In this section you will find information and resources for parents and caregivers to help them understand the important issues involved in the mental health of children ages birth to 5. We also give information specific to infants, toddlers and preschoolers including: ways to develop caring relationships, reaching important milestones in your child’s social and emotional development, information about maternal depression, understanding how stress affects infants and young children, how to get the best help for your infant or young child, and infant/early childhood services and supports available locally and nationally. This section provides an extensive resource library filled with publications, facts and figures, links and frequently asked questions specific to infant/early childhood mental health issues.
Margaret Holmberg, Past President of the Connecticut Association for Infant Mental Health, wrote and edited much of this Infant/Early Childhood Mental Health section.
To learn more about the Child Health and Development Institute’s work on Infant/Early Childhood Mental Health click here.
Introduction to infant/early childhood mental health
Infant and early childhood mental health refers to the quality of a child’s first and early relationships and the child’s social and emotional development. When we talk about infant/early childhood mental health we mean a child’s ability to:
- experience warm and responsive relationships with caregivers;
- create relationships with others;
- explore and learn;
- communicate in play; and
- express and control emotions.
We know through scientific research that a child’s early experiences—whether good or bad —affect the development of children’s brains and their health (Center on the Developing Child, Harvard University). The first three years of a baby’s life is a time of big growth and development. A newborn’s brain is about 25 percent of its adult weight. By age 3, your child’s brain has mostly grown and is making connections and learning about the world (Zero to Three). Your baby and toddler need caring, sensitive adult-child contact to help him/her develop trust, understanding, compassion, kindness, and a conscience. We now know that babies’ brains do not develop fully when this warm care giving is missing. Healthy and caring parent/caregiver relationships help children get ready to enter school so they can be happy, well behaved and willing to learn. Research has shown that as a child grows, kind relationships with parents/caregivers shape his or her self-image and give the child the skills needed to face new challenges.
Developing warm and caring relationships
Early relationships are so important for a young child to have good mental health. Parents and caregivers play a large part in their children’s mental health. When parents are open and caring to their babies and toddlers’ needs they create a secure and trusting relationship that later relationships will be built upon. Infants thrive on human stimuli –parents’ faces, voices, touch, and even smell. They are born with the need to be with people and not just for food. Their first “toy” is Mommy or Daddy’s face. They love to look at eyes and mouths. Babies would rather listen to speech or singing than any other kind of sound.
As babies get older and do more on their own, they still need physical care, but they also need their parents/caregivers for their emotional care. Close and caring relationships help infants, toddlers and preschoolers with a healthy- start in their mental health. There are many things that a parent/caregiver can do with their child to help their child’s learning every day.
Great ways to interact with your young child
- Learn to read your babies cues and what soothing techniques work.
- Talk often with your children from the day they are born.
- Hug them, hold them, and respond to their needs and interests.
- Listen carefully as your children communicate with you.
- Read aloud to your children every day, even when they are babies. Play and sing with them often.
- Say “yes” and “I love you” as much as you say “no” and “don’t.”
- Ensure a safe, orderly, and predictable environment, wherever they are.
- Set limits on their behavior when necessary and guide them calmly, not harshly.
Adapted from the Early Childhood-Head Start Task Force, U.S. Departments of Education and Health & Human Services
To learn more about good parenting skills that help your child ‘s healthy learning and development please see the following publications from different organizations:
Child Health and Development Institute of Connecticut, Inc. (CHDI) handbooks:
Caring for Connecticut ‘s Children, Volume 1: Promoting Health and Safety
Caring for Connecticut ‘s Children, Volume 2: Promoting Healthy Child Development
Zero to Three: Everyday Way ‘s to Support your Baby and Toddler ‘s Early Learning.
Center for Early Childhood Mental Health Consultation: Social Emotional Tips for Providers Caring for Infants.
Feeding and eating
Creating a supportive feeding relationship that is right for each child’s developmental stage, nutritional needs, and neuromuscular growth is the key to the healthy development of your child’s mental health (Zero to Three). For newborns and infants, parents/caregivers should follow the signals of their baby to know when to feed them, and to feed the baby quickly when the baby is hungry, before the baby becomes upset from heavy crying. It also helps if the parent/caregiver allows the baby to control how much he/she wants to eat or stop feeding when the baby does not want to eat or shows that they are full or turns away, refusing to open the mouth, or arching the back.
When a child is developmentally ready (around 3-6 months) the baby’s doctor or pediatrician will suggest that a parent/caregivers begin to gradually offer solid foods, one kind of food at a time. For toddlers, parents/caregivers can give regular healthy meals and snacks as well as introduce new foods in a kind way. Many toddlers will accept new foods if they are given to them over and over, without pressure or reward from the parent/caregiver to eat the new food. Toddlers need more structure and discipline during mealtimes so they learn the social behaviors at mealtime. It is important not to get into fights with your toddler over eating. Eating is one of the few ways that toddlers have control over what is happening to them. Let your toddler know that you respect what and how much they eat. Generally when toddlers have healthy choices, they will choose what they need. To learn more about helping a child with good eating habits, click here or search our resource library.
