Following the last post, here are some insights from Erica Komisar’s book Being There: Why Prioritizing Motherhood in the First Three Years Matters (Penguin Random House, 2017). Read her book for more context, evidence, insight, and advice. As with the preceding post, this summary is not intended to make readers feel bad about their parenting decisions. Corroborate these views with other sources of evidence and expertise before acting on them.

Fundamentals

For infants and toddlers, physical and emotional presence trump creature comforts. Your baby does not care if she has a bigger room or goes on extravagant vacations; what she wants is the safety and security of being in her mother’s presence.

A stay-at-home mother who is inattentive to her child’s needs; distracted by her phone, tablet, or computer; or caught up in social or other family obligations is as absent to that child as a mother who spends long hours away from home.

From the beginning, babies know who their mothers are. Only her mother sounds the way she does, smells the way she does, and looks at her with the right eyes. Babies as young as six months mourn when their mothers are not present. While there is some leeway, mothers, fathers, and other caregivers are not interchangeable. They serve different roles.

Cognition

In a society that values academic achievement, parents worry about their children’s cognitive development. But concentrating on a child’s cognitive development (left brain) instead of her social emotional development (right brain) before the age of three is like putting on her shoes before her socks.

The first three years of your child’s life should be spent nurturing her emotional health and social development through attachment, play, and nonverbal communication. The ability to read social cues, relate to others, and develop lasting emotional connections, lays the foundation for later cognitive development. Without that foundation, a child may not be able to tolerate the frustration and mistakes necessary for effective learning.

Presence

When babies are frustrated or angry, mothers should mirror their feelings using voice and facial expressions. When playing with the baby, do not think about the dishes in the sink or email. You and your baby are involved in a dance of connection and space, attachment and separation, engagement and disengagement, rupture and repair. Sometimes your baby leads and you follow, and sometimes you lead and your baby follows.

This playfulness and intimacy help shape your baby’s developing brain and personality. Let go of all distraction and stimulation. Focus on eye contact, touch, your tone of voice, facial expression, body language, and awareness of your own mood and emotions.

When a mother cannot be there, she should be sensitive to the cues of her child when she returns, aware when she has been away too long or is too disconnected. Children are wise beyond their years. They are born with an innate sense of their essential needs.

A mother’s sensitivity will alert her to whether those needs are being met, and can instruct her in how to help her baby upon her return. When a baby is anxious and clingy, or turns away from his mother after a separation, a sensitive mother recognizes the need to repair the rift.

• Mute your phone when you are walking down the street with your baby. Before the age of six months, your baby should be facing you in the stroller, so that you can make eye contact and engage her as much as possible
• Inform your nanny or caregiver that there will be a strict no phone policy while he or she is on duty. The caregiver should use a cell phone only in an emergency or to reach you
• Make sure your baby can see you when you speak to her. Don’t talk to her from another room
• Turn off the TV and radio when you are not actively listening to them or when you notice your child is not listening to them
• Inform your work, friends, and family that you will be not be responding to calls, texts, or emails for specific periods of time unless it is a true emergency

Absence

Say goodbye when you leave your child. When you have to leave to go out and your baby shows distress, reflect your baby’s feelings of sadness and pain and put those feelings into words. Then reassure him that you will return later, that his caregiver is there to take care of him, and that you will miss him too. When you are leaving, allow extra time. Let your baby be sad and angry when you leave, rather than rushing away from his feelings because they are uncomfortable for you (and him).

Create a routine for when you leave and when you are reunited. Before you go out the door, tell your child what he will do during the day, who will stay with him, and when you will return. Sing a leaving song or give your child something of yours to keep until you return, a long and loving hug, and the reassurance you will return. When you return, let him return the object (if he wants to) or sit on the floor immediately, and let your child come to you on his own terms.

Whenever possible, once out and once in is easier on babies then in and out, in and out. If you have to leave shortly after you return from an absence, it’s better to stay away for the longer period of time. Do your best to be present for the big transitions, like morning waking and going to sleep.

Respect your child’s need for transitional objects like blankets, stuffed animals, and/or pacifiers, which represent you and the security you provide, in your absence. The ability to self-soothe is not evident in all babies. If your child naturally takes to a transitional object, it will be easier for you to leave for short periods of time. Sometimes babies use their thumbs or toes as transitional objects to soothe themselves in your absence.

A baby who sucks his thumb or his hand or his foot is a very resourceful baby. Dentists are always trying to scare mothers about thumb sucking, pacifier, or nipple dependency, and yet these are the babies who do the best when separating from their mothers. There are many reasons children need braces; ignore the dentists in favor of your child’s emotional health.

