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Children’s and Young People’s Mental Health

The following information is drawn from different sources that discuss young people’s mental health. It includes the mental health continuum, gathering information, ways to support and nurture, and the impact of nature, anxiety, and a list of resources.

Mental Health Continuum

The Be You Mental Health Continuum (Be You, 2023b) is a tool designed to assist practitioners in knowing when to seek support for a child or young person who may be experiencing mental health issues or in need of extra support. It has three areas:

1. What to notice—a list of behaviours to indicate where on the Mental Health Continuum thye might be sitting.

2. When to be concerned—a checklist to guide decision making around the whether or not to seek support for the young person.

3. What to do—evidence-based actions to support (a) mental health for everyone, (b) mental health for some as necessary, and (c) actions essential for a few who may need external professional support.

Mental health and mental health conditions are different and exist on a continuum

At one end, Flourishing represents optimal functioning in which a child or young person feels good, functions well, relates well with others, and approaches their learning with purpose, curiosity and optimism.

Next are children and young people who are Going OK. They experience good mental health and an absence of frequent or significant feelings of distress.

In the Struggling range are children and young people who may come to the attention of educators due to more noticeable but generally time-limited periods of distress which have a mild impact on their behaviour, learning and relationships.

These experiences may either be a) an expected part of development and growing up, b) an expected emotional reaction to challenging life circumstances, or c) the early signs of an emerging mental health condition.

Finally, children and young people at the far right-hand-side of the continuum have thoughts, feelings and behaviours that are distressing and have a severe impact on everyday activities.

Children and young people shift back and forth along the continuum.

Mental health changes over time in response to different stresses and experiences. There are many factors, both internal and external, that affect where someone generally sits on the continuum, and also where they sit at any given point in time.

Most children and young people sit at the positive mental health end of the continuum, most of the time.

Determining whether a change in a child or young person can be explained by age and context or whether it’s the early signs that a mental health condition is developing, can be hard and may only become clear over time.

Remember, mental health professionals diagnose or make conclusions about a child or young person’s state of mental health.

The Mental Health Continuum is merely a guide to increase a person’s understanding of mental health, assist in determining the level of concern and inform actions.

The Mental Health Continuum is complemented by the BETLS Observation Tool (Be You, 2023a) available at

Assessment / gathering information

From Emerging Minds (2022a)

OARS (Emerging Minds, 2022) is a framework for gathering information about a child’s mental health and their family’s stories. OARS stands for:

  • Open-ended questions

  • Affirmation

  • Reflections

  • Summaries

OARS can be used to build a parent’s motivation to act or change. It is likely that parents are going to have to do something different in order to address their child’s mental health difficulties. Their motivation will often be the driving force behind any change that parents make.

Open-ended questions

Open-ended questions are questions that invite the parent to provide a longer answer. They are intended to seek out what the parent thinks and feels about a particular issue.


  • 'How does your baby respond to you when you try to soothe/settle them?’

  • ‘What does this look like?’

  • What’s this experience like for you and your family?’

  • When Jelesha runs off after you have asked her to do something, what happens next?’

  • Who are your main supports?’

  • I noticed when you are talking to Mohammed, he doesn’t look at your face. Have you noticed that? What do you make of that?’

  • ‘What would you like to do next?’


Affirmations are supportive comments or statements about a parents’ behaviour in relation to:

  • values (e.g. ‘…I can tell you take Liam’s learning seriously…’)

  • strengths (e.g. ‘You’re good at letting people know what you need.’)

  • effort (e.g. ‘You’ve really had a good crack at trying to solve this problem.’); or

  • intentions (e.g. ‘Sounds like you’re really keen to see this through.’).

They help build self-confidence, which is linked to motivation. These simple affirmations are also great for general engagement and can be used during first appointments (and beyond).

Complicated affirmations are aimed at a particular behaviour in which a parent wants to/is contemplating change.


  • You regret yelling at the kids, and you are keen to find another way to respond when this happens.’

  • 'It’s really important to you that your child knows that you’re here, and you won’t leave them.’

