a better start. Furthermore the harm done to them is likely to be perpetuated in an intergenerational cycle if they have children of their own (Glover, Champagne, 2015).

Social influences on brain development

It takes most of the first year for a human infant to reach the level of development most mammals have achieved at birth. At least three quarters of the upper brain – the cerebral cortex whose eventual great size and complexity comprises everything that makes him human – grows and develops its interconnections only after birth. The hippocampus, temporal cortex, prefrontal and anterior cingulate are all immature at birth but grow so rapidly during the first year that by his first birthday a baby’s brain has more than doubled its weight. It is because this vital human brain-building happens outside the womb that it is so open to social influence. The longest period of complete dependency experienced by any species permits and even requires an intense social bond to develop between parent (or other caregiver) and child. The baby’s genetic inheritance is there from the beginning, of course, but the extent to which some or all of those genes will be expressed and the baby’s genetic potential fulfilled, depends on social input from his environment. It is this intense bond that generates the biochemicals that facilitate brain growth and rich neural connections (p. 28 Fearon).

A healthy newborn baby’s brain has all the neurons she needs (p. 171 Balbernie). She does not need to make any more now or in the future. What she needs is not more neurons but more connections to link them up and make them work for her; complex connections between different areas of the brain and a growing ability to use particular areas of it. A dramatic burst of these ‘synaptic connections’ in the prefrontal cortex takes place in the second half of the first year so that they achieve their highest density just when the attachment relationship between the baby and her parents (or other primary attachment figures) is building towards peak intensity.

An infant brain requires a balance between different biochemicals for optimal growth and development and it is positive, enjoyable interactions with the mother or a nurturing person which secure that balance. For example, early positive experiences increase glucose metabolism, and higher levels of glucose washing through the growing brain increase the richness of its network of neuronal connections. The capacity for pleasure – and the anticipation of pleasure throughout life that we summarise as optimism – depends on the numbers of dopamine receptors and opiate receptors that develop in the baby’s brain, especially in the prefrontal cortex. Dopamine, a neurotransmitter which is released from the brainstem and makes its way to the prefrontal cortex, enhances the uptake of glucose, helping new tissue to grow in the prefrontal brain. It also produces an energising and stimulating effect that has earned it the nickname ‘the feel good hormone’. A baby who experiences high levels of warm, rewarding contact with the mother or other primary attachment figure (and/or is particularly successful in the genetic lottery) may develop a brain with high numbers of dopamine synapses. In contrast, a baby who is deprived of affectionate contact with his mother or mothering person or lives with high levels of stress, may have a permanent scarcity of dopaminergic neurons because stress hormones, such as cortisol, effectively ‘turn them off’.

More and more research is demonstrating the long-term importance of social and emotional experiences in the environment to building baby brains (Belsky & de Haan, 2011). In these first 2 years the mother, the father or whoever is the child’s primary attachment figure is an infant’s environment and any interruption of the contact and the attunement between them is stressful. Only repairing the attunement (‘making up with mum’ as a 5-year-old might call it) turns the stress-reactions off again. When researchers compare children of any age on any aspect of development – language, say, or persistence in learning, resilience when things go wrong, or sociable play with other children – the tuned-in-ness and responsiveness of their mothers or principal attachment figures in these first years explains more of the difference between high- and low-achieving children than anything else, more even than differences in socio-economic circumstances (p. 119 Young).

Attachment: Starting at the beginning, staying influential forever

It is extraordinary that the overwhelming importance of that first relationship is still not universally recognised. It was 75 years ago, in 1940 and a year after his death that Freud’s unfinished work ‘An outline of psychoanalysis’ was published. In it he described mothers’ close and loving bonds with their infants as ‘unique, without parallel, established unalterably for a whole lifetime as the first and strongest love-object and the prototype of all love relations’.

This was an important part of the extraordinarily broad swathe of ideas from which John Bowlby derived his formulation of attachment theory (Bowlby, 1969; 1973; 1980). As well as psychoanalysis Bowlby called on animal behaviour, evolutionary biology, psychology and even the dawning field of information processing. In ‘Attachment’ (1969/1982) Bowlby showed that the perspectives of both Freud and Darwin were relevant to his understanding of the mother-baby bond. Stepping even further ahead of his time he speculated about the brain systems involved in this evolutionary mechanism.

Attachment theory has gone through a number of reformations and continues to develop. From the beginning Bowlby said that the attachment between mother and infant was an emotional bond not just a sharing of information, but as long as psychological research was focused on behavioural models, it was attachment behaviours rather than attachment feelings that attracted interest. By the 1980s, psychology’s focus had shifted away from behavioural towards cognitive models so cognitive representations of attachment, especially Bowlby’s ‘internal working models’, life-long templates for the reliability of relationships, dominated attachment research. By the 1990s however, theoretical and clinical science moved towards a deeper study of emotion, the central core of attachment theory. Alan Schore described the shift like this:

I integrated the current studies of brain development and developmental psychology of the first 2 years of life to create a theory of social-emotional development. Over the last two decades we have seen an explosion of studies on emotion and with them a paradigm shift. Beginning in ‘the decade of the brain,’ neuroscience, especially affective and social neuroscience, began to explore the brain system involved in not just behaviour, language, and cognition, but the processing of bodily-based emotion.

(Schore, 1994)

Now, a generation on, attachment theory, through its close links with neuroscience and especially infant brain development, has become a coherent interdisciplinary theory of infants’ emotional and social development that has dramatically changed our understanding of human infancy (p. 28 Fearon).

Attachment is a survival mechanism. All human beings have an inbuilt genetic predisposition to seek refuge with an attachment figure when they are alarmed or distressed. People go on forming attachments throughout life, to non-familial adults, to childhood and adolescent peers and to adult sexual partners, but the first attachment to the primary caregiver forged in the first year of life is the crucial foundation for all that follow. Secure attachment relationships are the base and motivating force a child needs in order to have the self confidence and courage to explore, to learn and to relate to other people. A child who has a secure attachment can explore and experiment freely provided the person who is his ‘secure base’ is available, or trusted to become available if he needs her. Her readiness to give any help he needs increases his sense of security and the assistance she gives models for him solutions to his current problem.

While all children must attach themselves to a primary caregiver – who will usually be the mother – the nature of the attachment varies according to their early experience of the relationship, especially whether it is valuable, reliable and safe. Attachment is a two–way, mutually reinforcing process depending on both mother and infant playing their part. Secure attachment develops through the mother’s attunement and responsiveness to the baby’s signals and his resulting confidence that she will be there for him when he needs her. By reflecting back the baby’s feelings she lends them meaning, and by balancing and moderating them she provides him with emotional regulation before he can self-regulate. In insecure attachment, of any of several types, the infant lacks a mental representation of his primary caregiver (mother) as reliably there for him and responsive to his feelings. Attachment is a genetic imperative. Such infants must still attach themselves to their primary caregiver but will develop different strategies for getting close to her and gaining her attention, the strategy adopted depending on the infant’s experience of the mother’s behaviour.

Mary Ainsworth’s pioneering work (Ainsworth, 1973) assessed the nature of toddlers’ attachment by means of the ‘strange situation test’, which observe...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Notes on contributors
• Preface
• Acknowledgements
• Part I Issues in infant wellbeing
• Part II Evidence
• Part III Action
• Index