FARGO — Every parent knows the feeling — your child complains about not feeling well, but you're not sure if it's no big deal or something that warrants a visit to the doctor. "Rub dirt on it" and move on or "Get in the car, we're going to the ER." Much of the time, it happens when your child complains about physical ailments. That's hard enough. But how do you know when your child needs help when it comes to their mental health?

Debbie Svobodny, an integrated health counselor at Sanford Health in Fargo, gives parents a simple way to figure out whether their child might need help for their anxiety.

"When you start to notice your child’s inability to live, laugh, love and learn, then you recognize that there might be something going on," said Svobodny.

She says it's more than just having a bad day once in awhile. Repeated red flags include:

  • Inability to engage in school
  • Inability to engage in peer relationships
  • Inability to engage with family members
  • Avoidance of activities or situations
  • Trouble concentrating or focusing
  • Perfectionism
  • Reluctance to get out of bed, get showered and dressed
  • Physical symptoms including: shaky hands, chronic stomachaches, headaches, dizziness or shortness of breath, insomnia, eating too much or too little

Jo Ellison, a clinical psychologist at Essentia Health in Fargo, says having one or more of these symptoms doesn't necessarily mean your child has anxiety. It's more a matter of how all of these symptoms affect their lives.

"You can have all kinds of symptoms, but unless it’s impairing you in some way or distressing you in a big way, then we might not label it a problem or a disorder," said Ellison.

If you think the behavior is negatively and regularly impacting your child's life, it might be time to get professional help.

Seeking professional help

"Having them being seen by their primary care provider I think is the first point of contact. They can get seen and be evaluated," says Svobodny.

And that might be where Svobodny comes in. As an integrated health counselor, she gets called in when a primary care physician wants to further examine ways to treat a child with anxiety.

"Maybe the primary care provider will want to start them on a medication," she said. "Then we’re helping the primary care provider get the patient referred to the right therapeutic treatment."

Svobodny says they can counsel the patient for a short time — 6 to 8 sessions — or they can refer to other therapists around town for long-term counseling.

"Going to a primary care provider first is a nice stop, especially if you're wondering about developmental milestones. A pediatrician can walk you through the different stages of life," Elllison says. "But I don't think it's absolutely necessary to go to your primary care doctor first."

Ellison says there many excellent therapists in town who will let you make an appointment for your child without a referral from an M.D. Many also will take insurance. Check with individual counselors and your insurance plan for details.

While the child might get prescribed medications and start visiting a therapist, there are things parents can do (and not do) at home to ease the anxiety.

Don't accommodate too much

"I think the worst thing for anxiety is to avoid the anxiety," says Tracy Hansen, a counselor at Fraser, Ltd. Valley Hope Counseling. "We put a lot of accommodations for kids, and that is certainly needed for some kids, but other times I think we might accommodate too quickly. What it does is it helps kids avoid the things that cause their anxiety."

Hansen says parents will help their children avoid even small things that make them anxious. The drawback? When the child and his or her anxieties get bigger, they haven't learned skills for coping.

"Don’t avoid those things that make you anxious, sometimes you have to face your fears," Hansen says.

Spend more time with your kids

Teens, especially anxious ones, are highly likely to spend a lot of time alone in their rooms, avoiding friends and parents. But counselors say make an extra effort to spend time with them, and it doesn't even need to be a deliberate sit down.

"You can get them in the car and just have a conversation," Svobodny says. "You don't have to ask the right questions. It's not a matter of asking the right questions. It's just a matter of spending that intentional time with your child."

Cut the (charging) cord

Consider a limit on social media time. Help them to interact — in person — with more people. Get fresh air and exercise. Get them out of their virtual world and into the real one.

Ellison says parents, and even therapists, can put limits on time spent with screens, but the kids themselves have to understand why.

"It’s all about motivation, and it has to come from the client. It’s very important for them to come to that conclusion. We need to really look at all the things going on in their life and how they’re spending their time, monitoring their moods and their anxiety levels and then figure out what really helps," she says.

Emphasize confidence over control

Hansen says anxiety is trying to control something that probably can’t be controlled. She says it's not about being perfect, but learning how to handle adversity or know that no matter what happens, there will be something that can be figured out.

"We need to help build emotional intelligence so that teens are aware of their feelings, have opportunities to figure things out on their own, which will lead to greater confidence in their ability to cope," Hansen says.

And while parents might be nervous about how their children will handle anxiety once they're out on their own, Svobodny says it is reassuring that Gen Z is plugged in to the problem.

"This generation is going to be the generation that will identify that they need to be seen, and this generation is a generation who will actually identify that they have concerns about their mental health because it’s very normalized," she says. "Many will know they need to get help."