  • You’ve been trying a bunch of things to solve this issue.’

  • ‘You’re good at setting boundaries with…’

  • ‘You’re not really sure of the next steps, but you’re eager to find a way for Sara to learn how to settle herself to sleep without you.’


Reflections are the most important aspect of OARS. They show understanding of the parent’s thoughts and feelings. Reflections can be simple. They build empathy. For example, when a parent says they’re annoyed, the practitioner can indicate an understanding of the emotion:

  • Parent: ‘I just don’t understand why the kids won’t just listen to me … when we’re in a rush, I just get so annoyed at them…’

  • Practitioner: ‘It’s frustrating when the twins don’t do what you asked – in fact, it sounds like it’s wearing really thin at the moment.

Complex reflections involve inferring what a parent may have meant (by what was said), without them directly saying it. These reflections can be powerful to emphasise the reasons for change and motivate the person to make the change:

  • Parent: ‘I just don’t know why they do what my partner says, but not what I say. Why is that?!

  • Practitioner: ‘It sounds like you’d like to work out a way to communicate with the kids so that they follow important instructions.’


  • You aren’t worried that Lily has tantrums at home, but it’s really hard to manage when she does this in the supermarket and other public places. Is that right?’

  • ‘It sounds like, while you’re feeling unsure about how best to handle this, you’re seeking support from trusted friends.’


Summaries are a way of consolidating the main points from a larger or complex conversation. They build engagement by letting the parent know you’re listening carefully to them.

For example:

  • Let me see if I’ve understood it all. One, you and your partner are struggling to pay the rent; two, you’re fighting with your mother, and she looks after your kids while you and your partner work; and three, the early learning centre educators are saying that Mohammed is hitting the other kids a lot. Have I covered everything? Is there anything else?

  • At first you thought Declan was relating OK with others, just like other kids, but now you’re not so sure. You’ve noticed that he prefers to be by himself, and rarely smiles when other kids come to play with him.’

  • ‘While things are feeling chaotic at home at the moment, you feel like you’ve got things under control and that things will be smoother in a few weeks.’

A Screening Tool for Children and Parents (OHSU, 2019)

Rhodes (2023) suggests practitioners use the “Screen for Child Anxiety Related Emotional Disorders Assessment” with both parents and children during intake.  The assessment statements for children (e.g., “When I feel frightened, it is hard to breathe,” “I don’t like to be with people I don’t know well”) and parents (e.g., “My child worries about other people liking him/her,” “When my child gets frightened, he/she feels like passing out”) are rated on a scale of 0 (not true or hardly true) to 2 (very true or often true).”  The assessment gives an insight into a child’s understanding of their own anxiety and what parents may notice but the child does not recognize.  The SCARED tool is included in the References section that follows (OHSU, 2019).  However Rhodes goes further, suggesting screening is not the sole determining factor for diagnosis.

Asking parents if they have noticed any changes in their child’s behavior or if it is affecting the child’s daily functioning is also used. To determine this, parents are asked questions like the following:

  • Is my child having trouble going to school every day?

  • Is my child unable to enjoy fun events?

  • Is my child obsessing over something or someone?

  • Is my child feeling afraid more often?

  • Is my child irritable every day and unable to control their emotions?

For example, if a child refuses to attend school, has trouble concentrating in school, avoids sleepovers and parties or doesn’t try new things or if their physical symptoms (such as stomach aches or headaches) cause them to be impaired, then the child should be assessed for anxiety (Rhodes, 2023).

Ways to support & nurture

From Emerging Minds (2023)

Children’s mental health is influenced by a mix of strengths and vulnerabilities (i.e. risk and protective factors) with both contributing to mental health outcomes. The best way to support a child or family is by promoting their strengths, while acknowledging and adjusting for their vulnerabilities, i.e. understand what is working well for a child, parent and family; what challenges they’re facing; and what supports they need to grow and thrive.

What are child mental health strengths?

Strengths are areas of a child’s life that support their healthy development and improve their wellbeing. Some examples of child mental health strengths include:

  • family and school connections

  • prosocial behaviours such as helping, sharing, cooperating and volunteering

  • developmentally appropriate emotional and behavioural responses; and

  • positive relationships with their peers and the adults in their life.

