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Mental First Aid for Children

Revital Ordan, Psychiatric Nurse;  Dr. Yuval Raveh, Director of the Department of Child and Adolescent Psychiatry, Mental Health Division, Ministry of Health
6 October 2024

When our kids show signs of mental distress, we can help them as parents. We can help them with their mental health right away to stop problems from getting worse and ease their pain.

How can we tell whether a child is in mental distress?

Children express mental distress in a wide variety of ways, each of which depends on age, personality and the specific circumstances. Some children will express this in a direct verbal way, such as by saying: "I am very depressed, sad, nervous, hurt," etc. In other cases, the distress will manifest itself in a behavioral change, such as: restlessness, withdrawal, apathy, sadness, crying, low frustration threshold, irritability, anger, difficulty concentrating, exaggerated and inappropriate laughter, dysfunction, avoiding activity, and difficulty sleeping. They will occasionally experience behavioral regression that will manifest as excessive clinging to parents, separation anxiety, urinating or bowel movement (in children who have been toilet trained). The emotional distress will occasionally manifest as physical (psychosomatic) reactions such as complaints of stomachaches and headaches.

How to help children who are experiencing mental distress

  • Maintaining a routine: it is important to make sure that the child is in a safe and protected, comfortable and familiar place and to maintain a regular routine and schedule to the extent possible.
  • A significant figure: it is very important that a significant figure be near the child during difficult moments, such as a family member, a close friend or girlfriend, parents, teachers, etc. Make sure to quickly connect with this figure by phone or by physical arrival.
  • Presence: hugging, talking and even sitting next to the child is critical and helpful. It is very important to invite the child to share and talk (but not pressure) and never leave the child to cope alone.
  • Normalizing the situation and legitimizing emotions: listen in an inclusive and non-judgmental manner, reflect feelings arising from the child's statements, allow feelings to be expressed and help separate facts, thoughts and feelings.
  • The role of physical activity is to encourage the child to perform an age-appropriate activity and task on a daily basis. Promote physical activity such as walking, ball games and dancing with you.
  • Discuss the future: suggest that your child discuss future plans, e.g. where they want to go during summer vacation? Have you thought about what club you want to be in next year?
  • In the event of repetitiveness and flooding: if the child is focused on the details of a serious event in a repetitive and overwhelming manner, try to moderate this discussion.
  • Screens and media: limit use of electronic media and prevent consumption of content that is inappropriate for the child's age.
  • The MAASEH Model is suitable for such behaviors as introversion, detachment, withdrawal, unrest, distress, and overwhelming confusion in response to a life-threatening crisis.
  • Ashan Dak Model: a model practiced in the education systems a tool for the child to cope with emotional distress on their own.
  • Creating a quiet, stimuli-free environment: in extreme circumstances only, such as a panic attack or unusual behavior, keep the child away from other children and then perform an intervention that will help the child regain function.

Children of any age may may experience emotional distress that requires mental health first aid. This can be attributed to being bullied or socially ostracized at school, a personal crisis, exposure to crisis events (even if through the media) and sometimes even without a specific event but due to difficulties in emotional regulation.

As parents, we can help our children when they are displaying signs of mental distress and provide them with mental health first aid. This help can quickly alleviate and reduce the distress that the child is experiencing and return them to normal function. In addition, when it comes to difficult events such as war, mental health first aid can also help reduce the risk of long-term effects.

How we know if the child is in mental distress?

Children can express their distress in a variety of ways, depending on their age, their character and the specific circumstances. Some children will express this in a direct verbal way, such as by saying: "I am very depressed, sad, nervous, hurt," etc. Distress can also manifest itself as abnormal behavior, such as increased restlessness or vice versa, withdrawal, crying, irritability, anger, or exaggerated laughter that does not correspond with the situation, avoiding entering the classroom, etc. In other cases, the distress will manifest itself as psychosomatic physical reactions such as complaints of stomachaches, headaches, etc. that are not attributed to illness.

What to do if the child experiences mental distress

Some basic principles can help to improve the ability to cope with various distressful situations, including crises. Every child is different, so you should think about how you can personally adapt the apply the to them, their age and their personal abilities.

