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Between January and April 2021, Children’s Hospital Colorado’s pediatric emergency department saw a 72 percent increase in behavioral health visits compared to the same period in 2019. Meanwhile, twice as many patients at Children’s Pediatric Mental Health Institute reported increased anxiety, depression, and feelings of isolation and social disconnectedness. Eighty-seven Colorado kids ages 10 to 18 died by suicide in 2020.
Those are scary numbers—and they led Children’s CEO Jena Hausmann to declare a “pediatric mental health state of emergency” in May 2021 and Children’s chief medical officer, Dr. David Brumbaugh, to say “our kids have run out of resilience.” While health officials contend the pandemic and related stressors have been a big factor, they also believe this crisis has been brewing for some time. More resources for treating the symptoms (adding psychiatric beds, increasing inpatient hospital staff) would help, but even those measures are not a cure.
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What is? No one knows for sure, and not all mental and behavioral health problems can be prevented, of course. But helping kids develop resilience is a key part of the strategy, according to experts. The good news is that teaching children to persevere—that “adversity is something to learn from and even celebrate, not avoid,” as Denver child psychiatrist Dr. Chris Rogers puts it—doesn’t require an advanced degree. Instead, caregivers can use everyday interactions to show children and teens how to gradually build the skills that will allow them to better navigate life’s challenges—from spills on the bunny slope to teenage breakups.
Babies are completely dependent on their caregivers, which makes the mental and emotional health of those adults especially critical to their development through the first couple of years of life. The other unique thing about this stage, says Dr. Anna Zimmermann, a neonatologist at Rocky Mountain Hospital for Children, is that “every single thing that they do is new, and every single thing that they do, they’re going to fail at, again and again and again.” Those struggles—to walk or bring a spoon to their mouths or stack blocks—are opportunities for adults to offer encouragement, praise the effort, and “normalize the fact that you’re not supposed to get it on the first try,” Zimmermann says. –Jessica Larusso
Local experts’ top resilience-building strategies.
The Theory: Caring relationships with parents, in which babies become confident they have consistent love and support, serve as an external source of resilience that will be the foundation for developing internal sources as they get older.
The Practice: Showering babies with attention and affection, comforting them when they are sad, and actively listening to them is easier when caregivers are tending to their own needs. Thus, prioritizing self-care like exercise, socializing with friends, or simply watching a little TV isn’t selfish; what’s good for the parent is good for the baby.
The Theory: Trying anything unfamiliar can be scary at first, so it’s important for kids to learn that they can grow to like new things.
The Practice: When you feed your six-month-old avocado and he spits it out, don’t assume he’s destined to hate guacamole. Instead, praise him for sampling it and continue to offer it every few days. Odds are he’ll learn to enjoy it once he becomes more comfortable and confident with the flavor and texture.
The Theory: Knowing when to ask for help—and feeling like it is acceptable to do so—is a crucial skill children need to develop to successfully navigate challenging tasks and emotions.
The Practice: Instead of telling your toddler she can’t carry her water bottle to the park because it’s too heavy, let her attempt it and experience a little frustration before kindly (read: no need for an “I told you so”) offering to help.
Virtual care and connection for new moms might be here to stay.
Research shows that poor caregiver mental health negatively affects children’s mental and physical wellness, so giving birth in the middle of an anxiety-inducing pandemic was not ideal—for moms or babies. “It was especially hard for women who didn’t have family nearby or who needed to isolate from grandparents for health risks,” says Dr. Celeste St. John-Larkin, a child psychiatrist and medical director of Children’s Hospital Colorado’s Healthy Expectations Perinatal Mental Health Program, which has offered psychiatric services and group therapy to local moms struggling with mood and anxiety disorders for more than 15 years. With in-person meetups unavailable, Healthy Expectations took most of its programming to Zoom. “We’ve had really great attendance,” St. John-Larkin says—so good they’ve extended virtual options for the foreseeable future. “It’s easier for moms to get to their [one-on-one] appointments via telehealth, without having to pack up baby and everything else.” Healthy Expectations also moved its free support groups online and began offering a new meetup for Black mothers led by Dr. Shaleah Dardar, a Black psychiatrist and mother herself.
