Depression in Early Childhood
By: Mary McAteer
Infancy and childhood are times for family growth and new roles of nurturing. The mixed joys and responsibilities are usually rewarding and complicated. But for the 1 in 40 infants experiencing depression, families may be at a loss to discover what is wrong and how to manage it successfully. Parents who are aware of what depression is can better advocate for their child to get an accurate diagnosis and seek help from the multiple child health providers who can treat their child’s depression effectively.
The cause of infant depression is usually multifactorial, which should help parents take the pressure from themselves as the cause of their infant’s problems.
Genetics forms determinant elements of the brain and body, such as chemical systems to make and use neurochemicals, brain architecture, and how the body will develop over time. Events that took place in utero may impact the development of the fetus. For example, mothers exposed to toxins or medications can interfere with their baby’s development. The physical environment of the prenatal period and after birth can affect the development of the baby, such as the presence of lead or mercury.
As with all diagnoses, early intervention is key. Therefore, if parents are concerned it can be helpful to see their doctor, before the baby is born, to discuss their concerns. Such as family history of depression, exposure to medications, etc. Following the birth of their child, if concerns are present, a consultation with the child’s pediatrician is recommended. Pediatricians are importantly trained in how to determine if symptoms are signs of depression or simply differences in stages of development, due to an illness that needs treatment, or changes in the environment that can be dealt with. It is extremely valuable for parents to know their child to the point of seeking help when things do not seem right. Below is an outline of information for parents to use to explore their concerns.
Symptoms of making a diagnosis of depression are like those in adults.
- Depressed mood
- Loss of interest or pleasure in all activities
- A change in appetite
- Sleep disturbance
- Agitation or lethargy
- Low energy or decreased efficiency
- Sense of worthlessness
- Impaired ability to think, concentrate.
- Recurrent thoughts of death
The last 3 items will be difficult to ascertain from infants due to their inability to express these high-level thinking skills. I include them to reflect the experience with adults and children that have informed us of the importance of those symptoms to the severity of depression.
Babies may clearly show us signs of the first 6 symptoms. To consider it significant for diagnosis the symptoms must cause clinically significant distress or impairment in functioning, occur in all settings, and observed by multiple caregivers for over 2 weeks at a time, and not be due to disease or result of medication or other substance.
Let us look at how these symptoms may appear in infants.
- Not smiling responsively. Infants acquire the ability to smile within the first few weeks of life and those smiles are directed at important people in the infant’s life.
- Interactive Gaze. Children do not have language to express how they are feeling, or what bothers them, but they do have definite interactions with their caregivers with eye gaze, especially with people they love. This leads to a special language of comfort.
- Inconsolability. Babies move their bodies when excited or uncomfortable. Over a few months, caregivers discover what those movements mean and how to respond to them.
- Sleep pattern changes. Infant sleep patterns are predictably wild and whacky, but a long trend that becomes problematic can be a result of something treatable.
- A change in eating pattern, either a decrease or increase.
- Cognitive skills, or attention. A concern that the baby is not making developmental progress in one or more areas.
All are normal symptoms of growing up, but also can be signs of depression if these symptoms cause clinically significant distress or impairment in functioning, are not due to disease or result of medication or other substance, occur in all settings, and observed by multiple caregivers for over 2 weeks at a time.
These symptoms can exist in children on a periodic basis, some with good reason, such as adjustments to major changes in a child’s life, like a death in the family, change in daycare provider, or illness. Fortunately, the symptoms usually resolve, and parents can recognize when the child is back to their baseline. When the child does not return to baseline, getting the child to the doctor with an awareness that the doctor or staff may need some personal information about the details of a child’s life will help get the appropriate care in quick time.
Fortunately, depression can be treated. Family is important in understanding what is happening, delivering treatment, and following along to measure treatment success.
Parents and physicians can create a care team. Physicians offer personalized and accurate assessments of symptoms, offer medication when needed, look for and address additional concerns that can interfere with healing, offer options for therapies, and provide support for parents and caregivers who are also suffering. The care team may utilize psychologists, play therapists, music, physical massage, feeding team, occupational or physical therapists, speech therapists. Parents meet regularly with their physician to be sure progress is made and the child’s depression is getting better through symptom improvement.
