Holding the Baby in Mind in Times of War

Sherri L. Alderman, MD, MPH, IMHM-E Clinical and Policy, FAAP

March 10, 2022

As the man-made humanitarian crisis continues to rage in Ukraine, whole populations are being devastated. The short- and long-term impact on culture, community, family, and individual health and well-being will be substantial.

At the top of those most affected are babies.

The infant mental health field grew out of the atrocities of WWII when the global world recognized infants’ special psychological needs as important as physical needs. Yet over and over again, infants around the world are overlooked and suffer physically and mentally from the devastation of war, even more so among the least resourced, most marginalized, and people of color. We must stop this pattern now.

“Infants have critically essential needs and are exquisitely sensitive to environmental conditions.”

Children are not little adults because of their unique needs and vulnerabilities. Similarly, infants are not little children for the same reasons. Infants have critically essential needs and are exquisitely sensitive to environmental conditions. As ill-prepared as response efforts are across the board in wartime, the greatest deficit is services intended to minimize the adverse effect on infants.

Research clearly tells us that early experiences during rapid brain growth lay the foundation for all social, emotional, and cognitive development and resilience. Unresolved stress becomes toxic and ruptures that foundation.

There is no baby without a caring adult. An infant is considered protected within a healthy relationship. Within the dyadic relationship, secure attachment provides the baby with a sense of safety and emotional regulation.

But that cocoon of love, warmth, and sensitive care is shattered in times of war when societal supports for the family are ripped away and the parent-infant relationship stands alone, naked, and fully exposed to the environment, an environment filled with danger, loss, and fear. The very relationship that protected the infant becomes, in these circumstances, the medium through which the baby vicariously experiences their primary attachment figure’s valid pain and suffering. Ultimately, it is the baby who quietly internalizes that fear and suffers the most.

Not even the womb is protection from wartime devastation. A pregnant woman’s chronic cortisol stress levels course through her body, exceed the placental enzymatic mechanism intended to shield the developing fetus, reach the fetus, and eventually adversely impacts fetal brain and physical development.

We must hold babies around the world in mind as we implement strategies to protect them. Fathers are separated from their families to defend their country. Mothers are sheltering in subway tunnels in order to escape the violence. An estimated 2 million people have escaped and are now refugees in adjacent countries, countries that are well-intending but are lacking resources and services to care for such a large number of people. Young Russian children are being jailed for laying flowers at the steps of the Ukrainian embassy.

All these conditions will, without repair, have lasting consequences to health and well-being throughout the life span.

Humanitarian responses must not forget the babies. When I served as a pediatrician for FEMA, I heard many stories about the lack of expertise to address the needs of infants’ and young children’s mental health in a disaster. Without advocates voicing the special needs of infants, the infant is overlooked and unheard.

We must be the voice for babies and accept nothing less than infant mental health-informed resources and services to address their special needs. Responses must happen without delay. Not only parents but pregnant women, as well, must be prioritized. The faster the protective response, the less damaging the traumatic experience.

We, as pediatricians, can make a difference immediately and in the long-term. We are the trusted and respected expert voices for babies. We know what is needed to minimize adversity for infants, young children, and the unborn child. We recognize the importance of early brain development and relational health. We honor diverse communities and cultures. We need to act now.

In the short term, we can raise our voices on behalf of infants and their caregivers. Families with infants and young children and pregnant women must be prioritized. Specialized infant mental, physical, emotional, and social services must be considered basic necessities. Families must be provided the means to stay together, safely and securely, free of racist- and ethnically-based maltreatment.

In the longer term, we pediatricians must remember to ask about traumatic experiences and weigh that information in our care plans. The presentation that babies impacted by traumatic experiences show changes with maturity. The trauma-primed limbic activated response persists, evolves in synchrony with overall development, and manifests in psychological, physical, and behavioral ways that disguise its origins.

We pediatricians can make the connection, nonetheless, and tailor interventions that heal both the infant or young child and the dyadic relationship.

At the macro level, we pediatricians can advocate for child rights, rights displaced by violence during wartime, and bring them front and center. We can advocate for an agenda that calls for policies, alliances, and international agreements that hold the baby in mind and assures the best interest of the child at every touchpoint here at home and around the world.

History will critically judge how the global community responded to this man-made humanitarian crisis. I believe that we pediatricians can be centered in the camp of promotion of infant mental, physical, emotional, and social health and well-being, but only to the degree to which we are the voice for babies.


*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Sherri L. Alderman, MD, MPH, IMHM-E, FAAP

Sherri L. Alderman, MD, MPH, IMHM-E, FAAP, is a faculty member at Portland State University, chair of the AAP Council on Early Childhood, and a board-certified Developmental Behavioral Pediatrician with over 10 years of experience in clinical and policy work in infant mental health. Dr. Alderman also is the principal investigator on the Act Early Oregon COVID Parent Mentor Project focused on empowering migrant and seasonal farm-working communities.