Can babies be depressed?

Is Rainder depressed? Not yet. But he is highly likely to develop depression a few months down the line. Prof Astrid Berg, Senior Consultant and Lecturer at the UCT Parent-Infant Mental Health Service at Red Cross Children’s Hospital in Cape Town says that depression can only really occur after the age of about 18 months. Children younger than this cannot actually be diagnosed with depression and they do not yet have the mental capacity to experience depression. But young babies do show signs of being unhappy, and this can and does develop into depression from halfway through the 2nd year of life onwards. Some of the early signs of an unhappy baby are withdrawal and failure to engage actively with people and the outside world. Unhappy babies are often seen as ‘good’ because they are quiet, undemanding and not very much trouble. They often do not seem to need much attention from their parents because they tend to lie quietly alone without showing much eagerness to explore and discover the world.

Withdrawn, unhappy babies look objectively sad. They don’t smile or laugh much. They might have a faraway or glazed look in their eyes, and they don’t easily play or engage with other people. They are the babies that get neglected and ignored in hospitals, orphanages or other institutions because they don’t make a fuss and because they don’t tend to capture the interest of the nurses and other caregivers. It is much harder to get a reaction from a withdrawn baby and attempts to connect with, play or get a smile or a giggle are often unsuccessful. This is very different to the way in which psychologically healthy babies are quite easily tempted to play hilarious games, for instance when you pull funny faces at them or hide your face and peep (with a big grin) out at them again. A withdrawn baby might be unable to participate in these games, or she might even start crying when there is an attempt to interact with her.

But strangely enough, unhappy babies sometimes do not cry much at all. This is confusing and misleading because one might think that if a baby is unhappy you would know about it by his crying. Researchers such as Antoine Guedeney have found that psychologically healthy babies react to discomfort by yelling with great gusto and outrage. They are then easily comforted, often by the mother’s attempt to offer her breast for a feed. But babies who will go on to experience psychological difficulties do not necessarily cry (or not immediately) when they are subjected to a traumatic experience. They are more inclined to continue whimpering or being distressed, despite all efforts to soothe them. Don’t be duped into thinking that a baby who never cries is psychologically healthy and robust. He might have learned that crying doesn’t help, or he might not have the energy to cry. Vigorous crying is a passionate message from a baby that something is wrong and he needs help. Unhappy babies have very little passion and they don’t have any expectations or illusions that help is going to be forthcoming.

In contrast, healthy babies are full of life. In fact, as you might have noticed, they can drive their parents quite mad by their continual demands. Life for a baby is jam-packed with interesting objects, encounters, events and experiences. From about 8 or 9 months onwards, their activity levels are high and they need a fair amount of attention. They grab, shake, throw and sometimes destroy just about anything they can lay their hands on, particularly valuable ornaments and important documents. They love to turn their mommies’ handbags upside down in their search for delightfully exciting odds and ends that can be tasted or chewed, shaken or broken. Healthy babies and toddlers are very much on the go, making their way, once they are mobile, to all kinds of forbidden and dangerous places, like down the steps and into the pot plants. They often experiment with eating (or at least tasting) stones, ants, toys or anything they can find. The world, for healthy babies, is not only their oyster, it is their playground and their kingdom.

Unhappy, withdrawn babies know nothing about playgrounds or kingdoms. Or if they do know about them, they just don’t care. They have little interest in the unchartered territory of this world, the treasures and the novelties waiting to be discovered. They often don’t care much for the culinary surprises that come their way. In fact, their own feeds might not even hold much appeal.

Talli is the first child of a 20 year old single mother whose boyfriend left her when she was pregnant. Talli is small, pale and thin, and although she is actually 6 months old she looks more like a 3 month old baby. She does not seem interested in her feeds, even though she has been exclusively breastfed since she was born.  She hardly ever smiles or laughs and she makes very little eye-contact with her mom or with anyone else. Since she was a few weeks old, Talli’s mom has been concerned about her failure to gain weight and her “feeding problems”. She has taken her to a paediatrician who has given his assurance that there is nothing physically wrong with Talli, except that she is small and underweight for her age. “She’ll catch up” he said to Talli’s mom. “Or perhaps she’ll always be a small person. It’s probably in her genes.”

It is possible that Talli’s paediatrician is correct and that her failure to eat and grow normally is of no real concern but Prof Berg has made some important observations in her clinical work with babies who don’t seem interested in feeds and who fail to thrive. If there is no underlying physical condition or illness, says Prof Berg, there might be a psychological reason why some babies don’t grow normally. Perhaps, she says, the life force or libido that drives us all to carry on living, growing, eating, loving and exploring is very weak in these babies.

