A phase usually comes and goes, and your child still manages school, friends and home life around it. Something more tends to last for weeks or longer, cause real distress, or get in the way of daily life. The National Institute of Mental Health (NIMH) says children commonly feel sad, anxious, irritable or aggressive at times, and that most of the time this is typical development. It also advises considering help when a behavior or emotion lasts for weeks or longer or causes distress or problems with functioning.
Part of our guide: A Parent’s Guide to Child and Teen Mental Health
You do not need to be certain before asking a professional. An evaluation can also conclude that your child is doing fine, and that is useful to hear.
If safety is the question, skip the waiting. If your child talks about suicide or self-harm, or you think they are in danger, call or text 988 (988 Suicide & Crisis Lifeline), call 911, or go to the nearest ER.
Four questions that separate a phase from a pattern
No single behavior settles this. These questions help you describe what you are seeing, and they are close to what a clinician will ask.
How long has it been going on?
A bad week after a friendship falls apart is different from two months of withdrawal with no clear end. Write down roughly when you first noticed the change.
How much distress is your child in?
Some children are loud about a problem and fine an hour later. Others are quiet and clearly suffering. Look for signs that your child is unhappy about it too, or stuck in it and unable to shift.
What is it getting in the way of?
Look at school, sleep, eating, friendships, activities and family life. The American Academy of Pediatrics frames it this way: when difficulties occur more than usual and begin to get in the way of regular functioning, it could be a sign of something more serious.
Is it a change from who your child usually is?
A child who has always been shy is different from a once-social child who has stopped seeing anyone. A shift from your child's own baseline often tells you more than a comparison with other kids.
Signs that deserve a closer look, by age
These lists draw on the American Academy of Child and Adolescent Psychiatry (AACAP) and NIMH. One item on its own does not mean a disorder. They are prompts for a conversation with a professional.
| Younger children | Pre-teens and teens |
|---|---|
| Frequent, unexplained tantrums, or irritability much of the time | Severe mood swings or a prolonged negative mood and attitude |
| Often seeming fearful or worried; regularly refusing school because of worry | Worries strong enough to get in the way of daily life |
| Frequent physical complaints | Marked changes in sleeping or eating |
| Persistent nightmares | Marked decline in school performance, or extreme trouble concentrating |
| Marked fall in school performance, or poor grades despite trying very hard | Repeated use of alcohol or drugs |
| Persistent disobedience or aggression lasting longer than 6 months | Frequent outbursts of anger, or repeated threats to run away |
| Threats to harm or kill themselves | Thoughts of suicide, self-injury, or threats to harm self or others |
The CDC adds a useful reminder: symptoms change as a child grows, and they can show up in how a child feels, handles emotions, plays, learns, speaks and acts. A young child may have no words for sadness or worry, so it can come out as behavior or stomachaches. The site's article on behavior as communication in kids goes further into that.
Common situations that make this harder to judge
There is an obvious reason
A move, a divorce, a death or a new school can explain a hard stretch, and that stretch may ease with time and support. A clear cause does not rule out needing help, though. If the struggle is not easing or is growing, it is reasonable to ask, even when you know why it started.
Your child looks fine at school but falls apart at home, or the reverse
Different settings bring out different things, which is why teachers are worth asking. NIMH suggests starting with people who see your child regularly, such as teachers. A problem showing up in only one place is still information, and it is worth passing on to a clinician.
Your teen will not tell you anything
Some privacy and distance is part of being a teenager. What deserves attention is the bigger change around it, such as dropping activities, sleep shifting sharply, or grades sliding. The article on signs your teen is struggling but not saying it covers quieter signs and how to approach a teen who is not opening up.
Other adults disagree with you
A relative may say you are overreacting. A teacher may be worried when you are not. AACAP suggests that if problems persist over an extended period, or if others in the child's life are concerned, it may be time to consult a mental health professional. You know your child well, and outside observations add to that.
What to do this week
- Talk gently with your child. AACAP says the first step is to gently try to talk to the child, because an open conversation about feelings often helps. Choose a calm time. Describe what you have noticed and ask what it has been like for them.
- Keep brief notes. Jot down what happens, how often, and what seems to set it off. A few weeks of notes will help more than your memory during a stressful appointment.
- Ask the people around your child. A teacher, coach or caregiver may have seen something you have not, or may tell you it is not showing up elsewhere.
- Book a visit with the pediatrician. NIMH recommends talking with your child's health care provider and asking for a referral to a children's mental health professional. The U.S. Preventive Services Task Force recommends screening for major depressive disorder in adolescents aged 12 to 18, so a pediatrician may already have a questionnaire ready. For children 11 and younger, the Task Force found the evidence insufficient to weigh the benefits and harms of routine depression screening. That is about routine screening and does not stop a clinician from assessing a child you are worried about.
- Watch your own stress. Worrying about a child is draining. Parents who are looked after are better able to stay steady at home.
What an evaluation actually involves
Many parents hold back because an evaluation sounds like a label waiting to happen. According to NIMH, a comprehensive evaluation usually involves a parent interview about development, temperament, relationships, medical history and past treatment, along with information from school and, if needed, testing and observation of the child.
The result may be a diagnosis, or it may be practical guidance with no diagnosis at all. Either gives you more to work with than guessing. If you are unsure which type of clinician to start with, see when a child should see a psychiatrist or a therapist and what happens at a child psychiatric evaluation.
If it turns out to be a phase
That is a good result. You will have shown your child that their feelings get taken seriously and that asking for help is a normal thing to do. You will also have a baseline and a contact to go back to if things change later.
If your child's struggles have lasted or are getting in the way of daily life, the child and adolescent psychiatry and therapy page explains how care works at Mind Body Seven. Details on costs and claims are on the fees and insurance page.
FAQs
How long should I wait before getting my child evaluated?
There is no fixed waiting period. NIMH suggests considering help when a behavior or emotion lasts for weeks or longer or causes distress or problems with functioning. Unsafe behavior or talk of self-harm calls for immediate help.
Will asking about it make it worse?
Talking with your child is the first step AACAP recommends. For suicide specifically, NIMH reports that studies show asking does not increase suicidal thoughts or behavior.
Are mood swings normal for teenagers?
Ups and downs are common. Severe swings, a low mood that lasts, or changes that affect school, sleep or friendships are worth raising with a pediatrician or mental health professional.
Who should I call first?
Your pediatrician is a common starting point and can refer you. You can also contact a child mental health clinician directly. In an emergency, call or text 988, call 911, or go to the nearest ER.
