“No Such Thing as a Baby” in the Year of the Nurse and Midwife

Winnicott was an influential pediatrician and child psychiatrist from the United Kingdom, who made this famous statement in 1947. In it, he implies fundamental truths about infant mental health that are essential to understand the foundations of child health and development—that infants cannot exist outside of a relationship and that their very survival depends on their caregivers (Abram, 2008). Simply put, it does not make sense to speak of infant mental health, removed from discussion of their parental caregivers. Thus, many of the articles in this special issue are devoted to infant mental health in the context of parental mental health and stress. Another key figure in our understanding of infant mental health was Winnicott’s contemporary, John Bowlby (1907–1990), who wrote seminal books on attachment and separation anxiety in infancy (Bowlby, 1969/ 1982, 1973, 1980), explaining infant development in the context of relationships with attachment figures, who in his time, were usually mothers, but today we think of as mothers or fathers (or nonbinary parents). Joining forces with Mary Ainsworth (1913–1999), the two defined Attachment Theory (Bretherton, 1992). Ainsworth connects Canada to Attachment Theory by completing her PhD dissertation at the University of Toronto on “An evaluation of adjustment based on the concept of security. ” She went on to create the gold standard measure of infant–parent attachment security that is used widely today (Ainsworth et al., 1978), including in a paper in this volume led by Elena Ali. Secure infant– parent attachment is analogous to optimal infant mental health in that the secure infant is likely developing in a context that responds to the infant’s socioemotional and cognitive growth needs as well as physical needs. Research has shown how secure infant–parent attachment relates to long-term child and adult mental and physical health (Puig et al., 2013; Sroufe, 2005). Bowlby and Ainsworth theorized that qualities of the parent–infant relationship, especially high parental sensitivity and responsiveness to infant cues (that signal needs) predict secure infant–parent attachment. Research bore out this hypothesis, with moderate effect sizes; however, other factors likely contribute too (De Wolff & Van Ijzendoorn, 1997). The evidence induced the Harvard Centre on the Developing Child to share the metaphor of “serve and return” to translate the importance of high parental sensitivity and parental responsiveness to parents, policy makers, and clinicians like nurses (Shonkoff & Bales, 2011). A serve, for example, could be a child’s cue such as fussing due to hunger and an appropriate return, for example could be the mother’s breastfeeding the child to address the hunger. Serve and return is understood to underpin infant and child mental health and brain development or “brain architecture” (Center on the Developing Child at Harvard University, 2016). Nurses (and midwives) have long attended childbirth and guided new mothers in learning to read and respond to infants’ various cues that signal needs, including infant hunger/satiation, fatigue, and ill health. They guide new mothers in general infant care and how to promote socioemotional and cognitive growth and development with caregiving activities like sleep schedules, bathing, and playtime activities. Essentially, long preceding and during the time that Attachment Theory and measurement were being refined, nurses were caring for and/or promoting social reforms to support childbearing families. In 1894, none other than modern nursing’s founder and social reformer, Florence Nightingale (1820–1910) said “money would be better spent in maintaining health in infancy and childhood than in building hospitals to