Evolving evidence means evolving action for babies

As part of this year’s Infant Mental Health Awareness Week, co-ordinated by the Parent-Infant Foundation, we want to help raise awareness of the emotional needs of babies. As a pioneering mental health charity, we work to transform care for babies, children, young people and families through science, collaboration and clinical innovation.

In this blog we learn how the evidence that shapes action for babies has evolved over time, helping us to advance wellbeing and clinical practice as well as decision-making at the heart of government.

Dr Michelle Sleed, Senior Research Fellow - CHAPTRe (Child Attachment and Psychological Therapies Research - a partnership between Anna Freud and UCL) reflects on more than 20 years of work in the field of parent-infant relationships, describing how her own understanding has changed as neuroscience and new evidence emerges, shedding new light and improving practice.

We didn't always know what we know now

We now know that babies’ social and emotional development is actively shaped by the relational worlds around them, be that the comfort they receive, the safety they feel or the consistency of the adults who care for them. The recent advances that have been made in research with babies and their caregivers has had a powerful impact on what we now understand about babies’ experiences and how important they are for their life trajectories.

Over the past two decades in particular, professionals across health, social care and early years services have begun to recognise something that infant mental health specialists have long understood: babies have emotional lives, and those emotional experiences matter profoundly.

A happy-seeming baby is not always a thriving baby

Before joining Anna Freud (21 years ago), I worked on an evaluation of a home-visiting programme for families with babies and young children. This involved travelling around the south of England and doing in-depth interviews in families’ homes. Many of the families were living in extremely difficult circumstances. Looking back, I remember being struck by how “happy” many of the babies appeared, despite the chaos around them.

At the time I thought babies were very resilient. They seemed cheerful and adaptable. It was only later, working alongside parent-infant psychotherapists at Anna Freud, that I encountered the idea of the “precociously good baby” - infants who appear unusually compliant or emotionally self-contained because they have adapted to environments that feel unpredictable or unsafe.

That completely changed how I understood babies’ cues. A happy-seeming baby is not always a thriving baby.

This remains one of the central challenges in infant mental health work: babies cannot explain what they feel in words, and professionals can sometimes miss the meaning behind what they observe.

The “baby blind spot”

Infant mental health specialists now refer to this as the “baby blind spot” - the tendency for adults to overlook infants’ emotional experiences, particularly when families are already under pressure.

When practitioners see adults that are in crisis, it can become very difficult to hold the baby’s perspective in mind. Partly because thinking about a baby suffering is so painful.

This can happen across systems and services. In situations involving domestic abuse, for example, professionals may naturally focus on the experiences of older children while assuming babies are “too young to understand”.

But decades of developmental research and evidence tell a different story.

Babies are highly sensitive to the emotional environments around them. Their developing brains are shaped through relationships, and experiences of fear, inconsistency or relational trauma can become deeply embedded, even before they are old enough to consciously remember them.

The growing evidence base builds on early theory

Babies do remember. Babies do feel. The body remembers, even when we cannot consciously recall those early experiences.

Longitudinal studies, neuroscience research and adoption studies have all contributed to a growing evidence base linking early relational experiences with later emotional and developmental outcomes.

Much of this understanding builds on attachment theory and the pioneering work of figures including John Bowlby and our founder, Anna Freud.

Bowlby’s early observations of children separated from caregivers during hospital stays challenged prevailing assumptions of the time. Separation had often been seen as beneficial or even necessary, with parents discouraged from staying because children became distressed in their presence.

What Bowlby demonstrated instead was that children’s distress reflected attachment, not “bad behaviour”. Separation from caregivers could itself be deeply traumatic.

Anna Freud’s influence

During the Second World War, our founder Anna Freud opened the Hampstead War Nurseries, offering refuge for hundreds of children made homeless by bombing. The Nurseries provided a unique opportunity for observational research into child development and study of the impact of the war on children. Her work further reinforced the importance of stable caregiving relationships for young children, even during periods of upheaval and separation.

Since then, infant mental health has gradually moved from a specialist interest to a growing area of mainstream awareness. The expansion of Infant Mental Health Awareness Week reflects that shift, alongside increasing policy attention on the “critical 1001 days”.

Challenges remain

Yet significant challenges remain. Specialist parent-infant services are still limited in many areas, and professionals working with families often face impossible pressures. Some practitioners acknowledge that services can struggle to respond adequately to the most complex relational difficulties, particularly where trauma is intergenerational and intertwined with poverty, racism and social exclusion.

There’s a need therefore for more practical tools to help frontline professionals identify concerns in parent-infant relationships earlier.

We have excellent research tools but many are time-intensive and require specialist training. But the sector is continuing to work hard to turn research into improved but realistic everyday practice.

Part of my current work focuses on developing more accessible approaches that help professionals “hear the voice of the baby” and respond as early as possible.

Evidence offers hope

Importantly, infant mental health research has also evolved in ways that offer hope. Studies such as the “still face” experiment have shown not only how sensitive babies are to caregiver responsiveness, but also that healthy relationships do not require perfect attunement.

Good relationships include lots of ruptures. What matters is repair.

Missed cues, misunderstandings and moments of disconnection are part of ordinary caregiving. What supports healthy development is the experience of reconnection - helping babies learn that relationships can recover after moments of stress or difficulty.

For professionals working with babies and families, this offers an important reminder: infant mental health is not about perfection. It is about relationships that are safe enough, responsive enough, and supported enough to allow babies to grow, communicate and feel understood.

And perhaps most importantly, it is about continuing to make babies visible - not only as passive witnesses to family life, but as people whose emotional experiences matter from the very beginning.

Our current research projects focused on babies

Learn more about some of the research projects colleagues across the sector and I are currently working on to improve the wellbeing and emotional lives of babies and their families including:

• Start for Life programme evaluation: Anna Freud has been a part of a large evaluation consortium focusing on perinatal mental health and parent-infant relationship. The evaluation is heading into the final stages now with results due this summer.

• National Parent and Infant Relationship (PAIR) Framework: Anna Freud is the lead research team in this four-year project that aims to develop best practice guidance to support implementation of parent-infant relationship pathways and improved provision. It draws on best practice from parent-infant teams and services across the UK, and brings together people with lived and learned experience, research, evidence from practice and professional guidance.

• Evaluation of the Early Years Workforce pilots: This was a two-and-a-half-year study looking at the effectiveness and implementation of innovative workforce models in five local authorities. This study, which is just coming to an end, provided learning on how best to deliver health, support, and wellbeing services to families in the first 1001 days.

Want to find out more?

At Anna Freud, we also offer a range of resources and training developed by expert clinicians to support early years professionals.

Learn more about activities planned by the Parent-Infant Foundation for Infant Mental Health Awareness Week and follow us on Instagram this week to learn more about pioneers in baby development theory.

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