Background: Childcare center attendance is crucial for socio-emotional and cognitive development in toddlers and preschoolers, offering opportunities for peer interaction and relationships with caregivers outside the family. Children with disabilities, especially children showing externalizing symptoms in the context of mental disorders are at risk for exclusion from childcare settings. Thereby, the loss of peer and caregiver relationships can represent a significant psychosocial stressor, especially when accompanied by other stress factors affecting the patient but also the family system. Despite its potential impact, exclusion from childcare in psychiatric cohorts remains underexplored.Material & Methods: Ethical approval for the retrospective data analysis was obtained by the local ethics committee (Reference Number: 2025-420fs) for a Toddler and Preschoolers Cohort. Cases with patients who experienced full exclusion from childcare center attendance were selected as a case series.Case Presentation Summary: We present a case series of n=8 patients treated in a psychiatric day clinic who were affected by full exclusions from Childcare center attendance. N=7 patients were male, N=1 patient was female. Among the total of 8 patients, N=2 were diagnosed with childhood autism (International Classification of Diseases (ICD 10) code: F84.0), N=3 with other mixed disorders of conduct and emotions (F92.8), and N=3 with childhood emotional disorders (F93.8). The mean age at admission to the Psychiatric Day Clinic setting was 4.56 ±0.83 years. The mean duration of treatment was 2.78 ±2.39 months. In two cases, a transition to another setting with integration was successfully realized during treatment. In the remaining cases, relevant changes were initiated, for example the involvement of an integration aide or the application for transfer to a special education facility.Discussion and Learning Points: This case series highlights the clinical and psychosocial relevance of childcare center exclusion in toddlers and preschoolers with mental disorders. While childcare attendance is essential for socio-emotional and cognitive development, especially for patients with mental disorders, systematic data on exclusion in psychiatric cohorts are lacking. Our findings suggest that exclusion occurs across different diagnostic groups, including autism spectrum disorder as well as mixed emotional and behavioral disorders, and represents an additional psychosocial burden for families. While two patients in our sample were successfully reintegrated into inclusive settings during treatment, in most cases, changes could only be initiated, such as the involvement of integration aid or referrals to special education facilities.These findings underscore the importance of early identification of children at risk and the timely provision of support to prevent further disadvantage. Mental health professionals can support the re-integration. Early, proactive interventions are crucial to improve long-term developmental and educational trajectories.
