10.6: Children’s Mental Health

Learning Objectives

By the end of this section, you should be able to:

• Discuss what mental health is and what that looks like during early childhood.
• Explain how mental health practices should begin during infancy.
• Outline ways early care and education programs should be supporting young children’s mental health (including engaging families).

Warning: This chapter contains information about childhood trauma that may be triggering for some readers.

Introduction

Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in early care and education programs and school, and in their communities.⁵⁰⁵

Mental health is an important part of overall health and well-being. Mental health includes emotional, psychological, and social well-being. It affects how people think, feel, and act. It also helps determine how people handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.⁵⁰⁶ When early educators and families know more about early childhood mental health, they are better able to support children’s learning and development.⁵⁰⁷

Foundation for Mental Health

Beginning at birth, children need positive relationships with the adults who care for them. When children learn to recognize and share their feelings with trusted adults, they feel good about themselves. These relationships help them develop the confidence to learn new skills. Children thrive when adults support their strengths and needs. Responsive adults help children feel safe and valued and learn how to get along well with others.

Children who can manage their feelings can learn and play with peers. They are better able to plan, monitor, and control their behavior. They can also adjust to changes in schedules and routines. Children who get along with adults learn to work together and follow rules. They can also show concern for, and share, take turns, and compromise with other children.⁵⁰⁸

Figure 10.6.1 – It is important to care for children’s emotional well-being from the beginning.⁵⁰⁹

Mental Health from the Beginning

Infant mental health practice applies knowledge of relationships to support and enhance healthy social and emotional development and to prevent and treat mental health disorders. The following definition of infant mental health was developed by a group of experts with the common understanding that observing young children’s interactions with parents and other significant people is key for the assessment of emotional well-being.

In addition, experts also suggest keeping in mind the infants’ underlying biology which could include temperament and compromises to resilience from early trauma. Infant mental health is the developing capacity of the child from birth to three years old to experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn—all in the context of family, community, and cultural expectations for young children. Infant mental health is synonymous with healthy social and emotional development. (ZERO TO THREE Infant Mental Health Task Force, December, 2001) The mental and physical health of infants and toddlers is critically influenced by the daily behaviors of their caregivers.

The following sections describe key concepts related to the mental health of infants. These concepts enhance what is included in the previous definition:

• “Developing capacity” highlights the extraordinarily rapid pace of growth and change in the first 3 years. Although newborns experience intense feelings and are active partners in their relationships with adults, the differentiation and complexity of a young child’s emotional and social development increases markedly over time.
• Infants and toddlers initially depend heavily on adults to help them experience, regulate, and express emotions. Infants’ cries and coos evoke strong reactions in their caregivers. An infant’s ability to master feelings develops through give and take.
• Through relationships with parents and other caregivers, infants and toddlers learn what people expect of them and what they can expect of other people. Infants and toddlers learn through what they experience within relationships and what they observe in adult’s interactions with one another.
• Infants and toddlers share and communicate feelings and experiences with significant caregivers and other children. Infants and toddlers interact with one another in emotionally meaningful ways. Parents and caregivers help young children name their feelings and understand their effect on others.
• The drive to explore and master one’s environment is inborn in humans. An essential component of infants’ and toddlers’ well-being is the self-esteem that grows out of mastering their bodies and the environment as well as sharing that mastery with parents and significant caregivers.
• Every child is a unique blend of characteristics; infants’ and toddlers’ developmental pathways will reflect not only their individual constitutional differences but also the contributions of their caregiving environments. Temperament, or the way an individual approaches the world, influences how tentatively or vigorously an infant might engage with a new person, toy, or situation.
• The state of adults’ emotional well-being and life circumstances profoundly affects the quality of infant-caregiver relationships as well as infant and toddler mental health. Parents and other significant caregivers bring their own temperament and past experiences to relationships.
• Culture influences every aspect of human development. This broad influence affects the way that infant mental health is understood; the goals and expectations adults have for young children’s development; and the childrearing practices that parents and caregivers use to promote, protect, or restore infants’ and toddlers’ mental health.⁵¹⁰

Pause to Reflect How does this toddler’s exploration relate to his self-esteem? Figure 10.6.2^511

Mental Health in Early Childhood

Early childhood mental health (birth to 5 years) is a child’s growing capacity to do these things, all in the cultural context of family and community (adapted from ZERO TO THREE):

• Experience, regulate, and express emotions
• Develop close, secure, relationships
• Explore the surroundings and learn.

Early childhood mental health is the same as social-emotional development.⁵¹² Social and emotional development is important to early learning. Many social-emotional qualities—such as curiosity; self-confidence as a learner; self-control of attention, thinking, and impulses; and initiative in developing new ideas—are essential to learning at any age. Learning, problem-solving, and creativity rely on these social-emotional and motivational qualities as well as basic cognitive skills.

