Managing Depression or Sadness: Tips for Families—Mental Health Toolkit

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What is depression?

Depression is another word for feeling sad over a period of time. Feeling sad is normal. It does not result from lack of coping ability or strength. Certain events in a child’s life understandably make them feel sad, such as if a close friend moves away or a pet dies. But when a child’s feelings of sadness get in the way of normal activities such as sleeping, eating, going to school, and playing with friends, it’s time to take action.

Children experience depression differently than adults. Your child may not be able to tell you they are feeling sad, and they may not even feel sad at all. Instead, you may notice your child seems irritable, frustrated, restless, discouraged, or tired. These are some other common signs of depression in children.

Either having trouble sleeping or sleeping too much
Crying a lot
Not wanting to eat or eating too much
Losing interest in things they used to care about
Cutting themselves off from family and friends

How can I help my child at home?

These tips are helpful for all children, but they can be especially helpful for children with depression. Parenting is a busy job, so use your judgment about which tips make the most sense for your family.

Connect with your child

Set aside one-on-one time every day. Even just 10 minutes can make a big difference. Try cooking dinner together, playing a board game, or taking a walk or a bike ride together.
Find out what’s worrying your child, because stress can make depression worse. For example, if your child seems unhappy when they get home from school, you might ask, “Did anything happen today at school that you’d like to talk about?”
Ask about your child’s friends and social activities. Inquire about online relationships, as well as in-person relationships.
Praise your child and make them feel good about them selves. For example, “You did a great job on that homework assignment!” or “Thank you for helping me with the dishes. I’m so lucky to have your help.”
Learn new skills together to help with worries (anxiety), such as deep breathing or thinking in a more positive way. Websites such as Inner Explorer (www.innerexplorer.org) may be helpful.

Encourage your child to have fun and be social

Set aside time for activities your child enjoys, such as watching a baseball game or going on a bike ride.
Help your child plan time with friends and family. Children who feel depressed may cut themselves off from the people they care about, which can make depression worse.
Limit “social” screen time. Communicating by text or social media isn’t a substitute for spending time with friends or family in person, and it can actually make your child feel more cut off from others. Monitor and limit how much time your child spends on texting or on social media until they are feeling better. If your child is separated from friends by distance or other circumstances, such as COVID-19 (coronavirus disease 2019) restrictions, demonstrate and support live virtual conversations to the extent possible (for example, telephone, Zoom).

Build healthy habits

Get active! Encourage your child to be active for at least an hour every day. This activity can include playing outside, joining a sports team or an activity at the YMCA, biking or walking to school, or dancing at home to favorite music. Physical activity is good for mental health.
Do the things you have enjoyed in the past. Enjoying yourself is an important part of self-care.
Eat healthy. Eat healthy meals every day, including fruits and vegetables, whole grains, and protein foods. Remember to eat breakfast!
Get plenty of sleep. School-aged children need 9 to 12 hours of sleep every night, and teens need about 8 to 10 hours.
Limit screen time. Try for less than 2 hours a day of entertainment screen time. Avoid scary or violent TV shows, video games, and movies.
Keep family routines. It’s important to follow a regular schedule for playtime, mealtime, and bedtime. Knowing what to expect can help your child feel safe and secure.

It can be very scary to even think about your child hurting himself. But if your child feels depressed, take extra steps to make your home a safe place by removing weapons, alcohol, medicines, and harmful household chemicals. If you can’t remove these items, store them safely (for example, in a lockbox).

How can I help my child at school?

Difficulty at school can be either a cause or an effect of depression. Children may find it hard to focus on or even go to school when they’re feeling sad, and children who are experiencing difficulty learning or problems with peers can feel frustrated and sad. What looks like laziness or lack of interest may be depression. If your child is having trouble in school, try these ways to help.

Ask your child’s teachers whether your child is having learning difficulties, and request academic testing if your child is struggling or falling behind.
Ask teachers and the guidance counselor whether your child could be experiencing bullying; if so, enlist their help in addressing it and protecting your child.
If your child has frequent physical concerns (for example, headaches, stomachaches, cramps) in the morning and does not want to go to school, gently but firmly tell them why it’s important to go to school; develop a plan with your pediatrician and school personnel as to how requests to go home from school early should be handled.
Praise your child’s efforts toward improvement in school, as well as successes.
If you think family stress or pressure to do well in school is upsetting your child, let them know they are doing a good job and you’re proud of them.
Help your child set realistic goals for school. If they are setting goals that are too hard to meet, they can wind up feeling worse about themselves.
Consider reasonable and short-term changes in demands and responsibilities (for example, negotiating extensions for assignments or other ways of reducing stress at school).

It’s also important to let your child’s doctor know if your child is missing school more often.

Remember, you know your child best.

Whether it’s at school or the doctor’s office, you are your child’s biggest advocate. Don’t hesitate to speak up on behalf of your child.

When do I need to go back to the doctor?

If your child’s feelings of sadness continue or get worse, it’s a good idea to go back to the doctor. The doctor can help you decide whether visiting a specialist for therapy could help your child. A type of treatment called cognitive behavior therapy, or CBT, has been shown to be helpful for depression. For some young people, CBT and medication, together, are helpful.

Also, ask for the doctor’s help in creating a safety and emergency plan, with numbers to call, if

Your child starts to have other behavior problems, such as anxiety or fearfulness.
Something happens in your child’s life that may make their depression worse, such as a breakup or a death in the family.
You suspect your child’s depression is affecting another medical condition (for example, if your child’s asthma gets worse with depression).
Your child has thoughts of harming themselves or of suicide.
There’s a suicide in your child’s friend group.

Make time to care for yourself too.

Parenting can be stressful. If you’re feeling overwhelmed, don’t be afraid to ask for support from family, close friends, social services, or your faith community. Children pick up on the stress and worries of adults around them, so getting support for yourself can help your child too.

To learn more about childhood depression and what you can do to help, visit these websites.

American Academy of Pediatrics HealthyChildren.org: www.HealthyChildren.org
American Academy of Child and Adolescent Psychiatry: www.aacap.org
American Psychological Association: www.apa.org
National Alliance on Mental Illness: www.nami.org
National Federation of Families for Children’s Mental Health: www.ffcmh.org

The information contained in this resource should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original resource included as part of Addressing Mental Health Concerns in Pediatrics: A Practical Resource Toolkit for Clinicians, 2nd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.