If your child is experiencing any of these symptoms, it's best for them to have a psychiatric evaluation within 24–48 hours:
Escalating risk of harm to themselves
- Saying (out loud or online) that they want to kill themselves
- Searching online about how to kill themselves
- Writing a suicide note
- Giving away favorite belongings
- Taking steps to kill themselves (stockpiling pills, getting a gun or other lethal weapon, making a noose)
- Hurting themselves with intention to die (cutting or taking pills), or if you think that's their intent, and they won't discuss it
Escalating risk of harm to others
- Saying (out loud or online) they plan to kill another person or group of people
- Episodes of increasingly severe and frequent physical aggression or violence toward other people
- Threatening a person with a weapon
- Starting fires or otherwise intentionally destroying property
- Intentionally harming animals
Unusual thinking or behavior
- Speech that's confusing or disorganized (makes no sense)
- Abnormal physical behavior (frozen like a statue, urinating on themselves)
- Paranoia about others, with actions to protect themselves
- Seeing or hearing things that aren't there
- Unusually high energy and rapid speech, coupled with no sleep for several days
In these situations, your child requires an urgent evaluation to ensure the situation doesn’t progress into one that’s life-threatening. You should have a plan to diligently monitor your child and limit their access to sources of danger (weapons, belts, pills). A mental health crisis is serious and frightening, but you can keep your child safe. With prompt psychiatric attention, they can get the care they need. To get an urgent evaluation, contact your pediatrician, mental health provider, or local youth mental health treatment center. Tell them you need an urgent evaluation within 24–48 hours. If they’re unable to see you within 24–48 hours, take your child to the nearest emergency department, or call 911 if you can’t safely transport them.
Certain mental health challenges require fast evaluation and treatment to prevent them from developing into issues that may require more intensive treatment. If your child is experiencing any of these symptoms, it's best for them to have a psychiatric evaluation within two weeks, if possible.
- Refusal to go to school
- Increase in risky, impulsive behaviors (reckless driving, unsafe sex, binge drinking)
- Substantial change in hygiene (only wearing dirty clothes, not showering at all)
- Hurting themselves with the intent to commit suicide, or without requiring medical care
- Withdrawal from friends at school and family at home
- Dramatic drop in energy and motivation that persists for weeks, and occurs on weekends as well as weekdays
- Loss of interest in most or all activities previously enjoyed
- Eating very little at meals and resisting efforts to get them to eat more, persisting at least one week
- Rapid and noticeable weight loss outside of a health-related effort to lose weight
- Rapid and noticeable weight gain outside of a health-related effort to gain weight
It’s ideal to have an evaluation within two weeks of these symptoms, but it’s important to know that mental illness is common in childhood and is always treatable. Here are some options if you have to wait:
- If your child is already in mental health treatment, contact their therapist or psychiatrist. They can guide you through next steps, based on their knowledge of your child and the current situation
- If you're unable to find a mental health provider who can offer a high-quality evaluation within two weeks, schedule a visit with your pediatrician as soon as possible. Pediatricians have screening tools and are also skilled at interviewing teenagers
- Be calm, curious, and patient when you listen to your child so they're not trying to manage alone
- Read through other sections on this website to learn what might be driving the changes you've noticed in your child
- Connect with mental health resources, such as NAMI, that provide parent support. View a list of helpful resources
- Create a crisis plan with clear actions if your child’s mental health ever escalates to an emergency. Include plans for keeping others in your household safe
Every family has been there. Your preschooler has a screaming tantrum when you tell them they can't have a treat before dinner. Your teenager yells and curses at your spouse in response to a question about an upcoming exam. Your seventh grader sullenly and silently goes to their room after school and won’t answer any questions when you go in after them.
When your child is in distress, it can be very upsetting for you and your family. Sometimes, when we’re worried and need some kind of reassurance, we bombard our child with questions, jump to conclusions about what’s going on, suggest that they shouldn’t be upset, or try to fix everything for them. Other times, we get angry and yell, punish them, or say something we can’t take back. These are normal, human responses. But they may increase your child’s distress and/or their withdrawal as they seek to soothe themselves or begin to worry that they’re a burden.
Remember: Experiencing distress and learning that they can manage it is how our children build mental fitness. This is the work of growing up — repeatedly experiencing discomfort, disappointment, setbacks, and failures, and knowing how to navigate it.
That doesn’t mean you should leave them on their own in a time of distress. They need your presence. They may need your comfort and support, your perspective or pep talk. They might even need a nudge to stick with the challenge they’re managing.
Keep these four “Cs” in mind. They can help you stay present without getting overwhelmed. That way, you both have a chance to master the situation.
- Calm: This is the first priority. Just as distress is contagious, so is being calm.
- When you stay calm in the face of your child’s distress, it shows them that you are confident they're going to be able to manage this situation, and they don’t have to do it alone.
- Your child won't be able to learn how to manage distress if you can’t manage your own distress.
- Remain calm. You can even fake it. If you can’t, defer to your partner or another loving adult who can.
- Calmly acknowledge your child’s distress, “I can see you're upset,” or, “It seems like something has really upset you.”
- If the situation is a genuine emergency (e.g., they're threatening themselves or you with a weapon), call 911. Yes, this is appropriate.
- Curious: Once you've calmly validated that they're upset, be curious about what's going on with your child. Don’t make assumptions. Don’t jump to conclusions. Be truly curious: open ears, open mind, and open heart.
- Talk to them using open-ended questions: “What’s going on?” or “Can you tell me about what happened?”
- If your child is talking, try not to interrupt them.
- Help them explain their experience. Ask questions about facts and invite them to provide details.
- If they get upset, go back to establishing calm.
- Compassion: As you're listening, there will come a point when you think you understand why they're so upset. Offer your compassion.
- Offer a compassionate statement or question: “I can see how that could make you feel hurt, sad, angry, etc.”
- If your child still wants to tell you more, stay curious.
- If your child rejects your offer (“I wasn’t sad!”), go back to being curious so they can tell you more before you try again.
- If you've acknowledged their genuine feeling, you might notice that they relax, cry, or seem to “release” some intense feeling.
- Conversation: Only offer advice, perspective, or constructive feedback once you’ve understood the situation and connected with compassion.
- Advice is powerful if it's grounded in your knowledge of your child: “Since you were a toddler, you've always been concerned about the feelings of others. I wonder if maybe that makes it hard to stand up for yourself when you need to…”
- Remind your child of their strengths and talents on which they might lean into during this situation.
- You might offer a story about your own childhood or a related situation with a family member that shows why they shouldn't be discouraged (how time may help, etc.).
- Help your child distinguish between facts and feelings if you think their emotions may be distorting their sense of what happened.
- Think with them about what's in their control, so they can identify choices they could make next that might improve or repair it.
If your child’s behavior changes, it's always a good idea to talk to your pediatrician for guidance.