Where to start
From birth to age 5 your child is not only growing in size, but also your child is learning, playing, moving, speaking and interacting with others. As a parent/caregiver you take your child to the doctor (pediatrician) to make sure your child is growing and gaining weight. Parents and caregivers also need to track their child’s milestones in how he/she learns plays, speaks, and acts. These milestones can help a parent or caregiver find any problems or concerns in their child’s development at an early age. Many groups publish a list of milestones for you to use such as the Center for Disease Control and Prevention’s Developmental Milestones charts and the Zero to Three Organization’s Age-based handouts.
As a parent/caregiver, you know your child best. If your child is not meeting the milestones for his or her age, or if you think there could be a problem with their development, tell your child ‘s doctor as soon as you can. You do not need to worry alone. If you live in Connecticut, you can call Connecticut ‘s 2-1-1 Child Development Infoline at 800-505-7000 or just dial 211. Care coordinators at the Infoline can help parents/caregivers with questions about their child ‘s development, behavior management ideas and programs, make referrals to services, and give advocacy and follow-up as needed. In Connecticut, there is also a resource called The Ages & Stages Child Monitoring Program which helps parents and caregivers learn about their child ‘s development and identify potential delays as early as possible.
Infant/Early childhood temperament and mental health
As your child grows it is important to learn about your child’s temperament or your child’s unique way of experiencing and looking at the world. Children are all different and their temperament will control how they behave and react to different situations. What is important for good mental health is the “goodness of fit” between caregiver and child. Some issues that parents and caregivers may have with their child include: inconsolable crying, extreme shyness, feeding issues, aggressive behavior, defiant behavior as well as sleep challenges. Parents will want to make the way they react match their children’s temperament such as being patient and kind for the shy child or acting calm and quietly firm to redirect the active child. As a parent or caregiver you can learn ways to deal with your child’s needs and challenges. There are excellent resources available in the Infant/Early Childhood Mental Health Services and Supports section as well as in our Resource Library to help you develop strategies to deal with your child’s behavior. It is also good idea to talk to your child’s pediatrician about your child’s needs. The Zero to Three website has a section on Challenging Behavior Tips and Tools and the Center for Early Childhood Mental Health Consultation has an excellent tool, called The Infant Toddler Temperament Tool. This tool allows parents and caregivers to learn about their child’s temperament and it also gives best practice tips adults can use to work with their child’s unique temperament.
High-risk children and mental health
In most cases very young children’s lives are filled with happiness, love, learning and fun. However, for some that is not the case. Rates of child maltreatment are highest for the youngest children, with children most at risk in the early weeks and months of life (Zero to Three). Stress on young children is known to badly affect brain development, and impacts learning, behavior, as well as physical and mental health. Children who are at a high-risk for high stress and thus may develop future learning/ behavior problems include children who are a victim of a traumatic event that go unresolved. Examples of these high-risk children are children who are abused or neglected, live in foster care, exposed to domestic violence, are homeless or have been exposed to drugs or alcohol during their mother’s pregnancy. Early intervention for young children who are at high-risk for experiencing high-stress can put a stop to future problems if care is given to them as soon as possible. For example, if a baby or toddler is put into foster care, that child should be getting some type of “early intervention” as well as the right therapy.
Other examples of “potentially traumatic events” for young children are:
- Physical abuse and maltreatment
- Sexual abuse
- Family, school, or community violence
- Death of a loved one, especially a parent or caregiver
- Witnessing Domestic violence
- Medical trauma
- Separation from a parent or caregiver
- Traumatic loss
- Natural Disasters
Even though babies and toddlers may not understand the meaning of what they see or hear, they take in the images that are around them and are deeply impacted by the emotions of the people that take care of them. Parents and caregivers play a key part in helping their child cope and respond to traumatic events. When parents are grieving or experiencing their own traumatic stress it can be difficult for them to provide the adequate attention needed by their children. In these instances, it is important for parents to seek support for themselves or reach out to others who can give support to their children. Spending quality time with your baby and toddler, loving and supporting them during difficult times is a great start in the healing process. The good news is that there is treatment for traumatic stress for all ages of children. Please see the Trauma section in this website, and click on the tab called, “Effective Treatments for Child Traumatic Stress“.
How to get the best help for your infant or young child
Talking about mental health may be difficult for parents and caregivers. You may want to think about your child ‘s developmental and mental health issues just as you do their physical health issues. For a sick child, you would make an appointment with your child ‘s pediatrician and talk about your concerns. Your doctor is the place to start with a social/emotional or mental health concern. Share your worries and describe what is happening at home or at school. Your pediatrician can help you decide if you need more help. In some cases, your doctor can assure you that some of your concerns are normal issues for your child ‘s developmental age and phase. In other cases, your pediatrician might ask you to get a further evaluation or refer you to a qualified child mental health professional.
