Singing, gazing intoa baby’s eyes and responding to their needs withlove, comfort and reassurance are instinctive for many new parents and caregivers. But for some parents, these small bonding moments, which are crucial for healthy brain development, take time to develop.
Financial or relationship pressures, mental health difficulties or early parental trauma can all impact the bonding process. But it is during the first critical 1,001 days, from conception to age two, when babies’ brains grow at such a rapid rate that the lifelong foundations for mental andphysical health are laid.
Early years practitioners are at the front line of working with new and expectant parents. The relationship often starts before their babies are born, when they look around and enrol in the setting. But with more babies entering nursery from this September, due to the expansion of the funded hours, what role can nurseries play in supporting parents to build stronger bonds with their babies?
Karen Hardy, specialist health visitor in perinatal and infant mental health at Humber Teaching NHS Foundation Trust, says nursery practitioners are in a ‘privileged position’ because they have day-to-day contact with babies at a crucial stage in their development.
She says, ‘Not only can they speak to parents about the importance of positive parent-infant relationships on a supportive level but they have an important role to play in helping build the connections that lay the foundations for healthy brain development.’
By the time a baby enters nursery, she says she ‘hopes’ that health visitors would have identified any additional vulnerabilities that would potentially make some parents ‘more predisposed to experiencing difficulties around bonding and attachment’, and provided the required support.
‘These could involve parental mental health problems – in mums and dads – substance and alcohol misuse, domestic abuse, past parental trauma, and dealing with major life events or having multiple children,’ Hardy adds.
But she stresses the importance of the first 1,001 days as a critical time period when babies’ brains are vulnerable to stress and neglect.
‘If babies don’t have their needs met and responded to in that time period, for whatever reason – and it is often not intentional in the majority of cases – it can have a long-lasting impact on their physical, social and emotional development and even their ability to learn, regulate themselves, build resilience and form positive relationships,’ she explains.
‘IF THEY COULD TELL YOU’ CAMPAIGN
Supporting parents in building secure bonds and nurturing their baby’s future mental health is a key mission of the Department for Health and Social Care’s ‘If they could tell you’ campaign, launched earlier this year as part of the £300 million Family Hubs and Start for Life programme.
The campaign signposts parents to the Start for Life website, which gives tips and advice on how to interpret and respond to cues such as babies’ expressions, reactions, noises and cries. It also offers guidance for frontline practitioners on how to have reflective conversations with caregivers around their relationships with their babies, with a view to providing support.
Despite being primarily aimed at healthcare professionals, such as health visitors, midwives and family support workers, early years practitioners are cited in the guidance as one of a ‘host of frontline professionals’ who may be able to identify parents and carers who ‘may be struggling to connect with their baby’.
The practitioner guide to Parent-infant relationships: starting conversations (see More information) states that early years practitioners who work with families every day can use the following prompts as part of their existing interactions with families ‘once a positive and trusting relationship’ has been established. Before asking any questions, it says that it is important to create a ‘safe environment’ that is non-judgemental:
- What three words or phrases would you use to describe your relationship with your baby?
- What brings you the most joy in the relationship with your baby?
- What is your biggest fear about your relationship with your baby?
The prompts are part of a three-step process derived from the Leeds Early Attachment Observation (EAO) tool, used by health visitors in the routine six- to eight-week postnatal contact.
Caregivers responding to the first question might use positive words, such as ‘loving’ or ‘cuddly’, or negative words, such as ‘hard work’ or ‘worrying’. For the second question, they may describe how they love it when their baby giggles, or they may struggle to point out any positives. Question three focuses on aspects of the relationship that a parent or carer may be struggling with, such as bonding with their baby or concern around physical development.
‘The words the caregiver chooses may give an indication as to how they are feeling generally about the relationship they have with their baby,’ the guidance states.
Clare Stead, who has developed training for nurseries and childminders on Baby Brain Building in the First 1001 Daysvia the Oliiki app (see More information), says the first two questions are great conversation-starters that can be used to ‘sensitively support’ the observations which may be seen, as well as reinforcing to parents that their baby is in a safe space and that families are cared about.
She says, ‘The EYFS sets out what providers must do, working in partnership with parents and carers, to ensure that a child’s “entire early years experience contributes positively to their rain development and readiness for Key Stage 1”. We should be advocating for these conversations. Early years professionals have a real opportunity to be that voice, as we are often the first consistent childcare professionals the family has been in contact with. But there should be no judgement involved, it’s more about creating a safe space for them to open up and tell their stories, while providing strategies for success.’
But she warns, ‘Question three might invoke a response that early years educators are not routinely trained to deal with. We are not trained to talk about postnatal depression or psychosis – and we need to know where to signpost. The implications of getting this wrong are huge and we must be cautious.’
