• Low mood may present as sadness, anxiety and worry or, conversely, anger and frustration.

• Low mood may be apparent for a number of days or even weeks and, without intervention, may result in depression.

• For children, having an emotionally available adult who can listen and help in providing supportive resources is key to recovery.

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• Self-harm is often a direct result of unbearable feelings.

• Although it can be difficult to comprehend, self-harm can be an attempt to cope with extreme emotional distress and intrusive thoughts, a means by which an individual can gain some manner of control and/or a cry for help.

• No matter how shocking an injury may appear, it is important for those supporting children to stay calm, employ active listening skills and ensure that appropriate support is put in place for the underlying emotional needs.

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• Disordered eating describes an eating pattern which impacts negatively on an individual’s life. While it might not have reached the point of becoming a clinically diagnosable eating disorder, it still has the potential to be harmful.

• Disordered eating and eating disorders are commonly linked to negative body image, low self-esteem, self-criticism and emotional distress.

• Young people might start saying they are ‘fat,’ become secretive about their eating, avoid activities which include food, wear ill-fitting clothes, make frequent trips to the toilet and/or exhibit changes in weight.

• Taking time to listen empathetically without judging is important as a precursor to ensuring appropriate interventions are in place.

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• Anxiety is usually underpinned by worry or fear, possibly related to the experience of trauma.

• It might present as irritability, negative thinking, low confidence, deficient concentration, avoidant behaviours and/or angry outbursts.

• The support of an emotionally available adult to help explore anxieties, identify coping strategies and build resilience can prevent anxiety becoming a clinical need which requires specialist support.

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• Social withdrawal can result from low mood and depression or as a result of anxiety.

• It is therefore important to notice signs of social withdrawal and use a trusted relationship to explore a child’s thoughts and feelings.

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• Although some children and young people may be somewhat indifferent to personal hygiene, it is also important to recognise that it might be a sign of neglect.

• Deterioration in personal hygiene, particularly in young people may also be a sign of low mood and depression.

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• Problematic sleep can be a vicious cycle. For an individual experiencing poor mental health, sleep may be harder to achieve. Poor sleep then impacts on mental health.

• Achieving a good sleep routine and identifying any underlying worries, which an individual can be supported with, is therefore crucial.

• It is important to be vigilant to signs of ongoing tiredness in children and young people.

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• The majority of children will have benefited from a secure attachment experience as an infant, characterised by a consistent nurturing, attuned and responsive relationship with their caregiver(s). Unfortunately, the early attachment experience of some infants is characterised by neglect, inconsistent nurture, fear and/or trauma. An insecure attachment experience can have lifelong implications, both physiologically and mentally, and affects the ability to regulate behaviour and form positive relationships with others.

• A child with a history of trauma may present with a variety of behaviours from withdrawn, anxious and low in confidence to acting out with aggressive and challenging behaviours. As young people, they may exhibit self-harm, problematic eating, and risky, anti-social behaviours.

• Providing trauma informed interventions coupled with key relational skills can help to repair the early attachment experience and impact of trauma on the brain, and support a child in developing healthy relationships.

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• Although children may be overactive and have difficulty concentrating for a range of reasons, these behaviours might also be an indicator of Attention Deficit Hyperactive Disorder (ADHD).

• Children with ADHD may have a short attention span, have difficulty in executing instructions and sticking to task, be constantly fidgeting and moving around, act without thinking and have little sense of danger.

• It is quite common for other conditions e.g. anxiety to co-exist with ADHD.

• A conversation with the school SENDCo would be most appropriate to establish strategies which will help children to manage this condition.

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• Hypervigilance presents in children as an increased sense of alertness and sensitivity to their surroundings. This may mean they have jumpy reflexes, overact to loud noises and can be prone to flight behaviours.

• Hypervigilance can be a characteristic of ADHD but can also be a result of trauma and abuse. In either case, specialist support may be indicated.

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• Absence from school may occur for a variety of reasons but for some children, this may be emotionally underpinned by high levels of anxiety.

• Overcoming this type of anxiety is likely to require a multi-agency approach as a child may engage in a range of avoidant strategies e.g. not getting dressed, provoking arguments in the family home, complaining about feeling ill (psychosomatic complaints).

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• Anger in children can be an outward manifestation of internal emotional distress which may be compounded by a child’s inability to articulate their thoughts and feelings.

• While unacceptable behaviours cannot be condoned, it is important to engage in relational practice to build a trusting relationship within which a child may find the means to explore their feelings and develop an understanding of the source of their anger.

• Once this has been reached, a child may be open to strategies to effectively manage and reduce anger.

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• Difficulties with peer relationships are common among children and where bullying takes place, the school’s anti-bullying policy should be followed and appropriate support put in place to mitigate any impact on mental health.

• It is also important to be cognisant that difficulties with peers may be indicative of emotional distress and/or adversity.

• Children who start withdrawing from peers may be struggling with anxiety and low self-esteem, and may be experiencing other familial and/or social difficulties.

• Where young people particularly change friendships and potentially socialise with older people, this can in some instances be indicative of child sexual and/or criminal exploitation. It is therefore important to take notice of friendship groupings and be mindful of children’s presentation when these change.

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• Evidence shows that the greater number of adverse childhood experiences a child has, the greater the risk of a range of risk taking, challenging and anti-social behaviours including alcohol and substance misuse.

• One of the protective factors for children is access to an emotionally available adult.

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• Children vary in how they cope with family break-up; this often depends on how well the separation was explained to them, ongoing support from parents and extended family and/or age of the child.

• However, for some children family break-up is very stressful and it may have an impact on their mental health.

• This could present in a variety of ways including being withdrawn, appearing anxious and low in mood to acting out and displaying challenging behaviours.

• It is important to support children experiencing family break-up through consistent, strong relational practice.

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• Children are likely to experience a number of losses as they grow up. Some are unfortunate in that one of these losses might be the death of a loved one. In the first instance, the support of an emotionally available adult is crucial.

• It is important to remember that with support, the majority of children will undergo normal feelings relating to grief and will recover.

• For those children where long term changes in behaviour and presentation are observed, this might indicate a need for specialist support.

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• For some children, the transition between different educational stages and settings can provoke anxiety and worry.

• Most children will settle quickly following a positive transition experience and the support of emotionally available adults.

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• Children who identify as LGBTQ+ often experience problematic mental health for example, low mood, depression, anxiety.

• Although sexual orientation and gender reassignment are protected characteristics under the Equality Act 2010, the LGBTQ+ community are often subject to prejudice and discrimination which may arise out of ignorance and a lack of understanding.

• This may increase the anxiety attached to ‘coming out’ and integrating a positive sense of sexuality and gender identity into personal wellbeing.

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