Attachment

Children who are put into daycare early (under the age of one), who spend extensive time (full or near full time) in daycare, and who are in daycare consistently until the start of preschool at age three are at higher risk of aggressive behavior and emotional problems than those who spend fewer hours a week in nonmaternal or non-primary-caregiver care. Earlier research showed that children who spent less than twenty hours a week in daycare did best.

Insecure avoidant babies adapt to their absent mothers by detaching emotionally and avoiding the pain of a relationship with their mother. Insecure avoidant children often lack empathy and show signs of uncontrolled aggression and anger at a young age. They may be the bullies of the class or seek negative attention when they are in distress or hurt; they tend to withdraw rather than seek comfort from their mother.

Insecure ambivalent babies were emotionally volatile, and clingy when their mother left and hysterical when she returned. They suffered from intense separation anxiety and were unable to be easily comforted by their mother and were often angry at her. Their mothers were often anxious, and these babies absorbed their mothers’ fear and anxiety and rarely felt safe in the world or trusted those around them to comfort them. They clung to their mothers and rarely learned to regulate their own emotions.

Insecure disorganized babies alternated between different methods of coping: one moment ignoring their mother and pushing her away, and the next moment clinging desperately. They were often very angry at the mother and unable to be comforted easily. Though their first impulse may be to seek comfort, when these babies are close to their mother, they feel frightened of precisely the person who should be comforting them with their fears.

Attachment security is passed down generationally from mother to child. In all of these cases of attachment disorders, the mother is absent somehow.

Secure mothers create secure babies who grow up to be secure mothers. Secure mothers are emotionally present without being intrusive and use nonverbal communication, such as eye contact, facial expression, tone of voice, posture, and gestures, matching the infant’s emotional state. The secure mother allows the baby to be upset or angry without taking it personally or feeling rejected and waits patiently for the baby to turn again toward her to engage. She addresses her baby’s feelings but allows a few moments to let the baby try to resolve some of his feelings without rushing in.

The secure mother transforms the baby’s feelings of anger into love by responding to her baby in an empathic manner: When the baby cries and seems to reject her, the secure mother does not automatically feel rejected or hurt. She remains calm, accepts the baby’s strong emotions, and soothes the baby with her body and her words. Her ability to think about what the baby is feeling and to feel what the baby is feeling helps her through this trying moment.

Mothers who talk to their babies, not only expressing their own emotions but also accurately putting their baby’s feelings into words, raise children who can, in turn, easily express their emotions and are less prone to depression and anxiety. Babies do not understand the words, but they will pick up non-verbal cues.

Discipline

Trying to discipline a child before she develops a conscience (that internal voice that tells her she’s doing something wrong, an important developmental milestone) and is able to internalize a sense of rules and structure is useless. For most children, this happens around twenty-four months. The best way to help a child to control her behavior when she is a toddler is to help her name and understand her emotions when she is a baby.

Teaching your toddler to obey rules and respect boundaries is a balancing act. It requires patience and self-control on your part, and the ability to regulate your own emotions while your toddler is trying to master hers. Saying no to a toddler is like waving the proverbial red flag in front of a bull. A hard no should be used only when there’s an issue of health and/or safety at stake.

If your toddler reaches for a pair of scissors say, “No, that is sharp and that can hurt you, we don’t play with scissors,” and gently but firmly take the scissors away from her. But when health and safety are not an issue, try (difficult as it may be) to understand what your toddler is feeling and reflect it back to her, as you did when she was an infant, and show by your example what the right way to behave is.

If your child throws her sippy cup full of juice, try saying, “I know it’s fun to throw your sippy cup, but if you drop your cup the juice will spill out and you won’t have any more juice. There will be a mess we have to clean up, and you might be sad, so let’s not throw the sippy cup anymore.”

Children model their parents’ behavior. Mothers and fathers who can control their anger and frustration are teaching their children to tolerate frustration and regulate their aggression.

In working with children who have anger issues, I have found that often the mothers and fathers have issues similar to the child’s. I helped a family because the school was concerned the child was very bossy and aggressive with his peers, who thus no longer wanted to play with him. In treating the mother, I discovered she was also extremely controlling at home, literally telling her son what and how to build with his blocks. A mother who struggles to regulate her own aggressive impulses may become depressed or angry when she has to deal with her baby’s or toddler’s needs. Afraid that she won’t be able to handle her own feelings, she may believe that by leaving her baby in the care of others she’s doing what’s best for her and her child. However, if she runs from her feelings rather than explores their source, she may never get the help she needs, and both child and mother suffer.

