Early Childhood – Understanding the journey

Author: Sally Hogg, Dr Christine O’Farrelly, Dr Beth Barker and Professor Paul Ramchandani, Centre for Research on Play in Education, Development & Learning (PEDAL), University of Cambridge.

Good mental health is key to a happy and healthy life. Mental health is not only the absence of mental illness, but the ability to feel good and function well, to sustain strong relationships and to thrive.

A wealth of evidence shows that early childhood experiences and development shape mental health in childhood and later life. Nurturing relationships and positive experiences in the important period from pregnancy to preschool can lay strong foundations for good mental health. Conversely stress and adversity can increase the risk for mental health problems in later life. 

As the evidence for particular programmes or services builds, it might be tempting for policymakers to invest in an intervention with compelling research results, seeing it as a panacea. But no single intervention “vaccinates” children against mental illness or guarantees good mental health. A range of services and support are required in early childhood and throughout life to support everyone to experience good mental health now and in the future.

To describe a whole-system approach to improve the population’s mental health and wellbeing, we use the analogy of a car starting a journey. Let us explain...

Imagine a group of cars about to embark on a long journey. These represent our children and the lives ahead of them.

Both journey and destination matter

As the saying goes, it is not just the destination but also the journey that matters. Our goal is not simply for the cars to reach their end point, but also to have a safe and comfortable journey.

In the case of mental health, we care about what happens to babies and young children not only because it affects their future wellbeing and how much support they will need from public services as adults. We want to ensure that children are happy and healthy now, and at every point of their journey. Early life is not just about creating healthy adults, childhood itself matters too. 

Effective support can both improve the journey and the outcome

High-quality support in the early years is like putting good-quality tyres on a car. They can make each stage of the journey safer, easier and more enjoyable, and improve the chance that we get to our intended destination. Similarly, services like home visiting, parenting programmes, family hubs or early help services, can improve children’s lives now and improve the likelihood that they will be mentally healthy in adulthood. 

In our Healthy Start, Happy Start research health visitors used a video feedback programme to support parents to interact and play with their babies and toddlers in a sensitive and responsive way. Sensitive relationships improve children’s lives now AND our evidence shows that this intervention reduced the incidence of behavioural problems later too.

Getting support in place early reduces problems and saves money

The cars that have good-quality tyres from the start will have fewer problems and are less likely to need to stop for repairs on the journey.

Similarly, good early intervention for children saves money through accumulated benefits across the child’s life, and the reduced need for additional support. For example, improving mental health and reducing behavioural problems in the earliest years means children can make the most of later opportunities and experiences. They are more likely to enjoy and achieve at school and go on to contribute to the economy and society. These children are also less likely to need additional mental health or educational support. 

There are many components of success

On our cars, good tyres matter. But tyres alone will not guarantee that the journey is successful. We also need to attend to other things, such as the brakes, headlights and fuel.

We need to consider several different aspects of child development to ensure that our children have happy and healthy lives. Services like health visiting can provide a range of support to families and identify if a child needs additional help with aspects of their health or development. These holistic, universal services can support different aspects of early development such as parent-infant relationships and language development, which have significant impacts on children’s wellbeing.

Children and families might need additional help from a range of other services, so it is important that there are clear pathways to ensure children and families get the help that is appropriate for their needs. In some cases, children might need specific interventions that address single issues, for others, more holistic interventions such as Family Nurse Partnership (a home visiting programme for first-time young mums and families) might be needed to support the child and their family across several domains of development.

Although it is vitally important to provide well-evidenced interventions, getting it right for every child is not simply providing the intervention with the strongest evidence base. It is about providing the intervention that works best for the child, their needs, and their context. (Just like in a car, there is no point in providing the best new tyres, if the issue was failed brakes).

The best start does not eliminate later difficulties

Even if we get our cars in top shape at the start of the journey, it will not guarantee future success. There may be challenges ahead. Even the best tyres will struggle on a very icy road or if they hit a nail. 

