When a child is going through emotional or behavioral challenges, parents may feel unsure whether a child's shifting moods are normal, age-appropriate behavior or something more serious. While it can be difficult to imagine your child endangering themselves or others, it's important for parents to watch for signs of serious health concerns or a mental health crisis.
"Parents are often the first to notice signs or symptoms of mental health or emotional challenges in their kids because parents typically spend more time with their kids than anyone else. They know their rhythms and routines, and sometimes parents notice changes even before their children do," says Zachary Adams, PhD, a licensed clinical psychologist at Riley Children's Health. "Also, kids may feel safest opening up to their parents and caregivers."
It can be difficult for parents to decide to seek emergency care for a mental health concern. Some people don't think emergency rooms treat mental health issues. Others may be hesitant to take their children to hospitals due to financial reasons or because they associate hospitals with serious injuries or other types of illness. Calling 911 may invite law enforcement into the home, which concerns some families.
However, if you think your child is an immediate danger to themselves or to others, it's time to call 911 or go to the nearest emergency room. This includes danger from:
- Thoughts of suicide or self-harming behaviors
- Threats of violence to (or from) others
- Accidental or intentional intoxication or overdose from drugs or alcohol
- Hearing voices or hallucinations
- Confused thinking or speech
- Erratic behavior or agitation
If your child does not seem to be at immediate risk of harm to themselves or others, your primary care physician can screen and assess your child's needs and make the appropriate referrals if needed. The Indiana Family & Support Services Administration also provides a list of local community mental health centers that offer prompt assessments, crisis support and resources.
If you are unsure whether your child's behavior requires emergency care, you can dial 988, the Suicide & Crisis Lifeline. This hotline helps assess your situation and plan the next steps.
While some mental health concerns warrant a call to the pediatrician, Dr. Adams says it's time for emergency care when you see major, unsafe shifts in your child's behavior.
"A mental health crisis is a big departure from what's normal or typical for that child. The threshold for seeking emergency care is generally when there's a concern about keeping everyone – including the child – safe and alive," Dr. Adams says. "This is an extreme concern that makes you worry for your child's safety, and it's not something that can wait for an appointment at your doctor's office."
If you need to take your child to the emergency room, be prepared to speak with the clinical team about your immediate concerns and your child’s mental health history. Hospitals like Riley Hospital for Children have a dedicated team for children experiencing mental health emergencies. Your child will be assessed at the hospital. You will be asked questions about any recent changes in your child's behavior and what may have caused them. Keeping an updated list of your child’s medications handy will also be helpful for the team. Depending on your child's age and comfort level, care providers may ask you and your child questions separately to understand the situation better.
"The emergency care team may be able to diagnose some symptoms by observing your child, but they will also rely on what you and your child tell them," Dr. Adams says. "The team will assess what's going on to determine how serious the risk is. Be prepared to help them by sharing as much insight as you can so they can make the best decisions for your child."
Going to the emergency room doesn't always mean your child will be admitted to the hospital. "The team will assess your child’s level of need along the psychiatric continuum of care whether that be inpatient or outpatient treatment,” says Priyanka Reddy, DO, a child and adolescent psychiatrist at Riley Children’s Health. “They may also prescribe medications or recommend that you follow up with outpatient psychiatric resources or with your primary care physician. This team's job is to ensure your child is safe, then work to understand the situation and devise a plan to support your family going forward.”
Caregivers can support their children after a mental health crisis by following up on recommendations and keeping doctor appointments. Continue to monitor your child and check in routinely on their feelings. Help your children get good sleep and eat healthy foods to support their mind and body. While you may not want to push your child too hard after a crisis, keeping them on track is important.
"Some family members may be reluctant to encourage their child to do any work after a crisis, which might inadvertently contribute to other problems at home or school. Others may push too hard and expect too much, which can minimize the severity of what the child is going through," Dr. Adams says. "Work with your care team to collaborate on a routine for your child. There may still be unresolved issues, and you can ask for ways to help support your child and the rest of the family."
Through regular, open communication with your child and ongoing, responsive medical care, you can support your child to avoid mental health crises in the future. In addition to the 988 hotline, parents can also learn more about pediatric mental health through resources at the Child Mind Institute, American Academy of Pediatrics and American Academy of Child & Adolescent Psychiatry.
If you notice symptoms again, remember to look for immediate safety concerns. This will help you decide whether to head to the emergency room or contact your child's primary care team. If you’re unsure about what to do, contact emergency resources for guidance. Prioritizing your child's mental health needs now can help you and your child manage them in the future.