Recently, four-year-old Nicholas’s sister was born with an illness. Nicholas’s parents were spending a lot oftime at the hospital so he would stay at his aunty’s house. His parents were really tired when they came home from the hospital and didn’t feel like spending time together like they used to. Nicholas tried to make his parents feel better by drawing pictures, but it didn’t seem to help. Nicholas would become upset and confused when his parents were getting ready to go to the hospital and he started wetting his bed at night. On top of their own stress, Nicholas’ parents were worried he was having trouble coping, and spoke to his aunty about the change in his behaviour. Nicholas’s parents asked her to approach the staff at his early childhood service to explain what their family had been experiencing and how it was affecting Nicholas on a daily basis. Once the staff had an understanding of what Nicholas was experiencing they worked with his aunty and his parents to support him and spent time encouraging him to do things he enjoyed.
What are risk factors for children’s mental health?
Some children, for different reasons, are more at risk than others of developing mental health and behavioural difficulties. Children who have risk factors present during their early development can show difficulties later in life. Risk factors for children’s mental health are things that increase the likelihood of mental health difficulties developing; these may include events that challenge children’s social and emotional wellbeing. These experiences may be stressful for a child or family and make it harder for them to cope. Risk factors can be specific events, such as a death in the family, or can be a chain of events that are linked to each other, such as ongoing family stress that leads to family separation.
It is a combination of the negative effects of risk factors that lead to the development of children’s mental health difficulties. While the presence of risk factors does not always mean a child will develop mental health difficulties, they can increase the chance of this happening. Generally speaking, the more risk factors there are in a child’s life, the higher the chances of them developing difficulties. However, in saying this, some children who face many risk factors do not develop difficulties. This is because different combinations of risk factors will influence children in different ways, and because each child and family also has resources and strengths to help them through difficult times.
Every child and family will experience some difficulties, and each will have some resources and strengths to help through difficult times.
What are protective factors for children’s mental health?
Protective factors decrease the chance of a child experiencing mental health difficulties. Protective factors are related to good outcomes for children, and serve to protect children when they are exposed to risk. Protective factors relate to the idea that children who have good experiences develop the tools to have positive social and emotional skills, which are essential for good mental health. The more protective factors there are in a child’s life, the lower the chances of them developing difficulties. Examples of mental health protective factors for children include: having support from a wide circle of family, friends and community members and achieving developmental milestones. Children may experience difficult and stressful times as part of life (eg loss of a pet, death of a family member or experiencing family separation), but it is having support that enables them to be protected from the possible negative effects of these events.
Protective factors strengthen a child’s mental health and buffer them against risk, making them less likely to develop mental health difficulties.
Risk and protective factors: The effects on children’s mental health
Life is full of challenges for everyone; however, some people face more challenges than others. Challenges may build up slowly (such as feeling anxious in social situations); occur suddenly (such as moving overseas); or may come and go repeatedly during a child’s life (as in the case of chronic illness). Support from family, friends and early childhood services can help protect children who are experiencing risk factors and build their resilience- the ability to cope with life’s difficulties. If some of these factors in early childhood can be identified early, the effects of risk factors can be moderated by building protective factors that aid children’s resilience and development.
Risk and protective factors can be identified in three main areas of a child’s life, specifically:
- within a child (eg their temperament or natural abilities)
- within a child’s family circumstances and living environment (eg relationships with their parents or carers)
- as specific life events experienced by a child (eg important transitions, or experiencing loss).
The risk and protective factors within these areas, and their effects on children’s mental health and wellbeing are outlined next.
Children’s internal risk and protective factors
From time to time, children will show behaviour that suggests the presence of a child’s internal risk factors, which may be a part of their temperament or personality. Some examples of these behaviours include:
- feeling anxious
- withdrawing from or avoiding new situations
- being irritable or aggressive
- not being able to follow rules or instructions
- displaying behaviour that is difficult to manage
- lacking an understanding of consequences
- having difficulty understanding or using language.
There are many occasions where it may be appropriate for children to feel or behave this way, for example many children avoid new situations purely out of shyness. Building on a child’s internal protective factors, such as them achieving developmental milestones and a positive sense of self, can help them develop resilience-the ability to adjust to changes and secure positive outcomes. Protective factors within a child include:
- an easygoing temperament
- positive expectations of themselves
- hopefulness about the future
- a sense of independence
- good communication, problem-solving and social skills
- an ability to identify, express and manage their behaviour and emotions
- an ability to develop positive and lasting relationships with friends and family.
