Item C45. Attachment Patterns.

Type Parent Child

Secure Is sensitive, responsive, Feels valued and worthwhile;
attachment and available. has a secure base; feels
effective; feels able to explore
and master, knowing that
parent is available; and
becomes autonomous.
During the visit the child
engages with the healthcare
professional and seeks and
receives reassurance and
comfort from the parent.
Insecure and Is insensitive to the Feels no one is there for
avoidant child’s cues, avoids him, cannot rely on adults
attachment contact, and rejects. to get needs met, feels he
will be rejected if needs for
attachment and closeness
are shown and therefore asks
for little to maintain some
connection, and learns not to
recognize his own need for
closeness and connectedness.
During the visit, the child
may act fearful but also
angry with the parent, may
seek contact but then arch
away and struggle, and also
may act extremely helpless or
sad but not seek comfort and
protection.
Insecure Shows inconsistent Feels he should keep adult
attachment patterns of care, is engaged because he never
characterized by unpredictable, may knows when he will get
ambivalence and be excessively close attention back and is anxious,
resistance or intrusive but dependent, and clingy.
then pushes away.
This pattern is seen
frequently with a
depressed caregiver.
Reprinted with permission from Promoting mental health. In: Hagan JF, Shaw JS, Duncan PM, eds.
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Itasca,
IL: American Academy of Pediatrics; 2017:119.