Can You Identify a Child in Crisis?

Recognizing Signs of Distress in Young Minds

Mental health professionals know that children often communicate their distress in ways that can be subtle, masked, or easily misunderstood. Recognizing these signs early is crucial, as a child experiencing a crisis can face profound and lasting impacts on their development and well-being. However, the challenge lies in accurately identifying when a child is in crisis, especially in cases where the signs may mimic everyday behaviors or developmental phases.

Why Recognizing a Child in Crisis is Challenging

A child’s emotional and mental health is delicate, with behaviors and symptoms that often blur the lines between normal responses to stress and indications of a more severe crisis. Children can express distress through a range of behaviors, including withdrawal, aggression, regression, or academic difficulties, yet these can sometimes be attributed to typical developmental stages. This overlap poses a challenge: How can mental health professionals discern a typical reaction from signs of trauma or a deeper mental health issue?

Common Signs of a Mental Health Crisis in Children

Recognizing the signs of a mental health crisis in young children requires careful observation, empathy, and an understanding of their typical developmental trajectory. Clinicians are trained to detect shifts in behavior, mood, or functioning, however, children may not have the vocabulary or self-awareness to express their feelings. The following signs should be approached with heightened awareness:

Dramatic Behavioral Changes: Sudden changes in behavior, such as extreme irritability, aggression, or impulsiveness, can often be red flags. For children in distress, these behaviors can be expressions of inner turmoil they cannot verbalize.

Withdrawal or Isolation: Social withdrawal is a particularly concerning sign in children who once enjoyed connecting with peers and family. Clinicians often find that children experiencing crises may avoid interaction as a way to manage overwhelming emotions.

Academic and Attention Issues: Consistent difficulties in school—whether in concentration, memory, or attendance—can sometimes indicate more than a learning issue. Chronic emotional distress often manifests as an inability to focus on academic tasks.

Regressive Behaviors: Regression to behaviors such as bedwetting, thumb-sucking, or baby talk may signal a child grappling with stress, trauma, or a crisis. While occasional regression can be normal, persistent or extreme cases warrant attention.

Physical Symptoms Without Medical Cause: Somatic complaints like headaches, stomachaches, or fatigue without an identifiable medical reason are common among children experiencing significant emotional distress. These symptoms are often a child’s way of expressing anxiety, fear, or sadness.

How Clinicians Can Sharpen Their Ability to Identify Signs of Distress in Children

For mental health professionals, accurately assessing a child in crisis goes beyond recognizing symptoms, it requires insight, patience, and a flexible approach to understanding each child’s unique context. Here are some strategies to enhance identification:

Adopt a Developmentally Sensitive Approach

Understanding a child’s developmental level can help clinicians distinguish typical behaviors from potential crisis symptoms. For instance, mood swings are common in adolescence but may signal a crisis in a younger child. Clinicians should assess the age-appropriateness of a child’s behavior and response to stress.

Use Trauma Informed Assessment Tools

Trauma-informed care is invaluable for identifying distress in children who may have experienced trauma, whether known or undisclosed. Clinicians should be mindful that behaviors often linked to developmental changes, such as moodiness or sleep difficulties, may actually point to deeper trauma. Tools like trauma checklists, play therapy, and child-specific screening questionnaires can be effective in revealing underlying issues.

Healthcare providers can ask children and adolescents about protective factors and strengths, which identify factors that are protective against suicide and mental health crisis.

Questions to ask to screen for protective factors/strengths:

Do you feel connected to your family?
Do you feel supported by your family?
Do you have a supportive friend group?
How would your good friends describe you?
Are you religious or spiritual?
What do you think you’re good at?
What are you proud of?
Are you part of any school groups?
For parents: What are your child’s strengths?

Prioritize Parental and Caregiver Input

Parents and caregivers are essential sources of insight, often providing context that children themselves may not express. Clinicians can gather valuable information by inquiring about recent changes in the child’s home or school environment, familial stressors, or shifts in routine.

Create a Safe and Open Environment for Expression

Many children feel apprehensive about discussing their feelings, especially if they believe they’ll be judged or misunderstood. Clinicians should strive to create a safe, supportive space for children to express themselves. Creative outlets such as art, play, or storytelling can encourage children to share their experiences more comfortably.

Look Beyond the Obvious

A child’s distress may not always be apparent in obvious ways. A high-achieving student or an outwardly happy child can still be struggling internally. Clinicians should be mindful of the nuances of emotional and behavioral symptoms, noting that outward success does not always equate to emotional well-being.

When is it Time to Intervene?

Determining when to intervene can be one of the most difficult aspects of working with children. Intervention should be considered if:

A child’s behaviors significantly impact daily functioning (e.g., refusing to attend school, avoiding social activities).
Symptoms are prolonged and persistent, rather than situational or temporary.
A child expresses thoughts of self-harm, hopelessness, or worthlessness.

Identifying a child in crisis is a nuanced and often challenging task. However, by honing observation skills, embracing developmentally sensitive and trauma informed practices, and maintaining open communication with caregivers, clinicians can make critical strides in recognizing and addressing early warning signs. As mental health advocates, it is the role of clinicians to not only identify signs of crisis in children but to support them with interventions that offer hope, healing, and resilience. In doing so, clinicians pave the way for healthier futures, where children have the tools to understand and overcome their emotional struggles.

Elissa Singson, MSN, APRN, PHN, CPNP-AC, is an infectious disease pediatric nurse practitioner, medical aesthetic provider, health writer, and mother of two. She writes content to empower healthcare professionals, patients, and families with health and medical knowledge. She also loves to share tips on work productivity and efficiency to prevent healthcare provider burnout.

References

Ferro, R. A., Edwards, S., Coble, K., Riddle, M., Reinblatt, S. P., Ader, C., Meghan Crosby Budinger, & Bettencourt, A. F. (2024). Children in Mental Health Crisis: Pediatric Primary Care Providers’ Role in Bridging Treatment Following Higher Levels of Care. Journal of Clinical Psychology in Medical Settings, 1–9. https://doi.org/10.1007/s10880-024-10037-1

Hua, L. L., Lee, J., Rahmandar, M., & Sigel, E. (2023). Suicide and Suicide Risk in Adolescents. Pediatrics, 153(1), e2023064800. https://doi.org/10.1542/peds.2023-064800

Tolliver, M., & Hostutler, C. A. (2022). Pediatric mental health crisis: Propelling the Surgeon General’s advice to action. Families, Systems, & Health, 40(3), 305–311. https://doi.org/10.1037/fsh0000733