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Clinical decision-making in infant and early childhood mental health can be complex, shaped by clinical, legal, contextual, and personal factors. At the core of this complexity, however, lies an ethical dimension, which interacts with all other aspects of decision-making. This paper introduces a multidimensional model that places ethics at the centre of clinical formulation, offering a structured yet flexible approach to understanding complex challenges faced by practitioners. Through a series of illustrative cases, we demonstrate the model's applicability across diverse practice settings. A Mother-Baby Unit case highlights tensions between maternal mental health and infant well-being. A home visiting case examines how to balance a mother's autonomy with concerns for infant safety in the context of domestic violence. A neonatal case explores how a physician's personal history influences treatment recommendations, raising questions about consent. A childcare case considers conflicts between institutional caregiving policies and parental preferences. These cases demonstrate how ethical considerations should underpin clinical reasoning, even when not obvious. By explicitly integrating ethics into clinical formulation, this model provides a tool for practitioners navigating complexity. It has applications in clinical training, professional development, and reflective supervision, fostering a culture of ethical awareness in infant and early childhood mental health practice.