The content of this page was generated by AI. It was grounded in currently working resources from NIMH, MedlinePlus, SAMHSA, NIDA, Mayo Clinic, 988, and FindTreatment.gov.
How to use this guide
- Start with safety first.
- Look for patterns, not one-off bad days.
- Focus on how much the problem is affecting sleep, school, friends, family, and safety.
- If you are unsure, it is always reasonable to ask the pediatrician or a child mental health professional.
1) FIRST QUESTION: IS THIS AN URGENT SAFETY ISSUE?
Treat as urgent if:
- The child talks about suicide, wanting to die, or not wanting to be here
- The child is self-harming
- The child has a plan, means, or intent to hurt themselves
- The child is hearing/seeing things others do not, is very confused, or is acting detached from reality
- The child is out of control, severely agitated, not sleeping for days, or unsafe
- The child may harm someone else
- The child is intoxicated, overdosed, or in medical danger
What to do right now:
- Stay with the child; do not leave them alone
- Remove or secure dangerous items if you can do so safely
- Speak calmly and simply
- Call or text 988 for crisis support
- Call 911 or go to the nearest ER if the danger is immediate
Useful pages:
- 988 Lifeline: https://988lifeline.org/
- NIMH Suicide Prevention: https://www.nimh.nih.gov/health/topics/suicide-prevention
- NIMH Help for Mental Illnesses: https://www.nimh.nih.gov/health/find-help
2) GENERAL WARNING SIGNS / “I’M NOT SURE IF THIS IS NORMAL”
Sub-scenarios
A. Behavior changed, but you’re not sure why
- Mood swings
- More irritability or anger
- More tears, sadness, or anxiety
- More withdrawal
- Less interest in usual activities
- Trouble paying attention
- Bigger-than-usual conflicts at home or school
B. Physical and daily-life changes
- Sleep changes
- Appetite changes
- Headaches or stomachaches with no clear medical cause
- Fatigue
- Not wanting to go to school
- Grades slipping
- Missed activities, appointments, or responsibilities
C. Regressions or younger-child behaviors
- Tantrums
- Bedwetting
- Clinginess
- New fears
- Trouble separating from caregivers
What parents should do
Today:
- Write down what you noticed, when it started, and what makes it better or worse
- Ask the child what’s been hard lately
- Keep your tone calm and curious
- Check whether the school has noticed changes too
This week:
- If symptoms last weeks or keep returning, schedule a pediatrician or mental health visit
- Ask about sleep, stress, bullying, grief, family change, substance use, and trauma
- Keep routines predictable
- Reduce overload where possible
What to say
- “I’ve noticed you seem different lately, and I want to understand.”
- “You’re not in trouble. I’m here to help.”
- “Has anything been happening at school or with friends?”
- “Have you had thoughts of hurting yourself or not wanting to be here?”
When to escalate
- Symptoms last more than a couple of weeks
- Functioning is affected at school, home, or with friends
- The child seems to be getting worse instead of better
- Any self-harm, suicidal thoughts, psychosis, or severe agitation appears
Resources:
- Child and Adolescent Mental Health: https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health
- Child Mental Health: https://medlineplus.gov/childmentalhealth.html
- Children and Mental Health: Is This Just a Stage?: https://www.nimh.nih.gov/health/publications/children-and-mental-health
3) ANXIETY / STRESS / PANIC / CONSTANT WORRY
Sub-scenarios
A. Everyday stress that is building up
- Tests, sports, friendship drama, family tension, schedule overload
B. Anxiety that is starting to interfere
- Avoids school, activities, sleepovers, or speaking up
- Reassurance-seeking gets repetitive
- Repeated stomachaches, headaches, nausea
- Trouble sleeping because of worry
C. Panic-like episodes
- Fast breathing
- Chest tightness
- Trembling
- Feeling like something terrible is about to happen
D. School-based anxiety
- Morning meltdowns
- Refusing to go to school
- Frequent nurse visits
- Sudden drop in participation
What parents should do
Today:
- Name the feeling without judging it
- Reduce the immediate pressure
- Help the child slow down breathing and ground themselves
- Keep the routine as steady as possible
This week:
- Do not unintentionally reinforce avoidance by letting fear fully take over the schedule
- Support gradual return to feared activities in small steps
- Ask whether bullying, academic pressure, or social stress is part of the problem
- Consider a pediatrician or therapist if anxiety is persistent or impairing
Helpful parent actions:
- Keep sleep, meals, movement, and screen time regular
- Break big tasks into smaller steps
- Praise effort, not just success
- Help the child practice coping before the stressful event, not only during it
- Avoid saying “there’s nothing to worry about”; instead say “I can see this feels big, and we’ll get through it together”
What to say
- “Tell me what you’re worried will happen.”