When you as an adult become depressed, the chances that you will lose your appetite are high. Even if you previously loved your food, depression takes the joy of eating away. A loss of appetite and loss of weight are two very standard, common symptoms of depression. Besides this, depression also robs you of your energy, your zest for life and your ability to find pleasure in just about anything. It takes away your motivation and usually leaves you feeling like you just don’t feel like doing anything. So a depressed adult is often criticized for ‘moping’ around, staying at home, declining offers to go out, get exercise or meet people. The mistake is to think that lethargy is the cause of depression when it is actually a symptom. For a depressed person, just getting out of bed can be a major challenge. Being sociable, getting your work done and doing your chores when you are depressed can feel almost insurmountable and completely overwhelming. Depression flattens you and slows you down. It makes you look tired and defeated. In this way, the appearance of a withdrawn baby who will go on to become depressed later is uncannily similar to the experience and appearance of a depressed adult.

What causes a baby to become unhappy and withdrawn?

Prof Berg has brought together research on this topic from the past few decades. It would seem, from this research, that a baby who is showing signs of being at risk for depression later on has most likely experienced some form of loss. The mother is the most important thing in a baby’s life, so if the baby loses the mother in some form or another, that is extremely psychologically damaging for her baby. But the loss of the mother is often not literal or even permanent. Babies can lose their mothers when their mothers become emotionally unavailable by virtue of being depressed, anxious or physically ill. Preoccupied and upset mothers, whether it is because of marital difficulties, personality problems or work stressors, can also be experienced by a baby as an absence or a loss. Any disturbance in the relationship between a mother and her baby can contribute towards a baby feeling as though she has lost her mom. Bonding and attachment difficulties that develop for a variety of reasons may put a baby at risk for future depression because from the baby’s perspective, she has lost (or she never had) a vital and integral part of her mom. And of-course, a physical separation from the mother puts a baby at risk. Holidays, hospitalizations, business trips or any kind of absences from the mom can cause a baby to withdraw into a sorrowful state. This puts him at risk for developing depression in the 2nd year of life, and later.

What to do?

The good news is that the cure, according to Prof Berg, is relatively straightforward. It is simply to give the mother back to the baby. Depending on the circumstances of the loss, this might mean that the mom should be treated for her own depression, or that she should spend more time with her baby, or that her relationship with her baby should be strengthened and improved by consulting with a parent-infant psychotherapist. In the vast majority of cases these solutions are entirely realistic and manageable. Very, very occasionally in the most extreme of circumstances mothers and their babies cannot be reconciled. This is tragic, both for the mom and for her baby. But a baby who has permanently and irrevocably lost his mom needs just one thing. A substitute mom who can offer everything that a mom is supposed to give. That is, a foster or an adoptive mother.

Your baby needs you, both physically and emotionally, in order to develop and grow into a psychologically healthy person. The more secure, content, supported and psychologically stable you are, the better for your baby. There will always be struggles and difficulties that your baby will have to grapple with during infancy and beyond. Teething, weaning and being away from you at times are all part of the normal, everyday challenges that she has to face. But she is fortunate if you are present, available and tuned into her enough to notice when she is not feeling happy. Don’t ignore the early signals of depression. Take them seriously and get help. Withdrawn babies and depressed children are easy to forget about or to miss. Their suffering often goes unnoticed.

How and where to get help

This article has highlighted important early warning signs that, if left untreated, can develop into childhood depression. If you are concerned that your baby is withdrawn, now is the time to make an appointment with a parent-infant psychologist or a mental health professional who has training and experience in this field. Early psychological intervention is effective and powerful and it works far more quickly than trying to address a psychological problem years down the line. Child psychologists have discovered that the younger a child is the better the chance of therapeutic cure as long as the parents are willing to continue with the therapy and as long as they take an active, positive and responsible role in the process.

For parent-infant psychotherapy or referrals to a parent-infant practitioner in your area, contact jenny@perkel.co.za.

Possible early warning signs of depression in a baby

Withdrawal

Does not easily engage with adults

Unsociable

Difficult to soothe when distressed

Does not play easily

Does not smile or laugh much

Quiet, still and passive

Does not require much attention

Feeding problems (poor appetite)

Underweight

Failure to thrive (non-organic)

Developmental delays

Reluctance to explore the environment

Easily overlooked

 

 

Adapted from an article written by Jenny Perkel, published in Living and Loving magazine, 2009