Child Psychiatric Consultation: When to Consider One

A child psychiatric consultation is worth considering when a child's emotions or behavior have lasted for weeks or longer, cause real distress, or get in the way of school, home life or friendships. Most families start with the child's pediatrician or teacher, then ask for a referral. Any talk of self-harm or unsafe behavior calls for help right away, not a wait-and-see approach.

This guide is for parents and caregivers in Texas who are wondering whether it is time to involve a child and adolescent mental health specialist. It explains the signs, who to talk to first, what a consultation involves, how to prepare, what to ask and when to act quickly. It is general information, not a diagnosis for any child.

This article is general information, not a medical recommendation. Do not start, stop or change any medication without talking to your prescriber.

When is it time to consider a child psychiatric consultation?

It is time to consider one when changes last, cause distress or affect daily functioning. The National Institute of Mental Health (NIMH) advises considering help if a child’s behavior or emotions last for weeks or longer, cause distress for the child or family, or interfere with school, home or friendships.

Patterns that often lead families to ask about a consultation include:

• Ongoing sadness, irritability or angry outbursts that are out of proportion
• Worry or fears that keep a child from school, sleep or activities
• Big changes in sleep, eating or energy
• Pulling away from friends and family
• A sharp drop in grades or frequent trouble at school
• Stomachaches or headaches without a clear medical cause

Our guide on signs your child may need a psychiatrist covers warning signs in more depth.

How do anxiety and depression show up in children?

In children, anxiety and depression often show up as behavior and body complaints rather than words. The Centers for Disease Control and Prevention (CDC) notes that anxiety and depression in children can look like irritability or anger, trouble sleeping and physical symptoms such as stomachaches.

A younger child may cling, cry at drop-off or refuse to sleep alone. A teen may withdraw into their room, snap at family or stop doing things they used to enjoy. Because these signs overlap with normal development, duration and impact are what matter most. For an overview of conditions, see our guide to common mental health conditions in children.

Who should you talk to first?

Start with people who see your child often, then the child's health care provider. NIMH suggests starting by talking with others who frequently interact with your child, such as their teacher, and then talking with your pediatrician or health care provider and asking for a referral to a mental health professional who works with children.

The CDC also describes talking with a health care provider as a first step. A pediatrician can check for medical causes and help decide whether a therapist, a psychiatric clinician or both make sense. For a side-by-side look at those roles, see our guide on child psychiatrists and pediatricians for anxiety.

Who provides child and adolescent psychiatric care?

Child and adolescent psychiatrists are medical doctors with extra training in young people's mental health. The American Psychiatric Association notes that psychiatrists typically complete about 12 years of education after high school, and up to 14 years for child and adolescent psychiatry.

Other clinicians, such as psychiatric nurse practitioners, therapists and psychologists, also work with children and teens. When booking, ask which ages the clinician sees and what experience they have with your child's concerns. For Lyte Psychiatry, the age range treated requires confirmation before booking.

What happens during a child psychiatric consultation?

A consultation gathers information from several sources to understand what is going on. NIMH describes an evaluation that may include a parent interview about developmental history, temperament, relationships, medical history and prior treatment, information from the child's school, and, if needed, an interview with the child.

Visits usually end with a summary of what the clinician thinks is happening and a discussion of next steps. NIMH notes that treatment may include psychotherapy with parent involvement, and that medications are often used in combination with psychotherapy, depending on the diagnosis.

Our guide to pediatric psychiatry explains more about how care is organized.

How do you prepare for the consultation, step by step?

Preparation helps the clinician see the full picture in the time available. NIMH notes that asking questions and providing information to your child’s health care provider can improve your child’s care.

1. Write down what you have noticed. Include when it started and how often it happens.
2. Collect school information. Report cards, teacher notes or any school evaluations.
3. List medical history and current medicines. Include allergies and recent illnesses.
4. Note family history of mental health conditions, if known.
5. Talk with your child in simple, honest words about the visit.
6. Bring your top two or three goals. For example, "get to school on time without a meltdown."

What to say to a child (example): "We're going to talk with a doctor whose job is helping kids with big feelings. You won't get in trouble, and you can ask questions too."

What should you ask the clinician?

Ask about the approach, your role and how progress will be measured. NIMH suggests questions such as whether the clinician uses research-supported approaches, whether parents are involved, whether there is homework, how progress will be evaluated and how long treatment should last.

• What do you think is going on, and what else could explain it?
• What treatment options fit my child, including therapy only?
• If medication is discussed, what are the benefits, risks and side effects for a child this age?
• How will we work with the school?
• How often will we meet, and how do we reach you between visits?

What if your child does not want to go?

Resistance is common, especially in teens, and it usually eases when a child feels some control over the process. NIMH notes that therapists can coach parents and that parent involvement is often part of treatment, so you can ask the clinician for help with this too.

• Acknowledge the feeling: "It makes sense to feel nervous about meeting someone new."
• Explain the purpose in their terms, such as sleeping better or feeling less stressed at school.
• Offer real choices, such as the appointment time or whether to start by video.
• For teens, explain that some of the visit may be one-on-one.
• Agree to try one or two visits before deciding.

If your child flatly refuses, you can still meet the clinician yourself first. Parents often get useful guidance from that visit alone.

What should parents know about medication for children?

Medication is one option a prescriber may discuss, usually alongside therapy, and it calls for close monitoring. The U.S. Food and Drug Administration (FDA) requires a boxed warning about the risk of suicidal thinking and behavior in children and adolescents treated with antidepressants, and advises contacting the prescriber about new or worsening symptoms such as agitation.

This article does not recommend any specific medicine. Ask the prescriber how the child will be monitored, especially in the early weeks.

When should you get help right away?

Get help immediately if your child talks about hurting themselves or someone else, or if their behavior is unsafe. NIMH advises seeking help immediately in these situations.

The 988 Suicide & Crisis Lifeline is free, confidential and available 24/7 by call, text or chat. Other urgent signs include not eating or drinking, seeing or hearing things others do not, or a sudden, severe change in behavior. Call 911 if anyone is in immediate danger.

What should Texas families know about getting started?

In Texas, families can start with their pediatrician, the school, or a mental health practice directly. Telehealth can reduce missed school and travel. Lyte Psychiatry offers telehealth visits to patients who are physically located in Texas at the time of the visit. Insurance coverage and network status vary by plan, and the age range a practice treats differs, so confirm both before booking.

Getting support in Texas

Lyte Psychiatry offers therapy, psychiatric evaluation and medication management in Texas. In-person visits are available at Lyte Psychiatry's clinic in Pantego, in the Dallas–Fort Worth area. Lyte Psychiatry offers telehealth visits to patients who are physically located in Texas at the time of the visit. All Lyte Psychiatry services are available in Spanish.

Most new patients are seen within 1–2 business days. Weekend appointments are limited. Lyte Psychiatry is an outpatient practice. It does not provide inpatient care, crisis or after-hours coverage, medically supervised detox, or intensive outpatient or partial hospitalization programs. The age range Lyte treats, availability, insurance and clinician fit require confirmation.

Read about stress and self-esteem in teens and adults, learn about therapy at Lyte Psychiatry, or contact Lyte Psychiatry to ask which ages are seen.

If you are in a mental-health crisis in the United States, call or text 988. Call 911 for immediate danger.

Educational information, not a diagnosis or individual treatment plan.