WHY UNBORNS & BABIES
MATTER
Gary Sanders
Child & Parent Assessment Service
WHY DO UNBORNS & BABIES MATTER?
It is wrong for any child to live with neglect or abuse. The UN
Convention on the Rights of the Child enshrines our commitment to
ensuring vulnerable children are cared for and protected from harm.
Babies can’t defend their own rights, which is why we all must do
more on their behalf.
Early adversity has a long term impact. Pregnancy and the first year
are critical. This is a period of rapid development, setting the
foundations for all future learning, behaviour and health.
Abuse and neglect at this stage can have lifelong consequences.
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Pregnancy and the birth of a baby provide a critical
window of opportunity when parents are especially
receptive to advice and support.
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This is a chance for professionals to intervene and help
set the pattern for effective parenting.
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There is a strong economic case. Money invested in
support for children at risk is more cost-effective than
money spent later to deal with the consequences of
abuse, which accumulate over time and become
increasingly difficult and costly to manage.
WHAT IS THE RISK?
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Children under one are more likely to suffer
neglect and abuse than a child of any other age.
They are eight times more likely to be killed.
Almost half (45 per cent) of all serious case
reviews involve a child under one, and a large
proportion of these relate to the first three
months of life.
ROLE OF ATTACHMENT
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Secure attachment is vital
Research shows the links between infant-parent attachment and
psychological and behavioural development, such as empathy, self-esteem,
cognitive abilities, persistence in solving problems and the development of
peer relations.
Babies who don’t receive appropriate care and attention are less likely to
develop secure attachment. However, importantly, attachment can be
influenced by effective interventions.
A number of interventions promote sensitive care giving and secure
attachment as ways to prevent abuse and neglect.
Reflective functioning is essential to parenting and important in the
development of attachment relationships. A parent who lacks the capacity
to be reflective finds it difficult to understand the feelings and emotions of
their baby and fails to see their infant as having needs, desires and
intentions of their own.
Research Findings indicate that poor reflective functioning, even during
pregnancy, are indicative of identifying the likelihood of poor parenting
may put a child at increased risk of abuse or neglect.
By improving parents’ reflective functioning during pregnancy and in the
first 12 months we can give children a better start in life.
HARM & RISK
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No single factor causes babies to be abused. Singular
explanations of child maltreatment don’t do justice to
the complexity of family life.
Many factors influence a child’s development, and
these can interact and change over time.
However, it is clear that parental problems such as
mental illness, domestic abuse and drug and alcohol
misuse can make the job of parenting harder and may
increase the risk of neglect or abuse.
Analysis of serious case reviews shows that at least
one of these issues is present in many cases, and
there is often a high degree of overlap of these factors
in cases of child death and serious injury.
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These factors can affect children in a number of ways:
they may directly affect the growing foetus,
 expose a child to stress or harm,
 or limit the adult’s ability to parent.
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There are, of course, many parents affected by these
issues who do give their children all the love, care and
attention they need.
Reducing parental problems alone does not
necessarily improve parenting and child development.
Interventions should also focus on parental
behaviour, parent-infant interactions, the child’s
social environment and the child’s physical,
emotional, social and intellectual needs.
PARENTING AND LEARNING DISABILITY
Neglect –omission not commission(Booths, 2005;
Tymchuk& Andron, 1990)
 Discrepancy between parent’s knowledge, skills,
experiences & children’s needs(Bakken1993;
McGaw1999)
 Vulnerability to psychopathology(Tymchuk1993;
McGawet al., 2005)
 Poverty, stress, poor social supports(Feldman,
1997; Denny et al 2001)
 Link between Knowledge ---Skills --Practice
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HEALTH OUTCOMES FOR LD MOTHERS AND
THEIR BABIES
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Women with learning difficulties and their babies are
at greater risk of poor health outcomes during
pregnancy and the early postpartum period. Quality
care is therefore paramount in the antenatal period to
give these vulnerable mothers and their new born
babies the best start in life. During pregnancy,
women with learning difficulties are significantly
more likely than other pregnant women to:
Experience pre-eclampsia
Have babies with a low birth weight
Have their baby admitted to neonatal intensive care
or special care nursery
Experience adverse mental health outcomes, such as
depression, anxiety and stress.
More difficulties with maternal child interactions.