There’s a fine line between normative childhood behaviors (like tantrums) and cause for concern, but our experts suggest considering a behavioral health consult if you spot these red flags.
- Developmental regressions. If your child has been, for example, talking consistently and suddenly stops for a significant period of time, she may be experiencing an underlying issue.
- Lack of eye contact or interaction. Around or after six months, this can be an early sign of an autism spectrum disorder, even if your baby is meeting gross motor skill milestones like sitting or crawling.
The preschool and early elementary years are a period of widespread external exploration, characterized by rapid language development, make-believe play and emulation, and egocentrism. “Language becomes more complex as kids learn to speak in full sentences, and that comes with additional milestones in the way they interact with others,” says Jessica Hawks, child and adolescent psychologist and clinical director of ambulatory services at the Pediatric Mental Health Institute at Children’s Hospital Colorado. Yet, she adds, “they can only understand why things are happening in their world based on their own point of view.” Figuring out how to keep their cool after they’re told they can’t do exactly what they want to—often by a caregiver and for their own protection—is crucial to developing resilience at this age. —Julie Dugdale
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Hot Topic: Power Struggles
As kids begin to explore their independence, everyday tasks can become epic battles—and lay the foundation for how they think about conflict resolution.
Sneakers or snow boots? Holding hands or crossing the street alone? Sharing the truck or hitting a playmate? These are all choices preschoolers increasingly know they can make, although complicating factors—weather, heavy traffic, the feelings of others—are still beyond their grasp. Which, of course, necessitates intervention. “The hallmark parent-child conflict here is centered around children wanting to assert independence versus not really having the skills to do it safely,” Hawks says. “They’re becoming cognitively aware that they have the ability to influence the world around them, but allowing a parent to scaffold for them can sometimes be difficult.”
So how do you avoid a full-scale meltdown—and crushing your child’s well-intentioned initiative—when, for example, your four-year-old sets her mind on walking your 90-pound German shepherd down a busy road? “Kids need to have a great amount of perceived control,” says Dr. Chris Rogers, a child psychiatrist and medical director of Child and Adolescent Services at HealthOne Behavioral Health and Wellness Center. Try empowering her by giving her a decision to make: I trust you to hold the leash by yourself and walk Rufus in the park, or you can walk Rufus down our street if I hold his leash with you. Says Rogers: “We can create these easy wins for them by providing safe choices that we’re fine with.”
Parents also need to understand that failure is an opportunity for long-term learning, even if there’s some minor, short-term discomfort involved. Amie Lofton, a child psychologist and behavioral medicine specialist with Kaiser Permanente, encourages natural consequences (safety permitting) when possible, such as letting your raincoat-refusing daughter get wet. In the case above, you might say, “Rufus is really strong; if you walk him by yourself, he may pull his leash out of your hands.” Then (once you’re in a cushy patch of grass), let her experience the yank and turn to you to wrangle the dog. “Learning to ask for help,” Lofton says, “is building resilience.”
Local experts’ top resilience-building strategies.
The Theory: Healthy risk-taking during playtime allows kids to experiment with problem-solving. The key is finding an activity that feels high-stakes but isn’t actually dangerous.
The Practice: Rock climbing at a gym like ABC Kids Climbing in Boulder requires self-direction and offers significant reward for risk at any level. While a fall can be frustrating, harnesses and ropes put climbers right back where they started to build on what they learned.
The Theory: Parental reactions to stress (shouting, slamming a door, storming away) are often kids’ earliest guideposts for how to deal with adversity.
The Practice: “It’s important for parents to pause, wait, and decide how they want to react when their first instinct is to get frustrated,” says Dr. Edward Taylor Buckingham, a child and adolescent psychiatrist with Kaiser Permanente in Denver. Calm your mind and body to set a positive example of how to manage big feelings and approach conflict resolution.
The Theory: It’s natural to compliment a win or an achievement, but if young children feel important or proud only after earning an award or scoring points, it can make them feel like their worth is tied to success.
