Depression In Children

“…but doctor, how were we to know that this was such a serious issue?”

This was a couple, whose 5 yr old son had been diagnosed with depression. “We just thought he has some infection…”

This child who had normal milestones; had joined a reputed play school and had been selected to a premier educational institution with no complaints either from parents or school until 6 months ago. As was unraveled the child lost control of bowel movements (which he had gained at the age of 18 months). Initially parents, as is apparent, did not take any action; they thought since he never had any problems with bowel movements this would be some innocent indigestion; after 3-4 months when he started losing weight and lost appetite and they were called to school that he would soil himself almost daily, they were concerned. Series of consultations later child was diagnosed to be a case of childhood depression.

This child suffered from Encopresis – voluntary or involuntary passage of stools in a child who has been toilet trained (typically over age 4), which causes the soiling of clothes. In absence of any history of constipation, it can be attributed to Emotional disturbance.

Whenever a doctor suspects any child to have any emotional problems and queries parents about any trigger; pat comes the reply “But what does he/she have to be depressed / stressed about?” Most parents add, “We try to provide whatever he needs/ demands”

This statement reveals few misconceptions:

1. Ignorance about emotional needs of the child
2. Providing whatever is wanted, is only satisfying material needs; but leaves emotional needs unattended.
3. Not realizing that kids absorb happenings in the environment and react to them
4. They believe that childhood is a carefree period of our life. They should recall their time and think how much they were affected by peer acceptance/ rejection; parental expectations and grades in the school?

We should not forget that kids are powerless and have no control over happenings around them and with any stressor they feel frightened/ frustrated.

A child’s such reaction may be due to an event that is too much for the child to take or, in rare cases it may be a pathologic reason largely due to family history of some or the other mental illness.

Any of the following, in an otherwise normal child, should ring a warning bell and alert the parents:

1. Ongoing irritability in a child who earlier had a pleasant demeanour
2. Low self-esteem; the child may start using terms like “I am bad; no one likes me”
3. Losing interest in activities previously enjoyed.
4. Loss of control of bowel movement/ urination (after having achieved control)
5. Recent onset stammering after having spoken normally for some time
6. Change in appetite (either increase or decrease).
7. Change in sleep patterns (either increase or decrease).
8. Failing in grades due to difficulty concentrating.
9. Unusual anger, even at parents
10. Unusual sadness; listless child
11. Physical symptoms (headaches, stomach pain, which your doctor can not diagnose)

Since we always feel we are doing more than warranted; Most of us parents ignore any subtle signs. We must be conscious of any change in the child’s demeanour/ behaviour as it may be a signal of something much more sinister.

The child described above was abused in the school by a peon.

Other reasons of reactive depression (where family history is not the cause but a specific event is) are:

1. Abuse (physical, emotional or sexual)
2. Chronic illness in a close family member
3. Death of a parent / doting grand parent at an early age
4. Parental disharmony – divorce or abandonment
5. Even a casual comment by a enraged parent, “I don’t know why we decided to have a child?”

Kids are more sensitive than adults; do not have the needed maturity to handle emotional mishaps and break much more easily. We must accept that not all children will grow from infancy through their adolescent years without experiencing some emotional trauma along the way. Yes, our child is unique, smart and special; but he / she is sure to encounter emotions, feelings or behavior that may cause problems in their lives and by default in our lives.

Let us develop a powerful antenna and keep the communication channels widely open 24X7 for the child to share the problems as they occur.

Dr Chander Asrani, father to three daughters and grand father to one, is a post-graduate in Family Medicine. He has over 35 years in clinical practice, launched www.growingwell.com in 2000 and since then has been writing on various subjects. Know more about him at about.me/drasrani.