Red Flags & When to Go In Person for Depression (Mild to Moderate) in Children and Teens

Audience: pediatric

Depression in children and teens can often be mild to moderate and may be managed with support and care. Telemedicine can help families understand symptoms and provide guidance. However, certain warning signs, or red flags, mean that an in-person visit to a healthcare provider is important. These include thoughts of self-harm, sudden changes in behavior, or worsening symptoms. Knowing when to seek in-person care helps keep young people safe and ensures they get the right support. This guide explains common signs of depression, when telemedicine can help, and when it’s important to see a healthcare professional in person. It also offers tips on preparing for telehealth visits and what to expect afterward. Remember, telemedicine is a helpful tool but is not a substitute for emergency care or thorough in-person evaluations when needed.

Red flags — go in person / ER

• Thoughts or talk of self-harm or suicide — seek emergency care immediately.
• Sudden severe behavior changes such as aggression or withdrawal — arrange urgent in-person evaluation.
• Severe mood swings, confusion, or physical symptoms like unexplained pain — get prompt medical attention.

What telemedicine can do

• Initial symptom assessment and education.
• Routine follow-up and monitoring of mild to moderate symptoms.
• Counseling and therapy sessions.
• Medication management discussions when stable.

What telemedicine cannot do

• Emergency situations involving self-harm or suicide risk.
• Severe or rapidly worsening symptoms needing physical examination.
• Situations requiring urgent physical tests or interventions.

Understanding Mild to Moderate Depression in Children and Teens

Mild to moderate depression involves feelings of sadness, loss of interest, or low energy that last for weeks. Children and teens may feel tired, have trouble concentrating, or lose interest in activities they once enjoyed. These symptoms can affect school, friendships, and family life. Depression is common and can often improve with support, counseling, and sometimes medication. Early recognition and care are important to help young people feel better and prevent symptoms from worsening.

Common Signs and Symptoms to Watch For

Look for changes such as:

These signs may come and go but if they last more than two weeks, it is important to seek help.

Red Flags That Need In-Person Care

Certain signs require prompt in-person evaluation:

If you notice these, seek emergency or urgent care immediately.

How Telemedicine Can Help

Telemedicine allows families to connect with healthcare providers from home. It can help with:

Telemedicine is convenient and can support ongoing care but may have limits for emergencies or complex cases.

When Telemedicine Is Not Enough

Telemedicine cannot replace in-person visits when:

In these cases, visiting a healthcare facility is important for safety and thorough care.

Preparing for a Telemedicine Visit

To get the most from a telehealth appointment:

Being prepared helps the provider understand the situation clearly.

After Your Telemedicine Visit

After the appointment:

Ongoing support is key to managing depression effectively.

How to prepare for your tele-visit

• Choose a quiet and private space for the telemedicine visit.
• Ensure your device (phone, tablet, or computer) has a stable internet connection.
• Prepare a list of symptoms, concerns, and questions to discuss.
• Include the child or teen in the conversation as appropriate.
• Have paper and pen ready to take notes during the visit.

After your tele-visit

• Follow the healthcare provider’s treatment plan and advice.
• Schedule and attend recommended follow-up appointments.
• Monitor the child or teen for any new or worsening symptoms.
• Seek immediate in-person care if red flags appear.
• Maintain open communication with your healthcare team.

FAQs

Can telemedicine diagnose depression in children and teens?

Telemedicine can help healthcare providers assess symptoms and provide guidance, but it may not replace a full in-person evaluation needed for a definitive diagnosis, especially if symptoms are complex or severe.

What should I do if my child talks about hurting themselves during a telemedicine visit?

If your child expresses thoughts of self-harm or suicide, seek emergency in-person care immediately. Telemedicine providers can offer support but cannot manage emergencies remotely.

How can I support my child’s mental health between visits?

Encourage open communication, maintain routines, promote healthy sleep and nutrition, and engage in enjoyable activities. Follow the treatment plan and reach out to healthcare providers if concerns arise.

Is therapy effective when done through telemedicine?

Yes, many children and teens benefit from counseling or therapy sessions conducted via telemedicine. It offers convenience and access to care, especially when in-person visits are difficult.

When should I consider switching from telemedicine to in-person care?

If symptoms worsen, new concerning signs appear, or if physical exams or tests are needed, an in-person visit is important to ensure comprehensive care and safety.

Sources

1. Depression in Children and Teens — MedlinePlus, U.S. National Library of Medicine.
2. Child and Adolescent Mental Health — World Health Organization (WHO).
3. Depression — Centers for Disease Control and Prevention (CDC).
4. Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts — American Academy of Pediatrics (AAP).
5. Telehealth for Mental Health: Opportunities and Challenges — National Institutes of Health (NIH).

This information is for education and triage only and is not a substitute for professional medical diagnosis or treatment. If you or your child experience emergency symptoms or red flags, seek in-person care immediately.