Depression in Children:

 What Parents Should Know

Depression doesn’t just affect adults—it can significantly impact children and adolescents too. Luckily, it is treatable if done early on in a child’s life. Recognizing the early signs, supporting healthy habits, and ensuring access to professional care can change a child’s life trajectory. Complications of childhood depression can include: difficulties receiving a job, problems with housing, higher rates of substance abuse, possible incarceration, and suicidal ideation.
Understanding the signs, prevention strategies, and treatment options is essential for early recognition and support.

Signs and Symptoms
Children with depression may not always appear "sad." Their symptoms can differ from adults and often include:
● Persistent sadness or irritability (especially common in kids)
● Loss of interest in activities they once enjoyed
● Changes in appetite or weight
● Sleep disturbances (trouble falling or staying asleep, or sleeping too much)
● Fatigue or low energy
● Difficulty concentrating
● Feelings of worthlessness or excessive guilt
● Somatic complaints (like headaches or stomachaches)
● Decline in school performance
● Thoughts of or behaviors related to self-harm or suicide
● Low motivation to participate in activities

Prevention Strategies
Early prevention efforts can make a big difference. These include:

● Addressing modifiable risk factors like:
○ Adverse childhood experiences (ACEs) - Includes physician, emotional, or
sexual abuse; neglect; household dysfunction (substance abuse, mental illness,
incarceration, drug use)
○ Bullying - Bullying can come in many forms such as via social media, verbal
abuse, or physical bullying. If your child spends much of their time on social
media, appears discouraged, or seems to have low self-esteem, these may be
signs they are experiencing bullying at school
○ Low physical activity - It is very important that your child participate in physical
activity, not just for physical health, but for mental and emotional strengthening.
○ Family conflict - Includes parents frequently arguing in front of child or divorce
○ Social isolation or stress - risk factors include poor or low social interaction with
friends. It is important your child has a group of friends they can rely on for
emotional support and participate in outdoor activities together.

● Promoting protective behaviors:
○ Regular physical activity (Aim for at least 30 min of physical activity per day)
○ A nutritious diet - Balanced meals with 1⁄2 vegetables, 1⁄4 carbohydrates, and 1⁄4 protein. Limit processed sugars such as candies, baked goods, and sugary
drinks.
○ Adequate sleep - Aim for 9-10 hours of sleep each night. Ask your child if they
experience frequent nightmares or night terrors, bedwetting, or difficulty falling or staying asleep

● Encouraging positive relationships at home, in school, and in the community
● Participating in school- or community-based programs aimed at supporting mental health. Ideally participate in physical, outdoor team-based activities to promote movement and positive relationships
The U.S. Preventive Services Task Force (USPSTF) and the American Academy of
Pediatrics (AAP) recommend:
● Annual depression screening for adolescents aged 12 and older, especially those at higher risk

● Use of validated tools like the PHQ-9 modified for teens. Pediatricians such as Sima Stein, M.D., can help evaluate if your child is at risk for depression and possible treatment options.

Treatment Options

Treatment depends on the severity of the depression:

Mild Depression
● Supportive care, psychoeducation, and active monitoring
● Regular follow-ups to assess progress
Moderate to Severe Depression
● Psychotherapy is first-line:
○ Cognitive Behavioral Therapy (CBT)
○ Interpersonal Therapy (IPT)
● Medications (if needed):
○ Medications such as SSRIs or SNRIs can be an effective treatment. Consult with
your pediatrician on which options are best for your child’s needs.
● Combination therapy (CBT + SSRI) is often the most effective approach.
Collaborative & Supportive Care
● Team-based care models involving primary care, mental health professionals, and schools. Programs such as the Children's Health Counsel (CHC), can be an effective resource for improving a child’s motivation, behavior, and mental health.
● Family involvement and psychosocial support are especially important for children with complex needs
If you're concerned about your child’s mood or behavior, talk to your pediatrician or a mental health provider. Dr. Sima Stein, board certified pediatrician based in San Jose, CA can help you and your child get on a track to success with early evaluation and treatment.