The carefree exuberance associated with young children can make the concept of childhood depression difficult to imagine. It is not surprising then that the existence of mood disorders in children has gained acceptance only in the last few decades. While debate continues regarding conceptualisations of childhood depression, evidence from over 20 years of research suggests that the major affective disorders often begin early in life. This article will outline current knowledge of childhood depression, including recent etiological evidence and implications.
There is no formal diagnostic category specifically for childhood depression, with the mood disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) intended to apply to both adults and children.
The key feature of clinical depression is a persistently depressed mood, or pervasive loss of interest or pleasure in nearly all activities. However, for children and adolescents, this mood may be one of irritability rather than sadness. Associated symptoms include feelings of worthlessness, concentration problems, energy loss, and unusual changes in appetite or weight.
These symptoms may occur in the context of major depressive disorder, which is marked by acute depressive episodes lasting at least two weeks, or in dysthymic disorder, in which such symptoms persist chronically for at least two years. Also grouped with the mood disorders is bipolar disorder, which is characterised by intermittent manic episodes. While this article focuses on unipolar depression, much of this information may apply to the less understood disorder of bipolar depression also.
For a number of years there had been some controversy over the appropriate timing of complementary foods to infants. It is with this background that the World Health Organisation (WHO) requested a review of the literature to establish the appropriateness of their recommendations. As a consequence, new guidelines were released in 2001 (WHO, 2001). The new guidelines recommend that complementary foods should be delayed until 6 months. It has been stressed in the literature review, however, that this is a population based recommendation and that infants must be managed individually so that appropriate interventions are provided (Kramer & Kakuma, 2004).
By all standards of good nutrition, babies younger than four months who are exclusively breast-fed, or appropriately artificially fed, should not be given solids. The case for delaying complementary foods is based on the health of breast-fed infants and their mothers. The strongest evidence for the recommendation from the infants’ perspective is a reduced incidence of gastrointestinal disease and the absence of any growth deficit. For mothers, the benefit is in prolonged lactational amenorrhoea and greater post-partum weight loss (Kramer & Kakuma, 2004).