A guide for parents: keeping kids mentally healthy transitioning back to school

While the summer break usually means a pause from school and loads of fun, it can also bring its own set of ups and downs for our kids' mental wellbeing as they transition back to school. Mental health issues are becoming more common among children, and up to 20% of children in the U.S. have a diagnosable mental health disorder, according to the National Institute of Mental Health. These can vary from anxiety disorders, depression, to conditions like ADHD.

Dr. Hannah Kathryn Scott, a Child & Adolescent and Forensic Psychiatrist at Children’s Hospital New Orleans, has diagnosed and treated mental disorders in children and adolescents for the past decade. She also has three girls, a 4-year-old and 6-year-old twins. Like many moms, she is challenged with making sure her children have a productive, creative, safe and healthy summer before returning to school.

“It's perfectly normal for a child to feel anxious, but if they can still get up, go to school, and participate in their usual activities, it's a sign they're managing those feelings well,” says Dr. Scott. “However, if anxiety or any other emotion is so overwhelming that they can't get out of bed or even out of the car, it may signal a mental health issue.”

This is what professionals often refer to as causing 'dysfunction'.

“As an outpatient doctor, I often encounter instances where these emotions start to interfere with a child's day-to-day activities,” says Dr. Scott. “For example, if a child is consistently feeling low, it might be a sign of depression.”

When transitioning to a school routine, it's essential to keep an eye out for changes and seek professional help when needed. These are the three most common mental health conditions children face:

• Depression: Diagnosing depression in children aren't always as straightforward as a constant sad mood. A strong indication of depression is if they’re sad for two weeks straight or lose interest in activities they once enjoyed. For children, symptoms include ongoing anger or irritability, being more withdrawn or isolated, sleep irregularities or change in appetite.
• Anxiety. Managing anxiety involves a combination of therapeutic strategies and, in some cases, medication. By learning and practicing coping skills, children can better handle their anxiety over time. It's not about avoiding anxiety, but learning to cope with it effectively, thereby preventing it from becoming a barrier to their success and well-being.
• ADHD. Attention Deficit Hyperactivity Disorder (ADHD) isn't something that only crops up during the school year; it's a year-round condition. It's characterized by a general lack of attention, difficulty with concentration, and often impulsiveness. While these traits are not uncommon in children, it can be more pronounced and persistent in those with ADHD. Look for other symptoms as well, including frequently daydreaming, putting off their work, misplacing things, and needing regular reminders. Left untreated, ADHD can potentially lead to other mental health concerns such as anxiety and depression.

This article reviews mental health conditions in children, symptoms and solutions for promoting best mental health practices in your child as they transition back to school, including the following:

• Establish regular routine
• Physical activity
• Social interaction
• Healthy diet
• Mindfulness and relaxation
• Creative play
• Screen time management
• Open communication

The Role of Regular Routines

Maintaining a routine can be a secret weapon in supporting your child's mental health. “If you established any sort of routine during the summer, you're doing great. I often express concerns about teens spending their entire day glued to their screens, but balance is key. A healthy mix of work, play, social interactions, and family time goes a long way in keeping a child's mind active and engaged,” says Dr. Scott.

As it's time to transition back to school, it's a good idea to adjust sleep schedules about a week ahead. Focus more on establishing a consistent wake-up time rather than a strict bedtime, as bodies take about a week to adjust to a new schedule.

“A routine isn't just about wake-up and sleep times. Incorporate daily physical activity into the schedule. Even during hot summer days, find cooler times to go outdoors, like in the evening after dinner. Doing so as a family can turn it into a fun, bonding activity,” says Dr. Scott.

Keeping routines and structure during summer doesn't mean sucking the fun out of it. It's about striking a balance that keeps our kids healthy, happy, and ready for the next school year.

Importance of Physical Activity

Physical health plays a pivotal role in our overall wellbeing. It's not about strenuous workouts or expensive gym memberships; simple activities like walking or cycling can make a big difference. “Engaging with nature, soaking in some sunshine, and moving your body - these are fundamental aspects of maintaining physical health,” explains Dr. Scott.

Regular exercise, even just 20 minutes a day of moderate aerobic activity, can have profound mental health benefits. “Excercise releases endorphins, our body's natural mood lifters, making us feel good,” says Dr. Scott. “Additionally, regular physical activity has been found to combat depression, in some cases almost as effectively as medication.”

