Cheryl Martin (Host): This is Children's Health Checkup where we answer parents most common questions about raising healthy and happy kids. Today we're diving into the topic, how to do a mental health check-in with kids, what it is, why it's important and its effect on children. Our expert is Marjorie Brown. She's the Behavioral Healthcare Manager at Children's Health.

I'm Cheryl Martin. Marjorie, delighted to have you on.

Marjorie Brown, LPC: Hi. Thank you. I'm so happy to be here.

Host: So first, Marjorie, what is a mental health check-in and why is it important for children?

Marjorie Brown, LPC: So a mental health check-in is really any way that you can check in or check up on someone's emotional wellbeing, and where they're at in that time. So it can be as simple as how was your day today or how are you feeling? What's been going on in your life? It can range from really quick questions to more deeper ones.

Host: So how often should parents check in with your kids, especially about their emotions?

Marjorie Brown, LPC: Yeah, so checking in with your kids about your emotions really can be a daily thing. It's something that you can check in when they wake up. How did you sleep? How are you feeling this morning? When you're picking them up from school, how was school today? How did you feel about class? Did you have any hard tests?

At dinner you can ask how are they doing? How's things been going with friends, family. So those kind of things, you can integrate little check-ins into your daily life. I would think that if there's any concerns that you would want to kind of do a more in-depth and targeted check-in at least once a week, where you and your child can sit together and really talk about what's been going on, how they've been feeling, and just do kind of a pulse check for both of you to make sure you're on the same page and you know what's going on in their life.

Host: So how would that once a week in depth check-in look? What questions probably should be asked then?

Marjorie Brown, LPC: So I would say that it should be something that's very intentional. Nothing that you are doing while you're also working or while you're watching TV or while they're scrolling on their phone. Make sure that you guys are giving each other your full attention. And you can ask your child, how have they been feeling this week?

Maybe what's the hardest part of your week been or your day been? What's made you really happy? Anything that you want to share with me? Is there anything I can help you with? Have you had any rough experiences that you need our support with? Things like that.

Host: Now I have been hearing, of course, we hear almost in the news every week about bullying or fights at school. Should a parent ask a child that question directly? Aside from any problems with kids, has anyone been bullying you?

Marjorie Brown, LPC: Yes. That is a question that you can ask directly. I always say that parents know their child best, and many times when there's something going on with your child, you're going to kind of recognize some signs. If you suspect that someone's bullying your child, causing them like any kind of hurt or harm at school or in any afterschool activities, I think the best thing to do is ask directly.

Now, most kids, are not going to exactly want to share that off bat. So you can ask them, are there any other kids in your class that you're having problems with, anybody that you don't get along with so much, anybody that's making you feel afraid or that you're worried about. And when they do answer you, I tell parents, try to lead with empathy and understanding first and save the judgment for when you're alone and not in front of the child.

So one of the things that can cause a child to really shut down are overly exaggerated responses or they're worried that you're going to take this information and maybe go to the teacher or the child's parent themselves, that you're willing to like jump into parent mode, understandably. But it does cause them to maybe want to shut down or not share as much.

So I would definitely ask directly and just try to be as open and understanding, listening, empathetic, non-judgmental as possible.

Host: I would think most parents, if the child confesses that there's another kid who's bullying me, the first instinct is, I want to go down to the school and take care of this. And the kid is like, no, no, no. So how does a parent handle this, and I'm asking because I read the story of this 10-year-old girl who committed suicide.

She was being bullied. She had shared it with her parents and they did go to the school, I think and the administrator says, you know, we've taken care of this, and they wanted to do more. And the kid was just nervous about that.

Marjorie Brown, LPC: Yeah. So 10 years old, honestly, really 10 and up, life is very socially important for children. So they're caring a lot about what other kids think of them, their peers, their relationships with them, almost more so than sometimes their family. And that's developmentally appropriate.

And so what feels like for you as a parent is doing the right thing, letting someone else in on what is going on can make the child feel really scared, right, and really nervous and makes it feel like it's really, really huge to them in the moment. And almost worse. Now as a parent, your first job is to protect your child. So like as a therapist, I tell kids all the time that there's certain things that I have to do something about if you share them with me. And there's different ways we can go about handling that once it happens. So I would definitely allow the child to have a say in how you guys proceed next. Is this going to be a, would you prefer that I talk to the other kid's parent first and not bring it to school?

