Babies that fail to receive stimulation and love in the first year are at risk of poor brain development and social skills, a child health expert has warned.

Dr Cheryl Power, a clinical psychologist at Alder Hey Children's NHS Foundation Trust told delegates at the Royal College of Psychiatrists annual meeting in Liverpool that health professionals too often focus on the problems of mothers with mental health difficulties, which may make the infant 'invisible'.

However, Dr Power - who is also North West Perinatal and Infant Mental Health Service Improvement Lead - warned this isolated approach can have a detrimental effect on babies' health and urged health workers including adult and child mental health professionals, midwives, health visitors, GPs, and social workers to focus on the whole mother-baby relationship and whole family.

She said: "A foetus will have approximately 100 billion neurons in their brain, however these neurons are meaningless until after birth when the environment they are exposed to will influence their brain development.

"The infant needs to be exposed to stimulation and social interaction to enable their brains to develop. Mothers with mental health difficulties are compromised in how they are able to provide stimulation and how they are able to interact with infants. That will influence how a baby's brain develops, the relationship between mother and baby and have a negative cycle."

Dr Julia Nelki, child psychiatrist at Alderhey Children's NHS Foundation Trust agreed: "Being able to parent successfully is central both to the recovery of the parent and the development of the infant. Adult mental health services may focus on adult mental health needs rather than the parenting needs.

"You need to think about the parenting role as much as their personal needs. If the mother can be successful in the social role of being a parent they are more likely to recover from their mental health difficulties and that's going to have a major impact on the development of the infant."

Common clinical cases include:

- An anxious mum who may be more likely to respond too much to the baby because she has excess worries. The infant may experience anger and turn away to limit this over-involvement.
- A depressed mum who may be disengaged with the baby so they don't respond to the cues of the infant. The baby might give up, become passive and withdraw from the interaction with mum. A vicious cycle then occurs where the mum may feel no good and rejected, which will exacerbate her anxiety and low mood.

To address the problem Child and Adolescent Mental Health Services (CAMHS) therapists working for Alderhey Children's NHS Foundation Trust have set up a new community based intervention for refugee mothers and babies.

The initiative, in collaboration with voluntary agency Home Start, is expected to start in September. It will provide support for mother and baby via a structured programme which includes mummy talk and baby talk time and food, home visits by volunteers, letters, stories, massages and videos.

The programme will focus on the relationship between the mother and baby and will be community-based with volunteers. There will also be active participation and use of feedback.

According to Dr Nelki, who is behind the initiative, the important factor is that every agency is working together to focus on the mother-baby relationship.

"The steering group comprises a health visitor, midwife, voluntary agency, Community mental health team, CAMHS, home-start, perinatal coordinator, university, commissioner and service user," she said.

Dr Power added: "Most mental health services are dealing with either children or adults. This needs to be thought about at all levels. Not just service providers but people commissioning services, they have to think about doing it jointly."

"We need to be moving towards thinking and working together at all levels, whether that be providing services or commissioning. It's essentially about keeping the whole family in mind, not just about addressing difficulty within the mother. We know there are longer term implications for the developing child if maternal mental health is not addressed."

Reference:
Annual Meeting of the Royal College of Psychiatrists, BT Convention Centre, Liverpool, 2 -5 June 2009

Source
Royal College of Psychiatrists