Core Childhood Needs (Part 1)

Much like a plant needs water, air, sun, and nutrients in order to grow, a child has core needs which must be met in order for them to thrive.  

These core needs include:

• Safety
• (Age appropriate) Autonomy and self-expression
• Food and shelter
• Empathy and attachment
• Parent-child communication and play
• Clear rules and limits
• Parents who can manage their own frustrations

Nobody is perfect, and these needs are unlikely to be met 100% of the time; however the less they are met, the worse the consequences.  For example, a child whose parents are very busy one week and unable to spend time playing with them may be hurt and upset by this, but if their parents make time for them the following week no lasting damage should result.  However, for a child whose parents never spend any time communicating with them, the effects may be more severe and long-lasting.

A child whose parents never play with or talk to them is unlikely to have sufficient opportunities to learn.  They may find it difficult to understand other minds, to develop language, and to reach the appropriate academic level.  Over time, the child may become acutely aware of their difficulties, with consequences for their self-esteem.  They may struggle at school, find it difficult to express their needs, and have problems making friends.

Children are very dependent on their families for both physical and emotional safety.  Parenting therefore involves teaching children to recognise danger, and minimising potential hazards in their environment.  It is inevitable that children will hurt themselves at some point in their lives (e.g. scrapes and bruises), especially as they explore the world and learn what they can and cannot do.  Parents cannot reasonably watch their children 24-hours-per-day and accidents (including broken bones or cuts needing stitches) may happen.  They may also be hurt emotionally, for example, by an untrustworthy 'friend'.  However, "good enough" parenting seeks to ensure damage is kept to a minimum and a child who has been hurt is protected from further harm.

Although a lack of food and shelter are certainly associated with physical consequences for a child, they may also result in emotional problems.  Being homeless can be an extremely stressful experience for all involved, and stressed, anxious parents may not have the resources to sensitively parent their children.  They may be socially isolated and thus unable to draw on the support of a social network, and may struggle to keep their child safe, warm, and fed.  This experience of adversity may have a lasting impact on a child's development. 

Feeling loved, understood, and validated is key to a child establishing a sense of their value and self-worth, and children with insecure attachment types, or those whose parents do not empathise with them are at greater risk of emotional difficulties.

Accepting a child and empathising with their feelings and experiences does not mean letting them do as they please, however!  Children need clear rules and limits in order to safely explore their environment, and to learn to conduct themselves in a way which is socially acceptable, and which will enable them to function as part of society as they grow up.  Although they may rebel against them, children come to understand that parents set rules because they care about them and the person they will become.

Effective rules and limits are consistent, clear, and developmentally appropriate.  A child who does not understand the rules may become anxious, frustrated, or distressed when they are punished for doing what they thought was expected of them.

Sometimes, if a family is very close, or has very strict rules, there may be limited opportunities for a child to develop a sense of who they are, and confidence in doing things independently.  In order to thrive, they must have the chance to try things for themselves, and to pursue their own interests.  In very close families where children spend all of their time with their parents and siblings, separation anxiety may arise, whereby a child becomes distressed when away from the family, preferring not to socialise with others, and experiencing physical symptoms such as stomach aches when even a temporary separation is anticipated.

Parenting is not an easy job, and when combined with other stressors, parents may struggle.  It is crucial, however, that they manage their own frustrations so as to protect their children from the impact of this.  A parent who does not effectively manage their frustration may be neglectful, emotionally or psychologically abusive, or even physically abusive towards their child, all with lasting consequences for the relationship and the child's well-being.  It is therefore vital that struggling parents seek help, be it from friends and family, their GP, or the appropriate health service.

If core childhood needs are consistently unmet, a child is at increased risk of mental health problems, both now, and later in life.

PROTECTIVE FACTORS

As afore mentioned, nobody is perfect, and children's needs will not always be met perfectly, 100% of the time.  How this impacts a child, and the likelihood of them developing a mental illness when one or more of their needs are not met over a longer period may depend on the balance of protective and risk factors in their lives.

Let's look at an example of a child with lots of protective factors which will minimise the chances of her developing a mental illness.

This is Olivia.  

Olivia has a lot of personal, protective factors. These are things specific to her, rather than her environment.  Olivia appears to be a naturally optimistic child with an easy temperament, and a tendency to recognise her own achievements.  There's no real history of mental illness in her immediate family, and the pregnancy and her birth went well with no complications.  Olivia has never been seriously ill or suffered any severe injuries.  She has learned healthy coping mechanisms (for example, seeking help when distressed) as a result of her secure attachment/s.

Olivia is lucky enough to have two parents who have a loving, harmonious relationship,  Their parenting style is authoritative (warm and child-centred, with a moderate level of control) and allows Olivia to develop a sense of age-appropriate autonomy, which improves her self-confidence.  Her parents both communicate clearly with her, and she understands what is expected of her.

