Infants and early years

Introduction

A child’s mental wellbeing is the result of healthy development within a nurturing environment. In the early years, infants make emotional attachments and form relationships that lay the foundation for future social and emotional wellbeing.

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Scottish Government policy context

The Mental Health Strategy for Scotland 2012-15 (external website) and the National Parenting Strategy (external website) emphasise the importance of positive early experiences in the family and home environment in creating the conditions for good mental health.

The Early Years Framework (external website) sets out the government’s 10-year policy programme to realise its vision to give all children the best possible start in life. It covers the period from pre-birth to age 8.

Getting it right for every child (external website) sets out the government’s approach for people who work with all children and young people. It identifies eight indicators of wellbeing (external website) that are the basic requirements for all children and young people to grow and develop and reach their full potential.

Risk and protective factors

A child’s experience in utero and during the early years of life can have a life-long impact on their social, emotional wellbeing and development and their relationships.

However, life circumstances will not inevitably determine adult health outcomes. A developing child responds to a complex interaction of risks and protective factors which change over time.

The NHS Health Scotland paper, Guidance about Effective Interventions to Support Parents, Their Infants and Children in the Early Years (external website) summarises the range of factors that increase the risk of, or protect children against, developing social, emotional and cognitive difficulties in the early years.

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Health inequalities

The poorer children are, and the longer they spend in poverty, the worse their health can become - including social, emotional and behavioural difficulties. The opportunity to reduce the impact of health inequalities is likely to decline as children age.

For more information, read our section on Mental health inequalities.

The Scottish Government report, Growing Up In Scotland: Health Inequalities in the Early Years (external link) provides more detailed information on health inequalities in terms of risk factors and outcomes.

Reducing the impact of poverty

Effective interventions to reduce the impact of poverty include:

  • those to maximise household income and resources, and
  • intensive support to families who are likely to experience poorer outcomes (e.g. home visiting and pre-school education/child-care).

Potentially effective interventions for tackling the underlying social causes of poverty include:

  • addressing structural changes to the economic, tax and benefits system, and
  • legislative controls and enforcement.

An NHS Health Scotland briefing on child poverty provides an overview of child poverty and its relationship to health and wellbeing.

See also: Mental health inequalities.

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Identifying and addressing maternal mental health

Maternal mental health and wellbeing is recognised as a key influence on child development during the early years of life.
Around 10-15 per cent of mothers experience depression in the postnatal period, while one to two per thousand women experience postnatal psychosis. Risk factors for postnatal depression are well established. They include:

  • a previous history of depression or other mental health problems
  • poor social support, and
  • a poor relationship with their partner.

Providing social support and structured psychological short-term treatment for women with risk factors has some benefit in preventing depression.

A paper by NHS Health Scotland summarises the evidence of effectiveness of antenatal and postnatal interventions to support mental health improvement (PDF: 420 KB) (external website).

Scottish Intercollegiate Guidelines Network (SIGN) guidance has been published on the management of perinatal mood disorders (external website). It provides the most recent overview of evidence for clinical practice and guidance for practitioners and service providers.

Promoting positive relationships between parents and infants

Interventions which promote positive parent-infant relationships can have long-term benefits.

Attachment describes the bond from a child towards their parent or primary caregiver. Secure attachment is increasingly recognised as vital to the healthy development of infants and children and is associated with positive outcomes for self-esteem, self-confidence, resilience and emotional regulation. Disorganised attachment is a strong predictor of later relationship and emotional difficulties. Children who have experienced sensitive, responsive care-giving are more likely to develop a secure attachment style.

An NHS Health Scotland briefing paper on attachment (external website) provides an overview of the theory and practice of promoting secure attachment.

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Promoting child development and wellbeing

Effective interventions to promote social, emotional and cognitive development include:

  • pre and postnatal home visiting of vulnerable children and their families, led by suitably skilled health professionals
  • high quality early years childcare and education
  • enhanced specialist group-based parenting programmes.

An NHS Heath Scotland briefing on interventions to support mental health improvement summarises the evidence on:

  • effective methods to promote bonding between parents and their infants, and
  • effective interventions during infancy and the preschool period.

Further information

Our Evidence page provides links to the relevant UK and Scottish evidence based clinical practice guidance from the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN).

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