Why this L.A. hospital says infants have mental health needs too
A major initiative at the Los Angeles children’s hospital aims to meet a critical but very neglected need: mental health care for families knowing the complex flow of joy, fear and upheavals during the first years of the life of a child.
A myriad of problems can emerge or be exacerbated in a family after the birth of a baby, including postpartum maternal depression, sleep problems, attachment problems between caregivers and children, the first signs of behavioral challenges, domestic conflicts between parents and insecurity of housing which often worsen as a family develops. If a child also has a medical problem, including a prolonged hospital stay, a serious congenital anomaly or a development delay, these problems can be aggravated.
A gift of 25 million dollars of the Tikun Olam Foundation of the Jewish Community Foundation in Los Angeles will allow the hospital to extend screening and mental health services to 30,000 children aged 3 and under who are looking for children’s hospital care each year, making one of the first hospitals in the country to provide universal health services for the family. Currently, the hospital provides these services to around 1,800 children each year.
The idea behind the program is to provide attention and care that can strengthen the bond between parents and children during the baby’s first years – and help prevent longer -term spiral problems.
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These links are essential to the development of the healthy brain of a baby in a period of rapid neurons training and of great sensitivity, said Melissa Carson, pediatric psychologist at the hospital and co -director of the Stein Tikun Olam connections program.
Medical problems and family stress factors – also called unfavorable children’s experiences – can disturb this process, but are often identified only at preschool or later, when behavioral or other problems have in a spiral.
1. Several of Vicente Giron Sarria’s medications fill up a cabinet at his home. 2. Evy Soto replaces the cap on Vicente Giron Sarria’s feeding tube. 3. Stephanie Blanco shuffles through a cabinet of her son’s medical records. 4. Evy Soto gives Vicente Giron Sarria, 6, formula through a feeding tube before he wakes up for the day. (Juliana Yamada / Los Angeles Times) 5. Stephanie Blanco gets her son Vicente Giron Sarria dressed for the day.
“Just a little support at a critical moment can really prevent the need for much more intensive service later,” said pediatric psychologist Marian Williams, the program’s co-director.
Children’s Hospital Los Angeles has been offering mental health screening and services to the sickest young children who pass through its neonatal intensive care unit for about 10 year. That program was also funded by Mindy and Gene Stein, whose Tikun Olam Foundation focuses on early childhood.
The demand became evident when the hospital found that many families that were offered mental health support in the neonatal intensive care unit stuck with the services after leaving the hospital. Soon, other departments, such as the cardiac unit, were requesting similar services for their patients as well.
“I hope this becomes something that everybody understands and looks at as a crucial part of a child’s development,” Mindy Stein said.
A ‘window’ of opportunity in early childhood
The hospital will also use the funds to train providers in infant and family mental health care and research the effectiveness of the program in the hopes that the model will spread to other hospitals.
Psychologist Marian Williams at Children’s Hospital Los Angeles.
“We have this kind of window when you have a new baby. And there’s also a window when you have a medical need,” Williams said. “There’s probably a lot of parents who will say, ‘I don’t really need you. I’m here because of a cut finger, and we’re fine.’ But I imagine there’s going to be a lot more who say, ‘Oh, wow. Since you asked … .’”
Many families probably could benefit from a handout or video about a common early childhood problem such as sleep issues, picky eating or excessive crying. Some might want to join a parent group with others facing similar challenges, or benefit from a few home visits from a therapist who can help them adjust to life with a new baby.
But other families may need more intensive assistance, such as longer-term therapy. The hospital will also screen them for needed social supports such as housing, food, transportation and internet access, — the lack of which can contribute to a family’s stress and a child’s long-term mental health challenges.
What is infant-family mental health?
The term “infant mental health” can be confusing. After all, it’s difficult to believe that a baby could already be experiencing emotional difficulties. But mental health care in the early years is laser-focused on supporting the developing relationship between the caregiver and child, which can set the trajectory of a child’s life.
For an infant, a therapist might work with the parent to help them notice their baby’s cues, find activities to help the baby explore their environment, and work on their own emotional regulation. As a baby gets older, the therapist also uses play to help develop the bond and begin to treat the child more directly.
