Childhood should be a happy, carefree time, but for many children, their formative years are a traumatic or otherwise difficult time. In fact, while teens have always been thought of as vulnerable to developing mental health problems, more than half of all mental illness begins before age 14. So why aren’t we talking about it?

One reason for the lack of conversation about childhood mental health issues may be that a substantial portion of it goes untreated. In the United States, experts estimate that about 1 in 7 children and teens have a diagnosable mental health condition, but half of children go untreated. This stems from a combination of stigma, lack of diagnosis, and a shortage of child and adolescent mental health professionals – and lack of treatment may be compounding the problem.

Research consistently demonstrates that early interventions can improve outcomes for children with mental health issues, but knowing care is necessary and accessing care are hugely different issues. Here’s what we know about childhood mental illness and how we can manage it and, more importantly, why we need to act fast.

Besides the lack of psychiatrists and psychologists prepared to treat children and teens, one reason that childhood mental illness may go undiagnosed is that these conditions often present differently. There are several reasons for that, but prime among them is the simple fact that children don’t have the language or cognitive abilities to accurately recognize all of their emotions. Instead of saying that they’re anxious, then, children most commonly complain of stomach pain or loss of appetite. They may also have trouble sleeping or suffer from increased or age inappropriate separation anxiety.

Both parents and doctors need to recognize how mental health issues present in children because recognition is the first step to management. We know how adults talk about anxiety or depression, but we still have a lot to learn about mental illness in children.

When we talk about mental illness, we tend to focus disproportionately on mood disorders, but a large percentage of childhood mental health issues stem directly from trauma – and, what’s more, trauma can lead to long-term ill health and other negative life outcomes. Using a framework known as adverse childhood events (ACEs), researchers have demonstrated that children who experience abuse or neglect, witness violence in their home or community, or suffer other major traumas are more likely to develop problems with drugs and alcohol, suffer from diseases like cancer or diabetes, experience physical injuries, and even die earlier than their peers with a lower number of adverse experiences.

Research into ACEs has been hugely valuable as far as our understanding of childhood mental health and this scorecard also offers a measurable way for professionals to identify children who need a greater amount of support. Based on this information, Rush University Medical Center launched a community partnership this fall meant to provide early support and intervention to children on the West Side of Chicago, which immediately neighbors the hospital. These children have limited access to both healthcare and early education opportunities, meaning that the traditional practice of “watchful waiting” won’t work, as there aren’t properly trained adults in their lives.

Rush isn’t the only group committed to addressing childhood mental health needs. Kaiser Permanent recently pledged $2.75 million to further research ACEs and how to mitigate them. The healthcare network framed their pledge as part of a “total health” approach, one that could potentially lead to significant healthcare savings down the line. Preventing and mitigating ACEs could improve lifetime health, as well as lead to increases in wealth and educational attainment.

Early interventions can include providing children with counseling, teaching mindfulness, and teaching parents strategies to support their children; many mental health conditions are easier to treat in early childhood. Helping anxious children develop healthy thought patterns through CBT is easier than teaching adults to do so. Similarly, while the newly recognized eating disorder ARFID (avoidant/restrictive food intake disorder) is often viewed as picky eating in young children, it can be extremely difficult to treat in teens and older adults; it can also lead to serious physical health issues, such as stunted growth, weak bones, and vision problems.

We’re increasingly recognizing the importance of talking openly about mental illness in adults, but we can barely even diagnose it in children, and we need to do better. Our failure to diagnose and treat – or, in many cases, to prevent – these issues, will have harmful consequences on our children for the rest of their lives.