In recognition of Children’s Health Month in October, we sat down with Chief Science Officer, Lindsey Burghardt, M.D., M.P.H., FAAP, who shared her thoughts on the importance of understanding and supporting sound mental health, particularly for our youngest children. In addition to her role as Chief Science Officer, Dr. Burghardt brings a clinician’s perspective to these issues, as a practicing pediatrician herself.
Q: When it comes to infant health, we often focus on physical development – how much a baby is growing, when they start crawling, etc. What does it mean to expand our thinking to include mental health for babies and toddlers?
A: When we think about infant mental health, we’re thinking about a young child’s capacity to express and navigate emotions; form close, secure relationships; and explore and learn about the world around them. Just like adults, babies and young children are experiencing emotions and environments that impact their mental health, and they are particularly sensitive to those influences in the prenatal period and first 2-3 years.
During this period, the interaction between genetic predispositions and positive or potentially harmful influences in a child’s environment can lay either a strong or an unstable foundation for mental health. Positive influences include things like stable, responsive relationships with caregivers at home and in early care settings, a home free of heavy metals like lead, and an abundance of green space to play in. Conversely, the presence of negative environmental influences such as polluted air or water, a lack of green space or lack of access to nutritious foods, can create a more unstable foundation for mental health.
These foundations endure well into the adult years, so expanding our view of infant health to include good mental health is essential, including providing the necessary resources for caregivers to support their children’s development with that holistic perspective.
Q: The COVID-19 pandemic has led to tremendous challenges for both children and caregivers, including an increase in mental health issues and a lack of access to providers who can help. As a pediatrician, what are some of the issues you have been seeing in your own practice on this front?
A: There have been so many strains on caregivers during the pandemic. In particular, many working families have struggled to maintain access to consistent, high-quality childcare, which puts incredible stress on both caregivers and young children. The childcare environment is so important for children’s healthy development—their relationships with immediate caregivers matter a great deal, but so do their relationships with providers in early care and education, as well as with other adults in their communities.
The COVID-19 pandemic has put significant stress on an already strained system, with a shortage of providers and limited options for parents to balance caring for their children and working to maintain their income. I’ve heard from many caregivers that they are experiencing significant stress, and in some cases job insecurity, due to the lack of consistent childcare. For caregivers who work nontraditional hours such as overnight shiftwork, or for those who care for multiple children, the stresses can be even greater. I’ve also observed increases in behavioral challenges and anxiety, including among young children.
Q: Amidst all these challenges, how can caregivers and providers help create environments that foster strong mental health for babies and toddlers in a post-COVID world?
A: The role of caregivers and providers is critical in fostering good mental health, so we must support the needs of the adults who care for children, through both individual and systems level approaches. When we support adults directly and tackle the systemic inequities that challenge families and providers, we help ensure that children can develop in health-promoting environments.
Beginning in early infancy, establishing routines at home is a simple and impactful way to promote mental health. Children, even infants, feel secure and thrive when they know what to expect. Mini routines like the 3 B’s (bath, brush teeth, & book) before bed let a child know that it’s time to unwind. Around mealtimes, this can look like singing a song while washing your hands or sitting down together and talking about your day—even babies can participate in dinnertime, and mealtime routines with caregivers are a great way to foster connection and a sense of security.
“By creating environments with an abundance of positive factors—from access to healthy nutrition to greenspace to play—and including support that meets the needs of caregivers, we can support the healthy emotional development of infants and young children and lay a strong foundation for good physical and mental health.”
–Dr. Lindsey Burghardt
Chief Science Officer, Center on the Developing Child
For providers, fostering mental health for babies also means taking care of the adults who care for them. Checking in on the mental health of caregivers, including conversations around postpartum depression and anxiety and referrals to resources when appropriate, is one way to approach this. Providers can also discuss the value of routines and the benefits of a positive parenting approach during regular appointments. By creating environments with an abundance of positive factors—from access to healthy nutrition to greenspace to play—and including support that meets the needs of caregivers, we can support the healthy emotional development of infants and young children and lay a strong foundation for good physical and mental health.
“The role of caregivers and providers is critical in fostering good mental health, so we must support the needs of the adults who care for children, through both individual and systems level approaches.”
–Dr. Lindsey Burghardt
Chief Science Officer, Center on the Developing Child