One of Olivia's mums was securely attached as a child.  Her other mother was not, but has worked through her issues and resolved them so she too is able to provide a secure attachment figure to Olivia.  Both parents have healthy coping mechanisms and good self-esteem, and have accurate expectations of Olivia, based on her development and personality.

Olivia's parents are not afraid to seek help and advice from other agencies to ensure Olivia's needs are met.  They engage positively with her teachers and any doctors she comes into contact with, and are committed to helping her in any way they can.

Olivia's little brother, Jasper, is now in day care, just like Olivia was before she started pre-school.  The day care is of a high quality with a low infant to staff ratio, which ensures the staff are able to be responsive to the children's needs.  It is safe, spacious, and well-equipped to meet the needs of little ones.  When Olivia was in day care she had a secure attachment to staff there.

When Olivia later went to pre-school she learned to start to take some responsibility for herself, for example by putting her coat on her peg, or by helping to tidy up after herself.  This helped her develop confidence and age-appropriate independence.

Now Olivia is in primary school.  Her school takes an authoritative approach, expecting high standards but offering a lot of emotional support to the children.  There are clear rules and expectations, and plenty of role models  for good behaviour.  Olivia gets lots of feedback about her work, and is rewarded for her effort and achievements.

Because Olivia has a good relationship with her parents, has learned healthy coping strategies, and knows how to behave appropriately, she has been able to make friends at school.  Olivia feels a sense of belonging and like she is valued by her friends, which boosts her self-esteem.

Olivia's experiences at home and in the wider world are teaching her that she is a valuable individual who people like to spend time with.  She is confident that someone will help if she needs it, and that she is safe and loved.  These messages have boosted her self-esteem, confidence, and independence and reduce (though by no means eliminate) the risk of Olivia developing mental health problems in later life.

In Part 2, we will think about the risk factors which increase the chances of developing mental health problems in childhood or later life.

The Bear xXx

Attachment: The impact of early relationships.

Attachment (Bowlby, 1969) is an instinctive tendency to seek safety in the company of a specific other when feeling anxious or vulnerable.  This is most evident in babies, who are especially in need of the care and protection of a parent or caregiver in order to survive, but is a major component of human experience, and continues to play a part in how we relate to others throughout our lives.

With limited communication skills at birth, babies express their needs through their behaviour and facial expressions.  The infant's needs are both practical (safety, warmth, nourishment, etc) and emotional, and the absence of one or other type of care can have a long-term detrimental impact on their development.  

Over time, the child learns what to expect of their caregiver and their environment, and begins to form an "internal working model"; a sort of blueprint for how things might go, e.g whether they should anticipate frequent threat and/or danger, and how the caregiver might respond should such circumstances arise.  The general pattern of responses from the caregiver also helps the child to develop a sense of themselves and their value, e.g. are they worth the caregiver's time, and are their needs important?

For succinctness, I will refer to the primary caregiver as "mum" from now on; however for many children this might be their father, another relative, or perhaps a foster-parent.  Who the person is is less important than what they do.  Simply meeting the child's physical needs will not necessarily invite an attachment, something effectively demonstrated by Harlow's monkeys.  In Harlow's (rather distressing) study, newborn rhesus monkeys were separated from their mothers and placed in a cage with two 'surrogate mothers', one of which was made of wire, and held food, and one of which offered no food, but was covered in terry cloth, and thus offered tactile comfort.  Harlow found that all of the monkeys preferred the cloth 'mother', and would stray from her only to access food.  If a frightening object was placed in the cage, the babies would flee to the safety of the cloth mother, and cling.  He thus concluded that attachment was about more about comfort than the provision of food.

Attachment in human infants

As an infant's sense of self-worth and safety is contingent on the attachment relationship, the quality of this attachment (Ainsworth, 1971, 1978) is paramount.  

Secure attachment

Here we have Luke and his mum Clare.  Luke is securely attached to Clare, because she is attuned to his needs, and interprets his cues accurately enough.  Since Clare is not psychic she will not know Luke's mind all of the time, and might misunderstand what he wants and needs occasionally!  This is okay, because for the most part she is at least close with her interpretations, and her responses are therefore appropriate.  Luke communicates a need and he feels confident that Clare will meet it.

Because Luke believes help will be available as and when he might need it, he feels able to explore his environment and learn about the world.  From time to time he looks back to check Clare is there, and might bring things to her or draw her attention to something he is looking at to see what she thinks of it.  This kind of social referencing helps Luke learn what he should make of things and what is safe or unsafe.  If at any time he becomes uncertain or scared, he can run back to Clare who will comfort and protect him.  In Luke's internal working model, the world is relatively safe, and people are helpful, responsive, and available.

Avoidant attachment

Kelsey's mum, Sarah, is not sensitive to her needs in the way Clare is to Luke's.  Sometimes Kelsey cries for a very long time before Sarah responds, or she finds that Sarah is overwhelmed by her needs and gets upset or angry herself.

