When Your Child Has Gone Flat

The swimming bag has been by the front door since Friday. On Saturday morning, at a quarter to ten, the parent goes up to say the car is leaving in five minutes and finds the eleven-year-old exactly where she was at nine: in bed, on her side, facing the wall, not asleep. She is not ill. She does not want to go. She does not, when asked, want to go anywhere else instead. She says she is tired, which she has said most mornings for a month, and then, when pressed, that swimming is boring, which is new, because a year ago swimming was the thing she would have chosen over almost anything.

The parent goes back downstairs, car keys still in her hand. She is not sure what she has just seen. Her daughter has not cried. She is not, in any obvious way, sad. She is flat, and has been since some point her mother cannot quite date, sometime around half-term, and the flatness has acquired an edge: the snap when homework is mentioned, the shrug at supper, the friend who used to be round every Saturday and has not been mentioned for weeks. The other parents’ group chat is asking whether she is coming to swimming. Her mother types not this week, for the third week running, and wonders what she is supposed to be calling this.

Parents who bring us this moment are caught between two explanations. One is that this is the age: tiredness, hormones, the phone, a phase. The other is that something is wrong. The answer is usually a little of both, and the difference between them is something a parent can learn to see.

What is actually happening

Everyone has low days, children included, often for reasons too small or too private to explain. Low mood is a run of those days. Depression is the word for a low that has lasted most of the day, nearly every day, for at least two weeks, and has started to take things away from her: the pleasure in what she used to enjoy, the energy to start anything, her sleep, her appetite, her concentration, the friendships that needed a little effort to keep going.

In children it rarely looks the way adults expect. The international diagnostic guidance is explicit that in children and teenagers, depressed mood can show itself as irritability, and that in younger children it can arrive as headaches and stomach aches. A low child is often cross rather than tearful. She says things are boring. She has dropped the hobby she cared about without much explanation. She is harder on herself than she used to be (I’m rubbish at everything), slower to get going in the morning, quicker to give up on homework. Younger children sometimes say, in passing, that they wish they were not here. That sentence frightens parents, it should always be taken seriously, and we come back to it below.

None of these on its own means depression. The same guidance adds that irritability by itself is not evidence of a depressive episode; plenty of irritable eleven-year-olds are simply eleven. What matters is the pattern: how many of these things are present, how long they have lasted, and whether she can still be reached by the things that used to reach her. A teenager who is short with her parents and still comes alive with her friends is usually doing adolescence. A child who has gone flat across the board, with her friends as well as with you, is the one to take seriously. The library’s chapter When They Stop Talking to You draws the same line from the other side.

Depression is uncommon before puberty and becomes more common through the teenage years. After puberty, girls become around twice as likely as boys to experience it. Low mood that falls short of a diagnosis is more common still, and worth attending to, because it carries many of the same risks.

### Why it happens

There is rarely one reason. NICE, which sets clinical guidance in England, lists the factors most often in the picture: conflict in the family, bullying, abuse, other difficulties such as anxiety, drink or drugs, and a parent’s own depression. If you think someone may be hurting her, act that day, using the routes under “If you need help right now”, at the foot of this page; if that person may live with her, in either home, go straight to children’s social care or the police. Autistic children, children with ADHD, and young people who are lesbian, gay or bisexual are all at higher risk, which is worth knowing if your child is one of them. To that list we would add what we see most often in our work: a friendship group that has reorganised without her, a year of finding the work harder than it looks, a body changing faster or slower than her friends’ bodies, sleep that has drifted later and later, and the steady pressure to do well at school.

Screens are where most parents’ worry goes first, and the evidence is less settled than the headlines. Across large studies the average link between social media and teenage wellbeing is small, though it is stronger for girls who use it heavily, and the government’s own review could not say which way it runs. So we would not blame the phone. We would notice what it is replacing: sleep, daylight, friends in the same room, the things that used to fill a Saturday.