The Practice: Team sports, such as soccer, provide plenty of opportunities to offer affirmation when you see behaviors you’d like to encourage, like helping a teammate up, rather than an outcome.
Increasingly, behavioral health care access is as easy as going to your well-child visit.
Since its launch in 2005, a Children’s Hospital Colorado initiative has been implementing integrated behavioral health services in the Denver area. Though the name sounds complicated, it simply means Project CLIMB (Consultation Liaison in Mental Health and Behavior) embeds mental health professionals inside pediatricians’ offices. That way, if a parent expresses concern during a well-child visit about a kid’s sudden refusal to participate at school, therapists are already there to assess the child’s state and any contributing familial or environmental stressors before offering insights, strategies, and potentially referrals. And because patients are likely to come back again soon (flu season!), a continued dialogue is built in. Project CLIMB operates out of Children’s three on-site primary care settings, but its impact has been much broader: It has provided training and education to a range of metro-area private practices and hospital systems, including Denver Health Medical Center, that have started similar programs. “Primary care is the front line, the front door,” says Ayelet Talmi, director of Project CLIMB and professor of psychiatry and pediatrics at the University of Colorado School of Medicine and Children’s. “Having the social-emotional services, support, and resources they need in a setting where they already are is key.”
- Outbursts that consistently disrupt everyday tasks. Do you avoid going to the grocery store, for example, or to a friend’s house due to the near certainty of an excessive meltdown?
- Overly aggressive behaviors with peers, such as constant and prolonged hitting or kicking.
- Inability to follow basic directions…ever. Noncompliance is a hallmark of this age group as kids explore boundaries and push for autonomy, but failing to demonstrate an increasing ability to listen as they grow older is problematic.
Kids in this age group are developing the language and cognition to express their thoughts and feelings—e.g., saying “I’m mad at you for riding my Razor” instead of just decking their sibling—in ways that foster healthy coping methods, says Scott Nebel, director of clinical services for child and family at the Mental Health Center of Denver. They’re also establishing more social and emotional independence from their parents and honing the ability to think for themselves. Even so, many still see the world in black and white, says Kendra Dunn, a licensed psychologist in Littleton. Caregivers can help progress their children’s thinking beyond regarding situations as either successes or total, irredeemable failures by emphasizing nuance and framing difficulties as growth opportunities. —Jenny McCoy
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Hot Topic: Organized Sports
Tween athletics come with opportunities for parents and kids to win the game of fostering resilience.
As you pull your car into the rec center roundabout, your nine-year-old silently slides into the back seat with wet hair and dampened spirits. He got outtouched in the 50-yard backstroke. Again. Your caregiver instinct tells you to soothe his disappointment: “That was so unlucky!” “You just have to think positive.” “Who wants ice cream?”
A better approach, says Dr. Brooke Pengel, pediatric sports medicine physician with Rocky Mountain Hospital for Children, is to encourage your child to adopt a growth mindset: the perspective that failure is not an inherent part of who they are but rather an opportunity to learn what to do differently next time. In this scenario, step one is to help your swimmer move on from focusing on the result—“I’m a loser”—to identifying something that did go well: “OK, I didn’t win, but I got a good start off the block.” From there, ask him to discuss what he could have done better and help him choose one or two specific things to focus on in practice—like flip turns, for instance—that might help him improve his time.
Giving kids those kinds of concrete objectives can help with motivation and increase their ability to bounce back from challenges, says Dunn, who specializes in sports psychology. Emphasizing learning and mastering new skills doesn’t mean you have to completely dismiss your child’s inner will to win, though. “That competitive nature is really what motivates us,” Dunn says. “It’s part of what makes it fun.” Just be sure to balance it with reminders to focus on what is controllable. If you do that, athletics can teach kids to see adversity as a path to becoming stronger—a crucial skill that will help them navigate everyday disappointments such as getting a bad grade on a test or learning that their BFF no longer wants to sit with them at lunch. “Sports,” Dunn says, “are a beautiful way to help build resilience.”
Local experts’ top resilience-building strategies.
