The baby brain

I have spent much of my professional career, spanning over 30 years working with some of the most deprived, neglected and damaged children initially as a social worker and then as a child and adolescent psychoanalytic psychotherapist. Many of the children and young people I have seen and continue to see have spent their early years in abusive and neglectful environments. Over time as I became more experienced and knowledgeable I found myself becoming acutely aware of the huge difference between children and young people who have lived with abuse and neglect from birth, and those that have had a good start to life but have gone on to have horrific and abusive experiences later. The children who have had a good start to life seemed to be able to tolerate emotional stress and could think about their feelings and their experiences. The children who had suffered early abuse and neglect could not tolerate even a small amount of emotional stress.

I shall give you an example of Lisa, She is aged 7. She was chronically neglected as a baby and toddler and was placed in care at aged 4 years. She found the ordinary task of drawing a picture impossible, leading very quickly to abandonment or destruction of her picture. Whether this reaction was about the frustration of not being able to get it right first time, or a disturbing thought, feeling or memory that the task of drawing stirred up, or indeed something else was impossible for me to understand because Lisa could not tolerate her emotional response long enough to be able to communicate what was worrying her. Time and again I found myself imagining helping Lisa to build a place in her mind, brick by brick, where she could hold her thoughts and feelings long enough for these thoughts and feelings to be thought about. We had to go through the same process many times with me pondering quietly and gently before it was possible to begin to wrap some thought around what it was about drawing that was so difficult for Lisa.

As a child and adolescent psychoanalytic psychotherapist the roots of difficulties as a consequence of a child’s early experience is very much a part of the training. To qualify students have to complete a 2 year baby observation as close to birth as possible and an under 5’s case which is seen for 3 times a week for therapy. They also have to read many articles about how babies understand and experience the world and grow emotionally and cognitively. This gives an in depth understanding of the baby and child’s mind, how they see the world, what sense they make of their outside experience and the impact of their care on how they develop emotionally. Despite all this knowledge it was difficult for me to really understand why it is so hard for children with early trauma to be able to learn and develop when they subsequently have a good care experience, and why I felt like I had to build a structure in the child’s mind where thoughts and feelings could be held.  It was 10 years ago that neuroscience began to throw light on these questions, with more and more evidence coming to the fore about the effect of a child’s early experience on how the brain structures grow and develop.

In this blog I am going to talk about how the baby’s brain grows. In a future blog I shall focus on toddlers, because in so many ways the parental task for toddlers needs a very different emphasis than that with babies.

Babies are not born with their brain fully developed it is the early years of a child’s life when the brain is growing at its fastest. Within the first year the baby’s brain doubles in size and by 3 years it is almost 80% of its adult size. The most sensitive (and crucial) period of the brain’s development is 0-18 months. It is this part that I want to think about today.

The first part of the baby’s brain to develop (in utero) is the part which deals with emotions. The function of emotions is to guide the baby’s actions to ensure their survival and the baby is completely governed by them. Emotions are produced by the most primitive area of the brain ‘the reptilian brain’ as it was termed by one writer. This is made up of the brainstem and sensorimotor cortex which includes the amygdala and the hippocampus. The amygdala is the organ that produces our fight, flight or in babies freeze response. The amygdala is usually stimulated by sense (taste, pain, touch) stimuli in the babies outside world or inside their body which then produces an emotional reaction. However it can also be stimulated by the internal feelings themselves, the babies feels inside that they are not being held or going to fall apart. When human babies are born they need a caregiver in order for them to physically survive so much of babies survival skills are directed towards their caregiver. They instinctively seek out interaction with others, especially their primary care givers. This calms them.They also have some basic abilities to regulate their own internal state, turning away if they are overwhelmed, freezing if they are terrified or screaming if the pain of hunger, cold or illness becomes too much.

Every baby has got to get from this position to a grown human being who can fit into their family and society. In order to do this they will need to develop more complex emotions and to be able to control these emotions. Babies are not able to do any of the above because they do not yet have the brain structures in place. These structures develop after birth in an area of the brain called the prefrontal cortex. The first structure to develop is the orbitofrontal cortex. The development of the orbitofrontal cortex is dependent on the experiences the baby has from birth. It is dependent on interaction with a care giver. In so many ways this makes sense as it allows the baby to fit in with the family and community in which they find themselves and within which they have to survive.