If your pediatrician is not able to help, you can seek a consultation through a local child mental health provider, community agency, early intervention program, or Connecticut residents can call 211 or the Child Development Infoline at 1-800 505-7000. A Consultant from Help Me Grow at 211 will help you get the right referral for your child. Programs available to help you in Connecticut include: Birth to Three Early Intervention that can provide a developmental evaluation or preschool special education through your local school district, a community referral or a way for you to follow your child ‘s development using Ages and Stages (see below section on Developmental Screening). Remember it is very important for the young child to have his/her developmental or mental health concerns found early, so that he/she can get the right services or intervention. To learn more about the infant/early childhood programs available in Connecticut and nationally, click on the section called, “Infant/Early Childhood Mental Health Services and Resources.”
Problems at child care or pre-school
If your child is having problems in child care or pre-school, if a teacher has concerns, you will want to work with your child’s teacher to find an answer. Often there are mental health consultants who can work with you and your child’s teacher to provide guidance for how to respond to your child or how to change the classroom environment to meet your child’s needs. In Connecticut, the Early Childhood Consultation Partnership provides consultants to child care programs and to Foster Parents for mental health concerns. You may ask for help to get an evaluation to see whether your child can get special education services (for ages 3-5 years). If your child is age birth to three there are services available through Part C of the Individuals with Disabilities Act (early intervention).
A child can get special education and related services if they have a significant delay in one or more areas of development, such as learning, speaking or playing. Special education and related services are required by federal and state law. Early childhood special education as defined by the federal law known as the Individuals with Disabilities Education Act (IDEA Part B) is for 3-, 4- and 5-year-old children with disabilities who need special education. In Connecticut, special education and related services are available to eligible children by age 3 and are provided by local and regional school districts. Connecticut residents can call the Child Development Infoline at 1-800-505-7000 to find out about services in each town or to find the nearest local school district.
To get information about mental health in schools for an older child (age 6-18), please read the section of this website, called, “Mental Health in Schools.”
Evaluation and screening
An assessment or screening is the way a practitioner may start a conversation with a parent or caregiver about his/her young child’s social and emotional and physical development. The screening will ask parents and caregivers questions about their young child and his/her physical, social and emotional milestones. The practitioner may ask questions about the child’s learning and care-giving places as well as give the parent/caregiver the chance to share their concerns about their child’s needs. It is important that the evaluation or screening for your infant or toddler be done in your home or a place where you are comfortable.
A Birth to Three Evaluation, as well as evaluations from other home visiting programs will take place at your home. Other settings where the evaluation can be conducted for children older than three are: your pediatrician’s office, at a mental health provider’s office, through an early care or educational institution, through a family resource and support center, or through a community mental health center. A parent/caregiver will want to be with their child during the assessment. Some children will not do well on any type of assessment if they are not comfortable with the place that it is given. Also, it is important for parents/caregivers to understand that they can get a second opinion about their child’s assessment results if they do not agree. The section called Infant/Early Childhood Mental Health Services and Resources, has a list of Connecticut and national organizations/programs that can help a parent/caregiver with the screening/assessment process.
Please see the main section of the www.kidsmentalhealthinfo.com website called, “How to get the Best Help” and “What Questions do I Ask” section. These sections will help a parent/caregiver understand more about the screening process and have access to a list of questions to take to a provider in a first meeting with him/her.
Once a screening or assessment is done, the right service plan can be developed for the child and family. It is important to understand the different treatment choices, which can include consultation in your home or child care, parent/child psychotherapy, play therapy or medication in very special cases. You will want to talk about the options with a health care professional who has experience treating your child’s developmental and mental health issues. For children ages 0-6, parents and caregivers almost always participate in their child’s treatment in some way. For very young children, parents and children often participate in “dyadic” treatment which is when the parent and child take part together in treatment such as parent/child psychotherapy. As your child grows older and does more on his/her own, you may be less involved in your child’s treatment.
Types of treatment
Each infant or young child’s treatment plan will be different depending upon his/her diagnosis and needs. The following are some of the types of treatment available for infants and young children with developmental delays or behavioral problems.
Early Intervention: Early intervention services are for children ages birth to three who have a disability or developmental delay (IDEA, Part C). Depending on your child’s needs, his or her early intervention services may include:
- family training, counseling, and home visits;
- special instruction;
- speech-language pathology services (sometimes referred to as speech therapy);
- audiology services (hearing impairment services);
- occupational therapy;
- physical therapy;
- psychological services; medical services (only for diagnostic or evaluation purposes);
- health services needed to enable your child to benefit from the other services;
- social work services;
- assistive technology devices and services;
- nutrition services; and
- service coordination services.
To learn more about Early Intervention services, please visit the National Dissemination Center for Children with Disabilities website. For Connecticut residents please go to www.birth23.org
Psychosocial therapies: Infant Mental Health Specialists can help parents try and understand what their babies and toddlers might be thinking or trying to communicate. There are limited therapies available for young children. Please see a selection of key treatments below and please also see the section entitled, “Infant/Early Childhood Mental Health Services and Resources.”
