How to talk to your child about anxiety and depression

During the COVID-19 pandemic, we all went without hugging loved ones or getting out of the house to see friends. It was hard on everyone, but especially kids. “In the past year, some children have experienced increased depression and anxiety related to the pandemic restrictions,” says Nekeshia Hammond, PsyD, author of The Practical Guide to Raising Emotionally Healthy Children.

We see this struggle play out through a spike in visits to hospital emergency departments for mental health-related reasons. For children, those numbers started increasing in April 2020 and stayed high through fall. In that time, emergency room visits for children ages 5 to 11 were up 24%, according to the Centers for Disease Control and Prevention. For children ages 12 to 17, the increase was 31%.

The explanation, in part, is that children need more daily human interaction. “There are areas of a child’s brain that contribute to language and social development,” says Reena Kumar, DO, a child and adolescent psychiatrist at the University of Arizona. “It’s important for them to spend time with other people.” When children don’t get to be social, they can grow anxious and depressed, she says. (Here’s how to help if your child is having panic attacks.)

Fortunately, pandemic restrictions are beginning to ease up. As life returns to normal, kids are increasingly able to socialize again. But the effects of isolation could linger. And new problems can always emerge as a normal part of childhood.

Talking about mental health can feel taboo, but don’t let the stigma keep you from helping your child. Here’s how.

(If anyone in your family needs medication for a mental health condition, Optum Perks can make paying for it easier. Download our discount card today.)

Schedule check-ins with your child

Set up weekly family chats, says Francisco J. Sánchez, PhD, associate professor of counseling psychology at the University of Missouri. These should be conversational. Everybody shares, but you don’t want to treat the discussion like therapy. Ask how your child is doing and share (within reason) some of what you are experiencing.

If there are signs that something is off (like behavior/mood shifts), mention it, Sánchez says. You could say, “I’ve noticed that you haven’t been eating much lately,” or “You seem a little down today. What’s going on?” You could schedule the check-ins weekly and see how that works, Sánchez says.

One strategy for making these chats casual would be to schedule them in a relaxing place, such as an ice cream shop or restaurant your family loves. “This can be a helpful place to discuss feelings around various changes that are happening,” Hammond says. At the meetings, everyone gets a turn to discuss whatever’s on his or her mind.

During the chats, make sure your child knows it’s okay to feel sad or anxious. “It is important to normalize feelings of fear, anger or sadness that your child may be feeling,” Hammond says. “You should also discuss self-care strategies.”

If weekly doesn’t feel natural, you can adjust the schedule. Teens may balk at what they see as too frequent parental check-ins, says Sánchez. So the timing will depend on your child and your family, but it’s important to keep the check-ins regular. You don’t want them to fall off the calendar entirely.

Keep it loose

Approach tough topics in a relaxed way. Younger children are more likely to engage with you when you ask questions in a playful way. This prompts them to share their feelings, Dr. Kumar says. If your child gives vague answers, don’t push it. Ask again at the next check-in. “When they feel safe to talk to you about the little things, over time they will feel more comfortable sharing more sensitive things,” Dr. Kumar says. “Don’t overwhelm your child with a stream of questions if she seems distressed.”

Remain neutral

“With a younger child, you can talk about sadness or worries and how you find ways to better deal with these yourself,” Dr. Kumar says. You can have a more in-depth talk with an older child. Tell them that you have noticed that they seem more sad, down or worried lately, Dr. Kumar says. Explain that you would like to know what might be going on, in case you can help. “When kids see that they can talk about mental health topics without judgment or criticism, they will be more likely to approach you,” Dr. Kumar says.

Be a role model

“Your child turns to you for guidance, and if you respond negatively, they will pick up on it,” Sánchez says. “They are watching you and hearing you.” Think about how your child responds to your reaction if they fall and scrape a knee, he says. If you get upset, they will too. If you stay calm, he or she will also see that they just need a bandage and don’t have a severe injury. (If you’re struggling with your own feeling of depression or anxiety, the new virtual care platform from Optum Perks can help. It can connect you to licensed therapists and medication prescribers in your state.)

Stick to a schedule

It’s smart to create a routine that goes beyond your family check-ins, says Sánchez. “Kids do well when they know what to expect next,” he says. They thrive on structure, which provides a sense of stability. “A schedule is important because it offers consistency and certainty, which is reassuring to kids.” So be consistent with sleep/wake schedules (especially with younger children), mealtimes, game night and the nightly tooth-brushing routine, he says.

Check feelings about going back to school in person

Returning to school at the end of summer vacation can be stressful for kids even during normal times. But it can be particularly tough if they spent most of last year in remote learning. “It can be hard to re-engage with other students,” Sánchez says. “Some children may be shy and introverted.” Here, too, you can share your feelings to help them open up. You could say something such as, “I’m excited about seeing my co-workers again, but it feels weird being back in the office.” (Here’s how parents can prepare children with ADHD to go back to school.)

If you are worried, seek help

If your child’s problems seem beyond your capacity to help, don’t hesitate to reach out to a professional. This will set a good example on asking for help. Start with your child’s doctor, or contact a mental health professional, says Hammond. The American Psychological Association (APA) and the National Alliance on Mental Illness (NAMI) offer information about support groups and other resources. If a child is expressing wishes to not be alive, says Dr. Kumar, call the National Suicide Prevention Lifeline at 1-800-273-8255.

There is a stigma around seeking help for mental health treatment. Reaching out for help for your child does not mean you have failed as a parent. “Asking for help for your child represents a positive behavior for your child to model,” Hammond says. “Getting help for your child is a critical part of parenting.”

Ask your child’s doctor about medication

Children with anxiety or depression might benefit from Prozac® (fluoxetine) or Lexapro® (escitalopram), says Dr. Kumar (click the links for coupons). The FDA has approved the former for major depressive disorder in children and the latter for major depressive disorder in young teenagers, ages 12 to 17. “It is important to talk to the doctor about the symptoms of depression or anxiety so he or she can determine whether a combination of psychotherapy and/or these medications are most appropriate,” says Dr. Kumar.

She also recommends making lifestyle modifications to improve your child’s mood. Regular exercise, getting enough sleep and eating a minimally processed diet with plenty of fruits and vegetables can all help, she says. In fact, you might even plan your chats around healthy activities: Cooking a family dinner or hiking a local trail provides a great opportunity to talk.

And the more you normalize conversations around mental health, the less likely it is that your child will have to go through something difficult alone.

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