The six-month-old baby boy seemed healthy but didn't cry or coo or make a fuss – he just lay patiently, silently, in his crib for long periods of time. It would be easy to think. `What a good baby, not demanding at all'.

But the baby in this scenario might actually be in a lot of trouble. He may be exhibiting signs of depression and withdrawal, and that's why he just lies there, says Chaya Kulkarni, director of infant mental health promotion at the Hospital for Sick Children.

"Other (depressed) babies may be inconsolable – and cry almost like a grieving mother," says Kulkarni.

The problem with depressed infants and toddlers is that they can't tell anyone in words what's wrong – so professionals need tools to assess the diverse signs of young children struggling with mental illness, often in complex home situations, Kulkarni explains. They have to know what sort of circumstances put these most vulnerable children at risk.

That's why SickKids saw a need for a course for front-line professionals – anyone who works with infants and children under the age of 3 – so they could recognize environmental risk factors, as well as the early signs of infant/toddler depression and mental illness, and get them help.

The hospital teamed up with York University in 2002 to develop and offer the 120-hour Certificate in Infant Mental Health, which involves eight courses offered through the school's continuing education department.

"There's been a lot of research about early brain development, and a greater understanding of how critical those early years are," says Kulkarni.

It's believed that the first three years of life have a formative impact on development, relationships and how people function throughout life. There has also been recent medical research indicating a correlation between infant trauma and long-term illnesses later in life, says Kulkarni.

"If we don't support those years properly, or if children experience trauma or some issues of mental health and it's not addressed properly, the impact is lifelong."

"The reality is that social workers or physicians or child-care workers or nurses – most of them have no training in infant mental health," says Kulkarni.

"So they are the ones who are working with these little guys ... who may be the only professionals involved, and yet they're not actually very well-equipped in knowledge (of mental illness) and skills. And that really was the impetus for creating the Infant Mental Health certificate."

She says the course will help social workers assess the situation if, for example, they go into a home and spend 90 minutes with a mom and baby who never makes a peep.

"How an infant responds to a primary caregiver is really key – it tells us a lot about what is going on. You have to know what it means when you have an unresponsive baby ... when the mom walks in the room and that baby is indifferent. We know that's not normal."

The students also look at the factors that place infants "at risk" of developing some form of mental illness.

These include a wide range of circumstances, from dysfunctional family settings to a mother's postpartum depression or a parent's own mental illness.

They also explore options to prevent infant mental illness in those high-risk situations, and how to assess what intervention may be appropriate.

Kulkarni says the certificate program has a good reputation. "Other provinces are calling to see how they can bring the course to their jurisdictions, which is very exciting."

Jodi Jaffray, an Ottawa-area early childhood consultant with Infant Development Services, took the certificate course at York in 2005 because she felt she needed to understand much more about infant-child mental health.

"Children's mental health is an area that is neither well funded nor well understood by much of our society," says Jaffray, who works with infants and children up to age 6 who are at risk of developmental delay or who have a diagnosed delay.

Her agency provides services primarily through home visits. Some of the children on her caseload are already getting therapy at the Ottawa Children's Treatment Centre, which provides a range of services for children, youth and some adults with physical and/or developmental disabilities.

"Since taking this course, I am much more aware of the need to focus first on the parent and child relationship when meeting new families," says Jaffray.

"This program also reinforced for me the need to help parents and caregivers to ... understand their infant's unique cues, depending on their developmental abilities, and respond to them in a consistent manner to foster a healthy attachment."

So far, 600 people have taken the York certificate course, says Marina De Bona, the school's program and logistics manager of continuing education.