Expert Tips from Just Ask Children's


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Keep your kids healthy with valuable tips and information from the experts at Children's Hospital Colorado. Every month we answer parents’ top questions on a new topic. Sign up for our free e-newsletter to stay in the know.  

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This month's topic: mental health for kids

Mental health is a lot like heart health, or kidney health — which is to say that it’s essential to your overall health, and it’s worth taking care of. That’s especially true for kids. Just as their bodies are developing, so are their minds. Their formative years lay the foundation for how they’ll see and engage with the world throughout their lives.

May is Mental Health Month — the perfect time to talk about what mental health means for you and your family. We asked two of our experts to answer questions on kids’ mental health: Marlena Romero, a senior behavior health clinician at Children’s Hospital Colorado, and Lisa Costello, Outreach and Advocacy Coordinator for the Pediatric Mental Health Institute at Children’s Hospital Colorado.

1. What does good mental health look like in children?

Mental health is about more than how we feel — it’s also about how we perceive the world and react to it. It’s about how we connect to others, make choices and deal with stress. Ideally, it begins with a state of emotional well-being that affects all these factors.

A child’s ability to cope with stress in effective, age-appropriate ways is one basic measure of good mental health in kids. Take tantrums, for example. A 2-year-old’s anguished response to not getting an extra cookie, while extreme, is pretty typical of the age. The same response to the same thing in a 12-year-old, on the other hand, would be cause for concern. Ideally, as we grow, we learn better tools to cope with what life throws at us.


2. How can I tell if my child is developing on track with her age?

A child’s development is often grouped in five key areas: language, physical, emotional, social and cognitive. Each age has its own developmental milestones. Still, it’s important to remember that what’s “typical” (we like to say “typical” rather than “normal”) of a given age can be broad. Your pediatrician can be a great resource for explaining developmental milestones and evaluating your child’s progress toward them.

For a broad overview, you can also find a number of online resources with basic information about child development.


3. How can I help my child cope with stress?

The ability to deal with stress doesn’t necessarily come wired into us — it’s actually a skill kids need to learn. One of the best ways to teach children positive coping strategies is to model them. Deep breathing, progressive muscle relaxation and even going for a walk are great ways to relax. Practice these techniques when kids aren’t stressed, and during stressful situations, your child will know what to do. Employing relaxation techniques in response to stress can come as naturally as riding a bike.

Good sleep, good nutrition and regular physical exercise are also essential to kids’ ability to deal with the challenges of everyday life. Spending time together as a family on relaxing activities is a great way to bond and have fun, while building a foundation of healthy habits in the process.


4. What's the best way to handle tantrums?

Between infancy and about 3 years old, tantrums happen. That’s just a fact of life. No strategy is likely to make tantrums go away completely, but there are a few ways to help kids learn to manage and, eventually, grow out of them:

  • Teach kids emotional vocabulary. Small children lack the vocabulary to always make themselves understood, and that can be frustrating. Try labeling feelings: “I see you’re angry,” “I see you’re sad” and so on. Try labeling your own emotions for them or pointing out the emotions of characters in books. Acknowledging their feelings, rather than just reacting to them, sends the message that it’s okay to have emotions and okay to express them and be understood. It’s not okay to break things, but it is okay to be mad. The best time to practice with emotional vocabulary is during normal daily interactions — not during tantrums.
  • Teach kids to deal with emotion in constructive ways like going for a walk, taking a deep breath or spending some time in a quiet place. The most important thing is that parents model the same behavior they want to see in their kids.
  • Show empathy. Pointing out facial expressions, acknowledging their words and body language and expressing empathy can all head off a tantrum by making a child feel heard.
  • Perhaps most importantly, stay positive. Keep encouraging what they’re doing right, and let the tantrums come and go.

5. My teen wants to date. What’s an appropriate age to start?

It depends on how we define “dating.” For a middle schooler, the definition of “dating” might be as limited as “mutual romantic interest.” They hang out at school, maybe hold hands in the hall and at the end of the day they go home and text. If middle schoolers want to call that “dating,” that’s probably okay.

