Module 2: Supporting Your Child's Mental and Emotional Well-being
Mental Health in Early Childhood
How Can I Help Them Flourish?
20 MINUTE READ
Published August 2024
AUTHOR
Margaret Vadiee, PhD
Contributing Editor, Licensed Psychologist
You want to consider and foster your child’s mental health from an early age, but don’t know exactly what that looks like. This is all new information! It may have never been modeled for you. What do you focus on? What do you look for? These are common questions whirling through parents’ minds. We’ll walk you through what you need to know about mental health and wellness in your 0-5 year old.
It’s not as complicated as you think
This guide gives you the 101 on all things mental health in early childhood. You’ll learn about widely-accepted research on why mental health symptoms develop in children, what mental health even is in early childhood, and what you can be watching for and doing at this point. We’ll also dispel some common myths along the way. But the main takeaway is to focus on your relationship with your child to support your child's mental health and wellness. Your child learns about the world around them and themselves from you! A young child’s mental health is essentially equated to their sense of relational safety with their parents.
Breaking it down further
We all want to understand why our children think, act and feel the way they do. These are questions that researchers have been tackling for decades. Current research answers this question with the stress-diathesis model¹. To explain the stress-diathesis model we’ll use an analogy. Pretend you have a cup. In the cup is a certain amount of sand. The amount of sand you have in the cup cannot be changed. The sand is your biological predisposition to develop any kind of mental health symptoms (e.g. anxiety, depression). Next, you have water. Water is life stressors - big and small. When you experience something stressful, water is poured into the cup. The cup is able to hold some amount of water. It differs for each person based on the amount of sand in their cup. At some point (especially if the water isn’t removed with coping strategies), the cup overflows. When the cup overflows, you see the mental health symptoms. That’s why it can be major stressful life events or small stressors that bring about a mental health concern.
Defining mental health in early childhood
The term “mental health” with regard to an infant or small child can feel confusing or misplaced. “Mental health” often has a negative stigma attached to it, and infancy and early childhood tend to have positive associations of new beginnings and potential². Mental health in infancy and early childhood is defined as: “The young child’s capacity to experience, regulate, and express emotions, form close and secure relationships, and explore the environment and learn. All of these capacities will be best accomplished within the context of the caregiving environment that includes family, community, and culture expectations for young children. Developing these capacities is synonymous with healthy social and emotional development”³.
What sets ages 0-5 apart with regard to mental health?
With ages 0-5, the primary focus for a child’s mental and emotional health is their relationship with their parents. Working towards your child’s mental wellness means pouring into your relationship with your child. If you seek mental health treatment for your child when they are 0-5 years, there will be a heavy parenting component to the work most likely. When a child turns 6, it is sometimes appropriate to continue using some of the same strategies as before. Sometimes, 6+ year old children are cognitively ready for different types of coping skills. Therapy with a 6+ year old often looks much different than a 0-5 year old.
Is there anything I can do before there is a “problem?”
The best thing you can do for your young child’s mental health and emotional development is lean into your relationship with them. An infant and young child’s relationship with their parent is paramount. How you interact with them now sets the tone for your relationship with them down the road. When you show up for and follow through with your child, you’re teaching them that they matter and they can count on you.
As a bonus, establish relationships with anyone caring for your child. Get to know your child’s pediatrician and child care provider(s). Creating channels of open communication with these providers can help set the stage for them to keep you informed about what they are noticing.
What should I be keeping my eye on?
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Beginning around 18-24 months, toddlers start pretending and imagining as they play. This type of play is the precursor to them having the skills to play with another child.
Before age 3, children usually don’t initiate playing with another child⁴.
It’s not until 3 years old that we can expect children to take turns or share with their peers (and it still can be hard at 3 and beyond!)⁴.
At age 3, children can start to identify who their friends are. Sometimes they enjoy playing with friends, and sometimes they prefer to play alone because social interactions can be tiresome. For example, a 3-year-old typically cannot figure out how to solve a problem with a peer on their own and needs guidance from an adult.
At age 4, children start to enjoy playing with friends more, and often play pretend.
At age 5, children are more able to share and start to help each other.
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Infants learn about a basic sense of security, which can impact their feelings of safety throughout their life. Babies whose needs are not consistently met are more likely to develop anxiety later in life.⁵
It’s normal for children to experience separation anxiety toward the end of infancy and through early toddlerhood, peaking around 18 months.
