BirthWays
Join our mailing list!
newsletter-header

BirthWays Newsletter

Supporting Attachment During the Transition to a New Childcare Arrangement

June 15, 2011

By Lindsay Germain

When Ella and her mom arrived for the first day of their art class for three-year-olds, Ella seemed like a quiet, shy little girl. The other children worked and played together while their parents were away, while Ella sat in her mother’s lap, quietly avoiding the other children. On their third day in the group, I gently suggested her mom could take an hour for herself while Ella was with us; I was confident Ella would do well. Nervous about leaving Ella alone, particularly in light of her apparent shyness, her mother decided to say goodbye and wait outside the room where she could hear how Ella was doing. Though Ella had never before been away from her family, she began to interact with the other children, and turned out to be anything but shy. She appeared confident, focused and self-directed; with a little encouragement she was easily able to ask for what she needed and play with the other children. Soon enough, Ella’s mother was dropping her off and taking some much-needed time for herself during class.

Sending your little one into another’s care for the first time is a monumental experience. This first separation can bring up nervousness, doubt, mistrust, and grief for even the most even-keeled parents. The process can be quite trying, but can also provide an opportunity for growth where you can examine your feelings and reaffirm your love and commitment to your child. Your child has an opportunity to master separating from you in a secure and confident way that keeps your attachment strong. In this article, we’ll explore some ways you can help your child make this transition with confidence and ease.

What is Attachment?

Attachment is the bond between a child and a principal caregiver, formed over the period between birth and age three. You can think of attachment as a template for relationships, forming the set of expectations a child will carry into adulthood about close relationships. This template can prove to be a huge help, or a hurdle, toward developing close, loving relationships in adulthood.

In the early stages of human brain development, infants and young children lack the capacity to conceive of the motives and complexity of the world around them. If an infant cries and no one responds, the infant experiences powerlessness. Over time, this is internalized as the message: The world is a harsh place; I cannot trust the world to be a place where my needs will be met. When an infant cries and a caregiver responds lovingly and consistently, the baby gets quite a different message: I have the power to get someone to care for me. The child internalizes this type of consistent loving care into a more global view: The world is a safe place where I will be taken care of.

There is tremendous power and resiliency in a worldview like the latter. Imagine how differently these two babies might cope with adversity in relationships, loss, health challenges, financial struggles, and all the rest.

To give an example, Annette was four years old when her father was killed during the Holocaust. She fondly remembers him as a strong, reliable, honorable man who loved her dearly and set an example of living in his power and loving his family. To this day, though she struggles with the wounds of her experiences and loss, her memories of her relationship with her father give her strength and comfort and help remind her of how to love and take care of herself and others.

Developing a secure bond with caregivers in early life helps a child to develop the resiliency to weather life’s challenges with relative confidence and ease. To build a secure attachment children need consistent, loving, responsive care from all of their primary caregivers, especially during times of transition.

Supporting Attachment

This section discusses some ways in which you can support your child’s attachment and help ease the transition to a new childcare arrangement.

Time the beginning of your new childcare arrangement to meet your child’s developmental needs. There are stages during infancy and early childhood where it is relatively easy for your child to be away from you, and other periods where it is quite difficult. Between seven or eight months and twelve to fifteen months, your child may develop separation anxiety that may make a first time separation quite difficult. This is because your child is beginning to understand that you exist even when you are not present. Knowing you are out there but not knowing where, when, or whether you’ll return can cause anxiety for babies during this time. When possible, it’s best to begin a new caregiver arrangement before or after this period.

Choose a caregiver or caregivers you trust.
From birth to age three, your child’s developing brain is learning to recognize and read faces and emotions. Your child looks to you for cues about whether a new caregiver is a safe, trusted person. In order to feel secure in a new caregiver arrangement, your child (under age three) needs to see that you feel good about the people who are caring for him/her. For referrals and a free class on your childcare options and how to choose a childcare arrangement, visit Bananas (5232 Claremont Ave, Oakland, CA, bananasinc.org).

Let your child know what to expect in advance.
Your words will help your child prepare. Don’t skip this explanation because you think your baby is too young to understand. Verbal comprehension develops before speech, and these conversations get through even to babies who don’t talk yet. Even if your child can’t understand all the words, your tone and confidence during the transition will send a strong message of support. For older children, talking about the change also creates an opportunity for children to voice their fears or feelings about the arrangement and begin to process them.

