Alone - in a land of giants

I am writing this article and voicing my concerns about the present day practice of leaving tiny children in nurseries (however kind the staff) in the first two to three years of life. I was a psychiatrist for 35 years, specializing in unresolved trauma and dissociation. I know what can, and frequently does, happen to a young child in a situation that causes either fear or pain or both.

Let me explain why I have this viewpoint.

This practice is prevalent, particularly as increasing numbers of women want to be mothers yet do not want to interrupt their careers to do the ‘mothering’ which a child needs. Some women have little choice, I accept that, but I suggest that other arrangements should be made available - for all. A baby and young child needs a one-to-one relationship with a loving and caring adult – someone who is prepared to give time and selfless effort, be it the mother or another adult who loves or can love the child.The mother is the natural one for this role.

It is my opinion that being away from a parent or other loving one-to-one carer can be detrimental, at ages below two and half to three years, to the emotional wellbeing of the children involved. Learned people do tests and say that the mental development is ‘normal’ – yet, how do they know the possible potential of any child?

Even in the older nursery school aged children, I believe all-day placement is wrong, and should be 3-4 hrs at the most, a morning or an afternoon, two or three times per week. Anyone knows that school children in their first year are extremely tired by the end of their school day – even the most resilient. To expand this, just now, I think that before school and after school classes purely for ‘baby-minding’ for working parents, rather than ‘chosen-by-the-child activities’, is wrong.

This is not a critical article nor intended to make parents feel guilty – it they do, then at least they are questioning and maybe able to change their decision – if too late for one child then for the next.

No, it is for information. To make a decision or choose to go in one direction rather than another requires information, without which and with no intent or guilt, mistakes can be made. Information is particularly important if that decision affects another vulnerable human being who has no choice or if it could have long lasting effects. 

Let me explain.

When I was a junior doctor working in a children’s ward, I closely observed the children in the ward. Virtually all the children cried when they were initially left in the ward, unless they were, by that stage, too ill to respond. Through the ignorance of those years, the practice of parents leaving their children alone in the ward was thought ‘best for the child and the parent’ by those in high authority and visiting hours were allowed daily but were very short. But, though the children were very ill, after a short while they stopped crying.

Fortunately that practice was recognised to be wrong and was eventually, over many years, changed.

Most people thought the children had ‘settled’. I didn’t as it didn’t seem right. To me, observing closely, the children did not ‘look’ quite the same. The children in the ward became like little robots – it worried me greatly.  To hear them cry was distressing; to see them when they stopped crying was confusing. It was as though I watched them ‘disappear’ in some way. I knew that, even with our dedicated care and treatment - which in those days was limited when compared to today’s wide range of drugs and advanced diagnostic techniques - these children were still in distress and often in pain. Yet, that ward had an eerie silence, until broken by the next patient to be admitted. Then soon, silence would reign again.

Another event had happened a few years earlier – when I was 17 yrs of age – something that stuck in my memory. My little brother, nearly 3 yrs old at the time, was admitted to hospital for a relatively minor operation – his physical pain was not great, though, in those days hospitalization remained until the last stitch was out and the wound fully healed.

This was a child I helped to look after, a child I spent endless hours with and loved deeply. I went to visit him and couldn't see him, until I realised that I had walked straight past him in the ward. I was stunned. Totally shocked! How could I not recognise my little brother? The reason was that, though externally the same, to me he looked so different. I hadn’t seen him for about a week, but the happy, jolly child had disappeared and in his place was a white faced, frightened little boy with staring eyes whose ‘light had gone out’. He was able to recognise me, but showed no emotion – he did not smile and he did not cry. Even then, I asked myself, ‘what has happpened’. Once home he was soon back to himself, but, he became a rather obsessive and fearful child. That episode was unfortunate, but it was not caused deliberately and it only lasted two weeks. That was the effect of being isolated away from home in unfamiliar surroundings, even though seeing at least one of the family for an hour or two every day!

My interest in the psychological reactions to trauma began.

Let me say now, that small nurseries with kind and gentle staff, with groups of 4-6 children, for the over two and a half year – three year olds, provide a very good system and help in the emotional and social development of the child. But these should be for a few hours per day, two or three times per week to start with and building up to 3-4 hrs daily before starting school, This is what should be provided for all children, in the two years before they go to school, to prepare them for this challenge with enthusiasm.

This was the concept of nurseries when they first began in the early 1960’s. They were never intended to provide women who chose to be mothers to have the freedom from the daily care nor so that women could continue or further their careers. They were designed for the children’s benefit, not the mothers.

It is the effects - in the first two years of life - of full time nursery attendance and care in large nurseries that I am writing my concerns about.  I hear of babies of only a few weeks being taken to nursery at about 7 am so that the mum can catch the early train to work, and being picked up at around 7pm! What is a government thinking of to even let this happen, let alone encourage the practice?

Imagine, if you will, that suddenly you have been taken from your comfortable bed to a strange place and handed over to a giant. You have lost your ‘adult’ abilities of understanding and perspective and  are not able to recognise either faces or places. So, though you can see and hear you cannot make sense of anything around you - everything is strange and loud, and unfamiliarity brings fear. These giants and the place are so big! ‘What will they do to me? What will happen? Where am I?’

The person who handed you over, who you recognise and with whom you feel safe has gone- disappeared. Where is she/he? Will she/he come back? If she said so, you couldn’t make sense of her words. All you know is that you are alone and in a land of giants.

Time passes and other giants appear. You cry. Occasionally someone you don’t know picks you up. You hear others crying – who are they and why are they crying? Are they being hurt? The fear of that unknown, makes you cry even more. What is going on? What can you do?

The answer is nothing, you must just wait.

Giants are talking but you cannot understand what they are saying. The nasty feeling in your stomach gets stronger. Where is the person that you knew? Eventually, it is too much and tired with distress, you fall asleep.

You awaken and the giants are still there and you cry again. They do not hurt you, but you are lost.  

Eventually, after what seems like for ever, the person you know and feel safe with comes and picks you up and takes you away from the unknown giants and back to the bed you left many hours ago. You feel safe at last.

But, the next day – oh no, the same thing happens.

And the next,

and the next,

and the next.

You never now feel safe or relaxed, even with the person you knew. That feeling of safety has gone. Even with her, you are always waiting – waiting to be taken away again?

You have no choice, day after day, but to face what is, for you, always a changing unknown. Some days you feel a pain, and cry even more. Sometimes you feel ill, so everything seems much worse. There is no point in wishing you were back in your own bed, no point wanting the person who left you there – you have no choice but to live each day as dictated by others. You have no voice, no say, and no rights.

Translate that scenario into being a baby, a few months - or even weeks, old being taken to a large nursery for all day care. No matter how kind, how caring, how skilled the staff or how pleasant the surroundings, such very young children do not know where they are nor can they recognise faces or people.  

If this was translated to the animal world the RSPCA would be ‘up in arms’, but the NSPCC seems to say nothing! 

But, very young children have a safety valve to protect them from too much stress - an unconscious and inbuilt mechanism – they can drift away from your body so that they lessen or even stop unpleasant feelings. How ‘far’ they drift depends on the level of pain or fear. Then, they cannot feel whatever they would feel. So it doesn’t matter. If the situation continues, they learn, gradually and slowly, not to care. But, once they learn not to feel pain and fear, they inevitably and eventually also give up their ability to feel good feelings – of happiness, love and joy .

If all- day nursery care is absolutely the only way a baby can be cared for, then the baby should have only one or two dedicated carers and be cared for in small ‘cosy’ rooms, so that he/she can build up a feeling of safety and security.

Ask even an intelligent, happy- at-school, five year old the names of the children in his/her class and you will get just a few names. Ask them the way to school – they do not know, unless it is just nearby where they live and they walk the same route regularly. Many travel by car and do not know the way. Tiny tots – under two years, are unable to know where they are, who they are with in a strange place and have no concept of ‘the time’ i.e when they will be collected to go home’.  They have to accept, with no choice where adults place them and what they do to them.  But, should this be a continued, regular situation, i.e every day , they are also very likely to  learn how ‘not to care’ about themselves or others. They become denied the right to feel happiness, by the very people who are meant to love them, their parents.

When that happens, you have someone who cannot form an emotional attachment, and who may not be aware of their own or other emotional needs. In other words they easily, or maybe permanently, become detached from their feelings. Being ‘switched off’ is neither pleasant or normal, and they may crave to have ‘feelings’ and use whatever becomes available ,eg drugs to heighten their awareness.

Of course, all children are different and some may be affected less or more than most – some are more resilient by nature. How do you know how a child is going to react?

At that age, it is impossible to know which child is going to be easily fearful or highly sensitive to pain or fear, perceived or real.

I visited a country, I won’t say which, and saw many young children on the streets begging – it upset me greatly. Someone said to me, ‘Oh, don’t worry, can’t you see their smiling faces?’ I did, but I also saw their empty eyes. Empty - from too much suffering. I didn’t enter an argument – it would have been pointless. I simply said, ’We are all made the same. Would you be happy where they are?’, and walked away.

But, I couldn’t do anything in that situation. Now, I can write my concerns at what is happening in many parts of the world. I was trained as a doctor, and worked for 35 years in psychiatry. I became a Consultant. Yet, I consider that those years spent at home with my young children until both went to school were, without a doubt, the most important of my life.

It wouldn’t take rocket science to reorganize the present system – for the benefit of tiny tots. However, in the present day, when money is the only god that is truly worshipped around the world, the wellbeing of children is not a first priority, whatever ‘government or parental speak’ we hear.

Child labour was, thankfully, outlawed in this country, England, centuries ago – though sadly not throughout the world. There was a period, when I was young, when young children’s needs were a priority and mother’s stayed at home to care for their children.Most women were proud to do so and thought this not only their duty but a privilege. They usually had the help of their own mothers who lived nearby. Until the Second World War, women who married and had children were actually expected to leave work and stay at home. Families managed on one income – however meager. Most may have forgotten that.

Now, many women see their career as most important and their children are ‘fitted into’ that timetable, rather than the other way round. Many people live away from their place of origin and their support system of close family. Expectations are higher. But a child’s needs remain the same, whatever the era and culture.

Do all those making the decisions have their own children in large nurseries while less than two years of age? Do all the wives of the politicians telling others what to do, put their child into all-day nursery when only a few months old?

It is perfectly obvious, in recent years, that any government has money for what it wants money for.

I could suggest a different system that has a young child’s best interests at its heart.

1) 3 years compulsory maternity/paternity leave from work for one or other parent – or a shared arrangement - so that one or other parent (if a child is lucky to have both) can look after their child in those years.

2) An adequate ‘child allowance’ given to the poorest, but not the affluent.

3) Nurseries and staff would still have an important but different role in our fragmented society. Parents could attend WITH their tiny tots and thus, in the absence of local support of grandparents and other family members, receive whatever help they may need to understand parenthood and gain a support system of other parents and make friends at the same time. There must be an understanding that parenthood is challenging and often difficult, but good ‘mothering’ by a mother, grandparent or one-to –one carer is the bed rock of a happy society.

4) Deferment of repayment, if necessary, of any mortgage payments for the first three years of a child’s life – this would extend the time when the mortgage was finally repaid, but allow a window of opportunity to cope with a single salary.

5) A guaranteed possibility of return to part time work or training/career for one or other parent - until the child reaches 16yrs.

6) Make it quite clear from a government level, that one parent should be responsible and accountable for their child at all times – into the later teenage years. School holidays would automatically be included for one parent.

It may take some dedicated arranging – but the price of the present system is, in my opinion, too high a price to pay. The future will depend on having caring, individuals who can love and respect themselves and others. Wipe out the basic core of ‘love’, which should be developed in those early years  and you wipe out the nation’s heart  and leave the path open for the ever and increasing presence of drugs, alcohol, crime and abuse and continued aggression and wars.

A change of emphasis is needed based on information.

It won’t affect me. I have already had my ‘three score years and ten’. I have retired from psychiatric work, but I continue to care very much about the future and, in particular, about children. I see so much happening that I believe, from my psychiatric work and training, is potentially and psychologically wrong.

Copyright©A Coatesworth (2009)