Is It Just a Phase or Something More? Understanding Your Child's Mental Health

Interviewer: There's been a renewed focus on the importance of mental health for adults in recent years, especially after the COVID-19 pandemic. But what about children's mental health? Joining us today is board-certified pediatrician and member of the American Academy of Pediatrics, Dr. Ellie Brownstein.

Now, I guess the question that I have at the top of my mind is, do children experience the same sorts of mental health issues or concerns, that say, adults do, or is there something different?

Dr. Brownstein: Yes, they experience a lot of the same things, and yes, they can be somewhat different. I mean, kids can be anxious, kids can be depressed, and that can start at really young ages because the same sort of things that are going on in our big heads, when we're bigger, can go on when we're littler. But we also have some things that don't show up so much and also, depending on the age of the child, a very different coping mechanism and brain capabilities to understand things. So it can make what would be the same sort of anxiety a very different thing for an adult and for a kiddo.

Common Mental Health Concerns in Children

Interviewer: What are some of the, I guess, common concerns that we have when it comes to mental health and children? Is it anxiety, fear, depression? What are some of the things that, as a pediatrician, you want parents to be on the lookout for?

Dr. Brownstein: The things we probably see most commonly are attention problems, issues in school, anxiety, and depression. And those can be a set of overlapping mixed things. So they can come together, they can come singly, one can lead to one or the other, but those are probably the most common issues and concerns that we see.

Recognizing Signs for Mental Health Concerns in Children

Interviewer: For a parent who is maybe seeing some of these things in their children, is there like a line or a test or something? How can a parent tell when is it the standard, typical experiences of children growing up, and when it might be a more significant mental health thing that probably should be dealt with, with a professional?

Dr. Brownstein: So the biggest thing I would look at is how successful they're being in their life and/or how much of their life this issue takes up. For example, if your kid has anxiety and they're like, "Oh, my God, I'm stressed about this test," but they get themselves ready, they get to school, and however they do on the test, but they can function through their day, I don't worry as much as the kid who is so anxious that they can't get out the door or struggle so much to get out the door that they're late 30 minutes every day or going into a school building with that many other kids is really anxiety-provoking and so they can't go or they are struggling in school because they can't focus.

So if the kid is being successful in a way, I think I'd say, "How do we work with this?" And those are not the ones I worry about as much as the kids who are struggling in day-to-day life. Or the other piece is and I'll ask kids sometimes, it's like, "When you're doing something fun, is it enjoyable, or do you sit there and worry through that too?" Because that's a big red flag to me. If you can't go off and do the things that you find enjoyable without stressing or worrying, then that tells me we have a problem.

Interviewer: And I guess just for clarification, if a parent is concerned about the mental health of their child for one reason or another, is that something that a pediatrician deals with or something that a mental health expert or a psychologist deals with?

Dr. Brownstein: It could be a mixture of all of the above, and some of it probably depends on how comfortable their pediatrician is in dealing with these things. Some are more comfortable and have had more training than others. And so it's a good place to start or at least ask how your regular provider feels. And some insurances also require a referral from a physician to see a mental health professional and some do not, so that you've got to know.

Post-Pandemic Challenges for Kids and Teens

Interviewer: We are living in a post-pandemic world, right, and there has been a renewed focus on some of the things that we're dealing with after the fact, etc. What kinds of experiences, when it comes to mental health issues, are we seeing with kids, and teenagers, as we are now trying to return to normal?

Dr. Brownstein: So it ranges anywhere. You can take some of our younger kids who are just heading off to preschool and kindergarten, whose first years of life were in a pandemic, and who haven't been in large groups of people. And that can be a scary thing. And I think some of those kids are a little slower to warm up, a little slower to be comfortable going out and leaving their parents. I think the vast majority of kids will discover that this is kind of fun. I like hanging out with people my own size and age. See you. But there are some who really struggle with that.

A family told me once about their kiddo who, when they had a workman come into the house for something, the kid hid because he was so used to not having strangers in the house. And again, given time, a lot of those things will get better. But sometimes you need to be aware and watch how much is this affecting your day-to-day life, how much is affecting your kid, and do you need additional help, or are you moving in the right direction.

Interviewer: Sure. And what about, say, little older, elementary school kids? They went online for a while for their schooling, and now they're back in classrooms. What kind of issues are we seeing with some of them?

