Every parent wants their child to thrive. But what happens when something feels off – when your usually chatty kid goes quiet, or your easygoing teenager seems overwhelmed by everything? Knowing when a child is struggling emotionally, and how to talk about it, can make all the difference.
Dr. Marissa Michel, a pediatrician at The Iowa Clinic, sees the impact of untreated anxiety and depression in kids regularly. “Parents often tell me they noticed something was different for months before they brought it up,” she says. “Trust that instinct. You know your child better than anyone, and early conversations lead to earlier support.”
Why Children’s Mental Health Matters More Than Ever
Anxiety and depression are two of the most common mental health conditions in children and adolescents – and both have become prevalent in recent years. According to the American Academy of Pediatrics, 20% of all children have an identified mental health condition annually, and 40% of all children will meet the criteria for a mental health condition by age 18.
The good news: these conditions are treatable, especially when caught early.
Warning Signs to Watch For
Kids don’t always have the words to express what they’re feeling – so their emotions often show up as behavior changes instead.
Here’s what to look for.
Signs of Anxiety
- Excessive worry about everyday things (school, friendships, what-ifs)
- Physical complaints with no clear medical cause (stomachaches, headaches)
- Avoiding activities or situations they used to enjoy
- Trouble sleeping or frequent nightmares
- Needing constant reassurance from parents or caregivers
- Irritability or meltdowns that seem out of proportion
- Difficulty concentrating or finishing tasks
Signs of Depression
- Withdrawal from friends, family, and activities they used to love
- Low energy or chronic fatigue
- Frequent talk or feeling worthless or like a burden
- In older children and teens – talk of death or not wanting to be here
Some of these signs – especially sleep changes, appetite shifts, or emotional swings – can be part of a normal development. If you’re seeing several of these signs together, or they’ve persisted for two weeks or more, it may be time to take action.
Starting the Conversation
Bringing up mental health with your child doesn’t have to be a big, formal sit-down. In fact, the most productive conversations often happen in the car, during a walk, or over dinner.
Dr. Michel recommends these approaches:
Start with observation, not accusation. Instead of “What’s wrong with you lately?” try “I’ve noticed you seem stressed. I’m here if you want to talk about it.” This opens a door without putting them on the defensive.
Normalize it. Let your child know that struggling emotionally is not a weakness or something to be ashamed of. You might share your own experience, such as “I’ve felt really overwhelmed before too – it’s okay to talk about it.”
Ask open-ended questions. “How have you been feeling lately?” gets more than “Are you okay?”
Listen more than you talk. Resist the urge to problem-solve immediately. Sometimes your child just needs to feel heard. Validate what they’re sharing before you jump to solutions.
Keep the door open. If they’re not ready to talk, that’s okay. Let them know the conversation can happen whenever they’re ready.
How Your Pediatrician Can Help
A lot of parents don’t realize that their child’s pediatrician is a first-line resource for mental health – not just checkups and sore throat.
At well-child visits, pediatricians routinely screen for anxiety and depression using validated tools. But you don’t have to wait for a scheduled appointment. If you’re concerned, call and ask for a visit specifically to discuss your child’s mental health.
Here’s what a pediatrician can do:
- Screen and assess your child’s mental health in a clinical, low-pressure setting
- Rule out medical causes for symptoms (thyroid issues, sleep disorders, and other conditions can mimic depression and anxiety)
- Provide referrals to therapists, psychologists, or child psychiatrists when needed
- Support you as a parent with tools, resources, and guidance on how to help at home
“Parents sometimes apologize for ‘just’ bringing in a mental health concern,” says Dr. Michel. “There’s no ‘just’ about it. We are partners in your child’s whole health – and mental health is a huge part of that.”
When to Seek Immediate Help
If your child expresses thoughts of self-harm, suicide, or harming others, do not wait for an appointment.
Call or text the Suicide and Crisis Lifeline at 988 for immediate support. If you believe your child is in immediate danger, call 911 or go to your nearest emergency room.
You Don’t Have to Have All the Answers
Talking about mental health with your child doesn’t require a psychology degree. It requires showing up, staying curious, and making sure your child knows they’re not alone in what they’re feeling.
If something feels off – trust that. The Iowa Clinic’s pediatric team is here to help. Schedule an appointment by calling 515.875.9000 or book online today.
MarissaMichel , MD
Marissa Michel, MD joined The Iowa Clinic Pediatrics department to be part of a physician-owned clinic dedicated to providing exceptional patient care. As a pediatrician, Dr. Michel is passionate about caring for children and developing strong relationships with her patients and their families. As both a mom and doctor, Dr. Michel brings a unique perspective to her practice, understanding parental concerns and striving to provide solid, evidence-based advice to help parents make the best decisions for their families.
A lifelong Iowan, Dr. Michel grew up in Dubuque where she pursued her undergraduate at Drake University, and later completed her medical degree and pediatric residency at the University of Iowa Stead Family Children’s Hospital.
Outside of work, Dr. Michel enjoys spending time with her husband and three boys, staying active outdoors, exploring new places, or curling up with a good book. If she wasn’t a provider, she would have opened a combination bookstore and coffee shop – combining two of her favorite things.