Kidsburgh Mental Health Guide: What do we mean when we talk about kids’ mental health?

Parents get offered lots of advice on how to raise physically healthy kids. Books, websites, friends, relatives — they all tell us about feeding babies and helping them sleep well. As years pass, we learn to clean scraped knees and comfort kids through head colds. When we’re concerned about an injury or signs of physical illness, we know to call a pediatrician or visit an urgent care center for help.

But we’re given much less information about raising mentally healthy kids — even though mental health is just as important as physical health.

We all are somewhere on the spectrum of mental wellness at any given time. And it’s very common for people to struggle with periods of anxiety or depression at some point in their lives, says Megan McGraw, a behavioral health specialist at UPMC Children’s Community Pediatrics-Bass Wolfson. And yet for generations, people avoided even mentioning mental health. 

In a Kidsburgh survey of 260 Pittsburgh-area teachers and school personnel, we asked what educators wished parents knew about mental health. 

“Mental health needs are just as serious as physical health needs,” one educator replied. “Mental health requires maintenance and attention.”

The good news is that plenty of information and support is now available to help families cultivate the best possible mental health. And attitudes are finally changing: People are realizing that everyone needs to understand and take care of their mental wellbeing. 

What does good mental wellness look like for children and tweens/teens?

When we talk about mental health and wellness, we’re not just describing challenges like depression or anxiety. Good mental wellness includes things like coping with difficult situations, having a sense of resilience and emotional safety, and holding positive beliefs about ourselves. 

In children, good mental health can best be described by skills like this: 

• Feeling capable of experiencing and handling uncomfortable feelings
• The ability to experience joy and have fun 
• Being able to get needs met (going to a caregiver for comfort, asking for what they need)
• Having more good days than bad ones 
• Having self-care strategies to calm themselves when they get upset or overwhelmed 
• Having a sense of security about themselves and their place in the world 

What are the best ways to talk to kids about their mental wellness?

We’ve broken down this guide by general age-groups, but “none of this is a precise science,” says Diana Schwab, a child development specialist at Kids Plus Pediatrics. Kids’ development can vary widely, so the best approach with one 5-year-old, for example, might not be quite the same for another child that age.

Toddlers through Kindergarten Age

A great first step in teaching young kids about mental wellness is helping them find words for what they’re feeling, Schwab says. Explain that people can notice and name their feelings, and show them how you do that. Soon, they’ll build a vocabulary to describe how they feel. 

Let them know that everyone feels difficult feelings sometimes, and that’s OK. Explain that just as we eat healthy foods and exercise to make our bodies healthy, we can learn to work with uncomfortable feelings like anger or fear. 

Also, let them know it’s OK to feel two different feelings at once: They might feel happy that a relative they love has popped up on a video call, and also sad that they can’t give that person a hug right then. It helps kids to hear that these conflicting feelings make sense to you. You can reassure them that even if feelings are very big, we don’t need to fear them.

You can mention that sometimes change makes people feel grumpy, and that’s OK, too.

One key, says Schwab: It’s not your job to talk a child out of how they feel. Instead, talk to them about how to handle whatever feelings they have, and let them know they can always come to you for a hug even if they can’t quite describe the difficult feelings they’re having.

To encourage conversations about feelings with kids in this age group, try an app like Daniel Tiger’s Grr-ific Feelings. Through games and songs, the app guides Daniel through managing his feelings. 

Elementary School Students

With kids this age, you can bring up good mental health by pointing out a time when they handled a situation well and managed their emotions. Tell them that one power we all can develop is “getting comfortable with being uncomfortable,” McGraw says. 

Kids this age are ready to understand that it’s OK to feel things like anger and loss, especially during this difficult year. But we can build tools to manage those feelings. 

One key for parents is to ask themselves what they were taught about expression of emotions. Were you allowed to express anger, fear or sadness as a child, and were outbursts of good feelings allowed? Even if you grew up in a home where emotions weren’t tolerated, you can create a home for your child where it’s OK to feel and express the full range of emotions. 

One valuable way to begin talking about feelings around COVID-19 is asking a child what has changed and what hasn’t since quarantine began last March. Have them help you make a list, and include funny things as well as serious ones. (You can mention that the child still loves ice cream, so that hasn’t changed. But not being able to see Grandma has changed, and you all have feelings about that.)

If children this age don’t seem to want to talk about their feelings, it can help to bring up the subject while you’re out for a walk or a drive, or doing an activity together, like baking. While you’re doing this activity, you can bring up how you’ve been feeling and then ask the child about their feelings. 

