Catch them Young! Early Childhood
- A Children’s Day Mental Health Series -

Dr. Mona Nongmeikapam / Dr. Meesha Haorongbam *

Childhood is supposed to be the happiest times but given the expectations that a child is born into these days, are they really happy? From the Chagumba ceremony itself, the poor baby is expected to decide whether it wants to be a scholar or pursue business and earn loads of money. Given the current trend of fewer/ single off-springs it is indeed a matter of do or die for the parents.

An experienced School Principal in his letter addressing the parents before the students’ exams sum it all so well: “The exams are about to start and I know that you are really anxious for your child to do well.

But please do remember, amongst the students who will be sitting for the exams, there is an artist, who doesn’t need to understand Math. There is an entrepreneur who doesn’t care about History or English Literature. There is a musician whose Chemistry marks won’t matter. There is an athlete whose physical fitness is more important than Physics.

If your child does get top marks, that’s great! But if he or she doesn’t please don’t take away their self-confidence and dignity from them. Tell them it is OK, it is just an exam! They are cut out for much bigger things in life. Tell them, no matter what they score, you love them and will not judge them.”

As parents, one must realise that these precious children are not fixed deposits that one can encash or prized possessions to show off and brag about. Their presence in our lives and the joy of being a parent is the reward and our role is to capacitate them to attain what they are capable of, to the best of their ability and help them overcome their shortcomings as and when possible.

Children can develop the same mental health conditions as adults, but their symptoms may be different. Mental illness in children can be hard for parents to identify. As a result, many children who could benefit from treatment don't get the help they need. It is important that parents are aware how to recognize warning signs of mental illness in children so that timely intervention can be done.

Defining mental illness:

Mental health is the overall wellness of how we think, feel and behave. Changes in the way we think, feel or behave, that disrupts a person’s day to day functioning could be defined as a mental illness. In children, it is generally delays or disruptions in developing age-appropriate thinking, behaviors, social skills or regulation of emotions.

This could cause distress to the child and disrupt the way they function at home, in school or in other social situations. Childhood mental health disorders are always a challenge due to various factors. Vital signs and clues could be missed as normal part of growing up, and the client (here, the child) would not be able to explain or tell how or why they feel or behave in a certain way.

Concerns about the stigma associated with mental illness, the use of medications, and the cost or logistical challenges of treatment often pose as barriers. Locally, we also have the problem of not having exclusive Child and Adolescent OPDs or enough manpower trained in the field.

Early childhood can be classified as:
o Infancy: 0 to 3 years
o Toddlerhood: 2 to 3 years
o Preschool age: 0 to 5 or 6 years

Types of disorders commonly seen:

1. Relationship disorders: reactive attachment disorder

A child’s development may suffer because of an overinvolved parental attitude- very dominating and authoritative, or on the contrary from an underinvolved attitude- insensitivity or neglect.Such children will need timely intervention with consultation of a specialist in child psychiatry, parental counselling and training.

2. Disorders of food intake: feeding disorders

The prevalence of diagnosed feeding disorders in 18-month-old infants is 2.5%. About 25% of parents subjectively report problems feeding their infant in the first six months of life. Difficulties with food intake arise in up to 80% of developmentally delayed children.

One-quarter of all very low birth weight preterm infants (weighing less than 1500 g at birth) have feeding problems in the first year of life, with persistence into the fourth year in 25% of cases.

If slowing or stunting of the normal gains in height and weight, or a generalized interaction disturbance resulting in intense familial stress is seen, an interdisciplinary diagnostic evaluation and prompt treatment is needed.

3. Disorders of motor regulation/hyperactivity

The child has difficulty regulating his or her emotional, behavioral, and motor responses to sensory stimuli. This could lead to impaired development and impaired functioning (e.g., disturbed parent–child interactions because of excessive crying).

These disorders are classified into hypersensitive types (fearful-cautious and negative-defiant types), hyposensitive types (abnormally low responsiveness), and stimulation-seeking, impulsive types. These signs are reported by the parents as early as 3 years of age. Mild symptoms call for supportive parent counseling and reduction of psychosocial stress factors. Medications may be needed for more severe cases.

4. Affect disorders: anxiety and depression

Children display various emotions from the initial first few months itself. Infants react to caregivers’ anxiety and depressive affects with their own manifestation of distress. Mothers with post-partum depression, disturbed early relationships and a genetic predisposition to depression are the usual causative factors. Parental counselling and where warranted, pharmacotherapy is the line of management.

Parenting Skills Training

Parenting skills training aims to enhance or support the parental role through education and training, thereby improving emotional and behavioral outcomes for children.

Increasing positive parent-child interactions, teaching parents how to communicate emotionally with their children, teaching parents the use of time out as a means of discipline, and supporting parents to consistently respond to their children’s behaviors have shown to have the best effects.

We live in difficult times. It is imperative for the parents/ teachers/ caregivers to help raise mentally resilient individuals. It is also important that they are able to recognize the mental health challenges early on and seek help for better outcome. A stitch in time always saves nine.

Dr. Mona Nongmeikapam (pukningpothasang(AT)gmail.com)-
Assistant Professor,
Department of Psychiatry,
Regional Institute of Medical Sciences

Dr. Meesha Haorongbam (meeshahao(AT)gmail.com)-
Senior Resident,
Department of Psychiatry,
Shija Academy of Health Sciences