Children's Emergency Department is now located in Children's Tower: 1001 E. Marshall Street.
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Children's Emergency Department is now located in Children's Tower: 1001 E. Marshall Street.
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While nursery furniture and baby clothes may be at the top of the “to-do” list when preparing for a new baby, being emotionally ready is extremely important too. Preparing for what to expect, planning for needed support, and having an understanding of the emotions associated with caring for a newborn support the emotional attachment between a mother and child that leads to a good start in life. Child and adolescent psychiatrist Dr. Bela Sood shares more about why this is so important and what can help.
The unique emotional relationship that a mother and father have with their child lays the foundation for the child’s physical, emotional and social growth. This is because human babies are totally dependent on their parents for a longer time than any other mammals.
As a baby is forming in the womb, parents begin to make a place for the new addition within the family. The parents, particularly the mother, begin to imagine what the baby will be like and wonder about things like how they’ll care for it and if the baby will love them back. In addition to the obvious physical and hormonal changes occurring in the mother’s body as she gets ready for the birth, this awareness of a new being within the family starts the process of becoming attached to the baby in an emotional way. The process is gradual and by the time the baby is born the mother typically begins to experience the baby as an extension of herself. Fathers – and others who take a primary caregiving role in a baby’s life – also experience this emotional attachment as they become involved in cleaning, bathing and caring for the newborn in other ways.
The multiple ways of ensuring that a baby is cared for physically and emotionally typically comes naturally to the new mother. The baby’s cry, smile and restful sleep all become understandable and intuitive to a new mother who begins to strongly attach to the new baby, show affection and love, and provide care that includes feeding, cleaning and allowing the baby to rest. The tender loving feelings that develop as a mother responds to a baby’s needs are considered bonding between the mother and baby. (Note: While this article focuses on attachment between a mother and baby, the attachment process applies to all of the primary caregivers in a baby’s life including the father and others closely involved in the baby’s care.)
Over time, the baby begins to recognize their primary caregivers (most often the mom) through multiple contacts (feeding, bathing, singing, cooing, etc.) and feels soothed by their presence. If the baby’s needs – diaper changes, feedings, comfort when in pain, etc. – are met in a reasonable amount of time, a baby grows securely. In turn, the baby’s increasingly positive responses to the care they receive increases the caregivers’ confidence in their role and attachment to the baby. Caregivers become less anxious and more secure in their ability to care for, soothe and understand the baby, and this confidence and security is transferred to the growing infant who begins to see their primary caregivers as dependable, loving and comforting. This process of falling in love with each other – infant and primary caregivers – is loosely called attachment.
Both bonding and attachment are vitally important to a child’s development as the dependence of the human baby on their caregivers to have their physical and emotional needs met is essential to good and steady development. As this process unfolds, it is not uncommon for new mothers to be totally preoccupied by the baby to the exclusion of others. However, they may also lack confidence in how to take care of the baby for a period of time. Gradually, confidence in “reading” the baby’s needs produces a positive attachment to the baby which has far-reaching implications. In fact, research shows that when a baby is parented well and with care, the child has a higher probability of being a good parent as a grown-up. This ability to parent gets “hard wired” in the newborn and gets further solidified if stable, nurturing parenting continues.
The danger of poor or no attachment is that the natural process of development in the baby can be slowed. The child may look normal, but their capabilities of being in a state of taking in life experiences and benefiting from them, or thriving, dwindle. Just as you could have a plant with great potential, if it’s missing good soil and enough water and sunlight, it will grow, but its growth will be stunted and it may not produce blooms.
A baby needs a parent/caregiver who is mindful of providing enough food and nutrition so both the body and brain develop well and who is attentive to things like taking them away from too much noise, anticipating where danger lurks (e.g., stopping a child from rolling off a bed and injuring themselves) and establishing a sleep-wake schedule that makes their world predictable. Together, this physical and emotional care helps a baby be alert and more capable of learning new information. It also helps a baby’s nervous system develop in a stable manner. The nerve cells of a poorly-cared-for baby often do not mature as they should and this can lead to disorganized behavior, anxiety in the child and failure to thrive. Such children are at high risk for being neglected as their parent/caregiver may feel inadequate about being able to soothe them and, in the worst-case care scenario, may end up maltreating the child because their disorganized, whiny, “cranky” behavior frustrates them.
It is vitally important that a baby’s birth is anticipated with positive expectations and that parents and caregivers prepare for it in their own unique way. The anticipatory period in which a mom fantasizes about the unborn baby, and the tender feelings that develop while caring for the newborn, is a state in which the protective actions, care, and physical and emotional availability of the primary caregivers all lead to the mutual dependence, bonding and attachment that helps the infant thrive – and allows natural biological processes to unfold.
Be prepared – Prepare your body and your mind to receive the baby so you’re looking forward to the event. Develop a plan as to how the baby will change your lives. Plan how you’ll get ready, how you’ll handle the responsibilities of newborn care, and who you can turn to (both professional and non-professional) for advice or help.
Focus on soothing – Understand that babies have needs, their only way of communicating discomfort is to cry, and it’s often a gradual process of coming to recognize each type of cry. Being able to soothe the baby on the first try is usually a skill acquired slowly after observing the baby keenly. It’s important not to take the baby’s crying personally (the baby is not mad at you) and also to focus on finding a way to soothe them. When frustrated, recognize it and find respite and support. Give yourself a “time out” to rest and regroup. This is important to prevent you from developing negative feelings toward your baby or “falling out of love” with them – which is something that should never happen. If these are emotions you recognize in yourself then call your professional or non-professional support person. Assess if you need to seek additional help and assistance.
Mother-child attachment appears secure when the mom feels the baby knows them, when the mom coos to the baby and the baby “talks” or “smiles” back, when they can each hold each other’s gaze, and when the mom is able to feed and satisfy the baby. For all parents/caregivers, it’s deeply satisfying (and a sign of secure attachment) when they can correctly identify a baby’s different cries, recognize what the baby wants, and know they are able to soothe and stop the baby from crying by responding to their needs accurately. Secure attachment is also expressed as the child tolerating separation, perhaps by crying, but welcoming the parent/caregiver on return with unbridled joy and not rejection.
There are certain conditions which can put expectant mothers at risk for not feeling adequate as a mom which affects attachment. Depression, substance abuse, or a history of being abused as a child or as a partner in a romantic relationship may impede bonding and thereafter attachment. A mother’s age may also play a role as very young mothers are considered more at risk for attachment issues.
Expectant mothers with identified high-risk conditions or red flags should seek care in specialized clinics that can not only help address the issues, but also work with them on bonding and attaching with their baby. Treatment reduces the risk for maltreatment of the child. This treatment explores why the mom feels the way she does and helps develop bonding and attachment with the baby through special exercises centered on exploring and replacing reactions/behaviors that impede attachment.
The most appropriate first step in seeking treatment is for a conversation to occur between the pregnant mom and her medical provider. Exploring the expectant mom’s emotional health and ongoing aspirations about the baby should be a routine part of prenatal visits. If there is concern expressed about worries, feeling unprepared, rejection of the pregnancy, etc., a referral to a mental health provider may be appropriate to help evaluate the situation and develop an appropriate intervention plan may be necessary.
Mental health professionals at our Virginia Treatment Center for Children are collaborating with community partners to help moms in the high-risk categories above reduce their risk for poor attachment to their babies. For more information or to schedule a consultation, call (804) 828-3129.
By Bela Sood, MD, child and adolescent psychiatrist, Virginia Treatment Center for Children
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