Children’s family and environmental risk and protective factors
Often the family and environmental risk factors a child experiences are beyond the control of any one person. However, the effects of these factors can be moderated and this is where opportunities to promote children’s positive mental health and wellbeing lie. Examples of these family and environmental risk factors may include:
- family conflict
- unsupportive or neglectful relationships
- harsh or inconsistent parenting
- lack of supervision by adults
- family separation
- forced migration to a new state or country
- cultural and social isolation
- being affected by natural disaster
- family financial difficulties.
Enhancing family and environmental protective factors means children are less likely to be vulnerable because they receive the acceptance, warmth and support required for their learning and development. A focus on protective factors can make it easier for children to learn to understand, express and manage their emotions and behaviour. These aspects can also lead to increased physical health in children (eg being less vulnerable to common viruses because they are nurtured and nourished). This also allows children to build positive mental health and wellbeing and develop skills, for example, the ability to respond to stress and experience positive social, emotional and behavioural development.
The environments that children share with their peers, early childhood service, family and friends can all have effects on their mental health and development. For example, if children are living in an environment free of stress or violence they may be less likely to experience difficulties. When children have support from adults within these environments, including when adults provide consistent care and ongoing supervision, communication between children and their parents or carers and staff can be clear and open. Support from adults can help children develop social relationship skills-an important part of positive mental health. When children are raised in supportive environments (eg at home and at their early childhood service) that offer loving, safe, consistent care and support, children have the opportunity to develop close relationships. Close relationships with family and peers give children a sense of trust and are important for children’s positive mental health and wellbeing.
Specific events as risk and protective factors for children
During childhood, many children will experience specific events that can be considered risk factors which may influence their wellbeing. However, just because children are exposed to a risk factor does not mean they will develop mental health difficulties. As long as children are surrounded by caring and supportive adults, the impact of risk factors can be reduced.
Some examples of specific risk factors are:
- death of or illness in a family member, friend or pet
- separation of parents or carers
- change of preschool or moving house
- loss of a friendship
- moving to a new country
- being affected by natural disasters
- being diagnosed with a disability or medical illness.
When children are uncertain of their world they can become frightened and may respond by crying, feeling anxious, having bad dreams, clinging to their parents or carers, feeling angry or irritable, being unsettled or losing motivation. Children may also react by behaving in ways that would be expected of a younger child.
For example, they might start wetting the bed or sucking their thumb. Some children may become increasingly worried that the events they have experienced will happen again or become worse over time. For example, during family separation when one parent or carer leaves the family, children can become anxious that their other parent or carer will also leave them. Often this fear is expressed through behaviours rather than words, such as becoming very clingy to their parent or carer, or not wanting to sleep by themselves. When children are provided with a stable environment where they understand their daily routines, are supported and their emotions and behaviour can be monitored, they will have the best opportunities to overcome these challenging times.
A distressing event (such as loss) can mean big changes for children. Sometimes the effects an event has on parents or carers, including stress or grief, may make it difficult to support their child. When this is the case, it is important to seek support from friends, family, early childhood service staff or health professionals. This support may help make it easier to support their child. Although the effects of distressing events on a family may be intense or long lasting, seeking support can mean these do not interfere with a child’s ability to manage everyday life.
Children need lots of reassurance from caring adults to help them cope with major loss or change. If parents or carers are closed off or only give vague answers, children are likely to make up stories to try and make sense of what has happened. Sometimes those stories can cause more confusion, worry and anxiety. Children may keep these feelings inside until they cannot manage them by themselves any more. Communication from caring adults supports children through change and distressing events. Addressing risk factors creates opportunities for children to have positive mental health and wellbeing in childhood and beyond.
Reducing risk factors and increasing protective factors supports children’s mental health
Families and early childhood service staff can help reduce risk factors and increase protective factors in a child’s life. When families and staff notice children’s feelings and behaviour and communicate openly with one another, they can effectively support children’s wellbeing (eg identify and address children’s areas of risk, such as difficulties with social or emotional development). Many people experience changes for reasons that cannot be controlled; this means there are some aspects of children’s lives where risk factors cannot be addressed. In this situation, increasing both internal protective factors (such as a child’s positive coping skills) and external protective factors (such as a supportive environment) is beneficial. For example, during stressful times families may experience changes in the amount of time they spend together or in their routine. To protect a child from the risks associated with this, parents, carers and early childhood staff can work together to maintain children’s regular routines, such as bedtimes and mealtimes, as much as possible. A child’s internal strengths, such as having an easygoing temperament, can also help them through this time.
Together, these can help reduce the number of changes in a child’s life and help them feel secure. Children can feel reassured by knowing that a responsive adult is taking care of them and is looking after their needs. This can help to reduce the stress and disruption in their life.
Promoting the positive aspects of children’s lives can mean challenges are less likely to get in the way of leading a happy, healthy and successful life.
Children who are connected and feel they belong to their family, early childhood service and community are more likely to develop a strong identity, a positive sense of self and strong relationships with others.