W HY B ABIES C OUNT : P RESENTATION S UMMARY

W HY DO 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.

Pregnancy and the birth of a baby provide a critical window of opportunity when parents are especially receptive to advice and support. This is a chance for professionals to intervene and help set the pattern for effective parenting. 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.

W HAT IS THE RISK ? 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.

R OLE OF A TTACHMENT 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. They may wrongly attribute behaviour – for example by seeing a crying baby as manipulative or malevolent – and may respond harshly or inappropriately. This is an emerging area of research, but findings indicate that poor reflective functioning may put a child at increased risk of abuse or neglect. By improving parents’ reflective functioning we can give children a better start in life.

H ARM & R ISK 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.

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. 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.

P ARENTAL M ENTAL H EALTH 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: 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’.

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 per cent of new fathers with depressed partners are depressed themselves.

D OMESTIC A BUSE 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.

S UBSTANCE M ISUSE 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.

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.

E VERY BABY NEEDS LOVE, CARE AND NURTURE 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.

S ERVICES 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.