Early Childhood Mental Health & OT

Written By Julia Bantimba

Happy New Year (almost)! I hope you’ve had a restful & rejuvenating break of some kind and meaningful connection with your people.

I’m ending out 2024 talking about the state of children’s mental health and how we, early childhood providers, can support it! We’ll kick off the new year with a little series on early childhood mental health. 

For anyone who is working with children and families today, it’s incredibly clear how needed mental health support is. In August 2024, the surgeon general issued an advisory on the “mental health and wellbeing” of parents. Dr. Murthy reported that over the past decade, parents have more consistently reported high levels of stress compared to non-parenting adults, a staggering 1 in 3 parents reports high stress levels. In his advisory, Dr. Murthy continues on to discuss how harmful stress can be on adults and in turn on the children they are raising; “children with parents with mental health conditions may face heightened risks for symptoms of depression and anxiety and for earlier onset, recurrence, and prolonged functional impairment from mental health conditions” (hhs.gov, 2024). Children’s mental health depends on the mental health of those caring for them. Over 20% of children aged 1-7, worldwide, have a diagnosed mental disorder (Vasileva et al, 2020). It seems as though while we are in a mental health crisis for parents, we may also be in one for children.

What is Infant and Early Childhood Mental Health?

“Infant and early childhood mental health is a diverse, inclusive, multidisciplinary field ranging across many professional and community backgrounds and systems, focusing on enhancing the emotional and social competence of infants, toddlers, and preschool-aged children and their caregivers and families through healthy relationships” (Zero to Three, IECMH Guiding Principles, 2024).  Occupational therapists, speech pathologists, psychotherapists, nurses, early childhood educators and many other professionals make up the IECMH field through their therapeutic work with families and children between conception and kindergarten. Providers across disciplines can also receive specialized training in infant and early childhood mental health. For me, training in infant-early childhood mental health has meant that through my work as an occupational therapist I can better understand how the emotional life of my clients impacts how they move through occupational therapy, what kind of progress they make and at what pace.

We know that even young children can have significant mental health challenges. Things like early exposure to adversity or lacking an attentive, attuned, regulated caregiving system can result in serious mental health challenges in children. Families or school staff (or you!) might refer very young children for mental health support when they are showing signs of social-emotional difficulty like:

  • Difficulty with social skills and building relationships with others the way their peers often do

  • Difficulty managing their emotions or being soothed when upset

  • Challenging, dangerous or destructive behaviors at home, in the community or in the classroom

  • Delays in meeting developmental milestones (there’s a caveat here we’ll get into…)

This is obviously not an exhaustive list but these are some of the broad areas that have brought children into my care and the care of my psychotherapy colleagues over the years.

Why Should We Focus on Early Childhood Mental Wellbeing?

If you’re reading this, you probably already know the importance of children’s mental health. But, it’s not uncommon to hear things like “they’re so young, they won’t remember” or “children are resilient” as a way to diminish the impact of the experiences young children have. I’ve even heard these things from well-meaning pediatricians, people who are highly educated and should have a sense of how children’s mental wellbeing develops. It feels important to get on the same page.

Thousands of children each year develop depression, anxiety, post traumatic stress disorder and other mental health challenges. Many children experience profound sadness and loneliness, persistent fear and the many disruptive behavioral manifestations of these feelings. Often, adults notice the challenging behaviors and stop there. My goal is to help anyone who’s here look beyond th behavioral signs to see the experience of the child. Once we know where the behavior came from, we can provide much better support.

If this blog were for policy makers or economists, I would focus on the fact that it’s estimated that for each dollar spent on early childhood programs can yield a return of $7-10 when factoring in the long term benefits such as higher academic achievement, better physical health outcomes, and reduced involvement in the criminal justice system (Heckman Equation). That means that each dollar we spend to address the wellbeing of children brings back up to ten times that much as those children grow up! The World Bank says that “investing in the early years is one of the smartest things a country can do to eliminate extreme poverty, boost shared prosperity, and create the human capital needed for economies to diversify and grow” (2024, World Bank Group).

For those of us who are more focused on the children in our classrooms, offices and clinics… the benefit is the same. Investment of our time and resources into supporting early childhood mental health means that our children are less likely to have behavioral challenges at home or school. They are more likely to be well connected to their peers and make friends and more likely to learn at a pace similar to their peers. 

Most importantly to me- all children deserve to enjoy their lives and be good at something they love to do. Some people can do that without the support of professionals but some can’t (yet). We have the enormous privilege of contributing to more children enjoying their lives and feeling connected to the people around them.

How Can OTs (and any provider) Support Early Childhood Mental Health?

Anyone who works closely with young children, pregnant people, or families of young children is well suited to support early childhood mental health. A dear mentor of mine says a therapist is anyone who intentionally supports the development of children through their relationship with them (paraphrased, K. Brandt). Although I’m talking about OTs, I hope it’s abundantly clear that you are a therapist too, whether or not the word is in your official title!

Occupational therapists are uniquely suited to integrate IECMH principles into our practice and also to use our training to address mental health challenges in young children. We focus on engaging clients in meaningful occupations both as a goal and as a means to achieve a functional goal. I work with a preschooler now who has handwriting and fine motor goals. His difficulty with fine motor skills comes from a larger challenge with sensory processing and balance. The goal is handwriting, but we work on balance and gross motor games to build skills he will later use for handwriting. Another student I work with for fine motor skills and social skills is really motivated to make art, so we use writing and art making with peers as both the goal and the “means” to achieve the goal. Children that we work with are often working on functional goals related to rest/sleep, play and leisure, feeding, bathing and self care, and education.

Participation in meaningful activities improves quality of life and improves mental wellbeing in children and caregivers. 

  1. Support nervous system regulation in children and caregivers. 

  2. Enhance children’s participation in the activities that are most meaningful to them and their families

  3. Build caregivers’ ability to parent in a way that aligns with their values, culture, and the developmental needs of their child 

  4. Focus on building authentic therapeutic relationships with the children and caregivers in your care

Over the next few weeks, we’ll elaborate on each of these strategies and build our childhood mental health tool kits for every practice setting! Make sure you subscribe so you don’t miss any posts in the series! Also, send this to a colleague who’s working with young kids!

What kind of work are you doing with your kids and families?

References and Resources

Julia Bantimba
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Early Childhood Mental Health: How Trauma Impacts the Nervous System & What We Can do About it?
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Practical Sensory Based Strategies for Trauma- Responsive Co-Regulation