What is missing from this welcome paper on systemic approaches in the early months of life is attachment, the most thoroughly researched paradigm in developmental psychology (Music 2011). Attachment is a biological system that we share with all mammals (and many other species) for protecting the infant, but the mother's capacity to do so - to love her child - is powerfully influenced by her own relationships, particularly with her mother (Fonagy et al 1991).

Thus while it is important to identify depression and anxiety in new parents (Glover 2011) it is also essential to ask at first contact how well mother feels supported by her parents, and by her partner. We are indeed programmed to be attuned to infants (Tronick 2007, Strathearn et al 2008) but there are many anxieties and disappointments from the past that can interfere with this delicate and fundamental process. "The ghost in the nursery" is the imprint of care experienced in the previous generation (Freiberg et al 1975).

Rather than adding complexity this view simplifies the clinical task because there is always a need to find out how the mother sees her baby. As the authors say the carer's experience is the 'core driver', but that applies as much to her recollection of being looked after in her own childhood as to what she now thinks is the matter with her child.

The transdisciplinary approach advocated here encourages the routine inclusion of mental health assessment and provision in perinatal and infant paediatric services (Barlow et al 2010).

Barlow J, McMillan AS, Kirkpatrick S, Gate D, Barnes J, Smith M. Health-led interventions in the early years to enhance infant and maternal mental health: A review of reviews. Child and Adolescent Mental Health 2010;15:178-185. doi: 10.1111/j.1475-3588.2010.00570.x

Fonagy P, Steele H, Steele M. Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Dev 1991;62:891-905. doi: 10.1111/j.1467- 8624.1991.tb01578.x

Freiberg S, Adelson E, Shapiro V. Ghosts in the nursery. A psychoanalytic approach to the problems of impaired infant-mother relationships. J Am Accad Child Psy 1975;14:387-421.

Glover V. Annual research review: prenatal stress and the origins of psychopathology: an evolutionary perspective. J Child Psychol Psyc 2011;52:356-367. doi: 10.1111/j.1469-7610.2011.02371.x

Hofer M. Psychobiological Roots of Early Attachment. Current Directions in Psychological Science 2006;15:84-88. doi: 10.1111/j.0963- 7214.2006.00412.x

Music G. Nurturing Natures: Attachment and Children's Emotional, Sociocultural and Brain Development. Hove and New York: Psychology Press, 2011.

Strathearn L, Li J, Fonagy P, Montague, PR. What's in a Smile? Maternal Brain Responses to Infant Facial Cues. Pediatrics 2008;122:40-51 doi:10.1542/peds.2007-1566

Tronick E. Depressed mothers and infants: the failure to form dyadic states of consciousness, in E. Tronick, The neurobehavioral and socio- emotional development of infants and children. New York and London, Norton, 2007 (274-92).

Conflict of Interest:

None declared