The importance of physical, social, emotional, and spiritual well-being and development during the early years of life is widely recognized (Center on the Developing Child, 2020; Pontoppidan et al., 2016), Additionally, research has shown the lasting impact of infant mental health on later development (Izett et al., 2021; Skovgaard et al., 2022). Given the rapid neuropsychological development of infants (birth to 2-years-old), early intervention becomes essential for those in need. However, symptoms of mental illness during this phase often go unaddressed, either passing unnoticed or appearing less disruptive or alarming to those around them (Pontoppidan et al., 2016).

Mental health disorders in infancy may manifest through symptoms such as excessive crying, sleeping problems, feeding difficulties, attachment issues, and motor or affective disorders (Klitzing et al., 2015). Considering that mental health problems during infancy “are strongly predictive of poor mental, physical, cognitive, and social outcomes during childhood, adolescence and adulthood” (Izett et al., 2021, p. 2), it becomes crucial to understand the most effective ways to support infants and their mental health development. This includes providing support for the parent-infant attachment relationship, which serves as the context for this development (Ainsworth, 1991; Bowlby, 1969). When considering children in the later years, specifically ages 5 to 9 years old, the World Health Organization [WHO] (2022) highlights the prevalence of mental health disorders in approximately 8% of this age group. For adolescents, ages 10 to 19 years old, the prevalence increases to around 14% globally. Children under 5 years old are most commonly affected by idiopathic development disorders and autism spectrum disorders. In an earlier report, the WHO (2003) estimated that 10-20% of children and adolescents worldwide faced challenges related to neurodevelopmental, emotional, and behavioral issues, with higher rates observed in deprived areas.

Since the 1990’s, there has been a growing global effort to support infant mental health through research and professional care (Osofsky et al., 2017). The effort involves various organizations, including the World Association for Infant Mental Health, Wisconsin Alliance for Infant Mental Health, the Alliance for the Advancement of Infant Mental Health, Australian Infant, Child, Adolescent and Family Mental Health Association, Zero to Three: National Center for Infants, Toddlers and Families, and the Center of Excellence for Infant & Early Childhood Mental Health Consultation. Intervention programs, primarily targeting parents of young children, encompass a range of initiatives such as the Rose Program, Mothers and Babies, Couple Care, Mom Power, Hugs, Circle of Security, Minding the Baby, Tuning in to Toddlers, Family Foundations, and Baby Triple P. In Australia, programs such as Sing and Grow have been implemented, while in Brazil, there are important initiatives such as the Centro Internacional de Estudos e Pesquisas sobre a infância, Sistema Nacional de Intervenção Precoce na Infância, and Associação de Pais e Educadores para a Infância. Despite growing recognition of mental health needs, the current “responses are insufficient and inadequate” according to the WHO (2022, p. 36). There is an ongoing need to develop interventions that can effectively reach and support families across all psycho-socio-economic statuses.

When infants suffer toxic stress, due to traumatic events, premature birth and hospitalization, prolonged separation from their primary caregiver, or when their caregiver is facing mental health challenges, or when they have idiographic disorders, they may develop cognitive, emotional, and social symptoms. These symptoms can be accentuated by their limited ability to verbally express themselves. These situations interfere with and potentially delay the developing brain of infants (Horton, 2016). Over the past two decades, studies on the negative effects of adverse childhood experiences on development and health have underscored the importance of investing in early-stage services to improve outcomes (Osofsky et al., 2017). Timing is crucial, as research consistently highlights the “compelling evidence that the foundations of lifelong health are also built early, with increasing evidence of the importance of the prenatal period and first few years after birth” (Center on the Developing Child, 2020, p. 1). The services provided encompass prenatal programs and preventative measures (Wolfgang et al., 2011) directed by specialized or multidisciplinary providers.

As infants depend on their primary caregivers to help them in regulating and expressing emotions when they feel frightened or overwhelmed, caregivers play a pivotal role in fostering secure relationships, facilitating exploration of the environment, and supporting the infant’s learning and growth (Izett et al., 2021). The caregiver’s ability to respond sensitively is a central aspect of their adaptability in fulfilling these roles. When caregivers’ support is compromised, such as in the cases of postpartum depression, treatments that focus on the caregiver-infant relationship can serve as a protective buffer against potentially damaging effects (Geller et al., 2018; Nylen et al., 2006). These treatments, which may include mother–infant psychotherapies and home-based interventions, should aim to address the specific needs of the caregiver-infant dyad and their relationship.

