Can Babies Be Depressed?

Infants don't have a life history to weigh them down or make them sad, but that doesn't mean they can't experience depression. Many mental health professionals believe, based on case studies and clinical experience, that babies can and do become depressed.

"There is a perception that early childhood is supposed to be a happy and carefree time but, in many ways, childhood can be overwhelming and scary," notes Christina Fiorvanti, PhD, a pediatric psychologist in the pediatric behavioral health integration program at Montefiore Health System.

"Little is known about depression in infants because these children don't have language to express their feelings, fears, or wishes," explains licensed psychologist Patricia A. Farrell, PhD. "The only way we know that they are depressed is to look at changes in their behavior," she notes.

This article discusses some of the signs of depression in infants and some of the potential causes. It also explores what parents and caregivers can do if they notice signs of depression in their babies.

Symptoms of Infant Depression

Infant mental health includes a child's ability to express emotion and engage with the people around them, explains Mary Mackrain, MEd, IMHP-IV, director of maternal and child health at the Education Development Center. Important social milestones include calming when being held and smiling in response to attention from caregivers.

"As infants grow and develop, they may often have days when they exhibit less social-emotional well-being and an increase in irritability, sadness, or engagement, but this typically passes. For example, if a parent transitions back to work or an infant is not feeling well, you may notice more expressions of sadness or fussiness for a few days," Mackrain says.

While all children will have days when they are less socially or emotionally engaged, longer-lasting periods of irritability or withdrawal might be a sign of a problem.

One of the primary ways to recognize depression in infants is their emotional vitality. In order to gauge this, ask yourself the following questions:

• Does my baby appear withdrawn, perhaps frequently staring into space?
• Does my baby's facial expression appear sad (infrequent smiling)?
• Is my baby expressing a vibrant range of emotions?
• Is it difficult to get my baby to engage with me socially?
• Is my baby quiet and subdued?

Rather surprisingly, crying is not necessarily a sign of a depressed baby. In fact, a depressed infant may get labeled as being a "good" baby because they do not cry or make a fuss that often.

Although different babies will naturally have different personalities and temperaments, if this behavior represents a change from your child's normal behavior, it could be a sign of depression.

Causes of Depression in Babies

During previous points in history, many people believed that it was not possible for infants or even children to become depressed. More recently, scientists and physicians have recognized that pediatric depression is not only possible but perhaps much more prevalent than previously thought.

"Early on, the psychodynamic folks said infants couldn't be depressed because their egos had not yet been developed," explains Lea A. Theodore, PhD, a licensed psychologist and professor at Adelphi University. She notes, however, that "the same symptoms are seen in infants as adults—lack of interest, dulled senses and responses, sleep/eating issues, irritability, lethargy, and in extreme depressive conditions, failure to thrive."

Although the exact causes are not fully understood, there are several possible causes of depression in infants. Like other types of childhood depression, multiple components may contribute, such as:

• Brain chemistry
• Environmental factors
• Genetics
• Mental health of the parent or caregiver

Since babies learn a lot about their emotions from those around them, if a parent has depression, the baby may have a greater chance of developing it. Infants in poor or abusive homes are also at an increased risk.

It was previously believed that premature birth might be connected to an increased risk for pediatric depression. However, one 2017 study found no differences between full-term babies and premature infants. 

What the study did find, however, was that infants were more likely to develop depression prior to age two if they had stronger connections between the amygdala and other areas of the brain. The amygdala is often referred to as the fear center of the brain. 

However, the researchers note that environmental factors also play an important role. Experiences can impact how genetic predispositions are eventually expressed and can also play a role in changing connectivity patterns in the brain.

Diagnosis of Infant Depression

Recognizing possible symptoms of depression is important. But if a baby exhibits some signs of a depressed mood, it doesn't necessarily mean that they are experiencing clinical depression.

According to the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood "(the DC:0-3R), which was published in 2005 by a non-profit organization called Zero to Three, the following five conditions should be met in order for a diagnosis of depression to be made in an infant:

• The emotional and behavioral patterns must represent a change from what is typical for the child.
• A depressed or irritable mood must be present every day, for most of the day, over a period of two weeks.
• The depressed symptoms should occur in more than one activity and within more than one relationship.
• The symptoms must cause the child distress, impair their functioning, and/or impede their development.
• The symptoms must not be due to a general medical condition, a medication, or an environmental toxin.

Babies who show signs of depression may be more likely to experience depression and other mental health issues as they grow older. If you notice signs that your child is experiencing depression, talk to a healthcare provider for advice and treatment options.

Treatment for Depression in Babies

If your child has only been experiencing these symptoms for a few days, it may well be that they are simply going through a brief upset related to your absence which will quickly pass as they adjust to the return of your normal routine.

"If you are concerned about your infant's behavior, you should talk with your child's doctor and ask about social and emotional screening," Mackrain suggests.

If your infant continues to have difficulties, you may wish to make an appointment with a parent-infant psychotherapist or another mental health professional with experience working with young children.

Although medications and therapy are not administered to children so young, a psychotherapist can work with you to help you better understand and fulfill your baby's needs so they feel safe and secure in their environment.

Early Childhood Interventions

Because the family environment is such a critical part of infant development, treatment needs to include both the child and their caregivers. "There is an array of treatments available for infants and families. It is important families get access to treatment that fits their unique needs and culture and has evidence of being effective," says Mackrain.

Professional early intervention services can play an important role in protecting the mental health of both children and caregivers. Talk to your child's healthcare provider to learn more about programs and services available in your community.

This might include services that pair a mental health professional with the family in order to provide services in the child's home. Mackrain also notes that Part C early intervention programs, which are designed for children from birth to age three, offer family-driven services in a child's natural environment.

"Keep in mind that any assessment and treatment for early childhood depression should be dyadic, meaning that the parents are actively involved with the intervention," Fiorvanti says. "You are the expert on your child and you have the biggest impact on their social-emotional development."

Coping With Infant Depression

Deciphering your infant's emotions is never easy, and throwing the possibility of depression into the mix can make it even more daunting. After all, babies are unable to verbalize their mood or describe how they're feeling or what they're experiencing.

According to Dr. Farrell, physical contact and verbal interactions are important when a child experiences symptoms of depression. “Show interest in the baby and what it does in its continuing mental and physical development,” she suggests. She also recommends physical stimulation such as toys, age-appropriate children's picture books, and playtime with other children in the home.

Dr. Fiorvanti also recommends strategies such as child-directed play and age-appropriate books. "One of the best tools we have for helping children who are experiencing social-emotional distress is play," she suggests.

Parent Mental Health

One of the best ways to cope as a parent or caregiver is to take steps to protect your own mental health, which includes getting help if you're also living with depression or coping with postpartum depression.

"Parental depression, in particular, is a major risk factor for a child’s social-emotional development, and obtaining the correct help for the parent often significantly improves the child’s mental health," explains Dr. Fiorvanti.

If you are wondering whether you might be experiencing postpartum depression or postpartum anxiety, set up an appointment with your obstetrician right away. Treatments are available that can help you feel better.

Caring for your infant means caring for their physical health as well as their emotional health. If you start early, you can make mental health a priority in your family and prevent depression from manifesting into more severe problems later in life. 

"Mental health is part of every child's overall health and well-being and is as important as physical health," Mackrain notes. "Don't worry, but don't wait if you have concerns about your child. You know them best."

If you suspect that your infant has depression, talk to their pediatrician. In addition to helping your child, you should also make sure that you are caring for your own mental health, particularly if you might be experiencing symptoms of postpartum depression.