When learning occurs in groups, such as in preschool classrooms or family childcare programs, the social environment significantly influences how learning occurs. When young children enjoy interacting with adults and other children, they are more enthusiastic about activities and participate more. Furthermore, the interest and enthusiasm of others fuel the child’s own excitement about learning, and children are also motivated by others’ acknowledgment of the child’s accomplishments.⁵¹³

It is important because it affects a child’s ability to:

• Express their needs
• Pay attention
• Solve problems
• Get along with others
• Follow directions
• Persist when challenged
• Manage their emotions
• Take initiative
• Be curious and interested in learning⁵¹⁴

Interviews with preschool and kindergarten teachers indicate that children who have the greatest difficulties in learning are hindered by the lack of these social-emotional qualities more than by the inability to identify letters or numbers. Children who are delayed or impaired in developing these social-emotional and motivational qualities:

• may have difficulty controlling their emotions or behavior,
• may not readily work independently or in a group,
• often appear to lack curiosity or be uninterested in learning, and
• may have difficulties getting along with others, which may undermine the learning environment for all children⁵¹⁵

Children’s mental health is critical to their later school success as well. Children who

• are able to follow directions and pay attention are able to focus on learning.
• can express their feelings are able to get help when they need it.
• learn to persist when frustrated can overcome challenges.
• feel good about themselves are able to work on their own.
• can control their behavior are able to stay on task.⁵¹⁶

Finally, the importance of social-emotional development in early learning is consistent with the research on brain science. The developing brain is not neatly divided into separate areas governing learning, thinking, and emotions. Instead, it is a highly interconnected organ with different regions influencing, and being affected by, the others. This means, for example, that young children who experience emotional challenges (perhaps because of stress) are less ready for learning because brain regions related to memory are being affected by other regions governing emotion. This conclusion from brain research is, of course, consistent with the everyday experience of teachers of children whose stressful lives often lead to emotional, behavioral, and learning difficulties.⁵¹⁷

Early Care and Education’s Role in Children’s Mental Health

Many practices of high-quality early care and education programs promote mental health and well-being including:

• Screening and assessment of infants’ and toddlers’ social and emotional well-being support the functions of promotion, prevention, and intervention.
• Integrating curriculum and individualization.
• A well-designed space is comfortable for infants and toddlers with different temperaments as well as for their teachers and parents.
• Poorly designed environments are stressful. Teachers are concerned about the safety and well-being of children, and their saying “no” occupies a great deal of teacher energy and attention. The time teachers spend monitoring keeps them from interacting with an infant or toddler in ways that build self-esteem.
• Having partnerships with community resources that families can be referred to.

Reciprocal communication with families. ⁵³⁴

Mental health services in early care and education programs can address:

Promotion—helping all children to feel good about themselves, to get along with others, and to manage their behavior.

Prevention—reducing the likelihood that children will develop mental health problems and reducing the impact of mental health problems that do exist.

Early Identification—paying attention to mental health problems early on.

Treatment—helping connect families with appropriate help for children with mental health problems. ⁵³⁵

Table 10.6.1 – Nine Things Early Care and Education Programs Should Know ⁵³⁶

Nine Things Early Care and Education Programs Should Know

Mental health is an essential part of health.

The mental health of young children is linked to the wellbeing of the people who care for them.

Promoting the mental health of infants and young children can make a positive difference for years to come.

Positive relationships support positive mental health.

Culture plays an important role in young children’s mental health and in how families view mental health and behavior.

The more staff and families know about mental health the better they are able to support it.

Addressing mental health concerns when children are young is more effective than waiting until they are older.

Mental health must be an integral part of early care and education programs.

Programs that focus on mental health are able to design services that improve children’s behavior.

Supporting Children Under Stress

Supporting children’s mental health also extends to helping children deal with the stress that they may encounter. One of the most important things professionals can do is provide the child with a predictable, safe haven where children can feel secure. Teachers can create a comfortable and comforting everyday routine that is child-centered, individualized, responsive, and helpfully structured to give young children a sense of control and predictability that may be lacking in other aspects of the child’s life. Central to these efforts is providing children with supportive adult relationships that are reliable and helpful. This may be more difficult than one would expect because young children under stress often test these relationships to see whether teachers and other adults will remain responsive to them even when children act defiantly or negatively.

