Many factors influence early childhood mental health.

Brain Development

The early years (0-6 years) are a critical period for brain development. There is rapid growth and development of the brain during early childhood. In fact, by four years of age, a child’s brain is already 90% of the size of an adult’s brain and the brain has mapped out the way it will communicate with its different parts and the body. During these early years, there is the most opportunity to impact brain development. This is also a time when the brain is the most vulnerable.

The Brain: A Sum of its Parts

Although the brain is a complex system of interconnected parts, the functions of these parts can generally be identified by their location in the brain. Different areas of the brain are responsible for different functions. However, all of these areas interact together to allow the brain to work as a whole system.

How does the brain communicate between different areas?

Communication within the brain is called neurotransmission. Neurotransmission takes place using neurons (nerve cells) and neural networks (connections between neurons). Neurons communicate with each other through electrical stimulation that passes from one neuron to another. There are over 100 billion neurons in the brain. Many of these are already formed by the time that a baby is born, although some are added after birth. However, although many neurons already exist at birth, they are not connected in any meaningful way that allows for “communication”.

What are neural networks?

Neurons that are stimulated together form connections and these connections develop into networks of interconnected neurons. These networks are developed and reinforced in a “use-dependent” fashion. The repeated stimulation of neural networks through similar experiences reinforces or strengthens them. When neural connections are not reinforced, they “die” off or “fade away”. This process takes place in early childhood and the networks that are strengthened are based on the sorts of repeated experiences the child has, e.g. if a child has frequent positive interactions, his brain will become ‘wired’ to perceive, interpret and respond to positive interactions.

Consistent caregiving is one of the key forms of repetitive experiences available for very young children. Stimulation through repetitive experiences, such as, listening to their mother’s heartbeat, rocking, caregiving routines, and hearing soothing sounds, all build neural networks.

How does the brain develop?

The brain develops in a sequential and hierarchical fashion starting from the lower regions and working its way up. Picture this as a pyramid with the lower regions as the base. If the base is not properly developed, the whole structure will be impacted.

Not only can the function of the brain be affected during early childhood, so too can the actual structure of the brain. Children who are abused or neglected have been shown to have smaller brains and other structural differences compared to the brains of a children who come from positive caregiving backgrounds.

If the brain does not develop properly in early childhood, can it still be “fixed” later on?? The answer to this is no and yes.

Brain structures that are underdeveloped in childhood or whose structures have been impacted by stress related chemicals will probably not be able to be what they would have been if they had not been impacted.

However, neural systems are plastic and can be changed. This can be a lengthy process and some systems are easier to change than others. Change is easiest at an early age but is possible later in life as well. Change to neural networks must occur in the same order that development normally does and therefore it is important to start from the lowest areas of the brain impacted.

Social Determinants of Health

Children are at an even higher risk from environmental factors (social determinants of health) because they are completely reliant on others. Experiencing challenges with one or two social determinants will not necessarily have an influence on family and child health, however, as the number of determinants negatively impacting a family increases, the risks also increase.

When discussing early childhood mental health, it is important to remember look holistically at children and their families. It is easy to develop a limited perspective of a family based on the context we meet them in. Please see the list of the social determinants of health below. The list provides some examples of factors that may have a positive or negative influence on a family and child.

Income and Social Status
  • Access to affordable food
  • Access to transportation
  • Access to services
Social Support Networks
  • Presence of extended family
  • Influence of peers
  • Support from other families in the community
Education and Literacy, i.e. health literacy
  • Availability of literacy friendly health resources and information
  • Computer proficiency
Employment/Working Conditions
  • Availability of work for one or both parents in the community
  • Safe working conditions
  • Availability of child care for working parents
Social Environments
  • Availability of free or affordable resources and community events for families
  • Safe environment in which children can play
  • Safe home environment
Physical Environments
  • Geographical location or isolation
  • Access to safe environments for community gatherings during the winter
  • Space within home, e.g., overcrowding
  • Living space, e.g., a house, apartment or a shelter
Personal Health Practices and Coping Skills
  • Resilience and coping skills
  • Understanding of health information
Healthy Child Development
  • Understanding of child development
  • Availability of referral and assessment services
  • Clear, literacy friendly information about child development and parenting
Biology and Genetic Endowment
  • Illness or disability in child or family
Health Services
  • Availability of family doctors in the community
  • Access to emergency service
Gender
  • Roles and expectations
Culture
  • Cultural norms and expectations about child rearing

Prenatal

There are some factors that impact children prenatally that will have an impact on their future mental health. These include:
  • Genetics
  • Prenatal alcohol exposure
  • Prenatal exposure to other substances, including tobacco
  • Nutrition
  • Biological abnormalities of the central nervous system
  • Environmental exposure to lead
  • Prenatal trauma
  • Maternal stress and anxiety
  • Chromosomal syndromes

Prenatal Alcohol Exposure

FASD occurs as a result of alcohol use during pregnancy. Alcohol is a teratogen that interferes with the normal development of the fetus. The majority of the damage caused by alcohol occurs in the central nervous system. This permanent damage to the developing brain leads to disabilities faced by individuals with FASD throughout their lives.