Parent-Child Dyadic Therapies:
Child-Parent Psychotherapy (CPP): CPP is an intervention for children aged birth through age 5 who have experienced at least one traumatic and, as a result, are experiencing behavior, attachment, and/or mental health problems, including post-traumatic stress disorder (PTSD). The main goal of CPP is to support and strengthen the relationship between a child and his or her parent (or caregiver) as a way to restore the child’s sense of safety and attachment, and improve the child’s cognitive, behavioral, and social functioning. To learn more about this intervention, click here.
Parent Child Interaction Therapy (PCIT): PCIT is a parent-child treatment program that helps parents of children aged 2-7 years old with behavioral problems (aggression, non-compliance, defiance, and temper tantrums). PCIT focuses on promoting positive parent-child relationships and interactions while teaching parents effective child management skills. PCIT has been adapted as an intervention for many different types of families (child welfare population, at-risk families, adoptive families, foster families, and other languages including Spanish and Chinese). To learn more about PCIT and to find a PCIT therapist in your area, click here to be linked to the PCIT Training Center.
Child FIRST (Child and Family Interagency Resource, Support and Training): This home-based program focuses on prevention and early identification of at risk children and their families. Child FIRST was developed by Dr. Darcy Lowell, a developmental pediatrician, and is an innovative evidence-based model which effectively decreases emotional and behavioral problems, developmental and learning problems, and abuse and neglect among very vulnerable young children (prenatal through age six years) and families.
Birth to Three: The Birth to Three System helps families to meet the developmental and health-related needs of infants and toddlers who have delays or disabilities. Parents and caregivers can call the Child Development Infoline and ask for an evaluation for their child, or download a Referral Form on the Birth to Three website.
Minding the Baby: MTB is an intensive home visiting program for first-time young mothers and their families living in New Haven, Connecticut. This program brings together a home visiting team including a pediatric nurse practitioner and a licensed clinical social worker to promote positive health, mental health, life course, and attachment outcomes in babies, mothers, and their families by helping mothers understand or wonder about what their baby is thinking.
Nurturing Families Network: This program is a no-cost, voluntary program that provides information, guidance and assistance to first-time parents. Available through some 33 community agencies and birthing hospitals throughout Connecticut, the network offers home visiting services, access to parents support groups and community assistance.
Emergency Mobile Psychiatric Services (EMPS): Services for children and adolescents that gives immediate, mobile assessment and intervention to individuals in an active state of crisis and can occur in a variety of settings including the member’s home, school, local emergency department, or community setting. Because this service is mobile and available to all Connecticut residents, it can be a helpful alternative to bringing your child to an Emergency Department in a time of crisis. To access EMPS services across Connecticut, call 2-1-1.
Understanding perinatal mental health (maternal depression)
Giving birth and raising children can be very hard. The time right after having a baby can be a very hard time for some women, due to hormonal changes and the stress of caring for a new baby. Although many women feel a short period of sadness after giving birth, (which is a very normal reaction) about 10 to 20 percent of women experience a perinatal mental health issue, which may last for a few days or a few months. These issues may be twice as high for mothers living in poverty. Other mothers may experience longer perinatal mood disorders and need help.
Perinatal Mental Health refers to the emotional and psychological experience of women and their families during the preconception through the postpartum period. Other terms include maternal mental health, maternal depression, postpartum depression, Perinatal Mood and Anxiety Disorders, perinatal emotional complications.
There are many reasons why a mother might be experience a perinatal mood and anxiety disorder such as marriage problems, money problems, not enough social supports, having a child with special needs, problems with spouse and many others. While many women who experience a perinatal mood and anxiety disorder are very good mothers often their parenting is affected. Mothers who are depressed or anxious may not play with their babies, they may not breastfeed, they may not show books to their child, or talk with their infants and are less likely to follow routines (Addressing Maternal Health in the Pediatric Medical Home, CHDI.org).). Many depressed or anxious mothers think they are bad parents and can be hard on their child and in some cases act mean toward their child.
There is evidence that these disorders have bad effects on infants, toddlers, school-age children and adolescents. Children of depressed and/or anxious mothers have been found to have a hard time establishing warm relationships, and bonds with their caregiver. Researchers have found that young children of depressed and/or anxious mothers are tired, do not have energy, have trouble separating, more afraid than children of non-depressed mothers. School-aged children of depressed/anxious mothers may have school problems, poor friend relationships, lower self-esteem, behavior problems and are at-risk of getting their own depressive and anxiety problems. However, not all children will have a bad reaction from their caregiver’s perinatal mood disorder. Each child is different and how they react will be based on their genetic make-up as well as by their surroundings.
The good news is that there is treatment for perinatal mood and anxiety disorders and getting this treatment as early as possible is important for a mother/caregiver. If you think you might be experiencing a perinatal mood and anxiety disorder or any other type of depression please consult a doctor immediately. If you live in Connecticut, you can also call 2-1-1 or visit their website to search for support. Another website called, Postpartum Support International is a great resource to find support groups and resources in your state. For Connecticut’s chapter of Postpartum Support International, click here.