Hardy says ‘a lot of nurseries’ in Hull contact health visitors for advice and support.
‘It may be that the health visitor has also noticed concerns around the parent-infant relationship, and we can be part of a shared discussion. Where possible we attend Team Around the Child meetings to look at the difficulties the family is facing, and what support may be necessary. For the nought to two age range, with consent from the parent, we can offer Video Interaction Guidance, a specialist intervention used for difficulties with the parent-infant relationships, although capacity is limited,’ she says.
NEXT STEPS
For most parents and carers, an initial conversation will be all that is required to identify any needs. However, the next step in the framework involves the use of clinically validated assessment tools used by trained health professionals to help identify potential areas of need. They include the Alarm Distress BaBy Scale (ADBB), Newborn Behavioural Observation tool and Mothers Object Relations Scales.
ADBB is an observation tool that detects signs of social withdrawal among babies and supports parents and carers with bonding and attachment. It has recently been trialled by health visitors across two NHS trusts, Humber and South Warwickshire, after receiving funding from the Royal Foundation for Early Childhood, which found ‘overwhelmingly positive’ results.
In an evaluation report published by the Institute of Health Visiting and The University of Oxford, researchers say that it is ‘normal’ for babies to use withdrawal behaviours such as looking away, closing eyes and sneezing to control the pace of social engagement. However, sustained social withdrawal behaviours could suggest an ‘early alarm signal’ for relational challenges and a ‘coping mechanism’ that babies may use if their initial protests are not responded to.
Hardy used the tool with new parents in the trial period between July and November 2023. It involves ten to 15 minutes of observing the child in a structured interaction, such as being undressed for weighing and measuring or having a nappy change, and rating each social behaviour on a scale of 0-4.
The tool was used as part of a routine holistic health and development assessment, and if there are concerns about the baby’s behaviour, follow-up support is given, which could involve emotional wellbeing support, infant massage, video interaction guidance or signposting to other agencies, such as Family Hubs, specialist perinatal mental health teams, local mental health support services, or onwards referral for any identified medical need such as GP, dietetics, audiology or orthoptics.
Hardy says, ‘The ADBB is a useful tool to help build a picture around how babies are doing, in terms of their communication, attachments and social emotional development, and aids early identification of possible problems so that timely targeted intervention and support can be implemented.’
CASE STUDY: Eagley School House Nurseries, Bolton
Baby brain development and attachment are at the heart of Eagley School House Nurseries’ practice. Owner Julie Robinson says, ‘We focus on preventative action and empowering families to build their baby’s brains through positive interactions. We build the relationship from day one, starting with a home visit, where we can observe if a parent is over-anxious, or if a child is not settling. We offer support in a gentle way, listening to them and offering help when needed.
‘On a home visit recently, a professional was overwhelmed with going back to work, her baby’s routine and the state of her house. We made her a cup of tea, talked to her about her concerns and reassured her. It transpired that her baby had stopped sleeping and was underweight, and she felt like a failed parent. We gave her some ideas to get the baby back into a routine and how we would support her at nursery. Now that the relationship has developed, she’s less anxious and talks to us without feeling judged.
‘We also notice when new mums might be struggling. Perhaps she doesn’t want to go to settling-in visits, she just wants to leave the baby and go. We might talk to the parent about low mood, monitor them and ask if they would like us to have a chat with the health visitor, and maybe suggest having a meeting at the setting so we’re on hand to support them.
‘One of the biggest challenges has been around supporting parents’ understanding of the significance of brain development and how they can support development of neurological pathways. Providing parents with knowledge and power early helps children develop and become emotionally regulated. On enrolment, we give every parent the Oliiki app with daily activities focused on bonding, attachment and child development, from conception to age two. The app is at the centre of our interactions with parents and gives them the grounding to shape their baby’s brains prior to starting nursery. Dads love it because they’re connecting with their babies while using tech. Our practitioners also receive training in the app and the first 1,001 days.
‘We’ve introduced a Dad’s Natter Chatter and a mum’s group to bring together everyone in the setting and create a trusted space where conversations naturally evolve. Parents also have three free sessions with our on-site Wellbeing coach, who supports with attachment if needed.
‘We use the Ages and Stages Questionnaires (ASQ-3) screening tool, which is not mandatory, but gives reliable, accurate information on a children’s social-emotional developmental milestones between birth and age six.’
- See nurseryworld.co.uk for additional content
MORE INFORMATION
- Parent-infant relationships: starting conversations (practitioner guide): GOV.UK (www.gov.uk)
- Oliiki –Specialist Baby Development App for First-Time Parents in the First 1000 Days of Life: oliikiapp.com
- Barnet Early Years Alliance: https://beya.org.uk
- Eagley School House Nurseries – The Leading Force in Pre-School Education & Care: eshn.co.uk
