Infant and early childhood mental health (IECMH) practice involves building trusting, dependable, and safe relationships. Indeed, this relational approach provides the foundation for working with struggling families for whom the ability to provide responsive, nurturing, consistent, and safe caregiving is the primary goal of service delivery. Insights from attachment theory, and increased understanding of parent-infant relationships and the impact of early experience on development have shaped approaches to parenting education and support, therapeutic interventions, and workforce development (Zeanah & Zeanah, 2019).
Yet this powerful, exciting, hopeful work often leads to ethical challenges. What should we do when the interests of the child are not perfectly aligned with the best interests of the caregiver? Community resources may be inadequate to address family needs that are urgent, if not at the crisis level. System priorities and approaches may work against the needs of those they purport to serve. What response is sufficient when resources are scant, and family needs go beyond the practitioner’s knowledge or skills, or the agency’s scope of services? Is doing something always better than doing nothing? How do we work out the “right” action for a given family when science conflicts with community or cultural practices, or when the practitioner’s views are in tension with the family’s priorities? Often, the answer to such questions is, “it depends,” as we consider the details of the clinical situation including family preferences and resources, legal directives, personal perspectives, or programmatic, system, and cultural contexts (Lim et al., 2026).
Of course, not all clinical decisions are equally complex, but when conundrums arise and especially when there is urgency, there may not be consensus or clear guidance about the “right thing” to do. Such conundrums also can result in moral distress or even moral injury for clinicians when they are unable to respond in ways that accord with deeply held personal or professional values (VanderWeele et al., 2025).
As clinicians and practitioners representing different mental health disciplines (psychology, child psychiatry, nursing) and working in different settings in which vulnerable infants are seen (e.g., child protection, childcare and early consultation, hospitals, and home visiting), we began to explore the role of ethics in IECMH (Zeanah, C. et al., 2023). Ethics is concerned with the basis for moral judgements of “right” and “wrong” and is central to the clinical endeavour (Lim et al., 2023). Beauchamp and Childress (1979) defined four underlying principles of biomedical ethics, which have become highly influential in health and social care practice: respect for autonomy, nonmaleficence, beneficence, and justice. These principles are incorporated, to varying degrees, in the Codes of Ethics representing the multidisciplinary field of IECMH (Zeanah, P. et al., 2023). Although the role of ethics in clinical decision-making is rarely explicitly addressed in the IECMH literature, informal and formal discussions and presentations with colleagues demonstrate a desire for more recognition of ethical issues and guidance on ethical decision-making. A significant challenge in understanding how ethics informs IECMH practice is that IECMH science and theory, as well as our existing professional ethics codes, primarily reflect Western and northern hemisphere perspectives.
In partnership with members of WAIMH leadership, we developed a survey to better understand the extent to which WAIMH and WAIMH affiliate members experience ethical challenges in their work and what support they have for addressing these challenges. This is the first attempt that we are aware of to capture the ethical challenges faced by IECMH professionals across disciplines and from different regions across the world. The findings will lay the groundwork for future work addressing questions such as: What are the unique ethical challenges facing professionals in the field of IECMH? Are there specific ethical conundrums based on the type or setting of IECMH work being undertaken, or based on social or cultural mores? What types of resources are available, and what are needed to support ethical decision-making in IECMH? Does IECMH need its own code of ethics?
We are inviting all WAIMH and affiliate members to participate in this survey and share their experience and opinions. We plan to share findings from the survey through publications, presentations, and WAIMH venues. For more information and to access this 5–10-minute survey, please use this link (it may be necessary to cut and paste the link into your web browser): https://redcap.link/ethicsandinfantmentalhealth
References
Beauchamp, T. & Childress, J.F. (1979). Principles of biomedical ethics. Oxford University Press.
Lim, I., Korfmacher, J. Steier, A., Zeanah, C. & Zeanah, P. (2023). The ethics of infant and early childhood mental health practice. Infant Mental Health Journal, 44, 651–662. https://doi.org/10.1002/imhj.22055
Lim, I., Korfmacher, J., Steier, A., Zeanah, C. & Zeanah, P. (2026). Ethics at the centre: A multidimensional model for formulating complex decision-making in infant and early childhood mental health. Clinical Child Psychology and Psychiatry, 31(1), 140-149. https://doi:10.1177/13591045251390671
VanderWeele, T.J., Wortham, J.S., Carey, L.B., Case, B.W., Cowden, R.G., Duffee, C., Jackson-Meyer, K., Lu, F., Mattson, S.A., Padgett, R.N., Peteet, J.R., Rutledge, J., Symons, X., & Koenig, H.G. (2025). Moral trauma, moral distress, moral injury, and moral injury disorder: Definitions and assessments. Frontiers of Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1422441
Zeanah, P., Steier, A., Lim, I., Korfmacher, J., & Zeanah, C. (2023). Current approaches and future directions for addressing ethics in infant and early childhood mental health. Infant Mental Health Journal, 44, 625–637. https://doi.org/10.1002/imhj.22077
Zeanah, C.H., Korfmacher, J., Lim, I., Steier, A., & Zeanah, P. (2023). Ethical dilemmas in infant mental health: Examples from child protection, home visiting, and medical contexts. Infant Mental Health Journal, 44(5), 614-624. doi: 10.1002/imhj.22062
Zeanah, C.H., & Zeanah. P. (2019). Infant mental health: The clinical science of early experience. In C.H. Zeanah (Ed.), Handbook of infant mental health (4th ed., pp. 5-24). Guilford Press.
Authors
Zeanah, Paula, PhD, MSN, RN, FAAN
Adjunct Professor, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine,
New Orleans, Louisiana, USA
Korfmacher, Jon, PhD
Senior Research Fellow, Chapin Hall Center for Children,
Chicago, USA
Lim, Izaak, FRANZCP
Clinical Academic Child & Adolescent Psychiatrist, Early in Life Mental Health Service, Monash Health,
Australia
Steier, Alison, PhD
Vice President, Mental Health Services, Southwest Human Development,
Phoenix, Arizona, USA
Zeanah, Charles H., MD
Professor of Psychiatry and Pediatrics, Director of the Institute of Infant and Early Childhood Mental Health, Tulane University School of Medicine,
New Orleans, Louisiana, USA
(Infant Mental Health Ethics Collaborative)
