Emotional or Behavioral Problems in Children Younger Than 5 Years

Abstract

Symptoms suggesting social-emotional or behavioral problems in children younger than 5 years may occur inThe child (eg, irritability, fearfulness, dysregulation, difficulty adjusting to childcare or preschool)The caregiver (eg, negative attributions about child, unable to offer comfort, disengaged or excessively protective)The relationship between the child and caregiver (eg, lack of social reciprocity or focused attachment)Early identification requires surveillance for environmental risks, strengths, and adversities; formal psychosocial screening of the child and primary caregiver using validated tools; and observations of the child and caregiver(s).Assessment involves differentiating positive findings from normal variations, considering medical and developmental problems that may mimic or co-occur with social-emotional or behavioral disturbances, evaluating the caregiving environment(s), reviewing diagnostic criteria of disorders (DC:0–5; Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood), and, as indicated, referring the child and/or caregiver to an appropriate specialist.Pediatric clinicians can use "common factors" communication techniques to reinforce child and family strengths and reach agreement on achievable steps towardAddressing social adversitiesEncouraging healthy habits and activitiesOvercoming barriers to specialty referral for diagnostic evaluation and evidence-based therapy—recommended for any child/caregiver dyad with impairing symptomsWhile awaiting specialty services, pediatric clinicians can apply common elements of effective therapy: reduce family stress, promote positive parent-child interactions, coach in positive parenting principles, and teach relaxation and anxiety management.