Mental Health Awareness: Answering Your Submitted Questions


As part of the foundation’s mission to educate and raise awareness for mental health issues among youth, the Thielen Foundation partnered with M Health Fairview to answer user submitted questions about mental health.

Read responses from Dr. Jessica Cici, M Health Fairview’s Medical Director for Child and Adolescent Psychiatry, below.

Learn more about the Thielen Foundation’s work with the Behaviorial Health Unit at the University of Minnesota Masonic Children’s Hospital HERE.

“What can I expect about the process for reaching out to a professional?”

“How can I be more understanding toward a loved one with a mental health disorder?”

“How do I help a child with a mental health disorder if they’re reluctant to get treatment?”

"What is a 'normal" level of anxiety in kids, and when should you seek professional help?"

Emotions including joy, sadness, anger, and fear are normal; we all experience them. They’re healthy and serve a purpose. Emotions prepare us and help us communicate our needs to others. For example, it’s helpful for a child to feel nervous before a big exam at school. It motivates them to prepare, so they perform well. When a child feels sad, it helps others know they need to be comforted.

Throughout childhood, it’s normal for young children to experience worry and fear, whether it be fear of the dark, thunderstorms, or ghosts. When they get a bit older, social situations and current events are common fears. When the worries start to get in the way at home, school, or in relationships, they may have an anxiety disorder.

What does an anxiety disorder look like? While some kids talk about their worries (fear of being apart from parents, fear of judgment by peers, frequent worries about the future), others do not. In these cases, look for other signs of anxiety such as difficulty sleeping, low energy, headaches, stomachaches, irritability, anger, isolation, or frequent requests to stay home from school. Having one of these symptoms doesn’t necessarily mean your child has an anxiety disorder, but it doesn’t hurt to get an evaluation by a professional. Sometimes getting reassurance or some simple next steps can go a long way.

-Dr. Jessica Cici, M Health Fairview

"Do you have any advice for someone struggling with their eating habits?"

Encourage family meals cooked and plated by a parent. Those with eating, body image, or weight issues may struggle to make good decisions around food.

Eat regularly, every three to four hours. That’s three meals and one or two snacks per day. Our bodies need a steady stream of energy to function, so going long periods without eating makes us prone to overeating.

No diets. No foods are “bad” when consumed in moderation. But when we make rules around food, it’s easy to break them, and that often leads to feeling out of control and overeating. Diets are also rarely sustainable.

Do something calming after eating. You could use a warm pack on your stomach, aromatherapy such as peppermint or citrus, or guided visualization. Calling a friend can also distract from any uncomfortable body sensations or thoughts that pop up after eating.

Exercise in moderation. Getting our bodies moving is helpful for our mental and physical health, but spending hours a day exercising can be harmful.

Remove scales and excess mirrors. These items can keep us focused on unhealthy attitudes and feelings about our weight and shape.

Seek professional help. If you’re concerned about yourself or a loved one because they’re engaging in unhealthy eating behaviors or you’re worried about their safety, please reach out to a professional.

-Dr. Jessica Cici, M Health Fairview

“At what age should parents with young children start establishing routines to promote good mental health?”

First and foremost, the relationship you build with your child is the foundation for the rest of their development. If you provide love, comfort, and security, your child will learn to trust not only you, but themselves.

Beyond fostering this relationship, children thrive on schedules.  Here are some helpful hints for those early years: 

Babies: From the moment your child is born, they need structure and routine. Give them skin-to-skin and tummy time daily. Feed and change them at least every three hours. Sleep is not regular at this age, but a schedule should develop over the first year. Read and sing to them regularly. Explore their new world with them.    

Toddlers: This is the time to establish regular sleep routines, healthy eating habits, physical activity, reading, and play. It’s also important to set clear limits and communicate them in a kind, but firm manner. When your child struggles with these limits, first check in with yourself. Are you feeling calm? If not, this is a great opportunity to practice what you’d like your child to be able to do: take a break and a few deep breaths, and name what you’re feeling. Then, you can help your child do the same.   

Preschoolers: They need all of the above for their mental health, plus more. This is when their world opens up. They are curious little beings; engage in this curiosity with them. Just when you think they’ve asked every question in the universe, they’ll come up with yet another. Savor these sweet moments, because in a few short years, you will no longer be “the expert.” 

Parenting, while exhausting at times, is also filled with so many amazing firsts. Each moment is an opportunity to teach them something.

-Dr. Jessica Cici, M Health Fairview

"Are there any red flags to watch out for if you suspect a child of being mentally abused?"

Children who are being abused are often scared to speak up – for fear of their own safety or because they feel protective of the abuser, as abusers are most often someone the child knows. Reaching out for help requires talking about their experience, which is often very painful. It may also bring up feelings of shame and guilt, because many victims of abuse blame themselves.

