Mental health is part of whole-person health, affecting human beings across lifespans and including the youngest patients. Pediatricians may encounter young patients (birth to 5 years) who exhibit concerning behaviors, such as non-engagement with their caregiver, difficulty adjusting to preschool or childcare settings, or frequent tantrums that cause damage. These early signs could indicate underlying mental healthcare needs that require prompt identification and intervention. By recognizing these potential indicators, your practice can play a crucial role in supporting the overall wellness of young children and setting them up with social and emotional tools for life-long success.

Recognizing the Signs

Behavioral difficulties and emotional impairments can be early indicators of mental healthcare needs in young children (birth to 5 years). Potential signs include non-engagement with caregivers, impulsivity, tantrums that cause damage to others or objects, difficulty calming or sleeping, excessive sensitivity to sensory stimuli, and difficulty adjusting to preschool or childcare changes. Other patterns include not speaking in public, even with reassurance, and rigid or anxious behavioral patterns that disrupt daily living.

Caregivers may also offer signs that behavioral and mental health support is needed in the family unit. They may speak about their child only in negative terms or praise or fail to notice a lack of engagement, citing silence or shyness as “good” behavior. The child may fail to engage with their caregiver to share joy, ask for comfort, or seek reassurance. These situations may fall within the scope of neglect or abuse and should be evaluated carefully.

In this video from the American Academy of Pediatrics, watch a role-playing exercise that shows how effective motivational interviewing is when used to assess a child’s emotional healthcare needs.

The Importance of Early Identification

Earlier identification of potential impairments indicates better long-term health outcomes for young patients. Here are several strategies recommended by the American Academy of Pediatrics for supporting early childhood mental health:

Comprehensive Evaluation

Conduct a thorough assessment of the child's developmental, behavioral, and emotional well-being. This may involve collaboration with mental health professionals, such as child psychologists or therapists.

If your practice uses CHADIS questionnaires, you have several to choose from, including the Ages & Stages Questionnaire(s), Early Childhood Screening Assessment (ESCA), Preschool Pediatric Symptom Checklist (PPSC), and many more. CHADIS questionnaires integrate seamlessly with PCC EHR, meaning you can send them to parents through the patient portal prior to their visit for convenience. There are also questionnaires for parents’ support.

Parent/Caregiver Support

Provide guidance and resources to help parents and caregivers understand their child's needs and learn effective strategies for supporting their child's mental health. Encourage open communication and collaboration between the pediatric practice and the child's caregivers.

Referrals and Coordination of Care

Connect families with appropriate mental health services and community resources, such as early intervention programs, counseling, or support groups. Coordinate care between the pediatric practice, mental health providers, and other relevant professionals to ensure a comprehensive and cohesive approach to the child's well-being.

Ongoing Monitoring and Follow-up

Monitor the child's progress and adjust treatment plans as needed. Provide continued support and guidance to families throughout the child's development.

Resources for Pediatric Practices

The AAP offers a variety of resources and guidelines for pediatricians on the topic of early childhood mental health, including:

• Addressing Mental Health Concerns in Primary Care: A Clinician's Toolkit
• Promoting Optimal Development: Screening for Behavioral and Emotional Problems
• Much more education and resources for each patient’s individual needs.

Community Resources

Identify and collaborate with local mental health providers, early intervention programs, and support groups that can offer additional resources and services to families. Develop a referral network to ensure seamless transitions and continuity of care for young patients and their families.

PCC is dedicated to supporting pediatricians’ desire to grow and better serve their patients’ needs. Several of our practices have reported that The Reach Institute’s programs have been helpful in increasing their confidence in diagnosing and prescribing for mental and behavioral health disorders.

Through a collaborative and proactive approach, we can help children and their families navigate the challenges of early childhood mental health and set them up for long-term success. Early intervention and support are crucial to serving a child’s needs and building a relationship with their medical home to serve them into adulthood.