Vicente plays with a train set in his bedroom at his home.
For families in the midst of a medical crisis, these early days and months can be particularly fraught, said Patricia Lakatos, a psychologist at the hospital who works with families of children who have been treated in the intensive care unit.
In the neonatal intensive care unit, parents are not only dealing with the day-to-day medical reality, but they’re also “grieving the imagined baby — the baby you thought you were going to have,” Lakatos said. Her work is to visit the family regularly during their stay to help the parent work through their grief and understand how their baby communicates.
Stressful experiences can also affect the baby’s well-being. A baby with traumatic medical needs, for example, may panic every time an adult tries to touch them.
Psychologist Patricia Lakatos.
Lakatos said she can read the signs of a struggling newborn in their eyes. Healthy babies, she said, “have a bright, shiny look that tells you, ‘I’m ready. I’m here. I’m curious and want to engage with the world.’” But babies who experience distress often have a “dull, glazed look in their eye. You might try to engage them, and they’re really not engaging with you.”
Others have eyes that are “wide open, almost like hyperalert,” she said. They’re easily startled and may arch their back and splay their hands, as if to say, “The world is stressful for me.”
But having a nurturing, supportive relationship with a caregiver helps buffer that stress. Supporting this bond includes helping the parent notice the signs that the baby is ready to engage — even momentarily — or whether the baby’s cues are telling them they need to “soften my voice or just hold them and not try to look at them because that’s too much stimulation.” The ultimate goal is to help the caregiver find the joy and delight in the baby they have.
A lifeline of support for mother and baby
Stephanie Blanco of Mission Hills first learned she would be having a baby with major medical complications during an ultrasound early in her pregnancy. “I didn’t think I was going to be able to handle it, going through that,” she said.
1. A photo of Stephanie Blanco and her son Vicente Giron Sarria as an infant hangs on the fridge at their home. 2. Stephanie Blanco’s ultrasounds of her son, Vicente Giron Sarria.
But right away, she was referred to Children’s Hospital’s Fetal-Maternal Center, which specializes in pregnancies with complex medical conditions, where she met Lakatos. Her son, Vicente Giron Sarria, had been diagnosed with facial deformities, and Lakatos began joining Blanco and her partner at every meeting with the craniofacial team.
“They would explain [the problems] For me, but you would go through so many emotions at that time. So she said to me: “It’s good, I’m here”, “and asking her how she felt herself. It was a moment of great tension and stress with his son’s father when they were sailing what their new life would look like. She was not sure they would make a couple. But Lakatos helped them treat their feelings together, she said, and would learn to communicate on the health of their son.
Vinny was born with many complications even beyond the facial anomalies provided, including the need to eat through a food tube, and spent about two months in the intensive care unit, where Lakatos visited the family every two days.
Stephanie Blanco and Vicente dance on one of Vicente’s favorite YouTube videos.
Lakatos taught his breathing exercises, helped her connect with her son and encourage him to take time for herself on walks on the hospital campus. Blanco was able to bond with his baby. “You think, I can manage this,” she said. “It’s my baby, and we’re going to go through. Love comes out. “
The challenges did not end when Blanco and Vinny finally returned home, and neither did Lakatos’ support. Vinny needed several surgeries, and Blanco had to learn to feed him six times a day – including the middle of the night – through a tube of gastronomy.
But Blanco and his partner, Jesse Giron, continued their visits with Lakatos for several years. Vinny was finally diagnosed with non -verbal autism and a crisis disorder, and Blanco joined a support group for the parents that Lakatos led.
Blanco said that she always treats life with a medically complex child who needs constant care at home. “Every day is something new. Every day, I learn something. Some days are more difficult than others. ”
But she attributes to Los Angeles of the children’s hospital and the children’s hospital to save her life – and her relationship. “If it was not for them and their kindness, their compassion and their advice, I would be lost.”
This article is part of the Times early childhood education initiative, focusing on the learning and development of California children from birth to the age of 5. For more information on the initiative and its philanthropic donors, go to latimes.com/earlyyed. The Stein Early Childhood Development Fund at California Community Foundation is one of the donors.
Blanco holds Vicente and their dog Benny at home.
