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Bipolar Disorder in Children and Teens: Beyond Normal Ups and Downs

If your child experiences major mood swings, paired with dramatic changes in the way they deal with school, family and friends, you may wonder if this is just part of growing up—or a sign of something more serious.

Mental health has been in the news lately, and virtually all parents and caregivers are concerned about it. Many of us assume that, with love and understanding, our kids will manage somehow. At the same time, we know that 1 of every 6 young people lives with a mental health condition that won't get better without professional help.

Around 1% to 2% of all U.S. kids under 18 live with bipolar disorder, a condition associated with episodic shifts in mood and behavior. Here's what you need to know about bipolar disorder—and how to tell if your child might be struggling with it. With treatment, children and teens with bipolar disorder can get better over time.

What is bipolar disorder?

Once known as manic depression, bipolar disorder is a brain condition that causes extreme changes in mood. Depending on the type of bipolar disorder (bipolar I disorder, bipolar II disorder, or cyclothymia), people with this condition go through manic periods marked by extremely elevated or irritable mood, and high energy. They sometimes may also have depressive periods when they feel sad, hopeless and discouraged. Children and adolescents are more likely to have mood fluctuation even within the acute manic or depressive episodes they experience.

Parents: Share this video about bipolar disorder with your child:

Kids living with bipolar disorder might also show symptoms that are confusingly similar to those of other common childhood disorders such as attention deficit hyperactivity disorder (ADHD), disruptive mood dysregulation disorder (DMDD), as well as major depression, anxiety, conduct and substance use disorders. Childhood trauma also plays a critical role in mental health. These are just some of the reasons that medical professionals often find it hard to make a clear diagnosis, even when kids show several signs that they may have bipolar disorder.

What do bipolar episodes look like in children and teens?

Kids who live with bipolar go through dramatic and episodic changes in sleep, mood and energy levels, making it hard for them to think clearly and get along with others.

When a child is experiencing mania, they might:

  • Act incredibly happy, silly or even giddy

  • Feel more irritable or impatient than usual

  • Talk rapidly, hopping from subject to subject

  • Need much less sleep than usual without feeling tired

  • Struggle to stay focused on one task or topic

  • Show strong interest in dangerous/risky activities

  • Make snap decisions that seem out of character

  • Lose or break things they value (mobile phones, bikes, jewelry, etc.)

  • Experience more conflicts or misunderstandings with others

When they're in a depressed mood, kids with bipolar disorder might:

  • Feel sad, discouraged or hopeless

  • Show more anger and irritability than usual

  • Complain of pain, such as stomach troubles or headaches

  • Sleep much more than usual—or have trouble getting to sleep

  • Experience "brain fog" that makes it hard for them to concentrate

  • Have much less energy than normal for them

  • Turn away from friends, family and activities they usually love

  • Eat too much or too little

  • Talk or think about death or suicide

My child has a few of these bipolar disorder symptoms. Should I be worried?

Most young people go through times of stress, doubt and fear that might make it hard for them to sleep, handle schoolwork or relate well to family and friends. This built-in volatility is part of growing up, especially in a time when social media reflects strong pressures for kids to fit in.

The challenge of determining what is "normal" mood variability and what might instead be bipolar disorder has puzzled medical experts for some time. Until recently, many believed that bipolar disorder could not be diagnosed until the early to mid-20s, when a young person's brain is more fully developed.

Newer studies have helped us understand that many kids do, in fact, live with bipolar disorder—which means they need specialized help and support.

How will I know if my child should be evaluated for bipolar disorder?

Here are some questions that can help you think about your child's symptoms and determine when to call your pediatrician for help.

  • Do mood shifts get in the way of my child's ability to handle everyday life?

  • Am I seeing episodes of intense "highs" and/or "lows" that dramatically change their thoughts and behaviors?

  • Are these patterns dramatically different from the way my child used to feel and act?

  • Are their school, sports, friendships and family life suffering?

As you consider these questions, keep in mind that even if bipolar disorder is not the cause, your child urgently needs help. Kids whose lives are seriously disrupted by mental health symptoms will NOT just "snap out of it." Without proper care, many struggle for years, suffering judgment and stigma along the way. You can prevent this by seeking help now.

Is it common for parents to struggle, too?

Absolutely. Many parents don't feel they know anything about mental health, so they shy away from the subject. Others feel guilty or ashamed, assuming they're the source of their child's difficulties (especially if there's a family history of mental illness or their child has suffered from abuse, violence or other trauma.)

If you're struggling to ask for help, think of it this way. You'd never fail to call the doctor if your child had a broken bone, a terrible cough or a painful skin rash. Mental health is no less real than these physical conditions. And with millions of kids in virtually every part of the country facing mental health issues, you and your child are not alone.

What kind of bipolar disorder treatment will my child receive?

After a careful evaluation to determine if bipolar disorder is an appropriate diagnosis that explains your child's symptoms, health care providers will put together an age-appropriate treatment plan. A combination of medication, cognitive (talk) therapy and calming strategies may be recommended. Sleep will be crucial, too, since getting enough rest is critical for brain health, especially for children and teens.

Typically, your pediatrician will be part of your child's care team, along with a psychiatrist who specializes in managing medications for psychiatric conditions. Kids with bipolar disorder also benefit from talk therapy that helps them deal with fears and doubts that people usually face when they're diagnosed with a serious (and possibly lifelong) health condition.

Support groups can be helpful, too—and not just for kids. The National Alliance on Mental Illness (NAMI) offers resources and support groups for children, teens, parents and families. The Depression and Bipolar Support Alliance (DBSA) also offers support groups for people of all ages, including family and friends of people living with bipolar.

What if my child is having suicidal thoughts?

Call 988 immediately if your child is thinking of suicide or threatening to hurt themselves. This new number links you to the national Suicide and Crisis Lifeline, where experts will help you find emergency care close to home.

You can call 988 in non-emergency situations, too—or text HELLO to 741741 to find support and resources.

Things to remember about bipolar disorder in kids and teens

  • Mental health is part of human health. You don't have to feel embarrassed if your child is showing signs of bipolar disorder (or any other mental health condition).

  • Bipolar mood swings come and go, but this condition won't go away by itself. Kids with bipolar need specialized treatment to regain their balance and re-engage with school, family, friends and the community.

  • Your child can recover and live a healthy, meaningful life, even with bipolar disorder. (Here's an inspiring life story you and your child might enjoy.)

  • Family support makes a healing difference. You are your child's advocate and guide as they adjust to the challenges of having a mental health condition.

More information

Last Updated
American Academy of Pediatrics (Copyright © 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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