‘Early Experiences Matter’ for Mental and Behavioral Health of Infants, Young Children

The P2P study provides insight into risk and resilience factors in early development, by identifying the ways in which the confluence of parents or caregivers and environmental factors and mechanisms critically influence early child development and mental health.

Editor's Note: Where Discovery Leads is a multimedia storytelling project that delves into key research themes at Children's Hospital of Philadelphia Research Institute. This is part one of a five-part series that focuses on the scientific studies aimed at addressing behavioral and mental health.

Complementing the series is a brief video featuring Tami Benton, MD, Psychiatrist-in-Chief, as she highlights CHOP's behavioral health lifespan research, which is moving treatment closer to personalized medicine.

The first five years of life are a critically important period of physical, social, cultural, and emotional development in the lives of children, as 90% of the brain develops during this time period. It sets the foundation for young children's future health, development, and well-being.

Additionally, social determinants of health — including where young children and families live, work, and play — are crucial in understanding how contexts impact health and development.

Leading the research in this area at Children's Hospital of Philadelphia Research Institute is Wanjikũ F.M. Njoroge, MD, an infant and preschool psychiatrist. Dr. Njoroge started the Young Child Clinic at CHOP, where patients 5-years-old and younger are seen for emotional and behavioral challenges. Her research focuses on identifying targets for interventions, to optimize health outcomes for infants and their parents including families from historically marginalized and disenfranchised populations.

"From a research perspective, if I'm trying to move the needle and help with outcomes, then the best time to do any kind of behavioral health research is with families of very young children," said Dr. Njoroge, who is also a faculty member of PolicyLab. "To ensure that all children have optimal development and good mental or behavioral health, the earliest years are a perfect time to intervene." Helping parents and families with very young children to think about their own experiences and what that means is crucial to prevent challenges and promote health — because early experiences matter."

Behavioral Health Lifespan Research: Moving Closer to Personalized Medicine. Access the video transcript.

Prenatal to Preschool Study

Wanjikũ F.M. Njoroge, MD

Dr. Njoroge's current research involves the longitudinal study, "Prenatal to Preschool: The Pandemic's Impact on Mothers and Children, Focusing on Syndemic Effects on Black Families," or P2P. Funded by the National Institute of Mental Health, this prospective research longitudinally observes and evaluates the simultaneous effects of the COVID-19 pandemic and structural racism among a cohort of mothers, caregivers, and their developing children recruited during the initial phase of the pandemic.

This ongoing study provides insight into risk and resilience factors in early development, by identifying the ways in which the confluence of parents or caregivers and environmental factors and mechanisms critically influence early child development and mental health.

"We want to tell an increasingly nuanced story about the impact of the past five years on families," Dr. Njoroge said. "We hope to be able to specifically delineate those experiences through our research study P2P."

The researchers followed mothers, secondary caregivers, and their children through the years, checking in with detailed questionnaires assessing mental health, racism, support, and resilience, among other items at multiple time points beginning when the child was 24 months old. They conducted clinical interviews with the mothers, gathered electronic medical records of mothers, and videotaped dyadic interactions with mothers and children at 24 and 48 months old. A subset of Black participants was asked to participate in qualitative interviews when the child reached 36 months old.

"The overarching goal of this project is to deeply characterize the experiences of women, children, and families impacted by the syndemic, filling the gap in the research by identifying specific maternal and environmental factors and mechanisms that critically influence early child development and mental health, allowing for future intervention development," Dr. Njoroge said.

Early experiences matter, and those experiences are broad, according to Dr. Njoroge. It's all about the child's experiences of the world, which include their parents' experiences of the world and the context in which children and families find themselves. That context may not just be the home but a larger environment, which can include a pandemic, gun violence, or neighborhood violence.

"We need to understand all of these larger environmental stressors," Dr. Njoroge said. And families need to feel comfortable in talking to those of us who see them clinically so that while we may not be able to help certain environmental contexts (i.e.: neighborhood violence, lack of green spaces, and the like), we can certainly work together to find tools and effective strategies of how to handle these stressors such that it doesn't impact their health or that of their babies."

The journal JAMA Psychiatry published the findings.

Real-life Implications

With the oldest child in the study recently turning 5 years old, the data collection portion is now complete, and the analysis and writing stage has begun.

The researchers hope to tell a story that will allow policymakers to understand in real time how multiple intersecting stressors impact mother/child dyads and can affect early childhood development. While data are still emerging, initial findings reflect some of the impacts of the pandemic on parental and child mental health.

To date, Dr. Njoroge and her team have detailed how different women experienced the pandemic with some reflecting the importance of race, socioeconomic status, and partner support. For example, data collected in April 2020 demonstrated that Black women with greater COVID-19 negative experiences and greater rates of perceived racism were at increased risk of postpartum anxiety and depression compared to their non-Latinx white peers.

Taken together, the pandemic crisis and the experiences of families with very young children are concerning to the researchers due to unparalleled growth and development during this life stage and risk for disruptions in positive parenting.

"The piece we will be able to tell is not just the risk factors but also the resilience factors," Dr. Njoroge said. "How families were able to, in the midst of all these challenges, still do well. How these babies were able to grow and develop in a way in which researchers and clinicians would consider optimal."

For more information, see this PolicyLab video: Behavioral Health at the Earliest Ages: Building an Evidence Base.