Infant mental health

Can babies and children under 5 experience mental health problems?

The short answer is yes they can. But it's understandable why you might assume that young children do not get mental health problems. It can be very hard to get your head around a child as young as one or two having mental health problems. But the most recent national Children and Young People's Mental Health survey told us that 1 in 20 preschool children in England were found to have a mental health disorder.

What is infant mental health?

The mental health of young children (often called infant mental health) is entirely linked to their relationships with others.

Babies love connection. In the early years, it is obvious to us that young children are physically reliant on their parents and caregivers. But they are also socially and emotionally reliant on us too.

For babies, what is so critical to their mental health is whether they have a caregiver who can sensitively respond to them. A sensitive caregiver is one that:

  • is aware of their child's emotional and physical needs;
  • can respond appropriately to these needs; and
  • can respond to their child's consistently and quickly.

What can childcare providers do to support infant mental health?

One way for childcare providers to help support the mental health of the babies and young children in their care is by spotting any mental health concerns early on. If you do, this could help reduce the chances of a potentially more series problem affecting the child later on. There are also ways that you can engage with the child's parents or carers, to help ensure a child gets the support they need.

Spot the signs that there may be concerns

When young children do not have a sensitive caregiver, they can struggle to:

  • make close relationships with others;
  • understand the feelings of others and start to share their own feelings; and
  • explore and learn about their environment.

In young children, these struggles are most likely to be picked up in the childminder, nursery or childcare setting in the following ways.

  1. Physical problems. The child may frequently complain about stomach aches or headaches or have ongoing difficulties with feeding or sleeping. A baby is particularly likely to show feelings of distress in a physical way. For example they might become rigid, arch their back, look unfocused, struggle to settle to sleep, or have difficulties feeding.
  2. Mood or withdrawal problems. These could include excessive crying, clinginess to childcare providers, or separation anxiety with parents at drop off. It may also be that the child does not play with the toys and children around them, but instead withdraws into themselves and shows a limited range of feelings. In little babies, you may see a very quiet baby that rarely cries, and they might 'switch off' from those around them.
  3. Behaviour problems. These could range from difficulties concentrating, being agitated or easily distracted, to unusually aggressive behaviour. For example, a child might switch quickly from one type of play to the other - without showing any pleasure in the play. Or they might start being aggressive towards themselves, ie. by head banging.
  4. Milestone delays or regressions. There has been so much focus on training up childcare professionals to think about spotting Special Education Needs (SEN) or Autistic Spectrum Disorder (ASD) - so it makes sense why you might think that developmental delays or regressions might fall into this camp. However, the most common reason for development delays is actually due to there being an infant mental health problem.

The good news here is that if  these difficulties and delays are related to infant mental health problems, they can actually improve or be reversed if that child is supported to develop sensitive relationships with a parent or caregiver.

All children from time to time can experience some signs of mental health problems, so it is important to pay attention to the frequency, severity, and duration of the signs. Equally it's important to consider the amount of impact or disruption that these difficulties may have on their daily life.

It is also essential to think about young children's mental ill health by taking into account their families, homes, and communities. The emotional well-being of young children can be directly tied to the way their families or care givers act, and how their home lives function.

Things you can do to help the situation

Notice how the child responds and relates to their parent. If you notice that these responses are triggering emotional reactions within you, then think about what they are, and why you may be having them. This will help you think more clearly about the child's experience and the meaning behind the child's distress.

Approaching parents and carers. Opening up discussions about infant mental health can feel daunting but it is absolutely possible to do in a way that is strengths-based. When approaching parents or carers, it can be very useful for you to:

  • gather information around the child's daily routine, how things have been going with their developmental milestones (i.e. starting solid foods, toilet training), any changes or stressful events in the family home and in the child's environment (i.e. nursery) including his/her interactions with peers and other adults
  • help the parent or carer look at things from the child's viewpoint, by talking for the child or asking them when they think their child might be thinking or feeling when certain things happen
  • acknowledge with parents how challenging parenting can be and how particularly hard it can be for a parent or carer when a child is distressed and they are not sure what they can do to resolve the situation
  • tell the parent that young children can respond very well to supportive interventions which will support their mental health and development.

Next steps if things don't get better

If signs of mental health illness persist, you should consult with other professionals and, when appropriate, refer to specialist mental health children teams to make sure the child receives the correct kind of support for their needs.

Click on Early Years in Mind for more guidance from the Anna Freud Centre about how to improve the mental health and development of the children and babies in your care.

Dr Camilla Rosan (Head of Early Years at the Anna Freud Centre) and Katja Simoncelli (Therapist and Trainer - Early Years Programme)