Hopscotch Infant Mental Health Policy
A Handbook for staff, from the perspective of babies and small children
What is this book? It doesn’t look like the other stories in my nursery…
This book is the story of my social and emotional development in the time that you’ll be looking after me. Did you know that the first two years of my life, starting from when I am in the womb, are the most rapid growth and change that I’ll ever experience?
From the moment I am born, there are one million connections forming in my brain every single second (Harvard Centre for the Developing Child)! In fact, by the time I’m one year old, my brain will have doubled in size (Knickmeyer et al, 2008).
Because I’m a baby and my brain isn’t fully grown, the things I need to help me develop and feel good are different to older children and grown-ups. However, my feelings of hunger, tiredness, happiness, sadness, fear, excitement are just as strong as older children and grown-ups. The difference is that I don’t yet have the words to tell you how I feel.
This is known as ‘infant mental health’.
What is infant mental health?
It means how I feel, how I am growing and developing, and my relationships with the people who look after me and are special to me. I need to be helped to feel loved, cared for and secure.
The Association for Infant Mental Health UK (AIMHUK) say that infant mental health means:
“…the way in which infants develop from the antenatal months through early life, and especially to understanding their capacity and need to build relationships with adults during this time and the unique importance of those relationships to brain development.” (AIMHUK)
Special grown-ups are very important to me and they help my brain to grow
How I feel and how I’m developing is dependent on the people who look after me, especially my special grown-ups. In the UK babies mostly have one or two special grown-ups (mummy, daddy, primary carer). Babies who grow up in other countries and cultures might have a wider circle of special grown-ups (Keller, 2022). One thing that’s true for all babies is that we are born ready to socialise. We prefer to look at faces and are already familiar with our grown-up’s voice and smell from when we were in the womb (Sullivan et al, 2011). This is very comforting in this new and unfamiliar world.
The way I am held, spoken to and looked at by my special grown-up are particularly important to me. For example, when I see them smile at me and celebrate something I’ve done, I’ll try my best to do it again. This is how my special grown-up helps me to develop. It feels good for both of us.
The good feelings feel nice, but there is also something magical about them: the good feelings actually grow my brain (Schore, 1994). When I see my grown-up smile at me, chemicals like oxytocin flood my brain and the brain of my grown-up. These chemicals strengthen the pathways and connections in my brain and grow our bond too. In this way, the kind of brain I will develop depends upon my relationships with my special grown-ups (Gerhardt, 2015) and this is why bonding is so important to me.
My special grown-up helps me with overwhelming feelings
When I was in the womb I was very comfy in there and wanted for nothing. But from when I was born, I began to have this awful, terrifying feeling that gripped my entire body and it was so scary. My grown-up called it “hungry”.
This is how babies feel feelings and it’s a bit different to grown-ups. We get new and overwhelming sensations in our bodies that can be very hard to tolerate. It can make me cry and scream, or throw myself on the floor, or jump for joy, or run around and not be able to focus or sit still, or bite and scratch, or give bear hugs.
Having my special grown-up understand my cries, name the hungry feeling and then feed me each time I needed feeding, really helped. I felt heard, relieved and could play again! And when I went back to playing and exploring, I learned more new things. This is another way my special grown-up is helping me to develop: I feel less overwhelmed when this feeling comes now and begin to be able to tolerate it. Eventually, I might even learn the word or sign for “hungry”, so I can start to use it.
My relationship with my special grown-up shapes my identity, my relationships with others and is important for my survival
The way my grown-up cares for me helps me to develop my identity. From being held and interacted with in a consistent way – chatting, singing, rhymes - I learn what kind of person I am. For example, an important person, or a loveable person. I learn about others too, like whether they will help me and whether I can trust them. This influences how loved, cared for and secure I feel (Bowlby, 1969).
From around 9 months old this attachment to my grown-up becomes like a template for all my relationships (Bowlby, 1969). This template is important for my survival because it helps me to know how to stay safe and reduce threats to my emotional or physical safety (Crittenden, 2016). For example, if I am scared I may try to move closer to my special grown up for protection and comfort, or cry loudly to get them to come to me. If my special grown-up consistently shows me I can rely on them for help, I’ll be more likely to ask for help – and to get it -as I grow.
