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Depression in children

depression; child; sad; miserable; angry; children; childhood ;

Family losses, personal disappointments and difficulties have an effect on children as well as on their parents and adolescent brothers and sisters. Not all children can bounce back emotionally from these events.  When children are miserable and show a number of other changes in behaviour that stop them from participating in their normal activities, it can be called depression.

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Everyone knows children can be sad and miserable at times in their lives. Family losses, personal disappointments and difficulties have an effect on them as well as on their parents and adolescent brothers and sisters.

Until recently, we have tended to assume all children can bounce back emotionally from these events. However, for some children sadness does not lift, but lasts for a long time. When children are miserable and show a number of other changes in behaviour that stop them from participating in their normal activities, it can be called depression.

Many depressed children become depressed adolescents and adults, so it is really important to do something about depression in a child. Get some help and support now so that the child can look forward to a happier life ahead.

Rate of depression in children

Children, even very young children, can become depressed although depression is less common in children than in adolescents and adults.

Some studies have found:

  • 4 in a 100 preschoolers (4%) have some symptoms of depression
  • 10 in a 100 (10%) children between the ages of 6 and 12 have persistent feelings of sadness which can last for a few weeks or months. 2 in a 100 (2%) children become seriously depressed.
  • The rate goes up with age, so that about 5 in a 100 (5%) young people (over 12 years) suffer a major depressive illness which lasts for a few weeks or months at some time.

Before puberty, the rates of depression in girls and boys are about the same, but after puberty more girls than boys experience depression.

What to look for

Children probably will not recognise what is happening to them, so they may not be able to tell others that they cannot get rid of the sad feelings. They may also not know the words to describe what they feel. Some may feel ashamed or too embarrassed to do so.

Parents and others need to take the lead and notice changes in the child. A child who has several of the following signs that continue over time needs help and support from parents or carers. Even if they are not signs of depression, they are signals that something is going wrong for your child.

  • A sad, unhappy mood most of the time that lasts for weeks or more
  • Lack of interest or pleasure in activities they have previously enjoyed
  • Avoiding friends
  • Irritability
  • Disturbed sleep over some weeks
  • Changes in appetite; weight gain or loss
  • Daytime wetting or soiling in a toilet trained child
  • Poor concentration
  • Feeling hopeless or worthless
  • Self blame for troubles of family or friends
  • Being tired most of the time
  • Talking or playing a lot about death
  • Mentioning suicide
  • Risk taking and not seeming to care if hurt or in pain
  • Harming other children or animals
  • Being angry or resentful a lot of the time.

Important Note: Sometimes children use aggression and toughness to mask their sadness. It is important to remember this, particularly with angry adolescents.

Anxiety is different but can sometimes accompany depression. The child may have aches and pains that have no physical cause.

What causes depression in children?

Usually, there are reasons that trigger depression - children having to face ongoing situations that do not get any better, or a series of difficult events that come all on top of one another. Only some children will become depressed, but many will become sad, angry or anxious.

These might be:

  • ongoing conflict in the family or between parents
  • relationship problems with parents or carers
  • friendship problems
  • family break-up
  • death of close people or animals
  • losses of other kinds (like moving house and losing friends)
  • some other upsetting thing happening in the child's life
  • serious or continuing illness or disability
  • abuse or bullying
  • continuing failure in the eyes of others at home or school
  • sometimes if a parent is depressed, children unconsciously learn the parent's way of dealing with life
  • medications taken for other reasons occasionally disturb children's moods.

Sometimes there is an inherited family tendency towards depression that means children could be less able to handle the stresses mentioned above and so are more likely to suffer depression.

Depression in babies

Most researchers think babies can be depressed too, if they are not getting enough warm, nurturing contact (both loving touching and baby talk) with at least one person in their world. If babies become apathetic, uninterested in people and unresponsive, or fail to gain weight, it is important to get help from a health professional.

What you can do

Even though a depressed child may be hard to talk to, it is really important for someone to try to make contact and to understand what has set off the depression. If parents do not have success with this, get help from someone the child can trust. This may be a relative (for example, aunt or grandparent), friends or someone from the child's school.

In talking to children the following things are important.