Exposure to Other Substances

There is limited research on the impact of substances other than alcohol on the human fetus. However, the following chart summarizes some of the known effects of both prescription and illicit substance use. It is important to remember that if a woman is taking prescription medication prior to becoming pregnant, she should consult her physician about its safety during pregnancy. The physician will then weigh the benefits of taking the medication, the impact of withdrawal on the mother and fetus, and the potential harm to the fetus into consideration.

Substance Impact on Fetus Impact on Newborn and Longer Term
Amphetamines
  • Not known
  • Neonatal withdrawal symptoms
Antidepressants
  • No increased risk
(Note: Results depend on type of antidepressant)

  • Increased risk of poor neonatal adaption resulting in increased use of neonatal intensive care
Antiepileptic
  • Older drugs: increased risk of neural tube defects
  • Newer drugs: less risk
  • Older drugs: have been associated with lower IQ scores, neurobehavioral deficits, and developmental delays
Antipsychotics
  • No increased risk
Typical antipsychotics

  • Newborn may have severe rigidity, muscle spasms, shaking or restlessness, for several months.

Atypical antipsychotics

  • No known neonatal effects.
Benzodiazepines
  • Insufficient data
Abrupt discontinuation syndrome (neonate)

  • Sedation, hypotonic, reluctance to suck, apnea, cyanosis, and impaired metabolic responses
Cannabis
  • Smaller birth weight
Studies have indicated some of the following effects on children whose mothers smoked cannabis during pregnancy:

  • Sleep disturbances
  • Hyperactivity
  • Impassivity
  • Inattention
Club Drugs
  • Significant increase of congenital anomalies
More studies needed
Cocaine
  • Fetal hypertension
  • Prematurity
  • Intrauterine growth retardation
  • Lower birth weight
  • Smaller head circumference
  • Possible link to neonatal genitourinary malformations
  • Neonatal neurobehavioral impairments, e.g., irritability, tremors, muscle rigidity, and seizures
  • Long term effects are unknown
Inhalants
  • Small birth weight
  • Neonatal abstinence syndrome
  • possible long term
Neuro-developmental deficits
Opioids
  • No known effects
  • Neonatal withdrawal (can last for several weeks)
Tobacco
  • Preterm delivery
  • Low birth weight
  • Neonatal nicotine withdrawal syndrome (irritability, tremors, and sleep disturbances)
  • Higher risk of Sudden Infant Death Syndrome (SIDS)

Neonatal withdrawal symptoms, as well as other short and long term effects of the substances listed above, can impact attachment, brain development, socialization, emotional and behavioral regulation, and increases the risk for acute and chronic illness/ disability.

Preconception and Prenatal Care

There are many ways to try to ensure a healthy pregnancy. Please follow the link below for more information about preconception health (health before pregnancy) and prenatal health (health during pregnancy).

Parent Readiness

Several factors can influence an individual’s readiness to be a parent, including:
  • if the pregnancy was planned or wanted
  • violence that is occurring in the home the baby will be born into
  • prior psychiatric symptoms
  • whether the parents are able to think of themselves as parents and to prepare themselves for caring for a child
  • age of the expectant parents
  • experience of sexual abuse in their past
  • if the parent’s support system or friends have children
  • if the parent will be a single parent
  • if they are supported around the pregnancy
  • how many changes they will have to make in their lives when the child arrives

Men have a harder time than women adjusting to being a parent as they do not have the bodily and hormonal changes preparing them for this life transition throughout the pregnancy.

The ease of this transition has been shown to impact perceptions of the parent about their child prenatally and after it is born as well as attachment.

Prenatal and Parenting Programs

Researchers have noted that participation in prenatal and/or parenting programs can help parents make the transition into their new roles. Please see the links below for information about programming that may be available to you in your community.

Temperament

Temperament refers to individual differences in behavioural patterns that are present very early in life and colour the way that we interact with the world. Temperament is not behaviour; rather, it is traits or dispositions that may influence behaviour, emotional responses, attention, and motor activity. Although temperament is biologically rooted, the relationships we have and environment that we live in during our early childhood can lessen or intensify the expression of various traits.

Temperament is very important because it impacts that way that we interact with the world. Theories such as “goodness of fit” (i.e. how well the temperaments of parent and child work together) help us to understand how temperament can hinder or strengthen the experiences and relationships that we have.

Disability and Illness

Over time, experiencing a chronic illness or disability can have impacts on a child’s mental health, including attachment, communication, social skills and emotional regulation. Young children’s physical health can be connected to school readiness as well as later problems in adolescence, including mental health issues and criminal activities.

