This story contains multiple references to suicide, mental illness, and self-harm. If you or someone you know is thinking about suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text TALK to the Crisis Text Line at 741741.
American youth are in trouble. US Surgeon General Vivek Murthy has warned that youth mental health is one of the “significant public health challenges of the country”.”
When can problems be identified and addressed?
From infancy, says Dr. Wanjiku FM Njoroge, medical director of the Early Childhood Clinic at Children’s Hospital of Philadelphia.
Njoroge, the only child psychiatrist at CHOP, sees children up to age 5 who already experiencing behavioral problems, depression, anxiety or trauma.
“It’s very difficult for us to understand a 3– or 4– or 5–year–old people having these kinds of challenges, but we know they do,” she said.
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Address these issues early can have lifelong implications. Njoroge says 90% of the brain develops in the first five years of life – about 75% in the first three years. Traditionally, she says, child psychiatrists see patients around age 6. “But if 90% of the brain develops before that time, we’re really missing critical opportunities,” she said.
Njoroge worries about the impact of so-called “toxic stress” on the brains of small children. Stress in small amounts is a good physiological response. But when the stress is constant, as it has been for some families during the pandemic, it can be extremely damaging. “You’re literally killing developing brain cells,” she said. “And since 90% of the brain is formed in the first five years of life, that changes everything.”
Cracks in this neurological foundation can impact a child’s cognitive abilities, motor skills, and problem solving. But the fact that the brain is developing also means that it is time to act and prevent damage.
In Njoroge’s CHOP office, toddlers aren’t supposed to lie on child-sized couches and talk about their parents.
Young children may not be able to express how they feel, she says, but they can express themselves through play.
“What you’ll see in every early childhood person’s office is a dollhouse and a whole bunch of dolls for the child to create what their family looks like,” Njoroge said, pointing out that in her office there are dolls with phenotypic differences so children can find dolls that look like them. Other times, she might use dinosaur toys to allow children to express their aggression.
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She also wants to see how the child interacts with each of her primary caregivers. Njoroge and his team speak separately with anyone who spends a lot of time with the child – parents, family friends, grandparents, aunts and uncles.
“When you see a patient, you also see their family,” she said.
And while the conclusion may be that a young child is anxious, traumatized, or depressed, other adult diagnoses do not apply to early childhood.
“Just because they have a friend you can’t see, are they psychotic?” No. They are 4,” Njoroge said.
The purpose of this assessment is to make a plan that could include various forms of therapy, whether at CHOP or in the community.
Njoroge says that over the past decade mental health issues in children have worsened, especially for black children.
“We talk about the increase in suicidality in black children as young as five years old,” Njoroge said. “It’s frightening.”
In 2021, with colleagues from CHOP, she co-author of a study in the Journal of the American Academy of Child & Adolescent Psychiatry which revealed that preadolescent black Americans thought and attempted suicide at higher rates compared to their white peers, and that the increase was associated with exposure to discrimination.
In the past, she says, there was a outdated belief that only older teens think about suicide and that it’s not a problem for black kids. But recent data shows that none of this is true, she said.
For nearly a century, studies have shown that very young children can internalize negative ideas about having darker skin – and darker-skinned children can extend these thoughts to how they look. perceive.
The impact is so profound that a pregnant woman’s experiences of racism can have an impact on their baby’s development, she says.
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“We know from this body of research that racism is like the air we breathe,” Njoroge said, adding that children are exposed directly through their experiences with racism and indirectly through those of their parents.
The solutions don’t stop at the psychiatrist’s office, she says.
Talking to young children and reading books about race aloud can help them learn that “it’s okay to recognize color differences.” She says a workplace leave policy that allows parents to care for their child and breastfeed if they wish without losing income can prevent toxic stress.
“If we do these things early on, we don’t have to worry about me being the only child psychiatrist at CHOP,” Njoroge said.