UNDERSTANDING SUPPORT IN THE CONTEXT
OF A NETWORK
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It is important to consider those around the mother:
Explore with the mother the support that others
intend to provide and how these compliment her skills
With the mother’s permission, involve those in her
support network to identify any ‘gaps’ in how care will
be provided for the new baby
Teaching parenting skills will be more effective for
mothers with learning difficulties if skills are
presented in a way that is:
Specific
Structured
Situational
Parent-directed
Skill-focused
PARENTAL MENTAL HEALTH
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Around 144,000 babies under one in the UK have a parent with a
mental health problem.
Maternal depression is the most common condition. Around 14 per
cent of mothers in the UK experience postnatal depression.
Depression generally does not begin at birth: symptoms frequently
occur during pregnancy.
Depressed mothers are at risk of displaying two types of negative
parenting styles, typified by ‘intrusive and hostile’ communication at
one extreme and ‘withdrawn and disengaged’ at the other.
Fathers also experience depression. A recent study found that 4 per
cent of fathers experience depression during the first year of their
child’s life. Having a partner who’s depressed can be a trigger: 24-50
per cent of new fathers with depressed partners were depressed
themselves.
Fathers matter both because of the direct impact of their depression
on themselves and their children, and because of their role in relation
to maternal mental illness, where they can act as a buffer between
mother and child. Research shows fathers with depression have less
involvement with their children, and higher rates of ‘infant directed
negativity’.
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Serious mental illnesses – such as schizophrenia
and related psychoses – and affective disorders
can pose significant challenges to parenting and
risks to children, particularly when mothers lack
insight into their disorder and are acutely
unwell.
The first three months after child birth are when
women are most likely to experience, and be
hospitalised for, psychiatric disorders. In 90 per
cent of maternal filicide cases, psychiatric illness
was documented.
24-50 per cent of new fathers with depressed
partners are depressed themselves.
DOMESTIC ABUSE
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It is estimated around 39,000 babies under one in the UK have a
parent who has experienced domestic violence in the last year.
This underestimates the extent of domestic abuse, as it captures only
physical violence and not the full breadth of abuse that can operate
within an intimate relationship such as sexual, emotional,
psychological and financial abuse.
Many women first experience domestic abuse, or an escalation of
abuse, during pregnancy or immediately after birth. Studies suggest
that domestic abuse can escalate during pregnancy and the period
directly after birth.
Domestic abuse during pregnancy heightens maternal stress, which
extends to the foetus and later to the newborn child. Once born, a
baby faces three main risks: observing traumatic events, being
abused, and being neglected.
Infants as young as one year old can experience trauma symptoms
from witnessing domestic abuse.
Around 39,000 babies under one in the UK have a parent who has
experienced domestic violence in the last year.
SUBSTANCE MISUSE
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An estimated 109,000 babies under one in the UK live with a
parent who is a hazardous or harmful drinker or a user of
class A drugs.
Substance misuse can harm a child’s development both
directly through exposure to toxins in the womb and indirectly
through its impact on parenting capacity. Parents can become
less loving, caring, nurturing, consistent or predictable as a
result of substance misuse.
Research shows that alcohol is one of the most dangerous
neurotoxins affecting the brain during pregnancy, more so
than many illegal substances.
Most drugs cross the placenta, and research has charted a
range of adverse consequences associated with drug misuse
during pregnancy.
The majority of infants born to dependent mothers (60-90 per
cent) will show varying symptoms of neonatal abstinence
syndrome.
Around 14 per cent (109,000)of babies under one in the UK
live with a parent who is a substance misuse.
ANTENATAL PERIOD
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Men can have a profound impact on families and
need to be centre stage in strategies for
intervention. Professionals must consider and
engage the key men in a child’s life, to assess the
risks they pose and the strengths they bring to
family life.
Promoting informed choices and resilience before
conception creates the conditions for families to
thrive, and the antenatal period is vital for child
development and preparation for parenthood.
EVERY BABY NEEDS LOVE, CARE AND
NURTURE
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The quality of parent-infant interaction is
paramount.
Interventions that foster secure attachment can
prevent abuse and poor parenting.
Parents’ capacity for reflective functioning (or
‘keeping the baby in mind’) is likely to be
instrumental to their ability to provide effective
care.
Physical punishment of babies is ineffective and
unacceptable.
SERVICES NEED TO ‘THINK FAMILY’
Assessments need to take into account the whole
family context.
 When addressing parental problems such as
mental illness, substance misuse and domestic
abuse, we need to ensure that parents are
supported to fulfil their parenting role and that
children get the help they need.
 Dads and father figures have a profound impact
on families and should share centre stage in
strategies for intervention.
 The antenatal period is a vital stage in child
development and in preparation for parenthood.
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