Supporting mental and behavioral health for elementary school children

Supporting mental and behavioral health for elementary school children | Image Credit: © WavebreakMediaMicro - stock.adobe.com.

Back-to-school season brings a whirlwind of emotions for elementary school children as backpacks are filled with sharpened pencils and lunch boxes packed with favorite snacks. From the excitement of new teachers and friends to the anxiety of unfamiliar routines, this transition can significantly impact a child’s mental and behavioral health. As pediatricians, we are uniquely positioned to support families during this pivotal time, offering reassurance, guidance, and intervention when needed.

The kindergarten leap: A world of firsts

For kindergarteners, the start of school is a major developmental milestone. This transition marks the beginning of formal education and can be exciting and stressful. These young learners are navigating a new world—classroom rules, peer interactions, and prolonged separations from parents and caregivers.

Common mental and behavioral health concerns in kindergarten:

• Separation anxiety: Clinginess, crying, and reluctance to attend school
• Social challenges: Difficulty sharing, taking turns, or making friends
• Regulation issues: Trouble sitting still, following directions, or managing emotions

Tips for parents of kindergarteners:

1. Establish routines early on: To help children adjust, begin school-day routines (wake-up, meals, bedtime) 1 to 2 weeks before school starts.
2. Practice separation: Arrange brief separations (eg, playdates, short classes) to build confidence.
3. Visit the school together: Attend orientation, walk through the classroom, and meet the teacher.
4. Validate feelings: Acknowledge their anxiety and reassure them it is normal to feel nervous.
5. Use books and play: Read books about starting school and engage in role-play to make the experience more familiar.

When to consult the pediatrician

If a child experiences prolonged distress (more than 2-3 weeks), physical symptoms (eg, stomachaches, headaches), or regression (eg, bed wetting), it is time to involve the pediatrician. Pediatricians can screen for developmental or behavioral concerns, provide reassurance, and recommend referrals if needed.

First to fifth grade: Building resilience and independence

As children progress through elementary school, their social worlds expand and academic demands increase. They develop greater independence but may also experience stressors related to school performance, friendships, and extracurricular activities. This age group is also more aware of peer comparisons and may internalize feelings of inadequacy or anxiety.

Mental and behavioral health challenges in first to fifth graders:

• School avoidance: Complaints of physical symptoms, refusal to go to school
• Generalized anxiety: Worry about grades, friendships, or making mistakes
• Mood changes: Irritability, sadness, or withdrawal
• Attention and behavior issues: Difficulty focusing, hyperactivity, or disruptive behavior

Tips for parents of elementary school-aged children:

1. Open communication: Create a safe space for children to share their feelings. Ask open-ended questions such as “What was the best part of your day?” and “Who made you smile today?”
2. Limit overscheduling: Balance structured activities with downtime to avoid burnout.
3. Foster healthy habits: Prioritize sleep, nutrition, and physical activity.
4. Encourage problem-solving: Help children think through challenges and develop coping strategies.
5. Model emotional regulation: Demonstrate how to handle stress and frustration healthily.

The social media frontier: Navigating digital stress

For many fourth and fifth graders, the transition to upper elementary school coincides with increased exposure to social media and messaging apps. Although some platforms are not technically intended for children under 13 years, it is not uncommon for older elementary students to begin using them, often with older siblings or peer influence. This early introduction to the digital world can have both social and emotional implications.

According to the American Academy of Pediatrics, early exposure to social media may lead to increased anxiety, poor self-esteem, and attention difficulties. Children may begin comparing themselves to curated online images or feel left out when excluded from digital conversations. Inappropriate content or cyberbullying—whether subtle or overt—can quickly escalate without proper monitoring.

Tips for parents navigating the digital landscape:

• Delay access when possible: Wait until your child is developmentally ready before allowing access to social media.
• Set clear limits: Use parental controls and screen time settings to ensure balanced digital use.
• Coview and coengage: Know what apps your child uses and engage with them. This encourages trust and allows you to monitor behavior.
• Talk early and often: Have regular conversations about digital citizenship, online kindness, and what to do if something makes them uncomfortable.
• Model healthy habits: Show your child how to disconnect and maintain tech-free times (eg, at dinner or before bed).

Red flags that warrant pediatric evaluation:

• Persistent mood changes or behavior shifts lasting more than 2 weeks
• Sudden academic decline or teacher concerns
• Sleep disturbances or appetite changes
• Excessive worry or panic attacks

Pediatricians can perform behavioral screenings, offer parenting strategies, and connect families with school counselors, psychologists, or behavioral health providers as needed.

Partnering with your pediatrician: A team approach

Regular well-child visits are crucial touch points for monitoring physical development and emotional and behavioral health. Pediatricians can use validated screening tools such as the Pediatric Symptom Checklist or the Strengths and Difficulties Questionnaire during well visits to identify early signs of emotional distress.

How parents can collaborate with pediatricians:

• Share observations: Be honest about any concerns regarding your child’s behavior or mood.
• Bring teacher feedback: Information from school can help provide a fuller picture.
• Ask about resources: Pediatricians can recommend books, parenting classes, or community services.
• Stay proactive: Don’t wait for a crisis—early intervention is key.

Setting the stage for success

Back-to-school season is an opportunity to foster resilience, independence, and emotional well-being in children. Although transitions can be challenging, they also offer a chance to build strong routines and relationships that support mental health throughout the year.

With the right strategies at home, a supportive school environment, and a collaborative relationship with their pediatrician, children can thrive not only academically but also emotionally. By recognizing the unique needs of kindergarteners and older elementary students, we can help families navigate this time with confidence and care.