It's hard to imagine an 8-month-old baby being clinically depressed, but Rahil Briggs has seen it. Briggs, a child psychologist at Montefiore Medical Center in New York, treats tiny babies who have "flat affect"—no joy in the things that a baby would normally delight in, such as playing with parents or discovering a new toy.
If this shocks you, you're not alone. Many pediatricians aren't aware that depression can be a problem for very young children. Many parents aren't, either. Count me among them. I called Briggs to find out how we parents can tell if a young child is depressed, as compared with the annoying whining I get from my 6-year-old when the laces on her sneakers don't line up properly.
"Depression as a young child can spark long-term problems with social and emotional development," said Briggs, who directs the Healthy Steps early intervention program at Montefiore. And preschoolers who are depressed are more likely to be depressed one and two years later and to not snap out of it, according to new research from Washington University in St. Louis. In other words, this is real clinical depression. But Briggs says many people are surprised at that. "There are still people who say, 'What are you talking about? Is this a baby on the couch?' "
So how do you tell if your baby or preschooler is depressed? Any prolonged loss of interest in activities or ongoing disturbance in eating or sleeping is a sign. (This doesn't mean a 3-year-old who refuses to nap or a 2-year-old who's decided she's only eating cookies.) If your kid brightens up when it's ice cream day, that's not depression, Briggs says. "If they can't express that excitement, that's when I start to worry." Ask your pediatrician for help and a mental health referral, or look to groups like zerotothree.org for information on mental health programs in your state.
Treatment depends on a child's age, but it almost never includes antidepressant medications. Briggs has a conversation with a child who is old enough to talk about feelings and why people feel the way they do. With a child too young to speak, therapists often use play therapy. Always, the treatment needs to include the parents or other caregivers. "What we're saying is something's going pretty wrong here," says Briggs. "We've got to address the caregiver dynamic, the levels of stress in the home. A good standard of treatment is going to be very family-focused."
I wrote recently about how hard it is for teenagers to get help for depression. It's even harder finding quality care for younger children with mental health issues. Here are some practical ways to find affordable mental-health care for your family.