Kirsty at six months: Early enquiry

Kirsty, the Holyrood baby, by Jenny Proudfoot

Kirsty, our fictional Holyrood baby, has turned six months old. 

Born as our MSPs sat down to begin the fifth session of the Scottish Parliament, Kirsty has grown.

At six months, Kirsty is beginning to notice the details. The feeling of water on her fingers, the hard nose of her teddy bear. She reaches out to grab her mother Caley’s hair, her necklace and pulls at her ears.

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She reaches out her arms to be picked up.

Her brain is developing rapidly, and turning her onto her stomach is helping her build the muscles in her arms and legs and develop her motor skills. It won’t be long before she will be exploring the flat, and Caley knows it.

“Six months is a really exciting time,” says child neurodevelopment expert Dr Peter Willatts of the University of Dundee. 

Kirsty is developing both physically and emotionally very quickly, he says, approaching an important milestone: being able to sit up.

“When that happens they can sit on the floor, their hands are free and they can start to explore things.”

However, born into one of Scotland’s most deprived communities, Kirsty faces enormous challenges to fulfil her potential.

And she isn’t alone. Last week, a study for the End Child Poverty Coalition suggested 3.5m children are living in poverty in the UK – with 220,000 of them in Scotland.

The results, released as Chancellor Philip Hammond prepared his Autumn Statement, are broken down into local authority area. They reveal Glasgow City is the worst-hit, where 34.1 per cent of children live in poverty. In North Ayrshire, 30.4 per cent live in poverty.

Kirsty could live in any local authority area, though. Even Shetland, the least affected, has one in ten children living in poverty, according to the study.

The coalition, made up of the Child Poverty Action Group, Barnardo’s Scotland, One Parent Families Scotland, Children1st and the Poverty Alliance, called on governments in Holyrood and Westminster to include local authorities in a strategic approach towards creating a Scotland free from child poverty.

“Living on a low income not only affects their wellbeing now, but can have a negative impact in the future,” said Peter Kelly, director of the Poverty Alliance.

“This is an unnecessary situation and one that requires urgent attention.”

And as Holyrood has already explored with Kirsty, the roots of inequality exist before a child has even been born. 

“There really is no time like the present” for tackling health inequalities, says Pauline Craig, head of population health at NHS Health Scotland.

Research shows all kinds of factors can impact on a child’s health, development and life chances in the nine months before a baby is born, and in the critical first 1,000 days of life.

At six months, Kirsty’s development and increased awareness needs to be encouraged, according to Willatts.

“You need to feed that, be ahead of the baby’s development and stimulate them in ways that are appropriate. They need toys. They need things to play with. What they don’t need is a television or something like that, because it’s just so passive and also very attention grabbing. They need to handle things, to explore the world and they also need to be playing with people.”

Six months is a critical time in forming relationships. Evidence shows secure attachment with the main care-giver will have a positive impact for the rest of Kirsty’s life: how she relates to others, how confident she is and how she can resolve and recover from conflict.

Willatts says it isn’t easy. “Getting that right is really critical, so you need to have the people who are caring and looking after the baby around regularly, they need to be playing and talking with the baby. It’s quite a tough demanding time. You do need to spend time with the baby. There’s not a substitute. You can’t just dump them down and expect them to occupy themselves.”

These consistent relationships create the necessary pathways in a baby’s brain to allow it to develop, and then to ensure that these connections become ‘hard-wired’. 

In other words, the attainment gap, which the Scottish Government has identified as its nemesis, is already forming for Kirsty.

“Yes, very much so, and in all sorts of ways,” says Willatts. “It can affect what’s available at home, it affects the self-esteem of children. If you have low self-esteem you’re not motivated to learn.”

One of the complicating factors in establishing good secure attachment with a baby is stress. As someone whose income is not likely to be stable, who is more likely to feel insecure in her community and more prone to illness herself, Caley is at a higher risk of stress than other mums. 

Mothers in the lowest income quitile are four times as likely to experience repeated mental health problems as the highest quintile, according to the Growing Up in Scotland study.

“It is going to interfere with the way they interact, the way they talk, the time they have to play,” says Willatts.

And the more stressed a parent is, the more stressed a baby is likely to be.

The impact of stress on a baby cannot be overstated. At a time when the brain is forming more synapses than it will for the rest of her life, high levels of stress can actually weaken the connections in the brain or can cause brain cells to die. 

Parents like Caley need advice and support to encourage them to keep talking and playing with their baby even when they themselves are stressed, says Willatts, who suggests underinvestment in health visiting over a long period has led to a decline in such a service.

“We used to have a really good health visitor service to identify mums who are having problems. That has kind of fallen away. There’s not enough investment there, but that’s a service which is really very valuable, particularly with this group. People who can come along, talk to mum regularly about some of the problems and then give this practical advice.”

The Scottish Government did announce the creation of 500 new health visitor posts between 2014 and 2018, but as of this summer, 8.6 per cent of the workforce was unfilled, with a rise in vacancies.

And the role has become less attractive as proposals to give every child in Scotland a named person led to accusations the health visitor would act as a ‘state snooper’.

Meanwhile research shows encouraging a baby to develop its physical and mental resilience is vital. 

“It’s absolutely clear it makes a difference,” says Willatts. “What these families need is access to help, advice and suggestions, and it has to be practical, appropriate and something they can manage.”