Even while your child is going to school, there are plenty of opportunities for kid-friendly physical activities that can be fun for the whole family in the mornings, evenings or weekends, including:

• Swimming
• Riding a bicycle or scooter
• Walk in the morning or late evening
• Visit playgrounds and parks

Encouraging Healthy Social Interaction

Family and peer interaction is a cornerstone of mental health. Spending time with neighborhood friends and engaging in playdates can do wonders for a child's sense of belonging and emotional wellbeing.

“One of the simplest yet most powerful ways to cultivate family bonds is through shared meals. The Academy of Pediatrics recommends having a family meal together, and I'd advocate for this every night if possible. Regardless of the kind of day everyone has had, coming together to share a meal provides a reliable, comforting touchstone,” says Dr. Scott.

To guide family dinner conversations, Dr. Scott has a tradition of sharing their “Rose, Bud, and Thorn.” The 'Rose' is the best part of the day, the 'Thorn' is the challenging part, and the 'Bud' is something they're looking forward to. This structure encourages open sharing, active listening, and acceptance. It also helps steer conversations away from potential mealtime disputes and instead offers a unique insight into each family member's day and overall mood.

“It's crucial to consider safe ways for kids to socialize, both online and offline. Face-to-face interactions are particularly vital for teenagers, especially those dealing with anxiety. While it's commonplace to see kids on their phones even when they're together, encouraging them to engage more directly can be beneficial,” says Dr. Scott.

This might mean devising activities that promote active participation, creativity, and collaboration, reinforcing the importance of true, present interaction over passive, digital relationships.

Promoting a Healthy Diet

If a diet relies heavily on processed food and sugar, it can cause insulin levels to spike, which in turn can affect mood and energy levels. That being said, a healthful, balanced diet can contribute significantly to your child's mental well-being.

“While I'm not a dietician, one thing I firmly believe in when it comes to diet is balance. We shouldn’t label foods as 'good' or 'bad', and even junk food and candy can have a place in a healthy, balanced diet - the keyword here is 'moderation',” says Dr. Scott.

So how do we ensure a balanced diet for our kids, particularly in the summer when routines are more relaxed?

“The key is in offering a variety of foods and encouraging a balanced approach. For instance, if your children are heading to camp or need a snack, providing fresh fruits is a great option, but don't shy away from the occasional fruit roll-up or similar treat,” says Dr. Scott. “If you make something off-limits, it makes it more alluring.”

Incorporating Mindfulness and Relaxation Techniques

Mindfulness might seem like a complex concept, especially when it comes to children. But at its core, it's about being present in the moment, and there are many simple, fun ways to introduce this concept to kids.

“One of these methods is through calming, repetitive activities, like swinging,” says Dr. Scott “The rhythmic motion can help soothe a child's mind and provide a sense of grounding. Other activities might include drawing, coloring, or even playing with a sensory toy.”

Breathing exercises are another effective and accessible tool for cultivating mindfulness. “One technique that I personally find helpful is the ‘5, 6, 7 method’. Here's how it works: breathe in for a count of 5, hold the breath for a count of 6, and then exhale slowly for a count of 7. This mindful breathing not only encourages relaxation but also distracts from overbearing thoughts and promotes a sense of calm,” says Dr. Scott.

As the counting helps keep the mind engaged, this technique can be beneficial for children who are feeling anxious or overwhelmed. It’s a portable relaxation tool that’s always available and can be used anytime, anywhere. These mindfulness techniques, when practiced regularly, can enhance a child's ability to manage stress, reduce anxiety, improve focus, and cultivate a more positive outlook - all of which are fundamental to good mental health.

The Role of Creative Play

Periods of unstructured, creative play can offer substantial benefits for a child's mental health. Dr. Scott offers an unconventional thought of wisdom – allow your kids to get bored.

“For kids to be bored is a really good thing. When they get bored, they get creative. Necessity is the mother of invention. I want them to get bored and figure out what to do,” says Dr. Scott.

When kids say, "I'm bored," it's not necessarily a call for structured activities or screen time. Instead, it's an opportunity for them to exercise their imagination, come up with new games, or discover different ways to engage with their surroundings.

Keeping art supplies readily available can also stimulate this creativity. “Simple materials like paper, scissors, tape, or even a stapler can spark a world of imaginative play and learning. Older children might enjoy painting, water coloring, or using colored pencils. Engaging in these activities can be incredibly relaxing and help children - and teens - express themselves creatively.”

Encouraging teens to journal about their day can also provide them with an outlet to express their thoughts and feelings. Some might even discover a passion for music and pick up an instrument.