Resources and Community Support:
Connecticut Information and Referral Programs for Peripartum Mood Disorders (Maternal Depression)
Postpartum Education for Parents: http://www.sbpep.org
Postpartum Support International: http://www.postpartum.net
National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/depression/index.shtml
National Mental Health Information Center: http://www.samhsa.gov
(Sources: much of this section has been based on publications from the National Center for Children in Poverty and the NYU Child Study Center):
Infant/Early childhood mental health services and resources
This section lists Connecticut and national resources for infant/ early childhood mental health. To find more resources, please search the Resource Library as well as the section called Parents & Caregivers.
211 Child Development Infoline (CDI): CDI care coordinators provide education on development, behavior management strategies and programs, make referrals to services, and provide advocacy and follow-up as needed. By calling the toll free Child Development Infoline # (1-800-505-7000), families, child care, health care and social service providers can access many of Connecticut’s programs and services for children and their families.
2-1-1: Connecticut residents can call 2-1-1, which is Connecticut’s free information and referral service. Simply by dialing 2-1-1, a toll-free number throughout Connecticut, callers can reach knowledgeable, multilingual staff and get information, referrals or seek help in a crisis.
Community Collaboratives: These are groups of service providers, advocates, and family members who meet together to help families find needed services and develop treatment plans with input from the family. Each of the Community Collaboratives has Care Coordinators and Family Advocates who work with families to help find the child’s service needs and the family’s choices for the kind of service they want. Families do not need to be DCF-involved or in HUSKY to get help from the Community Collaborative, but some services that are recommended may require enrollment in HUSKY or in DCF’s Voluntary Services program.
Child Guidance Clinics: There are 67 Child Guidance Clinics in Connecticut that offer outpatient behavioral health services for children ages 0-18 and their families, regardless of ability to pay. Child Guidance Clinics may not have staff qualified to service infants and toddlers and their families but referrals are still important to establish the need. The clinics will know who in the community is available to serve you.
Connecticut Behavioral Health Partnership (BHP): The CT BHP is a partnership that consists of the Department of Children and Families (DCF), the Department of Social Services (DSS), the Department of Mental Health and Addiction Services (DMHAS), ValueOptions® and a legislatively mandated Oversight Council. The BHP provides behavioral health services for Connecticut’s Medicaid populations, including children and families who are enrolled in HUSKY A, & B, DCF Limited Benefit, Charter Oak Health Plan, Medicaid Low Income Adults (LIA) and Medicaid Fee for Service programs.
Birth to Three: The Birth to Three System helps families to meet the developmental and health-related needs of infants and toddlers who have delays or disabilities. Parents and caregivers can call the Child Development Infoline and ask for an evaluation for their child, or download a Referral Form on the Birth to Three website. There is also a list of Birth to Three programs for each town listed on this website. The town links will then take you to a page of information about that town including which Birth to Three Programs are available as well as information about the school’s preschool special education contacts for transition.
Help Me Grow: Help Me Grow is a prevention program of the Connecticut Children’s Trust Fund. This program helps to identify children at risk for developmental or behavioral problems and to connect these children to existing community resources. Families can also receive information on different topics related to their child’s development, such as managing difficult behavior, toilet training, sleep issues, promoting language development, and typical developmental milestone information. To get a referral to Help Me Grow, call the Child Development Infoline at 1-800-505-7000.
Early Childhood Special Education and Related Services: These services are provided to eligible 3, 4 and 5 year old children with disabilities who are entitled to a free appropriate public education in accordance with their individual needs as mandated by special education law. In Connecticut, special education services are provided by local and regional school districts. The Child Development Infoline at 1-800-505-7000 can help families find their local or regional school district’s Preschool Special Education services to discuss the need for an evaluation.
Children and Youth with Special Healthcare Needs: Children & Youth with Special Health Care Needs (CYSHCN) are those who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and need health and related services beyond that required for children in general. The Child Development Infoline at 1-800-505-7000 can help families link to services in their communities.
Educating Practices: This pediatric training program is based at The Child Health and Development Institute of Connecticut, Inc.. Educating Practices informs pediatricians and their staff about critical children’s health issues including screening for early childhood mental health and development issues.
Child First (Child and Family Interagency Resource, Support and Training): This home-based program focuses on prevention and early identification of at risk children and their families. Child FIRST was developed by Dr. Darcy Lowell, a developmental pediatrician, and is an innovative evidence-based model which effectively decreases emotional and behavioral problems, developmental and learning problems, and abuse and neglect among very vulnerable young children (prenatal through age six years) and families.
Minding the Baby (MTB): MTB is an intensive home visiting program for first-time young mothers and their families living in New Haven, Connecticut. This program brings together a home visiting team including a pediatric nurse practitioner and a licensed clinical social worker to promote positive health, mental health, life course, and attachment outcomes in babies, mothers, and their families by helping mothers understand or wonder about what their baby is thinking.
Early Childhood Consultation Partnership (ECCP): The Early Childhood Consultation Partnership is a statewide program managed by Advanced Behavioral Health, ABH® and funded by the Department of Children and Families (DCF). There are 20 master’s-level Early Childhood Mental Health Consultants who are subcontracted by ABH® through 10 non-profit behavioral health care agencies throughout the state. The programs offer child/family, classroom, and child care center-based consultation to support the social and emotional health of young children.