Things get more complicated if my special grown-up – the person I rely on for safety and comfort – is also a threat to me. In this situation, I am good at adapting to make myself as safe as possible. For example, I might stay very still or very quiet or go to others to get my needs met instead. Amazingly, I begin to adapt to the care my special grown-up gives me from just four weeks old (Crittenden, 2007).
My teachers at nursery are also really important to me and my development
Starting at nursery can be a scary and overwhelming time. It means leaving my special grown-up who knows me so well and who loves and comforts me the best. Often nursery is the first place outside home.
This love really matters to me because it makes me feel good and it helps to grow my brain and to keep learning (Gerhardt, 2015). Love is different to care – it’s more than just helping me eat, sleep and play. It’s about feelings, connection and being together. For example: Knowing and understanding me. Delighting in me. Learning from me. Truly seeing and accepting me. Being in the moment with me. Experiencing all this about me in a genuine way. However, you can’t tell people how to love and be with each other – there’s no checklist. It’s something that is grown between people.
Teachers can grow to love the babies in their care, however, this may take time and isn’t always easy. Showing me that you like and appreciate me and are interested in meeting my needs shows me how much you care. This is the best start for me.
Some grown-ups might find it strange; the idea of a teacher loving the babies and small children they look after for a job. But it’s not strange to me and my friends. We love to be loved! It’s what helps us to learn and develop best. A scientist called Dr Jools Page asked lots of special grown-ups about this. They said they want nursery to be a loving environment for us and they give our teachers permission to love us (Page, 2011). Hooray! She calls this ‘professional love’ (Page, 2018) because it’s different to the love my special grown-up gives me. Even the Government agrees that love is part of “high quality care” in the early years (Development Matters, 2023). Now you know it’s a professional thing, and something that I need for my development, I hope you’ll feel more confident in being a loving teacher to me.
You can read more about professional love and watch a video about what it means, here: What is Professional Love? | Professional Love
The science: Why do relationships in the first two years matter so much?
Did you know that grown-ups have done a lot of science experiments about babies in the first 1001 days of life? They found that:
- The first two years is a really important time, starting from when I was in the womb. No other time in my life will have such a big lifelong impact. Our experiences before third birthday can even influence generations to come through ‘switching on’ or ‘switching off’ certain genes (National Scientific Council on the Developing Child, 2010)!
- The relationship I develop with my special grown-up lays the foundation for all my future learning, development and relationships. Babies who have a secure attachment to their special grown up (where they feel safe, secure and loved) are more likely to enjoy and achieve in life overall, including in health, relationships, school and work (National Scientific Council on the Developing Child, 2015)
- If babies have really tough times (‘adverse childhood experiences’) in the first 1001 days, sadly this can also affect them for the rest of their lives. For example, my friends who live with grown-ups who hurt each other. Or my friends who don’t have enough clothes or food. Or my friends who have a grown-up that hurts them, or doesn’t show them love or cuddle them enough. These babies are more likely to struggle at school, in work and relationships, have poor heart and immune system health and are more likely to experience serious mental health problems (Nelson, 2020). Their grown-ups could probably to do with extra love and support too and may have had some hard times themselves as babies.
- Special relationships in these early years make a HUGE difference. And grown-ups don’t have to be perfect – just good enough is best for us (Winnicott, 1953). As my teacher, you’re not just helping me to learn, but you’re actually growing my brain! You’re doing so much more than looking after me: you’re laying the foundations for positive relationships, achievement, resilience and success for the rest of my life. Thank you!
How does understanding infant mental health guide my teachers and my nursery?
Help me to settle in. Please understand that because I rely on my special grown-up to feel safe, loved and secure, being away from them at nursery can feel scary, sad and overwhelming. Nursery does look really fun though and I desperately want to play and join in! Having my special grown-up come with me - at least at first – will help me feel more comfortable. Especially if my grown-up seems to like my teacher and can feel relaxed and confident about me being there. HOP3 Settling In: Information Pack .
