When babies see shrinks

Victoria Clayton • E-mail

Traditionally, young children have rarely crossed paths with psychiatrists or psychologists. Not anymore. With a growing amount of research focusing on early brain development, more youngsters — even infants — are being targeted to receive the services of mental-health professionals.

There are no hard numbers available for just how many pre-kindergarten children are being seen, but experts say infant/toddler mental health is moving into the mainstream. Psychological research on this age group is a hot topic at major universities, and last year the American Academy of Pediatrics launched a task force with at least part of its purpose to push more infant/toddler mental health intervention.

This may cause some readers to roll their eyes — especially those who believe Americans have a tendency to pathologize and treat the slightest blip of a bad mood.

Before you pass judgment, however, it’s important to understand what infant/toddler mental health is all about, says Ngozi Onunaku, a policy analyst with Zero to Three, a Washington, D.C.-based nonprofit organization dedicated to furthering mental wellness for preschool-age children.

“When you put the words ‘infant’ and ‘mental-health treatment’ next to each other, that’s really scary to some people,” says Onunaku. “People think of medication and, from a more comical standpoint, they think of a baby on the couch.”

Onunaku says that, in fact, a more accurate way to talk about this issue is to call it infant/toddler mental wellness. “It’s more helpful to see mental health as a continuum. There are kids who need intense interventions, there are kids in the middle who are at risk for a problem and then at the other end you have your everyday, typical children who also need their caregivers to promote mental health and wellness.”

While all humans can benefit from what researchers and doctors are learning about infant mental development — namely, that infants are sentient, perceptive beings whose brain development can be strongly influenced in the first weeks, months and years of life — there are certain issues that drive most parents to get help for their children.

When there may be a problem Specialists in early childhood mental wellness say parents tend to be at least nominally aware of their children’s problems well before they’re officially diagnosed. For this reason, parents should be frank with their pediatricians. Don't rush to judgment about your child, but the following behaviors and symptoms — particularly when persistent — are worth mentioning to the doctor: — Refusing food and losing weight — Sleep problems so severe that your child or you aren’t functioning well during the day — General listlessness — Inconsolability — the child is always crying or screaming — Failure to walk, talk or relate to other children

Eating and sleep issues are primarily why mental-health professionals see babies, says Dr. Thomas Anders, an infant psychiatrist at the University of California, Davis M.I.N.D. Institute and president of the American Academy of Child and Adolescent Psychiatry.

Toddlers are more often seen because of developmental delays or behavioral problems such as temper tantrums.

Other reasons infants and toddlers are evaluated include abuse, adoption or other separation from a birth parent, maternal depression, premature birth and trauma such as a natural disaster or illness.

With the right therapy and care, many of these conditions can be helped significantly and often swiftly. “Sometimes one session or two sessions and a couple of phone consultations are all you need to take care of a problem,” Anders says.

Parent-infant therapy
Oftentimes, it’s just a matter of educating parents or teaching them some very specific parenting skills. For example, Anders, who studies infant sleep, says he may get a call because an infant appears to have a sleep disorder but sometimes it’s a matter of working with parents to establish a more productive bedtime ritual.

“Most of the treatment for children under 3 or 4 is what we call parent-infant therapy,” says Anders. “Medications are very rarely used in this age group.” In fact, when a young child is having any sort of problem it’s always a matter of determining how the family can solve the problem.

“What we’re really doing primarily with infant and toddler mental health is saying, ‘What guidance can we provide to help a parent cope better?’” says Penny Glass, a developmental psychologist with Children’s National Medical Center in Washington, D.C. “Sometimes it’s amazing when you just counsel parents on how to establish structure.”

Glass notes that having organized mealtimes and bedtimes often help families feel as if they have more control and helps eliminate toddler behavioral problems. “Even if you just help a child get a decent amount of sleep many of the problems don’t seem so big,” says Glass.

In some cases, parents may mistake one issue for another. Glass recently saw a boy, age 3 and a half, who was referred to her for behavior problems. But when Glass did the full evaluation she found out that the child was actually developmentally delayed and operating more at a 2-year-old level. He didn’t understand some of the words or thoughts and ideas that people were trying to convey to him because they were speaking to him at the level of a 3- or 4-year-old. Once this was understood Glass could recommend therapy to help get him up to speed, but she could also counsel the parents, teachers and caregivers in how to speak and treat him appropriately.

Just knowing the problem and what they were dealing with, Glass says, helped the parents feel better, understand the child better and treat him in a more health-promoting way.

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