Unfortunately, parents and others find it difficult to accept that children of any age can be depressed. Yet, infants in hospital and at home who are too docile and quiet, are often depressed and suffering from an anxiety due to a fear of being separated from their parents and family. Little children who are depressed will often sleep face down and bottom up. On the other hand, a child who is a troublesome little-devil may, in a wholesome way, be fighting back.

'Depression' is also found in small school-going children and may be seen in their complaining of 'feeling unwell' for no apparent medical reasons. To them, difficulty in school may be avoided by tummy ache, feeling sick, etc., and this is particularly true of children who are backward in reading who often get quite depressed.

Many other causes can be found: family stress, arguments and other stress between parents, a death of a parent or beloved grandparent or a fear of losing one or both parents, undue pressure to excel at school, fear of a particular teacher, bullying by other children, or competition with a brother or sister. Older children frequently react painfully to moving house, perhaps from a modest friendly road to a more select area. The child often feels the loss of friends acutely, and the play and association pattern is shattered.

In general, childhood depression is indicated by general dullness and low spirits, loss of interest, poor appetite, weepiness and restless sleep. Often the child attempts to escape the painful situation by running away. Distinguishing between other kinds of disturbed behaviour and childhood depression can be difficult and usually requires the help of those trained to deal with this, such as a child guidance department. Diagnosis and treatment, almost inevitably, require help for the from the parents. The co-operation of the child's teachers is usually given generously.

The serious effects of rejection must be stressed. To the rejected child, the world is seen as hostile and unfriendly, and the youngster is unable to give love later in life. The hostility tends to produce anti-social behaviour and delinquency, and all these matters are relevant to the development of depression in later life. Attitudes are often reversible, and one of the aims of treatment is to alter them.

The medical treatment of childhood depression is complicated, and can involve and any of the following: psychotherapy with the child, help for the family from social workers, family group therapy, drug treatment, in patient care, day patient treatment, etc. When a child attends a clinic either as a day or in patient, the day to day observation is invaluable. Apart from formal psychological testing, much information about the child is gained indirectly by play therapy, modelling and so on.