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When to See a Mental Health Provider?

By Desiree Shapiro, MD, psychiatrist at Rady Children’s Hospital and professor at UC San Diego
Knowing that children experience feelings of sadness, anxiety and anger, what should you be looking for as a parent, guardian or caregiver?

As a parent, guardian or caregiver, you live through it all: the excitement and thrills of life; the tears and the fears; the illnesses and the disappointments; and everything in between. Knowing when to worry and seek out help for mental health concerns may be challenging and unclear, given the spectrum of behaviors seen in developing children and adolescents. Children are changing physically, emotionally, cognitively, socially and behaviorally each year. One fascinating aspect of their growth is their brain development. It can help explain tantrums, risky behaviors and vulnerability challenges with peers. Knowing that all children (and humans) experience feelings of sadness, anxiety and anger, what should you be looking for as a parent, guardian or caregiver?
 
As the expert of your child, pay attention to any changes in behavior, interactions with friends or functioning. Pause if your child becomes less talkative, less engaged in activities or starts having trouble in school. It is important to ask your child about what you have noticed in a non-judgmental way. Some children can verbally articulate their feelings and emotions easily while others express themselves differently. Acknowledging their feelings will allow your child to feel safe and comfortable to share their experience.  
 
Some signs of a mental health problem include, but are not limited to:
  • Hearing concerns from friends, coaches, teachers or family members
  • Changes in functioning, i.e., symptoms leading to impairment in regular activities
  • Changes in eating, energy, sleep or activity level
  • Decreased enjoyment or interest
  • Changes in mood
  • Isolation from family and friends
  • Increased stress
  • Persistent worry, embarrassment or panic
  • Excessive irritability or anger
  • Self-harm or talking about escaping or dying
  • Substance use
  • Stomachaches or headaches that persist after pediatric evaluation 
  • Persistent behavioral problems or outbursts 
 
If you have concerns about your child, it is typically best to start a discussion with your trusted pediatrician. Your pediatrician is knowledgeable about development and knows when to refer children to a behavioral health specialist. In some situations, pediatricians have known patients for years, which is valuable when individualizing a plan. 

Your pediatrician may recommend your child see a therapist and/or a psychiatrist. These professionals will talk with you and your child about concerns, strengths and functioning in school, at home or in activities. In therapy, youth learn about themselves and their feelings; they learn skills to self-soothe and cope with challenges. It is important to seek help from a mental health professional who has advanced training and experience and who is a good match for your child and family. The earlier mental health problems are identified and treated, the better the outcome for all.
 
Dr. Shapiro is LJCDS’s wellness partner. She serves as a child and adolescent psychiatrist at Rady Children’s Hospital and faculty member at the University of California San Diego. Please reach out to dlshapiro@ucsd.edu for questions.
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