Similarly, even if children have the best start in life, they may need additional support along the way as new challenges emerge. A one-off intervention may be sufficient for some children, whilst others might need ongoing support. It is important to note though, that giving children the best start in life can mean they are in a better position to take advantage of later support.

We are currently doing a five-year follow-up of the children in the Healthy Start, Happy Start research. We know that children whose families received the brief intervention when they were one- and two-years-old showed lower levels of behavioural problems two years later. We now want to understand how much of the initial impact is sustained and if families need additional support as their children grow. 

Early identification is hugely valuable

In the car, early warning lights enable drivers or mechanics to pick up and address issues before they escalate and become more difficult to deal with: It is better to have a light to warn you that the pressure on a tyre is dropping, rather than to end up stranded with a flat tyre.

Similarly, early identification of both risks and issues in children’s mental health can enable us to act before problems emerge or escalate. These risks might be apparent very early or may emerge over time. Therefore, we need well-resourced services, such as early years practitioners and health visitors, who have contact with babies and young children, and have the opportunity, skills, and tools to identify if the child is exhibiting any developmental delays or problems, or if there are risk factors for them and their families. 

Our Helping Little Minds Thrive project will be developing new ways to support early identification to help professionals to target early support to children whose mental health is at risk.

Adversity might cause problems that are not immediately visible

Back to our car: An incident, such as hitting a nail in the road, might immediately cause obvious harm and send a car off-course. Or it might cause an issue like a slow puncture - which is not obvious at first but emerges over time.

Similarly, early traumatic experiences such as maltreatment or family breakdown, can have immediate impacts on children’s wellbeing and development. But in some cases, there may not be visible impacts, but changes to the child’s developing cognitive and biological systems might make them more vulnerable to problems later in life. This is “latent vulnerability.” It means we should consider what additional support should be provided to children who experience adversity, even if they are not yet exhibiting any problems.

Relationships matter

Ensuring a smooth journey is not just about getting the car into the best shape. We also need to look at the people around the car, such as the driver and navigator. Right from the start, a successful journey depends on the car, the driver, and the interactions between them. Later, other people will be involved in the journey, such as mechanics who may service the car.

Similarly, a child’s mental health is shaped by their relationships. From pregnancy, interactions and relationships with parents or caregivers are particularly important for early development. Sensitive, responsive, and consistent care is a critical ingredient of good mental health.

Supporting parents to tackle issues in their own lives, such as mental health challenges or relationship conflict, not only improves parents’ wellbeing but also helps them to have the capacity to provide their children with the nurturing care they need to thrive. 

The environment matters

Context is important too. Ideally, every car would drive on a safe and well-maintained road. But some vehicles may end up on more difficult terrain and may need additional support to deal with this. 

We improve children’s mental health not only by focussing on individual wellbeing and resilience, but also by addressing risk factors in families, communities and wider society that might harm children’s mental health. Poverty and parental stress for example, make parenting harder and put children’s mental health at risk. We can tackle inequalities in mental health through addressing structural factors, like poverty, which put some children at greater risk of poor outcomes.  

We may not always be able to tackle the persistent challenges that families and communities face, such as poverty, disadvantage and intergenerational trauma. However, we can provide additional, high-quality support to families to mitigate the impacts of these risks for babies. Targeting high-quality support towards families facing adversity helps to ensure all children have the best chance of a happy, healthy life. 

Our Playtime with Books research supports early parent-child relationships by helping parents to spend quality time interacting with their babies. The research is especially interested in refining how the support is delivered so that it reaches families facing the highest levels of disadvantage and works for them. 

In complexity comes opportunity

The analogy of the car shows us that there is no single way to ensure a smooth and successful journey, but there are many ways to make a difference. Securing children’s mental health now and in the future requires the universal promotion of good mental health and early identification and prompt action when risks or issues occur. It is more complex than a single vaccination, but that complexity also represents opportunity. There are many ways in which policymakers and practitioners can improve children’s lives and life chances, and many reasons why it is important to invest in strong support from the start.