Unique Child Mental Health: Infant depression

Clinical depression, an overwhelming and persistent feeling of hopelessness, sadness and lack of self-worth, is not confined to adults. Children can suffer from it too.

It is only in recent years that it has been recognised that even young children can be depressed. In the early 1980s many psychiatrists believed children were incapable of experiencing depression because they lacked the emotional maturity to feel despondent. Now it is thought that children as young as 18 to 24 months old can display symptoms of depression, once a certain level of emotional and cognitive development has been reached.

'Childhood depression is more common than people expect, because it often goes undiagnosed,' says Robin Balbernie, consultant child psychotherapist in Gloucestershire. 'It is easy to diagnose a child with ADHD because they are the one bouncing up and down. But a depressed child is sitting quietly, not mixing and not being noticed. Yet even if it is diagnosed there is not a lot of medical intervention, because children cannot be prescribed medication for depression.'

CAUSES

Many factors can contribute to a child becoming depressed. Triggers may include:

- Loss, such as the death of a close relative or parents separating

- Not bonding with a primary carer at an early age, for example if the mother had post-natal depression, or not being loved

- Being abused or neglected

- Stress - such as family circumstances changing, for example a child being put into care or a parent leaving home

- Glandular fever or flu-like illnesses might occasionally lead to depression.

SYMPTOMS

Symptoms often go unnoticed because of people's lack of awareness of infant depression, which is also harder to diagnose because young children are less capable of articulating their feelings. Mr Balbernie says, 'I would be worried about depression going unnoticed in a young child, because it can become a way of life. If a young child is in one state for too long it can become a trait, because the brain adapts to a state and the neural pathways change. In under-twos this can become a personality trait. I would worry that this would be putting the child at heightened risk of developing depression later on in life.'

Common symptoms in young children include:

- Appearing unhappy, being more tearful or clingy than usual
- Being irritable or introverted
- Psychosomatic complaints such as headaches and stomach aches
- Refusing food
- Losing interest in favourite activities
- Problems sleeping
- Listlessness and having no energy
- Low self-esteem
- Appearing tense or floppy

DIAGNOSIS

As psychologist and early years consultant Jennie Lindon stresses, it is not an early years practitioners' job to diagnose that a child is clinically depressed, but good practice can help to highlight cases early. 'The closeness and personal relationship between a practitioner, particularly a keyworker, and a child should flag up when a child has gone beyond being a bit sad,' she says.

'Childcare practitioners need to refer to their child development knowledge - what was the child like before? Has the child changed? This has to be combined with what the normal range for a child of that age is. That the child has been quiet and easily upset may be in the normal range, but that they are constantly bowed down and sad, or that they are trying to hurt themselves, is not within normal range.'

If a practitioner is concerned that a child appears depressed, they should:

- not put the worry to the back of their minds

- confidentially discuss concerns with a senior manager (childminders should gain support from their childminding network) - lay out what is worrying them and why, based on observations of the child

- carefully raise the concerns with the child's parents

- suggest that the parents get in touch with their GP or local Child and Adolescent Mental Health Service (CAMHS).

Diagnosis is usually based on the child's medical history, symptoms and circumstance. Treatment often involves working with the child and the family, such as counselling, psychotherapy and play therapy.

FURTHER INFORMATION

- 'Withdrawal Behaviour and Depression in Infancy' by Antoine Guedeney, Infant Mental Health Journal, Vol.28(4), 393-408 (2007)

- YoungMinds, www.youngminds.org.uk, parents' helpline 0870 870 1721

- Information on Child and Adolescent Mental Health Service, www.everychildmatters.gov.uk/health/camhs

CASE STUDY: A CHANGED FOUR-YEAR-0LD

Four-year-old Mia didn't seem 'herself'. Her parents noticed that she hadn't much energy, wasn't eating well and had stopped enjoying swimming. She was very clingy to her mother, Mrs D, and had started to have toileting accidents.

She was also getting upset and anxious when taken to nursery and would cry and not want her mother to leave. Previously Mia was sociable, but she began to have difficulties playing with others and preferred to be alone in the home corner or with a nursery worker. Mia's keyworker discussed her concerns with Mrs D.

Mia's seven-month-old brother Ben had been born prematurely and spent ten weeks in hospital, including an operation. This had been difficult for the family, but Mrs D felt Mia had coped well. She had often stayed with her cousins and her grandmother, to whom she felt close. Ben was now well and family life had returned to normal.

Mrs D was confused and concerned, so she called the YoungMinds Parents Information Service, saying, 'I know it sounds silly, but it seems like Mia is depressed'.

The helpline adviser explained that children can get depressed but reassured Mrs D that Mia's reaction was probably a normal response to the stressful time the family had been through. Perhaps Mia felt she had to be 'grown up' while Ben was ill and was now allowing herself to experience fear and anxiety and behave like a younger child again.The adviser arranged for Mrs D to discuss the situation further with a YoungMinds professional adviser.

The professional adviser reassured Mrs D that she was right to continue leaving Mia at nursery - to keep her at home would confirm Mia's fears that it was not safe to be away from Mum. He also suggested:

- keeping a 'communications book' with the nursery so that everyone was aware what was going on for Mia

- helping Mia draw her feelings and worries in a book, to encourage her to talk about them, or use her dolls and toys to help her think about when Ben wasn't well

- explaining to Mia what Mum and Ben would be doing while she was at nursery

- Mrs D and her husband could make sure that they had regular 'special' time with Mia, doing something she chose.

It was decided that if Mia didn't improve, their GP would be asked to make a referral to the local Child and Adolescent Mental Health Service. It could offer family and play therapy to help Mia explore her feelings and regain her confidence.