By Shelley Nortje
Depression, a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings and sense of well-being, is a word that is laden with negative connotations; fears, stigma and avoidance. Adult depression is a more common and better understood mental health difficulty. It is, however, often not expected or imagined that a baby or a primary-school aged child could also experience depression. But they do. Children are little humans in their own right with their own complex feelings and unique experiences. All children experience ups and downs and feel sad or down at times. When your child’s experience seems more exaggerated than expected and is impacting on their everyday ability to be at school and with friends, then it is important to open up a conversation with them about these big feelings that they are struggling to manage on their own.
Signs and symptoms
Children present with depression in a different manner than adults and adolescents. The complexity of childhood depression is exacerbated by the overlap of symptoms with other difficulties such as Attention Deficit Hyperactivity Disorder (ADHD) and anxiety disorders. Below are some common signs and symptoms of depression in children to be aware of as a parent or caregiver (Diagnostic and Statistical Manual of Mental Disorders Revised, DSM-IV-TR). Remember that some of these signs need to present for at least two weeks in order to be a red flag.
A change in mood: Often children are not able to label their feelings accurately or be able to understand fully why they may feel down. Unlike adults, children might not be able to tell mom or dad that they are ‘depressed’. Instead, a young child is more likely to seem irritable, sulky and have unexplained tearfulness. Small children may seem to be withdrawn and defiant at one point, and then scared and clingy at another time. Sometimes a child who is described as ‘lazy’ or feels ‘bored’ all the time is also at risk.
Aggression: Temper outbursts are also more common in children with depression. School fights and disagreements between siblings can sometimes be an indicator that your child is struggling with difficult feelings.
Eating: Eating patterns may also change for a child with depression. This means that the child may eat more or less. They may also refuse foods that used to be their favourites.
Sleeping: Sleeping patterns may also be affected. The child may struggle to fall asleep, wake up in the night, and complain of fears or nightmares.
School difficulties: A child who refuses to attend school, complains of being bullied at school, or is unable to concentrate on work or play activities may be giving a message that they are struggling with depression.
Withdrawal: A child with depression is also more likely to avoid social interactions, and prefer to hide in their room. They may avoid friends and family members, and be less enthusiastic or energetic about activities they usually enjoy.
Somatic complaints: Many children who aren’t able to verbalise their emotional conflicts yet, will express them as illness; complaints of headaches, stomach aches or nausea that usually have no medical explanation.
Low self-esteem: Children with depression may also have a poor self-concept which means they often might say or do things that show they don’t believe they are capable or worthwhile. Negative self-talk often goes with these kinds of feelings where your child might say things like “I am so stupid” or “I can’t ever do anything right.”
Play: Small children communicate best through play. They may give the message that they are struggling with their feelings in their play with themes of death or sadness becoming more frequent. Suicidal thoughts and gestures in young children need to be treated as an emergency and one needs to seek professional help immediately.
There are both internal and external experiences that can cause a child to be more prone to developing depression. The manner in which a child is able to cope with risky situations, has much to do with an interplay between their genetic inheritance, temperament, family dynamics and the severity of the event. The absence or death of a loved one, a divorce, maternal depression, experiencing an illness or hospitalisation, a trauma, bullying, poverty or social disadvantage, and even the arrival of a new sibling are all experiences that may be difficult for a small child to manage. They often need parents’, family members’ and caregivers’ affectionate touch and kind words to help them make sense of their big feelings.
The role of parents and caregivers
Parents play an important role in supporting their small child to make sense of their big feelings. This is not an easy task when parents oftentimes feel guilty and to blame for their child’s difficulties.
Here are some tips for parents to maintain healthy relationships with their children to help prevent and manage depression or anxiety symptoms:
Show Affection: Giving hugs and showing acceptance and love for who your child is, not who you expect them to be is important.
Special Time: This means giving your child regular one-on-one time with you, engaging in fun activities together and being actively interested in your child’s likes and dislikes.
Time-in not a Time-out: A small child is not yet able to reflect on their behaviour and think of how they might behave in the future when they sit alone in a ‘naughty corner’. Their brain just isn’t developed enough. Instead, a time-in where you help your child through a problem-solving process step-by-step, gives them a safe space to learn a better way to respond next time.
Limit Social Media: Try to monitor your child’s exposure to social media to prevent exposure to age-inappropriate material or unnecessary cyber bullying.
Strength-spotting and Building: Build on your child’s strengths by working together on things they enjoy; be it building a puzzle, cooking, or being outdoors.
Encourage Autonomy: Being too protective can prevent a child from trusting in their own abilities to cope with a difficult task. Encouraging your child with a challenging task can help them learn to manage with tough feelings of disappointment and making mistakes.
Stay Connected: Positive and strong connections to family and friends is very valuable to prevent depression. Team sports, going to the park and other community activities can be fun for your child and the whole family. Make sure your child has access to phone numbers of loved ones to contact in times of need.
Democratic Family Rules and Routines: Establishing a set of family routines, rules and consequences (that apply to mom and dad and others too) together in a family meeting can be helpful to create a safe, secure and predictable environment for your child to grow and develop.
Healthy Habits: A balanced diet, daily exercise, limited ‘screen time’, and sufficient restful sleep can go a long way to help children feel happy and healthy.
Name It To Tame It: Help your child to put words to difficult feelings so that they are less overwhelming and more manageable. Using emotion face charts can be helpful to facilitate this conversation. Labelling your own feelings in front your child is another way to help children learn ‘feeling vocabulary’.
Minimize Conflict: Help to create a safe and supportive environment at home where it feels safe to talk about difficult things, without arguments, criticisms and harsh discipline. If violent interactions are common in your home please seek immediate professional help.
Role Modelling: Showing your child first-hand how you deal effectively with difficult situations, make choices and problem solve can be an effective learning experience.
Be Calm in yourself: Although it is a demanding job, caregivers need to hold their children’s big feelings for them sometimes, without burdening their children with their own struggles. Try to always help your child or deal with a big feeling when you are calm, caring and connected.
Treatments and Interventions
At first, the thought of your child suffering from depression can feel disempowering and disheartening. Depression is hard to take in for both the child and the parent. However, there are various professional services available to support the whole family. Many psychologists are trained to offer services such as parent counselling, play therapy, or family therapy. Child-oriented therapies often use play as a means of communicating with the child in order to help them develop coping skills and understanding their emotions. Depending on the nature of each individual case, it may also be necessary to consult with a paediatrician or child psychiatrist, as some symptoms of depression can also be caused by medical difficulties. In some situations, parents may seek assistance for their own mental health difficulties first in order to be better equipped and available to support their child. It is important to remember that psychological treatments are not ‘quick fixes’ and may take time. A commitment to an agreed upon treatment plan is only the first step to helping your child.
One of the most valuable things a parent can do is to take a child’s feelings seriously. Even small people have big feelings that deserve much respect and care. An available parent or professional who is willing to talk to and listen to the child is an invaluable ally when dealing with the overwhelming symptoms of childhood depression.
“Listen earnestly to anything your children tell you, no matter what. If you do not listen eagerly to the little stuff when they are little, they will not tell you the big stuff when they are big, because to them all of it has always been big stuff.” – Catherine M Wallace –
Daniel Siegel’s helpful and hands-on book “No-Drama Discipline”
SADAG: South African Depression and Anxiety Group – www.sadag.org
DSM-IV-TR (Diagnostic and Statistical Manual – 4th edition – revised)