Joy V. Browne, Ph.D., PCNS, IMH-E

Infant and family-centered developmental care (IFCDC) includes several guiding principles, one of which is the application of Infant Mental Health (IMH) to practice in intensive care. The emerging knowledge base of IMH clearly shows how early experiences affect babies’ social and emotional well-being and should be a major consideration in all caregiving. Within the field of IMH, the constructs of regulation, relationships, and reflection guide thinking about the optimal environment of care on 1) the baby’s organization/regulation, 2) the baby’s ability to be an active interactor, 3) the primary role of the m(other) on the baby’s organization, and 4) optimizing neurodevelopment. See Figure 1. Engaging in a reflective stance regarding the impact of care on the baby’s and family’s experience individual experience assists the professional in implementing the principles included in IFCDC practice. (1) IMH considerations are vital in the conceptual model of how IFCDC should be implemented in intensive care. (2, 3, 4)

IMH is becoming more relevant to babies and young children’s social and emotional development. Intensive care professionals must understand and implement strategies to enhance rather than detract from optimal developmental outcomes. (5, 6) Implementation of appropriate IMH approaches should be provided in the context of the baby’s family, the family’s cultural and social orientation, and their caregiving preferences.

Historical aspects of IMH

IMH is now considered an essential consideration for robust infant and child development. Its roots come from a shift in focus from more adult-oriented psychodynamic approaches to seeing the baby and young child as unique within their caregiving relationships. Early studies by Selma Fraiberg (7), Donald Winnicott (8, 9), and Claire Britton (Winnicott) (10) recognized the impact of early childhood traumatic events as well as disturbed relationships as affecting the young child’s mental health and behavior. Interventions developed by those early investigators focused on understanding the infant and young child’s world, beliefs, and fears. They recognized that as the child is dependent on others for both physical and emotional growth, a sensitive, nurturing relationship with the primary caregiver is essential for optimal outcomes.

More recent emphases on early childhood social and emotional development have resulted in theoretical and practical founda- tions for IMH assessment, prevention, and intervention. Accumulating scientific evidence has pointed to the neurobehavioral and social, and emotional impact of early experiences and the protective nature of nurturing early relationships. (11, 12)

Defining IMH and its primary principles

IMH is typically defined as “the young child’s capacity to experience, regulate and express emotions, form close and secure relationships and explore the environment and learn. These capacities are best accomplished in the caregiving environment, including family, community, and cultural expectations for young children. Developing these capacities is synonymous with healthy social and emotional development”. (13)

The field of IMH is “represented by multidisciplinary professionals of inquiry, practice, and policy concerned with alleviating suffering and enhancing the social and emotional competence of young children” (14), page 6. The guiding principles of IMH include the following:

• Infant-caregiver relationships are the primary focus of assessment and intervention
• IMH is a strengths-based discipline
• Caregivers’ past and current experiences influence theirrelationship with their baby/child.
• As the field strives to delineate, establish, and sustain positive development for infants and young children, intervention should not only alleviate suffering in the short term but also attend to future development through nurturing relationships.