Grow a special relationship with me that feels good to both of us: Having a special teacher will help me to know who I can count on for comfort and to know and understand me while at nursery]. This person can be like my ‘safe base’ at nursery and this will help me to feel secure and to explore my environment. Just like you, there are some people I am drawn to more than others. If you notice I am forming a special bond with one teacher in particular, please try and make them my special teacher (keyperson policy: 
Care .)
Care .) If you want to understand me, get to know my grown up. The government says this is one of the seven most important ways that you can be the best teacher possible (Development Matters, 2023). It’s hard for my teachers at first, because they don’t know me like my special grown-up. Please ask my grown-up all about me. If you notice I’m not myself, talk to my grown-up and ask them about this. Another good way to understand me is to watch me. Noticing my voice, body, face, activity, relationships with others, how I’m doing with eating, sleeping and toileting will tell you a lot about the person I am and how I am doing in myself. ( HOP3 Settling In: Information Pack )
My emotions are all over the place! And probably will be for some time until the part of my brain in charge of controlling emotions grows some more. This is a normal and healthy sign of my development. When my emotions become overwhelming I might do things like lash out, or collapse and cry on the floor. Some grown-ups call this “challenging behaviour” (because it’s challenging for them!) but really it’s a way of communicating my feelings. Please help me with my emotions and know that each time you help, you are growing my ability to do this for myself. There are lots of ways you can help:
Noticing if I seem stressed or distressed. Remember, babies and small children show how we are feeling differently to grown- ups. You might notice a change in my behaviour, speech and language, my relationships, or my emotions. This might be a one-off, or you might notice a pattern. All can be signs that I may need help.
Throughout my time at nursery I’ll be relying a lot on you being close by to help me with my feelings. Grown-ups call this ‘co-regulation’. It means being close by in case I need you; giving cuddles, rocking me, talking calmly and softly to me, getting me the things I need and showing me that you understand how I’m feeling. Co-regulation is especially important for younger babies who cannot talk or understand language and may not yet be able to move or crawl to find their special teacher. Babies’ brains are extra sensitive to non-verbal information (Gerhardt, 2015), so gentle touch, a kind face and soothing voice help me the most, as well as getting me the things that I need (food, nappy change). Even if you don’t get it right first time and I’m still upset, just the act of trying to help shows me that you care and contributes to me feeling helped and understood.
As I grow, supporting me to develop the language to express myself by talking with me about how I’m feeling, or by showing me other ways to cope with big feelings, like modelling staying calm yourself.
Using a positive approach to shaping my behaviour. This means giving me clear and consistent boundaries and always looking for opportunities to praise and encourage me when you see me doing well. This is good for my development and my self-esteem and confidence. You can read more about what this looks like in Development Matters (2023, p.42-58).
Offering lots of opportunities for creative and imaginative play, for example arts and crafts, music and dance, imaginative play because play is still one of the biggest ways I learn about and process my experiences.
Take extra care with feeding and changing me. These are sensitive because they’re about looking after my body when I eat or need changing. My body might be allergic to some foods. Being cleaned up at nappy time may remind me of a traumatic experience. It can make me feel really vulnerable so I prefer being fed and changed by someone I know well and who knows me [Policy Review].
Make my environment safe and fun: This is my space and I like it when things are familiar because it helps me to feel safe. For example, having a consistent routine around eating and napping. Having the same teachers in the room helps too. Or, if someone new pops into my room, I’d like them to introduce themselves and to talk to or smile at me so I can feel they’re a safe person and have me in mind. I love the fun and stimulation of nursery life, but I also need downtime because of the way my brain is developing. After fun and exciting experiences, my brain gets busy ‘wiring in’ these experiences. This is why it helps me to have lots of opportunities for quiet or less-structured time around fun activities, to give my brain time to process these experiences and make new connections and pathways. Making sure my room is a calm, peaceful and soft environment will help with this.