Disciplining is not about punishing or judging a child. Mothers provide the external guide to appropriate behavior and emotional control for a child. Eventually, the child internalizes these lessons as self-control and self-discipline. Often when mothers are not physically present enough or are depressed or excessively aggressive themselves, their child may have difficulty internalizing self-control.

Both boys and girls may show aggressive symptoms in response to neglect or to feeling abandoned by their mothers. Boys are usually more aggressive than girls in response to these feelings because they have more testosterone. But boys are often also more sensitive than girls; given the same kind of emotional environment, a boy may have a stronger and more intense response to neglect or a stressor, such as maternal depression, anxiety, or intrusiveness (the inability to allow a child to become frustrated or to explore on his own and, later, overinvolvement or helicopter parenting).

Boys may develop more autistic-like symptoms than girls; this is related to their sensitivity to environmental stress. Girls tend to have better coping mechanisms: They will look at a light, or suck their hand, or reach for a toy to occupy themselves when they feel frustrated, overwhelmed, or neglected, whereas boys tend to become increasingly upset and distressed. However, this doesn’t mean that a girl is unaffected by a mother’s neglect or absence. Girls are more likely to become depressed or hypo-vigilant in response to stress; depression can result from internalizing their aggression and not expressing it openly or directly.

Caregiving

The ideal surrogate caregiver is one who will care for your child as you would if you were there, will respect the unique bond between you and your child, and will promote that bond whenever you are present. When you are away, this individual embraces the role of primary caregiver, and when you are home with your child, the surrogate will step back and yield that role to you. This is harder than you might think, for both of you. A surrogate caregiver should be a constant in a child’s life for as long as possible.

Choosing the right caregiver for your child requires that you be realistic about your situation. If you are away from home for fifty hours a week and your child is awake for only seventy hours a week, the surrogate will become the primary caregiver by default and may know your child better than you do. You may feel a combination of relief that your child is well taken care of, guilt that you are not with him more, and jealousy toward your caregiver for the relationship she has with your child, especially if your child will not let you comfort him and turns to his nanny instead.

While this may be difficult for you, a caregiver who is emotionally involved with your child is providing an essential bond, and this relationship should be respected. Some mothers who feel threatened by the closeness between their caregiver and their child will hire a procession of nannies, rather than allow their child to develop a strong, secure bond with another person. Needless to say, this isn’t in the child’s best interest; a close and caring bond between caregiver and child is the goal, not something to be avoided.

Faced with a revolving door of caregivers, children often become anxious, depressed, and/or distrustful of others or overly attached to strangers.

When you’re interviewing a caregiver, consider her emotional intelligence as well as her practical skills and experience. She may have taken a course in first aid and CPR, but will she also give your child the affection and emotional nurturing that he needs?

Does the caregiver make eye contact? Is she comfortable with touch when you shake her hand or put your hand on her shoulder? Why does she want to work with children? What is it about working with children she enjoys?  Does she have children of her own? If she lights up when she talks about her children, it’s a good sign. Let her interact with your child. Does she engage her? How does she talk to her? If your child seems upset or fearful, does she try to soothe her or cheer her up? How does she do so? If your baby is asleep or calm during the interview, ask how she handles a baby who is in distress and crying, especially if he does not stop crying. How would she handle a toddler who is having a tantrum, one who is potty training and has an accident, or a child who is aggressive or angry? Does she like to play, and what kind of play does she enjoy with children? Ask her about her likes and dislikes. How does she communicate her feelings? Is she comfortable using the phone and computer to communicate with you while you’re away? How does she feel about working while you’re home? Does she see being a nanny as a profession or a temporary position?

Make it clear when interviewing that you are looking for a long-term commitment and someone who will essentially become a member of your extended family, even after your professional relationship ends. Trust your feelings. If someone ticks all the boxes, but you don’t feel comfortable, don’t hire her.

If after a few weeks your child still has not found comfort in a caregiver’s arms or her behavior changes, your child may be telling you that her connection with the caregiver is not working. Some regression is normal when a new caregiver comes into the home, but signs of a serious mismatch include sleep and eating disturbances, showing fear or anxiety when you leave or in the presence of your caregiver, developmental regression (such as increased trouble separating and potty-training accidents in an older toddler), and loss of language if your child has begun speaking. If your child’s distress continues, look for a new caregiver.

Playtime

Playtime will happen on your child’s schedule, not yours. Let her decide what she wants to do and follow her lead. You can model playing with toys or blocks or demonstrate how a toy works, but let your child make mistakes and resist the urge to show her the “correct” way to finger paint or arrange her pile of blocks. You can narrate her activity (“You’re picking up the blue block”) and participate in the play (“Would you like a green block too?”).

Be sensitive to how much stimulation your child can handle, look at her body language to see whether the music is too loud or too many toys are overwhelming her. Let her express all her feelings, even if they make you uncomfortable. If your child seems to lose interest in a toy, you can offer her another, but don’t get upset if she no longer wants to play with you.

0-12 months: If he is overstimulated and turns away, wait quietly until he turns his face back to you. You can help your baby feel powerful and confident in his abilities by encouraging him to reach for and grasp objects or your hand. Encourage your baby to shake his rattle rather than shaking it for him.

Playing peekaboo helps your baby practice separating. Hiding objects and making them reappear helps your baby learn object constancy, the understanding that even when they can’t see something, it still exists. This translates into the capacity to understand that when you go away you will return.

12-24 months: At this age, children are most interested in playing with their mother or primary caregiver and will play side by side with other children their age rather than interact. This is called parallel play.

24-36 months: Children of this age can internalize structure and rules, and, because of their increased language, physical competence, and problem-solving skills, they are more prepared to be part of group situations, like preschool. This is the time when children are also learning to resolve conflicts and tolerate more frustration, as they must share toys and take turns.

This is an aggressive age where children are testing their (and your) limits and often resisting the rules. Fantasy play continues to be important as their imagination grows. Simple props and dress-up clothes will keep them occupied for quite a while. They will want you to join them; do. Children will use toy animals, dollhouses, and dolls to act out stories and express their feelings. You can learn a great deal just by observing and listening as they do.

With potty training on the horizon, tactile materials like sand, mud, clay, and finger paints offer more socially and hygienically acceptable ways of playing with their poop.

Simple board games help your child understand rules and develop concepts of fairness and right and wrong. Your child may become more competitive in games and insist on winning. It’s okay occasionally to let her win, it helps her develop a sense of competence.

Daycare

A child’s participation in group daycare before she is two increases the chance she will develop other behavioral issues later in childhood as a reaction to coping with her fear of abandonment and loss. One of the ways this can manifest is a premature independence (not a good thing).

Not everyone has a mother or aunt who can pitch in or a spouse or partner who is willing to be a stay-at-home dad. Not everyone can afford to pay for a single full-time caregiver. A better option than institutional daycare, which can often be no more expensive, is sharing a caregiver with another family.

Research has shown us that for children under the age of two, the best ratio of caregiver to child is one to two or, at most, one to three.

If daycare is your only option, your presence is even more important to your child when you are with her. Make sure you are the one to drop off and pick up your child. The more hours a child spends in daycare, the more important nighttime security and daily repair of the mother-child bond becomes.

Make sure the facility is licensed, even if it’s in someone’s home. The more staff to children the better. One caregiver to two or three children is optimal. She should be assigned a specific caregiver. Look for a mature, experienced, stable staff. Ask how long the staff has been there and what kind of training and certification they have received. Is the staff willing to talk with you about your child? If they brush off your concerns or are unwilling to talk with you about your child’s day, look for another care situation.

Sometimes when I press my patients to recall painful childhood experiences, they argue that they never really had any. “I had enough food, a nice home, my parents gave me lots of stuff and sent me to good schools. So what do I have to complain about?” Of course, these things are wonderful (and in the case of enough food, essential). But they are not replacements for a lack of emotional connection, affection, and security, or a child’s feeling that he is not interesting or important because that is how he sees himself in his mother’s eyes, which is the most common root cause of emotional disturbance, mental illness, and social disorders.

Thirty years of cross cultural research yields these findings: Infants and toddlers who have the constant and consistent presence of an attentive and sensitive mother are more likely to be emotionally and psychologically healthy children.

A baby who seems content to lie quietly without fussing or who does not demand attention may be perceived as “good” or “easy,” but he’s not always the healthiest baby. This baby’s easy temperament may be a defensive reaction because his needs are not being met; often these babies exhibit failure to thrive or feeding issues. A demanding baby is easier to care for, because he lets you know that he needs something. Mothers must be more sensitive to a quiet, more passive baby so they do not miss his cues.

Children used to start preschool at four; until then they stayed with their mother, who acted as their constant emotional regulator. Today many programs take children as young as eighteen months; that’s a big difference in terms of a child’s emotional and physical development as well as his impulse control and ability to toilet train. It’s unrealistic to expect toddlers of that age to sit quietly or contain their boundless physical energy in circle time. What some people see as misbehavior, “acting out,” or symptoms of ADD or ADHD may be a normal reaction to being separated from their mothers before they are developmentally ready.

Support

A woman may have a strong conscious desire to have a baby, but this is not mutually exclusive of having conflicting feelings about mothering or caring for a baby. The desire to have a baby is driven by biology (and reinforced by culture). The desire to care for or nurture a totally dependent baby requires a woman to connect with a positive experience of being nurtured by her own mother. It’s common for a woman to have the fantasy that her child will satisfy her own unmet needs for love and attention, particularly if she had a conflicted or turbulent relationship with her own mother.

When a woman idealizes the experience of motherhood before she has experienced it, particularly if she has had a difficult relationship with her own mother, she may be setting herself up for disappointment. For many vulnerable women, this can be a catalyst for postpartum depression and can trigger her rejection of mothering. Childbirth is painful; the aftermath of childbirth is uncomfortable and messy; breastfeeding is often frustrating until you get the hang of it. Interrupted sleep is the norm for the first two years of your child’s life, but most intensely for the first few months after your child is born. There’s very rarely a day off. Caring for a baby is damn hard work.

Build your support system before your baby is born: your spouse or partner, family, friends, doctor, pediatrician, a doula and/or surrogate caregiver(s). In many cultures family and friends care for a new mother during the first month to six weeks after she gives birth; this is not considered a luxury but a necessity.

In the distant past, cultures glorified the power of giving and nurturing life. Today many women see themselves as warriors in the pursuit of power, money, and work equality and have turned away from nurturing as too soft and without substance. And yet they miss the point that mothering is the concrete foundation of the house that withstands the storms later. Becoming a stronger woman has come to mean being like a man and delegating mothering to strangers who are condescended to, paid low wages, and given little job security and little respect. Many of these caregivers leave their own children to care for others’, a painful choice that they would have avoided if they could.

We have to learn to ask for help from others: our mothers or mothers-in-law, female relatives, babysitters, friends, and other mothers but especially our spouses or partners. Today, it’s fathers who play the most critical role in supporting mothers, particularly when both partners must work. If your children are going to be your first priority, then your spouse or partner has to become a more equal partner in sharing the care of the household.

Even if a partner is already a willing (if not enthusiastic) participant, cook, or housecleaner, the most important way fathers can support mothers is to encourage them to make the choices that are best for them and their families, admire them, and respect them for doing what is the most important work in the world, that of being present emotionally and physically for their young children even at the expense of additional financial security.

Sleep

It is not healthy for your infant to cry for long periods of time without being comforted. This is why sleep training in the first six months, before healthy developmental separation has begun, is not recommended.

At around six months, a baby’s cries change from desperation when you do not come immediately (Mommy come right now. I am scared and can’t be alone and feel I will die if you don’t come) to dissatisfaction (You get over here right now and pick me up or I am going to scream until you do, do you hear me?), which indicates that she may be ready to tolerate slightly greater amounts of frustration.

When your child cries for you in the middle of the night, he is afraid. Go to him quickly and soothe him, using touch and your voice. Stay until he is able to fall back to sleep or until he is comfortable with your leaving. Ignoring your baby’s cries, or letting him cry to hysteria or vomiting, may teach him to fall asleep by himself in the short term, but may have long-term consequences for his emotional health.

Sleep is a matter of habit. Each child is unique. The only thing that is consistent regarding sleep and young children is inconsistency. It will get better over time. Before then, it is not recommended to sleep train before six to eight months old. Pay attention to child rather than to arbitrary cut-offs. Introduce frustration in small doses. If two or three minutes of crying doesn’t help your baby settle down, go in to comfort and reassure her, then leave again and wait a few more minutes.

If the crying continues check on her again, using your words and touch to reassure her. Remind her that you will be near her if she needs you, and that it is okay to fall asleep. If her crying persists for more than five minutes, it is probably too early to use this approach with your child. Try again in a few weeks. As children get older, you can extend the amount of time you wait outside the door.

Talk to your baby about the peacefulness of sleep. Create bedtime rituals. Be patient. Be aware of your anxiety about separation and sleep. Children may pick up on your anxiety and mirror it. If they come to you at night and want to sleep with you, allowing them to do so will create a habit that is difficult to break. If the goal is for the child to sleep in his own bed, then bring them back to their bed and sleep with them. Reassure them if they have a nightmare.