A child or parent’s abilities, resources, personal characteristics, interests and wishes are all seen as motivators and tools for positive change. By helping families to identify and build on their strengths, plractitioners can help them to reach their goals and find or maintain independence in their daily lives.

What are child mental health vulnerabilities?

Vulnerabilities are areas of a child’s life that may be of concern or could benefit from further attention. Without the right support, these factors may have a negative influence on the child’s physical and mental health, development, learning, relationships and future outcomes. Examples of child mental health vulnerabilities include:

  • individual factors, such as developmentally inappropriate emotional and behavioural responses, communication difficulties, disabilities, developmental disorders or delays

  • biological factors, such as prematurity (for infants), chronic or congenital health problems

  • family factors, such as stress or adversity, family and domestic violence, parental substance use or mental health difficulties, or a chronically ill family member; and

  • social and environmental factors, such as the quality and availability of health, social and support services; safety of neighbourhoods; experiences of discrimination and isolation; and lack of connections to culture.

These factors are complex – children will often experience multiple vulnerabilities at the same time.

Understanding the family’s context

The interconnected nature of the parent-child relationship means parents and children share the same vulnerabilities. Therefore, it’s vital adult-focused services keep the child in mind when engaging with parents about the problems they’re facing. But parents often worry about being judged or of having their children taken away from them and may be reluctant to speak honestly about how the challenges they’re facing are also affecting their children.

Asking adults about their parenting strengths and hopes for their child can help build trust and rapport, and be a way to overcome stigma and shame, without losing sight of the child’s experience. It can empower parents to break the cycle of intergenerational disadvantage. Adopting a trauma-informed approach (access via ‘contents’ on this site) will help social workers to remain sensitive, non-judgemental and hopeful in this work.

How to identify a child’s strengths and vulnerabilities

One way to identify a child’s strengths and vulnerabilities is to be curious about the important domains in their life. These include the child’s:

  • temperament

  • home life

  • interactions

  • community connections; and

  • development.

Exploring these domains builds a more complete picture of the child and how their strengths and vulnerabilities are influencing the problem. Talking with children about what they enjoy and what they’re good at can give you an idea of how they perceive the problems they’re facing.

But the child you’re working with may not know how to describe what they’re good at – or may not believe they’re good at anything at all. Games and tools like strengths cards can be a great way to draw out a child’s abilities and start those conversations. For example, in a game of Hangman you might ask the child to choose a feeling that they’ve had or something that they’re good at, then guess the answer. Asking the child what they think their friends like about them the most can be another helpful prompt. Another way of learning about a child’s strengths and vulnerabilities is by speaking with the supportive people in their life: parents and caregivers, teachers, other practitioners and friends. You might ask them to describe times when the child or young person has persevered, taken action, or demonstrated how much they know or care about something.

It can be easy for parents to focus on the problem – after all, it’s why they’ve come to see you in the first place. But it’s important to bring some positivity into the room to help the child and parents see that the problem is the problem, not them. Strengths-based practice recognises children’s right to be heard and have a say in the decisions that affect their lives. Getting children to see themselves through a different lens can really shift things for them and increase their chances of overcoming the problems they face.

From Mental Fills Counseling Store (2018)

How to nurture a child’s mental health:

From Self-Love Rainbow. (2018)

Self care and mental health for kids

Infants and Toddlers

From Emerging Minds (2021)

A growing body of evidence suggests that the first thousand days of a child’s life are central to child development – that experiences in-utero, through infancy (0–12 months) and into toddlerhood (1–3 years) can have lifelong impacts, both positive and negative, for physical and mental health, literacy, numeracy and socio-economic outcomes. These early years are vital in shaping a child’s long-term social and emotional wellbeing.

Infant and toddler development

To support parents and children as they navigate these early years, it’s essential for practitioners to have a baseline understanding of infant and toddler development. It’s also important to recognise that parents may have varying understandings about how children develop – what constitutes ‘normal’ behaviour at different ages and stages, and what may be signs of mental health concerns.

