Mental health in early childhood refers to a child's emotional, social, and cognitive development. Many professionals are hesitant to use the term mental health in young children because of concerns about how parents might interpret it and the need to avoid any associated stigma. Nevertheless, this aspect of development is important to a child’s ability to form relationships and regulate emotions, setting the foundation for later wellbeing and quality of life.
In the same way that a young child’s development proceeds in a largely predictable sequence, so does their social and emotional development. For example, babies go through an unsettled period from about five or six weeks of age, sometimes — and incorrectly — referred to as ‘colic.’ Similarly, we use the term ‘the terrible twos’ to refer to the behaviour of toddlers as they transition into a more independent phase of development. Space does not allow for an explanation of the neurological underpinnings that are responsible for these observed behaviours. Although we would regard them as a normal part of development, they are stressful for parents, and in some instances can be the seed of future problems, depending on how parents react to them.
Social and emotional development in young children is influenced by numerous factors, both biological and environmental. A child with a difficult temperament is likely to be more challenging for parents – more intense, reactive, with a low sensory threshold and poorer self-regulation. Children with an easy temperament tend to be calmer and easier to parent. The way the parents respond to the young child and the qualities of the caretaking environment play a critical role in the young child’s mental health. Health professionals should be aware of the risk factors than impinge on parenting, as many can be ameliorated.
Many parents struggle with the demands of raising an infant and toddler and find the experience very stressful and anxiety provoking. This is amplified when they face issues such as food insecurity, poor housing, or unstable employment, or when they are dealing with their own mental health problems. Marital discord or where there is verbal or physical abuse or violence can also impact negatively on the mental health of children.
Health professionals can play an important role in working with parents to provide a framework that helps them to create a nurturing caretaking environment that supports their child’s social and emotional development. In addition, they are able to pick up early signs of more serious problems such as autism and infant depression — indicated by a lack of engagement with parents and caretakers — or to respond to parent concerns that their child is not developing or behaving as they would expect.
A few simple questions and observations during regular health visits, depending on the age of the child, can lead to important and timely interventions. Is the child in day care or preschool (teacher observations are always valuable)? Does the child engage with the parents, siblings, other children? Is the child curious about the world around them, or mostly withdrawn? Do the parents have any concerns about their child?
It is also always worth simply asking the child’s parents how they are doing — this question tells them that the health professional is interested in them as well as the child and may serve to elicit relevant issues at home. Then in the office, observe how the child relates to the parent(s), and vice versa, and to you. Do they show interest in toys or books? Even if they are initially shy and hesitant, do they become more comfortable over time, or do they remain withdrawn despite efforts to engage with them?
Health professionals are aware that mental health in young children is a dynamic construct, and social and emotional development can fluctuate from day to day and depends on context. Furthermore, the warning signs that alert us to potential mental health issues vary according to age and stage of development. Eliciting parent concerns, identifying family risk factors, and observations during regular health checks are key.
Informed intervention by the health professional – providing information, advice, and guidance for parents, organising social supports when indicated, and informed referral for specialist assessment where there are signs of more serious issues – can prevent problems from becoming more entrenched over time and therefore, much more difficult to deal with.
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Professor Frank Oberklaid, Co-Director, Policy Equity and Translation, Murdoch Children’s Research Institute
Professor Frank Oberklaid is a developmental/behavioural paediatrician with a distinguished academic career encompassing clinical work, teaching, research and public policy. His interests include early childhood development, community-based models of service delivery that focus on prevention and early intervention, and the translation of research so it informs policy, service delivery and clinical practice.
Photo: © UNICEF-Bundzilo