Voice of the Infant: best practice guidelines and infant pledge

Co-produced by a short-life working group, on behalf of the Infant Mental Health Implementation and Advisory Group, which is part of the Scottish Government’s Perinatal and Infant Mental Health Programme Board.

Special Considerations

The approach to eliciting infant voice may be more challenging in some situations. This may be to do with the infants themselves or the wider context.

As with older children, the infant's perceived views should be taken into account when making decisions about their care (for example at a Children's Hearing). However, our response should not be to a single cue but rather to the overall picture we have of the infant, which should be considered alongside the views and observations of carers and professionals. What we have learned from the infant often acts as a stimulus, promoting discussion of all the evidence we might have about them. The Best Practice Guidelines support ways to bring the infant's voice into the room, and not to make judgements in isolation.

Times of stress and distress for family members and professionals may make the task of listening to the infant voice more difficult. There are a range of factors that can make it hard to focus on the baby's perspective, which should be considered in each case.

Factors to consider include:

Infant characteristics may include prematurity, complex physical health issues, or additional physical or developmental needs, where their communication is evolving in relation to specific challenges such as hearing loss or visual impairment. In these situations, the assistance of specialists such as Developmental Paediatricians or Speech and Language Therapists may be helpful.

Family context and relationships may include stress or trauma for the family, domestic abuse, social or economic adversity, housing issues, caregiver difficulties or needs (such as mental health needs and substance use), complex family dynamics, safety or child protection issues.

Service context may include role of the service, professional training and experience, differences of perspective and resource issues.

Developmental context may include considering the age/stage of the infant in their own development journey. Areas such as sleep and crying may cause stress and challenges to parents in terms of understanding and responding to their infants in a way that fully meets their needs. These need to be considered and understood as part of the infant's normal developmental journey. Infant sleep patterns will rarely coincide with adult sleep patterns, and babies' feeding patterns, particularly for those that are breastfed, are likely to be frequent throughout the day and night and may change where there are periods of rapid growth.

Crying may be the only way that the baby can communicate their needs, and along with other cues, should be considered as a normal developmental response to making their voices heard.

In all situations, it is possible to give space to infant experience and voice. Thinking about how to co-create the right space can be done in collaboration with others in the family and the wider professional network.

A Good Practice Checklist, to help you evaluate and improve your practice, is provided.

Good Practice Examples from multi-disciplinary professionals working with babies and very young children are presented in the following section.


Email: pimh@gov.scot

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