A four-year-old's months-long repeated expressions of sadness merit serious attention
A four-year-old boy has spent months repeatedly saying he is sad without being able to explain why; a psychologist says this warrants professional evaluation—depression in young children is rare but real, and treatable.
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Months of sadness is the key signal
This mother's four-year-old son has spent months repeatedly saying he is sad, sometimes the moment he wakes up. Rebecca Hershberg notes that even four-year-olds—and younger children—can experience depression. While young children rarely meet the formal diagnostic criteria for depression, a duration of ‘months’ is already a long span for a four-year-old. Add the mother's own long struggle with anxiety and depression: that family-level genetic loading is a variable beyond parenting style's control. With both factors present, Hershberg recommends direct professional evaluation rather than waiting for the podcast to air before offering guidance.
— Rebecca HershbergDepression in young children is rare but treatable
Host Sarah Bren cautions against panic at the word ‘depression’—it is genuinely rare in young children, and even if evaluation confirms it, it is entirely treatable. She frames the process as elimination, not crisis, aiming for parents to neither dismiss the signal nor fear seeking help. Her view: failing to screen is the riskier choice.
— Sarah BrenAppetite, sleep, and peer relationships tell the story
There is no single formula for whether to intervene, but Rebecca gives concrete dimensions to observe: the child's appetite, sleep, and how they interact with peers. She even recommends ruling out seemingly unrelated physical factors—children with prolonged low mood sometimes need thyroid screening. The pediatrician is the easiest first stop, though most are not mental-health experts and can only make preliminary judgments before deciding on referral.
— Rebecca HershbergThe change from baseline matters more than the emotion itself
Sarah adds that what matters is not whether a child says ‘sad’ but whether this represents a departure from their baseline—a shift in how they engage with the world, versus a temperamental constant. Typical departure signals are changes in relationships, loss of interest, and giving up things they once loved. The mother's description partly fits this pattern.
— Sarah BrenAge thresholds matter when finding a child therapist
Rebecca cautions that many who claim to do child therapy only accept ages six and up. Therapists who actually treat preschoolers should explicitly state expertise with young and toddler-age children. For this age group, therapy is nearly always play-based—stories, stuffed animals, puppets, not sitting down to talk. Parents must actively confirm the therapist's experience covers this age.
— Rebecca HershbergPlay therapy works for internalizing problems, not externalizing ones
Rebecca distinguishes two types: children who internalize emotions—sadness, anxiety, trauma—the ‘internalizing’ problems play therapy excels at; and those with ‘externalizing’ behavior problems like aggression or impulsivity, where play therapy struggles to transfer learning from the room to the world, often requiring family-system intervention. She urges parents to be ‘informed consumers’ because some therapists claim to handle all types.
— Rebecca HershbergParental presence is the safety net that makes therapy work
For children this young, Rebecca more often uses joint parent-child play therapy rather than having the child meet alone. She calls parental presence a ‘warm handoff’: the child experiences the therapist as safe, with the parent as a reference point. When discussing painful material, knowing both mother and therapist are ‘there’ lets the young child enter genuine emotional work with a stranger.
— Rebecca HershbergIn their own words · checked verbatim
this kid needs to be seen. You know, this kid, you know, I think that four-year-olds can have, and even younger actually than four, can have depression.
Rebecca Hershberg4:06
To me, again, what's the con in getting some professional help? Well, what's the downside? And I don't, I'm not sure there is one.
Rebecca Hershberg5:08
I just want to name like, while it's rare, it's also treatable and it might not be depression, but it's never a bad idea to rule it out.
Sarah Bren7:15
we're talking about what's called an internalizing issue. When a child is walking around with a lot of internal, you know, sadness, potentially anxiety, worry, trauma certainly is an area where play therapy can be very helpful.
Rebecca Hershberg16:42
It's like almost like the parent's presence to the gives the child almost like it's like a warm handoff. It's like, I'm here. I'm showing you this, this adult, this therapist is a safe person. And so you can use me as like a barometer in the room.
Rebecca Hershberg19:50
Figures
| Recommended parent-child play time | 45 minutes per week | 16:42 |
Glossary
- internalizing issue
- Emotions directed inward—such as sadness, anxiety, or trauma—which play therapy addresses well.
- externalizing
- Behavior problems such as aggression or impulsivity, which typically require family-system intervention.
- warm handoff
- The transition in which parental presence lets a child view an unfamiliar therapist as a safe figure.
- genetic loading
- Familial predisposition to mental illness, which increases a child's risk.
How to listen
Parents with preschool-age children who worry about their emotional well-being, and practitioners new to play therapy for young children.
The intro segment (0:00–1:01) is formulaic and can be skipped.