The Theory: Helping your kids put words to the difficult emotions they’re experiencing—and then asking them what they think they need to cope—encourages them to learn how to effectively manage challenging moments.
The Practice: The next time your child is clearly upset, say, “It looks like you may be feeling frustrated—is that right?” From there, ask how you can support her, whether that’s by talking about what’s bothering her; doing something active, like going for a walk; or giving her some alone time.
The Theory: Highlighting to your kid that other people have different points of view than they do can help them learn how to reframe difficult situations in a healthy, constructive manner and build interpersonal skills.
The Practice: Your child feels hurt that Pieper didn’t invite him to her birthday party at Water World. Validate his feelings, but also ask him to consider Pieper’s point of view: Maybe her mom could only afford to pay for a certain number of kids, or perhaps she decided she wanted an all-girls group.
The Theory: Allowing your kids to make their own choices helps build their sense of competence and decision-making abilities, and it also gives them ownership over choices that impact their lives.
The Practice: Instead of signing your child up for a weeklong baseball or mountain biking camp without consulting him—which can undermine his sense of autonomy and develop a reliance on caregivers—give him several options for how he can spend spring break. Then, honor his choice, whether that be hiking in Rocky Mountain National Park, taking a class about dinosaurs, or simply recharging at home.
At four Colorado Springs area schools, resilience is part of the curriculum.
Somewhere between learning the scientific method and discussing chapter 10 of Holes, some 2,000 students in Colorado Springs and Manitou Springs have received resilience lessons over the past two years, thanks to Children’s Hospital Colorado’s Building Resilience for Healthy Kids initiative. The six-week program pairs sixth graders from four different schools with trained hospital employees who serve as coaches. During weekly sessions, these professionals lead students through mindfulness activities—breathing exercises, visualization, progressive muscle relaxation—and help them set goals across a range of topics, from academics to building relationships to healthy lifestyle habits to self-esteem. Students report back on their experiences working toward, say, consistently attending soccer practice or managing distractions during homework time; coaches then help them identify lessons learned, celebrate achievements, and strategize next steps. Researchers at the University of Colorado Colorado Springs and CU Anschutz Medical Campus, who studied the effectiveness of the program, concluded that such efforts may improve resilience and self-efficacy among all kids and also ease anxiety specifically among those struggling with mental health.
- Dramatic shifts in mood. Not to be confused with mere temporary crankiness, this might present as uncharacteristic sadness or irritability that lasts a week or longer in your normally cheerful—or stoic—child.
- Social withdrawal. Pulling away from family and friends can be associated with anxiety and depression.
- Aggression. Younger kids, compared to adolescents, are more likely to express their emotional angst with their fists. Be on the lookout for an uptick in physical fights with siblings or friends.
- Physical symptoms. Kids can and do experience somatization (when psychological conflicts manifest as bodily pain), so take note if they frequently complain about ailments like stomachaches or headaches.
As if puberty weren’t tough enough, kids ages 12 and up are, relatedly, in the midst of major cognitive and social transitions. Their emotions are raging, and they haven’t yet fully developed executive function (the ability to regulate feelings and inhibit impulsive responses). Having more freedom to explore their identities and take on responsibilities means more distance from parents and increased dependence on peers as they get older. Those relationships outside the home are a practice ground for future adulthood, but parents and guardians still have crucial roles to play by validating their kids’ concerns and helping them think about the bigger picture when challenges arise. Caregiver support helps kids trust themselves during a time when they’re enduring a lot of change and builds confidence for facing adversity. —Meredith Sell
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Hot Topic: Social Media
How to teach your child to survive—and even thrive—in today’s digital landscape.
Kids these days are as well-versed in feeds and likes as Millennials were in Game Boys and Beanie Babies. But parents’ concerns about time and allowance dollars wasted on Donkey Kong can seem quaint compared to cyberbullying, sexting, and unhealthy comparison as teens hold their lives up to the airbrushed highlight reels of peers and influencers. So, should parents cut off social media entirely? Not according to Dr. Diane Straub, department chair of adolescent medicine, and Jenna Glover, director of psychology training, both at Children’s Hospital Colorado. Instagram and WhatsApp are normal parts of kids’ social lives now, and during the pandemic, they provided important avenues for interaction with friends. Plus, very high social media use and very low social media use are associated with depression. “In the middle is where the most well-adapted kids are,” Straub says.