In order for them to get help as soon as possible, it’s important to recognize these potential warning signs of emotional abuse in children:

▶️Changes in behavior, including anger, defiance, declining grades, missing school, or running away
▶️Not wanting to go home
▶️Withdrawing from friends and activities
▶️ Symptoms such as headaches or stomachaches without a medical explanation
▶️Depression, frequent worry, or low self-esteem
▶️ Substance use
▶️Self-harm or suicidal thoughts

If you suspect a child is being abused, you can report your concerns to the county Child Protective Services office.

-Dr. Jessica Cici, M Health Fairview

"Beyond eating well and exercising, are there other ways to help a child’s mental health during this pandemic?"

Here are several things you can do to ease the impact of the pandemic on your child:

Be kind to yourself: You’re in a tough situation. You’re expected to do it all right now. Pandemic or not, I like to echo the flight attendant’s oxygen mask instructions: “Place the mask on yourself before assisting others.” (No pun intended here. Masks save lives.) You can’t help your child if you aren’t first caring for yourself. Know that this is an imperfect situation, and you’re doing your best.

Adhere to a schedule: Children need routine and structure. Knowing what to expect can reduce anxiety. In a climate where children are already experiencing so much uncertainty, this is a way for them to feel a sense of security.

Make time for conversation: Ask them how they’re doing, how they’re dealing with things right now. Talk in simple terms about how you’re managing things during this pandemic. Not only is this a way to connect with them, but you being open with them about your feelings and how you’re coping shows them it’s safe to talk to about their feelings. It builds trust.

Arrange “over the fence” or virtual visits: Attending to healthy relationships is something we frequently focus on in therapy, because we know it helps us feel better. While the way we connect with people has changed during the pandemic, our need for social connection has not. Schedule virtual visits or outdoor, masked, socially distanced visits with family and friends.

-Dr. Jessica Cici, M Health Fairview

"Who is more at risk for developing depression as a teen, and are there any key warning signs?"

Risk factors for developing depression as a teen include but are not limited to:

▶️ Family history of depression
▶️ Chronic illness
▶️ Neglect or physical, emotional, or sexual abuse
▶️ Loss of a parent, divorce, or an otherwise stressful home environment
▶️ Poverty
▶️ Bullying or marginalization by peers
▶️ Low self-esteem
▶️ A learning disability, attention deficit hyperactivity disorder, or an anxiety disorder
▶️ Substance use

The symptoms below can be signs of depression. Your child experiencing any of them warrants an evaluation by a professional:

▶️ Significant and enduring sadness
▶️ Expressing hopelessness or negative thoughts about self
▶️ Irritability, anger, or frequent worry
▶️ Withdrawal from friends or family
▶️ Low energy and increased sleep
▶️ Low motivation, decreased enjoyment
▶️ Significant changes in eating habits or weight
▶️ Difficulty concentrating
▶️ Frequently missing school or declining grades
▶️ Substance use

If your child is injuring themselves or expressing thoughts of harm toward themselves or others, please go to the nearest ER or call 911.

-Dr. Jessica Cici, M Health Fairview

"How can my child help support their friends if they’re going through a difficult time?"

On a general level, it’s important to know your child’s friends: who they are, who their parents are. Get to know them personally and talk to your child about them. If you learn one of their friends is having mental-health issues, here are some things you can do to help:

Let your child know how special they are to be trusted by their friend. But also, ask your child how they’re doing in light of their friend’s struggles. Is it stressful, overwhelming, burdensome? Has this friend’s struggle impacted the friendship? Let your child know that illnesses like depression or anxiety can distort the way their friend thinks, feels, and behaves; the friend may be irritable or withdrawn. While it doesn’t make it OK for the friend to mistreat your child, it can help your child to understand why their friend may be acting this way.

Acknowledge to your child that it can be hard to know what to say to their friend. Tell them just saying, “I’m sorry you’re hurting. Let me know how I can help” can be enough. It validates their friend’s struggle.

Give your child permission to set boundaries in this relationship. They may be feeling responsible for this friend’s happiness and safety, but it’s their job to be a friend, not a therapist. Encourage your child to gently ask this friend to do activities with them. If the friend declines, ask again. Encourage them to keep trying. Depression and anxiety can make it hard to say yes to doing things. Your child’s persistence will let their friend know they haven’t forgotten about them. When the friend does say yes, it’s likely to boost their mood, even if only temporarily.

Meanwhile, encourage your child to recommend the friend seek professional help. If there are any immediate safety concerns, encourage your child to tell you or their friend’s parent.

-Dr. Jessica Cici, M Health Fairview