In the first three years of life, development is characterised by rapid physical and cognitive growth (Healthwise, 2019). From birth, infants are on a fast-track in language and communication development, as they learn to interpret and adapt to the words, sights, sounds and smells that are all around them. Over these years, babies’ brains triple in weight, establish billions of cells and produce more than a million neural connections every second. Physically during this period, children go from having very little control over their bodies, to crawling, standing, walking, then running.

Key timeline milestones over the first three years include the following:

  • 0–2 weeks: Builds relationships through facial expressions, gazing and crying.

  • Four weeks: Can follow an object and focus on a face.

  • 6–8 weeks: Interacts with caregivers through vocalisation, eye contact, smiling and crying.

  • Two months: Can lift head when lying on their tummy.

  • 3–4 months: Will increasingly initiate interactions, reach for objects, laugh and hold their head up.

  • Six months: Will use their carer for comfort and may roll over.

  • Seven months: May be sitting up and starting to crawl.

  • Nine months: May pull themselves up to stand, start to recognise emotions and experience separation anxiety.

  • By 12 months: May talk in their own language or say a few clear words; can hold things between thumb and forefinger.

  • 12 months: Enjoys communicating, understands more than they can verbalise, expresses more emotions and may walk.

  • 18 months: Can use some words, needs structure and routine and is developing individuality.

  • Two years: Likes to help; may build towers and engage in more complex play.

  • Two-and-a-half years: Uses 50 or more words; alternates between clinginess and independence.

  • Three years: Can throw a ball, speak clearly and carry out a conversation; may be toilet trained.

The rate of change, learning and adaptation across this time period is astonishing – and it’s clear that physical and mental development are inextricably intertwined.

The importance of attachment

Beyond learning to communicate and control their bodies, the major developmental challenge for an infant is to form an attachment with at least one reliable caregiver who can respond to their physical and emotional needs – a bonding experience that forms the foundation for their later social, emotional and cognitive development. This formative connection gives a young child a sense of agency in their world, and of the ‘trustworthiness’ of others – an internalised ‘working model’ that forms the basis for self-awareness, self-esteem, and emotional, social and cognitive development.

As an infant becomes a toddler, the secure knowledge that someone will be there for them when needed supports them to explore and learn beyond their primary attachment, and in the development of their sense of ‘self’. It is this fundamental nurturing relationship between infant and caregiver that sets children up for positive mental health later in life.

Risk factors in infant and toddler mental health

Infant and toddler mental health can be defined as a young child’s capacity to experience, regulate, and express emotions, form close and secure relationships, explore the environment and learn. If they are living in a setting that is responsive to their needs and stimulating to their development, most infants and toddlers learn to do all of these things and experience good mental health.

However, when an infant or toddler’s early attachments with caregivers are disturbed or disrupted, it can impact on their willingness and confidence to explore, and therefore affect their social, cognitive, and physical development, in both the short- and long-term. Risk factors working negatively against infant and toddler mental health can be grouped into three categories:

  • individual factors, such as birth complications, injuries and temperament

  • family and caregiver factors, such as parental mental illness or substance use issues; and

  • environmental, social and community factors, such as natural disasters, poverty, limited educational and economic opportunities, unemployment or inadequate housing.

Many of these factors are beyond a parent’s or a practitioner’s control. It is often the struggles of caregivers themselves that can render children most vulnerable to poor mental health. In addition, most Australian parents acknowledge that they do not know how to recognise or respond to mental health struggles in young children.

Early intervention and anticipatory guidance

In supporting parents, particularly when mental health concerns are part of the picture, a key strategy practitioners can employ is ‘anticipatory guidance’ – providing parents with useful, relevant and practical information about ‘what to expect’ in an infant or toddler’s behaviour, growth and development in the immediate and longer term. Anticipatory guidance can equip parents with ways to provide positive experiences and environments for their infants, in turn reducing parental anxiety and promoting positive infant mental health and wellbeing.