A therapeutic response from mental health providers should involve early detection and address both the needs of the infant and the caregiver (Wolfgang et al., 2011). This response should include providing encouragement in a sensitive and consistent manner, while also modeling secure and “responsive social-emotional interactions that can be protective of disturbances and traumatic experiences” (Wolfgang et al., 2011, p. 3). Special care must be taken in treatment planning when domestic violence and substance abuse are present, ensuring that both physical safety and psychological well-being are addressed. Daws (2008, p. 686) proposes that “by knowing their emotional state and then daring to be different, we help parents to have the courage to recognize that their infant’s state of mind may not be the same as theirs”. In order to achieve this, providers should actively listen and refrain from immediately offering solutions. “When active offering of solutions is replaced by reflective listening, parents are relieved at feeling understood and may find their own solution” (Daws, 2008, p. 689).

For decades Harvard scholars at the Center on the Developing Child (2020) have dedicated their research to studying this particular age group. Their work stresses the importance of preventive interventions, underscoring that early childhood prevention of chronic illness promotes the development of responsive and dependable relationships. Such bonds are essential in reducing sources of stress and creating a well-regulated environment for infants.

When selecting intervention strategies, it is crucial for mental health practitioners to have an appropriate understanding of this specific age group (Wolfgang et al., 2011). This includes considering their current stage of development, cultural and environmental background, and the quality of their relationships. Interventions commonly focus on adjustment, parenting skills and strategies, and on the needs of the infant. Psychotherapeutic interventions for children up to 3-years-old can be approached through various lenses, such as psychodynamic (mother-child therapy), non-directive, cognitive behavioral, and group interpersonal therapy (Kiltzing et al., 2015). These interventions target maternal mental health, parenting skills, involvement of fathers, couple relationships, the mother-infant relationship, reflective functioning, the infant’s wellbeing, or a combination of any of these (Izett et al., 2021).

Interventions commonly involve a range of assessment methods, including family interviews, observations, cognitive, social, emotional and developmental assessments, as well as assessments of parental sensitivity and interdisciplinary assessments. Continuous follow-up evaluations are conducted to monitor progress and make necessary adjustments. Professionals may utilize video recordings to provide feedback to the parents (Kennedy et al., 2011). Another approach involves encouraging caretakers to “watch, wait and wonder” (Kiltzing et al., 2015, p. 381). In psychoanalytic-oriented interventions, professionals may provide verbal descriptions of observed interactions to parents, facilitating discussions and interpretations of unconscious conflicts.

While singing and the use of songs as a means of caring for infants by parents, caretakers, and professionals have proven to be helpful, some professionals may still be unaware of their powerful and integrative properties (Sanfilippo et al., 2021). Despite being developed and utilized globally, in both formal and informal settings, singing is not yet widely recognized as a common practice for treatment plans in mental health manuals, pediatric practices, or the practice of mental health professionals. However, it is gradually gaining recognition as an evidence-based and effective option for both caretakers and professionals working with this population (Brisola et al., 2019; Fancourt & Finn, 2019). In Neonatal Intensive Care Units (NICU), maternal singing and lullabies are being used worldwide to assist with stabilization, self-regulation, development, and bonding. These approaches are easy to use, without cost, and can be easily adapted to meet the needs of each individual infant (Palazzi et al., 2019).

Singing is a universal activity found in every society and is often associated with infant care, healing, dance, and love (Mehr et al., 2019). Primary caregivers around the world engage in song, providing life-sustaining care, commonly through lullabies and/or play songs. This practice has shown to be highly effective in responding to infants, assisting in their regulation and relaxation (Bainbridge et al., 2021). Singing captures and sustains their attention, alters their arousal levels, and changes their mood (Trehub, 2019). Moreover, it plays a significant role in fostering the bond between caretaker and infant, nurturing, promoting, and strengthening their relationship (Brisola et al., 2019; Poćwierz-Marciniak & Harciarek, 2021).

Attending to an infant’s needs is vital, but equally important is both the way caretakers respond to the infant and the quality of their interaction, which can have a profound effect on their crying and behavior, particularly when bathed with close proximity and interaction (Robertson & Detmer, 2019). The voice, along with behavior and proximity, has “an organizing effect on the developing brain and help(s) to regulate neurobiological, sensory, perceptual, emotional, physical and relational systems” (Robertson & Detmer, 2019, p. 34). Singing, paired with activities such as reading, playing, and talking, can facilitate cognitive stimulation and convey essential emotional care, especially during the crucial period of an infants’ first 1000 days (Bust & Pedro, 2022). This period is characterized by rapid physical, psychological, and neurological growth (Moore et al., 2017). Singing, in general, captures infants’ attention more effectively than speaking alone (Corbeil et al., 2016), and familiar songs have shown to be particularly more effective in helping infant de-stress, evoking excitement and pleasure (Cirelli & Trehub, 2018).

