June was National Safety Month and it brings to mind an important form of safety that is different from wearing seat belts, applying sunscreen or not talking to strangers. Challenges with mental health, such as those caused by depression, are a significant factor to consider when ensuring a child’s safety.

This article briefly lists the risk factors, presenting signs, screening tools and management of pediatric and adolescent depression. It does not replace a conversation or evaluation with a healthcare provider. Please consult with you doctor as soon as possible if you believe your child or teenager may be struggling with depression and/or anxiety.


Risk Factors

Risks for childhood and teen depression include family history of depression, bipolar disorder, suicidality, substance use, or other psychiatric illness.


Other risk factors include:

– history of trauma, personal or family abuse

– adverse events, stressors, neglect or major transitions in the family

– struggles with gender or emerging sexual identity

– having witnessed a natural disaster

– hormonal or metabolic imbalances


Presenting Signs

Depression appears in a variety of ways and many of the symptoms overlap with other health conditions. I highly recommend speaking with a doctor first before diagnosing depression yourself- a trained eye can identify if there are other causes for your child’s symptoms other than, or in addition to, depression.


  • Depressed or irritable mood
  • Loss of interest or pleasure in almost all activities
  • Weight change, failure to achieve expected weight gain
  • Sleep disturbance- sleeping too much or too little
  • Fatigue, low energy
  • Feelings of worthlessness, excessive guilt
  • Decreased concentration, inability to make decisions
  • Suicidal ideation or thoughts of death



Often, a brief conversation during an office visit can serve as an appropriate screening. If your child is a teenager, the doctor may ask to spend some time alone with them to create a safe, confidential space for discussion.


One tool used in screening for depression is the Patient Health Questionnaire-2 item screen (also known as the PHQ-2). Each question receives points for the following answers: “not at all” (0 points); “several days” (1 point); “more than half the days” (2 points); and “nearly every day” (3 points).


Over the past two weeks, how often have you been bothered by any of the following problems:

  • Little interest or pleasure in doing things?
  • Feeling down, depressed, or hopeless?


Patients who score 3 or more on the PHQ-2 should undergo additional assessment for depressive disorder with a mental health specialist.


Next Steps

Conventional treatment for depression typically starts with a referral to psychotherapy, either performed by a counselor, cognitive behavior therapist or in group therapy. More advanced cases of depression may require pharmaceutical management, often with SSRI’s (selective serotonin reuptake inhibitors).


Naturopathic medicine has various additional and well-researched therapies that address depression, these include targeted nutritional, herbal and nutraceutical support, lab testing to identify metabolic and/or neurotransmitter imbalances, mind/body tools and much, much more. Each treatment plan is individualized to treat your child’s unique needs and presentation.


Intuition and Observation

I encourage you to seek medical attention at the first sign of a mental health disorder in your child. Your intuition is a powerful tool- it can detect disturbances or patterns in your child’s behavior well before depression develops. Trust these feelings and discuss them with a doctor that will acknowledge and address your concerns.