Stress and Trauma

What is Stress?

Stress refers to our biological and emotional responses to situations that are new, dangerous or a threat to our well-being. Stress is not always a bad thing. In fact, we experience stress everyday and this can be healthy as it teaches us how to adapt, cope, problem solve, regulate our emotions and seek support when needed.

However, some stress is toxic. Toxic stress is stress that is frequent, serious or prolonged. In cases of toxic stress, the child has little to no adequate adult support around the situation. This type of stress is the most damaging.

What is Trauma?

Trauma is an example of toxic stress. Trauma is defined as a young child’s experience of events that harm them physically or emotionally or that threaten to harm or kill the child or others around them.

Can young children experience stress and trauma?

Yes, young children (including infants) can experience stress and trauma. In fact, both stress and trauma can have immediate effects during childhood as well as lifelong impacts.

Do young children experience stress and trauma the same way an adult does?

Children’s bodies undergo the same response to trauma as does an adult’s. However, there are some differences. Young children experience stress reactions more often and more intensely than adults, and they do not have the ability to self-regulate or to process the stress. They rely on adults to help them during the stress and after the stress has occurred.

Young children can also develop sensitized stress responses, where their stress response system is triggered into action by non-stressful events. This can have a large impact on the child’s future physical and mental health, including chronic states of hyper-alertness, fatigue, damage to the brain and organs, and chronic illnesses.

Child Abuse

Child abuse refers to physical, emotional, sexual or neglectful maltreatment of a child. There is a widespread belief that child abuse is not harmful unless you can see physical evidence, e.g., cuts and bruises. However, all forms of child abuse are equally damaging to children. In fact, abuse that does not show evident physical damage is at times the abuse that goes on the longest.

All children are at risk of abuse. Abuse is not limited to any one socioeconomic, cultural or religious background.

What are the impacts on young children?

Young children are impacted in many ways by child abuse. The abuse is often prolonged and chronic. This can lead to chronic states of hyper-arousal and sensitized stress response systems. Also, if the abuse occurs at home, the child may not be able to form secure attachments and may not have a safe person to turn to. In our society, where many families often live in isolation from their community and extended families, young children are at even more risk as their immediate family may make up the entirety of their social contacts.

Witnessing Intimate Partner Violence

Domestic violence refers to abuse that occurs within an intimate relationship. Domestic violence is often referred to as Intimate Partner Violence. Both men and women can be either the victim or perpetrator. Domestic violence can happen in any intimate relationship regardless of length of time people have been together, whether they are living together or not, in a heterosexual or homosexual relationship, or are married or not.

Are young children impacted by abuse that happens in their home?

Yes! Young children are impacted by the violence that takes place between adults in their lives. For example, they may:
  • see violence occur
  • hear violence
  • see the aftermath of violence, such as injuries or depression
  • be threatened as part of the abuse
  • be abused themselves
  • be a confidant for their parent, and/or have their family break apart

What are the impacts on the young child?

Young children who are exposed to intimate partner violence can be impacted in several ways. Witnessing intimate partner violence causes ongoing, long term exposure to trauma. Some impacts of this will depend on the biological and developmental stage of the child. Some will be mitigated by supports and the child’s level of resilience.

Community Violence

Often focus is placed on whether a child is directly experiencing trauma, such as through abuse, or whether they have been traumatized by witnessing violence in their homes. It is important to remember that many children are exposed to violence everyday…on our streets, in our communities, at school and between friends. These incidences are also traumatizing.

One positive difference can be the caregiving environment in which the child is raised. Being safe in their home, having a caregiver with whom they can feel secure, being resilient, and, as they grow older, talking about the violence they see, can help mitigate the effects.

Intergenerational and Transgenerational Transmission of Violence

What does Intergenerational Transmission of Violence mean?

Intergeneration impact of violence means that abuse has occurred across several generations of a family. An example of intergenerational violence is a father who sexually abuses his daughter and later his granddaughter.

What does Transgenerational Transmission of Violence mean?

Transgenerational transmission of violence refers to the impacts of violence being passed through generations. For example, children who were removed from their homes at an early age to attend residential school may have experienced abuse. When these children grow up and have children, sometimes normal behaviours of their children can trigger reminders of this abuse and the subsequent stress response of the parent will impact the child. For example, young babies often mirror their parent’s emotional expressions and behaviours. If the parent becomes anxious when the baby cries, the baby will likely become more anxious as well.

Parental Mental Health

What is Parental Mental Health?

A parent’s mental health can impact their young children in a number of ways. Whether illness is chronic or acute, impacts can be seen.

The impact of chronic and acute mental illness of a parent on young children can depend on the environment in which it is experienced. Outcomes for children who live in families where only one parent is mentally ill are better than those who live in families with two parents who are mentally ill.

