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Cheryll Adams D(Nurs) MSc BSc(Hons) RN RHV Dip Man Independent Adviser, Nursing, Health Visiting and Community Health Policy and


Honorary Senior Visiting Lecturer City University

Promoting positive mental

health for every baby Identifying families in need of support can improve outcomes for both children and society as a whole


ecently I had the privilege of attending a seminar hosted by the NSPCC to mark 20 years since the ratification of the United Nations (UN) Convention on the Rights of the Child. The speakers made it clear that whilst this conven- tion was designed to protect children, and the UK is signed up to it, there is still much to be

done. The fact that the UN placed the UK bottom of a list of industrialised countries for child well-being in 2007 is testament to this. So what are the issues, and why do they matter to community nurses, midwives and health visitors? There is now a powerful research base demonstrating that what

happens to you as a foetus and in the very first years of your life can have a profound effect on your physical and mental health for the rest of your life. The bottom line is that the quality of your in- utero and parenting experience matters. Clearly this matters a great deal to community staff as they are often in the position of influencing health behaviours around the time a new baby comes into the world. It also reflects what we know about health inequali- ties, that those children growing up socially disadvantaged are more likely to die earlier and to suffer ill health. What is less well known is the impact of emotional disadvantage, and that this is closely linked to social disadvantage. Probably most readers will be familiar with Maslow’s triangle

which makes clear that in order to benefit from good health certain factors must be in place, and as one level is reached there is a new one can be aspired to. Fundamentally our physiological needs must be met, we all need shelter to keep us warm (or cool!) and good nutrition. If that is achieved, our safety needs become important to keep us alive. Then, if we are to embrace society, we must have a sense of being loved and belonging, which in turn provides us with the necessary self-esteem to develop cognitively, to embrace education or employment, and to maintain the necessary friendships which support our emotional well-being. When all that is in place, Maslow said that the individual had reached a point of

‘self actualisation’ or being able to be in control of their lives and to be effective, also to embrace good health. In the community and public health practice it is helpful to remember this model as it so clearly demonstrates how we can help our clients and practice good public health. I would like to suggest that it is also essential to consider this

y Haveour say! Do you agree?

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when considering the needs of babies. Their needs are exactly the same as those of children and adults, and as the UN convention on the rights of the child makes clear they should have the same rights as adults. Are they always given these rights, and how can you help to ensure that they are? This is a rapidly developing area of practice for midwives and health visitors, but I wonder how well-informed practice nurses are about the critical role of not only meeting an infant’s physiological and safety needs, but also ensuring that every infant has a loving caregiver to ensure they have the human right of developing positive health outcomes. It may be the practice nurse or general practitioner who first to notice that a new mother or family is struggling, or that the principle caregiver may not be connecting at all with their child. Postnatal depression is a common causative factor for the mother’s ‘attachment’ to her child breaking down, but there are a range of other mental health issues affecting new mothers as indeed there are social factors. Particularly important is consideration of the parental or couple relationship. Recent research demonstrates clearly that when this is poor there is a knock-on effect on the infant, and the effects will become obvious in terms of the development of cognitive and behavioural issues in due course. Indeed we now know that sleep difficulties in infants may be directly associated with their emotional environment. If we are to ensure that every infant has the best chance in life to meet their potential, the whole primary care team need to be aware of the importance of pregnancy and the critical first months for future development and health. We must all be alert to emotional and social risks in the home, or in the infant’s environment. The prime benefit to the infant will be having its human rights met, but the secondary benefits will be to the NHS and to society.

80 Nursing in Practice March/April 2012

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