So what happens in the orbitofrontal cortex? If the baby is cared for by a responsive caregiver, who is open to the baby’s communications and enjoys their baby than certain chemicals and electrical impulses are stimulated in the brain which allows the brain to connect up certain pathways. If there is frequent repetition of these pathways then they become established, creating a pattern of pathways essential for creating a social baby with good mental health. If the baby and mother relationship is difficult or abusive other pathways develop which create a pattern of pathways in the brain which may lead to poor emotional regulation and social integration. As pathways become established other potential pathways are got rid of or ‘pruned’, meaning the baby becomes less and less able to respond in a different way. The brain of this particular baby in this particular environment is taking shape. The development of these pathways is very useful for human beings as at this point in their development they can now anticipate their environment and how they need to react within the environment they find themselves in order to survive physically and emotionally.

The prefrontal cortex has many functions, one of these is to allow the individual to reflect on their experience and consider alternative ways of dealing with the situation  At 10 months the prefrontal cortex and the amygdala (the flight fight organ) start to connect up. It means we no longer have to just be governed by our emotions and the early patterns which are already being established. We can think about them. This process is nearly over by the time the baby is 18 months and marks an important point in human development (I will write about this in a later blog). If the baby is not responded to sensitively then the link between the prefrontal cortex and the amygdala (the flight fight organ) is not strong. This means it is very difficult for the child to go on to use their prefrontal cortex to regulate their stress emotions. They cannot use thought and reason to control their emotions. This means an individual will quickly feel stressed and anxious or enraged if certain patterns from their early history are evoked, even if these emotions are unhelpful in the environment they are in at that moment.

Take a moment to think about Lisa, being able to draw is an essential part of school life at 7 years old but drawing was clearly very stressful for her. It seemed to be eliciting a pattern of pathways which led to a very rapid stress reaction. At this point it was impossible for Lisa or indeed anyone else to know why this was and it took many months before it was possible to be able to think with her about this. For the brain to begin to develop different pathways and patterns which allowed Lisa to think about her experience.

Right, now if you are still with me after the science bit I would like to think with you about what this means for parents and children, both birth parents and adoptive and foster children.

Birth Parents

1. Enjoy your baby, play and talk to him from the moment he is born.
2. Try and follow his cues, if he turns away let him, he will turn back and you need to be waiting with a smile.
3. Spend lots of time holding him, against your body is best, it is very relaxing for your baby.
4. Establish a feeding routine which is not stressful, if this includes bottle feeding then bottle feed. You will spend a lot of time feeding so it is essential that you and your baby find it as enjoyable as possible. If you are stressed your baby will be also.
5. If you are concerned about your and your baby’s relationship, worried you will damage him, worried he is not progressing in line with other babies get help as soon as possible. Do not wait hoping it will go away. There is often a lot that can be done in these early stages of mother and babyhood that might save you years of distress.
6. It is difficult and often disturbing caring for a baby and most mothers have to work hard with the feelings it stirs up. Some babies are more difficult than others, finding it hard to feel settled and contained. If you feel your own feelings are making it difficult to respond sensitively to your baby do get help. There might be a whole host of reasons why you might be struggling with being a mother. A recent bereavement, Post Natal depression, A serious or life threatening illness, difficulties in your relationships or your own history has been stirred up by this momentous event. It is not a crime to recognise you are struggling and to think with someone about this.

Adoptive and Foster parents

You have a much more complicated task as many children will have been in abusive environments for a number of years and their brain structures will have been affected. However all hope is not lost as what we know is the brain continues to make new pathways through life. What makes it extra complicated with children is the combination of the effect of their history, the babies own constitution and temperamental factors and the particular developmental milestone they may be struggling with. All of these factors need thinking about in order to help the child move on.

Do find out as much as you can about attachment theory and what you should expect from a child who has suffered abuse. A lot of children are very behind on their emotional milestones and may need to work their way through these.

Try and get a sense of what the child has been through and how his behaviour might link to his history. This knowledge may not change your child’s behaviour but it will help you feel more tolerant and able to react to the behaviour in a more straightforward way.

Don’t be frightened to be firm, sometimes separating out the idea for the child of ‘need’ and’ greed’ can be helpful (more about this next month). A kind but firm ‘no’ is important to help children, from toddler age onward begin to develop their own emotional resources.

When you first have a child placed with you, you will really want to make it work, but allow them some space also. They need to know they are wanted but they also need to know that you will let them take their own time to get to know you at their own pace.

Keep an eye on your child, how are they developing? Are they heading in the right direction? Do they seem stuck, repeating the same difficult behaviours and responses again and again? Change takes time, as we can see from the brain science but If your child does not seem to be able to step outside these patterns you will need to think about getting help. Your social worker might be able to help or one of the support organisations e.g. Adoption UK. Sometimes just a one off consultation with an experienced professional can help you find a way forward, sometimes something more in depth might be needed.