Kelsey doesn't feel very confident that Sarah will be there when she is feeling distressed, or that she will help her feel better if she is.  She tries to be independent of her mum when exploring her environment, and doesn't seek her when she is scared or upset.  Kelsey's internal working model tells her help is often unavailable when she needs it, and her mum may even walk away at times.  She has therefore developed an avoidant attachment style. 


Resistant attachment

Mieko can be quite inconsistent in meeting Hiroto's needs. Though she tries her best she can struggle with depression and is sometimes emotionally or even physically absent when Hiroto needs her.  At other times she tries desperately to make things up to him and can be intrusive in a way which is frightening or confusing for him.

Because Mieko's behaviour is inconsistent, Hiroto is not sure what to expect from her.  At times he can cling and appear very dependent, but he might also reject her efforts when they interact.  Hiroto has been unable to form a sense of security in his relationship with his mother, so it is difficult for her to soothe him when he is distressed.  His attachment type can be described as resistant.

Disorganised attachment

Hope has a problem.  Her mother, Tracey, is terrifying. Sometimes, without any real warning, Tracey completely loses her temper and shouts and screams at Hope.

Hope's instinct (like that of any child) is to seek safety.  But the person who is supposed to protect her is the source of her fear.  There is no real solution available to her.  Sometimes Hope instinctively starts towards her mother for help, but then freezes as she remembers this isn't safe.  At other times she dissociates to remove herself psychologically from a situation she cannot physically escape.  Because Hope has no single effective way of relating to Tracey, her attachment style is disorganised.


Through our relationships with our parents we learn what to expect from our environments and from other people.  A child who learns the world is largely safe and that help is readily available when it is not is far more likely to feel confident in exploring it, and thus to access more opportunities to learn and develop than a child who has found the world to be a dangerous, frightening place in which they are very much alone.  In this way, early attachments begin to establish patterns in the way individuals think, feel, and behave, which may persist across their lifespan in the absence of corrective or reparative experiences.

The Bear xXx

Why does maternal mental health matter?

It is widely accepted that mental health is a product of both biology and environment, and the ways in which the two interact. However, some may be surprised by how early in life this begins to be the case.   Recently,  studies have suggested that our experiences in-utero can begin to shape us neurologically in a way that can have lasting consequences (Talge, Neal, & Glover, 2007).

For the sake of simplicity, let's imagine a mother and baby.

This is Sandra.  Sandra would describe herself as usually being "a bit of a worrier", and is having a stressful time at the moment.  As a result, she is feeling quite anxious and depressed.  She is not alone.  Up to 13% of women experience depressive episodes during pregnancy or within their baby's first year (Swinson, 2005).

Sandra's current mental health is associated with a biochemical imbalance.  Her norepinephrine and cortisol (stress) levels are high, and her dopamine (reward and pleasure) levels are low.  She is feeling sick with anxiety and eating less than usual.

Inside Sandra is her unborn child, Billy.  Billy is exposed to his mother's hormonal imbalance, and his behaviour becomes dysregulated.  His levels of activity, sleep pattern, and movements are not typical of a foetus at this stage of development.  His heart rate is also different, and he responds less to vibratory stimuli.  As a baby of a depressed mother, Billy is at risk of being born prematurely with a low birth weight, with consequences for his later development (Gold & Marcus, 2008).

At birth, Billy's sleep pattern is not predictable or settled.  He is less responsive to the facial expressions of others, and his own facial expressions tend to be sad or angry.

Sandra is still feeling depressed, and varies between being withdrawn (emotionally, and physically), and being overly intrusive (fussing, or interfering with Billy in a way that makes them both feel irritable).  Billy is not sleeping well and Sandra is frustrated and exhausted.  Whenever she looks at Billy he looks miserable, and he seems more comfortable with her when she is sad than when she is happy  (Field, 1998).  

If things continue like this for Sandra and Billy, Sandra may feel more and more defeated and less able to parent Billy, who in turn will feel and show more distress. Intervention is needed.

One recent study found that something as simple as music and massage therapy for both mum and baby can reduce levels of cortisol and norepinephrine in both, leaving mum more receptive to being coached to engage with her baby in a more positive way, with a resultant improvement in their relationship.

New mothers suffering with mental health problems may also need the support of their partner, friends, family, or a healthcare professional, and may even consider taking medication to reduce their symptoms.  Existing mental health problems can be exacerbated by pregnancy and the transition to parenthood, and first episodes can also occur.  The evidence suggests the impact of maternal mental illness on an infant is buffered by the input of a stable caregiver, for example, the child's father.

Sandra and Billy try music and massage, and Sandra confides in a friend and her healthcare visitor about how she feels.  She is supported to try relating to Billy in a different way, and to enjoy her time with him more.  Her partner ensures she has time for herself, during which she naps or pursues a hobby.  Both Billy and Sandra feel less stressed, his sleep settles into a more organised pattern, and he steadily gains weight. Both parties are happier and more connected.  The intervention came at the right time for Sandra and Billy.

But what happens when the relationship between infant and caregiver continues to be difficult?  This is where attachment styles comes into play.

The Bear xXx