How to Help a Child With Depression: 13 Tips From a Therapist

What Is Depression in Children?

Depression in children differs from the usual sadness and grouchiness that kids experience from time to time in response to negative situations. With depression, these behaviors continue for a long time. Over the years, depression has increased among children. Research shows that around 3.2% of American children and teens have depression, and surprisingly, even a two-year-old can be depressed.^{1, 2}

How Common Is Depression in Young People?

Research shows that about 20% of the U.S. population aged 12-17 has experienced at least one depressed episode. The prevalence is higher for adolescent girls (about 30%) than it is for adolescent boys (about 12%). Depression is more common among biracial or multiracial youth. Depression can develop at any age, but the average onset is in the mid-20s.³

What Does Depression Look Like in Children?

Many signs of childhood depression are similar to the general signs of depression, especially in older kids and teen depression. On the other hand, younger kids who are depressed tend to be more irritable, moody, and overly sensitive. Given that kids are naturally playful, depression robs them of their interest and enjoyment in play.

Common signs and symptoms of depression in children are:

• Changes in their appetite and weight (i.e., decreased appetite and weight loss)
• Complains of physical symptoms like stomach ache, headache, fatigue, and not feeling well despite the absence of a medical condition
• Has no interest in playing
• When playing, they’re often aggressive toward others and use self-destructive or sad themes
• Increased childhood anger, crying, and outbursts, even without a trigger
• Thoughts of being worthless, wanting to run away, disappear, or joining a deceased relative or pet
• Poor school performance and consistently low grades

What Causes Childhood Depression?

Researchers have not identified a single cause of childhood depression. However, it’s likely that family history, genetics, environment, psychological factors, and individual temperament all play a role in shaping mental health. Childhood depression runs in families, with research showing that 30-40% of children with depression have a family history of mood disorders.⁵

Some studies show that certain risk factors may increase the likelihood of a child developing depression. Such triggers for depression can include the death of a parent or family member, romantic relationship problems or break-ups, co-occurring ADHD or anxiety disorders, chronic stress, a history of trauma or neglect, and chronic medical illnesses.

What Is Your Role When Your Child is Struggling With Depression?

Getting professional help once you notice signs of depression is important. This includes finding your child a therapist and possibly seeing a psychiatrist. Additionally, encouraging them to use coping skills designed for children and continuously monitoring their symptoms improves a child’s treatment outcomes. Research shows that good parenting can improve a child’s ability to self-soothe and help reduce depressive symptoms.⁶

Recognizing depression allows for timely treatment. When depression is left unaddressed, it can increase the likelihood of attempting suicide. This is why a child who expresses suicidal thoughts should always be taken seriously. Moreover, untreated depression that continues for years can lead to substance misuse.⁴

How to Help a Child With Depression

The first and most important step as a parent of a depressed child is to recognize depression warning signs. This is especially true for younger kids, who are less likely to verbalize their feelings due to their limited vocabulary. Note that treatment usually involves a combination of prescription medication, psychotherapy, and developing a self-care routine for the child.

Here are 13 tips for how to help a child with depression:

1. Learn the Warning Signs

It can sometimes be challenging to recognize depression in children, especially preschoolers (3-5 years old) who cannot or won’t talk about their feelings. The older the child, the more similar their symptoms are with adult depression. Regardless, it’s important to observe behavioral changes, such as frequent temper tantrums and withdrawal from activities they used to love.

Whether or not you’re sure your child has depression, the presence of warning signs is always a good reason to seek help. The longer depression goes unrecognized and untreated, the bigger problems it can cause. In addition to making your own observations, be sure to ask their teachers how your child is doing in school.

2. Get Them Into Therapy

Depression is a real illness—it isn’t something a child can just snap out of. This is why kids need a structured and evidence-based treatment, such as psychotherapy, which helps them understand how their thoughts can impact their emotions and actions, and vice-versa. Through therapy for depression, they also learn positive coping skills for dealing with daily stressors and unexpected challenges.

If depression is mild to moderate, psychotherapy is considered the first-line treatment. For moderate to severe depression, a combination of therapy and antidepressants works better. Therapy is provided by a therapist whom you can find and connect with using an online therapist directory or online therapy for depression platform. Some parents start by talking to their child’s pediatrician, who will do a thorough evaluation before making recommendations.

