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In our work as infant and early childhood mental health specialists, we are often asked “How can babies and young children have mental health problems — they don’t remember anything!”

Another question is “How can you do therapy with a baby?”

As science uncovers more about how babies develop, the more we know that babies not only remember what happens during this period of rapid brain growth, but that the trajectory for life and emotional health is laid through their very first relationships.

Humans, born incredibly underdeveloped, are unable to survive for the first few years of life without a caregiver. And so our work cannot only be with the baby, but must be with their caregiving system.

Many professions supporting young children tend to support the parent/caregiver and baby/child separately — pediatricians and obstetricians, play therapists and talk therapists — and while those professions are needed, another kind of specialist can aid in providing support.

These professionals are specialized in infant and early childhood mental health, and as a result, the parent/caregiver and child are seen together, not separately.

The perspective is that the baby’s mental health can only be supported by caring for the caregiver’s mental health.

Just like with adults, most babies are within a healthy range of mental health. For these babies, programs help to inform parents about child development and provide a non-judgmental space for questions and concerns to be expressed.

Backgrounds Range Widely

For some babies and young children, there is a need for intervention. These children come from a wide range of backgrounds ranging from prematurity and time spent in the newborn intensive care unit, to medical conditions that can make family routines hard to establish. Some babies are fussy, colicky or hard to soothe, while others are removed at birth and suffer from trauma or adverse childhood experiences.

On the other hand, caregivers may need support for maternal/caregiver depression, histories of unstable childhoods, traumatic family events, anxiety and insecurity. The loss of an earlier child either through removal or death can make it hard to believe this child is worth investing in emotionally.

Either or both of these can make it difficult for a caregiver to understand and empathize with the needs of the infant.

The therapeutic work is more akin to coaching than how we usually think of therapy. We call this “dyadic” work, which means that there are two forces at play here: the baby/child and the parent/caregiver.

This dance is not always in sync. There can be challenges on both sides, and part of the intervention is to learn how to balance the needs of both the caregiver and the child at the same time.

Part of our work is building a relationship with parents/caregivers so they may better understand why they might be responding a certain way to their child. Oftentimes, parents respond with frustration or anger toward their child.

That response is not because they are “bad parents,” but maybe that’s how they were responded to when they were a child. Parents learn how they can understand their child’s reactions within the context of their stage of development — a 1-year-old child who continuously drops their food on the ground is not being “naughty,” but is learning about gravity through cause and effect.

The needs of both the infant and the parent are held by the specialist in a safe and nurturing place, asking, “What is it like to be this parent?” and “What is it like to be this child?”

For some babies and young children, there is a need for intervention.

Context and understanding of why actions or emotions occur is explored by all. The parent is not blamed or shamed; the infant is not bad or difficult. Through infant and early childhood mental health services, the needs of both partners are equally valued in the dance of child rearing.

The goal of our mental health efforts are to encourage optimal growth and development within a nurturing family system — and in order for comprehensive mental health services for young children to be offered, there needs to be a state investment in workforce development and reimbursement for those services.

We are a part of Commit to Keiki, which is a nonpartisan, state initiative that is focused on engaging with gubernatorial candidates to educate and encourage them to address the needs, like early childhood mental health, of our youngest keiki.

To learn more about this important initiative, visit .