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Our training calendar includes a number of opportunities to deepen your understanding of different elements of infant and early childhood mental health.
What do mental health issues in young children look like?
Key Takeaways
- Babies, toddlers and preschoolers can experience mental health challenges.
- Signs of childhood mental illness may involve emotional, behavioral, physical, social or developmental changes.
- Warning signs are more concerning when persistent, intense, worsening or disruptive to daily life.
- A child’s age, developmental stage and usual behavior provide important context.
- No single behavior or symptom confirms that a child has a mental health disorder.
- Early evaluation and developmentally appropriate support can benefit children and their families.
Babies and toddlers can and do suffer from mental health problems caused by trauma, neglect, biological factors, or environmental situations.
Mental health is an important part of a young child’s overall well-being. It includes emotional development, secure relationships, emotional regulation, play, learning and exploration.
Babies, toddlers and young children may not have the words to explain how they feel. Instead, signs of childhood mental illness may appear through changes in behavior, emotions, sleep, eating, relationships, play or learning. These signs can vary by a child’s age and developmental stage.
A single symptom or difficult behavior usually does not indicate a mental health disorder. Consider whether changes are persistent, unusually intense or interfering with daily life. When concerns arise, early support from caregivers and qualified professionals can improve outcomes.
Professionals evaluating infants and young children may use the DC:0–5™ diagnostic classification to understand concerns within the context of development and relationships.
Mental health is everyone's business
According to experts, around 1 in 10 children under the age of 5 experience mental health issues.
A young child’s mental health may be influenced by biological and environmental factors, family history, physical health, development, chronic stress, and experiences within their home and community. Traumatic experiences—such as witnessing violence, experiencing abuse or neglect, or surviving a natural disaster or accident—may also affect a child’s well-being.
These risk factors can increase a child’s vulnerability to mental health problems, but they do not determine the child’s outcome. Responsive caregiving, stable and nurturing relationships, predictable routines, and other positive experiences can serve as protective factors that support healthy child development and resilience.
There are lifelong implications when things don’t go well, but as with physical health, positive input in these early years creates a strong foundation that can withstand storms.”
For infants and young children, mental health and physical health are intertwined, just as they are for adults.
Infants and toddlers may not always be able to talk about their mental health conditions, but they can show physical symptoms and behavioral changes that professionals are trained to notice. These symptoms can often be overlooked or dismissed, but experts are able to tell when these are early signs of something that could become a severe mental health issue in the future.
Early Childhood Mental Health Signs and Symptoms
While these behaviors tend to be present in many children, the key is to look for these early childhood mental health signs of potential anxiety and depression in more of a collection than individually, with special attention to frequency, duration and intensity.
Also consider the child’s age and whether a behavior is developmentally appropriate or represents a significant change from the child’s usual behavior. Early signs of mental illness in children may warrant professional attention when they persist or interfere with sleep, eating, play, learning, relationships, child care, preschool or family routines.
Signs that last for weeks or months should be discussed with a healthcare professional. However, caregivers should not wait when a child’s behavior is severe, worsening or unsafe. These warning signs do not provide a diagnosis, and any one behavior does not necessarily mean a child has a mental health disorder.
Anxiety
- Has significant difficulty sleeping, frequent night waking, bad dreams, and/or night terrors
- Expresses frequent fears and worries around various activities (e.g., going outside, going to child care) or specific things (e.g., spiders, elevators, dogs).
- Displays a short fuse with strong emotions—doesn’t have space between an upset and a full-blown tantrum
- Is clingy and fussy beyond what seems typical for their age
- Has a need to use the bathroom excessively once toilet trained, and/or other toileting struggles
- Regresses or backslides in areas of previous skills
- Frequently complains of stomachaches and not feeling well
- Doesn’t meet developmental milestones as expected
Depression
- Lack of enjoyment in common activities
- Sad and unresponsive facial expressions
- Listless body posture
- Slower physical mannerisms
- Irritable and fussy
- Trouble eating and sleeping
- Unexplained physical aches and pains
Other Behavioral, Social, and Developmental Signs
Other changes in a child’s behavior, relationships, or development may also indicate a need for additional support. Possible signs include:
- Persistent aggression or unusually frequent or intense tantrums
- Extreme difficulty calming, even with caregiver support
- Withdrawal from caregivers or other children
- Reduced interest in interaction, play, or exploration
- Significant changes in communication
- Difficulty participating in ordinary routines
- Regression or loss of previously acquired skills
- Changes noticed across settings, including at home, child care, or preschool
Developmental differences, physical health conditions, sleep problems, stress, grief, autism spectrum disorder, ADHD, and mental health disorders can sometimes produce overlapping signs or occur together. A comprehensive professional evaluation is needed to understand what may be contributing to new behaviors or developmental concerns.
When Does a Behavior Become a Cause for Concern?
Occasional tantrums, clinginess, fears, sleep changes, or sadness can be part of typical development. These behaviors deserve closer attention when they become persistent, extreme, worsening or disruptive.
