Government data suggests that 8% of 5 to 10-year-olds and 12% of 11 to 16-year-olds may have a clinically diagnosed mental health condition. For many, their problems may have begun in the early years. Young children can show clear signs of emotional issues at a very early age, including signs of anxiety or depression, post-traumatic stress, attention-deficit or hyperactivity disorders and autistic spectrum disorders. Nursery staff must pay attention to these signs and act accordingly. Organisations such as the Mental Health Foundation firmly believe that many mental health problems in children are preventable and that there is considerable scope for intervention by early years care givers. What are some of the most effective actions that early years staff can take to promote good mental health in the under 5s and support families affected by mental health issues? Martin Hodgson investigates.
1. Recognise the importance of positive early experiences for mental wellbeing
The foundations for a child’s healthy emotional development are known to be laid down in their early years. Positive early experiences are particularly important. Feelings of attachment, security and positive stimulation within loving relationships help to strengthen a child’s developing emotional and social systems and make them more likely to thrive and become healthy adults.
However, not all children receive such a nurturing start to life. Some may be subject to stress and adverse experiences that instead contribute to developmental problems and emotional difficulties. This includes experiences such as abuse, mistreatment and neglect. It also includes other risk factors, such as exposure to family settings characterised by domestic violence, parental mental health problems or substance abuse, also known as the “toxic trio”.
All adults who spend time with young children have a responsibility to help in their healthy mental development and wellbeing. Given appropriate support, many children can overcome the challenges of early trauma and emotional harm. Staff in early years settings are in a particularly unique position to provide such support.
2. Ensure staff have appropriate expectations for the emotional development of young children
All children can, from time to time, experience difficulties with their behaviour, feelings, thoughts and emotions. However, some children may have more serious problems which are often identified by developmental concerns relating to the way they express emotions and form social relationships.
In some cases, there is a tendency for more weight to be given to cognitive, physical and verbal development than to emotional development. However, all are vital and early years staff should be aware of the outcomes that indicate healthy development in this respect.
In England, personal, social and emotional development (PSED) is one of the seven areas of learning and development set out in the Early Years Foundation Stage. Goals include managing feelings and behaviour and making relationships.
What to Expect, When? provides guidance on development during the first five years. It includes the emotional milestones expected at each stage. For instance, it states that by the age of five a child should be able to talk about how they and others show feelings and to know that some behaviour is unacceptable.
3. Children with recognised emotional health issues should be supported
Early years providers should have policies and procedures for supporting children with identified health issues, such as autistic spectrum disorder. These will usually include discussions with parents and caregivers and the development of agreed care and support plans.
Diagnosing mental health problems in early childhood is very difficult and healthcare professionals are usually wary of applying medical labels until children are older. On the other hand, in some cases, parents may welcome a diagnosis if it helps to explain behaviour and identify what support is needed.
The emotional and behavioural needs of children who have identified mental health issues are best met through a co-ordinated approach in partnership with other services involved. This includes child mental health services. Early years managers should establish links with such services and ensure that suitable training and advice is available.
Appropriate guidance should be followed, for instance, Autism Spectrum Disorder in Under 19s: Support and Management published in August 2013 by the National Institute for Health and Care Excellence (NICE Clinical Guideline CG170). Specialist guidance, training and support is also available from charities such as the National Autistic Society (NAS).
4. Ensure staff have appropriate training
Understanding how emotional wellbeing can be strengthened or disrupted in early childhood should be a key element in early years staff training. Knowledge in this area will help staff to provide the kind of environments and experiences for children that help to promote good emotional health and prevent problems.
Training should enable staff to identify any signs that a child might be having difficulty in their social and emotional development. It must include ongoing safeguarding training. Abuse, mistreatment and neglect, including domestic violence and family discord, are all likely to harm children and cause emotional damage.
5. Support parents in seeking professional help
The early recognition of children who may be experiencing emotional and/or behavioural difficulties means they can be referred for professional support and assessment. The need for an assessment will often be identified by a GP or by a health visitor as part of the Healthy Child Programme, including during the universal health review at age 2 to 2.5 years. In some cases, early years practitioners can help by raising concerns with parents and encouraging them to seek help.
Local GPs are supported by specialist NHS early years mental health teams who are part of Community Child and Adolescent Mental Health Services (CAMHS).
Early years services can support with a range of issues. These include:
helping with relationship issues which can affect bonding and attachment
supporting families through the usual child development stages
providing support with parents’ mental health problems such as post-natal depression, stress and anxiety.
Seeking help is a big step and is often a difficult one for families to make. Early years staff can make it easier by providing appropriate support and information and helping to facilitate contact.
Early years staff should always seek to work in partnership with NHS services in any interventions or support plans. It must be remembered that emotional or behavioural issues in a young child should always be addressed wherever possible in the context of the family. The emotional wellbeing of young children is usually directly linked to the healthy functioning of the families in which they live. Helping the family to address issues in the way they behave with each other is often a key factor in the development of individual children.
6. Parents and caregivers should be mindful of their own mental health and emotional wellbeing
Working with families who are under strain can be stressful for early years staff. They should be supported to cope with stress and address any mental health needs they themselves may have. This will mean that they are more able to deliver high-quality care for children. Managers should ensure that appropriate support mechanisms are in place, including effective supervision.
Some parents may also have mental health issues or physical health conditions. They should be supported wherever possible to help them deliver effective parenting.
Parenting can be challenging for all families at times, especially during periods of stress. However, it can be particularly challenging for families where parents or caregivers have mental or physical ill health or disabilities.
Maternal mental health is of particular importance. There is considerable evidence that infants of mothers who have mental health issues, such as depression, are more likely to themselves have emotional and/or behavioural difficulties. Public Health England identifies preventing maternal mental health as one of its “high impact areas” for improving emotional development in early years.
Staff in early years should:
recognise the importance of positive early experiences for mental wellbeing
ensure that they have a good understanding of their role in supporting children’s social and emotional development
support healthy emotional development by providing a warm, safe environment and caring interactions
support parents in seeking specialist professional help where necessary.
Further guidance and resources can be obtained from organisations such as the Association for Infant Mental Health and the Mental Health Foundation. Early years mental health training is available from organisations such as YoungMinds.
Overview of the Six Early Years and School Aged Years High Impact Areas, published by Public Health England, can be downloaded from the GOV.UK website.
Last reviewed 6 December 2019