Dr. Brownstein: Some of those, we're seeing some social anxiety. They're not as comfortable in a big group setting because they've spent a while not in a big group setting. So they struggle a little bit more with sitting down in a classroom and working with other kids and not just doing it their own way on their own. And some kids are struggling to get to school. That time when I turn on my computer when I get up in the morning and I do the assignments that someone gives me when I'm ready to do them, instead of we're all doing math right now, and here's our lesson, and here's the things we're covering is a different thing. And we had some kids who spent several years online, and then it's a big difference to go back to a classroom with a teacher who's like, "Okay, we're doing this paper at this time, and we're going to do it in a group. So you're going to work with four other people and listen to what they have to say as well."

Interviewer: Sure.

Dr. Brownstein: And then I was going to say, our biggest kids, I think sometimes struggle with they may have had a couple of years where they were not in school or not in as much school or no one paid attention if they didn't do their work. And now they're like, "What do you mean I have to go sit in class all day?" And they're used to doing what they want when they want. And because there were a fair number of kids who just sort of disappeared from school for a couple of years.

Parental Role in Child's Mental Health and When to Seek Professional Help

Interviewer: It's one thing to understand that these things happen, but what can a parent do? What can they tell their kid? What are some strategies that they might be able to use if they're seeing some of these mental health concerns with their kids?

Dr. Brownstein: Big things are talking, communicating, paying attention. If you've seen big changes in your kid, then you want to sort of dive in and sort of talk to them, figure out what's going on, figure out if they know what's going on because sometimes we're struggling to figure out where we are. And teenagers, kids sometimes don't have the words or the knowledge or as much scaffolding to put all of this stuff in place. And so it's a little harder.

And so the first thing, I think, is a lot of talking. And psychologists can be and social workers can be very helpful to help kids work through things and help families work through things together because, I mean, a kid is not isolated in their house. It's a family, and there are interactions. And so, as parents, I think if we know what kids are going through or we know what's going on, we can be more helpful and involved. And so, yes, counseling, therapy, family therapy, and maybe even some group ideas where kids can talk to other kids and realize I'm not the only one who feels this way or had this problem or had this situation come up.

Strategies for Parents to Help Children Cope

Interviewer: Is there any, like, tips or strategies or things to kind of keep in the back of your mind when you're talking to your kid about some of these potentially scary situations?

Dr. Brownstein: I think the biggest one is learning how to listen. I think a lot of us have conversations where we're already jumping to what we're going to say next and how in a way we fix the problem. And I think some of these things, sometimes the first thing we need to do is just listen and be supportive and not necessarily like, "Oh, I got this. We can fix it."

The first thing is figuring out where your kid is and, in a way, joining them there and helping them process where they are. And then, from there, I think it's an easier place to figure out how do I support you and how do I help you find your way forward rather than, "This is what I think you should do."

Interviewer: Sure. So we've covered communicating with your child and being open and listening, the potential for bringing in a professional therapist, social worker, or whatever needs to be done to maybe help them there. But are there any other strategies that parents might want to enact with their kids to maybe help them better cope with, say, anxiety or some of the other issues that they might be dealing with?

Mindfulness as a Coping Mechanism

Dr. Brownstein: So mindfulness is, I think, gaining more ground in our society these days, but I think it really can be very helpful. But I also like to joke that if you're anxious or nervous and someone says, "Take deep breaths," the first thing you want to do is punch them.

Interviewer: Sure. And even for kids, right?

Dr. Brownstein: Yeah, yeah. And so what you really need to do is, if you practice some of these skills, some of the deep breathing to help, it does change the hormones. It does help your body relax. But in the moment of stress is not the time to start trying. We do better if we practice a few minutes every day or we figure out what brings us back to peacefulness. And that could be playing music, making things, baking, coloring, exercising, as well as things like breathing, yoga, meditation. And if we know what those things are, when we start to stress out, we can then utilize those things. And that can be very helpful. And it does take a little thinking to start, in a way, ahead of time or just bring it into our lives so that when we need it, it's there. But it can be really helpful.

Advice for Overwhelmed Parents

Interviewer: If a parent is listening right now, and this might seem all kind of overwhelming, maybe it's their first kid, maybe it's their first time they've had to deal with this with their kids, is there any advice we might be able to share with that parent?

Dr. Brownstein: I would say that there are lots of kids who struggle with mental health issues of one kind or another, and the vast majority do just fine. What we need to do is figure out how we can best support them. So the first thing you've got to do is take your own deep breath and figure out what calms you down so that you can figure out how to be most helpful. And then there are families who struggle for a while and then do quite well. Sometimes it takes a little while to figure out the right way. Sometimes just a little nudge in the right direction will help families and kids get back to a more stable footing. But there are lots of people out there who want to help, and there are lots of ideas on things to try. And so center yourself and then go figure out how we can best help your kids.