Middle School and High School Students

As kids approach or get into their teenage years, you can go further in discussing and building social-emotional skills. Pennsylvania schools aren’t required to teach social-emotional skills beyond second grade, so your tween or teen may not be getting any instruction. 

You can help: “We can validate for kids that things can be hard, but we can get to the other side of those feelings,” McGraw says. Let kids this age know that while big feelings are important and need our attention, big feelings also come and go.

One major key to good mental health for tweens and teens is supporting them as they figure out who they are. Let them know you want to stay tapped into how they are doing emotionally, while still giving them space and privacy. And encourage them to pursue hobbies or express themselves in ways that appeal to them.  

It’s also OK to ask tweens and teenagers directly about things like depression. Research has shown that we don’t need to fear asking young people whether they’ve ever thought about suicide, says Bethany Hemingway, program officer at the Staunton Farm Foundation and a Mental Health First Aid instructor. Asking a young person whether they’re considering ending their life will not inspire thoughts of suicide, she says, and it can help a parent discover whether their child needs immediate intervention. 

At any age, it’s not productive to have emotional conversations right after a heated argument. Wait until tempers have cooled. Then let the child know what you were feeling during a moment of conflict and ask kids what they were feeling. Rather than going back over the subject of the argument, keep the conversation focused on what you all were feeling and how best to handle those feelings in the future. 

No matter the age of your child, experts say it’s valuable to regularly check in and discuss emotions. “Try to keep an open dialogue,” says Dr. Christie Sylvester, who practices child and adolescent psychiatry at AHN. “And always trying to validate whatever they may be feeling rather than discounting that.” 

While some parents worry that bringing up the subject of sadness or anxiety can make things worse, “if anything it would help make things better,”When parents make it clear that they’re interested in talking about emotions and mental wellness, she says, it allows kids “to come to you earlier and let you know before things get worse.” 

Strategies for building mental wellness — the tools in your family toolbox

• Many parents may feel obligated to ignore their own emotional needs and put kids first all the time. But kids feel adults’ stress levels. So parents need to take care of their own mental wellbeing, says Dr. Laura Voigt, a pediatrician at UPMC CCP-Bass Wolfson. It’s not at all selfish to make sure you take a few minutes for yourself while your child is occupied and breathe deeply. When possible, ask another adult to watch the kids while you get an hour’s break. By taking good mental care of yourself, you’ll be better able to bring calm and strength to interactions with your kids. Adults don’t need to hide their stress from kids. You can explain to children in age-appropriate ways that you’re taking positive steps to handle stress or difficult feelings. If you model that behavior and discuss it with them, kids can learn from your example and begin taking their own positive steps — like taking a nap or getting fresh air outside if they feel stressed.
• When a situation with a child gets heated, remind them they have the power to take a deep breath.
• Help your child find an interest or hobby that they can pursue to grow their sense of competence and confidence, says McGraw. The goal isn’t accomplishment. Instead, it’s about building knowledge they can be proud of. 
• A sense of humor is a great thing to have in your toolbox, Schwab says. If something mildly stressful happens, you can show kids that it’s possible to find the humor in it even as you’re dealing with the stress. And you can teach them to laugh at small difficulties, so they can tackle these problems without feeling overwhelmed by frustration. 
• If you need support, don’t hesitate to reach out. Parents shouldn’t be embarrassed to tell their pediatrician or a therapist “I think I’m yelling too much,” says Voigt. “We’re all human.”  
• If your child seems especially anxious about the threat of COVID-19, let them know what your family is doing to stay safe. Explain the specific steps you’re taking, like wearing masks, washing hands and social distancing. Sharing this information is important. 

Whether your family is struggling with the threat of COVID or another kind of crisis, age-appropriate communication helps. Parents may feel it’s best to avoid difficult subjects, but a lack of information can make children more anxious and fearful. So make time to talk about the good steps your family is taking to avoid the coronavirus.

“If kids don’t have good information,” says Schwab, “they’ll make up a story.” 

Welcome to the Kidsburgh Mental Health Resource Guide. Looks for additional guides: Where parents can access community services in Pittsburgh, the warning signs of mental health difficulties in kids and how your school can help.

For more Kidsburgh stories about mental health, click here. 

This guide is part of the Kidsburgh Mental Health Series, funded by a grant from the Staunton Farm Foundation. The Foundation is dedicated to improving the lives of people who live with mental illness and/or substance use disorders. The Foundation’s vision is to invest in a future where behavioral health is understood, supported, and accepted.

This story is part of the Kidsburgh Mental Health Series, funded by a grant from the Staunton Farm Foundation. The Foundation is dedicated to improving the lives of people who live with mental illness and/or substance use disorders. The Foundation’s vision is to invest in a future where behavioral health is understood, supported, and accepted.