Here are a few effective treatment options for children with depression:

• Cognitive behavioral therapy (CBT): As the gold standard therapy for depression, as well as other mental health conditions affecting kids, CBT geared towards children works by helping them notice and change unhealthy thought patterns.
• Art therapy: Art therapy for children involves drawing mandalas (geometric patterns and shapes), painting or coloring while listening to relaxing music, and creating a collage. Creative projects allow them to express themselves in a safe space and provide a sense of accomplishment, which helps with the child’s self-esteem.
• Family-based interpersonal psychotherapy (FB-IPT): Children ages 8-12 years old can also receive family-based interpersonal psychotherapy, which focuses on improving their interpersonal interactions. Parents will learn tips to support their depressed child at home, and the child will learn how to communicate their needs and feelings in a non-blaming way.⁷
• Dialectical behavioral therapy (DBT): DBT can be adapted for children with depression and suicidal ideation. Given that these kids are often irritable and critical of themselves, DBT teaches them distress tolerance skills and mindfulness for kids to feel less overwhelmed.⁸
• Play therapy (PT): In play therapy, the child makes use of dolls, stuffed animals, miniature figures, construction toys, clay, and board games to tell their story. The way that play therapy allows for healing is that it increases the child’s awareness of the traumatic event that happened, which then allows them to explore problem-solving strategies.
• Group therapy: In group therapy, the child receives support from others of the same age in a small group, and can be done as part of CBT or DBT. Being around others who are also working through depression reduces the child’s feelings of loneliness, plus it gives them a chance to offer the same encouragement they receive. Group therapy is available online and in person.

3. Consider Medication

Sometimes, therapy alone won’t be enough to treat depression, and this is where medication comes in. It’s usually prescribed for when symptoms worsen, and therapy alone fails to provide significant improvements. Antidepressant medications work by targeting neurotransmitters in the brain. For example, selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed class of antidepressants, increase levels of serotonin — a chemical that stabilizes mood.

As a parent, it’s normal to feel concerned about medicating your child. You may be worried about the safety and potential side effects of antidepressants, especially since your child’s brain is still developing. Their pediatrician or psychiatrist can provide more information on what to expect at the beginning of treatment. However, note that they will always start with the lowest possible dosage and make adjustments based on your child’s response.

4. Check In Frequently & Listen Without Judgment

It’s important to be a trusted source of support for your child. Do your best to check in regularly and ask your child how they are feeling. Remember to avoid shaming, lecturing, or advising them about what they need to do. It’s more important for you to cultivate a safe and secure space where they can talk openly without the fear of being judged.

5. Teach Them Relaxation Strategies

Relaxation strategies can support adaptive emotional regulation, and they can be especially helpful if your child struggles with feeling overwhelmed or irritable. Relaxation strategies come in many forms, and they may include deep breathing, progressive muscle relaxation, gentle yoga stretches, positive affirmations, or engaging in positive sensory experiences (i.e. jumping on a trampoline or listening to a favorite song).

6. Don’t Freak Out if They Tell You They Are Having Suicidal Thoughts

A child contemplating dying might say things like, “I wish I were never born,” “Things would be better without me,” or “I won’t bother you anymore when I’m dead.” They may give their favorite things away or talk about wanting to join a deceased relative or pet.

If your child mentions suicide or wanting to die, take them seriously but remain calm. When you panic, they might hesitate to open up. Let them know that how they’re feeling is valid, and give them a chance to tell you more about it. They might be worried about how you would react, which is why it’s important to reassure them that you’re grateful they told you.

7. Prepare Healthy Meals for Them

One of the ways to help your child with depression is by prioritizing nutrient-dense meals. Foods that may help alleviate depression symptoms and improve their energy include things rich in omega-3 fatty acids, B-complex vitamins, iron, and zinc.⁹ These can be found in foods like salmon, chia seeds, walnuts, chicken, beef, eggs, and dark leafy vegetables.

8. Get Them to Exercise Daily

While not a cure for depression, exercise can reduce depressive symptoms. A systematic review and meta-analysis found a significant association between physical activity and decreased stress, depression, and psychological distress in children and adolescents.¹⁰ The best approach is to have your child choose an activity they enjoy. Examples are biking, playing fetch with their pet, exploring a new park, or playing a sport.