### How a low mood keeps itself going

This is the part parents most need to understand, because it explains what helps. A child who feels flat does less. She stops going to swimming, stops asking friends round, stays in her room. Doing less means fewer of the small experiences that lift anyone’s mood: an hour that was fun, the satisfaction of having done something hard, the feeling of being wanted by the people she is with. With fewer of those, the mood drops a little further, which makes doing things harder still. Meanwhile her thinking turns inward and critical, and the hours alone give it room.

The kindest instinct a parent has, to let a low child off things and give her space, can widen this circle without anyone meaning it to. A low child left to wait until she feels like it may wait a long time.

What tends not to help

Most of what parents reach for first comes from love, and works well enough with an adult on a bad day. With a low child it tends to miss.

The pep talk. “Come on, it’s not that bad. You’ve got so much going for you.” A low child usually hears this as proof that you have not understood. She already knows she has things going for her. That is part of what she finds so confusing.

The interrogation. “What’s wrong? Has something happened? You can tell me.” Often she does not know what is wrong, and the question becomes one more thing she is failing at. Asked often enough, it teaches her that conversations with you are about her mood, and she starts to avoid them.

The list of solutions. “Why don’t you ring Maya? Why don’t you go for a run?” Each suggestion is sensible. Together they tell her that her low mood is a problem you would like solved by teatime.

Treating the irritability as rudeness. This is the hardest, because low children can be unpleasant to live with. If what is driving it is low mood, consequences for tone tend to make her feel worse about herself without lifting the mood at all. Hold the line on what matters, that nobody gets hurt and she still comes to the table, and let the tone go for now.

What helps at home

Say what you have seen, without a solution attached. Choose a moment when you are side by side: the car, the walk to the shop, the washing-up. “You’ve seemed flat for a few weeks, and I’ve been thinking about you.” Then stop, and let the silence do some of the work. She may say nothing. She may say she is fine. Either way she has learned that you have noticed, and that noticing does not come with an interview. Come back to it in a few days, somewhere else.

Listen more than you advise. When she does talk, resist the urge to correct the bleak parts (“That’s not true, everyone likes you”). Reflect what she has told you instead: “It sounds as if lunchtimes have got really lonely.” Being understood is different from being agreed with, and it is what keeps her talking.

Let doing come before feeling. Because low mood is kept going by withdrawal, one of the most reliable ways out is a gradual return to activity, before the motivation has arrived. Therapists call this behavioural activation: planning small, specific things that used to matter to her, and doing them whether or not she feels like it. In a large UK trial with teenagers who had moderate to severe depression, a brief treatment built partly on this did about as well as two talking therapies with more sessions. It was given by NHS specialists, and at home the same idea supports professional help rather than replacing it.

In practice it means making her life a little bigger each week, at a size she can manage. Not the whole swimming session, but ten minutes in the pool while you swim alongside. No party: one friend for an hour, with pizza, at home. Choose things with other people in them, things with daylight and movement in them, and things that let her feel capable. Expect her not to enjoy them much at first, and count turning up as the success.

Look after the body, lightly. In our experience, a regular time to get up, weekends included, does more for sleep than a strict bedtime, and daylight in the morning helps. Physical activity has a modest effect on low mood in young people, at least while they keep it up, and in our experience the kind most likely to last is the kind done with someone else. Phones and laptops out of the bedroom overnight protect the sleep that low mood erodes. These work best as habits the whole household keeps.

Lower the pressure, keep the structure. A low child often cannot manage everything she managed before, and it is reasonable to ask the school to ease the homework for a few weeks while you find help. But the shape of the day protects her: getting up, getting dressed, meals together, school if at all possible.

Keep her connected. Low children narrow their world, and the adults around them can keep a few people in it: one friend she still likes, a grandparent who takes her out for breakfast, a coach, godparent or older cousin she listens to more readily than she listens to you.

