In early childhood
Behaviours that would be concerning in later childhood are commonly seen in the early years. A major challenge is that children in the birth to school-age group grow and develop at different rates, making it difficult to recognise when a concern may be present. Parents, carers and early childhood staff can support children’s mental health by being aware of behaviours which are appropriate for each age group as well as some of the signs of early difficulties. Some signs of emotional and behavioural difficulties have been described for babies, toddlers and preschoolers below. These are general guidelines only and they do not cover all situations. Talking with a health professional for reassurance and/or early help may be useful if:
parents, carers or early childhood staff are worried about their babies or young children
- children seem to be very different from other children of their age, in development or behaviour
- children’s development goes backwards, losing their skills for more than a short time (this can happen at times when children are stressed or learning new skills).
Babies (birth to around six months)
All young babies have crying times as they adjust to the world. Sometimes they just cry and nothing parents, carers or early childhood staff do, seems to work. Some babies cry more than others and this may be called colic. Babies get comfort from gentle holding and rocking and, by about three months of age, they have usually adjusted better to the world, so the crying times decrease and they are much more settled.
Some signs that babies might need more support
It would be appropriate to seek the advice of a health professional if a baby:
- does not cry for attention
- does not startle with noises when newborn
- has a high pitched cry
- does not smile by eight weeks
- does not make any little voice sounds by three months
- does not put on weight
- has ongoing crying periods after three months and not comforted by being held
- stiffens and arches back often when held
- does not like to look at a parent's face or look into their eyes.
If a baby’s parent or carer feels or discloses that they are stressed or depressed much of the time, it is also important that they get the support and help that they need. Supporting the mental health of parents and carers means that they can cope better, enjoy their babies and experience positive wellbeing.
Toddlers (one year to around three years)
Toddlers are learning about being separate people and wanting to use their independence and say "no". They do not yet have good control of their feelings and are likely to have a tantrum if they are frustrated (for example, when something does not go how they want it to). They need lots of support from their parents and carers, as they move between being independent and needing support and comfort. They also like to have their world predictable as this helps them feel safe with all the new things they are learning, (for example, they are often very particular about what foods they like and do not want to try new things). They also may like to do things the same way each time (for example, reading the same bedtime story or getting very upset if someone changes the way they do things). They find playing with other toddlers hard and need lots of adult support. They find it hard to share, take turns and make choices, although they want to try. If they have a dummy or other comfort toy they need it when they feel stressed or are separated from their carers (for example, at bedtime).
Some signs that a toddler might need more support
It would be appropriate to seek the advice of a health professional if a toddler:
- has tantrums many times a day, or is not able to be comforted at the end of the tantrum
- is continually biting other children
- does not have any words by 18 months, or signs for words
- does not put two words together by two years
- does not look at things when you point at them, and does not point at things
- does not enjoy playing interactive games with parents or carers
- does not play
- does not smile and enjoy being with well-known adults
- uses toys repetitively, doing the same thing over and over such as spinning a wheel
- does not prefer to be with special parents or carers
- does not seem to notice when hurt
- does not imitate household tasks by age two
- does not like to be near other children
- is equally friendly to everyone, not favouring parents or carers
- is not comforted by parents or carers when upset.
Preschoolers (three to around five years)
Preschoolers have made big strides in their knowledge and learning. They know that they are separate people with separate minds and, compared with when they were younger, they feel more secure when they are not with their parents or carers. They are beginning to learn how to share and take turns and to play cooperatively with other children, although friendships are often temporary depending on the games. Four-year-olds may be very boisterous and bossy from time to time and like to say words that their parents or carers do not approve of. Children are usually getting over tantrums by age three and are much less likely to be aggressive with each other. Three-year-olds may be ready for toilet training although some children take longer. They usually sleep well unless something is worrying them, although they still might want to know that their parents or carers are near. Children usually give up their dummy or comfort object by the time they are four.