Connecticut Association for Infant Mental Health (CT-AIMH): The Connecticut Association for Infant Mental Health (CT-AIMH) is a membership organization that provides statewide opportunities to enhance knowledge and promote a positive influence on the social-emotional health and development of infants, young children and their families. CT-AIMH provides a set of Competencies in infant mental health which when met can lead to Endorsement in Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health.
Connecticut’s Network of Care for Behavioral Health: This website gives help to individuals, families and agencies concerned with mental health. It provides information about mental health services, laws, and related news, as well as communication tools and other features.
Connecticut Head Start Programs: This is a list of all the Head Start programs in Connecticut (go down to the bottom of the page to see the list). Head Start is a child development program that serves children from birth to age 5 and their families. Sponsored by the U.S. Department of Health and Human Services, Administration for Children and Families, programs are child-focused and have the overall goal of increasing the school readiness of young children in low-income families. Early Head Start provides services for young children birth to three and their families. These programs have an income eligibility requirement.
World Association for Infant Mental Health – lists the affiliate states in the United States with their web addresses
National Center for Pyramid Model Innovations
Center on the Developing Child, Harvard University
Center for Early Education and Development, University of Minnesota
National Center for Children in Poverty
New York University Child Study Center
Center for Social Emotional Foundation for Early Learning
Frequently asked questions
When we talk about infant/early childhood mental health we mean the early relationships infants and toddlers have with their parents or caregivers and their ability to experience emotion and explore their surroundings. These early relationships are important to a young child’s healthy development. Warm relationships by caring parents and caregivers are important to a child’s mental health.
Infant mental health is also the infant’s capacity to experience and control different feelings. Infants explore in order to learn.
Early childhood mental health refers to the social and emotional development of the child. It is the ability to have good social relationships with adults, including caregivers, teachers, and peers and to learn to express emotions in safe and healthy ways.
Here is what to look for in your young child that will show good mental health:
Babies are alert and willing to explore toys and play with caregivers. They enjoy being held and making noises with their caregivers. They play games like “So BIG” or “Patty Cake” happily. They are able to find comfort from their
Toddlers eagerly explore new things they find around them. They stay with a toy or activity even when it is hard for them to use. They can play with adults and other children, giving and taking toys, watching and smiling. They understand “no” and stop when they hear it to find out what to do next. They find their caregivers when they need comforting.
Preschoolers go to adults when they need help. They follow simple directions. They can wait when asked for a short period calmly without crying. They play cooperatively with other children with adults as their guides.
It is important to note that all children, even healthy children, will at times be frustrated, cry and have difficulty being soothed. However, when these concerns become chronic or overwhelming, the parent may need extra help and support.
Parents and caregivers of infants and toddlers can best support good mental health very early in development, even before the baby is born. Good prenatal care is very important to how mothers will feel about their babies after birth. Regular doctor appointments, support from family members, reducing stress, and getting rest are good practices that babies will “remember” after birth.
After birth, parents and caregivers will want to pay a lot of attention to their infants, soothing them when they cry, feeding them when they are hungry, changing their diapers when needed and holding them when they are awake and alert. These awake and alert times are when babies will gaze at faces, watch and track high contrast (black and white) pictures. Parents and caregivers should be aware of when babies get tired and are ready to sleep. These are the first steps to letting babies know that parents understand them and will give them what they need. They begin to connect with and to trust those who care for them.
A baby’s big job is to learn to trust someone. When babies cry they are upset about something. Some things you can solve: hunger, wet diaper, or tiredness. Other times they are just uncomfortable and need rocking, holding, soothing. Not giving the infant these things tells the baby that no one understands her or cares for him. Attending to babies’ cries is not spoiling but, in fact, is teaching babies that there is someone they can count on to help them and telling them they are safe. Feeling safe and secure is very important for babies and toddlers. Parents and caregivers need not worry about spoiling their infants during the first 12 months, the job is to respond. A warm and loving relationship will be a protection against the stress and trauma a young child may face later in life.
As young children become mobile and language begins, parents and caregivers will want to offer safe places for them to explore, safe objects they can put in their mouths. Celebrate the new things young children learn (holding a spoon, putting on a coat, listening to a story, putting a toy away) and compliment them whenever possible. Young children love to look at books and read. Read to young children right from birth. Parents and caregivers will want to be ready to comfort and support their toddlers and preschoolers when they explore and find toys that they can’t make work or when they are upset. Support their interests and willingness to try again. Be the one your young child comes to for help, comfort and encouragement. Give them hugs when they don’t expect it.