The question parents are frightened to ask

If your child seems very low, there may come a point when you wonder whether she has thought about not wanting to be alive, or about hurting herself. Most parents do not ask. They are frightened of the answer, and frightened of putting the idea in her head.

The second fear, at least, can be put down. Researchers have looked carefully at whether asking about suicide increases suicidal thinking, in adults, in teenagers and, in one recent American study, in children of eight to twelve. None of this research has found that it does, and being asked may even reduce it. NICE tells professionals to ask young people directly, and we think the same holds for parents.

Ask privately, calmly, and in plain words. “Sometimes when people feel this low, they have thoughts about not wanting to be alive, or about hurting themselves. Have you had thoughts like that?” Then listen. If she says no, thank her for answering and tell her she can always come back to you with it. A no does not mean you were wrong to ask; if she still seems very low, see the GP all the same. If she says yes, stay as steady as you can, thank her for telling you, and do not promise to keep it a secret. Tell her you are going to get her some help, and that she is not in trouble. Then act that day, as the box below sets out. Until help is in place, stay close to her, and keep all medicines, including ones bought over the counter, out of easy reach.

What the GP, the school and the NHS can offer

The GP is the usual way into NHS help, though some areas let you refer your child yourself. If the surgery allows it, book a double appointment, and go with notes: what you have noticed, for how long, and what has changed. Tell your child beforehand that teenagers can usually ask to see the GP on their own for part of the visit. Some young people say more without a parent in the room, and that is allowed.

What happens next depends on how low she is. For mild depression, NICE recommends a period it calls watchful waiting: a further assessment, normally within two weeks, for children who may recover without treatment. If it has not lifted, the next step is usually a short group or online therapy for two or three months. For moderate or severe depression, the next step is specialist children’s mental health services, known as CAMHS. Teenagers there are usually offered individual CBT for at least three months or, if CBT does not suit them, other talking therapies; for children under twelve, NICE’s options include family-based approaches, psychodynamic therapy and individual CBT.

Medication is not a first treatment for mild depression in children. For moderate or severe depression an antidepressant may be considered, normally alongside a talking therapy; NICE says a GP should not start one without an assessment by a child and adolescent psychiatrist. Fluoxetine is the one NICE recommends, as the only antidepressant whose trials show more benefit than risk at this age. She will be watched closely in the first weeks: tell the prescriber the same day about any new agitation, hostility or self-harm, or any talk of not wanting to be alive.

The difficult part is the wait. Waits for children’s mental health services in England vary enormously from area to area, and some run to many months. So ask the GP what is available while you wait, and knock on every other door at the same time.

The school is often the quickest route. Ask the pastoral lead or head of year what they have noticed, and whether there is a school counsellor. In the first large UK trial of school counselling, pupils aged thirteen to sixteen who were offered humanistic counselling in school reported a little less distress than those who had the school’s usual pastoral care alone, a difference that held at six months. School counselling is worth having alongside the GP route, not instead of it. Many state schools in England now have a Mental Health Support Team attached; independent schools usually make their own arrangements, often a school counsellor, and it is worth asking what they are.

Online support suits some teenagers better than any room. Soluna by Kooth, until recently called Kooth, offers free, confidential online support for young people in many parts of the UK, where the local NHS or council funds it.

Private therapy is an option if the wait is too long and you are able to pay. The BACP and NCPS directories list registered therapists and can be searched for work with children and young people; for CBT, which NICE offers first to teenagers with moderate or severe depression, the BABCP register lists accredited therapists. Look for experience with her age group, and check registration, because anyone can call themselves a therapist. The library’s page on finding a therapist goes through what else to ask.

At different ages

The bands below are descriptions, not boxes.

If your child is between nine and eleven. Low mood at this age lives in the body and in behaviour more than in words: tummy aches, tiredness, tears at bedtime, clinginess, play that has lost its pleasure, a new habit of calling herself stupid. Depression itself is less common at this age, so look first for what might be weighing on her: a friendship that has ended, a teacher she is frightened of, work that has got harder, a change at home, a loss. Ask the class teacher what they see. Keep her days small and warm, with some time alone with you that is not about how she feels. If the low lasts beyond a couple of weeks, see the GP; if she says she wishes she were not here, act that day, as the box above sets out.