Concern may increase when a behavior:
- Happens much more frequently than expected
- Is unusually intense or lasts longer than expected
- Continues or repeatedly returns over time
- Represents a major change from the child’s usual behavior
- Is unexpected for the child’s age or developmental stage
- Occurs across multiple settings, such as at home and child care or preschool
- Interferes with sleep, eating, play, learning, relationships, child care, preschool or family routines
The signs that caregivers notice may differ based on a child’s age and development. Babies may show concerns through ongoing difficulties with soothing, sleep, eating, engagement or connection. In toddler mental health, concerning signs in 2- and 3-year-olds may include extreme tantrums, persistent separation distress, aggression, regression or reduced interest in play. Signs in 4- and 5-year-olds may include withdrawal, difficulties with peers, preschool refusal, persistent physical complaints or difficulty participating and learning.
No single behavior confirms a mental health disorder. Patterns should be considered in the context of the individual child, including their development, usual behavior, experiences and circumstances.
What to Do If You Notice Warning Signs
If you notice concerning changes in a child’s behavior, emotions, or development:
- Observe when, where, and how often the behavior occurs.
- Note its duration, intensity, possible triggers, and effect on daily routines.
- Ask child care providers, preschool staff, or other caregivers what they observe.
- Discuss your concerns with the child’s pediatrician or healthcare provider.
- Request mental health, developmental, or medical screening when appropriate.
A comprehensive evaluation may consider the child’s medical and developmental history, sleep and eating patterns, play and communication, family history and recent stressors, caregiver-child relationships and behavior across different settings. Healthcare professionals may also consider physical, developmental and environmental explanations for the child’s challenges.
Screening is not the same as receiving a diagnosis, and seeking help does not automatically mean medication will be recommended. A child can benefit from early intervention and other forms of support without having a formal diagnosis.
The American Academy of Pediatrics recommends child-focused mental, emotional, and behavioral health screening beginning at 6 months and continuing at designated well-child visits. However, caregivers can raise concerns with a healthcare professional at any time and do not need to wait for a routine appointment.
Seek emergency assistance immediately if a child is in immediate danger, they are trying to hurt themselves or someone else or if a caregiver cannot keep the child or others safe.
Treating mental health issues after child trauma
Even in the most challenging situations, consistent access to age-appropriate and specialized therapies can help children and their families thrive.
Trauma is one of several experiences that may affect a young child’s mental health. Biological, developmental, family, and environmental factors may also contribute to mental health challenges. Not every child who experiences trauma develops a mental health disorder, and children can respond to similar experiences in different ways.
Because infants’ and toddlers’ brains grow so quickly, with intervention and consistent support from loving adults, they can often heal and thrive after traumatic incidents.
Success stories of trauma-informed IECMH care:
The DC:0-5 Casebook helps professionals strengthen their understanding of clinical disorders in infancy and early childhood.
Addressing mental health issues in young children builds healthy adults
There are many proven, cost-effective therapies that can help infants and toddlers recover from traumatic events and build their resilience.
Treatment options depend on the child’s age, development, symptoms, relationships, family circumstances, and evaluation findings. For babies and toddlers, treatment generally involves parents or caregivers and focuses on strengthening caregiver-child relationships. Therapy for a young child is not necessarily conventional talk therapy; it may use play, observation, caregiver coaching, and family counseling approaches.
Evidence-based treatments include Child-Parent Psychotherapy and Parent-Child Interaction Therapy. These therapies are delivered by qualified mental health professionals and can address trauma as well as behavioral, emotional, developmental, and relationship concerns.
Therapies for infants and toddlers are more effective, save taxpayer dollars down the road, and are less intensive than addressing severe mental health issues later in life. Parent-Child Interaction Therapy saves an average of $1,159 per child in long-term educational, healthcare, and criminal justice costs.
We need to invest – as a country – in a specialized and diverse workforce of mental health professionals trained to work with infants and toddlers.
How can professionals combat compassion fatigue?
Frequently asked questions about childhood mental health signs
Yes. Mental health challenges can occur in very young children, although signs may look different from those in older children. A professional evaluation considers the child’s age, development, relationships, experiences and behavior across settings.
Tantrums are common in young children. They may warrant closer attention when they are unusually frequent, intense, prolonged, difficult to recover from, unsafe or disruptive to the child’s relationships and daily routines.
No universal number of symptoms indicates that a child has a mental health disorder. Professionals consider the specific symptoms, their frequency, duration and intensity, the child’s developmental stage, and how the symptoms affect daily life.
Emotional regulation generally improves as children develop and receive support from caregivers. However, persistent, severe or worsening difficulties with managing emotions may warrant professional guidance rather than waiting for the child to outgrow them.
Start with your child’s pediatrician or family healthcare provider. They can help rule out physical causes and connect your family with an early intervention program or a qualified infant and early childhood mental health professional when appropriate.
Take Action
Tell policymakers to prioritize infant and early childhood mental health and support healthy emotional development from the start.