When parents and practitioners intervene early and work together to understand development, support attachment, and mitigate risk factors that can negatively impact on an infant or toddler’s mental health, it can make a real difference to that child’s long-term outcomes.

Impact of nature

From Norwood et al. (2019).

Can more time spent in nature benefit children’s mental health?

Several reviews have found exposure to nature (e.g. gardening, adventure and wilderness therapy, going for a walk, sitting in a park, having a picnic) can have a positive impact on mental, emotional and social health. Reviews of research literature have suggested that use of, and nearness to, green space by children is linked to:

  • increased emotional wellbeing,

  • decreased stress,

  • reduced depressive symptoms,

  • lower behavioural problems; and

  • enhanced attention (e.g. McCormick, 2017; Norwood, 2019).

Research has also found that spending time in nature can reduce Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms, as well as improve behaviour in children with ADHD. These effects are even comparable to outcomes from pharmaceutical intervention.

However, this research has often been correlational; that is, it has explored whether there is a relationship between nature exposure and children’s mental health. But it is not possible to say that the positive effects are caused by the natural environment, nor that the effects will be long-term.

Recently, the authors conducted a narrative and systematic review of research studies exploring the ability of passive exposure to the natural environment to promote emotional, behavioural, and cognitive change in children and young people.

The review included six studies that investigated whether nature can promote behavioural, cognitive or emotional change in children. Most of the studies had children walk in nature with the majority occurring in a school setting.

Key findings

Overall, the review showed that nature appears to have a positive impact on children and young people. Key findings were:

  • Greening the spaces surrounding homes and schools, and repeated immersion in nature, may result in reduced levels of inattentiveness

  • Greening the spaces surrounding homes and schools, as well as a student’s school commute, may have long-term effects on working memory

  • Spending time in a forest-based classroom rather than a standard indoor classroom may improve the mood of students

  • Repeated immersion in nature may also have positive behavioural outcomes.

A recent national study in the UK study suggests between 2-5 hours a week may be sufficient to benefit from nature exposure, and a growing number of researchers suggest tree cover is more effective at promoting positive learning outcomes than grassy areas or shrub land. However, the lack of studies makes it difficult to theorise about what a ’nature prescription’ might involve.

Anxiety in Primary School-Aged Children

From GoZen (2018).

Eight ways a child’s anxiety shows up as something else
  1. Anger: The perception of danger, stress or opposition is enough to trigger the fight o flight response leaving a child angry and without a way to communicate why.

  2. Difficulty sleeping: In children, having difficulty falling asleep or staying asleep is one of the hallmark characteristics or anxiety.

  3. Defiance (unable to communicate what is really going on): It is easy to interpret a child’s defiance as a lack of discipline instead of an attempt to control a situation where they feel anxious and helpless.

  4. Chandeliering (when a seemingly calm person suddenly flies off the handle for no reason): They have pushed hurt and anxiety so deep for so long that a seemingly innocent comment or event suddenly sends them straight through the chandelier.

  5. Lack of focus: Children with anxiety are often so caught up in their own thoughts that they do not pay attention to what is going on around them.

  6. Avoidance: Children who are trying to void a particular person, place or task often end up experiencing ore of whatever it is they are avoiding.

  7. Negativity: People with anxiety tend to experience negative thoughts at a much greater intensity than positive ones.

  8. Overplanning: Overplanning and defiance go hand in hand in their root cause. Where anxiety can cause some children to try to take back control through defiant behaviour it can cause others to over plan for situations where planning is minimal or unnecessary.

From Emerging Minds (2022b)


Experiencing anxiety every now and then is a normal part of growing up as children develop and learn about the world around them. It’s quite common for primary school-aged children (around 5- to 12-years-old) to feel anxious about a variety of situations and objects, especially as they face new experiences. For most children in this age group, anxiety comes and goes, and doesn’t last long.

At this age, anxious feelings range from ‘butterflies’ before a playdate or test to frequent feelings of panic that can prevent a child from doing things they want to do, such as going to school. It can be hard to recognise anxiety in children since many of the signs like stomach aches, trouble sleeping, and behavioural changes may also be symptoms of physical illness or just part of a phase of growing up.

