[00:00:02] Speaker A: Welcome to the Emerging Minds Podcast.
[00:00:07] Speaker B: Hi everyone, my name is Vicki Mansfield and you're listening to the Emerging Minds Podcast. Before we begin, I'd like to acknowledge the traditional custodians of the land on which this podcast was recorded, the Mowinina people of Nipiluna, and recognize the Palawa people as the original owners of La Trewenta, and thank them for the care they have taken of this beautiful country. I also pay respect to all Aboriginal and Torres Strait Islander peoples, their ancestors and elders past, present and emerging from the different first nations across the country.
During 2025, Emerging Minds worked with Dr. Anika Jaycar and Dr. Victoria Cooper, two paediatricians who are champions of infant and toddler mental health. In this podcast, Anagha and Victoria share their clinical experience of how relational and reflective skills guide their daily practice with infants and families. They provide insights into the key ways of relating to infants, toddlers and their parents, and these insights contributed to the development of a hybrid online facilitated training program for trainee pediatricians. I hope you enjoy listening and take away ideas for how to keep infant and toddler mental health in mind in your practice.
Anika, in your experience, how do infants and toddlers communicate with their care team?
[00:01:32] Speaker C: That's a really interesting question because babies and infants communicate all the time. Like right from pregnancy when the baby's moving in the womb and the mom can feel the movement.
Then during labor when the heartbeat is noted to see whether there is any distress, as well as the baby's first cry after birth and then all through from that moment onwards, the eye gaze, the facial expressions, the smiles, the cooing, the babbling and the talking. So there's a verbal communication as well as a non verbal communication and that is the hand movement, reaching out, following the mother, all sorts of cues which allows the mother to even identify the different cries. Okay, this is a cry for hunger. This is a cry. I don't want anybody around me, I want to sleep now. So there are lots of ways babies can communicate and it's really important for the parents and any caregiver to understand those cues and allow the baby to lead that interaction.
[00:02:37] Speaker B: And you mentioned letting the baby lead the interaction. How does that look in a pediatrics role?
[00:02:43] Speaker C: If the baby is sleeping, just let them sleep. Don't need to wake them up to weigh them. Just, just be mindful of the time when they're alert and wanting to interact and when they really don't want to interact. So even modeling it with the parents to say, okay, he's sleeping we don't need to talk loudly or we, you know, simple things like that. Even when you're examining, be mindful, sensitive, and look at the strengths of the baby when you're describing anything, so the parent feels the joy in their hearts.
[00:03:15] Speaker B: And for you, Victoria, how do you communicate and relate to infants and toddlers in your daily practice?
[00:03:21] Speaker A: I would say that they communicate in lots of different ways and that it somewhat depends on whether you're seeing an infant or as in a baby, or whether you might be seeing a toddler. Although there are obviously lots of similarities. Babies in particular communicate through using their bodies and using their gaze. So looking at you, looking away, moving their arms and legs, heads and necks, they communicate through their behaviours in terms of how they might respond to you when you're talking to them in the consult. And so a lot of that communication is obviously not with words or not yet within the toddler age range. Again, behaviours is a real strong communication tool for toddlers and I think that's something really important for us as paediatricians to be aware of that.
Often the behaviours we're seeing are not just a behaviour, they're often a way that that child can communicate what's going on for them. I think in paediatrics we see a huge number of referrals and even within the inpatient setting, where behaviour is the presenting issue that's being described. And I think it's really important that we as paediatricians recognise it as a communication of what's going on underneath and that we don't just try to think about the behavior as a symptom that we need to sort of problem solve, but more thinking about what is that behaviour telling us and what is it that I need to understand about why the infant might be using those behaviors to tell us something. I think it's about taking that step back and thinking, what's it like for this toddler, this child, and why are they needing to do this? Or why are they using that particular behavior to then be able to pause and observe? Observation is a really, really powerful tool that we use the time in paediatrics. Often labels are applied to particular behaviours and I think it's just. It's important that we. We do stop and pause and really think about what's going on for that young person.
[00:05:20] Speaker B: One of the tools introduced in the practice strategies for infant and toddlers courses is the speaking to or speaking for infants and toddlers, which is a way to intentionally engage with infants and to center their experiences during appointments.
It also invites parents to reflect on their child's experience. How might talking to or talking for an infant be a helpful tool for paediatricians?
