Children and Mental Health

Did you know that babies and young children have “mental health”? You may also hear the terms “mental wellness”, “mental well-being”, “social and emotional well-being” and even “stress”. In general, all these terms have similar meanings. Those of us who work with families with young children have a unique opportunity to offer support. Learning more about infant and early childhood mental health will increase our skill and confidence when interacting with families who may be facing mental health challenges.

What is “mental health” for infants and young children?

In short, infant and early childhood mental health refers to optimal social and emotional development from birth to school entry.

How a baby or young child demonstrates mental health depends on the age and developmental stage of the child. A child who is socially and emotionally healthy is developing their skills related to:

1. Establishing and maintaining close relationships. First with parents and caregivers, then progressing on to friends
2. Expressing and regulating their emotions
3. Continuous learning and exploring new environments
   

Why is infant and early childhood mental health important?

The early years matter!
Healthy social and emotional development starts very early in life. Experiences and relationships affect the developing brain. Negative experiences and “toxic” stress can interfere with all aspects of well-being throughout the lifespan. Nurturing the mental health of our children is essential because it provides a stable foundation on which all future development is built - including the ability to learn, form friendships, contribute to society and attain optimal physical health. Early identification and support or treatment is critical to prevent small concerns from growing into huge problems.

Everyone who interacts with young children and their families has a part to play in helping them be the best they can be.

What to look for

Early identification of infant and early childhood mental health concerns is crucial to getting families and children back on track to optimal well-being.

Just like early diagnoses of physical illness is necessary for determining effective treatment and preventing more serious illness, identifying mental health concerns early can avoid more significant problems, including difficulties at school, strain in the parent-child relationship, trouble with peers, behaviour challenges, family breakdown and parent mental health issues.

Parents are the experts on their child and it is important to listen to their concerns, in whatever capacity you interact with them. While 70% of parents have concerns about their child’s development, only 28% actually speak to health care professionals.That means many parents may reveal their concerns to other professionals in their life. Additionally, parents may be in denial or fail to recognize when there is a problem. Therefore, every professional who interacts with that family has a part to play in guiding that child towards effective treatment and support.

Signs and Symptoms

In addition to using screening tools such as the Looksee Checklist by ndds or the Age’s and Stages Questionnaire and having their healthcare provider rule out any physical causes, here are some signs and symptoms that potentially could indicate a mental health concern:

Infants

• Resists being held, even by a parent or familiar caregiver
• Seems difficult for the parent to comfort
• Does not sleep or eat “well”
• Does not seek or make eye contact
• Rarely responds when people try to interact with her
• Decline in language or social skills

Toddlers or Preschoolers

• Does not seem attached to any one adult
• Willingly and happily goes to strangers
• Seems irritable or fearful much of the time
• Has no interest in other people or toys
• Tantrums are frequent and extreme
• Is usually sad or withdrawn
• Decline in language or social skills
  

Parental and Family History

Parental and family history and circumstances can also be a risk factor for infant and child mental health concerns. Some things to watch out for include:

• Parents with a history of childhood abuse or trauma
• Parents with a personal or family history of mental health or addiction issues
• Difficult or traumatic birth experience
• Family conflict or violence
• Lack of strategies for coping
• Lack of social support
  

What You Can Do

What can you do if parents approach you with questions about their child’s behaviour? Behaviour changes can be a sign that a child is experiencing some stress. Below are some changes to look for and some suggestions that you could offer.

Parents sometimes need help and support too!

Encourage parents/caregivers to see their primary healthcare provider or seek out resources if you notice any of the following:

• often seems to be depressed or overwhelmed
• often appears to or expresses difficulty in interpreting the child’s cues/behaviour
• often appears to or states that they do not enjoy their baby
• often expresses negative opinions about their child
• is experiencing major life stresses, i.e. job, money, relationship
  

How To Talk With Parents 

Talking to parents about concerns we have regarding their child is often stressful. Approaching a parent about a potential mental health issue can be especially difficult. Although “the perfect conditions” may never be present, there are some things we can do to increase the odds that the conversation will be positive.

Here are some tips:

1. Sensitive information is best delivered in the context of relationship. Whenever possible, the staff person with the best rapport with the family should initiate the conversation.
2. Ensure as much privacy as possible. Consider timing and location.
3. Start the conversation by asking if the parents have any concerns. Have they noticed any changes in their child’s behaviour?
   
4. Using a standardized tool to help with the parents’ understanding is an effective strategy and gives credibility to your concerns. It goes without saying, being empathetic and caring will encourage trust and honest conversation.
5. Stress the value of early identification and intervention. Smaller concerns often become bigger problems if left untreated.
6. Know your community resources and how a parent can access them. Provide a handout or website reference wherever possible. It is easy to forget the details of an emotional conversation once you arrive home.
   
7. Summarize the conversation for the family to help ensure understanding.
8. Reassure the family that you are open to checking in with them and providing support along their journey.
   
9. Document according to your agency/college policy.

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