When a child’s anxious thoughts and feelings have an ongoing impact on their ability to enjoy and/or participate in one or more aspects of their daily lives it is important to seek further support. Talking to a general practitioner is a great place to start and can offer strategies to help or provide other resources should they be required.

Causes and triggers of anxiety in children

Anxiety is generally caused by a combination of factors including genetics/family history, and sometimes experiences of trauma or stressful events. Examples of experiences or anxiety triggers that are common in primary school-aged children include:

  • Younger children (around 5- to 8-years-old) may feel anxious about the dark, monsters or ghosts. They may experience separation anxiety when leaving their parent or caregiver. One of the biggest events in this age group is the shift from home or childcare to primary school. New routines, rules and changing friendships naturally lead to some uncomfortable feelings of uncertainty. At school, children need to practice skills such as independent toileting, eating and working, as well as the social skills of sharing and negotiating, which can be challenging and overwhelming for them at times.

  • Later in primary school (at around 9- to 12-years-old) most children are experiencing lots of changes – in their bodies, friendships, school environment and family relationships. They often have a growing awareness of local, national and global events like climate change and homelessness, which can add to their worries. Greater use of social media can lead children to feel pressured to look or act a certain way, while increasing the risk of cyberbullying and therefore the risk of anxiety.

  • Challenges with friendships may begin in these years including experiencing bullying or engaging in bullying behaviour, so it is important to be aware of any signs (physical or emotional). Signs that a child is experiencing bullying might include:

o cuts or scratches

o missing property

o being teary or withdrawn; or

o not wanting to go to school or staying close to teachers.

  • If a child is engaging in bullying they may talk about other children in an aggressive way or have possessions that don’t belong to them.

  • Children who have experienced natural disasters, like bushfires, flood or drought, and the trauma and family stress that often comes with them, have a higher risk of experiencing mental health difficulties and may need professional support. Parents should check in regularly with their child about how they’re feeling and keep an eye out for changes in their behaviour.

Identifying anxiety early and supporting a child to manage anxiety using strategies such as those outlined in the following examples can make a big difference. Parents who feel anxiety is significantly impacting on their child should talk to their GP.

How anxiety affects children: Signs and examples

How a child thinks about a situation, event, person or object influences their feelings and behaviours. For example, an anxious thought like ‘What if something terrible happens?’ can lead to a physical sensation (feeling sick or racing thoughts), anxious feelings (worried or scared), and then an action, like avoiding a situation (not wanting to stay at Grandma’s place or go to school).

Example 1: Time away from parents

Example 2: School example

Children experience anxiety in lots of different ways and it can be hard to identify. In primary school-aged children, anxiety can appear or be described by children as:

  • increased irritability and outbursts

  • butterflies or a sore tummy (stomach pains)

  • headaches and dizziness

  • being able to feel their heart beating, or heart beats really fast

  • trouble concentrating at school because they’re distracted by worrying thoughts

  • trouble sleeping.

The following are some examples of how children experience and show anxiety.

Anxious thoughts in children aged 5–8 years

What if:

  • …the door is unlocked and the ghost takes me away?

  • …Mum or Dad don’t come to tuck me in and check I’m OK?

  • …I don’t get this right and the teacher yells at me?

  • …no one likes me?

  • …the dog jumps up and bites me?

  • …my friends aren’t there and I’m all alone?

  • …Dad is late dropping me off at school and I’m late for the test?

  • …the plane crashes and my grandma dies?

  • …my friends aren’t there and I’m all alone? other kids laugh at me?

Anxious thoughts in children aged 9–12 years

Am I normal?

I can’t do this. Why can’t I do this like everyone else? They’re going to think I’m hopeless.

What if:

  • …the other kids don’t talk to me?

  • …I can’t get through the speech?

  • …I can’t get off the bus in time?

  • …I fail this exam?

  • …Dad is late dropping me off at school?

  • …I don’t have the right clothes for school camp?

  • …I don’t respond to Sarah’s message in time?

Then something terrible (insert following) will happen:

  • …I’ll never make any friends.