  • Listening to what they have to say, really listening. This is easier said than done and means not interrupting, not reacting and saying "that's silly" or, "it's your own fault", or even leaping in to try and cheer up or reassure. Just let children say whatever they can say and try to imagine what they are feeling as they speak.
  • You can ask a few questions to help understand the child's story, but do not quiz them, or ask 'why'. They may not know 'why', but they may know how they feel and they may know what they want to be different.
  • Showing you have heard is helpful, by repeating the words the children have used or, writing them down.
  • Letting them know you can see how they feel is also helpful. e.g. "I can see you are very sad about it".
  • If children cannot talk about it, they may be able to draw something that shows how they feel, or show it with dolls or puppets, or find a song or book that describes it.
  • Say and show that you care how they feel. Sometimes a parent just holding and cuddling a child can do more to make the child feel better than all the words in the world. For friends and teachers a hug around the shoulder, a touch on the arm or just sitting alongside can show you care.
  • There are some topics you might mention just in case the child is too embarrassed or afraid and needs you to start. Ask if anyone is hurting them and has told them not to tell. Tell them nothing is too awful to talk about, and that you will love them no matter what happened.

Once you feel you have tried to understand the reason for the child's sadness here are some suggestions.

  • Tell the child that feelings of sadness do get better eventually, and that there are things that can be done to help that happen.
  • If children are blaming themselves for something unreasonably, tell them they are not to blame.
  • Offer practical help to make a plan for change. There may be a lot of things that can be changed; help in making new friends, finding activities the child can succeed at, taking the pressure off by stopping some activities, protection from a bully at school or from an abusive person.
  • Make sure children know they have support and someone to turn to when the feelings get bad, especially when the situation is something that won't change (such as a death or divorce).
  • Help children learn to notice what makes the feelings worse and what helps.
  • Help children find ways to express sad feelings. Boys may need particular help with this.
  • Make sure the children know this could happen to anyone - they are not weird or strange.
  • Encourage or help the child to do the things you know they used to enjoy.
  • Notice the things they do well and tell them about it.
  • Get a physical check up with a doctor.
  • Encourage or help children to eat well (offer their favourites), get some exercise and find ways to relax.
  • Make sure your children know you love and approve of them.

If the child's sadness is not helped by what you have done or you cannot find a reason for the depression, it would be wise to seek professional help.

Sometimes this is hard for parents to do, from fear of what others will think of them. It is important you don't let this stop you getting help for your child. People will respect you for seeking help.

Where to get help

There are a number of different professionals who may be useful to your child.

  • A child and adolescent mental health service.
  • Your doctor.
  • A child psychiatrist.
  • A child psychologist.
  • A counsellor specialising in working with young children and depression.

The right help will depend on the individual situation and the stresses you and the child identify. For example, it may also be appropriate to look for:

  • grief counselling or child support groups for grieving children
  • support groups for children of separating or divorcing parents
  • self esteem, social or coping skills training
  • school anti-bullying programs
  • help from a child mental health specialist.

It may be that changes in the family will help your child more than anything else:

  • counselling for yourselves as a family to resolve family conflict
  • mental health or other treatment for parents who are depressed or stressed.

Medicines for depression?
Antidepressant medications have not been shown to be effective in helping children who are depressed, and there are risks from taking antidepressants. Psychological therapy is recommended.

Remember, your help and support to the child will make a difference. If you are worried about a child being depressed do something to reach out to that child.

Resources

South Australia

   For parents

  • Child and Adolescent Mental Health Service (CAMHS)
    Northern region - telephone 08 8161 7389
    Southern region - telephone 08 8204 5412
    After hours:08 8204 5511
  • Flinders Medical Centre - telephone 08 8204 5511
  • The Women's and Children's Hospital - telephone 08 8161 7000
    • Both of the above hospitals have a psychiatrist available at all times.
  • Parent Helpline 1300 364 100

   For children

  • Kids Help Line - telephone 1800 551 800 (free call for young people).
  • Children, Youth and Women's Health Service - Youth Healthline (for young people over 12 years old). Tel. 1300 13 17 19.

Australia - for children and young people

Headspace - Australia's National Youth Mental Health Foundation 
http://www.headspace.org.au/ 

Information in languages other than English

The Children's Hospital at Westmead 'Depression in children'
http://www.chw.edu.au/healthykids/

References

Australian Network for the Promotion, Prevention and Early Intervention for Mental Health

Barbara D. (1996). 'Lonely, sad and angry: a parent's guide to depression in children and adolescents'. Main Street Books.

Brown University Child and Adolescent Psychopharmacology Update 4 (12); 1,6,7,2002.

Graham P. and Hughes C. (1995). 'So Young. So Sad. So Listen'. Bell and Bain: Glasgow.

Mental Health Association of NSW. 
http://www.mentalhealth.asn.au/ 

RADAR (Rational Assessment of Drugs and Research). 'Selective serotonin re-uptake inhibitors in child and adolescent depression'. April 2005, p5-12.

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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