Throughout toddlerhood, the content of the anxiety changes. See the Stress & Anxiety in Young Children guide for more information.
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It is likely that your child will experience some sort of change during their early childhood. Children move bedrooms, schools, or across states. Younger siblings are born. Parents get divorced. Change can impact children to different degrees depending on many factors (e.g., the reason for the change, your child’s understanding of the change, how disruptive the change is for your child).
If you notice your child’s mood or behavior shift after a change, pay attention. You and your child may benefit from processing the change with the help of a mental health professional.
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Even though young children may not fully understand the concept of loss, they are still impacted by death and loss. This may show up in the form of questions about whatever happened, or may show up in how your child plays.
Often, parents are going through their own individual experience of grief while trying to help support their child through the grieving process. It can be emotionally challenging to navigate the balance between your own coping and your child’s coping. You can review The Experience of Grief in Young Children guide for more information.
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If your child witnesses or experiences a traumatic event, they may or may not develop trauma-related symptoms. Examples of traumatic events include a medical procedure, a natural disaster, and witnessing or experiencing any type of violence or abuse.
Some signs that your child may have trauma-related symptoms are having increased nightmares, being fearful of reminders of the trauma, all of sudden starts having toileting accidents, or a change in how they play. Seek consultation from a mental health professional to ensure your child has a helpful avenue to process what happened.
Dispelling common myths
Myth #1: What happens in infancy/early childhood doesn’t matter because you can’t recall it later in life.
Fact: Our experiences in infancy and early childhood shape our brain development. The brain is rapidly growing during this time so our experience really matters. Major and/or repeated adverse events can negatively impact brain development⁶,⁷.
Myth #2: When someone has a mental health problem, they are really just mentally weak and should toughen up.
Fact: Pushing through just creates more stress and can exacerbate the problem. It’s more beneficial for your child to acknowledge the concern and intervene.
Myth #3: My child is like this because of me. If I had done different things as a parent, we wouldn’t be in this situation.
Fact: Just because the parent can be a big part of the solution does not mean that the parent is a big part of the problem. The logic in that myth is like saying that someone gets strep throat because they don’t have enough antibiotics in their system. Antibiotics are part of the solution, but not the cause.
Myth #4: It’s best to wait until something really becomes a problem and several people have noticed before getting help.
Fact: There are numerous evidence-based interventions for mental health in infancy and early childhood. There’s no need to wait until they are “old enough” or it’s “a big enough problem.” In fact, early intervention is recommended! It’s better to be proactive, and address concerns as they arise. It’s often easier to course correct before getting too far off the path.
Myth #5: Once a child starts therapy, they’ll be in therapy for life.
Fact: There is huge variability in the length of time a child participates in therapy. It depends on many factors, including what the concern is, how severe it is, and how much support the child and family may benefit from. There are several short-term skills-based types of therapy that have research-support for this age range.
Myth #6: When my child is done with therapy, they are done with therapy forever.
Fact: While many children “graduate” from therapy, it is not a failure to return to therapy at any point for check-ins or to address new goals. As your child’s brain continues to develop and they have new experiences, they may benefit from learning new skills that they did not have the cognitive ability to master earlier or re-process what had previously happened to them in light of more recent experiences. Even though a child may return to therapy later in life, it does not negate the importance and numerous benefits of early intervention.
What the research says
Early signs of mental health disorders were present in 18 month old children, and prevalence rates of different mental health concerns were similar to those of older children. This echoes the importance of early identification and intervention for mental health concerns⁸,⁹.
It’s important to be educated on what to watch for because preschoolers with mental health concerns are the age group that are most likely to be expelled for disruptive behavior in the classroom¹⁰.
Parents of children with mental health disorders may view themselves more negatively, or in part to blame for their children’s difficulties. Remember that there is not one factor that causes mental health disorders, but that you can be a part of the solution for your child¹¹.
What it might look like for you
To support your young child’s mental health, focus on your relationship with them. This is the most preventative measure you can take to foster social-emotional development in your child. You’ll also continue to notice the signs your child shows you by paying attention to their mood and behavior. Early identification of a mental health concern can help everyone get on the road to recovery sooner. If needed, you’ll start therapy with your child to help them (and you!) get the support they need. The vignettes below illustrate stories of each of these stages of intervention.
