Module 4: Promoting Mental Health in Early Childhood


Feeling Valued and Capable

In order to experience a feeling of competence, it is necessary to feel responsible for the actions or outcomes that demonstrate competence. Experiences of personal success are a major contribution to children’s self-esteem. Opportunities for success should be made available to children at whatever level they can achieve.

Questions to Ask

  • What are some new things your child is doing?
  • Does your child like making independent decisions about what to eat and wear or where to play?
  • What are some of his favorite activities?
  • To what extent has your child developed independence in eating? Dressing? Toileting?
  • What other things can he do for himself?

Provider Tips

  • Help parents assess their child’s skills, temperament, and strengths.
  • Make a distinction between high expectations and damaging pressure to succeed. Point out that a child’s wish to please her parents may result in a sense of failure if expectations are not reasonable. This may lead to resistance, resentment, and damaged self-esteem.
  • If parents appear to have unrealistic expectations, help them devise at least one expectation that is appropriate for their child’s developmental level (see Bright Futures developmental milestones Information appears in a pop up window).
    Milestones at 12 Months
    • Pulls to stand, cruises, and may take a few steps alone
    • Plays social games such as pat-a-cake, peek-a-boo, and so-big
    • Has precise pincer (thumb-and-finger) grasp
    • Points with index finger
    • Bangs two blocks together
    • Has vocabulary of one to three words in addition to “mama” and “dada”
    • Imitates vocalizations
    • Drinks from a cup
    • Looks for dropped or hidden objects
    • Waves “bye-bye”
    • Feeds self
    15 Months
    • Has vocabulary of 3 to 10 words
    • Can point to one or more body parts
    • Understands simple commands
    • Walks well, stoops, climbs stairs
    • Stacks two blocks
    • Feeds self with fingers
    • Drinks from a cup
    • Listens to a story
    • Indicates what he wants by pulling, pointing or grunting
    18 Months
    • Walks quickly or runs stiffly
    • Throws a ball
    • Has a vocabulary of 15 to 20 words
    • Imitates words
    • Uses two-word phrases
    • Pulls a toy along the ground
    • Stacks two or three blocks
    • Uses a spoon and cup
    • Listens to a story, looking at pictures and naming objects
    • Shows affection, kisses
    • Follows simple directions
    • Points to some body parts
    • May imitate a crayon stroke and scribbles
    • Dumps an object from bottle without being shown
    2 Years
    • Can go up and down stairs one step at a time
    • Can kick a ball
    • Can stack five or six blocks
    • Has vocabulary of at least 20 words
    • Uses two-word phrases
    • Makes or imitates horizontal and circular strokes with crayon
    • Can follow two-step commands
    • Imitates adults
    3 Years
    • Jumps in place, kicks a ball
    • Rides a tricycle
    • Knows name, age, and sex
    • Copies a circle and a cross
    • Has self-care skills (e.g., feeding, dressing)
    • Shows early imaginative behavior
    4 Years
    • Can sing a song
    • Knows about things used at home (e.g., food, appliances)
    • Draws a person with three parts
    • Is aware of gender (of self and others)
    • Distinguishes fantasy from reality
    • Gives first and last name
    • Talks about his daily activities and experiences
    • Builds a tower of 10 blocks
    • Hops, jumps on one foot
    • Rides tricycle or bicycle with training wheels
    • Throws ball overhand
  • Discuss any delays in abilities revealed by developmental screening instruments. These delays may point to areas in which the child has not had the opportunity to develop.
  • Using the guidance listed below, discuss ways parents can help their child feel competent.

Guidance for Parents

  • You can help your child feel competent by providing him with challenges that are appropriate for his age, such as drinking from a cup, brushing his hair, or dressing himself. Although it may be tempting to step in and do things for your child, he will learn more and feel better about himself if you allow him to do the things he is able to do for himself. Praise him for trying as well as for being successful.
  • Simple household chores offer another chance for your child to feel good about his abilities. Let him help by putting napkins on the table, feeding the dog, putting his clothes away, or cleaning up his toys.
  • You may have to make minor changes to your home in order for your child to be able to do simple tasks easily and safely. The following are some ideas that you might try:
    • Make room for his toys on a low shelf or a large basket
    • Give him a small stool so he can reach the table or the sink Place hooks at his level so he can hang up his clothes
    • Choose clothes with big buttons and elastic waistbands
    • Buy shoes with Velcro closures
  • Try not to rush your child or criticize him when he is doing something by himself. Give him enough time to complete a task. Even though you are busy or feeling rushed, remember that your child may need a little more time to do things. If he feels hurried, he may become frustrated and feel incompetent.
Provider Resources

What Can Your Child Do? PDF

Bright Futures Case Studies for Primary Care Clinicians: Global Delay: Will David Catch Up?

Area of Concern: Effects of Trauma on Self-Esteem and Development more information

Traumatic events, such as abuse, the death of a parent, or witnessing violence, can damage children’s self-esteem and lead to the stalling of or regression in the acquisition of developmental skills.

Monitor children for significant and/or traumatic life events regularly. Asking parents questions such as “Have there been any changes in your family since our last visit?” may help elicit information about significant events such as divorce, deaths, and moves.

Discuss the importance of supporting children who have been traumatized. Advise parents to give these children accurate, developmentally appropriate information; to encourage them to express their feelings; and to allow them to regress temporarily. Monitor the child for signs of emotional distress (e.g., changes in activity level, irritability, changes in eating and sleep patterns), and refer the child to a mental health professional if signs of distress or diminished functioning appear.

Childhood Grief/Bereavement PDF is a comprehensive discussion of the traumatic experience of the death of a parent or other loved ones and includes suggested interventions.

Copyright Georgetown University Georgtown University Early Childhood