Infant mental health: Michigan clinic aims to build resiliency for a lifetime

• Even the youngest infants — just days old — are taking in their surroundings as they build their mental health
• Without language skills yet, they incorporate both trauma and feelings of security into their tiny bodies
• A new Detroit program angles into babies’ lives as early as possible in hopes to shape lifelong mental health trajectories

DETROIT — In the bright lights of a doctor’s exam room and as strangers move and talk around her, tiny Isis’s deep brown eyes search for her father’s.

Terrence Fulton’s hands wrap around her 15-day-old body — a squirmy child, just north of 7 pounds. 

“It’s OK,” he murmurs, his cheeks brushing the wisps of her newborn-fine hair. “I got you.”

She closes her eyes, her body growing still against his thick, security-guard torso.

A moment’s touch, warmth, security — these are the moments that bond relationships and can shift the trajectory of a life. They also represent an overlooked, but critical field of expertise — infant mental health — as Michigan and the nation grapple with a growing mental health crisis.

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“There’s the prevailing thought that infants don't remember their traumas and their challenges, that they won't remember it and that infants are still resilient,” said social worker Rebecca Wheeler.

That’s wrong, she said.

“The reality is that infants … remember, but their memories are more body-centered, more sensory,” she said.

Wheeler is part of the new Social Work Early Childhood Support Clinic, a first-of-its-kind program in Detroit that recognizes that a human’s ability to form relationships — and ultimately to regulate stress — begins in the first days of life. 

More specifically, moments of safety and the ability to build relationships helps Baby feel secure, understand the world around her, and build resilience for lifelong health. Those help build cognitive, emotional and social skills for life.

The clinic is a partnership between the Wayne State University School of Social Work, which offers specialized training in infant mental health, and Wayne Pediatrics, a health center staffed by clinicians from the university’s nearby medical school.

Early intervention, here and now, could be key in curbing at least some mental health crises in the years to come in Michigan, where the behavioral health system for years has been overwhelmed and understaffed.

“Fundamentally, intervening early gives you the most power to impact that child's life,” said Wheeler, the Detroit social worker.

“If you can make any small shift toward positive, resilient, secure parent-child relationships, that attachment relationship is the number one protective factor for people facing any kind of hardship” later in life, she said. “It’s like any investment strategy: The earlier you get in, the more the interest compounds.”

There’s research to back her point.

Economist James Heckman's work centers on measuring investments in early interventions in a child’s growth against long-time benefits. He created the Heckman Curve. For every dollar spent in early childhood development, society saves $7 or more in the long run, according to his research.

That’s based on better health and more earning power, for example. Heckman’s work isn’t without critics, but other studies have put the return on investment even higher.

Bottom line?

“The earlier that we support children and families and children's healthy growth and development — particularly in the zero-to-three-years (age group) — the more we save down the line,” said Holly Brophy-Herb, a professor of child development at Michigan State University and editor-in-chief of the peer-reviewed Infant Mental Health Journal.

Real life v TikTok

It was “Baby Day” at Wayne Pediatrics recently — a Wednesday when the clinic’s pediatricians focus on infant wellness visits.

At her laptop in an office around the corner from the exam rooms, social worker Beverly Weathington was reviewing the day’s list of appointments. With just two social workers for now in the new partnership, Wheeler and Weathington must focus now only on tiny patients most at risk. 

Sometimes the medical staff let them know about parents struggling with postpartum depression or anxiety. Weathington and Wheeler — co-coordinators of this clinic — also worry about the single parents and young mothers still struggling to graduate high school.

“You’re 17, and you see these TikTok videos of gender reveal parties and baby showers and mom-and-baby photo shoots,” Weathington told Bridge. “You don’t see videos of the sleep-deprived mom really struggling.”

Other times, a family’s medical history throws up other caution flags: domestic violence, food insecurity or risk of homelessness, for example. 

That’s when Wheeler or Weathington stop by the exam room, poke their head inside and ask the new parent or caregiver: Can we talk?

For his part, Fulton, 43, didn’t know he was going to be Isis’ father until, well, he was her father.