  • …the teacher will yell at me and everyone will laugh.

  • …I’ll have to move schools.

  • …I’ll be late and get a detention.

  • …my parents will ground me forever.

  • …I’ll cry in front of everyone.

  • …Sarah won’t invite me to the party and I’ll never make any friends.

  • …I won’t get into the soccer competition.

Words children may use
  • 'I don’t want to.’

  • ‘Can I stay with you?’

  • ‘I feel sick.’

  • ‘My tummy hurts.’

  • ‘I think we should go now.’

  • ‘I’m scared.’

  • ‘My head hurts.’

  • ‘I can’t do it, you do it.’

  • ‘I need you here.’

  • ‘When can we go home?’

Feelings in the body
  • Breathing fast (hyperventilating)

  • Tiredness

  • Racing heart

  • Difficulty concentrating

  • Needing to use the toilet

  • Stomach aches

  • Dizziness

  • Headaches

  • Difficulty getting to sleep

  • Suddenly feeling hot or cold

  • Sweating

  • Feeling shaky

  • Butterflies in the stomach

Anxious feelings

As an adult you may be able to identify and name anxious feelings such as ‘fear’, ‘worry’ or ‘panic’. However, children often find it harder to do so. The focus should be on children’s thoughts, actions, physical sensations and the words they use that will indicate they may be experiencing anxiety.


In response to their anxious thoughts and feelings, children may:

  • avoid, or try to avoid, or get away from situations, objects or people that bring on anxious feelings. For example, your child may say they can’t participate in an activity or go to an event because they feel sick or are in pain (when there is no medical explanation), or they might come up with excuses to leave an event early

  • constantly seek reassurance from adults by asking lots of questions. For example, ‘What’s going to happen?’ and ‘What are we going to do if…happens?’

  • try to control people or the situations that bring on feelings of anxiety. For example, they might ask someone else to do an activity or task which they could do for themselves.

At this age it’s common for children to manage their emotions while at school or in public, and then let their feelings out when at home, sometimes in the form of big emotional outbursts, like fighting with siblings or parents, swearing, yelling or crying.

What parents can do

There are lots of things parents can do to help your child better manage anxiety and reduce its impact on their life:

  • Acknowledge anxious feelings and thoughts (if possible) and let children know that most children feel anxious sometimes.

  • Gently encourage them to do things they’re anxious about, as avoidance makes anxiety continue and get worse, rather than go away. When they do try something new or face a situation that makes them anxious, praise them for these actions and talk about how they managed it.

  • Help them learn, and support them to use, calming and other strategies that will reduce the impact of anxiety on their daily life, such as deep breathing.

Identifying anxiety early and helping your child to manage it can make a big difference.

Getting professional support

It can be very difficult to tell if a child’s behaviour is just a phase, or a signal that they’re struggling with anxiety and need help from a health professional.

Parents should remember they are the experts on their child, and if they feel anxiety is impacting on their daily life, wellbeing, relationships, school achievement or family life, they should talk to their GP who can assess the child and talk about the types of support available. Getting professional support early can build resilience in the child which will be an important foundation as they grow.

Peer Relationships in Middle Years & Mental Health

From Truong & Joshi (2024)

This paper summarises the research evidence on the influence of positive peer relationships on the social and emotional development of young people in the middle years (8–14 years), as well as the factors that affect this association. It also outlines how practitioners working with young people might support positive peer relationships.

Key messages

  • Young people’s social relationships during the middle years (8–14) can affect their current and future health and wellbeing, learning and academic performance, and peer and family relationships.

  • Interactions with peers can help to develop the social and cognitive skills needed to navigate relationships in later life.

  • Positive peer relationships are associated with more positive mental health and/or fewer externalising behaviours (e.g. aggression, problem behaviours).

  • Peer support in the middle years can be a protective factor against negative mental health outcomes.

  • Practitioners working with young people can support their mental health by encouraging and supporting positive peer relationships.

  • Strategies and programs aimed at promoting positive peer relationships could include conflict resolution, resilience, communication and self-regulation.

