When to seek help for your child.
Your seven-year-old comes home from school and says that no one likes her — should you worry?
Your 15-year-old breaks up with his first love, is sad and is staying in his room — is this normal?
Your ten-year-old is struggling in school and no longer enjoys playing soccer — is this a sign of something serious?
Kids face a lot of pressure and it is normal for them to be stressed or feel blue at times, but how do you know if what your child is dealing with is normal or cause for concern?
Depression is one of the leading mental health issues in older children and adolescents. About five percent of children and adolescents meet the criteria for a depression diagnosis. It is a serious disease that impacts one’s ability to relate to others, to perform well in school and at work and, if left untreated, it could result in suicide — the third leading cause of death for 10- to 24- year-olds. But depression is a condition that with the right care can be treated and does not have to negatively impact someone’s long-term happiness and success.
There are many things that parents can do to help children and teens to develop a good sense of self and to learn how to manage their emotions. Kids develop best when they come from loving homes, with caregivers who set appropriate boundaries for behavior, and who teach them how to deal with negative emotions. This starts early by teaching children how to express anger, sadness and fear in a way that is productive and doesn’t just result in a “meltdown.”
It also comes from praising children for good behavior and good emotion management, not just correcting when a child gets overwhelmed. Children need to know that adults get angry, scared, sad and overwhelmed sometimes. Using statements such as, “I don’t like it when people say things I think are mean either. This is what I do when this happens…” can show children that a full range of emotions are normal.
Avoid situations that leave your children overtired, hungry or stressed out. Good nutrition, sleep habits and exercise help improve mood and are good for mental health. Make sure your kids have downtime. Most children do well with one or two activities outside of school. Overscheduling can stress them and is likely to result in decreased performance in the activities due to their being stretched too thin. You should support your children, not add pressure to them by encouraging unrealistic performance in sports, clubs and schools. Find activities that match your children’s strengths and abilities, and ones that they actually enjoy.
What should you do if it seems that your child is struggling with emotional or mental health issues? It is normal to be sad when we are stressed or when bad things happen. But normal feelings of sadness do not impact our ability to get through the day, do not last all day on most days and do not last for more than a month.
Depression affects different people in different ways. It is important to pay attention to your child’s symptoms. The risk of depression increases in those who have a family history of depression, anxiety, attention deficit hyperactivity disorder (ADHD) and other psychiatric conditions; in those who use/abuse substances such as alcohol and street drugs; in teens after puberty; in those who are bullied, are lesbian/gay/transgender or questioning, or who have learning disorders; and in children who are stressed.
The major symptoms of depression occur most of the day, every day, for at least a month and include:
* Feelings of sadness or of being worthless.
* Loss of interest in doing things your child enjoyed such as sports, hanging out with friends or playing games.
* Lack of energy or too much energy.
* Crabbiness or getting into trouble more than normal.
* A change in sleep habits, such as insomnia or sleeping too much.
* Changes in appetite, including weight loss or weight gain.
* Not being able to keep up with schoolwork or home chores because of difficulty concentrating or a lack of energy.
* Having too much guilt or low self-esteem.
* Suddenly complaining of lots of aches and pains — headaches, stomachaches or leg pains.
* Having feelings of wanting to hurt themselves or increased risk-taking.
It is important to note that these symptoms are not caused by grief, such as the loss of a loved one, a relationship break-up or a significant move or family change, including divorce. If you notice your child has some of these symptoms, especially if he has changes in energy or abnormal feelings of sadness, it is important for you to seek help. A great first step is to make an appointment with your primary care provider to screen your child for physical conditions that can cause children to act as though they have depression, to help get to the bottom of your child’s symptoms, and to help you get your child help, if needed. This can include a referral to a mental health specialist.
Children with depression do best when their symptoms are picked up early and they get the help that they need from qualified professionals trained at managing mental health conditions. This is one of the reasons why your teen needs an annual well visit beginning at age 11 that includes screening for symptoms of mental health issues.
People with depression can be treated in different ways. Those with mild-to-moderate symptoms do best with therapy to help them learn how to recognize negative thoughts and to learn ways to change their behavior when their emotions get to be too much. Other therapies that work include teaching caregivers how to help and to best take care of the child, and family therapy to help siblings and other family members learn how to deal with their feelings about the child’s depression. It is good to work with school professionals to help your child get set up for success at school. This can include plans for parent-teacher communication and evaluation of your child for an Individualized Educational Plan (IEP).
Sometimes medications are needed, although it is important to realize that medication alone is not effective in treating depression. For those with moderate to severe illness, research shows a combination of therapy and medication works best. If your child needs medication for depression, it is important to know the following:
* What is the medicine name and how should it be used?
* What are the signs that the medicine is working, and when should you see a difference?
* What are some warning signs that indicate the medicine is not working or that your child is having side effects that need to be checked out?
* When do you need to take your child for a medicine recheck?
We all have times when we feel sad or blue. Everyone gets stressed. But if your child’s symptoms seem like more than the normal emotions we all have, it is important to seek help. If you have any concerns, start with your primary care provider. And remember, depression can be treated very successfully and children with depression can go on to live happy, healthy lives.
Dawn Garzon, PhD, CPNP, PNP-BC, PMHS, FAANP, is a Teaching Professor at the University of Missouri-St. Louis, a PNP and a pediatric primary care mental health specialist. Her practice focuses on improving child and family health by empowering children and caregivers.