Supporting PCPs: How to Navigate Mental Health Conversations with Families

We all know that pediatric primary care providers (PCPs) are the front line of healthcare for children. They check for milestones, monitor growth, and ensure vaccinations are up to date. But there’s another area where they can make a huge difference in a child’s life: mental health. Many PCPs have already begun incorporating mental health conversations into their practices, and others are working with their teams to make sure every child is heard. Unlike a fever or a rash, anxiety and depression don’t come with a thermometer or a swab test. And discussing mental health concerns with families—especially those who may be wary, overwhelmed, or even defensive—requires a particular set of skills.

So let’s review the basics: How do you open the door to these conversations in a way that builds trust and reduces stigma? How do you support caregivers who may not be ready to hear what you have to say? And how do you move beyond “wait and see” when early intervention can make all the difference?

Even when we feel well-versed in a subject area, brushing up on these integral skills means we can begin moving from treating mental health issues to preventing them—from the ground up. 

1. Start with Observations, Not Diagnoses

One of the biggest barriers to discussing mental health is the fear—on both the provider’s and the parent’s side—that it means something is “wrong” with the child. This is why it’s critical to focus on behaviors rather than labeling conditions too soon.

Instead of saying: “I think your child has anxiety.”

Try: “I’ve noticed that your child isn’t sleeping well and seems to be withdrawing from activities they used to enjoy. I’d like to explore that more.”

Parents might not be experts in mental health, but they know their children. Leading with what you’re seeing—rather than a potential diagnosis—keeps the conversation open rather than triggering defensiveness.

2. Make Mental Health a Routine Part of Well-Child Visits

Mental health questions shouldn’t feel like an add-on; they should be as standard as checking height and weight. PCPs already ask about eating and sleeping habits, but it’s not just if a child is sleeping—it’s how well they’re sleeping. Not just if they go to school, but how they feel at school.

Questions like the following can provide critical openings:

• Do you feel sad or worried every week?
• Do you ever feel really mad, more than other kids your age?
• Is there anything at school or home that makes you feel scared or nervous?

Parents may not even realize their child is struggling until these questions bring an issue to light.

3. Address Caregiver Concerns with Empathy

Bringing up mental health with a caregiver can go one of two ways: They may welcome the discussion or immediately feel like they’ve done something wrong. The key is reassurance.

If a parent reacts defensively—“She’s just going through a phase”—respond with validation: “That’s completely possible, and kids do go through phases. But if this phase is making things harder for her, there are things we can do to help.”

Caregivers also often feel like they should wait and see if their child “grows out of it.” The truth is, mental health conditions can escalate quickly, and early support is key. Instead of just suggesting deep breathing exercises and checking in next year, offer proactive solutions: “If we start addressing this now, it could mean fewer problems down the road.”

4. Normalize Seeking Help—Coaching, Not Just Therapy

Many caregivers assume that bringing up mental health means their child will immediately need therapy or medication, which can feel overwhelming. This is where the concept of coaching can be a helpful bridge.

“You know how kids have sports coaches to help them improve their game?” you might say. “Mental health coaching is like that—it helps kids and parents navigate emotions, stress, and challenges before things get too big to handle.”

This approach makes support feel less clinical and more like a natural part of a child’s development.

5. Encourage Caregiver Involvement

Mental health care doesn’t happen in a vacuum. Parents play a crucial role, but many assume they can just drop their child off for therapy and expect results. Reframing their role is important.

Instead of: “Your child needs therapy.”

Try: “We can help your child develop tools to manage their emotions, but the biggest impact comes from what happens at home. You’ll be a key part of that process.”

This helps caregivers understand that they’re not just handing their child off for treatment but actively participating in their well-being.

Building a Future Where Mental Health is Standard Care

Pediatricians are already balancing tight schedules and packed appointments. But integrating mental health discussions doesn’t have to be a massive lift. A few extra questions, an adjusted approach to conversations, and a shift from “wait and see” to proactive support can make all the difference.

Mental health isn’t separate from physical health—it’s all connected. And the more we treat it that way, the more kids will get the care they need when they need it most.

Want to dig deeper? Send me a question on Instagram.