[00:05:47] Speaker A: I particularly love this tool and it is something that I do in, I probably could say in all of my consults. I'm fortunate enough to do quite a lot of clinics with infants and their families and also their carers. And I'll often start the consultants bit like I would with an older child, but I'll introduce myself and ask the baby their name and ask them a little bit about who they've come to their appointment with, how they've got there that day, what their day might have been like to try and really name up from the beginning that I'm interested in the. In the infant and similarly with the toddler. I'll talk to the toddler as they come into the room, ask them who they've come to their appointment with. Again, just trying to really center that sort of speaking to element to show that this is an appointment about them. Yes, I'm interested in all the other stuff that's going on, but I'm really interested to hear from them too. I think the speaking to the infant and for the infant is really helpful when we're examining and assessing babies and even during a baby check in terms of observing what you're seeing, talking to the baby as you go, trying to help just to provide a little bit of containment because a lot of our examinations and assessments can be quite stressful for infants and toddlers. So sort of explaining as you're going, that speaking too, which I think we do do often do do really well in paediatrics. But naming it in that way, to say that we see you when we want to, you know, understand you, I think is really validating. The speaking for is a tool I particularly use with babies, but also with toddlers and as you said, often to invite in reflection from the parent or even to just check in with where the parent's at, particularly with a toddler who's come because they're not sleeping, hyperactive or having challenges with transitions and of reflecting. What do you think? You know, I wonder whether so and so is feeling stressed in that moment or just needs a bit more attention in terms of support with transitions and things like that. What do you think about that? Or have you ever thought about what it. What. What might be going on as a way of sort of helping the parent to think more from the child's perspective? It can be hard, I think, as A pediatrician, we get the infants and toddlers usually aren't the loudest people in the room. And we can get very caught up in the parents experience of what is going on, which is extremely valid to understand to build that relationship. But we also really want to know what it's like from the infant or toddler's perspective too. And helping parents to just sort of slightly change and pause and think that actually, oh yeah, my child is going through this as well. What could be going on for them?
[00:08:27] Speaker B: Victoria, you mentioned building a relationship with parents. What skills are needed for engaging and developing a therapeutic alliance with parents?
[00:08:36] Speaker A: So building that therapeutic alliance is arguably one of the greatest skills that we have, along with obviously treating whatever else might be going on for the child. But if we haven't got the family on side, for want of a better way of putting it, then we're not going to be able to bring about some of the changes or approaches that we might, might want to happen. And that's the same, I think, in our patients as it is in inpatients. Bringing the family along is always going to be better for the child because they exist within, within their family, not in isolation in terms of the skills required, listening and attuned listening. So not just listening to what's being said, but listening to how it's being said, the emotions behind what's being said, but also listening to be with curiosity and wondering so that we're open to all the possibilities and not sort of going in with judgments. I think we, in pediatrics, we often find ourselves in quite challenging, sometimes quite distressing situations. And I think that just pausing and listening and really sitting with a family is, is a really, really valuable tool. I think curiosity and wondering is often the place I find myself sitting in when I'm trying to engage and work with families, particularly in this age group. And using those words, I'm curious, I'm wondering what you think about this I think is both helpful in terms of understanding information about what's gone on, but also when we're wanting to talk about, okay, well, where do we go through from here? Helping to bring families along by sort of saying, I'm wondering about this as a plan moving forwards. How does that fit with your family? Does that fit within your cultural settings or how you see things going for your family? And if not, how do we make this work for you?
So that we're not coming across or saying I've got all the answers, we're actually, it's a partnership. And while I might hold medical knowledge and medical understanding and behavior developmental understanding. I don't know what it's like for this family and for that infant child within that family, within that community, within that culture. And so really being able to be to sort of say, well, this is what I'm thinking, but where does that fit for you and how do we make that work within your context is a great skill to develop with families.
[00:10:58] Speaker B: I imagine it can be a tricky balance for doctors to hold that listening, wondering position because there may be pressure to move straight to problem solving or diagnosis. Do you think there's a tension to sitting in that place of wondering and uncertainty? And is it a relational skill that pediatricians have to build confidence in?
