When Your Child is Hurting

Education | September 15, 2023

Photo: Mother comforting a young female child.

Where to go and what to do when mental health is an issue

If your little one develops a fever, you call the pediatrician. If she breaks an arm or sprains an ankle, you head to the orthopedist. But when your child is struggling with anxiety or acting out with worrisome behavior, the next step is a little less clear. Should you reach out to a pediatrician or mental health professional? And if so—how?

For so many parents, it’s a familiar dilemma. One in five young people suffers from mental health issues, yet a shortage of adolescent mental health specialists has left parents struggling to find appropriate care when they need it. “Around the country, families seeking help for a child in a crisis often have to wait months for an appointment with a specialist, a delay that can cause great suffering,” says Vera Feuer, MD, director of emergency psychiatry at Cohen Children’s Medical Center. Others turn to their local emergency department — a high-stress space best reserved for extreme situations.

Northwell Health has helped expand behavioral health services for kids and teens in mental or emotional turmoil. But it’s not always easy to know when to make the first move or exactly what it should be. Here is a guide to getting your kids the behavioral health care they need.

STEP 1: FIGURE OUT IF YOUR CHILD NEEDS HELP

School stress, friend drama, family strife: The life of a child is a roller-coaster ride at the best of times. Plus, surging hormones are an inescapable part of development, which means that unpredictable behavior is sometimes unavoidable. Take teenagers for example, says Dr. Feuer: “Sudden moodiness or impulsivity may seem like a cause for concern, but it’s typical for teenage emotions to fly high.” So how do you separate garden-variety volatility from a serious problem?

Look for significant changes, especially if they persist, says Dr. Feuer. “Any changes that last longer than two weeks can be a red flag, especially when they begin to impact everyday life,” she says.

Be aware if your child:

Can’t sleep well or sleeps too much
Shows a loss of interest in usual activities
Feels overly sad, anxious, angry and aggressive, or having difficulty in school
Exhibits changes in eating habits
Struggles with social or family relationships

STEP 2: START WITH YOUR PEDIATRICIAN

You think your child could benefit from behavioral health care — now what? For most parents, consulting the family doctor is a good first step. Your pediatrician knows you and your child and, because she sees so many children, can provide an informed assessment of whether your young one’s behavior is outside the normal range.

Ask your pediatrician if she is comfortable and knowledgeable in addressing mental health issues. Since 2010, a New York State Office of Mental Health program called Project TEACH (Training and Education for the Advancement of Children’s Health) has been bolstering pediatricians’ ability to deliver care for mild-to-moderate mental health issues.

The program has provided psychiatric consultation support for more than 23,000 pediatric patients so far. (Northwell Health is a collaborator on the program.) Your pediatrician may refer you to a child and adolescent psychiatrist, clinical child psychologist, clinical social worker or other mental or behavioral health specialist for further evaluation, testing or treatment. Behavioral health therapies may include counseling, evidence-based therapies, education or medication.

Another good first stop: A school professional, such as a counselor or school psychologist. Such professionals can offer advice, refer you to resources and help coordinate a larger intervention team for your child if needed.

STEP 3: SEEK MORE URGENT CARE WHEN NEEDED

If your child’s emotions or behaviors are extreme or out of control, if he seems severely agitated and unable to calm down or is expressing thoughts of harming himself, he needs more urgent attention, says Dr. Feuer. In many cases, a pediatric behavioral health urgent care center can help. If you don’t have access to a behavioral health urgent care center, or if you’re concerned that your child’s or someone else’s life may be in immediate danger, go to your nearest emergency room or call 911.

STEP 4: KEEP TALKING

It’s hard for kids to admit when they’re struggling, says Dr. Feuer — they may be embarrassed to talk about their worries or impulses, or fear they’ll be blamed. It’s important to leave judgment at the door. Talk to them about what they are experiencing, and listen with curiosity and empathy. Say things like: I hear you, I’m so glad you told me, I’m here to support you, tell me more, suggests Dr. Feuer.

WHEN THE EMERGENCY DEPARTMENT MAKES SENSE

Although the emergency department (ED) can be unsettling for a child in crisis, there are times when it’s the right place to go. Call 911 or head to the nearest ED if:

Your child has hurt themselves

If your child communicates that they’ve taken an overdose or has otherwise put themselves in physical danger, you need a clinical setting staffed by ED doctors, nurses and crisis experts.

Your child is not cooperative

Some children are resistant to help. “Parents may have very real fears that their child might open the car door, jump out and run while they’re being transported,” says psychiatrist Vera Feuer. “If they’re not working with you at all, that could be a reason to get 911 involved.”

There's no alternative

Crises don’t respect the clock. If your child needs help when the urgent care center is closed, the ED is the best option. After your child is stabilized, emergency staff can refer him out to an urgent care center for follow-up.

It may be helpful to tell your child about other people who experience similar problems.

Also important: Be sure to emphasize that their problems are not their fault, that mental health challenges are not a sign that something is wrong with them as a person, and that the family is on their side every step of the way.

WHAT’S TROUBLING KIDS MOST

The most commonly diagnosed mental disorders in children ages 3 to 17, according to the Centers for Disease Control and Prevention, are: