Moodiness may seem like the very definition of the teen years. The ups and downs of puberty can perplex even the most patient parent. And children of any age can feel depressed, anxious, emotional or unfocused—just ask the parents of any child who wasn’t invited to a party or didn’t make the team.
These days, the ongoing fear, grief and uncertainty of the COVID-19 pandemic have trained a spotlight on our mental health. Everyone in the family is feeling stressed, including children. In fact, the American Academy of Pediatrics has called the worsening mental health of children during the pandemic a national emergency.
But how do you know if what your child is going through is normal for kids their age? And when do children experiencing feelings of depression or anxiety need professional intervention?
UNC Health pediatrician Rebecca Baum, MD, who specializes in developmental behavioral pediatrics, shared some tips for navigating a path forward.
Talk with Your Child’s Doctor—and Your Child
“If you are concerned, talk with your child’s provider. That’s a great place to start,” Dr. Baum says. “They can help you figure out if the behavior is normal for the child’s age. Even if it is typical behavior, it can still be a difficult time for the parents and child. Your primary care team can help you understand what’s going on and how to deal with it.”
Dr. Baum suggests letting teens and tweens speak privately with their doctors. They may bring up concerns they don’t want to share with a parent.
It’s also important to talk with your child before seeing the doctor to let your child know that you are concerned.
“Consider starting the conversation by assuring, ‘I care about you and want to make sure I understand how you’re feeling. Your doctor is someone who can help,’” Dr. Baum says.
Often, doctors assess mental health at well-child visits. The doctor may ask questions or have your child fill out a questionnaire about how they are feeling—mentally and physically.
Look for Signs That a Child Needs Help
While difficult thoughts and emotions are normal, your child may show signs that they need additional support, Dr. Baum says. These include:
- Feeling on edge or “wound up” most of the time
- Worrying about things for no reason, or having negative thoughts that are hard to control
- Feeling panicky or having physical symptoms such as headaches, stomach pain, rapid breathing, fast heartbeat and diarrhea
- Avoiding activities because of fear or anxiety
- Having changes in sleep habits (trouble sleeping or being tired during the day)
- Eating differently (eating too much or too little)
- Being quick to give up on challenging tasks
- Struggling with schoolwork
- Spending more time alone
- Feeling sad or irritable
- Feeling guilty about things
- Talking about death or suicide
If there are concerns about your child’s safety, emergency intervention through 911 or the emergency department may be needed.
“When concerns hit that level, families are stressed, and children are stressed. Your primary care physician or their office can offer support during a scary time,” Dr. Baum says.
Seek Treatment Including Counseling and Medication
Sometimes a child’s mental health issues may require a specialist—a therapist, counselor, psychologist, psychiatrist or social worker, Dr. Baum says. Your child’s provider can help you figure out what type of mental health specialist may be most helpful and provide support as you access care.
Undoubtedly, COVID-19 has contributed to the stress, anxiety, depression and other conditions children are facing. But one positive change the pandemic has brought about is a greater acceptance of telehealth.
“Counseling seems to be an area that can work well with telehealth,” Dr. Baum says. “It can reduce barriers—like transportation and time off from work—that families may experience with weekly, face-to-face visits.”
However, it’s important to remember that not every child has access to reliable internet or devices for talking privately and confidentially with a provider. Also, some children may have difficulty engaging with the provider through screen. “It has to be a good fit,” Dr. Baum says.
In some cases, medication may also help relieve your child’s symptoms.
“When we think about anxiety and depression, there’s really good evidence that counseling is important—maybe the most important—aspect of intervention,” Dr. Baum says. “But the more impairing the symptoms, the more likely that combining counseling with medication will be helpful.”
Even though mental health concerns are common, they often carry a stigma in our society.
“People sometimes wonder if these symptoms are real or if they are just being a lazy teenager,” Dr. Baum says. “You can help your child know that you love and support them no matter how they are feeling. Let them know that we all sometimes struggle, and that help is available.”
If your child has symptoms that concern you, talk to your doctor, or find one near you.