Times of India
02 December 2010
By Sayoni Sinha

Sudden social withdrawal, prolonged silences and drop in weight could mean your offspring is feeling down
When two–and–half–year–old Sonali Kokate refused to eat and watch television, her mother put it down to mood swings. But when the otherwise jovial kid lost weight and became malnourished, her mother started to worry. When Sonali came to Dr Shubhangi Parkar, she had dark circles, her eyes and cheeks were sunken and she refused to smile or make eye contact. "She was clinging to her parents and refused to answer any question," says the head of Psychological Medicine at KEM Hospital.

When The Going Gets Tough
A year ago, Sonali’s father lost his job and the financial crisis forced her mother to go to work. Soanli’s grandparents could not take care of her, which left Sonali alone to her own devices, with only a neighbour checking on her at intervals. Eventually, Sonali stopped talking completely. "Her parents put her in three different crèches but she did not interact with the children and sat looking out of the window. She only talked to her doll and was never without it," says Dr Parkar.

Childhood depression is difficult to identify as it is largely dismissed as bad behaviour. If not treated at the right time, such children do not develop physically and emotionally. After the initial investigation, Parkar concluded that Sonali was craving her mother’s attention.

"A child’s emotional state is altered if there is a sudden blow to her sense of security." explains Parkar. "Children have comfort zones comprising parents, siblings and grandparents. If he or she is separated from any of them, it affects them." A sudden or great loss, such as death of a parent or sibling, can also plunge a child into depression.

"We asked her mother to take a month’s leave to make Sonali feel secure and cared for," says Parkar. "Secondly, the parents were asked to stop scolding her completely."

Tell–Tale Signs
The symptoms of depression in children can vary are often left undiagnosed and untreated because they can be passed off as routine emotional and psychological changes that occur during the growing years. It is common for children to throw tantrums and doctors say it is fine to not put up with all their demands.

But there is a cause to worry if the child loses her natural temperament, weight, becomes listless, avoids social interaction with friends or at school, his or school performance is affected (see box).

"Though some of these symptoms are common in many children, it is important to look out for the more recent occurrences. In fact, any unexplained change in your child's behaviour is something you need to look into, especially if the child lacks interest in the things he or she liked doing earlier. Depression among adults often stems from untreated childhood depression," cautions Dr Parkar.

Help at Hand
The first thing parents should do is change their behaviour towards the child. "When a child is depressed, his self–esteem will be low. Appreciation is therapeutic," says Parkar. The team of doctors treating Sonali attempted to break ice by offering toys and chocolates, but it did not help.

They started play therapy, which involves games and toys. At first she refused to respond but gradually she opened up. Parkar advised the mother to watch Sonali’s interactions with the doll and behave similarly. Sonali would talk to the doll, play with it and even feed her own food to the doll. "She did everything with the doll which she wanted her mother to do for her," explains Parkar.

Both the parents started taking turns to spend time with Sonali. Taking a cue from her interaction with the doll, her mother began feeding her and gradually, Sonali started eating again.

A month later, Sonali gained weight, started talking more and also asks for food. "She weighed only 8 kg when she came to us. Now she is 10 kg and her parents are happy that her appetite is back. Now is on her way to becoming her chirpy self again," concludes her doctor.

Tell–Tale Signs
Sudden irritability or anger, Increased sensitivity towards rejection, Weight loss, Disrupted sleep pattern Excessive sleep, Reduced ability to pursue activities, Social withdrawal Reluctance to talk

Going to School
Going to school for the first time can be pleasurable as well as terrifying for a child and parents have to tackle the situation well. It is not abnormal for a child to be nervous before the big event. So it is necessary to prepare them for it. This also holds for a big change, such as moving houses or terminal illness of a family member.

Psychiatrists advise conditioning the child at least six months before the school starts. Take him/her shopping for new bags and books and to the neighbourhood school. Talk to them about the positives, such as what they can look forward to, Let him observe some school going siblings or cousins. This will slowly prepare them for the separation.