9. Encourage Your Child to Socialize

If your child often prefers staying in their room or wants to be alone, give them opportunities to be around others. While isolation is a symptom of depression in kids, it may also augment depression. Depression can make a child have negative thoughts, like worries about not fitting in, besides the fact that depression drains their energy to socialize.

Some positive social activities to consider include art classes, a movie night with the family, cooking or baking together at home, volunteering, and visiting a museum or art gallery. A good idea would be to suggest three activities and have your child choose the one they like the most. Offer encouragement, but avoid pushing too hard.

10. Set Healthy Rules at Home

If a child is resistant to developing positive habits and engaging in activities that support their management of mood, then parents can compassionately implement home values that make these habits the expectations of the home. For example, if your child is indifferent towards taking a shower or brushing their teeth, make sure your rules cover personal hygiene. The same goes for their sleep routine and eating habits.

Some parents aren’t sure how to go about setting limits or healthy boundaries out of fear that these rules might hinder their child’s recovery. However, having expectations still matters even if a child has depression. Whatever rules you set at home, see to it that these will work to their advantage and keep these rules clear and simple. For parents having trouble developing and implementing these expectations, it is important to seek the support of a child or family therapist who can provide guidance.

11. Find Opportunities to Praise Them

Given that kids who are depressed lack motivation, parents should look for opportunities to praise their child — even if it’s simply them showing willingness to try something. Research shows that praising effort helps them embrace improvement.¹¹ You can say something like, “Though it was challenging for you, you worked really hard” or “Thank you for [effort]!”

12. Plan Enjoyable Activities to Do One-on-One

Make sure that you are focusing on engaging in quality time with your child. Spending time together can foster connection and simply help improve your child’s mood. Try to be attuned to doing what they like best. If possible, try to schedule quality one-on-one time on a routine basis—this establishes a sense of predictability that you can both rely on.

13. Make Sure to Take Care of Yourself, Too

Your own self-care matters, particularly when you’re raising a child struggling with their mental health. If you don’t look after yourself, you risk parental burnout or becoming excessively irritable or fatigued, which can counteract your parenting efforts. With that, make sure you’re prioritizing your physical and emotional health. It’s also important to stay connected to your own support system.

What To Say & What Not to Say to a Child With Depression

Be sensitive, understanding, empathetic, and respectful toward your child’s feelings. One way to show this is by asking them how you can best support them or if they need anything from you. The last thing a child with depression needs is to feel dismissed, invalidated, or blamed for what they’re going through.

Here are a few examples of things to say to a child with depression:

• “It’s okay to feel this way.”
• “I’m here if you want to talk about it.”
• “It’s okay to take things one day at a time.”
• “We can work through this together, step by step.”
• “You don’t have to pretend to be okay. It’s okay to be honest about your feelings.”
• “I want you to know that you’re not alone in this.”
• “Let’s explore positive ways to cope with your feelings.”
• “Your well-being is important to me.”
• “I’m proud of you for sharing your feelings.”
• “Can I do something to make you feel better?”
• “I love you.”

Here are a few examples of things not to say to a child with depression:

• “It’s all in your head.”
• “You’re just being dramatic.”
• “Just snap out of it.”
• “Other kids have it worse.”
• “Stop complaining.”
• “I’m going to punish you if [behavior].”
• “You’re making me upset!”
• “You’re being difficult right now.”
• “You’re just looking for attention.”
• “This is your fault.”

When to Seek Professional Support

It’s time to get your child professional help for depression if their symptoms—such as persistent sadness, tantrums, loss of interest in play and other activities, poor school performance, unexplained physical symptoms, changes in their sleep and appetite, and social withdrawal—go on for more than two weeks and are significantly affecting their daily lives.

Signs of suicidal ideation in children include:

• Making explicit or implicit comments about wanting to die or not be alive
• Withdrawing from loved ones or friends
• Showing little to no interest in activities they once enjoyed
• Increasing in self-harm or other impulsive behaviors (substance use, disordered eating)
• Engaging in creative expression that highlights themes of death (poetry, drawing)
• Excessive sleeping
• Giving away items to others
• Somatic distress (headaches, fatigue, cramping)
• Sudden drop in grades and little to no motivation to engage in school