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Mental Health Infancy.Pdf INFANCY • 0–11INFANCY MONTHS INFANCY Introduction strengths as well as deal effectively with high-stress situations the family may face. It can also help par- he infant’s relationship to his parents, as ents anticipate the changing developmental needs well as the infant’s early experiences, pro- of their infant and grow in their parenting role. vides the foundation for future growth During the infant’s first year, the primary care and development. An infant’s mental health professional can gain awareness of parents’ Thealth is affected by his physical health, tempera- hopes for and perceptions of their infant. By listen- ment, and resiliency and by the love and support ing carefully, the health professional can identify he receives from his parents and other caregivers. stressors from parents’ pasts as well as current stres- When an infant’s basic needs are met, he becomes sors that affect their parenting; understand the increasingly able to respond to and benefit from the impact of the infant on the family’s interactions stimulation around him. The quality of an infant’s and daily activities; help parents appreciate and experience, as reflected by attachment, affection, capitalize on the strengths of the infant, family, and health, temperament, resiliency, and the mental community; and identify concerns that need inter- health of the infant’s parents, forms the roots of vention. By adopting an empathetic, nonjudgmen- future emotional well-being and self-esteem. In just tal posture, the primary care health professional can a short time, the infant develops as an individual, build a relationship that will promote mental begins the process of self-regulation, forms attach- health for years to come. ments to his family, and makes great strides in cog- nitive development. The first year of life presents a wonderful opportunity for the primary care health profession- al to build a strong and trusting relationship with the infant and the family. A health professional who works closely with the infant and family can establish a foundation for supporting healthy fami- ly behaviors and interactions and promoting men- tal health. Anticipatory guidance targeted to the needs of the infant and family and a relationship of trust are the building blocks of a long-term collabo- ration that promotes infant and family mental health. A working partnership between the primary care health professional and the family can help parents recognize and build on their infant’s 17 SELF Following are health supervision interview questions from Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents relevant to self in infancy: INFANCY • 0–11INFANCY MONTHS Throughout Infancy Is it easy or hard to find out what he wants? How is Carlotta doing? What new things is he doing? What do you enjoy most about her? 9–12 Months How would you describe her personality? How does it feel to have Jamil becoming more How easy is she to console? independent? Has she been fussy? What seems to calm her? What have his other caregivers noticed about him? Can you tell when Jamil wants to eat? Go to sleep? SELF: TEMPERAMENT persistence and attention span, rhythmicity (regu- larity), and sensitivity are indicators of his tempera- Each infant has a characteristic style, or tem- ment (Chess and Thomas, 1996). Being aware of perament, of activity, mood, and reaction. These their infant’s unique temperament can help parents genetically derived characteristics evolve and devel- respond to him effectively. op over time, and they often underlie interactions and behavior. It is important, therefore, for primary Tips care health professionals and families to understand ■ Help parents describe their infant’s tempera- the unique temperament of each infant. ment with questions such as these: ”What is The Emerging Self: Tanisha like? How calm/intense/active is she? How does she respond to changes in routine? Individual Differences How does she deal with a lot of stimulation?” If We Call Temperament the infant’s temperament is an area of particular concern, consider further assessment by using a During infancy, parents begin to recognize the temperament questionnaire such as the Revised unique temperament of their infant. Even though Infant Temperament Questionnaire (Carey and an infant cannot verbalize preferences, tempera- McDevitt, 1978). ment can be assessed through observation. An infant’s activity level, mood, adaptability, dis- ■ Discuss the infant’s overall mood and behavior. tractibility, initial reactions, intensity of reaction, If the parents describe emotions or motivations 18 INFANCY • 0–11INFANCY MONTHS that are more appropriately attributed to an older low) and limit the number of people who handle child or an adult, explore further. For example, the infant. you might ask, “What makes you think Monica is ■ Help parents understand that an infant who knocking over the blocks to make you mad?” seems irritable may simply be more sensitive to ■ Ask parents, “Does your infant remind you of his