In some circumstances, it can be helpful for teachers to obtain the advice of an early childhood mental health consultant who can observe the child in the classroom, talk with the teacher about the child’s behavior, and suggest strategies for providing supportive assistance. Early childhood mental health consultants can be valuable resources to an early childhood education program. They can help teachers provide much-needed support to young children who may not have other such sources of support elsewhere in their lives.⁵⁴²

Trauma-Informed Care

As mentioned, children who are exposed to traumatic life events are at significant risk for developing serious and long-lasting problems across multiple areas of development. However, children are far more likely to exhibit resilience to childhood trauma when child-serving programs, institutions, and service systems understand the impact of childhood trauma, share common ways to talk and think about trauma, and thoroughly integrate effective practices and policies to address it—an approach often referred to as trauma-informed care (TIC).

The context in which children live, learn, and grow shapes both their immediate and long-term well-being. Accordingly, children who experience trauma are more likely to exhibit resilience when their environments are responsive to their specific needs. Families, schools, community-based programs and services, and the individuals caring for children can increase the chances of resilience following childhood trauma when they become aware of the impact of childhood trauma, provide a sense of safety and predictability, protect children from further adversity, and offer pathways for their recovery. In other words, children benefit when these entities provide them with trauma-informed care (TIC).

Despite its focus on trauma, TIC is inherently a strengths-based perspective that emphasizes resilience instead of pathology. TIC has been defined and implemented in a number of ways, but the Substance Abuse and Mental Health Services Administration has identified four key elements—the Four Rs (see Figure 10.6.3)

Figure 10.6.3 – The Four Rs are the key elements of Trauma-Informed Care ⁵⁴³

Applying TIC to real-world settings begins with a child’s first contact with a program, institution, or service system. It requires a comprehensive and multi-pronged effort involving the many adults in children’s lives. For example, in a school or afterschool program, TIC means increasing trauma-related knowledge and skills among program facilitators, school administrators, bus drivers, food service workers, classroom assistants, administrative staff, volunteers, teachers, leadership, special education professionals, school social workers and psychologists, families, and anyone else who comes into contact with children. However, increasing trauma knowledge is only one aspect of TIC, which also means that the individuals who care for children must be able to:

1. Realize the widespread nature of childhood trauma and how it impacts the child’s emotional, social, behavioral, cognitive, brain, and physical development, as well as their mental health. In addition, adults must be aware of the influence of trauma on family members, first responders, service providers, and others who may experience secondary stress (trauma-related reactions to exposure to another person’s traumatic experience). In some instances, adults endure the same traumatic events or circumstances as the child (e.g., a natural disaster, community violence, death of a community member) and may benefit from similar supports.
2. Recognize the symptoms of trauma, including how trauma reactions (i.e., symptoms of posttraumatic stress) vary by gender, age, type of trauma, or setting. In addition, the adults in children’s lives must understand that a child’s challenging behaviors are normal, self-protective, and adaptive reactions to highly stressful situations, rather than viewing that child as intentionally misbehaving. Children’s trauma reactions are understood to be adaptive efforts to protect themselves in response to traumatic events. For example, a child may be hypervigilant about an adult’s anger or disapproval because, in the past, he or she experienced physical abuse by a parent. Or, a child may disassociate or daydream as a learned response that enables them to avoid feeling or thinking about a traumatic experience. In addition, TIC means recognizing that trauma may influence a child’s engagement in activities and services, interactions with peers and adults, and responsiveness to rules and guidelines.
3. Respond by making necessary adjustments, in their own language and behavior, to the child’s environment; and to policies, procedures, and practices to support the child’s recovery and resilience to trauma.
4. Resist re-traumatization by actively shaping children’s environments to avoid triggers (sounds, sights, smells, objects, places, or people that remind an individual of the original trauma) and protect children from further trauma, which can exacerbate the negative impacts of trauma and interfere with the healing process.

Resources for Further Exploration Georgetown University Center for the Early Childhood Mental Health Consultant Harvard Howard University Center for the Developing Child Tulane University Institute of Infant and Early Childhood Mental Health Zero to Three - Early Childhood Mental Health CDC’s Children’s Mental Health CDC’s Adverse Childhood Experiences (ACEs) National Scientific Council on the Developing Child’s Establishing a Level Foundation for Life Mental Health America MentalHealth.gov National Institute of Mental Health’s Helping Children and Adolescents Cope with Disasters and Other Traumatic Events: What Parents, Rescue Workers, and the Community Can Do Stress in Childhood Traumatic Events and Children Children and Mental Health Center on the Social and Emotional Foundation for Early Learning’s Inventory of Practices for Promoting Children’s Social Emotional Competence How to Implement Trauma-informed Care to Build Resilience to Childhood Trauma Early Head Start’s: Pathways to Prevention Infant/Toddler Training Modules Preschool Training Modules

References

This page was adapted from 11: Children's Mental Health. in Paris, J. (2021). Health, safety and nutrition. LibreTexts.

For references according to subscript, please see pages 279-305 of the original Health, Safety and Nutrition book (Paris, 2021) on Google Drive.