Many societal factors can either lesson the impact of parental mental health on young children or increase it. For example, poverty, unemployment, substance use, past childhood abuse of parent, and isolation may increase the impacts. Increased interaction with the health care system and social supports may decrease impacts.

Although most research on depression has focused on the mother, partners of women who have experienced depression are 50% more likely to experience depression themselves. Paternal (partner) depression may occur when the mother has experienced postpartum depression, but often has a later onset.

What are the impacts on the young child?

Paternal (or partner) postpartum depression has been associated with adverse emotional and behavioral outcomes for children aged 3-5 years and an increased risk of conduct disorders.

Those whose partners are experiencing postpartum depression often take over the role of primary caregivers during the time that their spouses are unable to do so. Later onset depression may impact the attachment relationship that they have already formed with their children.

Paternal or Partner Depression

What is Parental Mental Health?

A parent’s mental health can impact their young children in a number of ways. Whether illness is chronic or acute, impacts can be seen.

The impact of chronic and acute mental illness of a parent on young children can depend on the environment in which it is experienced. Outcomes for children who live in families where only one parent is mentally ill are better than those who live in families with two parents who are mentally ill.

Many societal factors can either lesson the impact of parental mental health on young children or increase it. For example, poverty, unemployment, substance use, past childhood abuse of parent, and isolation may increase the impacts. Increased interaction with the health care system and social supports may decrease impacts.

Postpartum Depression and Mental Illness

Approximately 10% of mothers experience postpartum depression, although this number may be higher due to under diagnosis. Postpartum depression and mental health issues impact every aspect of a people’s lives, including their extended family, friends, their own bodies, minds and spirits, their partners, and their babies.

For more information about postpartum depression and mental health issues, its impact on women, and how we can support women, please see our Postnatal Health Section on this website.

The impact of postpartum depression on young children has been the subject of recent research. The impact that postpartum depression will have on the young child depends on the length of time that the depression lasts, the supports that the women and infant have outside of their relationships, if there is a separation of the mother and child, and when the diagnosis occurred. Early intervention and treatment is the best case scenario.

Attachment

What is attachment?

Attachment is a biologically based (innate) connection children feel to their parent or caregiver on whom they rely to help them feel safe, cared for, and protected.

When does attachment develop?

The process of attachment begins at birth. Some people believe it starts before birth. By six months, children have begun to form expectations of how their parent will respond when they are distressed. By the end of their first year, children have a clear attachment to one or more of the people who provide regular care. Children can form attachments later in life.

Who do children become attached to?

Children become attached to people who take care of them regularly.

Why is attachment important?

Early attachment experiences have an impact on a child’s later social, emotional, and cognitive development by influencing:

  • brain development
  • how the child responds to experiences
  • expectations and behaviour in relationships throughout life

How do children try to get their attachment needs met?

Beginning in the first year of life, children naturally show they need care and protection through attachment behaviours, including crying, clinging, following, trying to be physically close, focussing their attention on you, cooing and smiling.

What are children’s attachment needs?

Children need their parents to be physically and emotionally available to help them feel safe, cared for and protected; and help regulate their feelings, physical states and behaviours.

Secure Attachment

What is secure attachment?

Secure attachment can happen when a child is able to rely on his caregiver(s) for comfort and protection.

Parents of children with secure attachment:
  • respond sensitively and consistently to the child’s needs
  • have an easy, relaxed, and intimate pattern of caregiving
A securely attached child:
  • trusts that their parents will be there for them when needed
  • feels confident to explore and play
  • seeks comfort if distressed
  • is easily comforted by their parents

Why is secure attachment optimal?

Secure attachment is a protective factor that contributes to resilience and psychological health through neural development, emotion regulation, and feelings of competence and self-efficacy. Secure attachment is related to fewer behavior problems, higher social competence and competence in general (e.g., problem-solving), as well as more empathy and better boundaries. Early secure attachment also provides children with the ability to deal well with, or recover from, difficult experiences later in life.

Insecure Attachment

What is insecure attachment?

Insecure attachment can happen when a child cannot rely on the parent to meet his attachment needs.

Parents of children with insecure attachment:
  • ignore, reject, or respond inconsistently to a child’s need to feel safe, cared for and protected

An insecurely attached child:

  • are anxious about whether her parents will be available to provide care and protection when needed
  • learns ways of behaving that keep his caregiver(s) close and available in case of real danger, but may not serve them well in other relationships

What are the risk factors for a child who is insecurely attached?

Children with an insecure attachment are at risk of developing behavior problems and potentially mental health problems. They are more likely to have problems such as:

  • poor social skills
  • low self-esteem
  • anxiety
  • impulsive behavior
  • angry and aggressive behavior
  • withdrawing when upset
  • giving up easily

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