Mental Health in Infants and Young Children

Julianna Finelli, MD1Mary Margaret Gleason, MD2,3Lindsay A. Thompson, MD, MS4

Author Affiliations Article Information

JAMA Pediatr. 2023;177(3):324. doi:10.1001/jamapediatrics.2022.5715

Emotions, behaviors, and relationships are the foundations of mental health and develop rapidly in the first years of life.

Like other development, genes, cultural expectations, and experiences shape patterns of mental health as children grow. Both positive and negative experiences impact mental health. The most influential experiences are relationships with important adults. Parents and caregivers support healthy emotional and behavioral development by being safe, predictable, and responding to a child’s emotional needs. Talking about feelings from an early age helps children learn to identify their own emotions. Children also learn about emotions by watching their caregivers. When they see their caregivers staying calm under stress, children learn to organize their own feelings.

Most children can organize their feelings and behaviors in ways that allow them to live, learn, and connect with others. Emotional reactions by themselves do not mean there are problems; everyone has feelings! However, about 1 in 6 young children have emotional, behavioral, and/or relationship patterns that interfere with development or everyday activities, and these problems can affect the child and family. Research shows these problems are linked to brain functioning and may increase the risk of future learning and mental health concerns.

A young child may need help when they show intense emotional or behavioral reactions or when those emotions or behaviors interfere with activities typical for their age and culture. A young child may have so much separation distress that they do not let a parent out of sight, even to use the bathroom or sleep. Other signs for concern might include extreme tantrums that happen many times a day or involve hitting or breaking things. Young children’s emotional reactions are developing, so how they express them may be mixed. For example, an anxious young child may cry, yell, or hit.

Pediatric primary care clinicians (PCCs) are experts in young children’s health. Bringing up concerns about a child’s emotions, behaviors, and relationships with PCCs allows children to get the support they need. Parents may also seek help with their own stress. Stress that is constant or overwhelming not only hurts parents, it can interfere with a child’s development. When parents get support, including for parenting challenges, the whole family benefits.

Your child’s PCC may ask you to complete questionnaires to help identify early emotional or behavioral difficulties or parent stress. When a PCC is aware of a concern, they can offer support and make connections with needed supports and therapies. Effective therapies include caregivers and focus on building strengths, practicing new skills, and organizing emotions. The good news is that these therapies work well, and they work better the earlier they are started.

Building strong foundations for mental health is just as important as for physical health. The important adults in a child’s life can provide the key ingredients for safe, stable nurturing relationships, and can ask their child’s PCC for help if they have concerns.

The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be downloaded or photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email

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Article Information

Published Online: January 30, 2023. doi:10.1001/jamapediatrics.2022.5715

Conflict of Interest Disclosures: Dr Finelli reported partial salary support from the Health Resources and Services Administration. Dr Gleason reported grants from Woebot and Hampton Road Biomedical Research Consortium and serves on the board of directors for Zero to Three outside the submitted work. No other disclosures were reported.