First steps to take when your child seems anxious or depressed

I am a primary care pediatrician. Over dinner gatherings with friends and relatives, I am often asked to describe the range of patients I see – newborns to college age students. For some reason, the conversation always ends with questions about mental health. Maybe it’s because they are curious about why it’s so common, or because they know someone who needs some help. Either way, I love the opportunity discuss and de-stigmatize mental health problems. Aside from ear infections, coughs, and well visit check ups, I have become very comfortable and interested in caring for kids with anxiety, depression, and ADHD. The latter will be discussed in a separate post. I’ll share how to recognize anxiety and depression in kids, and what to do next. This is for information only. This post is not meant to diagnose or treat. Please discuss with your child’s pediatrician if you have concerns about your child’s mental health or call 800-273-TALK in crisis. 

What signs do kids have when they are depressed or anxious?

Most kids don’t show up to a well visit with them or their parents asking me to help them with depression or anxiety. Rather, the kids usually show up in the office with problems related to school, grades, social interactions, sleep, change in behavior, or physical illness. It often takes a few visits or conversations to figure out the diagnosis. Sometimes, other medical problems can mimic anxiety or depression, so I might order thyroid testing or check for anemia to rule out medical causes of the behavior changes or symptoms.

Here are some examples of anxiety:

  • worrying so much that they stop hanging out with friends or can’t go to sleep
  • refusing to go to school
  • recurrent belly pain or headaches, especially around certain triggers such as school or tests
  • feeling numb or dissociated from the body
  • thinks people or other kids are “annoying”
  • concerns about weight or acne out of proportion to severity

Here are some examples of depression:

  • really low self esteem
  • feeling hopeless
  • sleeping too much, always being tired
  • thoughts about harming oneself or not wanting to live
  • hearing voices
  • crying a lot

Generally, I can suspect anxiety in a child, but I find that depression is more subtle and more often picked up through routine screening surveys given during teen well visits. The diagnosis is not always obvious and usually requires a bit of digging, detective work, and non-judgemental questions.

What can parents do if they think their child is depressed or anxious?

CHAT. Have frequent conversations with your kids, and start early. Talk in the car. Talk over family dinners (or modify it to family breakfasts or family weekend lunches, whatever works for your family). Take kids out on their own for one on one chats, even if it’s just on the way to soccer practice or an ice cream date or a hike in the park. While screen time prevails in our lives, I try to advise drawing the line in the car and at meal times so that it provides an opportunity for communication between parents and kids. Talk early and often so that it becomes routine for both you and your child. If you forgot to mention something in one conversation, there’s always another one right around the corner!

ASK. Ask your kids how they are doing. Ask what their friends talked about at lunch. Ask about who they are sitting with at lunch, talking to on the bus, or playing with at recess. Ask if they are feeling sad, worried, or have thoughts about harming themselves – it’s okay to ask. Research has shown that asking is not going to put suicidal thoughts into a kids’ mind. From what I have seen, kids are quite open with telling their parents once they asked. Sometimes they are in such a dark place that they don’t know how to tell their parents or feel that no one cares, but they are very willing to share when asked.

CHECK. Check your child’s social media and internet browsing history for posts of feeling down or having panic attacks or for searches of ways to harm themselves. Check openly and honestly. Check in the digital devices at bedtime to charge so that everyone gets a solid night’s sleep. Check for your messages from your child’s friends (since their parents might not be checking). As an aside, if anyone picked up my child posting inappropriate or concerning content, I would be very appreciative! I am a big fan of raising kids with a supportive village.

MONITOR. Keep track of your child’s concerning symptoms on a calendar. Are the problems worse on school days, during the menstrual cycle, after a certain event? Is there any association between their sleep pattern and their behavior? Do they have the same symptoms during the summer? This will be very helpful for the next step…

Where can parents go to get their child evaluated for depression or anxiety?

If the child is a danger to themselves or others, then call the crisis line: 800-273-TALK or 911. There are local crisis centers with operators who can refer your child to a place that can offer an urgent and timely assessment of your child and help connect your child to the appropriate resources.

Call to make an appointment with the pediatrician. The primary care doctor’s office is always a good place to start. Talk to the doctor about what started raising red flags and your concerns. The doctor will often also ask about school performance, peer interactions, interest in fun activities, stressors, sleep, diet, exercise, and family history of mental health disorders. Depending on the age, the doctor will also ask the child some questions alone. I will ask older kids about self harm thoughts in front of their parents and ask again alone.

The next step is to refer the patient to a therapist. I have local list of therapists and psychology companies who have received good feedback from my patients. I also guide families in what to expect when they see a therapist, from the intake process to regular appointments (see this post for more explanation – coming soon). Also, consider setting up an appointment to meet with the school guidance counselor and school psychologist (if available) to discuss your concerns. Some schools have an emotional support team who can help your child when they are not having a good day, and some guidance counselors will work with your child on strategies to decompress.

If the symptoms are very severe or have red flags of becoming severe (such as strong family history), I may also refer the child to a psychiatrist. Those who take insurance and care for kids are very few and require a long wait, even in a large city, so it’s always better to make the appointment ahead of time than be stuck in a crisis without a psychiatrist.

If the symptoms are more mild, then I will follow up with the patient again. And again. And again, until I know that they are feeling better with therapy. If they don’t improve and are not functioning well in school or with friends and family, and/or feeling very down, very often, then I will discuss medication options with the child and family.

Back at home, consider if there are changes in the daily routine can help boost your child’s general health – all things that can also boost your child’s brain health. Now, I realize that habits are difficult to change, so go easy. Start crawling first before you try to run. Even if you can do one small change everyday, your efforts will make a very big difference after a few months. For example, rather than trying to go to the gym as if that is the only answer and savior for good health, be determined to do 2 pushups or 10 jumping jacks every single day. Instead of striving for a home-cooked meal everyday for a family that is eating take out most of the week, aim for one home-prepared meal a week. What is my mantra? Imperfectly done is better than not done at all.

Brain boosting habits that don’t require a therapist or a prescription!

  • Exercise
  • Eat at least five fruits and veggies a day
  • Sleep 7+ hours a night
  • Minimize screen time
  • Practice gratitude
  • Drink lots of water
  • Minimize sugar and processed food intake

Online resources for kids with anxiety and depression

CDC data and statistics on children’s mental health disorders

NIH – What is generalized anxiety disorder?

NIH – Depression: What you need to know

Psychology Today – How to help kids with anxiety and depression

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This is not medical advice. I do not diagnose or treat through this website. Reading this blog post does not establish a patient-doctor relationship with me. Consult your child’s doctor for proper guidance and recommendations that fit your child’s specific needs.

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