Create a special goodbye routine and use it everyday. Having a consistent goodbye routine is critical to your child’s sense of security. Your child needs to learn that you are predictable to trust that you will come back.

Always get your child’s attention and say goodbye before you leave.
Do this even if your child doesn’t seem interested in you, is absorbed in something else, or doesn’t seem to need you. Often, the children who act like they do not to need their parents are the ones who need them the most. Some children ignore or pretend not to need their parents as a “test” to try and find out if their parents “love them enough” to say goodbye.

When you say goodbye, leave right away.
Your child needs to learn to trust you, so telling him/her what you are going to do and following through are important. Babies and young children are egocentric, conceiving of everything around them as if they caused it. If you sometimes stay after saying goodbye, your child might believe that something he/she did made you stay and may become fixated on doing the right thing to try to make you stay. You need to leave when you say goodbye to send your child the message that he/she doesn’t have control over when you leave, so that he/she can feel secure and be free to enjoy the day, rather than feeling preoccupied with trying to control something that has nothing to do with him/her.

As much as possible, keep things familiar.
You might consider asking a familiar person, such as a grandparent or friend, to care for your child the first time you are away. If your child will be cared for in your home, leave some reminders of you around the house – your shoes, an unwashed T-shirt, photos, movies, or anything else that will help remind your little one of you. Lots of children love to dress up in your clothes and play pretend!

If the child will be cared for outside of your home, visit the place together at least once and talk about the new arrangement. If this is your first time separating from your child, you should plan to visit together before the new arrangement begins and stay with the child in the new space for at least an hour or two. Your visit together gives your child a chance to explore and orient to the new space while feeling safe with you there as a “home base.”

Make sure your child has any special items, toys, or lovies.
These include any items to which your child is attached, and work best if they can be carried throughout the day. You can begin to encourage your child to start forming attachments to a special toy or lovie between three and six months of age.

Make a waterproof album of photos of your family your child can carry. Your childcare provider(s) can pull this album out to help your child feel secure by providing a reminder of your love and connection if your child misses you or in an emergency.

Give your child something to be excited about in the new arrangement.
Figure out what your child might enjoy about the new arrangement (a trip to a favorite spot, new friends, new toys, etc.) and help him/her get excited about it. It’s important to normalize your child’s feelings as you do. You might try saying something like, “It’s okay if you miss me. If you do, tell Grandpa and he’ll give you a hug and look at some pictures of our family with you.” Don’t be concerned if your child doesn’t react as positively as you’d hoped. It’s important for children to be able to express feelings and fears and it is a good sign if your child shows these feelings to you. A child will be able to process and move through emotions more effectively if you are able to listen, or be present, without trying to talk feelings away or by putting a positive spin on the situation. As you do this consistently, your confidence in your child’s ability to make the transition will come across and instill a sense of security even if your child seems quite anxious or upset.

Expect some tears, fears, and “clinginess”; but don’t be surprised if your child takes the separation better than you do. While you are getting ready to separate for the first time or anytime you’re starting with a new childcare arrangement thereafter, it’s perfectly normal for children with a healthy, secure attachment to appear “clingy,” sad, or nervous. If you’ve done what you can to support them to make this transition, they will be able to move on from their sadness shortly after you leave. Regardless of how easily or well children handle transition, separating can be tremendously trying for parents; full of anxiety, grief, and other emotions. Memories from your own childhood may even emerge. Be gentle with yourself and find support as you begin to say goodbye to your little one.

During the first few days, ask your childcare provider(s) to call or arrange a time to talk to share information and reassure you that your child is transitioning well.
This will provide an opportunity to make changes in the routine and communicate about important occurrences during the day.

Be present when you see your child for the first time at the end of the day. As you travel to be reunited with your child, take the time to unwind and let go of the stresses of the day. At the end of a long day, both you and your child may feel anxious, upset, or tired. Take some deep breaths and show up to your reunion with love. Your child might greet you with a smile, or a withdrawn, angry, or rejecting look. All of these reactions are normal and a sign that your child loves you. Be ready to hug them, show your love, and listen to how their day went.

Ultimately, your child will do well in this separation and the ones that follow because of your love, understanding and recognition of your child’s needs (predictability, unconditional love and acceptance, a space to express feelings without judgment or someone trying to “fix” things) and your efforts to provide support. Likewise, it’s important to find ways to meet your own needs during the separation. You might talk with someone about your feelings about the transition, reflect on your own experiences with childcare and separating from your parents, or find support for looking back on your own childhood experiences (see sample resource listing at the end of this article).

