Assessment of Parent/Infant Relationship

Assessing the relationship between a parent and their infant can be tricky and needs to be done sensitively.
It is an important part of assessing the effects of parental illness on the child/ren. As in other areas of medicine this can be done by history taking: either asking the parent about their relationship with their infant and/or asking someone else about the relationship, and, by observation or a ‘mental status’ examination of the relationship.

History taking

Most people want to share their concerns but they may not volunteer the information so you need to ask.
Start with more general questions and get more specific.
Adapt questions to the situation.

Some possible questions might be:

How are things going with your baby? (How are they sleeping/feeding/interacting? How is that for you?)
How are things going between you and your baby?
Do you feel happy with the relationship between you and your baby?
Do you feel confident with your baby?
Some people find it hard to connect to/relate to/ understand their baby. Has this ever been a problem for you?
What do you enjoy most about your baby? (if they struggle to identify anything this should alert you to problems in the relationship)
Does your baby make you feel anxious? ( If so when? In what way? What thoughts do you have? )
Do you ever wish you had not had your baby or that your baby would go away?
Have you ever felt angry with your baby?
Have you ever felt like shaking your baby? Or shouting at your baby? (If yes ask if they have ever done this).

Also ask about details of situations to clarify exactly what has happened.

Some mothers with perfectionist traits and a highly developed sense of responsibility may overstate their shortcomings in relation to their baby. If you suspect this you may be able to clarify the reality by asking about specific situations in detail. It is also advisable to ask the partner how they view the relationship between mother and child.

Any thoughts of harming the baby need further investigation by a mental health professional.

A mother with psychosis should not be left alone with a baby unless this has been thoroughly assessed by a psychiatrist, or skilled perinatal mental health professional.

For more information

See information for parents on baby attachment and baby states and cues.

Mental Status Examination of Parent and Infant

This will usually be a "snap shot" so may reflect as much about the situation or current state of either mother or baby (eg tiredness) as it does about the ongoing relationship between them.

However you will often be able to get a lot of information about the relationship by observing –

Physical contact – do parent and infant seem to mould into one another or fit comfortably with one another?
Eye contact – does the baby look at its parent? Do they actively avert their gaze from the parent? Do the pair seem to connect when looking at one another?
Emotional expression on baby’s face when looks at mother.
Emotional expression on mother’s face when looks at baby.
Do baby and parent ‘mirror’ one another eg one smiles the other smiles?
Effectiveness of mothers soothing of baby if baby is distressed.
Does infant readily seek out parent for comfort and accept the support offered? (this is more likely to indicate a healthy relationship)
The reciprocity in the relationship – this is a bit like a dance between the two is it smooth or jerky, does it flow from one to the other and back again, or not?
Does parent respond to baby in a timely and appropriate way?

The Postpartum Bonding Questionnaire

This is given below. It was devised to screen for problems in the mother-infant relationship.

There are four subscales:

Impaired bonding : or lack of positive feelings,
Rejection and Pathological Anger : Negative feelings/ lack of feelings
Infant-focused Anxiety : Anxiety in cares of the baby
Incipient Abuse : Risk of Harm

High scores are of concern (see scoring). While being of concern they DO NOT mean a mother is bad and they do not indicate that a mother is necessarily inadequate. What they do mean is that this Mum needs help to feel better about her baby or about herself as a mother. With help these feelings can change.

Any score on scale 4 requires immediate further assessment. If you are a mum filling out this questionnaire then seek help - having these thoughts is NOT the same as abuse and recognising these feelings/thoughts and getting help is likely to prevent you from acting on these thoughts.

It is a little complex and takes a bit of time to score but is usually quite easy for the parent to complete
Our online version is easy to complete and the scoring is done for you
Someone may not wish to complete this if they feel it means the baby might be taken off them – and this is the underlying fear of many depressed mothers.
Many mothers can be reassured by it
It can be a useful way of recording a change in feelings over time
It can be a useful way of opening up further discussion about the parents feelings towards their baby/infant

Take care not to undermine a parent’s sense of themselves as a parent.
No parent should be left to feel that they have little or nothing to offer their child. It is important to focus on the strengths of the parent while also ensuring child safety.

Click here for a self-scoring Postnatal Bonding Questionnaire

References

Brockington IF., Fraser C., Wilson D. The Postpartum Bonding Questioonnaire: a validation. Archives of Women's Mental Health. 9(5): 233-42, 2006,Sept.

Mares Sarah, Newman Louise, Warren Beulah. Clinical Skills in Infant Mental Health. 2005. ACER Press.

Meisels Samuel, Fenichel,Emily. New Visions for the Developmental Assessment of Infants and Young Children. 1996 ZERO TO THREE: National Center for Infants, Toddlers and Families.