The Work of supporting an infant’s emotional development and mental health begins in the neonatal intensive care unit (NICU). It depends on understanding the family and uses the parallel processes involved in relationship building to maximize the environment for the optimal development of the infant in the NICU. Occupational therapy service provision is discussed in light of knowledge about the developmental work of the full-term neonates and their parents and the corresponding work of infants in the NICU and their families. A brief vignette of occupational therapy services provided in the context of a relationship-focused infant mental health model is included.