As caretakers attend to feeding and helping an infant sleep, they learn what “works” and what does not work. Experiencing success (i.e., calming a child, witnessing their fulfilled appetite, getting them to sleep) can significantly boost the caretakers’ self-esteem and confidence (Brisola & Cury, 2018). Moreover, these positive outcomes also play a crucial role in fostering the bond between caretaker and infant.

By showing their baby they know how he feels, they add a dimension to the excitement of ordinary interchanges such as bathing, feeding, playing little games with him, and so on … for instance, if a baby is beating time with his hand on a toy, the parent may join in by singing to this beat, or by moving her own body in time to the baby’s singing sound.

The closeness and communication that musical care and singing enables, provides a sense of security for both the caretaker and the infant, nurturing the bond that shapes their relationship. This is what musical care is about: the “use of music – music listening as well as music-making – to support infant care, parental care, and the dyadic relationship” (Sanfilippo et al, 2022, p. 12). Importantly, the term “musical care” allows for a collaborative approach, blurring traditional boundaries among professionals who provide this care, such as psychologists, counselors, and music therapists (Sanfilippo et al., 2022).

In situations where an infant is facing additional challenges, whether they are physical or environmental stressors, musical care can help provide support to both the infant and their caretakers. It helps the infant cope with stressors while also helping their caretakers in managing the pressures of the situation, since “shared pleasure has the capacity to dissolve a negative painful affective spiral” (Ullsten et al., 2017, p. 8). For example, singing can help parents of premature infants who must deal with stress, anxiety, and can feel “guilt, fear, helplessness, and grief” (Cevasco, 2008, p. 274) in the face of medical uncertainties, giving them something to do, a means of dealing with these emotions and pressures, and fill the silence with their own sound. This musical care can bring hope, and instill meaning to the daily experiences and situations they are going through (Sanfilippo et al., 2022).

Researchers have observed the long-term effects of singing on infants and have found that it positively impacts various aspects of development. Singing has been shown to facilitate vocabulary building (Franco et al., 2022), support auditory development, enhance discrimination skills (Partanen et al., 2022), and promote social development (Gerry et al., 2012), among other benefits. Furthermore, singing has been found to aid in language development in congenitally deaf children following cochlear implantation.

Musical care has gained increased attention across a variety of disciplines, including psychology, sociology, social work, music therapy, and public health (Sanfilippo et al., 2022). Over the past three decades, research has accumulated information on singing and its effect on infants worldwide encompassing diverse cultures, theories, methodologies, and contexts, such as homes, parental groups, and neonatal intensive care units (Brisola et al., 2019). Studies have examined musical care in both the natural settings and targeted interventions (Sanfilippo et al., 2022). Professionals have the opportunity to offer support and care through song for infants and their caretakers facing health and/or environmental challenges as well as those in socially vulnerability situations (Brisola & Ilari, 2021).

Despite what some may imagine, musical interventions do not require musical training or professional singing skills, although these can enhance the experience. Providers may use their voice with this population, whether through speaking or singing as a different option for communicating. However, as mentioned before, singing offers unique advantages, while it engages memory, meaning, affection, and words on a different level than speaking alone (Brisola & Cury, 2018). But this does not mean therapists must have musical training or be a professional musician. What matters is a willingness to use their singing voice (or at least try to) and have a therapeutic objective in mind.

As mental health professionals engage with infants and their caretakers, they can consider integrating musical care interventions that encompass the following approaches: (a) Concentrate on nurturing the caretakers’ relationship with the infant through singing, (b) Utilize musical care with the caretakers to serve as a model and provide them with a personal experience of singing or (c) Direct focus on the infant, by singing to them, while concurrently modeling musical care. Outlined below are some suggestions of how therapists can incorporate these approaches into their practice. As always, care must be taken to ensure the assessment of potential trauma and, if necessary, incorporating suitable strategies to ensure age-appropriate recognition and potential behavioral and emotional responses, triggers, and dysregulation (Osofskly et al., 2017).

Whether the focus is on the infant, the caregiver, or their relationship, singing interventions can foster mental health by providing the care and safety that infants yearn for, while effectively communicating emotions and intentions at a deep and personal level. Infants are naturally tuned to the subtle nuances of sounds and often find them soothing or comforting. These favorable qualities of singing can be further enhanced by valuing clients’ preferences in songs and singing, as well as their cultural background, personal experiences, and family history.