  • 1
    Maintain a routine

    It is important to make sure that the child is in a safe and protected place and to maintain a regular routine and schedule to the extent possible. Maintaining a routine helps instill a sense of security.

  • 2
    Significant presence

    A significant figure such as a family member or friend should be close during difficult moments. Presence can include hugging, talking and even sitting next to the child om silence, these are assistive actions. It is important that you never leave the child to cope alone.

  • 3
    Normalizing emotions and legitimizing the feeling of distress

    Allow the child to express their emotions and help them understand them. It is important to help them separate facts from thoughts and feelings. This can be done by asking them to describe the facts and help them distinguish between them and thoughts and feelings that float and arise. Questions to ask in situations of emotional distress:

    • Where were you when it happened? What did you do?
    • What was the first thing you thought of?
    • How did you feel when it happened?
    • What helped you to feel less distressed?

  • 4
    Maintaining function and the role of physical activity

    Encourage the child to perform an age-appropriate activity on a daily basis. Promote physical activity such as walking, ball games and dancing with you.

  • 5
    Creating a quiet stimuli-free environment

    Shared coping with children in a group largely helps but in extreme circumstances such as a panic attack or unusual behavior, keep the child away from other children and then perform an intervention that will help the child regain function.

Note

Note

It is very important that you also be attentive to your own needs and mobilize resilience resources and support factors so that you can better help and care for your child who is dealing with mental distress.

Practical models for mental health assistance for children and adolescents

There are several ways to cope, each of which is appropriate for a different situation. Every parent should know the options so that they can be presented to the child and practice with them. In situations of sudden emotional distress, it is important to talk to the child in the language and concepts they are familiar with and to practice with them actions with which they are familiar and have experienced in the past. Performing familiar actions during an emergency will be more effective than introducing them to new concepts or actions during the emergency itself.

We recommend two models for assistance

The MAASEH model for mental health first aid adapted for children and adolescents

  • Focus and expression of commitment: to establish a sense of security in the child, prevent feelings of loneliness, convey commitment, and tell the child who needs help that they are not alone, that you are with them and will not leave them. If the child is not with their family, make every possible effort to connect them with the parents or with a significant figure for them.
  • Encouragement of effective actions: encourage the child to perform simple actions such as picking up scattered equipment and putting it in a bag, tidying up the classroom, and going to a safe place together.
  • Asking simple questions: ask simple questions that have few words about the event that triggered the mental distress. You should choose questions that encourage thinking, such as "Where were you?" or “Where did you come from?" or "Would you like to call a friend from class?" or questions to which the answers are very obvious, for example, "Where do you live?" or "Where is your mother now?".
  • Building continuity: help the child create a sequence of events that is easy for them to understand and comprehend, from start to finish. Describe the event that happened and ended. You can state that they are now in a safe place.

Guidelines for providing mental first aid: the MAASEH model

https://www.youtube.com/watch?v=kEJ353s1_U4

The Ashan Dak model

Children are exposed to this model in the education system and practice it as a self-coping mechanism when they are experiencing severe emotional distress. The name of the model is an acronym for several quick steps that can be adopted in situations of emotional distress to prevent its deterioration:

  • Stop! Take a break. By doing so, interrupt your current thoughts.
  • Muscles: transfer focus of attention in the brain to the body and muscles. To do this, clench your fists while inhaling in one deep and slow breath, then release your fist while slowly exhaling and making the sound: "Tssss...". If relevant, you can rest one of the two hands on the stomach.
  • Breathing: take one deep breath followed by one or even two slow breaths.
  • Speech: use calming inner speech and repeat a key sentence to yourself, such as "When I am inside the protected space, I am safe." or “I can cope with this.”.
  • Go ahead: now you can move forward and better cope with the situation, or let it go and come back and try to deal with it later.

If the emotional distress of the child continues, seek professional assistance, for example, from the educational consultant, the school psychologist, the pediatrician, or the mental health care services through your HMO.

Information and resources

Additional information and resources for parents on coping with anxiety in children and adolescents in stressful situations

Information on the government services website