Anxiety disorders are complex. Unlike normal anxiety—which everyone experiences—clinical anxiety does not go away and can worsen over time, interfering with daily responsibilities like schoolwork and routine activities.

Anxiety can present differently from child to child. Many parents find it helpful to watch for patterns of behaviors that are consistent and intense, including:

• Agitation
• Restlessness
• Inattention and poor focus
• Somatic symptoms like headaches or stomach aches
• Avoidance
• Tantrums
• Crying
• Refusing to go to school
• Meltdowns after school about homework
• Difficulties with transitions within school, and between school and an activity/sport
• Difficulty settling down for bed
• Having high expectations for school work, homework, and sports performance

Depression is characterized by a persistently depressed mood or a loss of interest in activities. It is different from a normal period of feeling sad, and symptoms can significantly impair daily life. Common signs include:

• Feeling chronically sad, hopeless, or irritable
• Not wanting to participate in or enjoy previously fun activities
• Changes in eating patterns (eating much more or much less than usual)
• Changes in sleep patterns (sleeping much more or much less than usual)
• Changes in energy (tired and sluggish, or tense and restless)
• Difficulty paying attention
• Feeling worthless, useless, guilty, helpless, or hopeless
• Self-injury and self-destructive behavior
• Extreme depression can ultimately lead a child to think about suicide or plan for suicide

Eating disorders can be difficult to identify in early stages. In a diet and weight-focused culture, what begins as a desire to “get healthy” can become obsessive. Early identification is important.

• Emotional and behavioral symptoms:
  • Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
  • Discomfort eating around others; denial of hunger
  • Food rituals (only eating foods in a particular group, limiting eating to certain times, cutting food into small pieces)
  • Skipping meals or taking smaller portions
  • Extreme concern with body size and shape
  • Focus on needing to be in control
  • Binge eating and/or purging
• Physical evidence:
  • Noticeable weight fluctuations (up or down)
  • Irregular menstruation
  • Feeling cold, lightheaded, or fainting
  • Dry skin, nails, and hair; hair loss

Differentiating between typical emotions and symptoms of a mental health disorder can be difficult. According to the National Institute of Mental Health, parents should seek help:

• If a child engages in unsafe behavior or talks about wanting to hurt themselves and/or someone else
• If a child’s behavior or emotional difficulties last for more than a few weeks
• If a child’s emotional difficulties cause problems at school, at home, or with friends

Treatment depends on the diagnosis and a child’s environment. In general, recommendations may include:

• Psychotherapy (talk therapy)
• Medications
• Family counseling
• Support for parents

Capital Area Pediatrics offers multiple entry points for families concerned about pediatric mental health:

• Diagnosis: Our team can help evaluate concerns and support families in making a diagnosis. We offer universal screening and have providers trained in the evaluation and treatment of common mental health conditions.
• Treatment: Counseling services are available at several CAP locations. Your pediatrician can discuss options and help coordinate your first appointment. CAP can also assist with basic medication management when appropriate. For complicated and/or emergency situations, doctors may refer families to our in-house Nurse Navigator, Jennie Boyd, RN.
• Referrals: When specialty care is needed, we can provide referrals and help coordinate care so specialists and your pediatrician can communicate effectively. We can also recommend supportive resources in the local community.