When we think of children’s health, we usually think of their physical well-being. “Are they active and fit? Do they get sick often?” Mental health is just as important as physical health. A young child’s mental health can affect all areas of development.
Mental health includes how people feel about themselves and other people, how they approach problems and challenges, and how they cope with life. Mental health aligns with how children handle stress, make wise decisions, and get along with others in childhood and throughout adulthood. Caregivers, teachers, and family members all have roles to play in fostering young children’s mental health. In this Q&A, we address questions about children’s mental health.
What factors impact children’s mental health?
A person’s genetic makeup can influence their mental health. Some mental health conditions “run in families,” but having a relative with a particular condition does not guarantee that a child will have the same condition. Environmental factors also play a key role in mental health. For example, being exposed to lead, mercury, or other toxins can change children’s brains in ways that affect their mental health.
Stress can also impact mental health. “Stress” includes experiences that interrupt a person’s sense of comfort or well-being and cause physical changes such as increased heart rate as well as emotional changes such as feelings of excitement or distress.
Scientists have identified several types of stress. Children are individuals and how they respond to a stressor may differ based on many factors, which is why adults should support children based on a child’s response to a particular event, not the event itself. Stressful events could include “normal” life events,
such as going to the doctor, getting a new teacher, or having conflict over a toy. Stressful events can also include major life events such as losing a loved one (including a pet) or having parents separate or divorce. A few types of stress are described below.
- Positive stress: Most children can adjust to positive stress if adults are supportive and show confidence that the child can manage and even learn from such experiences. Being able to handle stress can enhance a child’s overall mental health.
- Tolerable stress: This type of stress may be difficult for a child, and full recovery may take a long time. Supportive relationships with caring adults can help children learn to manage the stress and enhance their confidence about handling other challenging situations.
- Toxic stress: Negative experiences that persist or get worse over time can be toxic stressors that overwhelm children and make them especially vulnerable to mental health problems. For example, children who face recurring abuse, neglect, or domestic violence feel unsafe much of the time and are considered at risk for toxic stress. Community violence, housing or food insecurity, and parental substance abuse also contribute to toxic stress.
Mental health concerns aren’t the result of just one event. If a child has a mental health concern, it does not mean that a caregiver did something wrong. Mental illness is no one’s fault. Supports are available for children with mental illness concerns that can help them lead a positive and meaningful life.
What are some signs that a child may need professional help?
A child who is having mental health concerns may benefit from an evaluation and receiving some form of professional help, such as family counseling, play therapy, or other individual therapy. Listed below are several indicators identified by mental health professionals that an adult can look for in a child:
- Withdrawn from peers and adults
- Almost always appears to feel sad and hopeless; may cry a lot for no apparent reason.
- Often seems very angry or is constantly irritable or tense, getting extremely upset about things that seem minor to others
- Is frequently aggressive toward peers, adults, or pets, perhaps when child thinks no one is watching; is feared by other children
- Is often difficult to comfort or calm when angry, frustrated, frightened, or otherwise upset; often “lost” in negative feelings
- Regresses in toilet training or other developmental milestones
- Often expresses feelings of worthlessness; seems to feel excessively guilty, anxious, or worried
- Seems very afraid in situations that do not frighten other children
- Often has sleep problems, such as terrifying nightmares, or great difficulty falling asleep or waking up
- Avoids activities previously enjoyed, such as playing with friends
- Seems unable to relax or is in constant motion (much more than peers)
- Tries to hurt self, hurts self deliberately, or expresses desire to hurt self
- Is often “oppositional” or often defies adults’ requests for constructive behavior
- Seldom “stands up” to others who are bossy or bullying
- Becomes very upset if usual routine is changed
What can I do when I’m concerned about the mental health of a child in my care?
Caregivers and teachers may be the first people to notice that a young child is experiencing mental health concerns. Support from caring adults can help most children recover even when very bad things have happened in their lives. Here are important steps teachers and caregivers can take when a child’s behavior raises concerns.
- Observe and take notes on the child throughout the day. Do this over several days or weeks to notice patterns. Does the concerning behavior occur at certain times of day or in certain locations? Be sure to note the child’s strengths as well as areas of concern.
- Share concerns with the program’s director, principal, or social worker. Be as specific as possible in explaining concerns. Give details: “Emily pried the arms off all the dolls twice this week. Every day after lunch, she slammed into children who were playing alone, knocked them down, and ran away laughing. She seemed to single out children who are smaller than she is.”
- Learn and follow your program’s procedures for working with children with challenging behaviors. Whose responsibility is it to talk to the family? If a child’s actions are dangerous, can an extra adult stay in the room to help out? Does the school have a referral process in place?
- Be ready to talk with the child’s family about your concerns.
How can I support a child with mental health concerns?
When a child you know seems to be having mental health difficulties, you can take action to help the child. It is important to be sensitive to a child’s individual needs. For example, a child who is overly watchful as a result of trauma may not want to take part in any activity that involves closing their eyes. A child who is grieving may need some time to cry in private or on a teacher’s lap. Relationships with adults who are warm, nurturing, and respectful of the child can be extremely helpful.
