The COVID-19 crisis has brought concerns for mental health issues to the forefront for almost everyone. However, one group that is often overlooked is the very young. Often it is difficult for parents, childcare providers, and other caregivers to realize that even preschoolers can meet the diagnostic criteria for certain mental health disorders.  For many adults, it is hard to believe that children under the age of five can develop cases of clinical depression and clinical anxiety that require professional help.

So, how do you know if a young child needs help? 

It may be confusing to spot the difference between a normal response to the sudden changes we are all experiencing, and the more dramatic symptoms connected to a clinical illness. As a result of COVID-19, almost everyone is feeling more vulnerable, worried, and afraid.  In the context of COVID-19, it is normal for preschoolers to exhibit anxiety or even depressed behavior because of the multitude of sudden changes to their routine and their environment. Right now, their parents may also exhibit a variety of emotions and they may express more frustration than normal from changes at work and home. Parental changes naturally impact a young child’s emotional status.

How can parents determine the difference between normal emotional reactions and a possible mental health disorder when nothing seems normal and everything seems changed?  

As with all clinical disorders, a professional diagnosis involves identifying a certain number of symptoms that are exhibited, understanding a certain length of time that the symptoms have persisted, and evaluating the degree in which an individual’s day-to-day functioning is impacted.  

During the pandemic, emotions run high and some people describe feeling like they are caught on a roller coaster of up-and-down emotions.  The ability to function as usual is being impacted across age groups, but a definite external stressor is causing the situation.  For most of us, feeling anxious, afraid, angry, frustrated, and many other emotions is a normal response that is easily explained.  As long as individuals are generally able to function most of the time under these stressors, they would not meet the criteria for a mental health diagnosis. 

The same is true for preschoolers.  Tantrums, withdrawal, and behavioral regression are an expected response to changes in environment, schedules, and routines.  However, if your little one shows consistent tendencies to be anxious or depressed, you need to pay close attention.

Some symptoms associated with childhood anxiety and depression include (but are not limited to) the following:

  • headaches with no known cause
  • stomachaches with no known cause
  • crying a lot
  • worrying a lot
  • avoiding certain situations or places
  • avoiding social situations
  • having meltdowns, restlessness and sleep issues.  

If your child showed these tendencies prior to the pandemic and now you are observing even more significant concerning behaviors, it would be wise to get an evaluation.  Early interventions can assist in improving developmental outcomes which leads to a better future for your child. 

In addition to the child’s health, pay attention to the health of your child’s caretaker—especially if that primary caretaker is you.  Infants and young children are especially vulnerable because they have to rely on others to take care of them. Caretakers help influence how children respond to situations that occur in their lives.  Children will show more resilience if their caretakers help them feel safe and pay attention to fulfilling the needs of their emotional and social development. 

What can caretakers do to help kids?

  1. Focus on helping children feel nurtured and safe in their environment.   
  2. Notice changes in the child’s behavior and ask how they feel.
  3. When a child’s behavior is challenging, stay calm.  It can be tempting to raise your voice and correct the child or provide immediate behavioral consequences.  Instead, take a moment to explore why the child is doing what he or she is doing; figure out what may be behind the behavior. 
  4. Use direct developmentally appropriate language to answer questions that children ask.  Children may ask why parents are home or why people in stores are wearing masks.  Just be honest with them, using simple language. Keep explanations short.  Mom is home because the office is closed today.  Masks are important right now because people want to be healthy. You do not need to talk about the virus because they may be oblivious to COVID-19. 
  5. Manage your own stress.  It can be difficult right now to stay calm because of all the worries people have related to COVID-19 and the changes that have abruptly upset regular life.  Seek the help you need to process your worries so you are able to function for yourself and your children.
  6. Validate feelings.  Some children may be too young to identify their own feelings by name. Discovering names for their feelings can help them figure out what to do when they are angry or afraid.  Feelings need to be validated and simple strategies need to be learned over time to help manage certain feelings—like taking a step back when angry or taking a deep breath before responding when mad.
  7. Develop a routine of activities during the day and during the evening hours.  Schedules and routines help people know what to expect and that can be comforting.
  8. Include play time in the schedule.  Play is a way young children express themselves and just as some adults need to process what is going on with other adults, children need to play for a variety of reasons.
  9. Help children understand that they can count on you and tell you anything that might be concerning them.

If any adult or child is so overwhelmed that their functioning has significantly decreased, an evaluation by a medical or mental health professional is recommended.  More resources are available through telehealth than ever before.