If your child is in early secondary, eleven to thirteen. The move to a bigger school, a reorganised friendship group, a first phone and, for many, puberty arrive more or less at once, and this is the age at which the gap between girls and boys begins to open. Much of the withdrawal of these years is ordinary. The sign to watch is the loss of pleasure across the board: if she is flat with her friends as well as with you, and the things she used to love have stopped reaching her, take it seriously. Keep the side-door conversations going. Keep phones out of bedrooms at night.

If your child is mid-teen, thirteen to sixteen. Low mood becomes more common through these years, and more private. She may tell a friend, a teacher or someone online before she tells you, and that is worth knowing rather than resenting. She can see the GP on her own, and she should have a say in what help she gets: ask her what she would be willing to try. If the workload of the GCSE years is part of the weight, talk to the head of year.

Your own part in this

Living with a low child is lonely, and frightening in a way that is hard to explain to anyone who has not done it. Parents tell us about the rejection of being snapped at by the person they are most worried about, the guilt of wondering what they did, and the helplessness of not being able to fix it. Guilt is the least useful of the three. Depression in children almost never has a single cause, and it is not a verdict on your parenting. What does help is noticing the things in the house you can change: the arguments she overhears, the pressure that has crept up, the evenings everyone spends on separate screens.

If you have had depression yourself, your fear may be especially loud. A parent’s depression is one of the factors that raises a child’s risk, which is why NICE asks professionals to consider treating it alongside the child’s: looking after your own mood is part of looking after hers. The library’s chapter When You Are Not All Right is written for that.

Keep ordinary life going for everyone else. Brothers and sisters notice when a household reorganises itself around one child’s mood, and they need their own share of you. So do you.

The longer arc

With help, most young people recover from an episode of depression. There will be a good fortnight and then a bad day, and the bad day is not a sign that nothing has worked. Depression can return, for some young people more than once, which is why the things that helped are worth keeping in the family’s ordinary life after the worst has passed.

The eleven-year-old in bed on Saturday morning does not need a speech, and she does not need to be left there all weekend either. Go back upstairs. Sit on the end of the bed for a minute. Tell her she does not have to go swimming today, but that you would like her to come with you to the shop, because you would like the company. Then wait for her in the car.