Some signs that a preschooler might need more support
It would be appropriate to seek the advice of a health professional if a preschooler:
- has significant sleeping problems, waking a lot at night
- reverts to soiling or wetting after being toilet trained
- is often challenging, refusing to obey parents
- is still very dependent on a dummy or comfort object after four years
- does not enjoy being with children
- shows unprovoked anger or violence towards other children
- does not seek parents or carers for comfort
- does not play with other children
- does not ask questions
- cannot separate from parent or carer even with support
- is not able to be understood most of the time, by someone they don’t know
- has ongoing fears that prevent enjoyment of life
- has difficulties in understanding and responding to another person’s point of view or feelings.
How do we know when a child may be experiencing a mental health difficulty?
It can be difficult to recognise when a child is experiencing difficulties that are concerning enough to seek out additional support. Children’s behaviours, emotions and thoughts can be influenced by a range of experiences and situations. Taking the time to observe a child for:
- how often
- how long
- how severe
- what else is happening in their lives, and
- across how many settings particular difficulties are present, can help parents, carers and staff recognise the level of concern present.
For example, we would be more concerned about a preschool child who:
- has been withdrawn and refusing to play with other children every time they have been asked to play with them
- has been showing this behaviour for a number of weeks
- gets really withdrawn, doesn’t talk to others when spoken to, prefers to play on their own, and tends to show more withdrawn behaviours than other children of the same age group, and
- shows this behaviour towards siblings and parents or carers at home, when out at special events (for example, other children’s birthday parties) and when at preschool.
If a parent or carer feels that their child’s behaviour is a concern, it can be helpful to speak to a health professional who can provide further support, such as a mental health referral and assessment.
What to expect in a mental health assessment
Having a mental health assessment may be helpful when parents or carers are concerned about their child’s mental health. An assessment does not mean a child will be diagnosed with a particular mental health disorder; however, it will provide a greater understanding of how certain behaviours, emotions and thoughts are affecting a child’s daily experiences. This can then be used to inform the types of support that will be beneficial to the child’s development.
A mental health professional completes a mental health assessment, in collaboration with parents and carers. Parents and carers may also wish to ask early childhood staff to be involved as they have regular contact with their children. Together, the child’s behaviours and/or emotions, background, and strengths will be discussed. The mental health professional may ask questions about the child’s early history, progress and difficulties at home and at the early childhood service. They may also want to know:
- in what situations the concerning behaviours and/or emotions occur
- when the difficulties started and what was occurring at the time
- how the child gets on with other children and family members
- whether there are any learning difficulties parents, carers and early childhood staff may have noticed
- whether there are any developmental concerns parents, carers and early childhood staff may have noticed
Parents and carers may also be given the opportunity to complete questionnaires that will enable their child’s behaviours to be compared with others of the same age. Families may be asked to keep a record of their child’s behaviour for a period of time to give further understanding of how particular behaviours are affecting the child’s life.
The information parents and carers provide at an assessment meeting is considered confidential. All of the information gathered in the assessment will help parents or carers and the mental health professional understand the child’s difficulties and what may be triggering them. This provides a shared understanding of how best to support the child’s development at home and at the early childhood service.
Supporting children with mental health difficulties
After an assessment has been completed, the mental health professional will discuss with parents or carers (and early childhood staff where appropriate) what their child’s difficulties are and how they can use the child’s strengths to respond to these concerns. The mental health professional will work closely with parents and carers in the care of their child during this time. Sometimes this will involve visits to the mental health professional (either with or without your child), visits to your home or to the early childcare service that your child attends.
Parents and carers may have specific questions they would like to ask such as:
- What is the evidence to support the success of this method for responding to my child?
- What other options are available?
- How will I be involved in responding to my child?
- How can I inform early childhood staff about the best ways to respond to my child?
- How will I know if what I am doing is working?
- How long should it take before I see an improvement?
