From normal worries to warning signs: What families need to know about kids’ mental health

The first few weeks of school are always an adjustment. Children are shifting into structured schedules, getting to know new teachers, and trying to find their place among classmates. Some worry, crankiness or resistance to early mornings is expected. But for many Pittsburgh families, a harder question looms: How do you know when back-to-school stress is normal, and when it signals a deeper mental health struggle?

That question is at the heart of Dr. Melissa Nelson’s work. Working as an assistant professor of practice at the University of Pittsburgh’s School of Education, Nelson has spent more than three decades moving between classrooms, mental health clinics and school safety consulting.

She’s taught and led schools, worked as a clinician and crisis responder, and now advises districts and educators across Pennsylvania. With that experience, she has a wide-angle view of what families should be paying attention to this fall.

Sorting normal worries from warning signs

Nelson approaches children’s mental health through what she calls a “triaging system.” Rather than focusing only on the start of the school year, she looks at whether a child can move through daily life without major disruptions. The key warning signs are patterns that persist and interfere with well-being.

She lists them clearly:

• disrupted sleep or eating habits that cause problems
• difficulty forming healthy relationships with peers or adults
• significant trouble regulating emotions

“At any time of the year,” she notes, “these are the children whose caregivers I recommend talk with their child’s school-based team, pediatrician and community therapy providers, to dig deeper into why these struggles are occurring.”

She emphasizes that the list is not all-inclusive.

That doesn’t mean every complaint about school should set off alarm bells. Nelson is careful to distinguish between what’s expected and what’s concerning. “It is normal at the beginning of the year for students to feel some amount of normal worry, stress, and anxiety about how the year will go. Will I like my teachers? Will they like me? Will I have friends I can trust and count on? Will I do well in my classes and extracurricular activities? This is all very normal!” she says.

In fact, she adds, small doses of anxiety can be motivating: “Small doses of worry, stress, and anxiety help us to rise to the occasion of the newness of a school year.”

Nelson also points to the physical adjustment. After months of looser summer schedules, children may resist early mornings or complain of fatigue. “It is perfectly normal that a child, during this physical adjustment, may complain about not wanting to go to school, not liking school, or seeming particularly ‘cranky,’” she says.

The difference lies in persistence and severity: If reluctance lasts beyond the transition or is tied to deeper issues like bullying or feeling academically overwhelmed, parents should pay closer attention and seek support.

How the pandemic changed the conversation

Many families and educators believe the pandemic created today’s wave of anxiety and depression among kids. Nelson agrees that COVID-19 has had a visible impact, but she reframes the narrative.

“From a subjective point of view, nearly all of the educators and caregivers I work with across Pennsylvania have shared their concerns about noticeable changes in children’s mental health since the pandemic,” she says. “And yet, and still, I often like to frame these noticed changes in this way: Children and adolescents have been sharing that they have been struggling with mental health issues long before the pandemic.”

She points to long-running surveys like the CDC’s Youth Risk Behavior Survey and Pennsylvania’s biennial Youth Survey, which tracked rising rates of sadness, anxiety and self-harm well before 2020. For Nelson, the pandemic did not cause the crisis but exposed it.

“The pandemic brought a great deal of important and necessary attention to the already existing and ongoing issues with children’s mental health,” she explains. “Now it is our job to understand all of the factors at play with these changes so that schools, communities, health care providers, and caregivers can work together to build appropriate solutions and systems of support.”

Safety and school climate as two sides of the same coin

Nelson’s background in school safety and Behavioral Threat Assessment and Management informs her perspective on children’s mental health. She argues that physical security and emotional well-being are inseparable.

“The safest, most secure schools are schools that understand that positive climates, cultures, and systems of support are irrevocably entwined with safety and security,” she says. In her view, schools that invest in strong social-emotional supports, inclusive cultures, and student-teacher trust are also the schools best equipped to handle crises.

She cites a national example: a collaboration between the National Association of School Psychologists and the National Association of School Resource Officers, who worked together to develop guidelines for conducting safety drills. By approaching the drills through both a psychological and security lens, the recommendations emphasized not just preparedness but also minimizing stress and protecting children’s mental health.

This kind of multidisciplinary approach, Nelson notes, is essential. When educators, psychologists, and safety officers work side by side, schools can design environments where children feel both physically protected and emotionally secure.

The power of connection

Above all, Nelson stresses the role that relationships play in protecting children. “All educators and caregivers have the ability to be the greatest protective factor supporting mental wellness in children,” she says.

Research supports this: Children who feel connected to trusted adults develop stronger identities, greater resilience and a sense of belonging.

Without those connections, the risks multiply. Nelson warns that children who lack supportive adults are more likely to experience mental health challenges, substance use or risky behaviors.

The title of the adult doesn’t matter, she emphasizes. “It doesn’t matter what the title of the adult is in a child’s life: parent, grandparent, neighbor, teacher, pediatrician, coach. Ensuring that every child has trusted adults in their lives gives me the greatest hope for all of the children across Pennsylvania.”

This school year, Nelson’s guidance to families is straightforward: connection first.

“The solution for how we best support children to move closest to their ‘ideal’ mental, physical, social, emotional, and academic selves is to have positive, healthy connections with them,” she says.

That means slowing down and really listening. “When we take the time to lean in and listen to children, they will tell us what they need. We should never underestimate a child’s ability to help us notice and understand that they are struggling and need our help.”

Don’t miss our guide to talking with young kids about big emotions. And get more mental health-related information right here. 

Photo at top of story Joseph Gonzalez via Unsplash.