Frequently Asked Questions

The Basics

What is "early childhood or infant mental health"?

"Early childhood mental health" is defined as the healthy social, emotional and behavioral well-being of children and their families. Generally early childhood refers to children birth to 5 years of age and infant refers to children from birth to 3 years of age. According to the organization ZERO TO THREE; infant mental health describes a child's developing capacity to:

• form close, secure and meaningful relationships;
• experience, regulate and express emotions; and
• explore the environment and learn, all within the context of a child's family, community and culture

When children are this young, "mental health" is frequently referred to as "social and emotional development". These terms are used interchangeably as "mental health" may still carry some stigma for parents, extended family and others.

How can I support my child's mental health or social and emotional development?

The first thing parents can do is to take good care of themselves. Even before her baby is born, a woman who eats well, exercises regularly, and avoids harmful substances like drugs and alcohol is helping her child develop good physical and mental health. After a child is born, eating well and getting regular exercise are still important, but parents must also make sure their child has the chance to develop trusting relationships. From their first moments of life, children are learning they can rely on their parents/caregivers for their physical and emotional needs. They are beginning to develop trust and an all-important sense of security. Children who develop this trust take risks, explore their world, and try new things because they know they can return to safety. Here are some additional tips:

• Be sure your child has plenty of love, understanding and support
• Help your child talk about their feelings
• Encourage your child to try new things
• Provide a safe place for your child to learn independence
• Show your child effective ways to solve problems and resolve conflicts
• Allow your child to solve some problems on their own
• Teach deep-breathing exercises to help your child reduce stress
• Teach your child to appreciate and respect others
• Encourage your child to help others
• Surround your child with nurturing relationships
• Be happy- smile and laugh with your child
• Provide stable and consistent caregivers at home and in childcare
• Develop routines to promote security and predictability
• Comfort and reassure the child when he or she is hurt, scared or angry
• Learn developmental stages and have appropriate expectations and
• Identify early signs of emotional or mental health problems

Source: Early Childhood Indicators of Progress, Minnesota Departments of Education and Human Services and Project ABC, www.ProjectABC-LA.org

Can an infant, toddler or small child have a mental illness or delays in their social and emotional development?

Yes, infants, toddlers and pre-school children can experience mental illnesses or delays in their social-emotional typical development. A 2002 study showed that 16 percent of the infants and toddlers in families that were surveyed had social, emotional, or behavioral problems. Most of the concerns were addressed by regular program services, but 7 percent required additional services and/or urgent care. From time to time, your child may have behaviors and feelings that worry you. Many times these behaviors are a normal part of growing up. For example, adjusting to a new daycare may cause your child to be more irritable or anxious. Adjustment periods for such changes are normal. But sometimes disruptions can lead to more significant problems. If your child's feelings and behaviors seem to last too long, occur often over time, or are disruptive, talk with your child's doctor.

What are the early warning signs of social-emotional or mental health problems?

Parents sometimes wonder if their child's development is normal or if their child's behavior might mean that a problem exists. Although early childhood development does vary greatly, parents often seem to have an intuitive sense about their children. Many parents whose children have been diagnosed with a mental health disorder have said things like, "I knew by the time she was two something was wasn't quite right" or even, "He was different from the moment he was born." In some cases the parents may not raise the concern, but an early childhood professional who works with a child may suggest that a child they work with may benefit from an evaluation. Even though some neurological disorders such as autism or fetal alcohol spectrum disorders (FASD) cannot be totally overcome, the effects can be lessened with early intervention and these children, too, have a wonderful chance of growing into mentally healthy adults. Some things to watch for include:

• Lethargic or apathetic, cries a lot and is irritable or anxious
• Repeated nightmares; night terrors, unusual fear of the dark, fear of toileting alone, and other new fears
• Doesn't seek or resists comforting
• Has difficulty following instructions, motor skills lag behind others of same age, may rarely speak or carry on conversation, unable to comprehend danger
• Changes in sleeping, eating or toileting behaviors that last a long time
• Avoids eye contact, unable to sit and listen, increased social withdrawal, difficulty with non-verbal communication
• Increased outbursts of anger, repetitive movements, aggression to others fussiness or tantrums that seem excessive
• Easily over-stimulated and hard to soothe
• Sensitivity to clothing, sounds, lights touch, smells or shoes; limited diet because of texture

Where do I start if I think my child or youth is having difficulties?