In terms of “dating” as traditionally defined — spending one-on-one time with a romantic interest — high school is probably the natural starting point. Maturity-wise, high schoolers are typically starting to spend and demand more time unsupervised than before, sometimes with access to transportation. Some of that unsupervised time may include one-on-one time with a romantic interest. That’s usually okay. Talk to your kids about healthy relationships, and make sure they know they can talk to you about whatever’s going on. Be an open, non-judgmental presence, and if they run into issues, they’ll come to you.


6. How can I tell if my child needs mental health help?

You know your child better than anyone, meaning you’re in the best position to notice a change in your child’s behavior. Significant changes in your child’s eating or sleeping, significant acting out, withdrawal from activities previously enjoyed and fears that interfere with daily activities can all be signs of a potential mental health issue.

Of course, not everything has to be a full-fledged mental health issue. A child who’s having trouble controlling emotions, making friends or calming down when upset might benefit from some extra help. It never hurts to mention issues like these to professionals such as your pediatrician or your child’s school psychologist, or to possibly have your child evaluated if you have concerns.

Read about the signs and symptoms of mental health issues and the difference between typical teen behavior and something more.

A child talking about suicide, hurting or threatening to hurt him or herself or others needs immediate help.


7. What if my child comes to me with an issue that upsets me?

Occasionally a kid — teens, especially — might come to a parent with an issue that’s distressing even for the parent to hear. Maybe someone has behaved cruelly toward your child, or maybe your child has done something that crosses the line for you.

At these times, it’s crucial to be someone your child can trust. Teens aren’t quite adults yet, but they’re increasingly making their own decisions. One of the best decisions you can encourage them to make is to turn to you when they need help. Making your teen feel safe when she’s at her most vulnerable is the best way to do that.

Hear your teen out. Try not to judge. Be a good listener, and your teen will be more likely to listen to you. Ask your child’s primary care provider, a school counselor or a community mental health professional if you need help.


8. Does therapy really work?

Short answer: yes.

Long answer: today’s psychotherapy is quite a bit different from the popular but outdated image of a patient reclined on a couch recounting dreams and childhood experiences while a poker-faced therapist jots inscrutable notes. Which is not to say dreams and childhood experiences aren’t fair game for discussion, but in practice, evidence-based psychotherapy is more directed toward identifying problems and implementing solutions.

Kids get antibiotics when they get strep throat because there’s a body of evidence to show that antibiotics are an effective way to treat strep. In the same way, a body of evidence shows the effectiveness of cognitive-behavioral therapies that address anxiety, depression and compulsive disorders specifically calibrated to a child’s developmental stage. These therapies are based on years and years of research, and the evidence is in: they work.


9. What is mental health first aid?

If you saw someone choking, you would probably try to give her the Heimlich maneuver. If someone stopped breathing, you would try to administer CPR. If you saw someone having a mental health emergency, you would… what? It’s important for adults working with adolescents to be familiar with resources, know the risk factors and warning signs, and learn how to identify situations before they become a crisis.

Mental health first aid enhances knowledge about behavioral health, offers resources, helps reduce the stigma around mental health issues, and offers real world tips on helping someone in a crisis situation. It pays to know, and it just so happens Children’s Hospital Colorado is offering a course next month. It’s free, and anyone can attend. Visit www.mhfaco.org, select “Find a Class”, and choose the FREE June 3 class held at Children’s Hospital Colorado or select a course on a date/location that works best for you.


10. How can I promote good mental health for my kids at home?

The foundations of good mental health and good physical health are basically the same. Adequate sleep, a healthy diet and consistent physical activity keep kids (and adults) feeling mentally and physically at their best. Beyond those basics, good mental health is in many ways about relationships: learning how to interact with and relate to others in constructive, mutually beneficial ways. So be sure to devote time to your relationship with your child. Make time for fun and play, and try not to overschedule. If possible, leave time in the week that’s free and open, when your kids can spend time with you and talk or play.

Perhaps most of all, focus on the positive. Instead of devoting attention to the challenges of your relationship, focus on what’s good, what your kids are doing right. Your kids want your approval. Often, promoting the positive will take care of the negative on its own.