Where Infant and Early Childhood Mental Health and Child Welfare Intersect: A Continuum of Care

Hand of parent holding their baby's hand

For our youngest children, their mental health helps them manage their emotions, build strong, trusting relationships with the people who care for them, and confidently explore and learn about the world around them.

The key to developing good mental health in early childhood lies in forming positive, loving connections with caregivers in a safe and secure environment. These early relationships and experiences create a strong foundation for their future well-being.

Mental health is crucial to well-being for everyone, especially for our babies and toddlers.

Unfortunately, young children under the care of child welfare are experiencing significant stress that impacts their mental health. They are three to four times more likely to have a mental health condition compared to their counterparts not in foster care. Additionally, the high rates of adverse childhood experiences (ACEs) among this population can further jeopardize their mental health, possibly leading to developmental delays and long-term mental health conditions if left unaddressed.

Key Findings

From ZERO TO THREE’s The Basics of Infant and Early Childhood Mental Health: A Briefing Paper Examples of how mental health concerns can present in children from birth to age 3:

  • Chronic eating or sleeping difficulties
  • Inconsolable “fussiness” or irritability
  • Incessant crying, with little ability to be consoled
  • Extreme upset when left with another adult who is not the primary caregiver
  • Inability to adapt to new situations
  • Easily startled or alarmed by routine events
  • Inability to establish relationships with other children or adults
  • Excessive hitting, biting, or pushing of other children, or very withdrawn behavior
  • Flat affect (showing little to no emotion at all)
  • Refusal of comfort from caregivers

Black and Hispanic children are more likely to experience these adverse events at a disproportionate rate compared to their peers. Witnessing domestic violence or surviving abuse or maltreatment can cause severe emotional stress and put their healthy development at risk. Therefore, we must offer support to these families as early as possible by building a full continuum of infant and early childhood mental health (IECMH) care.

Child welfare involvement can further add to these traumas. The removal of children from their primary caregivers can inflict more distress and lead to poor outcomes. Once in the child welfare system, many children and parents don’t receive the mental health services they need.

The key to addressing these challenges is to prioritize keeping families together while providing holistic support and opportunities to heal relationships.

The health and mental well-being of caregivers are also crucial for young children. System inequities that cause further stress, such as financial insecurity, substance use, and trauma can strain the capacity of caregivers. Research has shown a strong link between caregiver mental health and child outcomes. Parents involved in child welfare often experience higher rates of trauma and mental health conditions. However, they frequently struggle to access the necessary services and supports. As a result, their children may also suffer poor mental health. Therefore, our focus must include supporting caregivers and addressing their needs to prevent and reduce child welfare involvement.

Early childhood mental health services are a foundational part of the care needed for children to thrive.

Learn how we can build a continuum of care to address the mental needs of young children.

Cover of Safe Babies Brief

Our new policy brief that details critical components of the IECMH continuum of care, emphasizing how these components contribute to strengthening families to prevent harm and further involvement in child welfare. 

What do mental health issues in young children look like?

A graphic promoting the ZERO TO THREE Conference for early childhood professionals.
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Integrating Infant and Early Childhood Mental Health into the Child Welfare Continuum of Care
Learn from the Policy team of Safe Babies, a program of ZERO TO THREE™, about the latest policy strategies to integrate infant and early childhood mental health in child welfare featured in the policy brief, Foundations of Well-Being: Policy Strategies for Integrating Infant and Early Childhood Mental Health into Child Welfare. Hear from a panel of experts on prevention approaches […]