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Andy was 9 months old when his mother first brought him to the Well-Baby Clinic, A neighbour, whose children had been our patients, realized that Mrs B was having difficulties in meeting her son's needs and suggested that we might be able to help. Andy is now 2 years old and, up to the time of writing, his life has been characterized by an excess of unpleasure as shown in prolonged, anxious crying, severe stranger-anxiety and intolerance of change. He seems to have given his parents little pleasure and they have felt burdened, anxious and guilty.
When seeking to understand our older child patients, we frequently lack details of their early life, and may only hear that ‘he never slept’ or ‘I had to carry him everywhere—I daren't put him down for a moment’. Such statements hint at a strained mother-child relationship in the early months and one that may set a pattern of expectation that is carried over into later stages with unhappy consequences. With this in mind, it may be useful to follow one child's development in some detail and attempt to answer the question: what went wrong? In other cases, other events will be of special significance and, of course, no two mother-child couples are the same, but we are accustomed to study the clinical material of one patient and apply it appropriately to others.
Andy is an only child, born when his mother was 34. In her first consultation in the Baby Clinic, Mrs B expressed her feeling that ‘things started badly with Andy’, and has returned to the view that ‘things were wrong from the beginning’ on several occasions.
The birth, which was induced, was uncomplicated. Immediately following the delivery, Andy was taken out of the labour ward. We assume this was to have his air passages cleared, but Mrs B was not given an explanation and her husband, who had been present at the birth and had followed the nurse out of the ward with the baby, was unable to report to his wife what had taken place. We surmise that Mr B was bewildered and a