Assessing mother-infant interaction should be an integral part of the care of women in the postnatal period.
Maternal factors contributing to difficulties with mother-infant attachment include:
Infant factors affecting attachment include medical complications, prolonged separations from the mother, prematurity, developmental disorders and infant temperament.
It is important to see the mother and infant together, observe their interaction closely and watch for patterns of interaction — especially whether the infant is able to ‘use’ the mother as a secure base from which to explore, as well as how the mother responds when attachment behaviour is triggered by the infant (see the below table).
If any of these indicators are present, consider referral, based on your clinical judgment, to a specialist with perinatal mental health training (e.g. enhanced child and family health nurse, psychologist, psychiatrist, mental health nurse).
Risk of harm to the infant can be related to suicide risk in the mother, but can also be a separate issue. Expressions of fear of harming the baby may be a sign of anxiety rather than intent, but require further assessment. Indications of risk include irritation with the infant, regrets about having the infant and wanting to or actually harming the infant.
Interventions to treat difficulties with mother-infant interaction: Interventions to treat difficulties with the mother-infant interaction depend on the nature and severity of the difficulties. Mother-infant psychotherapy may be indicated.
When a woman is experiencing a significant mental health disorder and has difficulties interacting with her infant, both problems need to be addressed.
The well-being of the infant needs to be considered at all times.