The longtime security guard got the call earlier this month as he was working an overnight shift at a Detroit night club. It’s a blur, he said.

A stranger was calling him. From a hospital. There was a baby — his baby. 

Something about “Human Services.” The mother was going to walk away.

Fulton, a father of children ages 22, 18 and 17, was stunned. He no longer had contact with the infant’s mother. He didn’t know she was pregnant.

“It was like that. Boom, I had another daughter!” he said.

Two days later, he said, Fulton was at the hospital, tucking Isis into a car seat for the car ride back to his Detroit home.

Especially for single parents, these first months can be exhausting and isolating and frustrating, Weathington said. But it’s also when parents need to be especially attuned with Baby’s needs.

The role of ACES

To understand the outsized impact of stress on a baby, one must understand stress hormones.

Adverse Childhood Experiences (ACES) occur in extended times of pain or fear, abandonment, panic, uncertainty. That can happen in cases of abuse and neglect, but also in life's other stresses: divorce, mental illness of a loved one, when a parent is incarcerated, or a natural disaster, for example.

These experiences can flood the developing body with toxic stress hormones that affect brain chemistry, reshape its architecture and disrupt genetic development. The resulting changes can be profound and life-altering — learning disabilities, emotional outbursts, criminal behavior, and long-term health problems, ranging from depression and substance use disorder to cardiovascular disease, diabetes and cancer.

To be clear, brief bouts of fear and anxiety can be helpful, said Carolyn Dayton, associate director of Wayne State’s Infant Mental Health Program at the Merrill Palmer Skillman Institute for Child & Family Development.

A child can feel temporarily abandoned or scared, “but if mom scoops her up — that little moment of fear is good for her. It teaches that it’s okay to be afraid for short periods of time. It’s ‘I can be a little scared and the world doesn’t end,’” Dayton said. 

But in cases of long-term exposure to stress, that same stress hormone becomes neurotoxic.

That’s because infants don’t have the language to help sort through and catalog traumas or to assign them context — place, time and people involved, for example. Rather, the stresses from pain, fear or neglect are absorbed into their bodies, disrupting healthy physical and mental development, Wheeler, Weathington and others say.

Dr. Herman Gray, chair of Wayne State’s Department of Pediatrics, illustrates the point by referring to Romania’s state-run orphanages decades ago. There, babies and toddlers laid in cribs with little human contact except when being fed, diapered or bathed on a schedule. (Their plight was exposed in 1989, when dictator Nicolae Ceaușescu was executed, and Romania opened to appalled journalists and doctors.)

The impact of the neglect was undeniable: The children had delays in cognitive function, motor development and language. One researcher noted the silence of the orphanages; the babies had learned their cries would be ignored. They were underweight and underdeveloped in height. They struggled with socio-emotional behaviors. 

They had higher rates of psychiatric disorders. 

The electrical activity in their brains, measured by EEGs, was different. 

“They're in a big orphanage sitting in a bassinet or someplace with nobody paying attention to them and feeding them in a caring kind of way. They just withered away,” Wayne Pediatrics’ Gray said.

While the Romanian experience is extreme, it reveals the depth of the need for human touch and care, he said.

The Detroit program is funded, in part, by a $100,000 grant from the Priority Health Total Health Foundation and a $150,000 grant from the Ethel and James Flinn Foundation. (Editor's note: The Ethel and James Flinn Foundation is a funder of Bridge Michigan. It had no part in conceiving or writing this story.)

“In this together.”

On that recent Wednesday, Weathington dropped by the exam room to see Fulton and Isis. 

Weathington smiled as she asked Fulton about the formula he was feeding her and how he was getting to appointments. She urged him to call a support group for fathers.

He stepped over to the sink to rinse Isis’ pacifier, offered it to her in his arms, then tucked her into her car seat, carefully adjusting the straps around her pink bunny onesie.

“You’re doing awesome,” Weathington said. “Just remember to call us if you need anything.”

He nodded.

“I’m trying,” he said, heading for the door. “I think we’ll be okay. Isis and me — we’re going through this together.”