Prevention: Focusing on your Relationship
After a long day of work, you give yourself the commute home to decompress from the stress of the day. You sit in silence for a little as your brain ties up loose thoughts from the day, and then you play your favorite radio station for the rest of the way. You are feeling a bit more like yourself as you walk through the door and see Tess. She smiles, shrieks, and runs toward you. She’s been waiting for this moment all day! You greet her with a big hug. You know you need to get to work preparing dinner, and you also know it’s important to fill Tess’ need for connection. You get down on her level and let her show you what she’s been cooking in her play kitchen. You delight in her play, and show you are paying attention by repeating back what she is saying to you. You tell Tess that you’ll be starting to prepare dinner in the kitchen, and that she can keep playing where she is or join you in the kitchen and help. Tess chooses to help you. She stands on her learning tower and helps you wash the broccoli in the sink. After dinner later on, you spend some time playing with Tess. You let her choose what she wants to play with (within reason), and you relish each moment.
Early Identification: Sensing Separation Anxiety
Mike was excited for an afternoon with his son, George, and had planned to take him to storytime at the same library he grew up going to. Mike reminisced on storytime there with his dad, and looked forward to sharing this with George. “Put on your shoes. It’s time to go!” George threw his shoe across the room and laid on the floor kicking and screaming. Mike didn’t want to be late and felt tempted to raise his voice and tell George to quit it with the whining and tantruming.
But instead, Mike chose to consider what may be going on for George (Empathy and Understanding) and consider the effect of identifying his behavior as “whining and tantruming” (Comments Matter).
He remembered that George had resisted his shoes the couple days before, and realized that George may have outgrown his shoes. He thought about how uncomfortable it would be to shove your foot into a cramped shoe, and then was able to connect with George about his discomfort (Empathy and Understanding, Actions and Attitude - Label Emotions, Validate).
Intervention: Seeking Professional Help
At Martin’s parent-teacher conference for Pre-K 4, Martin’s teacher indicates that she is concerned about Martin’s social interactions. She explains that Martin rarely plays imaginatively and spends any free time in the corner of the room alone. You’ve noticed some of this behavior too, but you weren’t sure if it was concerning or not because Martin is your first child! You decide to consult with a mental health professional to better understand what is going on with Martin and how you can best support him. To prepare Martin for his first appointment, you present the idea of starting therapy in a neutral way, without any shame or indicating that he is a “problem.” Martin has the opportunity to learn about his feelings and how to cope just like he has the opportunity to learn how to swim at swim lessons. After meeting with the mental health provider and providing background information, it’s Martin’s turn to meet them. You explain to Martin that he’ll be meeting with a doctor who will talk and play with him.
About the author
Margaret Vadiee, PhD
Dr. Margaret Vadiee is a Licensed Psychologist and a former Adjunct Clinical Assistant Professor at Southern Methodist University in the Psychology Department.
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expert support
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Your child’s child care provider has indicated that they have concerns about your child’s social or emotional development.
If you have concerns about your child having developmental delays, consult with a mental health professional or pediatrician. Check out the Navigating Neurodivergences program through Triplemoon too!
Your child witnessed or experienced something particularly scary or traumatic and has had changes in their behavior since then.
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Zero to Three (2001). Definition of infant mental health. Washington, DC: Zero to Three Infant Mental Health Steering Committee.
Santrock, J. (2014). Child development (14th ed.). New York, NY: McGraw-Hill.
Lieberman, A. F. (2017). The emotional life of the toddler. Simon and Schuster.
Koss, K. J, & Gunnar, M. R. (2017). Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. Journal of Child Psychology and Psychiatry, 17, 356-361.
Sheridan, M. A., & McLaughlin, K. A. (2014). Dimensions of early experience and neural development: Deprivation and threat. Trends in Cognitive Sciences, 11, 580-585.
Skovgaard, A. M. (2010). Mental health problems and psychopathology in infancy and early childhood. Dan Med Bull, 57(10), B4193.
Lavigne, J. V., Gibbons, R. D., Christoffel, K. K., Arend, R., Rosenbaum, D., Binns, H., ... & Isaacs, C. (1996). Prevalence rates and correlates of psychiatric disorders among preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 35(2), 204-214.
Zaim, N., & Harrison, J. (2020). Pre-school mental health disorders: a review. International Review of Psychiatry, 32(3), 189-201.
Eaton, K., Ohan, J. L., Stritzke, W. G., & Corrigan, P. W. (2016). Failing to meet the good parent ideal: Self-stigma in parents of children with mental health disorders. Journal of Child and Family Studies, 25, 3109-3123.