Would you prefer that I talk to your school counselor? That's someone who may not bring this up in class with you guys and may be able to talk to you and manage this without the rest of the school knowing? Depending on the severity of it, you might say, my options are to talk to the teacher or to talk to the parent, which one would you choose?

And that way they get to, at the very least, make a choice in what's going on, and they feel a little bit more in control. Like in a situation where someone's being bullied, they feel like a lot of things are going on outside of their control. There's a lot of anxiety and fear, and sometimes the threats that the bullying may make may make them think this is going to be even worse if the principal knows, or if a parent knows. I would just reassure the child that you're there to keep them safe. You're going to be with them every step of the way, and we're going to process this together. Just try to find ways in which you feel comfortable giving them a space to choose. Like I said earlier, whether that's, we can tell the principal together, we can tell the parent together.

You can choose which one you want to do, or I can tell the principal about myself, or we can tell the principal together. You can choose which one you feel more comfortable with, giving them that kind of choice, but making sure that both choices are healthy and safe, and you feel good with them.

Host: So if a parent is concerned, do you recommend they offer different scenarios on how to handle the situation, or do you suggest they take the child to a counselor or therapist who can give them coping mechanisms?

Marjorie Brown, LPC: I honestly want to suggest both. So you're the first line of defense for your child. Like I said earlier, you know them the best. They trust you. I would talk to them, get as many details as possible and if you feel that it's gotten to the point where they need to see a therapist, then that could be the next step.

And you can explain it to your child, the fact like, I want you able to talk to somebody judgment free. I want them to be able to help you, and I want you to be able to have all the resources that you need to handle this. And so the next step is we're going to go talk to someone. You have your own space to process everything that's going on. But first step would be getting the details. Because we want to know exactly what's going on, how bad it may be, and what needs to be managed.

Host: Now what if the child just doesn't want to talk about it? How should the parent respond?

Marjorie Brown, LPC: Yeah. So that's pretty common to be honest. Especially with teenagers, but very, very common where even if we're doing just a baseline mental health check-in or something deeper, they don't really want to talk. It can be scary, it can be anxiety provoking. Some kids are just not very talkative. So what I would say is allow your child to communicate in whatever way they feel best communicating. Sometimes that may be drawing, right? So everyone doesn't need to sit down in a chair and look each other dead in the eye and have a very tough conversation. Sometimes we may draw together, and in that we're talking. With younger kids that I work with, we play with dollhouses and they act out scenarios with the dolls.

And I say, oh, I wonder if it the doll's feeling sad or scared, and then they say, yeah, she's really scared of this. Have you ever felt that way? Yeah, I felt this way. This has happened. Sometimes it's easier to talk about an object than yourself directly, but you can get there. I think the primary thing is about patience. Not trying to force the conversation.

With my older kids, I would say let them know, Hey, I know you might not really want to talk right now, but I'm here when you need me. And then maybe going back to it later. So sometimes trying to force your child, your teenager to talk, really just makes things worse and they feel backed into a corner. So taking that space just to let them know that I'm here no matter what, they may come to you.

Host: Marjorie, at what age should parents start checking in on their child's mental health?

Marjorie Brown, LPC: I would say as soon as they can communicate, you can start checking in. As soon as your child is starting to like learn words, we can introduce feeling words, so happy, sad, mad. And you can go on Google. I've worked with kids as young as four. You can go on Google, find what I call a feelings chart.

It's just a bunch of faces with different feelings on them and let them know this is a happy face, this is a sad face, and how do you feel right now? And they can point to the one that they feel. And what that does is it really normalizes this. So it's harder when they're a teenager. You're just now coming to them with these kind of like, let's talk about your feelings.

But when, they're younger and you introduce this as part of just their daily life, it's just the norm. When you guys are watching TV together, just like how I kind of mentioned the dolls, you can say, I wonder how they feel right now in a scenario that you're watching on a show. And they may say, oh, that would probably make me really mad, or she seems upset, but I don't think that would bother me.

