4 Strategies to Help Your Child Handle Stress
A pediatrician's tips on handling the anxiety that comes with childhood
Stress, as a whole, will never, never, never go away.
Stress, the negative influences upon our daily lives, and anxiety, the worry and mental energy directed toward stress, are part of every human life from infancy through adulthood.
One particular stress or worry can be addressed, but it will inevitably be replaced by another. Teaching our children how to deal with the stress and anxiety of life is one of the more important things we can do as parents.
Given a person’s age, developmental level, personality, etc. anxiety can manifest in many ways. Classically, stranger and separation anxiety emerge around 6+ months of age. This represents a normal developmental milestone of learning how some people and situations are part of the “family universe” and some are not; and how a child learns a sense of “self.” As children grow, anxiety can begin to show itself in ways less obvious than just crying, such as elevated heart rate, nervous tics, tantrums, inattention or difficulty focusing, complaints of pain (tummy aches, headaches), etc.
Studies have shown that anxiety is highly inheritable. If a child is very anxious, not uncommonly, there will be a parent who has struggled with anxiety. Furthermore, recent evidence shows that not only is anxiety genetic, it actually may be even more of a learned predisposition. Children mirror their anxious parents. This actually is encouraging news, however. It means there can be a significant impact from teaching our children how they can effectively deal with stress and anxiety.
STRATEGIES FOR CHILDREN:
DISTRACTION: It is the most effective strategy for infants and very young toddlers but it can also be very useful for older children. For instance, instead of discussing immunizations/shots extensively, talk more about what prizes are to be had afterward or other positive things about the day. If you look for the good, you will find it. Help your child find it.
JUST BREATHE: As we become anxious, our “fight-or-flight” system, our sympathetic nervous system, kicks in increasing our heart rate, respiration rate, etc. As our minds subconsciously recognize this, it increases our anxiety further. Luckily, we can mindfully break this feedback loop by concentrating on our breathing. For kids, a timer is especially useful. You instruct a child to slowly breathe in through the nose for 4-5 seconds, then slowly out through the nose for 4-5 seconds. Watching the timer the entire time, trying to make the in and out of one breath to be about 10 seconds, and repeating continuously for just a few minutes can be remarkably calming. Doing it with them can also calm us. Breathing techniques can be adapted for the age of the child - such as “blowing out candles slowly” (use fingers for pretend) for younger kids and guided imagery - imagining a calm, peaceful place while breathing slowly - for older children.
BUILDING SAFE AWARENESS AND SUPPORT: The personal recognition of when and how anxiety hits is fundamental to dealing with it and a hallmark of Cognitive Behavioral Therapy (CBT), the most well studied treatment of anxiety. Once a child can learn to identify the onset of anxious thoughts, they can also start using their personal breathing/calming techniques, refer to personal, home-made cards with positive self-talk on them (“when I feel nervous, I remember that Mommy loves me no matter what”, etc).
EXPLORE WITH ART: It can be very helpful for younger children to draw their fears. This can help the parents understand particulars, help them discuss it, and actually serves to lessen the child’s fears. Older kids can benefit from journaling their anxiety. Interspersed with their written worries, written affirmations and strategies can help.
COMFORT THE CALM: If anxiety and anxious behaviors (crying, clinginess, whining, headaches, stomachaches, etc) receive lots of attention with repetitive reassurances and comfort, you can be assured that they will persist and worsen. If attention is lavished upon a “boo-boo,” that child will undoubtedly get many a “boo-boo.” It is normal, natural, and encouraged to provide reassurance to children when they are anxious, frightened, or hurt, but if we, as is often the case, give too much attention to them in such situations, this becomes very counter-productive. Rather, if we reserve the majority of our attention and love for overcoming the stress, for when they are calm, this is much more effective. Praising them for the bravery, resilience, etc. after overcoming adversity is much, much better.
FACE THE FEAR: It is extremely important not to let anxiety interfere with normal life. If a child is allowed to avoid “normal” situations that cause anxiety, this will only make anxiety worse, not better. If a child is nervous about school, gets a tummy ache, and is allowed to miss school or activities, this will inevitably worsen the symptoms. Such physical pains are commonly not “made up” but just the way that mental stress shows in the body. It is permissible to acknowledge the discomfort, but the anxiety and pain are worsened with avoidance of the stress. If there is something concrete that needs to be addressed, a bullying situation for example, it is of course important to address it, but teaching a child how to deal with stress and anxiety can be of even more long lasting importance. Bullies, stress with academics, problems with friends, etc. are universal and constantly in flux, but learning resilience is forever.
PERSISTENCE PAYS: Children will naturally avoid situations that cause anxiety, but the time allowed for avoidance does not serve to dissipate the anxiety - it just makes it worse. Getting “back on the bike” is crucial and the child’s effort in such regard should be praised effusively. It is ok to take small steps at a time, for instance, in overcoming fear of dogs, but steps are nonetheless important to take. If a child asks repetitive questions about an anxious situation, it is best to answer only once, subsequently reminding the child that the question was answered. Dwelling on the question/answer makes the anxiety worse.
SCREEN SCARINESS: Even the most seemingly benign character on television, movies, or videos can prove terrifying to a child. Network and cable news programs and The Weather Channel are also notorious causes of unrecognized fear and stress. Children, adolescents, and even adults at times often lack the mental aptitude to recognize the association between frightening images and resultant anxiety. This is one area that avoidance IS for the best. www.commonsensemedia.com is a good site for evaluating media for age/development.
ADDRESS YOUR ANXIETY: Children learn tons from watching their parents. If parents are anxious, the child will mirror that. If new, potentially scary experiences are viewed by the parents as fraught with danger and need for reassurance, the child will be anxious. On the other hand, if such novel situations are met with a parental sense of optimism, adventure, and/or nonchalance, the child will be more confident. Separation for school, activities, etc. should be seen as “matter-of-fact.” If parents make these a “big deal”, reassuring the child extensively, it teaches that the world is a frightening place.
A simplistic, but nonetheless helpful, dictum used in the primary care field as it pertains to mental health conditions is that when a particular problem - anxiety, inattention, sadness, etc. - becomes significant to interfere with “normal” life, professional help should be sought. For younger children and for those with mild problems, the information in this packet and resources listed herein may be sufficient. Play or talk therapy may be an adjunct. For older children with more severe problems, Cognitive Behavioral Therapy holds the most promise.
Medication can sometimes be indicated for severe anxiety. However, it should not be seen as a cure. Patients who just take medication don’t fare as well with anxiety disorders as those who take medication and teach the mind to deal with inevitable stress and anxiety of life.
Get to know J. Ben Worsley, M.D.
Dr. Worsley is a Cook Children's pediatrician at Southwest Harris Parkway. Dr. Worsley graduated with honors from Rice University in Houston, Texas, and received his medical degree at the University of Texas-Southwestern Medical Center in Dallas. His stay in Dallas would continue, as Dr. Worsley completed his internship and residency at Children’s Medical Center. He is board certified in pediatrics and his clinical interests include developmental pediatrics, asthma and allergies. Outside of the office, Dr. Ben enjoys spending time with his family, reading lots of books, meditating and trying to stay upright on his mountain bike. Cook Children's pediatricians at Southwest Harris Parkway are here to help you with well-child visits, vaccines, illnesses, behavior problems, learning disorders or answer questions all parents have. Learn more about their practice here.