Ten things I wish you knew about your child's mental health

The one universal truth of childhood is that there is always hope. As a developmental paediatrician who has worked with families for over twenty years, I’ve seen the most unsettled babies learn to be soothed, the wildest toddlers have their energy steered towards desired behaviours, the most sensitive kids thrive emotionally and the ‘baddest’ teens find themselves.

My clinical practice ranges from helping babies in their first weeks of life who are finding the cold and hungry outside world a little tough, to working with teens on the brink of adulthood who are battling mental illness that overwhelms them and their loved ones. This book aims to help you support children at any stage in that journey. If you’re caring for a young child, this book is for you. If you’re parenting a teenager, this book is also for you. My aim is to help you build the required skills to help children and teenagers by explaining the key devel­opmental stages our kids go through, as they relate to mental health. So often we assume that time on its own will teach our children these important skills. But time teaches us nothing. Just because a child can fall asleep on their own doesn’t mean they’ve learnt how to self-soothe. A child in primary school may still struggle with tantrums, and a teenager may have missed crucial aspects of attachment. All children are at risk of people seeing their age, not the specific thing they need help with. When we expect our kids to have figured things out simply because they’re a certain age, we can set them up to fail. One of the best things we can do instead is to first lower our expec­tations, meet children at their current level of functioning and gently help them to further develop their skills in the particu­lar area they are struggling with.

In these pages I will share what I’ve learnt about foster­ing strong mental wellbeing in children to give them the best chance of avoiding future mental illness. Fourteen years of study at university has provided me with a scientific lens to help, but it’s the honesty and trust of the people I’ve met in the clinic that have given me an insight into the biggest challenges, fears and regrets our kids experience. I’ve learnt from each and every person, and I thank them. Research has guided my approach, of course, but it’s children who have taught me what works. Please note that while I have changed names and personal details of the individuals I write about in this book to protect their privacy, the underlying stories are real.

Many of us feel lost as parents, wishing there was a guide­book to help navigate the rugged terrain of raising our children to be happy, healthy individuals. This book is aimed at develop­ing our skills as parents and guardians to better face whatever challenges we find in the journey ahead. We will also explore how to respond to our kids’ emotions, including when these emotions have deteriorated into mental illness. While I can’t see each reader personally, I hope to share some of what you might experience when seeing someone like me in a clinic. It is becoming increasingly difficult to access specialist support as waitlists all around the world increase due to more chil­dren struggling and services being under-resourced. This harsh reality further burdens those desperate to find help and often worsens the challenges faced by the children we care for. Identifying and addressing mental health difficulties as soon as possible is the best chance we have of them improving, yet so many families are waiting years to see an experienced profes­sional. Most are never seen. There is hope though. I’m here to tell you that there is no magic behind those closed doors and life does not happen in a consulting room. The children I meet in my clinic still require guidance in the real world. If you’re unable to access professional support right now, don’t be dis­heartened. There is still a lot you can do to guide and support your child as they face life’s challenges.

I hope this book provides clear and achievable pathways through some of these challenges. Regardless of your child’s age, I would encourage you to read this book from beginning to end so that you understand each stage of development. If you have a young child, it will set them up for their future. If you have a teen, it is not too late to go back and focus on the core issues of development and wellbeing.

Our society is drowning in mental anguish, and so much of the burden in our daily lives seems to be a fate we must accept. Suicide is one of the leading causes of death for teenagers and our adult peers. It devastates families and broader communi­ties in a way that few other fatal illnesses do. I believe this is because such shattering loss is actually preventable, and this knowledge compounds such needless suffering.

Adult mental health services worldwide tend to be reserved for those with resources or severe and chronic illness. But the majority of adult mental illness begins in childhood, usually before the teenage years. Without appropriate support, the adversity of these early stages of mental illness can have lifelong consequences for an individual’s self-esteem, relationships and daily functioning. But no child, regardless of their environ­ment or temperament, is destined to experience mental illness.

When I meet a child in the clinic I always wish I had helped them much sooner in their struggle. For anyone out there feeling like the children they support are struggling more than you can handle, please seek help. At the first sign of an issue, I would urge you to make an appointment with your family general practitioner or, for younger children yet to start school, with your maternal child health nurse. While you are waiting to see a clinical specialist, there is much you can do to help any child who is struggling, so that by the time you get to that appointment things are actually better, not worse, or you might not even need the appointment anymore.

We must all have a good understanding of the early signs that a child is struggling, to ensure that we see these as soon as possible, rather than waiting for them to be completely over­whelmed before we do anything. This is doubly important because getting in to see a specialist is really difficult. The public system is so overwhelmed that many families wait years for their first appointment, which means that by the time a child with a mental illness sees a specialist like me, their condition has usually worsened to such a degree that the child, their family and the professionals who support them are exhausted and at a loss as to what to do. And it’s no better for my colleagues working privately. The demand has got so high that for the first time, many of them are closing their books to new referrals.

In the chapters ahead we will explore how to best equip our children with the skills they need for good mental health, and our role in responding to challenges when they arise. Our communities will be stronger if we can find a way to ensure that all of us are safe, valued and feel a sense of self-worth. Decades of science and studies illuminate the way. The trick is to find the sweet spot between the textbooks and real life.

In 2019 I applied for a Churchill Fellowship to explore how to better support parents in guiding their children’s develop­ment and mental health. I still remember the final interview. As I was waiting nervously to be called for the last hurdle of a long application process, I found myself questioning my legiti­macy to even be standing in this fancy building, wearing a suit I’ve never felt comfortable in. As I sat down in front of a panel of twelve interviewers, it took everything in me to remain com­posed. A well-dressed man in the middle of the group abruptly asked the first question: ‘We’ve read your application and, frankly, I don’t believe there is any evidence that how we raise our children impacts their mental health. Please explain your­self.’ This book is an extended version of my answer to that question. Given that I was awarded the scholarship, I assume they found the answer I gave helpful. I hope you do too.