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Just like with bullying, schools struggle to help children cope with mental health problems. It helps if they already have a diagnosis. Many experts say there are danger signs even in children too young to go to school. A program in the Bronx is helping families recognize those warnings in infants and toddlers. WAMU's Kavitha Cardoza reports.
KAVITHA CARDOZA, BYLINE: Rahil Briggs, a child psychologist, walks the pediatric corridors of a health care center in the South Bronx. It's one of the poorest urban areas in the country.
(SOUNDBITE OF BABY CRYING)
CARDOZA: Crying babies don't face Briggs. She looks relaxed, like she just finished a yoga class. Briggs says babies' brains are sticky.
RAHIL BRIGGS: That's why they can learn Spanish in six months and it takes us six years. But that's also why, if they're exposed to community violence or domestic violence, it really sticks.
CARDOZA: Briggs watches both baby and parent. Does the baby look to the parent for comfort, and does the parent respond? When babies feel secure, it's far more likely their social and emotional development will be healthy, and that's the basis of mental health.
BRIGGS: If a baby feels safe, a baby will explore. And if a baby explores, a baby will learn.
CARDOZA: What can interfere with that learning? Things like divorce, neighborhood violence, poverty. Briggs says half of all children with mental illness show symptoms before they're 14.
BRIGGS: I don't want to wait until a child has missed five days of school because his anxiety is so bad that he can't get on the school bus. That, to me, is a red flag. I want to see the pink flags. And what I mean by that is the first day that he starts to chew on his shirt a little bit when you say tomorrow is school.
CARDOZA: The best place to spot these pink flags, she believes, is in a pediatrician's office. It's a place all new parents bring their babies regularly. It's also a place they trust, and that's the whole point of the Healthy Steps initiative at the Montefiore Comprehensive Health Care Center.
NINA CASTALNUOVO: Hey, girls. Oh, my goodness.
CARDOZA: Nina Castalnuovo, a pediatrician, bumps into a stroller as she enters the room. It's a full house today. There's Katherine and her daughters. Emma Rose is 2, and the twins are 1 - Kimberly Rose and Emily Rose. We're not using their last names to protect their privacy.
CASTALNUOVO: Emma, you look excited. You want to go next? I'm going to listen. Let's find your heart. Do you hear it? Boom, boom, boom, boom, boom, boom, boom, boom, boom.
CARDOZA: Pediatricians typically spend just a few minutes with each patient. There's no way Castalnuovo has time for a lot more than a physical exam, but today, the mother is worried. Katherine says her daughter, Emma, hasn't gained any weight in the last year.
KATHERINE: It's, like, the big deal of this appointment is, like, her weight. Like, you've got to go in there. She's got to be at least 24, 25. She's still 23, but...
CASTALNUOVO: I think she can also pick up a little bit that you're anxious about this, you know?
CARDOZA: So that's where the Healthy Steps program kicks in. Dr. Castalnuovo brings in Rahil Briggs. In other words, instead of the pediatrician giving the family a referral to a child psychologist, which they may never follow up on, Briggs is right here, close at hand. This is called a warm handoff, and it's a key part of this program. Briggs says battles over feeding, toilet training, sleep may indicate an underlying struggle and, if excessive, might have psychological roots.
BRIGGS: It's mostly in the social relationships and the parent-child relationships and not something medical.
CARDOZA: Again, those little pink flags. Briggs is reassuring. They work out a plan for Emma.
BRIGGS: Number one, we never want to force her to eat. Number two, we don't want to get into that struggle with her, into that back and forth, right?
CARDOZA: Briggs will follow up with the family over the next few months. She says it's all about empowering parents so they feel more confident. Briggs makes it very clear she's not diagnosing little tots as mentally ill. It's all about those little pink flags.
BRIGGS: I know a lot of people feel like normal childhood suddenly gets a diagnosis now, and that's not at all what we're trying to do. Everything starts somewhere. Diabetes starts somewhere. Obesity starts somewhere. And mental illness starts somewhere.
CARDOZA: Briggs says she's trying to focus on that starting point because, if we can predict it, she says, we can prevent it. For NPR News, I'm Kavitha Cardoza.
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