11 April 2023

Why we should follow the science on motherhood and childcare


As an American psychotherapist, I have spent most of my professional life looking carefully at the science behind young children being put into long hours childcare. There are plenty of problems in the United States with childcare and family separation. I hardly need to start worrying about another country, but the importance of the earliest years of a child’s life don’t change depending on which side of the Atlantic you are on. 

Later today I will be speaking at an event hosted by the Civitas think tank on how mothering has been de-prioritised as critical for emotional stability and mental health, and as a result we have a worldwide epidemic of mental illness in children and adolescents.  

The push for women to go back to work earlier and earlier, to leave their children in institutional daycare, is an economic equation which does not calculate the emotional and mental health risks for babies and mothers.  

The first three years of a child’s life is a critical period of social-emotional (or right brain) development. Infants depend upon their primary attachment figure to buffer them from stress through sensitive, empathetic nurturing that produces hormonal stimulation of the neurotransmitter oxytocin. 

Oxytocin protects against the stress hormone cortisol and regulate infants’ emotions from moment to moment, keeping their emotions from going too high or too low. A mother’s sensitive empathetic nurturing and oxytocin allow for a baby’s emotions to return to homeostasis. 

Put simply, the dependency upon this unique relationship cannot be replaced with transient surrogates found in institutional settings. Secure attachment is the foundation of mental health and resilience, which requires that mothers are present physically and emotionally throughout the day as much as possible. 

To ensure that children can develop a healthy ability to manage and cope with stress in the future, it is critical that they do not experience intense stress too early in development. Babies in daycare have been found to have higher levels of cortisol. Research shows that early maternal care has long-term effects on a child’s ability to become resilient to stress and adversity in the future. 

A small, almond-shaped and primitive part of the brain called the amygdala is the centre of stress regulation in the limbic system. It maintains and regulates our levels of stress throughout our lives. During the first three years of life, it is meant to be offline or quiet to keep its activity to a minimum. Separation from their primary care giver, usually the mother, switches it on and causes long-term harm.

The most compelling research to substantiate the need for mothers to choose to care for their own children is that of the discovery of a genetic precursor for sensitivity to stress which is associated with mental illness. More babies than ever are being born with a short allele on their serotonin receptor, a marker that is now known for making them more susceptible to stress and the long-term effects of stress. 

Sensitive babies are harder to soothe and are more sensitive to touch, sound and separation. They are often called colicky by pediatricians who do not understand the neurological sensitivity as the cause. When these babies are cared for by their primary attachment figure who is sensitive and empathetic to their distress, it prevents the expression of this gene and allows those babies to have as great a chance of becoming resilient as those born without the gene. However, babies who are sensitive but not provided with the sensitive empathetic care of their primary attachment figures (such as those in institutional care) in the first year are more likely to express this genetic anomaly through depression, anxiety, ADHD and behavioral problems.  

Studies have also connected daycare to increased cortisol in babies as well as increased aggression and behavioral problems in the school years. The research is clear, attachment insecurity in infancy and toddlerhood is associated with mental illness in childhood, adolescence and into adulthood. Anxiety, depression, ADHD and personality disorders such as Borderline and Narcissistic Personality Disorders are also associated with attachment insecurity in infancy. Longitudinal research shows that attachment security is critical to mental health in the long-term.

More than one in 10 women in the UK suffer from postnatal depression. One common theory is that the pressure for women to achieve success in work and family life all at once is increasing their conflict over mothering, and the harsh deadlines to return to work create a barrier to attachment with their babies.

Our society constantly sends contradictory messages. We say we value family, but mothers are pushed to stay in the workforce and often lack the choice to be present with their child during the most critical period of cognitive development. If we want to eradicate mental health issues like depression, anxiety, and violence, we must be willing to look deeply at the root of the problem – starting from birth.

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Erica Komisar LCSW is a clinical social worker and psychoanalyst from New York City. She is author of 'Being There: Why Prioritizing Motherhood in the First Three Years Matters'. This article is a summary of a talk she has given to the Civitas think tank.