- “What part is the hardest?”
- “Let’s figure out one small step together.”
When to escalate
- Anxiety is making the child miss school or avoid most activities
- Panic is frequent
- The child is not sleeping well for many nights
- Worry is constant, extreme, or leading to depression or self-harm
Resources:
- Anxiety Disorders: https://www.nimh.nih.gov/health/topics/anxiety-disorders
- Stress: https://medlineplus.gov/stress.html
4) DEPRESSION / SADNESS / HOPELESSNESS / WITHDRAWAL
Sub-scenarios
A. Mild but persistent low mood
- Seems down, irritable, or “flat”
- Less interest in favorite things
- More tired than usual
B. Functional depression
- Grades falling
- More school absences
- Fewer friends
- Trouble with hygiene or daily tasks
C. High-risk depression
- Talks about being a burden, hopelessness, or death
- Self-harm
- Substance use
- Giving away possessions or saying goodbye
What parents should do
Today:
- Ask directly how they are feeling
- Ask directly about suicide and self-harm
- Keep the child connected to safe adults
- Reduce isolation as much as possible
This week:
- Arrange an appointment with the pediatrician or a mental health professional
- Keep a sleep routine and encourage daily movement
- Help the child stay socially connected in small, manageable ways
- Watch for worsening self-harm or suicidal thoughts
What to say
- “I’ve noticed you seem more down lately.”
- “You don’t have to handle this alone.”
- “Have you had any thoughts about hurting yourself?”
What helps at home
- Regular meals and sleep
- Short walks or physical activity
- Less pressure for perfection
- Gentle structure for homework and chores
- More connection, not more lectures
When to escalate
- Depression lasts two weeks or longer and affects functioning
- The child has suicidal thoughts
- The child is self-harming
- The child becomes withdrawn, flat, or hopeless quickly
Resources:
- Depression: https://www.nimh.nih.gov/health/topics/depression
- Teen Depression: More Than Just Moodiness: https://www.nimh.nih.gov/health/publications/teen-depression
- MedlinePlus Depression: https://medlineplus.gov/depression.html
5) SELF-HARM / CUTTING / BURNING / OTHER NONSUICIDAL INJURY
Sub-scenarios
A. Hidden or suspected self-harm
- Unexplained cuts, burns, scratches
- Long sleeves in hot weather
- Sharp objects missing
- Blood-stained tissues/clothes
- The child seems secretive or ashamed
B. Self-harm used as coping
- The child says it helps with numbness, stress, or emotional pain
C. Self-harm plus suicide risk
- The child self-harms and also talks about wanting to die
- Escalating severity or frequency
What parents should do
Today:
- Stay calm
- Don’t shame, punish, or overreact
- Ask what the behavior does for them emotionally
- Check injuries for immediate medical attention if needed
This week:
- Remove or secure razors, blades, sharp tools, and other common means if possible
- Schedule a mental health evaluation
- Make a plan for what the child can do when urges hit
- Increase supervision if risk is high
What to say
- “I’m glad you told me.”
- “I’m not angry. I want to help keep you safe.”
- “What was happening right before you felt the urge?”
