Your Child’s Mental Health

How to Know When It’s Time to Reach Out for Help

As a company committed to helping families raise caring, confident, and resilient children, Slumberkins is grateful to be able to support parents and caregivers with tools and resources to teach early emotional learning. At the same time, it’s important to acknowledge that Slumberkins should be used as a supplement to, not a replacement for, any therapeutic and professional support children receive.

For tips on how to determine whether your child needs additional support, we tapped into the expert guidance of Helen Egger, MD, Co-founder and Chief Medical & Scientific Officer of Little Otter. Little Otter is dedicated to providing families with quality and accessible mental health care. With the numerous stressors many families have experienced in the past few years, it’s more important now than ever to check in with your child’s mental health. Little Otter provides a free, evidence-based assessment and report for children 2-12 with actionable tools to support your family’s wellness. You can find your free toolkit here.

For more ways to support and check in with your child during this season and beyond, Dr. Egger is sharing a list of questions that can help you determine whether your child’s emotions and behaviors may indicate a treatable mental health challenge. Read on for everything you need to know.
One of the biggest challenges parents face is this question: when should I worry about my child’s emotions and behaviors? As children grow, they develop their capacities to manage their feelings and regulate their behaviors. We are not surprised that toddlers and preschoolers have tantrums when they are frustrated and tired. They are beginners in learning to manage big feelings. As children head to kindergarten, we expect tantrums to decrease in their frequency and intensity. If children’s rages continue into elementary school and beyond, we then might be concerned because their behavior does not reflect our developmental expectations at that age. 

Children develop at different rates and have different ways of managing emotions or behaving. Some children are shy, others are exuberant. Some children love rough-and-tumble play while other children enjoy quieter, imaginative play. However, it is also important to understand that mental health challenges are common and often begin in early childhood! The rate of mental health challenges like anxiety, depression, ADHD, and behavioral problems in early childhood is similar to the rate in later childhood and adolescence. In fact, 75% of adult mental health disorders start before the age of 14. It is so important to identify when your child is experiencing an impairing mental health challenge because these challenges are highly treatable. Mental health care for your child and for your family can make a world of difference.

So when should a parent worry and consider a mental health check-up for their child? 

Here are a few questions that can help provide you with clarity.

  • Have your child’s emotions or behaviors changed? Has this change lasted more than a week?
    • Every person’s emotions and behaviors fluctuate. Many children have meltdowns at the end of a long day. They feel sad when they’re disappointed. What you need to look out for is an emotion or behavior change that 1) persists, 2) is intense, 3) is pervasive across settings, and 4) is unresponsive to your interventions.
    • Here are some changes to look for. Your child:
      • Is sad, tearful, or irritable for much of the day.
      • Has tantrums or meltdowns nearly every day and/or your child is aggressive during tantrums (hits, bites, kicks, breaks things).
      • No longer enjoys or wants to participate in activities that they previously enjoyed.
  • Has your child’s sleep or eating/appetite changed? Have these changes lasted for more than a week? 
    • First, you need to consider short-term events that could explain your child’s sleep or eating changes such as your child has been sick, there is a new baby in the house, you recently moved, or returned from a family vacation. 
    • Sleep disruptions can include bedtime resistance, waking up during the night, coming to sleep in your bed, waking with nightmares, waking earlier than usual, or waking up grumpy and irritable (again, you are looking for a change!).
    • Eating/appetite changes include reduced or increased appetite.
  • Is your child having newly-onset stomach aches, headaches, and/or joint aches and pain? 
    • Of course, you want to make sure your child is not experiencing a treatable physical problem.
    • However, children, particularly young children, often express anxiety and depression with stomach aches, headaches, and non-specific aches and pains.
  • Are you noticing themes of sadness, death, or danger repeatedly in your child’s play? Is your child repeatedly saying negative things about themselves (“I am a bad person.” “I am stupid.” “I am ugly.” “I hate myself.”) or expressing excessive guilt and worry?
    • Listen to your child. Be non-judgemental and open. You want your child to know that you care, take their feelings seriously, and will help them if they are suffering.
  • Have you noticed a change in your child’s functioning at school, home, or in relationships with other children or adults? Also, have you noticed that your child’s challenges are adversely impacting your family?
    • This is very important. If your child’s challenges are impacting their functioning or your family’s functioning, seek a mental health evaluation so that your child and your family can get help and support. You want to intervene and get help as early as possible so that your child can get back on track and thrive. 

How Little Otter Can Help

Little Otter is a pediatric practice for mental health. Just like a pediatrician who cares for your children’s physical health, Little Otter cares for all aspects of your children’s mental health and your family’s mental health and wellness. The cornerstone of our care are our proprietary assessments and quarterly mental health check-ups for your children and your family. We can help you figure out “when to worry” and what to do based on our assessments. From this foundation, we provide personalized care plans and an integrated care team to support your children’s healthy emotional development and treat emerging emotional and behavioral challenges. Little Otter also works directly with parents on parenting skills and with couples to strengthen their relationship. We know that children’s mental health depends on the mental health and wellness of the whole family. 

Little Otter’s services are available to California residents only, at this time. Little Otter is expanding to more states in the fall. Sign up for the Little Otter waitlist here:  If you live outside of California, you can access professional therapeutic services by getting a referral from your child’s pediatrician, searching for child and adolescent mental health specialists in your area, or by contacting your health insurance provider for an in-network child and family mental health specialist.

Helen Egger MD, Co-founder and Chief Medical & Scientific Officer, Little Otter

Dr. Helen Egger is a child psychiatrist, renowned research scientist in early childhood mental health, and an academic leader. After 30+ years in academic medicine, she co-founded Little Otter with her daughter, Rebecca Egger, to transform how children and families get access to high-quality mental health care. The foundation of Little Otter is Dr. Egger’s clinical, scientific, and operational expertise in evidence-based, high-quality pediatric mental health.

Prior to joining Little Otter, Dr. Egger was Chair of the Department of Child and Adolescent Psychiatry at NYU Langone Health (NYULH), the Arnold Simons Professor, and Director of the NYU Langone Child Study Center. As Chair, she led the department’s large, multi-site, private and public system of clinical care staffed by 145 providers. At NYULH, Dr. Egger also founded and led a digital child mental health research lab called the WonderLab.

Before moving to NYULH, Dr. Egger was a tenured faculty member at Duke Health where she founded the Early Childhood Mental Health Lab within the Center for Developmental Epidemiology. As creator of the first interview to assess preschool mental health and seminal NIMH-funded longitudinal studies, Dr. Egger has shaped the science and clinical practice of toddler/preschool mental health. At Duke, Dr. Egger also served as Vice-Chair and Chief of the Division of Child and Adolescent Psychiatry and led a transformation of clinical care called Duke Integrated Pediatric Mental Health. 

Dr. Egger served on the Board of Zero to Three (ZTT) for 13 years and is a co-author of ZTT’s Diagnostic Classification: 0-5

Dr. Egger attended Yale College and Yale School of Medicine. She completed her adult, child, and post-doctoral research training at Duke University School of Medicine.



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