Mental Health in Infants and Young Children: Pediatric Mental Health Minute Series

Mental health in infants and children is about how young children begin to organize their feelings and connect with other people. It includes their growing capacity to regulate and express their emotions and behavioral responses, to form secure relationships with others, and explore the environment in the context of their family, community, and cultural expectations (Zero To Three).

Scope in Pediatrics

• About 16% of children under 6 years have clinically significant mental health problems that require clinical care early in life. Most present with dysregulated emotional or behavioral patterns including anger, aggression, or anxiety that interfere with a child’s ability to participate in family and community activities.  These problems rarely resolve spontaneously without intervention but often respond to therapy and family support.
• Pediatricians impact mental health in infants and children through
  • Promoting infant and early childhood mental health for all families through developmentally specific anticipatory guidance; promoting safe, effective parenting practices; and modeling effective communication and care for others.
  • Identifying and amplifying protective factors including parent knowledge about access to supports, healthy parent and family communication styles, and social supports in the community.
  • Identifying and addressing child, family, and community factors that may increase a child’s risk of mental health problems, including chronic medical conditions, family or child adverse childhood experiences, and biological predisposition to mental health concerns, using systematic approaches including screening.
  • Identifying, addressing, and tracking children’s mental health status and symptoms, especially among children with known risk factors for mental health concerns.

Teaching Points

• Infant and early childhood mental health promotion can include a number of activities across early well child visits.
  • Anticipatory guidance about emotional and relational development starts with the first newborn visit to promote sensitive and responsive caregiving and respect for infants’ emotional experiences.
  • Usage of the parallel process; when parents feel supported and listened to by their child’s pediatrician, they share that process with their child.
  • Effective communication goes a long way! Using the AAP’s HEL²P³ mnemonic for talking about tough topics enhances care and reduces parent stress:

H - Hope
E - Empathy
L - Language
L - Loyalty
P - Partnership
P - Permission
P - Plan

• Educating families about safe, effective strategies to teach children to follow directions and modify behavior should begin early including positive reinforcement.

• Child mental health is affected by community, family, and child factors, increasing resilience or risk status. Pediatricians can use surveillance and screening to track a child’s relative risk status.
  • Surveillance includes monitoring for known community events and observable family interaction patterns and asking about basic needs and safety.
  • Family screening includes following the Bright Futures maternal depression screening periodicity schedule and can also include screening for social determinants of health and/or adverse childhood experiences.
  • Pediatricians can link with family advocacy and basic needs services in the community.