  • Young people can be encouraged to participate in social interactions and activities that enhance their interpersonal social skills and behaviours.

What are positive peer relationships?

The term ‘peer relationships’ covers multiple types of affiliations from broad social groups and casual interactions to close one-on-one friendships.  Research suggests the quality of friendships is more important than the number or presence of peers or friends.  Overall, there is a lack of consistency in how research studies define or measure peer relationships.  There is also a common lack of detail in the research as to what a supportive relationship looks like in practice.

Associations between peer relationships and mental health

Research evidence shows a strong association between young people’s peer relationships and their mental health during the middle years.  Positive peer relationships in the middle years are associated with positive mental health outcomes.  They can potentially moderate the impact of negative experiences and help cope with challenges.  Negative peer relationships are associated with poorer mental health outcomes. 

Some of the ways in which peers provide positive support during the middle years include peer intimacy, reciprocity and social support (including emotional, practical, information supports and empathy, caring and affection).  These forms of peer support can provide a protective factor for wellbeing by:

  • preventing or reducing stress

  • enabling access to a broad support network

  • enhancing self-esteem and identity

  • providing a sense of belonging

  • facilitating positive coping strategies.

Furthermore, research suggests that supportive friendships during adolescence can play a protective role against subsequent negative experiences such as intimate partner violence.

Considerations for practice

It is important that people working with young people and their families consider how they can help young people develop and maintain positive peer relationships. They can also support parents/carers to promote positive peer relationships among young people.  Direct work with young people can involve the following.

  • Practitioners and services should recognise the importance of positive and supportive peer relationships for young people in the middle years. When working with young people, asking about their peer relationships can provide insights into their mental health and/or any possible behavioural challenges they may be exhibiting.

  • Children with early depressive symptoms can be supported and encouraged to participate in social interactions that support their interpersonal social skills and behaviours. For example, involvement in extracurricular activities (e.g. team sports, music/theatre) may promote positive mental health.

  • Asking young people who are transitioning from primary to high school about their peer relationships and providing support to promote positive peer relationships can reduce transition stress and contribute to successful school transitions.

  • Strategies and programs aimed at promoting positive peer relationships could include working with young people to help them:

–       build resilience and enhance self-regulation (e.g. emotional regulation)

–       develop conflict resolution skills

–       develop prosocial behaviours

–       understand boundaries

–       develop communication skills

–       develop skills in perspective-taking

–       draw on multiple sources of support (peer, family and school).

  • Practitioners can help young people to identify and understand what a positive, safe and supportive peer relationship looks like. This may, for example, help them avoid or minimise negative peer interactions or influences that may have a negative effect on their mental health or that lead to engagement in risk-taking behaviours such as substance misuse.


Emerging Minds and the Parenting Resource Centre have released a series of fact sheets about the most prevalent chronic conditions that affect children in Australia. These fact sheets provide details on the health, development and mental health implications of each condition, as well as information on supports available for children and families.

The list of fact sheets:

Emerging Minds Resources – Children’s Mental Health

The Emerging Minds site is updated regularly with further articles. People searching for a particular topic can use the search facility at


Be You. (2023a). BELTS observation tool.

Be You. (2023b). Mental health continuum.

Emerging Minds. (2021). In focus: Infant and toddler mental health. Retrieved from

GoZen. (2018). 8 ways a child’s anxiety shows up as something else.

Mental Fills Counseling Store. (2018). How to nurture a child’s mental health.

Norwood, M. F., Lakhani, A., Fullagar, S., Maujean, A., Downes, M., Byrne, J., Stewart, A., Barber, B., & Kendall, E. (2019). A narrative and systematic review of the behavioural, cognitive and emotional effects of passive nature exposure on young people: Evidence for prescribing change. Landscape and Urban Planning, 189, 71-79.

Rhodes, L. R. (2023, August 7). Treating anxiety in children. Counseling Today.

Self-Love Rainbow. (2018). Self-care and mental health for kids.

Truong, M., & Joshi, A. (2024). The influence of peer relationships in the middle years on mental health.  AIFS, Policy and practice paper.


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