A basic understanding of attachment theory is central to appreciating the impact of discontinuity of care. Initially formulated by English psychiatrist John Bowlby, the basic precept is that an infant instinctively behaves in many ways to maintain proximity to her primary caregiver and feels most secure when in close proximity to that person. Attachment between infant and caregiver begins to form early in the infant's life as the caregiver responds in a nurturing manner to the infant's signals—with breast or bottle, singing or cooing, holding and rocking. Slowly, the infant learns that a particular caregiver provides her with a safe, predictable, and comfortable world. Attachment begins to form and grow. In the mind of the infant, it is the beginning of the development of trust--the primary developmental task of the pre-verbal years. The attachment that forms provides a secure base from which the child feels free to explore the larger social and physical world. Early lack of positive caregiving causes later social consequences, since the type of attachment that forms between child and caregiver serves as a prototype for later social relationships.

The most important spiritual message you can give to infants during the first year is that they can trust the people around them; that their environment is a safe, benevolent one; that their parents, especially the mother, are close by and attentive; and that they are deeply loved. —Source unknown

When caregivers change, it is impossible to prepare the very young because they cannot communicate verbally. "I love you," or "I'll be back later," means nothing to the infant. The despair of the young one who feels deserted is real despair, even if the desertion is no more than a parent's routine departure for work.

Based on early interactions with caregivers, the child creates in his mind what Bowlby termed an internal working model of the world, i.e., a forecast or expectation of how he will be treated in the new world outside of the womb. This will color his perceptions and interpretations of events throughout his life. Babies who receive responsive and consistent care develop the sense that their world is essentially satisfying; that people around them are responsive and caring. Those who learn they cannot trust may feel that adults are replaceable, love is uncertain, and human attachment is a dangerous investment. They may create internal working models forecasting an unpredictable, unreliable, and untrustworthy world, and be left with wounds that are difficult, perhaps impossible, to heal. A therapeutic reparative experience is initially based on trust—and these children have not learned to trust. Indeed, more recent findings from the world of neuroscience show that the brains of these children are not "wired" to trust.

This problem has received scant attention partly because the consequences often do not show up for years, and the connection between discontinuity of care in the early years and later aberrant behavior is not made. Furthermore the message is disturbing, and for many, guilt-producing. People don't want to hear about it, and don't want to deal with the implications. It is easier to deny that a problem exists and to "attack the messenger" as sexist, regressive, or non-responsive to the realities of the day, than to admit we are endangering our children.

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