What does mental health look like for a small child? 

October 11th 2023

As a former psychiatric nurse who trained and worked at the Maudsley Hospital, I realised quickly that mental health was the Cinderella service of the NHS. Years later, I joined the Cinderella service of the Education service, otherwise known as the Early Years.  

I must be a bit of a Cinderella fan – more inclined to rags than riches or maybe I have long recognised the richness and sheer joy of working with children and being able to advocate for them. 

Today, the term ‘mental health’ has entered the world of Early Years. It’s a term bandied about everywhere which is not hugely helpful because I am not sure everyone knows what they mean by it and so it has become a bit of a cliché and we know how quickly clichés become meaningless. The World Health Organisation (WHO) defines mental health as ‘a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’. The opposite of this is mental health problems which can have adverse and long-lasting negative effects. 


Can children in the Early Years have mental health problems?   

In terms of numbers, we don’t know. There has been less research on the profile and rates of problems in the under-5s and they were not included in the B-CAMHS surveys. One study showed that the prevalence of problems for 3-year-old children was 10%, with 66% of parents sampled having one or more concerns about their child. A further study showed that 7% of children aged 3–4 years exhibited serious behaviour problems.  

However, differentiating normal from abnormal behaviour in younger children can be difficult and a substantial proportion of children will ‘grow out of’ early childhood problems, particularly among the under3’s. However, longitudinal studies suggest that 50–60% of children showing high levels of disruptive behaviour at 3–4 years will continue to show these problems at school, age eight. Moreover, neurodevelopmental problems including language delay, ADHD and autism spectrum disorders first manifest in the pre-school years. 

We do know they suffer distress and are impacted negatively from adverse childhood experiences (ACEs).  This can be anything from child neglect, abandonment, mental ill health of a parent and domestic abuse. It is estimated that over 800,000 children are affected by domestic abuse and it has increased by 7.7% this year. Some of the work we are currently doing to improve supporting children with a parent in prison highlights the horrible statistic that 8/10 prisoners had at least one ACE, creating a generational cycle of trauma.  This does not just affect mental health, it can induce changes to the brain resulting in varying degrees of cognitive impairment and emotional dysregulation that can lead to a host of problems, including difficulty with attention and focus, learning disabilities, low self-esteem, impaired social skills, and sleep disturbances (Nemeroff, 2016). It’s serious. Right now, some children are demonstrating the emotional turmoil from Covid-19 through behaviour, emotional delay and cognitive disconnect as well as coping with the financial uncertainty facing their families.  


What have we done?  

As a society, and in a misguided attempt to protect our children, we have replaced play with computers and then terrorised parents into keeping children at home, away from cars and marauding paedophiles.  In a horrible twist of fate, keeping children on their computers has exposed them to much more horror on social media and the sedentary lifestyle has increased obesity. We have built towns and cities that don’t allow children to play freely and safely and then we wonder why children are distressed and unhappy! Very small children are given videos, music and cartoons on their phones because, to the untutored eye, it appears to engage children for a few minutes.  But there’s no real lasting impact and children’s concentration skills have shrunk to that of a gnat. 

Staff and a group of children sitting down at their local park engaging in an activity.

Staff and a group of children sitting down at their local park engaging in an activity.

How can we help?

Let’s start by saving their childhood and allowing them to play. Children need space and the freedom to be away from helicoptering parents so they can play in peace. The decline in independent activity is the cause of decline in children’s mental well-being.  

Playing promotes mental well-being through both immediate effects as a direct source of satisfaction and long-term effects by building the mental characteristics that provide the foundation for dealing effectively with the stresses of life.  Think about the following which are some examples of thinking about children’s mental health: 

  • Pay attention to children’s emotional and social development. Understand the importance of routine and regularity.  Create settings that are a safe, nurturing, and engaging environment for children, ensuring they feel secure and loved. 
  • Create lots of sensory play, using every medium. For example, clay is therapeutic and calming but can also help develop skills and dexterity.Large blocks of clay help develop muscles in the shoulder and upper arm, whilst the smaller balls of clay develop hand, wrist and finger movement. 
  • Play outdoors. It is very beneficial to children’s well-being. Let the children be joyful. Outside is not a classroom but a glorious place to learn using their whole bodies in a bigger space. Experience the joy of lying on the grass and listening to the leaves rustling the wind. Teach the children to delight in spotting a full moon or discovering spiders under a large leaf or spying a strange plant in a dark corner. 
  • Be attuned to signs of distress and sadness and know when to intervene or ask a question. Know when to give a child a cuddle or help affirm how they feel by giving them the words to describe their feelings. 

  • Help children to become independent and be able to seek help and build resilience.  Teach children to name their feelings, so they become emotionally literate. Build in calm breathing techniques, meditation, and mindfulness into your daily routine. 

  • Create local networks for children and families so they can participate and engage in a happy local community. 

And don’t forget, it’s not just the mental wellbeing of children that we need to support, but that of each other too. 

As many teachers and educators are fully aware, working with young children (whilst considering the needs of parents, colleagues and the local community) can be both joyful and stressful as it places a lot of physical and emotional demands on staff – all of which impacts their general well-being. Negative experiences of discrimination, financial concerns and relationship issues can also seriously affect people’s daily lives. Developing wellbeing strategies that can mitigate the impact of these experiences is therefore essential.  

Whilst there is no ‘quick fix’ or ‘one size fits all’ when it comes to wellbeing – the handbook which I co-wrote with Lala Manners in 2022, Think Feel Do explores how staff  can use the nursery environment and the activities of an average nursery day to strengthen the ten key elements of wellbeing – all of which should sit at the very heart of policy and practice.

Through communicating, listening and trusting others – we can ensure that self-care is not considered selfish but an essential part of everyday life.