[00:11:19] Speaker A: Yes, it's definitely a tension that we feel often. I think often by the time a family have got to see a pediatrician, they are often at a pointy end, especially when it comes to things, say, like behavior developmental in an outpatient setting where they want answers and they are expecting that we often are going to be able to provide a solution. However, we often know that we're not going to be able to provide a solution straight away. And that often, especially in that particular area of pediatrics, it really is about building a relationship. Now, when you're also marrying that with some of the pressures within, say, a hospital setting, it might be that I'm not actually the person that continues that journey with the family, but I might pull in other community resources and supports who are able to then continue to do that more continual work with families. Also helping families to set realistic expectations of, of a where we might expect their young person, their child to be at is part of that and not feeling the pressure to move a family on towards a particular diagnosis or before we feel comfortable that we have all the information. Remembering that the infant or the toddler is our patient and who we're there for. And yes, we need the family on board and we need to take their thoughts, feelings, wants into consideration. But just bringing ourselves back to what's it like for this child, you know, and marrying our clinical knowledge with the expectations of a family, really wanting to understand it before we apply labels or assessments or diagnostic lenses to the situation.
[00:12:57] Speaker B: Anika, we know that infants and toddlers have different ways of being in the world than older children or adults. Can you share your perspect on how to engage with parents and children in developmentally appropriate ways?
[00:13:12] Speaker C: So play is really a great way to understand the development of children and it becomes less formal and it is more enjoyable for the baby, infant, parent, as well as the Clinician. So just playing with the child and observing and talking, interacting with and talking to and observing and talking about, oh, this is great, you can do this. So that's what a four year old can do when you're three. And just doing, even if it's slightly repetitive, you know, in children where you have repetitive play and then breaking that cycle a little bit and seeing how they react is a really interesting way to understand, you know, whether they can navigate a change.
[00:13:52] Speaker B: How do you support parents to feel less anxious about playing in front of a health professional?
[00:13:58] Speaker C: I think getting on the floor and playing with the child and saying, mom, come join us. Allowing her into that thing and then backing away and letting them play is a really good way to be able to do that. But you need the space and a setting which allows that. And actually having clinics in a setting which allows that, you know, where there's a sand pit and just pouring sand and making a mess and saying that's okay. So if there's a playground there and observing what they're doing and giving them the positive response about what they're doing and checking what the next thing could be and seeing whether they can do that is one of the ways you can actually assess development in a playful manner. And even so, sometimes you know, there's another sibling who has come with the family. So getting the sibling involved is really important to see how they interact and then how mom interacts with that. So it tells us a lot in the half an hour, 45 minutes, one hour, whatever time he has about the family dynamics.
[00:15:02] Speaker B: I'm wondering then, how important is infant observation when we're working within very adult fast paced systems?
[00:15:11] Speaker A: I think it's a challenge that we face all the time really in that particularly infants are quite slow and are very sensorially orientated beings. Whereas our clinical setting is often fast paced, outcome driven. Whereas a lot of when we're being with an infant and trying to understand an infant, we often just need to take time to pause and observe and be with so that we can actually really see what it is that the infant is trying to tell us. Especially when they're pre verbal and don't have words. So much of it is our observation skills. Not only does it tell us about the infant, but it can tell us a lot about what's going on within the relationship. Acknowledging that we can't see the infant without seeing their relationship, but understanding even within that communication, what is it that the infant gets from the caregiver? Does the caregiver respond in a way that we think understands the infant or supports the infant in the way that we want, because that can be valuable information to then use when we say, performing a procedure or examining a child infant to know how we can best support them, especially in a clinical setting, in an inpatient setting, happening fast. If we've taken that time initially to observe, get to know, work out what it is that helps that infant, it can actually then help us to do a more efficient job later on in terms of getting things done, but still keeping the infant in mind because we've taken that time early on. The pressures that sit outside of, say, the clinic room or outside of, say, the hospital bed are very much there and very much need to be acknowledged.
But I think sometimes we can get a bit caught up on having a job to do and getting on with things, and we lose some of the humanness of our job, we lose some of the art of our job. We're all quite well versed in the science and the protocols and the practices, but it's the human element of our job which makes our jobs sustainable and allows us to sort of work within our values. But there are ways that we can perhaps take our own values of what, what we're, why we're doing, the work we're doing to sort of marry the two systems so that they can both be accommodated within how we work, but ensuring that we still very much remain grounded with our patient, who, if they are an infant particularly, we need to take that time to be with and observe, because that's going to be really valuable information, often to help us do the rest of our job at the pace that's required of the, the external system.
[00:17:41] Speaker B: How does reflective practice guide your work with infants and children? And why is it an important skill for early career doctors to develop?
[00:17:50] Speaker A: So I think reflective practice is extremely important in the work we do. It allows me to take my knowledge, my understanding, the research that has occurred, but then apply my past experiences, how I felt in different situations to then help to guide me as I move forward. Forward, which may actually be different from how I might have approached it previously because I've had time to just stop and pause and think about what might have gone on or how I felt in that situation. I think as a, as a whole, in my pediatrics training, reflective practice wasn't a skill that was strongly advocated for.
However, I do think it's a skill that's often part of the work that we're doing. We certainly often look back from a clinical perspective. We have mortality, morbidity meetings where we think about what went wrong or what we could do better next time. And I see that the reflection is along those lines, but more thinking about the feelings both for myself, but also for the family and the young person that were involved, which can then inform how I'll practice in the future in terms of what I do. It might be that after a particularly difficult consult with a family, I might just jot down some of what happened, but then also some of my thoughts and about what happened. So how did I feel? Why do I think I felt that way? What was it that I thought the parent or the carer might have been feeling? And then also what was that actually like? Or how do I think the young person was feeling or going in that situation and then thinking, are there ways that I could have done it differently? Where was I sitting in that consult in terms of how was I showing up in that? Thinking about my own biases, my own assumptions, and where I sit within that conversation or consult really just helps me to remain sort of, I guess, grounded in that, yes, I'm bringing to this my knowledge and understanding, but that I really need to make sure that I'm acting for and with the family and that it's not just my thoughts, it's about what's going to work best so that we get the best outcomes for the infant or young person. And that applies both within an outpatient and an inpatient setting. It's often a little bit more black and white in an inpatient setting when there's clear pathways to recovery, but still having that ability to reflect and think, how is this going to land with the family? So when I'm supervising the junior doctors, it's often around helping them move from the diagnostic lens to the more relational and understanding lens, I guess, of what's going on. And so really getting juniors to extend their thinking from just a problem that needs to be solved and moving more to how do I understand this better, to ensure that the pathway forwards is going to fit for this family and is actually going to lead to change for the family. In my day to day work with families, I use circle of security a lot. And I will often use parallels of that within how I see myself supervising junior doctors. So within the circle of security, we're talking about the parent or the caregiver being a safe haven or a secure base who is bigger, stronger, wiser and kind. And I often put myself in that role as the supervisor, in that I'm the secure base to help that trainee to start to explore their understanding and Learning and be curious and really build that curiosity in their thinking, but also the safe haven so that when they've had a particularly challenging experience, they know that they can come and we can sit and work through that together. So I like how that's a framework that we can use both with families, but also within supervision. The Solihull program, which is talking about the containment that we've talked about. And so I think often trying to help to contain some of what's on, going, gone on for the trainee when we're in that supervisor role, but helping them to extend out from just what was going on in the moment and thinking about a solution, but how they can then learn from that solution and grow their experience and understanding broader than that experience. And then the reciprocity element in terms of that back and forth, really sort of engaging, being open to hearing all that's gone on and helping accept that and hear it and validate that and then help work out, well, where do we go through from here? What's the management, the behavior management aspect of this?
[00:22:23] Speaker B: Anika, what's your perspective on reflective practice?
[00:22:27] Speaker C: I think the professional self awareness is so important because if the registrars or the trainees are continuing to see child abuse, it impacts them and then the vicarious trauma has to be managed. But if it is managed as we do it on a regular basis, then effects are mitigated and it also brings to mind our experiences as a child, as a parent.
So for a pediatrician, as a parent and as a professional, balancing that understanding and being able to be objective about the situation takes a lot of effort and emotion. And being aware of that emotion and finding strategies to help us manage that I think important for our own well being. I think professional awareness, self awareness is really important in all aspects of our life. And being self aware in and how the personal self awareness and the professional self awareness are similar but not the same is really important for each of us as professionals to understand. I think that allows us to be more sensitive to the needs of the others.
And if we practice keeping the infant or the baby, the adult, you know, everybody in mind, it just helps us to better understand not only the interactions but also ourselves.
