Bipolar disorder can show up in childhood. Noticing the signs and getting the right support for your child can make a big difference in their long-term mental health.

It can be tempting to explain any emotional and physical changes your child experiences as just part of the process of growing up. But when does their behavior point to a mental health condition like bipolar disorder?

Experiencing episodes of mania or depression (or both) could point to a diagnosis of bipolar disorder in children.

Bipolar disorder is a mental health condition where you experience shifts in mood for certain periods of time. There are three diagnoses for bipolar disorder:

  • Bipolar I. Your child has episodes of mania. They might also experience depression or hypomania (mild mania).
  • Bipolar II. Your child has had at least one depressive episode and an episode of hypomania.
  • Cyclothymic disorder. Your child experiences periods of milder depression and hypomania, and they have done so for at least one year.

If your child shares thoughts of hopelessness or dying and frequent but unexplained sadness, they may be experiencing a depressive episode.

On the flip side, a shift in mood where your child is more hyperactive than usual may be a sign of mania.

While bipolar disorder is often a lifelong condition, symptoms can start to show in early childhood. About 1% to 3% of children and teens could have bipolar disorder.

According to the National Comorbidity Survey, about 2.6% of teens reported that bipolar disorder severely impairs their day-to-day activities. Females were slightly more likely to have a bipolar disorder diagnosis than males.

One review reported that bipolar disorder could be more likely to develop around ages 15 to 24 years. And according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the average ages of onset for bipolar disorder are:

  • 18 years old for bipolar disorder I
  • mid-20s for bipolar disorder II

It’s still possible for some people to have symptoms earlier than that.

Bipolar disorder shows up differently in children than in adults. In kids, bipolar disorder can sometimes be mistaken for other conditions, such as ADHD.

Because of the chances of misdiagnosis, parental involvement in noticing signs and supporting the child can be key to helping them manage symptoms.

Does bipolar disorder look the same in everyone? Not exactly. According to the National Institute of Mental Health, children experience a range of symptoms and emotions depending on the episode.

Children with bipolar disorder may also be more likely to have symptoms of psychosis than people who develop it later.

For episodes of mania, children might:

  • have trouble concentrating
  • engage in risky or impulsive behaviors
  • experience strong anger, irritability, or restlessness
  • have more trouble getting to sleep at bedtime
  • seem extra silly or hyperactive

And in children, a depressive episode might look like:

  • unexplained and constant sadness
  • thinking or talking about suicide
  • lack of motivation or energy to do everyday activities
  • changes in eating patterns
  • irritable mood
  • not gaining weight as expected for age group

You can learn more about the symptoms of childhood bipolar disorder here.

There is no single cause of childhood bipolar disorder. But genetics and environmental factors such as stressful life events likely play key roles.

Genetics

A family history of bipolar disorder can make you more genetically likely to develop it. In fact, some research suggests bipolar disorder is around 60% heritable. Several gene mutations have also been linked to bipolar disorder.

Stressful life events

Trauma can increase the risk of developing bipolar disorder, especially in children genetically predisposed to it.

  • A recent study found that people with a bipolar disorder diagnosis who had experienced physical abuse in childhood showed altered gene expression for sleep.
  • Another study focused on people with bipolar disorder who experienced emotional abuse as children. It found decreased gene expression in two genes that help regulate stress.

If you think your child could have bipolar disorder, consider taking them to their pediatrician for a referral to a therapist or psychiatrist.

According to the DSM-5, mood changes need to be different from a child’s usual behavior and present for at least one week.

Children who’ve experienced at least one manic episode could meet the diagnostic criteria. Experiencing depressive episodes or a “mixed” episode — both mania and depression — helps in confirming your child’s diagnosis.

A medical visit could involve an in-person interview or a complete psychiatric evaluation with questions about:

  • family mental health history
  • sleeping patterns
  • energy levels
  • current symptoms and behaviors
  • family or environmental stress

Your child’s doctor might also rule out ADHD, which can have overlapping symptoms with pediatric bipolar disorder. Similar symptoms include:

  • rapid speech
  • tendency to get distracted
  • racing thoughts
  • less need for sleep

Your doctor might also interview family members, friends, and teachers to track your child’s changes in mood. This could help them determine whether it’s childhood bipolar disorder or two conditions together.

You have many options when it comes to helping your child manage bipolar disorder.

Treatment often depends on what symptoms your child has. For example, a combination of therapy and medication is usually recommended for severe bipolar disorder symptoms. Kids with milder symptoms might be best served by therapy alone.

Medication

Some common medications for childhood bipolar disorder could include:

Antipsychotic medications can stabilize moods for kids with bipolar disorder. Some examples include:

For children who experience depressive episodes, antidepressants could help. But if your child also experiences mania, antidepressants aren’t recommended. Fluoxetine (Prozac) is one antidepressant that could help during depressive episodes.

Some of these medications may cause side effects like irritability or weight gain. If you notice your child having side effects, it’s a good idea to let their doctor know.

Therapy

Therapy is another viable option for childhood bipolar disorder. Some therapies that could help include:

In therapy, kids with bipolar disorder can learn skills for managing emotions and mood changes.

At-home care

Managing an at-home care strategy can help keep symptoms at bay. The International Bipolar Foundation recommends daily exercise as a good outlet for releasing energy connected to mania. Kids may find it easier to overexercise if they’re experiencing mania, so moderation is key to preventing overuse injuries.

Exercise can also lift a low mood during depressive episodes, but your child might not feel up to it during these times. Rather than forcing anything, encouraging them to move in gentle ways — like taking a walk around the yard or playing with a pet — can be just as beneficial.

Getting enough sleep is important in stabilizing mood and overall child development. The Centers for Disease Control and Prevention recommends 9 to 12 hours of sleep for children 6 to 12 years old. By the time your child reaches their teens, the CDC recommends 8 to 10 hours per night.

If you have a child with bipolar disorder, you might find they have problems with school or socializing with friends. They may also go through times where they have a hard time holding a conversation or feeling motivated to get out of bed.

Children and teens with bipolar disorder could also be more likely to have another mental health issue. Anywhere from 20% to 80% of children and teens with bipolar disorder could have another condition like:

But with a care plan that fits their needs, your child’s symptoms can become more manageable.

Bipolar disorder can feel stressful for both you and your child, especially if you feel unsure about how you can help.

If you think your child is experiencing an episode, you can offer support by:

  • staying patient and encouraging them to talk out their feelings; listening helps children feel that they are not alone and helps remove the stigma around discussing their experiences
  • maintaining a routine for taking medication and leaving enough time for movement and sleep
  • teaching children how to cope with intense feelings of irritability or temper tantrums
  • limiting triggers for mood episodes

Bipolar disorder can be a lifelong condition. While it’s more often diagnosed in teens and adults, it can develop in younger children.

Managing the ups and down of bipolar disorder may feel overwhelming at times, but you’re not alone. Your child’s doctor can share various approaches to stabilizing moods and managing symptoms.

Some resources for parents on managing stress, including a space to share experiences with other caregivers, include: