Appropriateness of care and joint decision-making strategies

Abstract

The importance of the “1001 critical days”, defined by the UK cross-party manifesto for children as conception to age 2 (2014), underlies the need to act early in life to enhance children's developmental outcomes. The early years are a crucial period of psychoaffective development, and the events that occur then lead to structural changes that can have lifelong consequences. Lack of intervention is likely to affect not only the children of today but also the generations to come. Children who suffer multiple adverse events achieve less educationally and are less healthy; the perpetuation of the cycle of harm in the following generation thus becomes more likely. Psychological development is simultaneously a very powerful and a very vulnerable process. As Tronick and Reck (2009) have brilliantly shown, “good enough” mother–infant interactions are misattuned or out of sync about 50% of the time. What we call “resilience” usually allows infants and children to traverse daily developmental difficulties without major consequences thanks to what they called the “repair processes” within interactions. When it works, this system is one of the principal foundations of safe development. Of course, these repair processes have limits, and we must bear in mind that misattunements of early life can have durable developmental consequences. This is particularly frequent in cases of difficult parenthood.