Scott Webb (Host): It's never easy on parents to see our kids hurting, especially when they're trying to cope with depression and anxiety. I'm pleased to welcome Stanford Medicine Children's Health Pediatrician Dr. Nivedita More. She's here today to discuss the warning signs of mental health struggles in our kids and how professionals and parents can help our kids through these trying times.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb.

Dr. More, it's so nice to have you back again. Today, we're going to talk about helping our children cope with depression or anxiety. And, you know, I have a 16 year old daughter and all that that implies, you know, she plays sports, she's got lots of friends and so I'm trying to work with her and deal with her and make sure that she's okay, as I'm sure a lot of parents are.

 So let's just start there. What mental health concerns do you usually see in children?

Nivedita More, MD: You know, mental health concerns really vary depending on the age of the child. In children and teens, I usually see attention deficit disorders, anxiety, depression, eating disorders, post traumatic stress disorders, for example. Also some behavioral concerns. In addition to these, there are other disorders that can affect how a child behaves, learns, or handles emotions.

And those primarily include autism, learning disabilities, developmental disabilities, and other risk factors like substance abuse and self harm.

Host: Yeah. So there's a lot for kids think about, a lot for parents to think about. And just wondering, you know, how common are mental health concerns in children? You know, how often are you seeing patients in the office, children in the office and their parents with these types of concerns?

Nivedita More, MD: Quite often than you think, actually, Scott, about 13 to 20 percent is the estimated prevalence of mental health disorders in children. That is about one in five to six children have some sort of mental health concern. Unfortunately, these kids may remain unidentified unless parents or teachers see some warning signs, bring them up during a visit with their pediatrician or in a parent teacher meeting or something. You know, unless that is brought up, we don't identify these children unfortunately.

Host: Yeah, I'm glad you mentioned warning signs. You must have read my mind because that's where I wanted to go next. What are some of the warning signs? I know there's a lot of things we could be concerned about or could be looking for, but in general, what are the warning signs for parents?

Nivedita More, MD: Yeah, the warning signs that their children may have, thinking about mental disorders and mental health disorders include an array of things. A lot of things can be included in that. Mainly, we look at sadness that lasts over two or more weeks, changes in being social or staying away from others, including their friends, hurting themselves or talking about hurting someone, or even just talking about hurting themselves can be a sign. Talking about death or suicide can be a warning sign. Having outbursts or being very moody or testy can be concerning. Out of control behaviors that can be harmful can be concerning as well. Big changes in mood or behavior or personality. You had this real super quiet kid and now is suddenly angry all the time can be a huge warning sign.

Changes in eating habits. Sometimes eating disorders can start out with just not wanting to eat a lot or eating a lot after a sport all of those can be warning signs as well. Losing weight suddenly without any medical illness per se. Trouble falling asleep, can be a warning sign for anxiety, mainly.

Having headaches or getting stomach aches when there is no other underlying medical abnormality. Trouble concentrating at school can be a warning sign for ADHD or even anxiety and depression. Doing poorly in school or if their grades start slipping, I start getting concerned as a parent.

Not going to school, just wanting to lay in bed a lot. You know, not wanting to play their favorite sport, not wanting to meet their peers. These are all warning signs that I would worry about.

Host: Yeah, I see what you mean. And some of it may be just be, you know, normal teen stuff because teens need more sleep and sometimes they're tired and lazy. But, you know, I'm guessing it's one of those things where we notice some of these changes in our kiddos and then they persist, right? They continue on past maybe just a couple of days, right?

Nivedita More, MD: That is correct.

Host: So we have a sense at least of what some of the warning signs might be. And, I tease my mom because she still parents me even though I'm in my 50s and she's in her 70s. So, you know, once a parent, always a parent, you know? Uh,

Nivedita More, MD: That is right.

Host: Just to have a sense here, so you know, we're parents, of course, and we have children, and they start out really small, and then they grow. When we think about the ages looking for red flags, are we just, are we on duty, are we on call, like, almost immediately, and then all the way through? Or is there a time when some of these things might present more than others?

Nivedita More, MD: You are absolutely right. It's really at all ages. So parents need to keep an eye on their children's behavior on how he or she learns. How they play, how they speak, how they act, and how they handle emotions at pretty much all ages, including teenagers, 20 year olds, 30 something year olds, and beyond.

Host: Yeah, I try to remind my mom. I'm like, you know, I'm 55. I have two children of my own. I mean, I love you, but you're off the clock. You can punch out. And she says, no, once a mom, always a mom. I said, I understand. Along those lines of about parents and what we can do to help. What do you recommend?

Nivedita More, MD: You know, since parents know their children best, it is best to bring up any concern about their child's behavior at school or at home or with friends to their child's pediatrician right away. Parents can also call their insurance or their workplace to look for professional help without a referral if they want to do that.

Other school based help exists through school psychologists. And apps for families as well. A lot of people don't know this, but the state of California has now launched a website starting in Jan 2024 called calhope.org with two app based services based on the age of the child. And they are all free. They don't ask for insurance. They don't ask for your identity. They can be anonymous and it's easy to find help. There is an option for self-help for teens and children through the National Crisis Line, and that number is 988 if anybody wants to know that.

This is for any child or youth in crisis as well. This was launched a couple of years ago and it's now a national line, which links to the local helplines for youth and children in crisis.

Host: That's great. And always lovely to have you on. Let's finish up here today since you are a pediatrician. Let's talk about what pediatricians can do to help. Obviously we have to raise these concerns. We have to advocate for our children and talk about these things with you in the office, but then what do you do to help?

Nivedita More, MD: A pediatrician's role is to make the diagnosis early, intervene early, and to offer appropriate treatment options early with the appropriate community based resources for children and their families. I mean, of course, if there is a need for medication, prescriptions and such, definitely we play a role, but a lot of these mental health concerns can be mitigated with the help of behavioral modification and psychological help through books, through other resources, through therapy. So not everything needs medications and that's where the pediatricians step in to give you a lot of the resources that are available.

As pediatricians, we start screening for mental health concerns during the well visits really earlier on in the well visits. And as the children get older, we also talk to the teens privately regarding any concerns that they need to share without their parents in the room during the annual checkups.

So that opens up a whole, you know, Pandora's box sometimes, when the kids are alone with me as a pediatrician. All mental health disorders do not need medication, as I mentioned, and most can be managed with behavioral therapy by talking to a psychologist or through other self-help parenting applications and apps and there are a lot of companies now doing parenting classes online to help with these disorders.

Most families delay care because of the taboo that is prevalent with mental health disorders, but pediatricians can also help normalize mental health care by labeling it as a medical condition, just like a ear infection or a pneumonia or a fracture, which can get better with treatment. If I just normalize it like that, then they're like, yes, you're right. I think we need treatment for this.

Host: Well, that's perfect. I know we're going to speak again soon about bedwetting, which is maybe not quite as timely, but certainly timeless if you will. Lovely to have you on. Great speaking with you. It's good to know the things that we can do to help ourselves, to help our kids and that we have experts like yourself. So thank you so much.

Nivedita More, MD: Thank you, Scott, for having me on.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.