From the chapter ‘The early years‘
Sally Hogg, Senior Policy Fellow at the Faculty of Education, University of Cambridge and former Deputy CEO of the Parent–Infant Foundation
My career trajectory changed at the age of 17 when I did work experience with a GP caring for a disadvantaged community. Until then I had wanted to be a doctor; afterwards I wanted to help address the intergenerational social and economic issues that I could see were shaping people’s lives. I wanted to prevent disadvantage, not to treat it. As a psychology undergraduate, I learned how early experiences influence children’s life chances. Since graduating, I’ve been working to ensure that more children have the best start, with a particular focus on pregnancy and the earliest years, a period where we can make an enormous difference.[i]
This essay summarises the importance of parent[ii]–child relationships, and highlights a gap in support for families. I describe the vitally important role that parent–infant teams can play.
The science is now clear: early relationships are crucial. Interactions between parents and their babies are a critical element of development, influencing many of the capacities that we need to thrive, such as emotional regulation and language skills.[iii] Secure relationships enable young children to feel safe, able to explore the world and learn.
Without sensitive, nurturing care, babies can experience high levels of stress and distress. Prolonged periods of this ‘toxic stress’ can then disrupt their development, impacting their physical and cognitive development, including their immune system operation and memory.[iv]
Most parents want the best for their babies, but some struggle to provide the nurturing care they need. Factors such as domestic abuse, mental illness, substance misuse, unresolved trauma and poverty can make it harder for parents to protect, support and promote their young children’s development.
Supporting early relationships is a vital public service
There is a clear case for supporting early relationships, which play a vital role in many of the outcomes that public services work to achieve. Yet the availability of such support remains hard to find. One reason is, perhaps, that early relationships don’t have a clear place in the system: no public service sees strengthening and repairing early relationships as their core business.
Support for early relationships should be embedded across the universal, specialist and targeted services for families in the earliest years. Mental health services are, I believe, the best services to offer specialist relationship support for families where relationships are particularly problematic. This is because professionals are more likely to have the skills and understanding to work with parents’ and babies’ needs and their relationships, and to overcome complex intergenerational trauma.[v] However, parent–infant relationship support is not offered in mental health services in many parts of the UK – in a 2020 survey of NHS mental health professionals, only 36 per cent of respondents said that there were mental health services that could work effectively with babies and toddlers aged 0–2 in their area.[vi]
Specialised parent–infant relationship teams are our rare jewels
Hope comes from specialised parent–infant relationship teams,[vii] which, like rare jewels, are scarce, small and valuable. Parent–infant teams bring together skilled professionals from a range of disciplines, led by psychologists or psychotherapists. They provide a range of therapeutic interventions to support parents to process their own trauma and to ‘tune in’ to understand and respond to their babies’ needs.
These teams are few and far between – most babies in the UK live in an area without a team. There is not yet a large and robust evidence base for their work, but studies indicate a positive impact on parents’ mental health, parent–infant relationships and child protection outcomes.
Improving early relationships has an impact now, and in the future
Parent–infant teams ensure more babies have the nurturing care that is essential for development. This can transform children’s life chances.[viii] Although secure early relationships do not fully inoculate children against later challenges, they do increase their resilience and put children on a more positive developmental trajectory, better able to take advantage of the opportunities that lie ahead. Children who have had good early relationships start early education and school better equipped to be able to make friends and learn.[ix] These children are more likely to achieve their potential in later life and contribute to society and the economy.[x]
And it is, of course, not only the child who benefits from effective early support; so, too, do communities, public services and the taxpayer. Strengthening parent–infant relationships offers the potential to improve children’s learning and earning potential, and to reduce future demands on public services. In a recent study, children who were parented sensitively during early childhood cost 13 times less by the age of 12 than those who were not.[xi]
It is often remarked that the National Health Service is not so much a National Health as a National Illness Service, where the immediacy of injury, infection and disease continually crowds out prevention. Parent–infant teams offer a powerful way of starting to turn the tide.
Notes
[i] Parent–Infant Foundation (2021) ‘An age of opportunity’, Evidence Brief 1, First 1001 Days Movement, London, https://parentinfantfoundation.org.uk/1001-days/resources/evidence-briefs
[ii] I use the term ‘parents’, but this is intended to capture anyone who is a primary caregiver to a baby or young child.
[iii] National Scientific Council on the Developing Child (2004) Young Children Develop in an Environment of Relationships, Working Paper No 1, Harvard, MA, http://developingchild.harvard.edu/wp-content/uploads/2004/04/Young-Children-Develop-in-an-Environment-of-Relationships.pdf
[iv] Shonkoff, J.P., Garner, A.S., Siegel, B.S., Dobbins, M.I., Earls, M.F. and Wood, D.L. (2012) ‘The lifelong effects of early childhood adversity and toxic stress’, Pediatrics, 129(1): 232–46, doi: 10.1542/peds.2011-2663.
[v] Many professionals, even in mental health services, need additional training to work with early relationships, as there is a ‘baby blind spot’ in much professional training.
[vi] Parent–Infant Foundation (2021) Where Are the Infants in Children and Young People’s Mental Health? Findings from a Survey of Mental Health Professionals, London, https://parentinfantfoundation.org.uk/wp-content/uploads/2021/06/PIF-Where-are-the-Infants-in-CYP-MH-26-May.pdf
[vii] Specialised parent–infant relationship teams may be known by different names, such as parent–infant mental health services, infant mental health services, PIPs (parent–infant partnerships) and early attachment services.
[viii] Feinstein, L. (2015) Social and Emotional Learning: Skills for Life and Work, London: Early Intervention Foundation.
[ix] Geddes, H. (2006) Attachment in the Classroom: The Links between Children’s Early Experience, Emotional Wellbeing and Performance in School, London: Worth Publishing; Bergin, C. and Bergin, D. (2009) ‘Attachment in the classroom’, Educational Psychology Review, 21(8): 141–70; Siegel, D. (2012) The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are, New York: Guilford Press.
[x] Parent–Infant Foundation (2021) ‘The benefits of nurturing care’, Evidence Brief 3, London, https://parentinfantfoundation.org.uk/1001-days/resources/evidence-briefs
[xi] Bachmann, C.J., Beecham, J., O’Connor, T.G., Briskman, J. and Scott, S. (2021) ‘A good investment: Longer-term cost savings of sensitive parenting in childhood’, Journal of Child Psychology and Psychiatry, 63(1): 78–87, https://doi.org/10.1111/jcpp.13461