Mental health during the early years

We are supporting World Mental Health Day again this year, as we know how essential education and awareness of mental health is. Conversation around mental health is vital to ensuring we can spot the signs, remove the stigma and support others.

Looking after mental health in the early years is important, as poor mental health may develop into serious issues as the child develops. Our mental health in the early years series focuses on how practitioners can support children with their mental health.

The ‘early years’ of educating children are critical in preparing them for life at school and life in general. Part of this preparation includes helping children to have good mental health. However, much of the focus on children’s mental health tends to be on children of primary age and beyond. Research and even discussions about the mental health of pre-school children are limited.

Nevertheless, children can be susceptible to poor mental health during their early years. For example, attachment issues can affect babies and these issues can escalate to more serious problems as a child develops. As reported by Mentally Healthy Schools; ‘When children have a secure attachment with their parent/carer, it is an important protective factor for their mental health, while insecure attachments can be a risk factor for the development of emotional and behaviour problems’.

The ‘Mental Health of Children and Young People in England 2017’ survey provided some insight into the types of mental health problems pre-school children experience. The survey found that around 5.5% of preschool children had at least one mental disorder at the time of the survey. Behavioural disorders were found in 2.5% of children, autism spectrum disorder in 1.4% of 2 to 4 year olds and other common disorders found were related to sleeping and feeding. The survey also found that boys were more likely to experience mental health problems than girls. Despite the limited research, Early Years practitioners should work on the basis that a child’s mental health is just as important as their physical health and equally as important in preparing them for the future as their physical health.

Proactive promotion of good mental health

Personal, social and emotional development (PSED) is one of the key areas of learning in the EYFS and is a good place for practitioners to start in supporting the mental health of children. By considering the early learning goals related to PSED, practitioners can plan activities that allow children to learn and develop characteristics of good mental and emotional health. Activities such as storytelling can be used to help children identify their feelings. They could perhaps identify their own feelings from a character in a story and that could be the starting point for conversations about feelings. Similarly, play provides an excellent opportunity for children to interact positively with other children, learn to share and learn to conform with behaviour rules. Play is often associated with happiness and fun so allowing children to express themselves through play is good for their mental health. Freely chosen play helps a child learn how to make their own decisions and choices and learn to be independent. Other skills that are linked to good mental health and play are confidence, curiosity and resilience. Playing may also help a child to explore their feelings and creative or messy play where children are playing with paints or crafts allows a child to express themselves, express their feelings and establish their own identity.

Indicators of good mental health in pre-school age children include:

  • being able to listen and respond to teacher’s instructions, comply with and understand rules,
  • being able to form positive relationships with other children and with teachers
  • being sensitive to their own and other children’s needs.

During activities such as play, the child with good mental health knows how to share and play cooperatively with other children. Although it is entirely normal for children to be upset, the child with good mental health is resilient and recovers quickly after an ‘upset’ and moves on.

Reacting to signs of poor mental health

It stands to reason that a child’s parents or main caregivers will have the biggest impact on their mental health. If there is security and love in the home, this translates into a secure child who feels loved. However, children who live with domestic abuse, live with a parent who is a substance abuser or a parent who has mental health problems, are likely to be negatively affected in some way by these factors. Oppressive parenting styles which discourage a child from being or expressing themselves or physical chastisement of a child that borders on or is actually abuse, can also have a negative impact on a child’s mental health. External social factors such as poverty, poor quality or overcrowded housing may also have a negative impact on a child’s mental health.

During the current ‘unprecedented’ time, coronavirus may also have had a significant impact on the mental health of preschool children. It is too soon to know the full and long term impact on children of ‘lockdown’, social isolation and adults ‘masking up.’ However, there is a view that pre-school children may have been affected by being socially isolated from other children and from family members such as grandparents. In more deprived areas, poor quality housing, overcrowded households, limited indoor and outdoor space may also have limited children’s ability to learn and develop though play and social interaction with others.
Government guidance on possible symptoms of a pre-school child’s mental health being affected by the pandemic include:

  • infants to 2-year-olds - may become more easily distressed, may cry more than usual or want to be held and cuddled more
  • 3- to 6-year-olds - may return to behaviours they have outgrown, such as toileting accidents, bed-wetting, or being frightened about being separated from their parents or carers, may also have tantrums or difficulty sleeping.


Some experts use the analogy of a wobbly table to describe the impact of poor mental health in children. The analogy works as follows: If one leg of the table is wobbly, then until that leg is stabilised the entire structure i.e. the entire table remains wobbly. Practitioners therefore need to identify and address the ‘wobbly leg.’ In pre-school children indicators of a ‘wobbly’ leg could be any of those listed previously but could also be that a child is withdrawn, fails to form any relationships with other children or when becoming upset, displays an inability to ‘recover’, has attachment issues with other children or their teacher and so on. Early intervention is the remedy for these issues.

Depending on the severity of the issue, practitioners may need to consult with parents and work with them to identify a solution. Alternatively, specialist help from experts in child psychology or from paediatricians may be necessary. Early intervention is the key to preventing problems from escalating. The old adage remains true that prevention is better than cure. Therefore, the earlier a practitioner can intervene or respond to signs and symptoms of poor mental health in a child, the greater the chance of success in helping the child recover.

Ruth McGuire is an Education Inspector with nearly 15 years of inspection experience. She has taught in both further and higher education. She is also a well-established education and training consultant, writer and freelance journalist. She is a Governor of an outstanding sixth form college and also holds board roles within the NHS. You can read more articles from Ruth on CACHE Alumni.

Our Level 2 Certificate in Understanding Mental Health in the Early Years is designed for learners who wish to understand mental health in the early years, from birth to 5 years old, and the role of the Early Years Practitioner to support children’s mental health and wellbeing.