One obvious thing which mothers seek advice on is breastfeeding, a contributing factor to Caley’s stress. 

The feeling of not being able to feed your child can be a contributory factor in post-natal depression, which affects 12 per cent of mothers. 

Recent NHS figures show the number of mothers exclusively breastfeeding in Scotland is falling. While almost half of Scotland’s babies born in 2015/16 are breastfed, the number doing so exclusively at the very first health visit fell this year to just 35 per cent, following a gradual decline since 2006.

In other words, increasingly, mothers are combining with formula milk when things get tough.

Breastfeeding rates in poorer areas are even lower. Caley switched to formula after two months because she was finding it very difficult and painful, and none of her peers were still breastfeeding. 

Like many mothers who stop breastfeeding before this six-month point, Caley felt like a failure. All the advice she has been given tells her breastfeeding is key to protecting Kirsty from viruses and infections and lowers her risk of asthma and allergies.

Commenting on the breastfeeding statistics, Gillian Smith, director for the Royal College of Midwives in Scotland, said: “It is good news that breastfeeding rates have not fallen over the past decade, but real effort is needed to increase them.

“These figures show that serious effort needs to be made to tackle the inequality in Scotland and to target resources at those sections of the community suffering from poverty and deprivation. It is often these groups for whom breastfeeding will bring the greatest benefits.

“I am also concerned at the large regional variations in breastfeeding rates across Scotland. We need to know why there are such large differences and then take steps to eradicate them. We need to bring those with poor rates up to the levels of those with the highest, and we need to push them all to do even better.”

Nutrition doesn’t just impact on health outcomes, according to Willatts, it also affects brain development. “It’s absolutely clear that that, especially early on, can affect development in the first thousand days and it can have long-term effects. Our own research shows how babies were fed in the first four months affected their ability to solve problems at six or seven years of age.”

The long chain polyunsaturated fat DHA, found most prominently in oily and fatty fish, is vital for brain development in the early months, he says, at a time when the brain increases by 70 per cent in size. 

“We can’t make it ourselves, babies can’t and adults can’t, we need it in the diet. It’s in breastmilk, but it’s only in breastmilk if mums are eating foods that contain DHA. So there is huge variation. My guess is in the more deprived areas it is going to be really low.”

Iron is another key nutrient for the early months, he adds. “That’s really important for brain development and function. Children who get insufficient amounts, it will impair their development and you can’t reverse it.”

The situation can be remedied with supplements, he suggests. “If just for the period the mum is breastfeeding they are taking fish oil supplements that has a very clear effect, a lot of research is showing the benefits. I’d love to see them available in pharmacies on the NHS.”

Currently parents on benefits may be entitled to ‘Healthy Start’ packs, but takeup is patchy.

Now, of course, Caley will be weaning Kirsty onto solids and it is another thing Willatts argues she should be getting more advice on. 

“Mum really needs advice, because some of the stuff that parents will prepare for babies at that age can be awful. You know, they’ll chuck burgers into a liquidiser and give them that. It’s just awful. That happens all over the UK.”

With cheap unhealthy food so readily available, poverty is also “a huge factor” in diet, he says. “It affects everything. It affects your health, the amount of energy you’ve got, how you function mentally, and what the parents are eating is eventually what the kids are going to be eating. 

“It starts before the baby is born. There’s very good research showing that the kind of diet the mother has, some of the flavours will get through to the unborn baby and shape their food preferences later on.”

Does he feel the food industry and supermarkets need to share the responsibility? “They really do. It’s been ignored and ignored for so long. We’ve really started to get a grip on tobacco, that’s absolutely clear and it has been beneficial. The big one now is food. And probably sugar, that’s the big one legislators need to do something about. There is concern all over Europe for this, but the food industry is huge and very influential.”

Mothers like Caley are faced with “misinformation” about what is good for their child, he says. “If you’re drinking Coke, there’s a huge amount of sugar in [it] with clear consequences for health, for obesity and diabetes, but then people think, let’s go for the healthy option and go for fruit drinks, you know, juices, but they contain huge amounts of sugar as well.”

Giving children “a taste for sugar” will spill over into other things, he says, while artificial additives can have a big impact on children’s behaviour.

“It stops their self-control. It does produce ADHD-like symptoms, albeit briefly, so it can have a real impact on the classroom.”

But before she gets to school, Kirsty will enter formal childcare, the expansion of which is a flagship Scottish Government policy. New research from Heriot-Watt University has identified improving childcare as the single most effective policy that could reduce inequality. 

However, lead researcher, Professor Glen Bramley, told the BBC it would be no “magic bullet”, and while it will allow parents to work longer hours, there would be a knock-on impact on the relationship between the child and their parents.

But in the preface to his book, ‘How Inequality Runs in Families: Unfair Advantage and the Limits of Social Mobility’, Dr Gideon Calder of Swansea University argues attempts to tackle social mobility will be less effective than policy to reduce inequality itself. 

“We need to think about how far families should be allowed to serve as vehicles for unfair privilege – and also, how much of a gap we are prepared to allow between those on different rungs of the social ladder,” he writes.

So, at the heart of the Scottish Government’s childcare expansion policy is a tension. While it may allow more uptake of jobs, inevitably that means working mothers will spend less time with their children, thus diminishing the attachment children need for their brains to develop in ways which will enable them to be resilient learners with secure relationships. 

Kirsty will find out.