Start with your family physician or a pediatrician first. Many physical illnesses can mimic the symptoms of mental illness. A physical exam can help to rule out certain illnesses. If needed, they can discuss the possibility of a referral to a mental health professional or others such as their school district's Help Me Grow Programs or Early Childhood Special Education (ECSE) program to learn about their screening and evaluation process and available services. For more about ECSE, click here. Along with getting help for your child, you may consider asking about parent support groups-this is where parents share their experiences and concerns with other parents who have similar problems.

Treatment

Is this a temporary condition? Will my child get better?

Some mental health disorders are temporary; others are a lifelong condition that you and your child will learn to live with and manage. For example, a feeding disorder of an infant is something that your child can completely recover from. A disorder like autism may not disappear like a feeding disorder, but with early intervention you and your child can learn how to cope, the behavior effects can be lessened and your child can lead a full and productive life.

How are mental or social and emotional delays diagnosed in very young children (birth to 5 years old)?

A social-emotional developmental or mental health assessment of a very young child will include observations of the child's behavior, actions and reactions. The assessment will also include a developmental history, and parental and family history of physical or mental illnesses. The assessment considers environment and family resources and interactions as well.

These assessments will take place over a period of time and may occur in an office setting, at a child and family home or in the school/daycare center. In fact, the assessment must consider a child's behavior in a variety of settings and with a variety of information sources. Mental health assessments include assessment of the whole child, including cognitive and motor skill development, as well. For this reason, some mental health professionals are being placed on Early Childhood Special Education or Help Me Grow Teams.

How young is too young for treatment or "intervention"?

If your child has a mental health or developmental concern, it is never too early for treatment. Early intervention prevents more serious problems in the future. The benefits of addressing social-emotional development and attachment of children before the age of five are well documented in research. Secure and trusting attachments of young children provide a strong foundation for future development. When infants and toddlers are receiving services for delays in social or emotional development, it is critical to involve the parents and caregivers in treatment.

What are Early Intervention Services for young children? Do they have mental health services in Early Intervention Programs?

The Individuals with Disabilities Education Act (IDEA) ensures that intervention services are provided to young children with developmental delays. Help Me Grow resources help parents and professionals identify you children who would benefit from these services.

Minnesota's Help Me Grow inititaive provides information adn resources that will help parents, professionals, and community memebers identify children who may be experiencing delays in their development. Help Me Grow provides information that will equip those who interact with young children (birth to kindergarten) to better monitor each child's development. When developmental concerns arise, individuals are encouraged to make referral online at www.helpmegrowmn.org or by calling 1-866-693-GROW (4769). Eligable children and their families receive high quality infant/toddler intervention or preschool special services from local qualified profressionals.

How do I find a therapist who works with young children?

There are several kinds of mental health professionals who provide mental health assessments and treatment; however the number is a lot smaller when you narrow your search to mental health professionals who specialize in early childhood mental health. There is currently a statewide initiative in MN that will increase the number of well-trained early childhood and infant mental health therapists through 2015.

If you are working with a service coordinator through Help Me Grow or a children's mental health case manager, ask if they can provide you with a referral to one of the several mental health centers in the 4-county Community Adult Mental Health Initiative area who have therapists with training in early childhood mental health development, diagnosis and treatment. If you are calling for an appointment directly or have no service coordinator, ask the intake person at the mental health clinic if they have someone who specializing in treatment of children under the age of five and their families.

What should I do if I don't think my child is getting better?

Talk to your provider and share your concerns. Your provider may want to try a different form of treatment or care. If you feel like you may want to try a different provider, it is okay to be upfront and honest. Your relationship with your provider will impact your care; it is also okay to ask for a referral to someone else.

What questions should I ask a mental health provider?

