Kayla Fitch, PSYD

Children and teens face challenges that can bring excitement, stress and sometimes anxiety. A new school year, changing friendships and academic pressures can feel overwhelming.

Some stress is a normal part of growing up. In fact, it helps kids develop resilience and prepare for new experiences. When worry begins affecting a child's ability to learn, sleep, socialize or enjoy activities, they may need additional support.

The good news is that parents can play an important role in helping kids recognize their feelings and build healthy coping skills.

1. Listen & validate feelings

When children express fears or worries, parents often want to make them feel better. While encouragement is good, listening first and validating can help children feel understood.

Try asking open-ended questions about what's causing stress and acknowledge their feelings without judgment. A simple response such as, “I can see why that would make you nervous,” can go a long way toward helping your child feel supported.

Parents can also talk through upcoming situations and set expectations with their child. When it's time to start something new, knowing what to expect can reduce uncertainty. Having these conversations can also reveal whether a child is experiencing typical stress or something more persistent.

2. Recognize the signs of anxiety

Some children talk openly about feelings. For others, it shows up differently.

“Anxiety doesn't always look like worry," said Dr. Shital Gaitonde, Wellstar Children’s of Georgia clinical child and adolescent psychologist. "Sometimes it shows up physically through headaches or stomachaches.”

She said other children may have trouble sleeping or seem more emotional than usual: “You may also notice more worrying, clinginess or difficulty separating from parents.”

Signs of anxiety in children include:

• Worrying
• Frequent headaches or stomachaches
• Changes in appetite
• Difficulty sleeping
• Irritability or emotional outbursts
• Difficulty concentrating
• Avoiding school or activities
• Worsening school performance
• Repeatedly seeking reassurance
• Clinginess to parents

“It's normal to have stress; it's not normal to have anxiety,” said  Wellstar Children’s of Georgia Pediatrician Dr.  Andrew Doyle. "Understandably you get nervous with new situations that make you uncomfortable, but you're still able to do it and have fun. Significant anxiety starts to interfere with a child’s or teen's ability to do what they need to do—homework, school, social situations. That's when it's helpful to get it checked out.”

3. Create routines that build confidence

Children often feel more secure when they know what to expect. Consistent routines can be especially important during transitions.
“One of the best things parents can do is start talking about school before the first day," Dr. Gaitonde said. “A little reassurance now can help make the transition back to school easier.”

Parents can support children by:

• Establishing consistent bedtimes and wake-up times
• Talking through what the day will bring
• Visiting a new environment when possible
• Checking in regularly about friendships and academics
• Building downtime into busy schedules
• Encouraging independence in age-appropriate ways

Avoiding stressful situations may provide temporary relief, but it can make anxiety stronger over time.

Dr. Kayla Fitch, a behavioral health specialist works alongside pediatricians at Wellstar Children's of Georgia pediatricians.

“One of the things I'm the most passionate about is early anxiety treatment for kids. We can help kids when they're 4, 5, 6 years old,” she said. “I teach parents basic concepts around how to expose their children to anxiety-producing situations to decrease their anxiety.”

With guidance and support, children can learn to face challenging situations gradually, developing confidence and resilience over time.

What started as a research study has grown into a systemwide commitment at Wellstar to improve access to mental and emotional healthcare. By embedding licensed mental health practitioners in the primary care settings, Wellstar is making it easier for patients to receive behavioral health services alongside their routine medical care. 

Today, licensed clinical social workers (LCSW) work alongside primary care providers and pediatricians in more than a dozen Wellstar practices. And there are plans to grow that number.

“With social workers just steps away from an exam room, primary care physicians can make ‘warm handoffs’ for immediate behavioral health support,” said Dr. Jeffrey Tharp, chief medicine division officer for Wellstar.

“It helps lower barriers to mental health and substance use disorder treatment. And it removes some of the stigma some people associate with mental healthcare.”