Validate the child’s feelings, but set some limits. For example, let the child know you can accept they’re angry, but they are not allowed to hurt people or pets. It may be necessary to have an extra person in the classroom to help if a child’s behavior poses a safety threat to herself or others.
Maintain a consistent routine that will help a child feel safe. If there will be a change in routine, try to let children know ahead of time what to expect.
Keep in mind that a child who believes they are bad and unlovable may act in ways that make others dislike them. This is sometimes called a “recursive cycle.” They may believe that the teacher cares less about them than about the other children. Reassuring the child may be very difficult, especially if they seem to reject what the teacher says. It may take a while for children to understand that there is a difference between themselves and the things they do. Specifically separating the behavior from the child can be helpful. For example, a teacher might say, “I really don’t like for you to hit people, but I still like you.”
Some children will respond positively to suggestions for ways to express feelings effectively or ways to act on their own behalf. Suggestions include: “When you feel so angry you want to hit, you could punch this pillow or stomp your feet.” “When you feel lonely or sad, would you like to ask a friend or a teacher for a hug?” “If you don’t like what Jake says, you can tell him to stop.”
A child may need opportunities to draw or play about what has happened. Provide toys and materials that children may use to help express feelings or relieve stress. A child may start to cope with fear, anxiety, anger, or grief by playing with Play-Doh, clay, water, puppets, dollhouses, art supplies, and other “open-ended” items. A child involved in such therapeutic play may need to be able to play alone. Asking them to share or take turns at such times may not be helpful. Keep extra materials around to avoid conflict.
Be aware of how other children in the class may be feeling about the child who is having difficulties. Are they afraid, worried, angry, or rejecting? How the teacher responds to the child who is having difficulties in the classroom serves as a model for the other adults and children. Teachers can model acceptance of the child’s needs while at the same time assuring the class that each of them deserves the care and concern of everyone in the group. Teachers can help children find ways to express care and support for a child who is recovering from a difficult experience and show them how to stand up to someone who is treating them unkindly.
How should I approach a family when I am concerned about their child’s mental health?
When a teacher or caregiver has concerns about a child’s mental health, it is important to talk with the child’s family. Such conversations call for tact and thoughtful preparation. If a program has social workers, nurses, or counselors, teachers can ask them for suggestions about the best ways to approach the family.
Before talking with the family, teachers should find out about available support services. Parents may appreciate links to relevant websites or printed information about children’s social and emotional well-being or mental health services such as mental health clinics or play therapists who have been recommended by other parents.
Teachers can collaborate with other staff in their program to determine how various staff members can help the child. For example, what will the teacher do if the child puts themself in danger? Can an additional adult be assigned to the classroom to provide more support? Teachers can present these options to the family.
No parent wants to hear bad news about their child, and some parents may be defensive. They may accuse others, even program staff, of causing the child’s difficulties or exaggerating the problems. Some parents may not be ready to accept that a problem exists, while others may be relieved that someone else shares their concerns. In any case, it is important to be tactful but candid when expressing concerns. Here are some points to remember:
- Carefully word your comments so parents do not feel blamed. Talk about the child’s strengths as well as their difficulties.
- Seek the family’s point of view and suggestions. For example, “We’ve seen a change in Olivia. She cries very hard for more than an hour every day. Will you meet with us to talk about ways to help her feel better at school?”
- Avoid labels. For example, “Olivia seems depressed,” does not illustrate the situation. Instead, describe clearly what the child does. For example, “Olivia hides under her coat and cries herself to sleep. Hugs, kind words, and stories do not comfort her.”
- Do not use diagnostic terms. A mental health specialist should diagnose and explain conditions as depression and anxiety.
- Ask the parents if they see similar behaviors at home and how they have helped their child feel better?
- Invite parents to watch the child in the classroom so they can see what you have described.
- Explain how the child’s behavior gets in the way of friendships and learning activities. Describe behavior in detail. For example, rather than, “She doesn’t like her friends anymore,” say, “She stopped playing with friends about two weeks ago. When someone invites her to play, she turns her body away.”
Together, teachers and families can plan ways to help the child. Consider these examples. Parents might take their child to a pediatrician, bringing a letter from the teacher that describes the child’s behavior in the classroom. Parents might find counseling for their child while the early childhood program provides extra adult support in the child’s classroom. Parents and teachers should touch base regularly to discuss progress and ongoing concerns.
Are services available that can help me work with a child and their family about a mental health concern?
Caregiver Connections is a free statewide support program to help Illinois childcare providers recognize and address the social and emotional needs of the infants, toddlers, and preschool children in their care. Caregiver Connections professional consultants can work with providers in centers or childcare homes when there is a concern about children’s behavior or social-emotional well-being. The consultants can also talk with parents and refer them to evaluation services or to therapists, but they do not conduct evaluations or provide therapy themselves.
Childcare providers can also request training in their programs on a wide range of topics related to young children’s mental health. Head Start also provides some mental health consulting services and resources to their programs and staff nationwide. Information and resources are available online for administrators and directors and for staff members.
Many Illinois Preschool for All programs may provide children’s mental health consultations and behavioral management support services to families.
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