Defining IMH

Defining IMH

Although the field of infant mental health has been around for several decades, the term infant mental health can still be unfamiliar to families and those working with young children and families in a variety of disciplines (education, health, social work, mental health, etc.). To some, the phrase mental health evokes the idea and stigma of mental illness or the vision of an infant’s or toddler’s receiving specialized clinical services. However, it is essential to first understand infant mental health as a developmental process that builds the social, emotional, and behavioral capacity of infants and young children to:

  • Form close and secure interpersonal relationships;
  • Experience, regulate, and express emotions;
  • Explore the environment and learn,

all within the context of family, community and the cultural expectations for young children (Adapted from ZERO TO THREE Infant Mental Health Task Force, 2001).

Close and Secure Interpersonal Relationships
The mental health of infants and toddlers develops within the context of close and secure caregiving relationships and daily routines.  The child’s primary relationships with familiar adults, including parents and caregivers, who are responsive, nurturing, supportive, and protective help build positive and secure attachments (Weatherston & Tableman, 2002).  The responsive and reassuring connections made through daily routines – such as feeding, holding, comforting, and engaging with the infant – help to establish an emotional bond that allows children to feel safe, cared for, and able to explore their environment and learn.  While caregiving practices and daily routines may vary based on the family’s cultural and community context (cultural values, and beliefs, and practices), it is the consistent and responsive nature of these practices and routines that assure secure attachment and the foundation of infant mental health. It is through these nurturing relationships that infants and toddlers learn that they are valued, that their world is primarily satisfying and predictable, and how to interact with others.

Experience, Regulate, and Express Emotions
The infant’s increasing ability for self-regulation is a cornerstone of early childhood development that cuts across all domains of behavior. These include both physiological and behavioral regulation (maintenance of body temperature, reactions to external stimuli, etc.) as well as those that influence more complex behaviors (expressing feelings, paying attention, impulse control, etc.) (National Research Institute of Medicine, 2000).  Infants bring their own neuro-biology and temperament to the context of the caregiving relationship. Through the experience of interactions with parents and caregivers as described above, infants and toddlers develop the capacity to control or regulate their emotions, responses, and activities in their environment to meet their needs. Throughout the early childhood years, children become more adept at soothing themselves, seeking comfort when needed, identifying and expressing their feelings in words and actions, and better able to manage their own behavior.

Learning about the environment
Infants are born ready to learn and are active participants in their own development. There is a drive to explore and learn about the world around them; looking, listening, moving, touching, and interacting with their caregivers. As infants develop, they become more active and energetic in their play, exploration, and efforts to control their environment. They move away-from and back-to their secure base of reassuring caregivers who have important roles to support, encourage, and guide their exploration. Infant mental health is essential to learning; enabling infants to show interest, pleasure, and persistence in attempting to solve problems, approach new tasks, and master new skills. Infant mental health provides a firm foundation for development through the early years and ultimately school readiness.

Risks and Concerns in Infant Mental Health
There are known risks to the mental health of infants and very young children. These risks can be related to biological or developmental issues for the infant; family relationships and the quality of caregiving during these critical early years; the mental health of caregiving adults (e.g. maternal depression, parental substance abuse, etc.); and stressful family circumstances or early experiences (e.g. neglect, poverty, trauma, etc).. When infants do not experience safe and nurturing relationships, they are more like to experience early attachment disruptions that affect all areas of development (National Research Institute of Medicine, 2000). While infants and families are resilient and can respond to mental health related services, the science of early childhood development tells us that, for some children, mental health problems may begin early and endure (National Scientific Council on the Developing Child, 2008).

It is important for those caring for or providing services to infants and families to understand infant mental health, know strategies to promote healthy social-emotional development, and recognize the signs and symptoms of mental health concerns in very young children. Mental health concerns in infants and infant-parent difficulties may include signs in infants such as failure to thrive, difficult to comfort, over-response to stimuli, poor regulation, lack of interest, social restriction, anxiety, fears, difficult behavior, etc. A developmental framework, an understanding of infant mental health, and careful observation and screening can lead to early identification and appropriate intervention.


This product was developed [in part] under grant number 1H79SM082070-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.