Child Mental Health: Signs It's Time to Get Help

Every child has hard days, bad moods and rough patches. It can be tough to tell when something is a passing stage and when your child needs more support. If you are asking the question, that alone is a good reason to reach out. Mental health conditions in children are common and treatable, and getting help early usually makes the road shorter. This guide focuses on how to know it is time and how to find the right help.

Signs it may be time to get help

Look less at any single bad day and more at patterns. Concerns grow when changes last more than a couple of weeks, show up in more than one place (home, school, with friends), or keep your child from doing everyday things.

Young children

• Frequent, intense tantrums well past the toddler years
• Extreme fear of separation that does not ease
• Losing skills they had, such as toilet training or words
• Ongoing trouble sleeping or frequent nightmares
• Aggression that is hard to manage at home or childcare

School-age children

• Not wanting to go to school, or frequent stomachaches and headaches on school days
• Trouble focusing, sitting still or finishing work that is affecting learning
• Worry, sadness or anger that seems out of proportion
• Pulling away from friends or activities they used to enjoy
• Repeated behavior problems at school

Teens

• Sadness, hopelessness or irritability most days
• Big changes in sleep, appetite or weight
• Dropping grades, skipping school or losing interest in everything
• Withdrawing from family and friends
• Using alcohol, vapes or drugs
• Cutting or other self-harm, or talk about death or not wanting to be alive

The National Institute of Mental Health has a helpful guide for parents called Children and Mental Health: Is This Just a Stage?

Start with your pediatrician

Your child's pediatrician is a good first stop. Pediatricians know your child's history and can check for medical problems that affect mood and behavior, such as thyroid problems, sleep issues, vision or hearing trouble, or side effects from medicine. Many also use short screening questionnaires for depression, anxiety and attention problems.

To get the most from the visit:

• Write down what you have noticed, when it started and how often it happens.
• Bring notes or report cards from school and any comments from teachers or coaches.
• List recent changes or stresses, such as a move, divorce, a death, bullying or a new school.
• Share family history of mental health conditions.
• For teens, expect the pediatrician to spend some time talking with your teen alone. This helps teens open up.

Depending on what they find, your pediatrician may start treatment, refer you to a mental health specialist, or both, and can stay involved along the way.

Types of help

Mental health care is not one-size-fits-all. Common options include:

• Cognitive behavioral therapy (CBT) helps children notice unhelpful thoughts and practice new ways of coping. It is often used for anxiety and depression.
• Parent training programs, such as parent-child interaction therapy, coach parents to handle challenging behavior in young children.
• Family therapy works on communication and conflict within the family.
• Dialectical behavior therapy (DBT) teaches teens skills to handle intense emotions and is often used when there is self-harm.
• Medicine may help some conditions, often along with therapy. A pediatrician or child psychiatrist will talk with you about benefits, risks and follow-up.

You may meet different kinds of providers: psychologists, psychiatrists, licensed counselors, and social workers. It is fine to ask what kind of training they have with children and which approach they use. A good fit between your child and the therapist matters.

Some practical tips: call the number on your insurance card to ask about behavioral health coverage and in-network providers, get on more than one waiting list if needed, and ask whether telehealth visits are an option.

Support at school

School is where children spend much of their day, so bring the school into the plan. Talk with your child's teacher and school counselor about what you are seeing. If mental health is affecting learning, you can ask in writing for an evaluation for support under a 504 plan or special education services. These can provide things like breaks, a quiet place to calm down, changes to workload, or regular check-ins with a counselor.

In a crisis

Some situations cannot wait for an appointment. Act right away if your child:

• Talks about suicide, wanting to die or hurting themselves
• Has harmed themselves or someone else
• Is seeing or hearing things that are not there, or seems out of touch with reality
• Is so agitated or out of control that they are not safe

Call or text 988, the Suicide and Crisis Lifeline, any time, day or night. If your child is in immediate danger, call 911 or go to the nearest emergency room. Stay with your child. At home, lock up firearms, medicines (including over-the-counter pain relievers), alcohol and sharp objects. These steps save lives.

More information is available on child mental health from MedlinePlus.

When to call us

Call your A thru Z Pediatrics office if changes in your child's mood or behavior have lasted more than two weeks, are affecting school, friends or family life, or if you are unsure and want a second set of eyes. You do not need to be certain something is wrong to ask.

Call 911 or go to the ER if your child is in immediate danger or has harmed themselves. Call or text 988 for a mental health crisis.

To start the conversation, request a visit.