Emotional Milestones: No. 1

I had planned to finish this series after my last blog but felt after reviewing the series that it lacked something. I feel that understanding the brain science is very helpful and vitally important but it does not give you the whole picture.

So in this next blog I am going to look at emotional milestones. I believe that just as children have physical milestones, sitting, walking, talking, teething, weaning and potty training there are also emotional milestones which are linked both to brain development but also to the child’s social and emotional experience.  These emotional developments take place within the setting of home and nursery. Their resolution depends both on the child’s own constitution and their ability to tolerate emotional stress but also the support of the adults around them.

So what are these milestones?

  1. For the baby to develop an inner coherence and sense of self.
  2. For the baby to develop an idea of a caregiver (usually mother) who comes and goes, initially for short periods of time and then for longer absences.
  3. For the child to develop the idea that you have to share your mother not just with a father but also with other siblings.

If these milestones can be achieved than I believe that they form the foundations of good mental health. I am going to divide these milestones into ages, the age when the average child is working on this milestone. Again, a warning about averages, because they are just that, the age at which a general child is most likely to be working on that issue. If the milestone is not worked through properly then the child will struggle with managing in all sorts of ways, socially, emotionally and often academically. It may also affect how other milestones are managed and worked through.

Milestone 1: Developing an inner coherence

Let’s start with the infant. After the first 4 months the infant is being to develop an inner coherence, a state of mind where they feel held together. In this state of mind, they can be left alone to lie or sit. They are awake but settled, watching the world around or trying out their own body.  They can do this without actual contact with their own mother.  Without the development of this inner coherence the baby will not be able to grow into a child who can be left by their mother, they will not be able to settle to play, or indeed begin many of the other tasks needed to get through the other emotional milestones.

When a baby is born they leave the safety of the womb, where everything is on tap, they are never hungry, they are always the right temperature, for most babies there are no sudden loud noises or bangs that might hurt their arm or leg, the womb provides an environment where they always feel held and supported physically. When they leave the safety of this environment they will suddenly be in a world where the opposite is true, they can be too cold or hot, hungry or wet, physical conditions which cause discomfort physically but also emotionally. They may also feel emotionally uncomfortable, angry, frightened or unhappy. These feelings can make the baby feel like their mind is going to fall apart. At times even really good feelings can feel overwhelming for the baby, causing them discomfort. The new born is unable to understand whether the discomfort is in their mind or their body. Additionally once the baby is out of the womb they can do very little to alleviate this pain themselves. New born babies are utterly dependant on those around them to regulate their environment, all they can do is try and dispel the discomfort by screaming it out or kicking it out. Most mothers have an instinct that their baby needs to be kept quiet, warm and fed, conditions as close to the womb as possible. They know that new born babies need to be at the right temperature, in a physically comfortable position, not have an empty tummy for too long, kept quiet and relaxed. However they can no longer provide this for themselves. It is only there if it is provided for them, by an attentive and thoughtful mother. Feeding is a very important part of the new borns life. It is so often the nipple or teat, provided while tucked up close to mum that leaves a baby feeling at their most secure. It is this successful feeding relationship which is one of the most important factors in developing that inner coherence for babies.

What is also importance to the baby developing a sense of coherence is not just having their physical needs met but also having a mother who can take in and think about their feelings. This is often completely neglected in many texts on infant growth and development.  The baby may feel like it is falling apart not because it is physically uncomfortable but just because it is frightened.  There may be no physical trigger. At these times the baby needs the reassuring presence of the mother, who can take in how frightened her baby is and tolerate it. She may do this alongside holding or talking to the baby gently until the baby once again feels more gathered, but this taking in and tolerating part cannot just be replaced by ‘doing’ something

What is more, in order for the baby to develop this inner coherence the mother needs to be able to understand a lot of the time what it is that is causing the baby discomfort, sometimes she will need to do something, change a nappy, feed the baby, wrap them in a blanket, take off a layer of clothing, sometimes she will need to refrain from doing something and just notice that the baby is really frightened and needs her to talk to it, sing gently, rub the baby’s face, rock them or pick them up and hold them. In order for the world to feel like it makes sense to the baby and for the baby to feel understood, its actual needs must be met again and again. If the mother meets what she believes to be her baby’s needs but she continually gets it wrong this will not be helpful for the baby’s development, for example, she changes the baby’s nappy when the baby is hungry, or she tries to feed the baby when the baby is tired or just wants company and stimulation, or if the baby’s mother always thinks there is something physically wrong and so will always try and ‘do’ rather than just ‘be’ with their baby. If this happens regularly enough then the baby will not be able to match how they experience the world with how they are responded to or will not be able to start the important process of beginning to be able to tolerate and think about their own emotions.

As the babies needs are met time and again and their fears and anxieties are taken in by the mother, digested and thought about the baby begins to develop a picture of a world which is safe and secure.  The baby begins to gain an understanding of who they are and that they have a physical body and an emotional mind.  This is the basis for that inner coherence.

There are several writers from my therapy tradition who have written extensively about this early relationship and how important it is to allow the baby to grow emotionally and begin to develop inner thoughts. They were aware that in those early few months that the mother needed to be totally preoccupied with her baby, Bion called this state ‘reverie’ and Winnicott called it ‘maternal preoccupation’ A sense of a mother so preoccupied and entranced by her baby that she is never very far away and responds quickly and gently to both his physical needs and his state of mind. This is the mothers task.

However as I am sure you are aware especially if you are reading this blog there are so many things that can go wrong. I am going to list some of them.  Sadly, these difficulties will impact on your baby’s ability to internalise a safe, secure and robust picture of the world.

  • Many mothers, even when they have been really looking forward to having a baby may be overwhelmed by this tiny, vulnerable infant, who seems to need so much of them. For some women losing themselves in reverie can feel frightening and difficult, leaving them feeling like they do not know where they end and the baby begins. This can be true for all mothers on occasions but if it is a constant feeling for a mother it can get in the way of her being able to enter this state of reverie. Her baby can feel like a terrible burden.
  • The feeding relationship can be fraught with difficulty. Many mothers want to try breastfeeding and can feel very disappointed and inadequate when their baby finds it difficult to latch on, or mothers whose breasts become sore and painful, making breastfeeding a nightmare. I have always believed that while breastfeeding is important having a happy mother and baby is more important (and I believe in this early relationship they are inseparable) so if a bottle suits you better then use a bottle.
  • Many mothers feel very worried that their tiny, helpless baby cannot survive on their own at all so they respond anxiously to every murmur or whimper. This means that the baby will struggle to develop their own internal coherence and will always be dependent on their mother to be present. They have no practice managing their own frustration or indeed developing thoughts.
  • Babies who are in extreme physical discomfort. This may be because of a physical illness or premature birth or early and particularly invasive surgery. As you can appreciate it is going to really impact on the babies ability to internalise a mother who can make things better and so allow the baby to begin to build up the state of coherence which comes from this.
  • Babies who are born emotionally fragile, who can’t tolerate any frustration and distress and so cannot begin to internalise a responsive mother. This baby can end up feeling like the world outside and so inside itself is bad.

This blog is not meant to scare you and in my experience, most babies recover very quickly even if they have had a difficult early start.  Many babies can then go on to develop that inner coherence from which they can grow. However, if you are concerned about any of the above do get help.

Many professionals, even mental health professionals do not work with infants and mothers. A safe bet would be to get help from someone who is registered with the Association of Child Psychotherapy (ACP) or who has trained with OxPIP.

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