Infant Mental Health for the Pediatric Nurse Practitioner

Attachment is one of the foundational concepts of infant mental health. Attachment is an infant's tendency to seek comfort and nurturance from a 'special' person (most often the parent) especially when stressed. Attachment is a bond that endures over time evidenced in the behaviors an infant (and later child, adolescent, and adult) undertakes to ensure they are in a position to obtain from their primary caregiver comfort, nurturance, and security. Secure attachment is normal (with about 65% of older infants in low-risk samples exhibiting secure attachment). Attachment behavior is seen in all cultures. 

As new behaviors and capacities emerge during the first year or so of life, the infant exhibits describable attachment behaviors. These behaviors are affected by environmental limitations and caregiver weaknesses more than by the infant’s own physical or mental limitations. The parent should provide the comfort and security, not the other way around.

Appropriate social and emotional development depends on attachment security. How secure a child's attachment is often is predicated on the adult parent's attachment security. Infant attachment can occur in the context of abusive caregiving. Disorders that may emerge from attachment issues include reactive attachment disorder and disinhibited attachment disorder.

John Bowlby's attachment theory work developed within the context of his work with ethology, with infants who were deprived and without affection, and with the World Health Organization. Mary Ainsworth identified attachment patterns (using the strange situation procedure) in infants 12-to-16 months of age: secure, insecure/avoidant. insecure/ambivalent, and disorganized. Structured interaction and narrative interview are often used to assess attachment. 

Attachment is often worrisome in situations of abuse/neglect, foster care, foreign adoption, post-institutionalism, divorce, child custody, and intimate partner violence.


How do infants 'use' parents for comfort and security when in threatening situations at the primary care office?

References and Resources:

​Bowlby, J. (1965). Attachment. New York: Basic Books.

Moriceau, S. & Sullivan, R. (2007). The neurobiology of infant attachment. Developmental Psychobiology, 47:  230-242. 

Zeanah, C. H., Berlin, L. J. and Boris, N. W. (2011), Practitioner Review: Clinical applications of attachment theory and research for infants and young children. Journal of Child Psychology and Psychiatry, 52: 819–833. doi: 10.1111/j.1469-7610.2011.02399.