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Pediatricians see the problem every day in their offices: so many apparently well babies, so inconsolably fretful; not sleeping well; not feeding well, or feeding too much. So many toddlers whose behavior is out of control: obstinate, hyperactive; real temper tantrum factories. Could it be ADHD? Or bipolar disorder? At such a young age?

Or the "problem" older children. It’s not just that they may be oppositional or depressed, or may so often complain of a wide variety of symptoms which seem to defy diagnosis. It's just that there are so many of these children. All families have to deal with such issues from time to time. What's alarming is the epidemic proportion to which these problems have grown.

Sometimes you can find an answer. Maybe the parents are going through some tough times. Maybe they can’t agree on how to raise and discipline their kids. Or maybe they just don’t have the time they want and need to be with them. But all too often, an answer just isn’t forthcoming. Or maybe the damage was done long before a problem became apparent.

As a pediatrician, I strongly suspect that, at least in part, it’s the lack of time for mothers to remain with their infants before returning to work that’s responsible for so many of the dislocations we find in contemporary American society. The twentieth and early twenty first centuries have seen a mass movement of women into the workforce unprecedented in history. Other nations have made, or at least are beginning to make, the necessary accommodations, by mandating a paid maternity leave of sufficient duration to meet the needs of the child before the mother returns to work. The United States stands almost alone in making no such accommodations (the other three nations are Swaziland, Liberia, and Papua New Guinea). My guess is that we will pay a price.

Is it just an accident that prescriptions for mood stabilizers to treat adolescents and young children with bipolar disorder are now being written with alarming frequency? Or that ADHD, a diagnosis that seemed somewhat exotic until the 1970’s, is now diagnosed in up to 12 percent of the school-age population? Or that the incidence of autism continues to rise? Doubtlessly, any one of these problems stems from multiple causes, but a fundamental reality of childhood health should always be kept in mind: the earlier a problem occurs in the course of a child’s development, the more likely it is that the consequences will be profound and long-lasting, if not permanent.

Humans create and define themselves in relation to the world around them. The younger the human, the more important those relationships become in terms of physiological and neurodevelopmental health. In the first year of life, the most basic relationship for the infant is that which she forges with her mother. In a very real sense, it is the suitability of this relationship that determines how well the child adapts emotionally to the world around her.

Developmentalists call it “affect dysregulation:” the inability of a young child or toddler to modulate his emotional reactions to his world, with the result that he may be inappropriately angry, fearful or even euphoric when coping with environmental stimuli that children of similar ages would ordinarily have little trouble dealing with. Affect dysregulation has been associated with the development later in life of such problems as impulsivity, psychosomatic illnesses, impairment of social skills, poor school performance, and empathy disorders.

The faculty for affect regulation is seated in that part of the brain known as the orbitofrontal cortex, and it's been found that the normal development of the orbitofrontal cortex is highly dependent upon environmental factors, chief of which is the quality of the relationship with the mother. When that relationship is compromised in any manner, the result may well be the eventual emergence of serious psychosocial problems that prove to be very difficult to manage.

To date, developmentalists have focused on the character of the mother-infant relationship, but I would argue that the most fundamental element of that relationship has been largely overlooked: the element of time. More than anything else, normal neurodevelopment is predicated on the provision of an ample amount of time for mothers to be with their infants. And time is just what most working mothers don’t have, at least here in the United States, largely because the United States does not have a paid maternity leave policy.

Children must learn to feel before they learn to think. Without giving mothers the time they need to be with their infants, we will never accomplish what Mohandas Ghandi seemed to understand almost a century ago:

“It will not be denied, that a child, before it begins to write its alphabet and to gain worldly knowledge, should know what the soul is, what truth is, and what love is, what powers are latent in the soul.”


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