We do not like to think of children in pain, and have great difficulty with the idea that children suffer depression. Depression in childhood and adolescence is defined as a mood disorder that affects children under the age of eighteen years old. Those under significant stress, who have experienced loss, are subject to peer pressure and bullying, have learning, cognitive and anxiety disorders and are at a higher risk for depression.

Those without depression find it difficult to understand how certain events can affect others in such a way. Often, those with depression are questioned or judged, "Why are you not strong enough to handle it?" Childhood depression is quite different than the expression of normal everyday emotions that happen as a child grows and develops. When a child appears sad, this does not necessarily indicate they are depressed. If the sadness becomes persistent, or if it disrupts behavior and normal activities, this may possibly indicate there is more going on and the situation should be addressed.

The Rate of Childhood Depression

Approximately 2.5% of children in the United States suffer from depression. During childhood years, both boys and girls appear to be at equal risk for depressive disorders. Depression is significantly more common in boys under the age of 10 and by age 16, girls have a greater incidence of depression. During adolescence, girls are twice as likely as their male counterparts to develop depression. Often, children who develop major depression are more likely to have a family history of the disorder. While children show differences in rates of depression between gender, when it comes to symptom severity, there is no difference.

Sad or Depressed?

Symptoms of depression vary from child to child. These symptoms may go unnoticed and often untreated. Typical symptoms might be passed off as normal emotional reactions. One child's symptoms might include acting out or displaying angry behavior. While for other children, they display sadness which appears similar to many adults who are depressed. The symptoms of depression typically involve a feeling of hopelessness, sadness and changes in mood and behavior.

Signs and symptoms of depression in children might include:

• Being irritable or angry, including outbursts/crying.
• Continued feelings of sadness and/or hopelessness.
• Feelings of worthlessness and increased sensitivity to rejection.
• Social withdrawal.
• Physical complaints (such as headaches and stomachaches).
  
• Changes in appetite (increased or decreased).
• Changes in sleep (sleeplessness or excessive sleep).
• Difficulty concentrating.
• Fatigue and low energy.
• Thoughts of death or suicide.

Each child with depression does not display all of these symptoms. In reality, most will display different symptoms at different times and in different settings.

The Hard Reality

Depression in children and adolescents is associated with an increased risk of suicidal behaviors. Suicide is rare in children under the age of twelve, but young children do make attempts to take their life. Many times, this act is impulsive and they try when they are in the height of anger. According to published statistics, girls are more likely to attempt suicide, but boys are more likely to actually kill themselves when they make an attempt.

Why Pediatric Massage?

Pediatric touch therapy has been examined in numerous research studies. Upon review of studies performed using tactile stimulation for children, evidence has demonstrated that massage therapy consistently provides a reduction of anxiety, depression and levels of stress hormones. As is always the case, more research should be performed to further demonstrate the positive benefits of this noninvasive therapeutic approach.

When working with any pediatric client, we not only address their physical ailments, but their emotional care as well. This is not to say that we are acting out of our scope. We would never diagnose depression, but rather we must always use our best skills to support the possibilities that emotional support is needed. As a professional practitioner, you need to remember to empower the child by using a structured permission process, safe positioning and giving choices. Permission should always be obtained from our pediatric client, and proper support should be provided the ensure safety, trust and open communication.

Begin slowly and use slow transitions. It is important that we are consistent and interact with these children based on emotional age. So your communication must be age appropriate considering a child's unique cognition level, how many words they understand well and also consider their non verbal communication cues. Body language can be a big piece of our communication with pediatric clients. For children with depression, we need to do our research, obtain a detailed intake form and consider a safe approach to be most effective. With support and compassion we can make our best inroads with pediatric clients.

References:

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