NOTES

1. World Health Organization. Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders. WHO, 2024. The two-week duration; depressed mood presenting as irritability in children and adolescents, and as somatic complaints in younger children; irritability alone as insufficient for a diagnosis; the passive statements younger children may make; girls approximately twice as likely as boys after puberty.
2. NHS Digital. Mental Health of Children and Young People in England, 2017: Emotional Disorders. 2018. Depressive disorder in 0.3% of five- to ten-year-olds and 2.7% of eleven- to sixteen-year-olds, the last national survey to diagnose it directly.
3. Wesselhoeft, R., Sørensen, M. J., Heiervang, E. R. and Bilenberg, N. “Subthreshold depression in children and adolescents: a systematic review.” Journal of Affective Disorders, 2013.
4. NICE. Depression in Children and Young People: Identification and Management (NG134). National Institute for Health and Care Excellence, 2019. The factors associated with depression (1.3.1). Hudson, C. C., Hall, L. and Harkness, K. L. “Prevalence of depressive disorders in individuals with autism spectrum disorder: a meta-analysis.” Journal of Abnormal Child Psychology, 2019. Meinzer, M. C., Pettit, J. W. and Viswesvaran, C. “The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review.” Clinical Psychology Review, 2014. NHS Digital. Mental Health of Children and Young People in England, 2017: Behaviours, Lifestyles and Identities. 2018, on the higher rate of mental disorder among young people who identified as lesbian, gay or bisexual.
5. Steare, T., Gutiérrez Muñoz, C., Sullivan, A. and Lewis, G. “The association between academic pressure and adolescent mental health problems: a systematic review.” Journal of Affective Disorders, 2023.
6. Orben, A. and Przybylski, A. K. “The association between adolescent well-being and digital technology use.” Nature Human Behaviour, 2019. Kelly, Y., Zilanawala, A., Booker, C. and Sacker, A. “Social media use and adolescent mental health: findings from the UK Millennium Cohort Study.” EClinicalMedicine, 2018. Department for Science, Innovation and Technology. Understanding the Impact of Smartphones and Social Media on Children and Young People. 2026.
7. Goodyer, I. M. et al. “Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial.” The Lancet Psychiatry, 2017. The brief psychosocial intervention, which NICE describes as planning and scheduling valued activities and diminishing solitariness, was not bettered by either comparison therapy.
8. Recchia, F. et al. “Physical activity interventions to alleviate depressive symptoms in children and adolescents: a systematic review and meta-analysis.” JAMA Pediatrics, 2023. Carter, B., Rees, P., Hale, L., Bhattacharjee, D. and Paradkar, M. S. “Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis.” JAMA Pediatrics, 2016.
9. Dazzi, T., Gribble, R., Wessely, S. and Fear, N. T. “Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?” Psychological Medicine, 2014. Polihronis, C. et al. “What’s the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal.” Archives of Suicide Research, 2022. Hennefield, L. et al. “Asking preadolescents about suicide is not associated with increased suicidal thoughts.” Journal of the American Academy of Child and Adolescent Psychiatry, 2026. NICE NG134 (note 4), 1.1.12.
10. Jones, J. D. et al. “Parent-adolescent agreement about adolescents’ suicidal thoughts.” Pediatrics, 2019. Many parents were unaware of their teenager’s suicidal thoughts. Royal College of Psychiatrists. Self-harm in Young People: For Parents and Carers, on keeping medicines out of easy reach.
11. NICE NG134 (note 4). Watchful waiting (1.5.1); no antidepressant as the first treatment for mild depression (1.5.3); group and digital therapies (1.5.6 and 1.5.7); specialist services for moderate to severe depression (1.6.1); the therapies by age (1.6.4 to 1.6.6); antidepressants, fluoxetine and monitoring (1.6.14 to 1.6.18).
12. Cooper, M. et al. “Humanistic counselling plus pastoral care as usual versus pastoral care as usual for the treatment of psychological distress in adolescents in UK state schools (ETHOS): a randomised controlled trial.” The Lancet Child and Adolescent Health, 2021. Department for Education. Mental Health Support Teams: Coverage and School and College Experience. 2026.
13. NICE NG134 (note 4), 1.1.17, on considering whether a parent’s depression needs treating alongside the child’s.
14. Goodyer et al. (note 7): 77 per cent of treated teenagers were in remission at 86 weeks. Birmaher, B., Brent, D. and the AACAP Work Group on Quality Issues. “Practice parameter for the assessment and treatment of children and adolescents with depressive disorders.” Journal of the American Academy of Child and Adolescent Psychiatry, 2007, on recurrence.

Where to go further

Lisa Damour, The Emotional Lives of Teenagers A US psychologist’s calm and clinically careful account of emotional life in adolescence, and of how to tell ordinary distress from the kind that needs help. The book we would give a parent trying to work out whether this is a hard patch or a problem.

Shirley Reynolds and Monika Parkinson, Am I Depressed and What Can I Do About It? Written by two UK clinical psychologists for young people of thirteen to seventeen and the adults around them, as a self-help guide built on cognitive behavioural therapy. Better read by a teenager with a parent close by than handed over as homework.

Lucy Maddox, What Is Mental Health? A UK clinical psychologist’s clear and unpatronising introduction for young people of ten and over. A good book to leave on the kitchen table, or to read alongside her.