What not to do
- Don’t say “you’re just doing this for attention”
- Don’t force a promise not to self-harm without support
- Don’t ignore it because it seems “not serious enough”
When to escalate urgently
- Deep wounds, infection, burns, or uncontrolled bleeding
- Any suicidal thoughts
- Rapidly increasing self-harm
- Child cannot agree to basic safety
Resources:
- Self-injury/cutting: https://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-causes/syc-20350950
- Children and Mental Health: https://www.nimh.nih.gov/health/publications/children-and-mental-health
6) SUICIDAL THOUGHTS / CRISIS
Sub-scenarios
A. Passive thoughts
- “I wish I could disappear”
- “It would be easier if I wasn’t here”
B. Active thoughts
- Thinking about how to die
- Feeling trapped
- Hopelessness with no future
C. Imminent risk
- A plan
- Access to means
- Intent
- Recent attempt
- Severe agitation, intoxication, or command hallucinations
What parents should do
Immediately:
- Stay with the child
- Remove or secure lethal means if you can do so safely
- Call or text 988
- If there is immediate danger, call 911 or go to the ER
What to say
- “Thank you for telling me.”
- “I’m taking this seriously.”
- “I’m going to stay with you and get help right now.”
- “Have you decided how you would do it?”
What to ask
- Are you thinking about killing yourself?
- Have you thought about how you would do it?
- Do you have access to that method?
- Have you tried before?
- What has kept you safe so far?
After the crisis starts to pass
- Do not leave the child alone until a professional says it’s safe
- Follow up on safety planning and treatment
- Make a concrete next-day plan for care
Resources:
- 988 Lifeline: https://988lifeline.org/
- Suicide Prevention: https://www.nimh.nih.gov/health/topics/suicide-prevention
- Help for Mental Illnesses: https://www.nimh.nih.gov/health/find-help
7) BULLYING / CYBERBULLYING / PEER EXCLUSION
Sub-scenarios
A. Direct bullying
- Teasing, threats, humiliation, physical intimidation
B. Social exclusion
- Left out, rumor spreading, friendship targeting
C. Cyberbullying
- Group chats, social media, gaming, posts, screenshots, fake accounts
What parents should do
Today:
- Listen without blaming
- Save evidence: screenshots, messages, dates, usernames
- Ask whether the child feels safe at school and online
- Check sleep, mood, and school attendance
This week:
- Contact the school and ask what the anti-bullying response process is
- Report severe online harassment to the platform
- Monitor for depression, anxiety, avoidance, or self-harm
- Help the child identify safe adults at school
What to say
- “Show me what happened.”
- “You do not deserve this.”
- “We’ll work on this together.”
What to avoid
- Don’t tell them to “just ignore it”
- Don’t force them to confront the bully alone
- Don’t minimize online harassment
When to escalate
- The child is afraid to go to school
- The child’s mood changes sharply
- There are threats, assault, sexual harassment, or extortion
- Bullying is tied to self-harm or suicide risk
Resources:
- Bullying and Cyberbullying: https://medlineplus.gov/bullyingandcyberbullying.html
- StopBullying.gov: https://www.stopbullying.gov/
8) SUBSTANCE USE / VAPING / ALCOHOL / DRUGS
Sub-scenarios
A. Experimentation
- Curious use, “just trying it,” occasional vaping/drinking
B. Pattern forming
- Secretive use
- Smell, paraphernalia, red eyes, sudden mood changes
- Lying, missed curfew, falling grades
C. High-risk use
- Mixing substances
- Driving/riding with impaired people
- Blackouts, overdose symptoms, withdrawal
What parents should do
Today:
- Ask directly and calmly
- Focus on safety, not shame
- Check whether the child is intoxicated or medically unsafe
- If they are acutely ill, call emergency services
This week:
- Set clear expectations and consequences
- Remove access where possible
- Learn what substance, how often, and with whom
- Ask whether stress, depression, anxiety, or peer pressure is driving use
- Consider treatment if use is ongoing
What to say
- “I’m asking because I care, not because I’m trying to catch you.”
- “What are you using, how often, and what’s going on around it?”
- “We need to understand whether this is experimentation or something bigger.”