environment. Suggest that they slow down anyone in your family? If so, whom?” Parents his routines, giving him more time to adjust to often respond to their infant based on memories transitions in activities. Discuss soothing tech- of their experiences with others. If the associa- niques they can use to calm their infant. tions parents make appear to be negative, help ■ Encourage parents to share their understanding parents see their infant as a unique individual. of their infant’s temperament with the infant’s other caregivers. The Uniqueness of the Infant ■ Tell parents never to shake, hit, or slap their How long will the infant wait for a feeding infant. Emphasize that shaking an infant can before becoming upset? How does the infant lead to blindness or other eye damage, brain respond to changes in household routines? Is the damage, seizures, spinal cord damage, or death. infant upset by bright lights or loud noises? Answers to these questions will gradually reveal the picture of the infant’s temperament. Infants who are very sensitive to their environment can quickly become overloaded, resulting in irritability, negative mood, and parental self-doubt. Tips ■ Praise parents for recognizing and responding to their infant’s temperament. ■ Ask parents to note their infant’s reactions to objects he sees, to sound, and to touch (e.g., Does he startle easily or respond calmly?). ■ Help parents learn how to protect the infant who is highly sensitive. Recom- mend that they keep the environment calm (e.g., keeping lights dim and noise levels 19 Tips Area of Concern: Infants with ■ Special Health Care Needs Ask parents about the fit between their infant’s temperament and their own personality traits, Infants with special health care needs (e.g., pre- parenting styles, and expectations of him. If the mature infants, infants with cognitive disabilities or infant’s temperament is an area of particular con- INFANCY • 0–11INFANCY MONTHS developmental delays) may not initially express their preferences and sensitivities as clearly as other cern, consider further assessment by using a tem- infants. These infants may exhibit varying levels of perament questionnaire such as the Revised responsiveness and less overall predictability. Help Infant Temperament Questionnaire (Carey and parents recognize their infant’s subtle signals and McDevitt, 1978). find ways to soothe their infant, such as making the ■ infant’s fingers accessible for sucking, speaking soft- Help parents find ways to deal with challenging ly, touching the infant repeatedly, and rocking. Help areas of their infant’s temperament (e.g., his parents identify signs of stress (e.g., change in skin response to change, intensity of responses, activi- color or tone, hiccups) and signs of social availabili- ty level, mood). ty (e.g., an engaging facial expression, extended arms and legs, clasping of the hands). Help parents ■ Explore opportunities for shared fun, emphasiz- understand that they will not always be able to con- ing that such activities can strengthen the con- sole their infant. Help them develop a game plan for nection between parents and their infant. Suggest dealing with their frustration (e.g., seeking support activities such as singing to, reading to, and cud- and respite from family members and friends). dling the infant. ■ Discuss child maltreatment with parents and how to avoid it. (See bridge topic: Child Maltreat- Temperament: “Goodness of ment, p. 213. See Tool for Families: Handling Fit” Between Parents and Child Anger and Countering Abuse in the Community, Mental Health Tool Kit, p. 141.) The “fit” between parents’ sensitivity, respon- siveness, mood, and expectations and their infant’s temperament can provide insight into parent-infant Sibling Differences interaction. Parents’ expectations and personality Often children in the same family are quite dif- traits may influence how they respond to their ferent in temperament. Children with easygoing infant. How parents respond will affect their temperaments may be more resilient and/or less infant’s self-esteem and adjustment. (See Tool for influenced by stress, whereas children with difficult Health Professionals: Age-Specific Observations of temperaments may need more structure. Parents the Parent–Child Interaction, Mental Health Tool Kit, may need assistance in adapting their parenting p. 24. See Family, p. 28.) A poor fit requires contin- styles and expectations to each child. ued monitoring. If the poor fit is persistent, referral for comprehensive evaluation by a mental health professional is warranted. 20 INFANCY • 0–11INFANCY MONTHS giving, feeding, and creating a soothing environment that allows for periods of rest and sleep as well as for periods of stimulation. Feeding Feeding time is a wonderful opportuni- ty for parent-infant interaction. It is a spe- cial time for parents and their infant to feel close to each other and to establish a posi- tive relationship. (See Table 3: Feeding in the First Year.) Tips Tips ■ Encourage breastfeeding.
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