Healing and Strengthening Attachments when Challenges Arise

Children need reliable, responsive care from a loving caregiver and a consistent goodbye routine in order to feel secure. This regularity helps your child — new to the world and learning what to expect — understand he/she is loved, will be cared for, and that you will come back. But what can you do if this transition doesn’t go ideally or you suspect that your attachment has been impacted?

Many factors can interrupt the formation of a strong, secure relationship between parent and child, including unforeseen events like divorce or death, premature birth, children’s unmet needs (i.e. predictability or unconditional acceptance), abandonment, abuse, and neglect.

When these or other factors affect a child’s developing attachment during this sensitive period from birth to age three, it’s important to know healing is possible. We are surrounded by community resources to support parents in strengthening attachments and treating attachment trauma (see sample resource listing below).

Local Resources

Bananas
bananasinc.org
510-568-0381 (Childcare Referral Hotline)
Childcare referral service for parents in Alameda County, free parent classes, resources and information for parents and childcare professionals

Hand in Hand Parenting
handinhandparenting.org
Parent classes and ongoing parent support groups on “Parenting through Connection” professional development workshops, parenting workshops on tantrums and difficult behavior, and support for healing from attachment trauma

Virginia Keeler-Wolf, MFT
Family Attachment & Adoption Center East Bay
1425 Leimert Blvd, Suite 302-A
Oakland CA 94602
510-339-9363 Fax: (510) 531-3394
attachadopt@aol.com
Attachment Therapist, specializing in attachment trauma and adoption


Lindsay Germain is an experienced nanny, doula, and preschool instructor. Her academic background focused on the psychology of environmental stewardship and early childhood education.

newsletter_break

A Pregnancy Story: Kiera and NAIT

By Kiera Sosinski

My wonderful son Reichen arrived via an emergency C-section due to decreased heart rate in April 2007. The hospital staff had no concern about Reichen’s development and discharged us within three days. My husband Drew and I went home with a healthy, happy little boy. At around four months of age, Drew and I started noticing Reichen was obviously left-handed. Although we thought nothing of it, I mentioned it in passing to the pediatrician who recognized early hand preference as a potential symptom of something larger and immediately referred us to a neurologist. After spending twenty minutes with our son, the neurologist confirmed the fears of the pediatrician – our son had some sort of brain trauma, most likely a stroke.

We were initially devastated as we tried to figure out what the stroke meant for our precious little boy. We soon learned that he was very fortunate. The stroke left some mild right side weakness but did not affect cognitive or language abilities. At five months of age, he started a variety of therapies and has worked diligently to progress his skills. He is now four years old and continues to amaze us each day with his personality and determination.

We had many questions about the cause of the stroke. Our initial concern was whether Reichen was at a higher risk of a second stroke, so we began meeting with a number of specialists to try to determine the cause of the stroke. Numerous blood tests were run and all of the results came back normal. We still had no answers about the cause of the stroke. We were told a vast majority of childhood stroke patients never learned specifically what caused the injury and that it was most likely a fluke.

After a few years, we decided that we wanted to expand our family. We consulted the specialists and no one saw any concerns with adding a new baby to the family. With these statements echoing in our minds, we decided it was time to add to our family. At the end of October we learned that we were expecting baby number two in early July 2011.

Early pregnancy this time around was much different than with my son. I had morning sickness, which I had avoided with Reichen, and I felt more run-down, but overall it was wonderful to be pregnant again. Trying to calm my fears, I asked my OB at each appointment whether I needed to worry about a stroke for this little child. My OB decided to refer me to a maternal-fetal medicine specialist (MFM) to have another set of eyes on the case; just to reassure Drew and me that everything was fine for this baby.

The MFM started out by asking my husband and me to tell the story of the pregnancy and delivery of Reichen. As she listened, she determined that there was one blood disorder we had not been tested for that seemed to match the story we told. She informed us it was a rare condition we would most likely not have, but that she wanted to make sure we had a complete work-up.