What helps
- Clear household rules
- Supervision and monitoring
- Talking before a problem gets bigger
- Screening for mental health issues that may be underneath the use
When to escalate
- Intoxication, overdose, withdrawal, or unsafe behavior
- Use with depression, anxiety, self-harm, or school collapse
- The child cannot stop despite consequences
Resources:
- Vaping Devices (Electronic Cigarettes) DrugFacts: https://nida.nih.gov/publications/drugfacts/vaping-devices-electronic-cigarettes
- Parent Resources — Talk. They Hear You: https://www.samhsa.gov/substance-use/prevention/talk-they-hear-you/parent-resources
9) SCHOOL REFUSAL / GRADE DECLINE / LOSS OF FUNCTION
Sub-scenarios
A. School refusal from anxiety or depression
- Morning tears, stomachaches, repeated absences
B. Academic decline
- Trouble concentrating
- Missing assignments
- Losing confidence
C. Social withdrawal affecting school
- Skipping lunch, clubs, sports, or peer interactions
What parents should do
Today:
- Ask whether school feels unsafe, overwhelming, or socially painful
- Identify whether the issue is anxiety, bullying, learning trouble, depression, or something else
- Contact school support staff early
This week:
- Request help from counselor/teacher/pediatrician
- Create a gradual return-to-school plan if needed
- Reduce overwhelm at home until the child stabilizes
- Ask if testing or accommodations are needed
What to say
- “What part of school feels hardest right now?”
- “Is it the work, the people, or the way you’re feeling?”
When to escalate
- Repeated missed school days
- Failing grades
- Panic or crying every morning
- Threats of self-harm linked to school stress
10) TRAUMA / GRIEF / MAJOR LIFE CHANGE
Sub-scenarios
- Divorce
- Death in the family
- Family move
- Abuse or violence
- Disaster
- Serious illness in family
What parents should do
Today:
- Keep routines predictable
- Be honest but age-appropriate
- Encourage the child to share, but don’t force details
- Watch for regression, nightmares, clinginess, or avoidance
This week:
- Offer extra connection and reassurance
- Reduce unnecessary stressors
- If symptoms persist, seek professional support
When to escalate
- Nightmares, panic, or avoidance last weeks
- The child is stuck, numb, or unable to function
- Self-harm, substance use, or suicidality appears after the event
11) SEVERE IRRITABILITY / AGGRESSION / RISKY OR OUT-OF-CONTROL BEHAVIOR
Sub-scenarios
- No sleep with high energy
- Grandiosity or extreme impulsivity
- Dangerous thrill-seeking
- Severe aggression at home or school
- Destroying property
- Fire-setting or unsafe sexual behavior
What parents should do
Today:
- Prioritize safety
- Reduce access to weapons, sharp objects, and dangerous items
- Don’t argue in the heat of the moment
- Seek urgent evaluation if the behavior is escalating
Possible underlying causes:
- Depression
- Mania/hypomania
- Trauma
- Substance use
- Sleep deprivation
- Psychosis
When to escalate urgently
- No sleep for many nights
- Bizarre behavior
- Hearing voices / seeing things
- Extreme agitation
- Dangerous impulsivity
12) WHAT TO DO IF YOU DON’T KNOW WHERE TO START
Best first steps
- Call the pediatrician
- Use the school counselor
- Use 988 if you’re worried about immediate safety or crisis
- Use FindTreatment.gov to locate care
- Use SAMHSA National Helpline for referrals
Resources:
- FindTreatment.gov: https://findtreatment.gov/
- SAMHSA National Helpline: https://www.samhsa.gov/find-help/national-helpline
- Help for Mental Illnesses: https://www.nimh.nih.gov/health/find-help
PARENT TALKING CHECKLIST
Before the conversation
- Choose a private, calm time
- Put away distractions
- Decide your main goal: understand, assess safety, or plan next steps
During the conversation
- Say what you observed
- Ask open questions
- Avoid arguing about whether feelings are “real”
- Ask direct safety questions if needed
- Listen more than you talk
After the conversation
- Write down what you learned
- Decide the next action
- Follow through quickly if symptoms are serious
A simple script
- “I’ve noticed a change and I’m worried.”
- “I want to understand what’s going on.”
- “You are not in trouble.”
- “Let’s figure out the next step together.”
SHORT SAFETY RULE
If you remember only one thing:
- Mild concern: talk, watch, and arrange care
- Moderate concern: add school/pediatrician support
- Self-harm or suicidal thoughts: 988 immediately
- Immediate danger: 911 / ER