Dr. Sophie Arkin, a psychologist in Wellstar’s Suicide Prevention department, said, “This is a great way to reach people who might otherwise fall through the cracks. It gives them a real opportunity to live a different life.”

Primary care clinicians connect adults to behavioral health specialists

Nearly 10 years ago, Wellstar was one of several health systems nationally that participated in a study of the effects of placing behavioral health clinicians in primary care.

The need is significant. Mental illness and substance use disorders are prevalent throughout the U.S. According to the 2024 State of Mental Health in America report, 22.5% of adults in Georgia had a mental illness in the past year. The report also said that 17% had a substance use disorder.

Primary care physicians at Wellstar routinely screen patients for depression, suicidal thoughts and alcohol or drug use. In other cases, they learn from conversations that patients may have:

• Anxiety or panic disorders
• Sleep disturbances
• Stress related to work, family life or finances
• Grief or unresolved trauma

Introducing the behavioral health clinician

When behavioral concerns emerge, the primary care team introduces the on-site clinical social worker. This specialist conducts an in-depth assessment to determine the next best steps for the patient. This is typically a short-term series of sessions that may lead to referrals to psychiatrists, psychologists or Wellstar’s suicide prevention team.

“One of the biggest strengths of this model is credibility,” Dr. Tharp said. “If a physician or nurse practitioner you trust says, ‘We have a counselor here I’d like you to meet,’ the patient is more likely to follow through.”

This model has proven especially effective for patients who are less likely to seek mental health support, such as men, seniors and caregivers.

Where primary and behavioral health cross paths

People with chronic conditions like diabetes, digestive disorders and kidney disease sometimes have or develop mental health conditions like depression and anxiety. As a result, patients may find it harder to:

• Get the follow-up testing and care they need
• Follow nutrition and exercise instructions
• Take medications according to their doctor’s instructions

Not treating behavioral health issues can contribute to patients’ worsening physical health and higher medical costs.

Conversely, many patients may go to their primary care physician because they’re having trouble breathing, their heart is pounding or they have frequent headaches. Or they’re sweating or feel faint, dizzy or nauseated.

Those can be signs of a medical problem. They can also be symptoms of an emotional or mental health issue. In that case, a behavioral health clinician is around the office corner.

“We know that stress and anxiety show up in lots of different ways in the body. Understanding that allows people to adopt a new philosophy about how to take care of themselves,” Dr. Arkin said.

Pediatricians screen and refer children for behavioral health

Childhood and adolescence are critical periods in development. Mental health issues can affect a child’s ability to learn, grow and develop healthy relationships both now and as an adult.

Pediatricians routinely screen children for behavioral health concerns. They ask questions about social, emotional and behavioral development. Screenings for autism risk begin in early childhood and depression screenings begin at age 12.

At Wellstar KenMar Pediatrics in Marietta and Kennesaw, pediatricians turn to their in-house behavioral health partner, Dr. Kayla Fitch. Common reasons to refer include:

• Behavior challenges
• Feeding disorders, such as extreme picky eating
• Mental health issues among children with chronic or acute illnesses
• Requests for attention deficit hyperactivity disorder (ADHD) evaluations
• Severe social or separation anxiety

While under her care, Dr. Fitch screens patients for anxiety and suicide risk.

“One of the things I’m the most passionate about is early anxiety treatment for kids. We can help kids when they’re 4, 5, 6 years old,” Dr. Fitch said. “I teach parents basic concepts around how to expose their children to anxiety-producing situations to decrease their anxiety.”

She helps children learn “coping strategies, like deep breathing and muscle relaxation. These are things kids can benefit from if we teach them creatively.”

Growing commitment to integrated care

Wellstar’s primary care model continues to evolve to meet the behavioral health needs of patients throughout their life. Time will bring even more collaboration and improved outcomes.

“It serves everyone—patients, families and doctors—to create these seamless connections between primary and behavioral health practitioners,” Dr. Tharp said. “We see the benefits every single day in our patients’ health and their outlooks.”

Learn more about behavioral health at Wellstar.