Preschool (age 2 to 4)

Preschool (age 2 to 4)

  • Good mental health, wellbeing, and cognitive development in under 5s is shaped from before conception by a complex interplay between genetic factors, and environmental protective and risk factors (Khan, 2016).
  • There are strong associations between untreated parental mental health conditions during the perinatal period (pregnancy and the first two years after birth), and the development of child mental health conditions. Infant mental health (under 2s) is covered in chapter 3 of the mental health needs assessment.

Local strategies

Recent local strategies have aimed to provide early support for parents and young children experiencing poor mental health, as well as early identification and support for ‘at risk’ families.

Table 6: Summary of recent local strategies relating to the mental health of children aged 2 to 4

Demographics

  • There were 48,630 under 5s in Cambridgeshire and Peterborough in 2021, which is equivalent to 5.5% of the total population (Office for National Statistics, 2022b).
  • There was a 4.1% decline in the population of under 4s from 2011 to 2021 (Office for National Statistics, 2022b).
  • There is a greater concentration of under 4s in Peterborough, where this age group makes up 7% of the population (Office for National Statistics, 2022b).

Mental health need

  • Almost all young children go through ‘phases’, such as experiencing anxiety in new situations, which resolve as part of typical child development. Some children become stuck in negative patterns of relating to the world, which can be distressing for both the child and their parents or carers (Khan, 2016). This can include excessive crying and persistent sleeping difficulties.
  • Between the ages of 2 to 4, poor child mental health, development or neurodevelopmental difficulties tend to be identified by the persistence of severe difficulties and tracking developmental milestones (Khan, 2016). Some children will continue to experience difficulties: longitudinal studies suggest that half of children showing high levels of disruptive behaviour at age 3 and 4 continue to show this behaviour at school age (Gardner & Shaw, 2009).
  • A large-scale national survey carried out in 2017 found that 5.5% of preschool children (aged 2 to 4) may have a mental health condition. The rate was higher in boys (6.8%) than in girls (4.2%) (NHS Digital, 2018).

Note that autism and ADHD are not mental health conditions, but have been included in these estimates as diagnoses are accessed through child and adolescent mental health services (via YOUnited).

Table 7: Estimated prevalence of mental health conditions in children (aged 2-4) in Cambridgeshire and Peterborough. Data source: Children and Young People Mental Health Dashboard. Note: lower and upper estimates are generated from 95% confidence intervals.

The vast majority of 2- to 4-year-olds with a mental health condition, have a condition that is specific to their age group. Definitions of these conditions are included in this survey report.

Table 8: Estimated prevalence of conditions specific to preschool children in children (aged 2-4) in Cambridgeshire and Peterborough. Data source: Children and Young People Mental Health Dashboard

Protective and risk factors

In 2021/22, almost 3 in 10 (29%) children in Peterborough did not achieve a good level of development at 2 to 2.5 years, compared to 16% of children in Cambridgeshire (Office for Health Improvement and Disparities, 2022). Levels of good development are below the national average in Peterborough, but higher than average in Cambridgeshire. Whilst developmental assessments do not assess mental health, developmental delays identified at this age are associated with poorer long-term outcomes, including general wellbeing and mental health (Public Health England, 2019b).

Development outcomes at 2 to 2.5 years

Whilst developmental assessments do not assess mental health, developmental delays identified at this age are associated with poorer long-term outcomes, including general wellbeing and mental health (Public Health England, 2019b).

What is the local picture?

In 2021/22, 84% of children in Cambridgeshire achieved a good level of development at 2 to 2.5 years, compared to 71% in Peterborough (Office for Health Improvement and Disparities, 2022). Levels of good development have been consistently higher than the national average in Cambridgeshire, but consistently below average in Peterborough.

Figure 13: % of children achieving a good level of development at 2 to 2.5 years, 2017/18 to 2021/22. Data source: Fingertips

Note that only around 50% of infants in Cambridgeshire and Peterborough received this health check in the final quarter of 2021/22, in part due to staffing pressures on this service. Infants who miss these checks are at risk of not receiving support provided through these checks (Unicef, 2022).

What do families say is important in promoting mental health in young children?

  • A large national survey carried out in August 2022 found that (Unicef, 2022):
    • 2 in 5 parents in England with a child under 4 had been worried about the behaviour, or social or emotional wellbeing, of their child.
    • 59% of parents with a child under 4 report that they have struggled with their own mental health; with 1 in 10 not receiving any mental health support, despite wanting help. Parents on lower incomes are more likely to experience poor mental health.
  • National research involving parents whose child showed severe behavioural problems found that (Khan, 2018):
    • Even when parents were concerned about their child’s wellbeing and behaviour, they delayed getting help. Reasons for this delay included not knowing if their child’s behaviour was within healthy developmental ranges, not knowing where they should access support, and feelings of failure and stigma.
    • Most parents eventually sought out support, typically from GPs or schools, but few received early help. Some parents had to talk to multiple professionals before getting the help they needed.
    • Children’s challenging behaviour could impact wider family relationships, and the wellbeing of other children in the house. Many parents felt that attending parenting courses would help them to reduce family stress levels.

What works to promote good mental wellbeing?

Mental wellbeing is an important outcome in itself. Higher mental wellbeing is also linked to being better able to deal with stressful events, recover faster from illnesses, and being less likely to put your health at risk (Public Health England, 2019c).

Figure 14: Factors important for promoting good mental wellbeing in children aged 2 to 4. Adapted from: (Campion, 2019)

Starting well

Promoting good mental wellbeing and giving children a good start in life is a key aim of the Government’s Best Start for Life strategy (Department of Health & Social Care, 2021).

Figure 15: Giving every child the best start in life. Image source: UKHSA

Evidence-based interventions for this age group include:

  • Interventions that support parents and promote their mental and physical health (such as smoking cessation programmes and support with infant feeding) are linked with a range of positive outcomes for children, including emotional and social development (Campion, 2019).
  • Reviews show that parenting and home visiting programmes improve attachment in preschool children; and that parenting interventions can improve attachment in children (under age 13) with severe attachment difficulties (Wright & Edginton, 2016).
  • Family support programmes can improve parental self-esteem and child mental health (Kuhn & Laird, 2014). Programmes that provide multiple types of support seem to be the most effective.
  • A universal parenting programme for parents with children under 7, which ran across 3 English local authorities, showed significant improvements in parenting efficacy and wellbeing (Lindsay & Totsika, 2017)

What is the local picture?

Developing well

  • NICE guidelines cover promoting health and wellbeing in under 5s highlight that health visitors should discuss the factors that may pose a risk to children’s social and emotional wellbeing with parents and carers during each of their 5 key contacts with families; and that children should have their speech and language skills assessed at their 2 to 2.5 year integrated review (National Institute for Health and Care Excellence, 2016).
  • NICE guidelines on supporting the wellbeing of vulnerable children highlight the importance of home visiting and high-quality early education services for children at risk of developing, or already showing signs of, behavioural, emotional or social problems (NICE, 2012).

What is the local picture?

  • Many local families are struggling to manage childcare costs, in part due to the cost of living crisis (Jarvie et al., 2023).
    • The average cost of 25 hours per week of childcare for three- and four-year-olds (including the universal entitlement to 15 hours per week funded childcare) in the East of England is £89.85. This is 82% higher than the English region with the lowest price (£49.26 per week in the North West).
    • The East of England has the lowest level of provision for early years childcare across England.
    • There may be further variation in the cost of childcare within Cambridgeshire and Peterborough.

Additional resources 

References

Full list of references is included at the end of this chapter.

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