In January 2011, at 15 weeks and 3 days of pregnancy, I received a call from the doctor to let us know that we tested positive for Neonatal Alloimmune Thrombocytopenia (NAIT). NAIT is a disorder where the mother is allergic to an antigen on the baby’s platelets. This means that my body creates an antibody that destroys fetal platelets. This can result in such effects as low platelet count at birth or a brain bleed (as in Reichen’s case), and if left untreated could be potentially fatal to the baby. The doctor walked us through the treatment process, which consists of a weekly infusion of an intravenous drip of an immunoglobulin (IVIG) extracted from the plasma of blood donors. IVIG treatments are very effective in preventing strokes. In cases where an older sibling has had a bleed due to NAIT, these treatments begin at 16 weeks of pregnancy.

My husband and I were still reeling from the diagnosis when I was checked into the hospital for the first IVIG treatment five days later. At this treatment I learned that there had only been a handful of mothers treated for NAIT at the large metropolitan hospital where I was and that I would be the first ever treated with IVIG in the labor and delivery ward of the hospital. That treatment was very difficult. I had reactions during the first infusion and after I got home, which included: low blood pressure, migraines, and extreme fatigue. We were initially told it would take about four hours for the infusion. It ended up being a 27-hour hospital stay. At that point, I realized just how complicated this pregnancy could get.

I reached out on the web and found a support group of women from all over the world who have experienced NAIT pregnancies. These amazing women assured me that there are things that could be done for the side effects and helped me to be an advocate for my treatments. They were there when I was checked into the hospital for complications from the IVIG; they understood the toll that the pregnancy, medications, and stress take on the body; and they knew what it was like to worry about whether your own body was attacking the baby where it should be safest.

Fortunately, after the first infusion, I started to tolerate the IVIG much better. The headaches became minimal and my energy level rose enough so I could carry on with everyday activities with my family, son, and work. The total time of each infusion was reduced to between 8 and 12 hours, which meant I no longer needed to spend nights in the hospital and instead could relax at home with my family. Throughout the pregnancy, medications and even brands of IVIG were adjusted to make sure it was the most effective combination with the least amount of side effects.

Since this pregnancy is so high risk, weekly baby monitoring and ultrasounds were needed beginning around 28 weeks. From that point forward we spent time each week looking closely for brain abnormalities or fist clenching (one sign of a stroke). After each scan, I would feel a sense of relief that she was still safe. It was also reassuring to hear the steady beat of her heart on the monitor for a couple of hours during each IVIG treatment so that I could hear that the treatments were not causing her stress.

During all of these treatments I started learning everything I could about NAIT. I learned that although this is rarely diagnosed, it is not all that rare. Some studies believe that up to 1 in 3000 mothers have NAIT, although the number of pregnancies that suffer brain bleeds is about 20% of that number.

I decided one of the things I was called to do as part of this pregnancy was raise awareness of NAIT and in utero strokes. It still scares me to think about how close we came to not knowing about this condition and potentially having this little girl suffer the consequences or even not survive due to NAIT.

As I write this I am 36 weeks pregnant. Since the antibodies ramp up during the final weeks of pregnancy, I will be delivering on June 13, 2011 at 37 weeks via a scheduled C-section. While the IVIG is usually very successful at preventing brain bleeds, there appears to be some cases where the platelet count of the baby is still below normal upon delivery. Due to the need to monitor her closely, our little girl will be taken to the NICU for a platelet count test. If the platelets are low, an infusion by a specifically matched platelet donor will be given to our daughter.

It is my hope to be able to share the news that this was a successfully treated pregnancy and that my daughter’s birth story is filled with joy. I feel so lucky to have been surrounded by doctors who thought to test for NAIT; nurses who have physically and emotionally supported me once a week during the 8-12 hour weekly infusions; an amazing online community of mothers who have also been through this; and friends and family who have been lifting us in thoughts, prayers, and deeds.

If you are interested in learning more about NAIT, please visit naitbabies.org.   If you would like to learn more about our journey with NAIT, there is a site set up at http://www.caringbridge.org/visit/kierasosinski


Kiera gave birth to a healthy baby girl on June 13, 2011. Audrey Elizabeth was born weighing 6 pounds and 12 ounces, 19 inches long, and has a normal platelet count. Congratulations to Kiera, Drew, and big brother Reichen! See Kiera and Audrey pictured below!

Kiera and Audrey

newsletter_break
« Newer Posts Newsletter Home   •   Submit an Article
1600 Shattuck Ave. Suite 122   •   Berkeley, CA 94709   •   510.869.2797   •   contact@birthways.org
This site was designed by Websites For The People and goforthedonut.com.
All content © 2012 BirthWays. All rights reserved.