In Dr. Scott’s family, when her children come to her and say they’re bored, she gives them a job around the house so they learn and become more independent. “Involving kids in household chores teaches them valuable life skills while gives them a sense of responsibility and belonging. Whether it's doing laundry, helping with dishes, or caring for a family pet, these tasks can help children feel valued and competent.”

Understanding and Managing Screen Time

In the digital age, managing screen time can be a challenge, especially with the constant stream of engaging content available to children. But how we approach and limit screen time can significantly influence our children's mental health and their relationship with technology.

The American Academy of Pediatrics advises that quality over quantity is key when it comes to screen time. “If kids are going to spend time in front of screens, it's essential that the content they consume is beneficial, teaching them values or lessons. Also, parental interaction during screen time increases its value – discussing the content, asking questions, or even playing a game together can enrich the experience,” explains Dr. Scott.

A family movie or game night, for example, turns an otherwise solitary activity into a fun, collective experience. This is a chance to make lasting memories together, especially if you involve kids in planning and preparing for the family event – popping the popcorn, gathering sugary treats, candy and salty snacks – to watch a movie they all are looking forward to. Moments like these, where a usual rule (no eating while watching TV, for example) is relaxed, can make it even more special.

“Excessive screen time can hamper creativity, especially as kids are at their most imaginative in the morning. Encourage them to engage in creative play and save screen time for later in the day.”

Dr. Scott also wants parents to beware of the potential pitfalls of video games, too. “While they can be enjoyable in moderation, excessive gaming can lead to addictive behaviors and cause friction within the family. If you observe changes in your child's behavior due to excessive gaming, like preferring video games over family dinner, it's a sign of addictive behavior.”

Striking the right balance between screen time and off-screen activities is key for nurturing their mental health and overall well-being.

Talking about Feelings and Emotions

Fostering an environment where kids feel safe and comfortable expressing their thoughts and feelings is crucial for their emotional development and mental health. “Suppressing emotions can lead to internalization and can teach children to hide their feelings, creating communication barriers. Instead, encourage them to freely express themselves, whether they're experiencing happiness, sadness, jealousy, humiliation, or embarrassment. Validate their feelings without trying to change them or fix the situation immediately,” says Dr. Scott.

When children express strong emotions, such as intense sadness, Dr. Scott says it's essential to validate these emotions. “Let them know it's perfectly okay to feel the way they do. Giving these feelings a name helps children identify and manage them. In the midst of a tantrum or an emotional outburst, it might be more beneficial to discuss these feelings when they're calmer.”

As for communicating with teenagers, it's important to understand that their need for validation and emotional space may be different. Younger children might require immediate validation (much like a Band-Aid), whereas teenagers may need time and space before they're ready to talk about their feelings.

“As parents, your role isn't always to provide solutions but to listen, empathize, and validate their experiences. Often, teenagers can figure things out for themselves; they primarily want their parents to understand them. Remember, each child is unique and needs individualized emotional support,” explains Dr. Scott. Maintaining open lines of communication about feelings and emotions helps build trust and promotes healthier coping mechanisms.

Resources Available at Children’s Hospital New Orleans

Recognizing when your child needs professional mental health support is essential. Mental health concerns can sometimes surface subtly, and knowing how to respond can make a significant difference.

• Primary Care Physician: If you notice changes in your child's behavior or mood that concern you, the first step is usually to consult their primary care physician. They can evaluate the situation and provide a referral to a mental health professional if needed.
• Emergency Situations: In the event of an emergency, such as a suicide attempt or a crisis, immediate help from a mental health professional is crucial. Never hesitate to seek urgent help in these situations.
• Suicide Hotline: The Suicide Hotline (dial 988 in the US) is a critical resource for those facing a mental health crisis. Please be aware that if you're trying to access a psychiatrist for the first time during a crisis, there might be waiting periods due to high demand for these services.

The Behavioral Health Center at Children’s Hospital New Orleans also provides several resources for further support:

• Therapists and Child Psychologists: These professionals are trained to help children navigate their feelings and develop healthier coping mechanisms. Your primary care physician can help refer you to these specialists.
• Parenting Centers: The center offers classes for kids, parents, and adults, with many classes being free of charge. They are a valuable source of information and support, and can guide you on how to get onto waiting lists or access other services.
• Parent and Caregiver Education: From mental health tips, information on mood disorders, video education, organizational resources and blog posts, visit Children’s Hospital New Orleans Family Resources Page.

Remember, there's no one-size-fits-all approach when it comes to mental health. Each child is unique and may require different resources or professional help at different times. However, the constant in all situations is open communication, understanding, and unwavering family support to encourage a positive start to the new school year.