[00:23:57] Speaker B: And when you're supervising early career doctors, what key skills or knowledge are you drawing on to mentor their skills in keeping an infant's relational experience or needs in mind?
[00:24:09] Speaker C: There are lots of skills, so basically the knowledge base, but what is not normal, abnormal has to be strong.
I think we want a strengths based approach and you want a curiosity lens and with that in perspective of the few skills which are really important is, you know, observational skills, perspective taking, you want to also have analytical skills. You also want healthy conversation and good communication skills as well as the pediatrician should be able to model and train others caregivers or schools with directory. For me to remember it, I call it proact. It's so P is for perspective taking, R is for reflective, then you have O is for observation because you need to observe the parent, the interaction as well as what's happening in the environment. And then C is for the communication and T is training and modeling so that you can demonstrate in a sort of opportunistic way. Using it as an opportunistic intervention is quite helpful.
[00:25:17] Speaker B: What does perspective taking look like?
[00:25:20] Speaker C: So perspective taking is really thinking about how does the interaction or what's happening in this space feel from the point of the infant or the child, from the parent and the clinician. So all three perspectives, which is really hard unless you think about it in those terms.
[00:25:39] Speaker B: And what about analytical skills? How do you use them curiously?
[00:25:43] Speaker C: So we really need to know from the history and the examination a formulation about what the child needs, maybe from a developmental perspective, maybe from a medical perspective and also from the well being, health and well being perspective. And so being able to analyze if, for example, if the baby or the child is not sleeping, what is it that is causing that?
Whether there are no routine setup, is it the environment is too noisy, what is the thing? So we need to analyze the situation from all these perspectives and then look at strategies. You know, asking the healthy conversation skills of open ended questions will allow the mother or the caregiver to expand on what the problems are without being judgmental.
And so that creates a safety for them to say what they feel genuinely and then exploring that and then going into more depth because most of the the solutions are within the parents. We just have to, you know, help them find it.
[00:26:48] Speaker B: Finally, I'm wondering how collaboration between the different parts of the system of care can support and promote infant and toddler mental health.
[00:26:58] Speaker C: Support networks are equally important because we've talked a lot about the parent child relationship. But the support network supports for not only the mom but also the dad and the family as a whole would be really strengthening. Support networks will help the family navigate a complex situation.
[00:27:19] Speaker A: I think it talks about advocacy for the young person. And again, that is another key skill that as a paediatrician, both when we're in a clinical context, but even when we're in our meetings, helping to center things in the child and think from the child's perspective perspective and bring out that child's voice. In terms of how we work collaboratively, certainly in my current role we often have care team meetings or lots of email trails going on, really trying to bring everybody around the table to ensure that we're, we're all holding similar, I guess, frameworks in how we're thinking about what's going on, that we've got shared understanding of what's going on not only so that we can show up and know where things are at, but also so that the family don't have to keep necessarily, necessarily going over things all the time. These different people become come involved but also acknowledging that we all bring slightly different skill sets to the table and that again we all have slightly different lenses or ways of or even our points of entry with a family to a ensure that we're being holistic in our thinking and our overview. For the family, I can share developmental knowledge, I can share other knowledge which might then mean that the team who are better able to support the family at that time have got all that information and knowledge as well. I think we're already doing a lot of this in our practice and I think as a profession within medicine we are well placed to be able to support and bring out the infant and toddler's voice while supporting the family and bringing them along for the journey. We've also got this amazing role of advocacy that we can have just to ensure that children and the young person's voice doesn't get lost in and amongst the bigger systems or parent voices that are often the loudest in the room. That we remain grounded in the work that we do and for the infants and young children.
[00:29:22] Speaker B: I'd like to to thank Annika and Victoria for sharing their practice skills with us today. Also for mentoring trainee paediatricians through your mentoring and championing of reflective, relational and collaborative practice within community and hospital pediatric settings, we are actioning a more comprehensive mental health care system during the foundational time of children's development. We look forward to sharing with you more insights into infant and child mental health soon.
[00:29:53] Speaker A: Visit our website
[email protected] au to access a range of resources to assist your practice.
Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The Centre is funded by the Australian Government Department of Health, Disability and Ageing under the National Support for Child and Youth Mental Health Program.
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