Help me make friends: Just like the scientists say, special relationships lay the foundations for other special relationships. Nursery might be one of my first opportunities to make friends. It’s not all plain sailing because my friends often seem to be playing with the toy that I want to play with! Please help me to play and interact with my friends. Please help me to build special friendships through showing and encouraging me to be friendly, kind and caring to others and by helping me to problem-solve and repair friendships when things go wrong (policy link: ➕Positive Behaviour )
Put me and my special grown-up in touch with specialist help if I need it. For example, the nursery special educational needs coordinator, my health visitor or specialist services that support child development or parent-infant relationships.
Protect me if you’re worried I’m not safe. If you see signs that I may be being hurt, or not well cared for, please tell someone who can help me. Often the first sign is a change to what is normal for me. However, it’s quite possible that I may not have been safe from when you first met me and so there is no change as such. Signs that I may not feel safe and am in distress can be physical (unexplained or unusual bruising, not being clean), emotional (seeming withdrawn or sad, lack of joy, looking frozen and stiff), behavioural (deliberately hurting myself or others, sexualised behaviour), or developmental (not developing as expected or going backwards in my development, e.g. toileting, language or play). Some of these can be signs that I am adjusting to less worrying situations, like the birth of a new sibling, or feeling unsettled after moving house. However, if you are worried you should talk to my special grown-up and follow the nursery safeguarding policy: Safeguarding at Hopscotch
- Helping my grown-up will help me: (Linking families in to additional support). Sometimes, it might be my grown-up who is having a wobble. I care about them a lot so please ask them if they are ok and whether they need any help with me. Together with your senior team member, please offer them advice or show them where else they can get help.
- If my teachers feel good, they will be able to take better care of me. My nursery should take steps to care for and look after the wellbeing of my teachers. If teachers feel good and enjoy working at the nursery they will also be more likely to stay. This is good for me because having the same teachers who I know well and who know me helps me to feel safe and secure. You can read more about promoting staff wellbeing here: https://www.annafreud.org/resources/under-fives-wellbeing/early-years-staff-wellbeing-a-resource-for-managers-and-teams/
Want to learn more?
I hope you enjoyed this story and learned a lot about how best to care for me. If you want to read more, do look at the following websites:
Or feel free to read the references in this handbook:
Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. New York: Basic Books.
Crittenden, P.M. (2007). CARE-Index: Infant Coding Manual. Unpublished manuscript, Miami, FL
Crittenden, P.M. (2016). Raising Parents: Attachment, Representation, and Treatment (2nd Ed.) Oxon: Routledge.
Gerhardt, S (2015). Why Love Matters. Routledge: Hove.
Harvard Centre for the Developing Child, Brain Architecture. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/brain
Keller, H. (2022). The Myth of Attachment Theory: A Critical Understanding for Multi-Cultural Societies. Oxon: Routledge.
Knickmeyer, R, C. et al (2008). A structural MRI study of human brain development from birth to 2 years. Journal of Neuroscience, Nov 19;28(47)
National Scientific Council on the Developing Child (2010). Early Experiences Can Alter Gene Expression and Affect Long-Term Development: Working Paper No. 10.
National Scientific Council on the Developing Child (2015). Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper No. 13.
Nelson, C., et al (2020). Adversity in childhood is linked to mental and physical health throughout life. British Medical Journal, 317.
Page, J. (2011). Do Mothers want professional carers to love their babies? Journal of Early Childhood Research, Vol 9 (3).
Page, J. (2018). Characterising the principles of Professional Love in early childhood care and education. International Journal of Early Years Education, Vol. 26(2)
Schore, A (1994). Affect regulation and the origin of the self. Hillsdale, NJ: Laurence Erlbaum Associates Inc.
Sullivan, R., Perry, R., Sloan, K., Kleinhaus, A., & Burchen, N. (2011). Infant bonding and attachment to the caregiver: Insights from basic and clinical science. Clin Perinatol. 19;38(4):643–655
Winnicott, D.W. (1953) Transitional objects and transitional phenomena: a study of the first not-me possession. International Journal of Psychoanalysis 34(2):89–9
Infant Mental Health Policy Handbook
PDF document 6MB
Infant Mental Health Summary Sheet
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