That's the way to kind of just check in to see where your child is emotionally and understand their temperament. So, like I said earlier, there are little ways that you can do it. Just checking in while you're driving home, while you're getting dinner, and then there are some more intentional ways. But I do think you can start as early as probably like three years old to asking them, how do you feel right now?

You have really big feelings. You seem angry, you seem sad, you're really happy. Reflecting those feelings lets them know how to put words to what's going on inside them.

Host: I really like what you're saying because I think in certain instances, a child, unless he or she is asked, will not tell you. If you start this early, and I love what you said, you could almost have a check-in every day. It becomes a normal routine, and I think especially if the parent listens well, you are establishing this relationship of intimacy and that my parent really cares and is in tune with what I'm going through.

Marjorie Brown, LPC: Yes, definitely.

Host: I think it's important also because I've known people who experienced abuse and bullying, and their parents never asked, and the abuser would say, if you tell someone, they will not believe you. Or I think some could threaten the child. So wouldn't you see that by having the daily check-in, that the child would be more apt to trust the parent and to go to the parent?

Marjorie Brown, LPC: Yeah, if this is something that's already been established, it doesn't seem like it's coming out of left field, so they'd be more likely to tell their parent. And if you already kind of have an understanding of your child's normal temperament, when you start to notice little things that are off, then you can say, this may be something bigger.

I need to dig a little bit deeper and see what's going on. Like I said earlier, I say it all the time, you know your children the best. So you'll know when something seems a little bit off. And when you're doing these regular check-ins or you noticing, typically they're fine with these. We enjoy these, we talk a lot.

But today it seems like, uh, they don't really want to talk and okay, maybe it's just today, but it seems like okay, this week they don't really want to talk. Or every day after soccer practice, they seem down, I wonder what's going on there. And in that way you can kind of ask more targeted questions like, okay, it seems like after soccer practice you're having a bad time.

Is everything okay? Is something wrong? Anything that we can help with and that can kind of open the door to have them open up and talk more about whatever's going on.

Host: Great. Marjorie, what is the most important message you want parents to take away from this conversation?

Marjorie Brown, LPC: Yeah, I would love parents to feel like they have more control in this relationship, that mental health isn't a really big, scary word. Sometimes I've talked to parents who notice things, but they're scared to talk to their kids. They're scared to bring it up because they don't want to make it worse or they don't know how to approach it.

And it doesn't have to be that scary. It can be just as simple as, like I said earlier, just in the morning, Hey, how are you feeling? What are you excited about today? What's making you nervous? Things like that. And then as you and your child grow together, you trust each other with these conversations and with these heavy topics.

And just like you want your child to check in with you and be open with you, you can be open with your child. So if you're feeling frustrated one day, I would say that out loud so the child knows, oh, this is what frustration looks like and my parent handled it in a healthy way. So you're feeling really happy about something, let them know that all these feelings are normal. They're not scary, they're nothing to hide. It's just something that we learn to live with and manage. And it should be something that's celebrated that we have all these feelings inside of us. Nothing to be afraid of.

Host: Any other advice you care to offer to parents or caregivers as we close?

Marjorie Brown, LPC: I would say that if you do have any concerns about your child's mental health, if you do notice any big changes and you're worried, when we do our mental health check-in, we ask our child, we can also check in with the teachers, other adults that see them, see if they're seeing any pattern changes and then, I want them to feel like they do have resources on hand. I would say that the first step would be maybe to go to the child's primary care provider or their doctor, and they can talk to them about what's going on. Our Children's doctors and PCPs do have experience in ways to deal with mental health and provide you with resources.

So if you don't know where to start, your PCP is a great place. Here at Children's Health, the program that I work for is called BIG. We actually train PCPs in how to spot these things in mental health and how to feel like they can handle it too. So they can spot anxiety and depression in children so they can help you guys manage them and provide them with resources.

Host: Marjorie Brown, thank you so much for talking about just the importance of a mental health check-in for kids and giving parents these great tips on how to start the conversation with their child. Great information. Thank you.

Marjorie Brown, LPC: Of course. Thank you so much for having me.

Host: For more information on how to support your child and their mental health, visit childrens.com/mentalhealth. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels.