School is in session again. By now your child has likely found their groove and settled into the new school year. While many kids look forward to seeing their friends again and starting classes, other children can find starting school to be more challenging.

Anxiety is the most common mental health disorder in children. Nearly one in six children aged 5 to 17 years had daily or weekly symptoms of anxiety or depression during the COVID-19 pandemic, according to the National Institutes of Health (NIH). And kids continue to be affected at an alarming rate.

Summit Health behavioral therapists Lisamarie Slattery, LPC, and pediatrician Nicole Garcia, MD, encourage parents to check in on their child’s mental health before the school year begins and continue to follow up regularly throughout the year. Together, they point out the most important things you should know about your child’s mental health including how to spot the warning signs of anxiety and depression, deal with bullying, and monitor behavior online. 

1. Check in before school starts and follow-up throughout the year.

Having an open dialogue with children about school is the key to identifying mental health concerns, explains Ms. Slattery. “Ask them how they feel about going back to school — perhaps they are excited about their teacher or have worries about their classmates or schoolwork,” she says. “Keep the conversation open-ended, so children are encouraged to respond.” 

Starting at the age of 12, a screening tool called the Patient Health Questionnaire is used at check-ups. This screening tool has nine questions that assess emotional symptoms and their effect on daily functioning. 

“I often take a quick glance at the questionnaire as I start the visit and use it as a jumping-off point to start a conversation with a young person,” says Dr. Garcia. 

The screening asks about the child’s sleep habits, their concentration, and how they are doing socially. Sleep disturbances, difficulties concentrating, and isolating oneself from family and friends are some of the most common manifestations of anxiety and depression in adolescents and young adults. 

2. Know the signs of anxiety and depression 

Parents tend to know their children best. Some of the things to look for in children of all ages include: 

• Changes in behavior or mood swings 
• Sleeping more or having trouble sleeping 
• A decrease or increase in appetite  
• Becoming withdrawn or isolated from family, friends, sports, and hobbies 
• Lack of communication 
• Acting out verbally or physically 
• Feelings of extreme sadness or hopelessness 

3. Understand the impact of COVID-19 and school violence 

Many parents report that symptoms of anxiety, which started in their child or adolescent during the pandemic have continued to increase even after the world began to return to normal.  Increasing rates of school violence have also caused anxiety to rise in kids.

"Children of all ages may be afraid to go to school due to the increase in school violence.  Many kids wonder if something bad will happen when they go to school on any given day,” says Ms. Slattery. “Having an open dialogue with your child can be helpful in reducing anxiety symptoms.”

Children who were previously outgoing and did not have trouble socializing with peers, may still be having some difficulties reacclimating to social situations post-pandemic.

4. Talk to your pediatrician about any concerns 

If your child is exhibiting mental health symptoms for longer than two weeks make an appointment with your Summit Health pediatrician. They can help you determine if what your child is experiencing is developmentally appropriate.

 “What I look at most is the level of engagement,” explains Dr. Garcia. “Is the child isolating themselves socially from friends or not wanting to spend time with family? Are they losing interest or motivation in activities that they had always loved? These are things I would consider to be a sign of a worsening and potentially severe emotional challenge.” 

5. Seek professional help when needed 

Our specialists at Summit Health Behavioral Health provide diagnosis, treatment, and counseling for children and adolescents of all ages. They can also help guide and offer support for parents who have young children with mental health conditions such as anxiety and depression. 

Cognitive behavioral therapy (CBT) is a common type of talk therapy that helps the child become aware of inaccurate or negative thinking so they can view challenging situations more clearly and respond to them in a more effective way. Therapists teach children tools to help them modify their thoughts and behavior and manage their emotions. 

“CBT is an evidence-based treatment that is very effective in reducing symptoms of anxiety and depression in children and adolescents with mild to moderate symptoms,” explains Ms. Slattery. “If symptoms are more severe and begin to interfere with your child's ability to function, further evaluation may be needed to see if the addition of medication may be helpful.”

6. Educate children about bullying 

Bullying is a concerning and common problem in the U.S. About one in every five students report being bullied according to the National Center for Educational Statistics. There are different types of bullying including physical violence to a person or their possessions and verbal assault such as name-calling or spreading rumors. Many cases of bullying also happen online. 

Parents should be aware of bullying behavior. Bullies are mean, do or say things that make your child feel bad about themselves, tell lies or put people down, and spread rumors.

Keep an open dialogue with your child about bullying. If they are being bullied, explain that this type of behavior is not right, and they should tell their teacher or a school counselor. Reinforce to your child that they should only be friends with kids that make them feel good about themselves, who don’t put them down, spread lies or rumors, and treat each other with kindness and respect. 

Dr. Garcia adds, “For a younger child, it is important to get feedback from the teachers about how they are interacting with their peers.” 

7. Monitor online screen time and behavior 

Encourage your children to spend time away from social media channels such as Instagram and Tik Tok that can foster feelings of anxiety and depression. Social media can cause teenagers to have unrealistic expectations about body image and chat rooms can have a negative effect on self-esteem.

“Social media is a form of communication for our children, so it is hard to avoid it entirely,” explains Dr. Garcia. “Learning to use it responsibly at an appropriate age is a part of their development as young people. That learning process requires close supervision from the parents.” 

Summit Health can help 

If you think your child is experiencing a mental health issue or disorder, schedule an appointment with a pediatrician at Summit Health. They will conduct an initial screening and when necessary, refer your child to a behavioral health specialist for further evaluation and treatment. Our counselors also help educate parents about their child’s mental health, warning signs, and when to seek out treatment.