Being a parent or caregiver is hard work and very demanding. Feeling sad and having lack of energy after giving birth is normal for 50-80% of new mothers. Many new mothers will feel anxious, tired, sad, irritable or angry within the first 10 days after giving birth. Usually these feelings go away. For a small number of new mothers and fathers more serious depression can occur anytime within the first year after birth of a child and the depression can last a year or longer. Depression can worsen when there are other life stressors, such as being poor, losing a job, marriage problems or lack of social supports, etc. Long term depression may include lack of interest in activities, decreased appetite, sleep problems, tiredness, feelings of worthlessness or guilt, not being able to make decisions and even thoughts of death.
Because depression can affect a parent’s ability to care for their infant, it is important to get help as soon as possible. Your doctor can help you figure out whether your feelings are normal or not and can refer you to a specialist who can help. It is important to talk to someone you trust about your feelings who can help you decide what to do next. If you live in Connecticut, you can also call 2-1-1 or visit their website to search for support. Another website called, Postpartum Support International is a great resource to find support groups and resources in your state.
Some children have temperaments or personalities that make it hard to be a good parent. Their parents and caregivers have challenges in searching for the right way to sooth, comfort, and even relate to their children. Some babies are not cuddlers or snugglers and their parents/caregivers must work hard to find the right “match” when holding, playing with, and comforting these little ones. Other children can have experiences that cause emotional problems such as: parents’ loss of a job, loss of a home, parent deployed with the military, parental depression, domestic violence, parental substance abuse, homelessness, foster care placement, divorce, or sibling concerns. These experiences can cause problems for young children and sometimes lead to more serious concerns.
We now know that even very young children can experience serious troubles and mental health disorders. We also know that many children go untreated for these mental health issues. A serious stress for young children such as loss of or separation from a parent/caregiver can be traumatic for young children. Young children can have anxiety disorders that interfere with their healthy development. Young children can also be depressed. Young children may have a lot of trouble adjusting to new situations. They may have problems understanding and controlling their emotions and actions in response to sensory stimuli such as touch, sight, sound, taste, smell and movement. They may be overly fearful and careful, or negative and defiant. Young children may also be under responsive, overly quiet or non-responsive to others. Young children can have sleep problems, feeding problems, and disorders in relating and communicating with others.
Although many of these concerns may be troubling, young children are resilient. With the appropriate care and support, many of these issues can be addressed and improved. As a parent/caregiver, when you have serious concerns about your child’s mental health, it is important to seek help early.
Some early warning signs can include: the lack of ability to be soothed, lack of regular sleep/awake cycles, and serious issues with feeding. Although all children experience these problems from time to time, when these issues become serious or interfere with the child’s quality of daily life, it may be time to seek help. Sleeping and eating are important for very young children and affect their growth and development and their relationships with you. Some of your child’s problems may be normal behaviors due to their temperament but they may also be signals that something is wrong. Support is so important for parents/caregivers and families at this time as well as talking with a trusting doctor.
Parents/caregivers of young children in child care may hear about their children’s misbehavior at child care or preschool. Hitting other children and biting are common for toddlers who do not yet have speech to tell someone about their needs. These children need support, good redirection, and understanding.
Young children may seem bored, not interested in others and in activities given to them. They may have little emotion and seem distant in their relationships with others. Parents/caregivers will want to talk with their doctors or get information from resources such as Zero to Three. If you live in Connecticut, you can call Connecticut’s 2-1-1 Child Development Infoline at 800-505-7000 or just dial 211. Care coordinators at the Infoline can help parents/caregivers with questions about their child’s development, behavior management strategies and programs, make referrals to services, and provide advocacy and follow-up as needed.
You do not have to worry alone. If you have concerns about your infant or toddler call your child’s pediatrician as soon as you can. Discuss your concerns and ask if these are normal activities of infants and young children and where you might get extra support and help. Many states now have Early Childhood Mental Health Systems of Care which are coordinated networks of community-based services and supports organized to meet the social/emotional needs of young children and their families. Early Intervention or Part C of the Individual with Disabilities Act is available in all states and will receive referrals from parents with concerns about their children’s social/emotional issues. Home visiting programs through hospitals, Family Resource Centers, and mental health agencies in your area can give support and resources. Look for those with infant mental health training through a state Association for Infant Mental Health.
Connecticut residents can get help from 211’s Child Development Infoline. The care coordinator at Infoline can also give information about services available in specific communities including child guidance clinics, referrals to programs like Help Me Grow, Birth to Three and Early Childhood Special Education. Connecticut residents can also get help from Child FIRST which is a home-based program that focuses on the mental health needs of young children and the family resources needed.
For a list of national and local resources specific to infant/early childhood mental health, go to the section called, Infant/Early Childhood Mental Health Services and Resources.
When you meet with your pediatrician or doctor, he/she is going to try to understand your concerns. Your doctor will ask you questions about your child’s symptoms, when they occur and under what circumstances. In order to get more detailed information your doctor may ask you more structured questions and you may be given a form that asks you specific questions about your child. These forms are called screenings or assessments.
Below is a list of commonly used screenings and assessment tools:
- Ages and Stages Questionnaire
- Ages and Stages Social Emotional Development
- Infant/Toddler Social Emotional Assessment (ITSEA),
- Devereux Early Childhood Assessment for Infants and Toddlers and
- Devereux for Early Childhood Assessment (DECA-I/T),
- Infant Toddlers Developmental Assessment (IDA) and the Child Behavior Check List (CBCL) for children as young as 2 years.
- The Diagnostic Classification of Mental Health and Development Disorders of Infant and Early Childhood (DC:0-3R).
The National Early Childhood Technical Assistance Center (NECTAC) has a list of screening tools used by different states and organizations in a document called, Developmental Screening and Assessment Instruments, with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five.
Once a screening or assessment is done, your doctor can determine what intervention and supports can best help you and your child. It is important to understand the different treatment choices, which can include consultation in your home or child care, parent/child psychotherapy, play therapy or medication in very special cases. You will want to talk about the options with a health care professional who has experience treating the mental health concern observed in your child.
In Connecticut you can also request an Ages and Stages Questionnaire from the Child Development Infoline, Help Me Grow by calling the Connecticut’s 2-1-1 Child Development Infoline at 800-505-7000 or just dial 211. The form is sent to you by mail at regular age intervals. Or you can fill out the form online by clicking here. When you complete the form and return it, a clinician will review your form and let you know how your child is doing. If there is a concern noted from your form you can follow the recommendations from the clinician and take the form with you to your pediatrician. Or you can give permission for the form to be sent to your pediatrician.
For very young children, the treatment typically involves working with parents and their children together. It often includes visiting with parents at home to find out what their concerns are and to see how the young children interact with others in their home environment. This approach of observing and problem solving with parents is referred to as parent/infant/child psychotherapy. This treatment is a relationship-based approach that recognizes that the family, neighborhood, and community are critical resources for early healthy development.
A large number of states now have competencies in infant/early childhood mental health and have a process for recognizing those competencies through an “Endorsement.” Persons holding this endorsement are competent to work with families of infants and toddlers. They know how to create relationships with families, to listen to families’ concerns, and with the family work through the issues or to help the family find the kind of clinical services or therapist needed. You can find persons holding this Endorsement in home visiting programs, private practice, and some Child Guidance Clinics. Families will want to ask providers what experience and training they have specific to young children. For Connecticut families, to find a list of providers that hold specific “Endorsements” visit the Connecticut Association for Infant Mental Health’s Endorsement Registry.
Other approaches include individual play therapy or art therapy when the young child has the right language and the parent is nearby. Successful programs that include good information for parents and caregivers are: Circle of Security, Strengthening Families, Center for Social Emotional Foundation for Early Learning, and Promoting First Relationships. These are programs that focus on helping children feel safe and give them support and strategies for successful interactions with their friends at preschool or child care.
Some children with more serious disorders that impact their social relationships and emotional development may need medical intervention. Parents should know and ask questions about the use of medication. Many medications have been tested only with adults. Medication should be monitored by a child psychotherapist and in consultation with the family’s pediatrician. To learn more about the use of medication for your child’s mental health issue please see the Frequently Asked Questions on the www.kidsmentalhealthinfo.com website.
You may want to talk to your child’s teacher to find out as much as you can about what is going on: when does this harmful behavior occur, who is involved (always the same child or everyone), and how often does it happen. Child Care Centers may have a consultant knowledgeable about young children’s mental health. The consultant may be from a local mental health clinic or a county mental health center. Together you may want to engage that consultant to help you and the staff figure out the best plan for your child.
It is important that you keep an open dialogue with your child care provider so that you are aware of and can address any problems or concerns as soon as they appear. Working collaboratively in partnership with your provider is often much more effective than developing an adversarial relationship. However, if you have concerns that your child’s needs are not being met or it is not the best environment for your child, you may want to explore other options. If you need assistance, and you live in Connecticut, please call 211.
In Connecticut, the Early Childhood Consultation Partnership offers help to child care programs for children with challenging behaviors. It is important that you and your child get help before your child enters public school. When children have problems with their teachers and peers early in life it can affect how they will learn in school when they become older.
It is very important to get help for any concerns you have about your child’s ability to play well with others or to respond well to adults. When young children don’t know how to get along with others or how to understand their own feelings and actions, they may have problems learning later in school. Information is growing on how early social patterns and emotional challenges do lead to problems in school by the 2ndgrade. However, it is important not to feel like your child’s difficulties are going to lead to lifelong problems. Many children experience difficulties at different times in their development and with the appropriate intervention and support they are able to get back on track.
Fortunately there are many ways to help young children learn good social skills before he/she gets to school. A good guide for looking at how your child is getting along with others is called, Ages and Stages and Ages and Stages Social/Emotional. Talk to your child’s preschool or child care teacher or to the mental health consultant at your child care for resources or to your home visitor. Early Intervention programs can provide an evaluation to assure that your child’s development is on the right path or that there is reason for concern. Early Head Start or Head Start staff for income eligible families can provide help to you and your children.
In Connecticut, the Ages and Stages Questionnaires are obtained from the Child Development Infoline (1-800-505-7000) and are mailed to you on a regular schedule. You can call the Infoline and enroll in The Ages & Stages Child Monitoring Program.