Mental health articles

Assessment of infant–parent interaction
Even in a brief interview with a family, many useful observations can be made
that provide information about the ‘quality’ of the interaction and relationship.
Relationship factors
The interaction between parent and infant and, where possible, between the
parents while they are with the baby, needs to be observed. This provides
information about:
• parental sensitivity to the infant
• infant responsiveness to parental care and attention
• the ‘fit’ between them
• infant and parent safety
• the parents’ capacity to work together to care for the infant and the quality of
their relationship.
The relationship and interaction with the infant is affected by:
• immediate contextual factors
• individual aspects and characteristics of the caregiver and infant
• events in the past, especially the parents’ experience of being parented.
The behaviour of the parents and infant while they are with you is as important as
what is said. It is recommended that the clinician pay as much attention to what
the parents and infants are doing as to what they are telling you. With the infant
in the room you will see how easily the infant settles, how responsive the infant
is to parental voice and touch, how the infant indicates his needs and how these
are responded to. With a toddler present, you will learn a great deal about how
free he feels to explore the room, how much proximity he seeks from his parent
and the behaviours that gain parental attention.
That said, the language used by parents, the way they talk to and about their
baby also provides a great deal of information. You may notice, for example: 1 offhand remarks and nicknames
2 stories, when a parent may consciously or unconsciously be talking about
other people or situations but describing something about the infant or their
interactions with the infant
3 non-verbal communication between parents, and between parent and infant,
particularly facial expression and touch
4 what the parents say to the infant, what they say about the infant and how
these compare.
EXAMPLES
The following examples illustrate how offhand remarks and comments need to
be taken in the context of the overall assessment process.
1 Karen had a severe post-partum haemorrhage after delivery of her first child.
Her mother had died early in her own life. She presented with anxiety and
depression, having difficulty caring for her baby. She described her daughter
a couple of times as ‘to die for’, conveying an aspect of her own sense of almost
dying during labour but also some uncertainty about whether mother and child
could both survive. Would she also have to die in some way for her daughter,
replicating her own loss?
2 Observed in a supermarket queue: Two young women with an infant of about
18 months were talking. The mother called her daughter a ‘pest’ a couple of
times. They began talking about going home for lunch. One turned to the
infant and said, ‘And what shall I give you for lunch Christie? Dog food I
reckon’. Now if asked about this, the parent may have said it was a joke and
that her daughter had tried eating the dog food, but unmistakable hostility to
the infant is conveyed in these offhand remarks and generates concern, which
in this context cannot be addressed—but could be, in a sensitive clinical
interview.
3 During a clinical interview, Jane described how she has been depressed, and
was still having difficult days when she would spend a lot of time lying on the
couch and crying, with her little girl of 12 months just beginning to take steps.
During the clinical interview the infant was a little shy but then began to play.
Sitting most of the time, she played independently, apparently ignoring the
conversation. However, when her mother took a tissue out and blew her nose,
the little girl’s head shot around to look at her and her fingers went to her
mouth. The mother apologised, explaining she had a cold and that her little
girl heard a lot of that noise. The clinician asked if perhaps the little girl was
sensitive to her mother’s emotional state and was fearful of her mother crying.
The mother confirmed this sensitivity and talked about how her toddler tries
to comfort her when she cries.

Tags: infant