To get there, Straub and Glover recommend encouraging children to be intentional about when and how they use social media. Set a household digital bedtime and establish digital-free zones, like the dinner table and bedrooms. Encourage active screen time (during which you and/or your kids are creating content, such as TikTok dance videos) over mindlessly consuming whatever YouTube throws their way. Monitor their activity and talk to them about cyberbullying and sexting: Ask open-ended questions, such as “Would you treat a friend this way?” or “Do you think this is appropriate?”
Social media shouldn’t replace live interaction, so make sure they’re spending time with friends IRL. And if your phone is glued to your hand, consider giving yourself a digital timeout—and ask your kids to hold you accountable. Changing your own behavior is a powerful way to show teens that they also have the agency to decide how much what’s happening online affects them. “If your kid is eating appropriately, sleeping appropriately, socializing, getting homework done, and getting some outside time,” Glover says, “his screen time doesn’t matter.”
Local experts’ top resilience-building strategies.
The Theory: Destigmatizing mental health removes shame from emotional and behavioral struggles and makes asking for help—whether from peers, family, or professionals—easier.
The Practice: Seasonal depression can hit hard during the winter. Use the weather to start a conversation with your kid and ask if she’s ever felt extra gloomy at this time of year. Be honest about your own experiences, and give her space to share what she thinks could be helpful for someone facing depression.
The Theory: Focusing on the learning process, instead of outcomes, shows kids how incremental steps can help them eventually conquer what seem like insurmountable obstacles.
The Practice: Shift your focus from achievement to progress, whether you’re on the ski slopes or checking your kids’ report cards. Ask about how they’re honing their carving technique (instead of how many black diamonds they skied) or what strategies they’re using to master linear equations in Algebra 2.
The Theory: Trusting your teen with an increasing level of responsibility encourages independence and helps them develop self-confidence.
The Practice: Give your son a corner of your garden to plant and tend. Don’t correct him if he picks a shade-lover for the sunniest spot, and when it wilts, allow him to diagnose and address the problem on his own.
Kaiser Permanente’s Ghosted program sparks conversations about mental health in local schools.
If a friend told you they had anxiety, how would you respond? Since fall 2018, staff from Kaiser Permanente Colorado’s Arts Integrated Resources team have posed questions like this to eighth grade and high school students in the Centennial State as part of Ghosted, a nationwide program designed to reduce mental health stigma. The assembly-style sessions begin with a 30-minute film about four students who learn about the others’ mental and emotional struggles and promise not to, in the parlance of our times, ghost one another. The video is followed by an interactive discussion, during which students talk through questions—How do you understand depression? What are some ways you cope with difficulty?—and are told about available resources. The film breaks the ice. “They can see a character and identify with them,” says Brian Harper, program lead for Ghosted. His favorite moments, though, are when students take over the conversation. In 2021, Kaiser debuted a follow-up program, Own It, which is exclusively available in Colorado and focuses on practical next steps for students who find out a friend is struggling with thoughts of suicide.
GET HELP: If your child is engaging in self-harm or has expressed suicidal thoughts, call the Colorado Crisis & Support Line at 844-493-8255 or the National Suicide Prevention Lifeline at 800-273-8255.
- Significant changes in eating and sleeping habits. Sleeping in? Normal. Never getting out of bed, though, isn’t. Snoozing too much or experiencing insomnia can be signs of emotional stress, and under- or overeating can indicate a range of mental and behavioral health concerns, from eating disorders to anxiety.
- Self-medication (vaping, alcohol, drugs). While some experimentation can be expected among teens, substance use is strongly correlated with avoidance of emotions and can be a sign that your kid needs extra support. Any level of substance use warrants a conversation.
- Self-harm. Cutting and other forms of self-harm are serious red flags and require intervention as soon as possible.