You should feel free to ask any questions that you are curious about. Before you visit the provider, make a list of questions that you want to ask. While you may already have a list of questions in your head, here are few more that you may want to include:

• My child has been having some problems in the following areas... (briefly provide examples of the behaviors that con­cern you). Can you give me an idea of what your approach to dealing with these types of problems might be?
• Do you involve parents (or guardians) in the counseling process?
• Do you provide family therapy? How do you decide if this is needed?
• What criteria do you use to determine whether or not a child needs medication? To whom do you refer for this type of assessment?
• If my child needs special accommodations at school, do you assist in making these arrangements?
• How flexible is your appointment schedule? Do you offer after school/ evening/Saturday appointments?
• If you or I decide that you and my child might not work well together, will you be able to suggest other referrals?

Where can I find a support group in my area?

Check out our Community Calendar or find one on our Resource and Provider Search.

Medication

Is Medication OK?

Deciding to use medication to treat the symptoms of a mental health disorder for children younger than 5 years old is a complicated process. Parents and health care providers must work together to determine when using medication is the best course of action. If a child's behavior is interfering with his or her ability to form and maintain relationships and other treatments have not worked, parents may decide to ask their doctor about the benefits of medication. While medication is not the first or only option for a young child with a mental health disorder, medication may be necessary in combination with other therapies to help a child cope with the symptoms of their disorder, build self-esteem, and continue their healthy emotional development.

Is Medication Safe for Young Children?

Each family must determine for themselves if the benefits of medication outweigh the potential risks. There is not a lot of research about the effects of psychiatric medications on young children-even though those medications that have been used for children for a long time. If a parent does decide to add medication to their child's treatment plan, it is very important to find the most suitable and effective medication and the correct dosage. Parents must work closely with the prescribing doctors to fully understand the use of any medication. When a child is put on medication, it is very important that parents observe and keep notes of what they see so they can report any changes in the child's behavior to their doctor. Because not all medications affect the body the same way, parents should also make sure they know what to do if a dose is missed. A doctor should also be consulted if the parent decides to stop using medication-stopping medications suddenly can be dangerous.

Stigma

Some children don't want others to know that they are taking medication. If a child does begin to take medication, parents should watch for signs of this and respect the child's privacy. This will also lessen the possibility that a child will be teased or made fun of by their brothers and sisters or their friends. It may help to use a subtle, nonverbal signal as a reminder that it is time for medication. If your child is in a daycare setting or preschool, you may want to suggest that similar strategies be used there if medication must be given during school time.

When Considering Medication, Consider These Questions

• Which symptoms will the medication help?
• Which symptoms will it not help?
• Are there side effects?
• Is there a risk of a bad reaction?
• What is the proper dosage and when should it be given?
• Does missing a dose or stopping the medication matter?
• Can the medication be taken with other medications (such as those given for asthma or diabetes)?
• How many doses must be taken before the medication will be effective?
• How will I know if it's working?
• Who should I call if there is a problem?

If you and your provider decide to use Medications, Keep Detailed Notes

• Are there side effects?
• Are the symptoms better or worse?
• When does the medication wear off and how can you tell?
• Questions you want to ask the doctor.

Source: "Medications: Early Childhood Mental Health Fact Sheet", Minnesota Association for Children's Mental Health (MAIECMH), 165 Western Avenue N, Suite 2, St. Paul, MN 55102, www.macmh.org

Payment and Insurance Coverage

How much is getting help going to cost me? Would a visit to a therapist be covered by my insurance?

Cost will vary. The best way to get this information is to call your insurance company. You may also see if your employer offers an Employee Assistance plan. If you don't have insurance, call the mental health clinic you are interested in and ask about a sliding fee.

Some mental health clinics have received a grant from the MN Department of Human Services Children's Mental Health Division to offer Early Childhood Infant Mental Health Services to uninsured and underinsured families. Ask the mental health center if they have received a grant that may cover services to your infant or toddler and their family.

You can also call your county human service department and ask about applying for medical coverage.

If you are referred for services to Help Me Grow, Early Childhood Special Education, most services are paid for by the education system. Ask the Help Me Grow service coordinator for more information.