Responding to children with mental health difficulties requires them to learn new skills and new patterns of relating to others. This takes time and practise. Children will often have to practise new skills and patterns at home and at the early childhood service. Regular discussions between parents, carers, early childhood staff and mental health professionals can help make sure that the child is being supported in the most effective way.
Keep in mind that a service which has worked well for one child may not be the best fit for a different child with a similar difficulty, as each child has individual and unique needs based on their experiences.
Putting it all together
When parents, carers and staff work together they can:
- share concerns for children
- take time to observe children and come up with ways to meet their individual needs
- make information available on appropriate mental health supports and how to access them in the local community
- work in collaboration with mental health professionals to support a child’s development
- seek support or advice from a service-based/regional psychologist or counsellor where available
- talk to a local health professional (for example, a GP) about getting a mental health referral
- adapt ways of responding to children in order to cater for their mental health and learning needs
- continue to provide support for families while their children are receiving help for mental health difficulties
- educate other families and children about mental health difficulties and how to support children and families managing these difficulties.
Regular discussions between parents, carers, early childhood staff and mental health professionals can help make sure that the child is being supported in the most effective way.
In later childhood
Parents and carers are usually the ﬁrst to recognise when their child has difﬁculties with their emotions, thinking or behaviour. Sometimes, these difﬁculties may be more obvious at school where teaching staff have the opportunity to observe a range of children and their behaviour. Early signs of difﬁculty include having trouble managing emotions (anger and/or anxiety), or coping with change, thinking negatively about themselves (eg often saying, “I’m no good”), working cooperatively and/or making and keeping friends.
Look for B-E-T-L-S
The key things to observe when you are concerned that children may have mental health difficulties are:
- Social relationships
How to gather good observations
- Focus on specific things that happen (what you actually see and hear rather than what you think about it)
- Take note of when a particular behaviour happens, where it happens and how often it happens
- Notice what things trigger children’s difficulties and what things make them better
Gathering good observations of particular behaviours is often a ﬁrst step towards helping children. Looking for all the ‘B-E-T-L-S’ allows you to get a clearer understanding of a child’s difﬁculties. This means better decisions can be made about when children need help and how to help. Finding out how your child responds in different settings allows you to get a more complete picture about your child.
What to consider
Behaviours that parents and carers might notice
What are the specific things your child does that concern you?
Consider your child’s behaviour, emotions, thinking, learning and social relationships.
My daughter seems to worry a lot. It stops her from having fun. She gets worried about things at school. She worries that her homework will not be good enough. She worries that the other children won’t play with her.
When and where do they occur?
Are there any specific triggers?
Getting ready for school in the morning is the worst time, especially Monday morning.
How often do these things occur?
What makes them better or worse?
At least once or twice a week. She seemed to get worse when one of her friends was moved to a different class.
She feels better when her friends phone her at home. She seems to feel included then.
How long has your child had this problem?
Since the start of the year. Some children were teasing her because she wears glasses. They stopped it but she stayed anxious.
Additonal factors to take into account:
How well the child manages feelings
Usually bottles things up, but then cries over something small. Once upset she can be hard to soothe.
How learning is affected
She does well in class because she puts in a lot of effort. But if she has to do a talk or present her work she gets panicky.
How well the child relates to peers and others
Seems okay with her close friends. But she is very shy with new people.
Any comments the child makes about him or herself or the situation.
She says things like “I’m dumb” and “nobody likes me.” She seems to put herself down a lot
Getting help for your child
If you are concerned that your child has excessive worries, fears, or feels 'bad' about him or herself and you are not sure how to go about getting help, try the following steps:
Find out more
Talk to teachers or others who have regular contact with your child and find out if they have concerns about your child.
Talk to your child’s school about seeing the school psychologist or counsellor
The psychologist or counsellor at your child’s school can listen to your concerns and discuss options for helping your child at home and at school.
See your general practitioner
Your doctor can explore any physical health concerns and help you decide about the need for further mental health assessment and professional support by referring you to a children’s mental health specialist if required.