They pull back the curtain on the realities of burnout in modern medicine, why corporate health care is driving unprecedented levels of stress, and how they’re working to reimagine the way doctors practice. From the evolution of work-life balance to deeply personal journeys that shaped their mission, this episode is an eye-opening look at the hidden struggles doctors face—and the hope for a healthier future.

If you've ever wondered what it takes to restore the passion for medicine, this is an episode you don't want to miss. Tune in now on Spotify, Apple Podcasts or YouTube.

• Changes in routine
• Traveling
• Missing family members and loved one
• Pressures to create meaningful experiences
• Family dynamics
• Holiday shopping and gift giving

So what can parents do? How can we help our children process pressures to protect their mental health and emotional well-being?

Communicate Expectations
Planning ahead and explaining arrangements can help prepare kids for traveling, adjusting routines, meeting new people and more.

“Kids love to know what to expect,” Ashley Pagenkopf, MS, CCLS, child life specialist in Cook Children’s Emergency Department, said. “Establishing realistic expectations is the most practical tip I would offer to families. Kids thrive with boundaries and expectations.”

When visiting family and friends or even hosting a holiday reunion at home, communicating with kids about who they may meet is important.

“A huge help for kids is to have video chats with family members and friends they will see in advance,” Lisa Elliott, Ph.D., psychologist and manager of Cook Children’s Behavioral Health Clinic in Denton, suggests. “For littles, even reading books to them over video chat is a great way to engage them.”

Let your children know that feeling anxious around unfamiliar people is normal. Staying together as a family can help kids feel safe, and it’s important to remind them they can speak up if they feel uncomfortable or need a break from social gatherings.

Practice Self-Care
Managing family anxiety often begins with parents addressing their own stress.

“Kids are very good at reading adult emotions even if they are not verbally expressed, so if you are stressed out, it’s likely your child is anxious as well,” Cook Children’s psychiatrist Akemi Watkins, M.D., said. “It’s like the safety message on airplanes where you have to put the oxygen mask on yourself first before your child.”

Simple self-care practices can significantly enhance parents’ well-being. Prioritizing sleep, nutritious meals and regular exercise can make a big difference. For more information about self-care for parents, Cook Children’s has a guide of resources listed here.

Focus on Connection
One of the best ways to reduce holiday stress is to focus on connection. Finding ways to bring family and friends together can be fun and meaningful.

“I’ve had multiple kids share their favorite family traditions,” Dr. Elliot said. “Experiences like taking baked goods, lotions or other treats to a nursing home, helping in a soup kitchen serving holiday meals and even adopting a family and going shopping together for them.”

The holiday season presents an opportunity to teach children about generosity – a concept that studies show actually improves mental health. Doing things for others makes you feel good – emotionally and physically.

It also promotes empathy and resilience, which are important building blocks to emotional and mental strength and coping skills that help children deal with challenges.

Read examples of ways families can serve others together here.

In this episode of Raising Joy, we discuss a new peer-to-peer support program that is underway in Cook Children's Pediatric Intensive Care Unit (PICU). Chaplain Amanda Payne Lindsay and Katelyn Terry, RN, join us to talk about the program's goals, how it works, and the impact it's having on PICU staff.

The PICU can be a traumatic environment for health care workers, and this program is aimed at limiting the impact of stress, depression, anxiety, and burnout. The program trains appointed PICU employees to serve as supportive peers to lean on in times of need.

Listen to learn how they started the peer-to-peer support program and why similar programs could benefit workplaces of all kinds.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Your child is a real go-getter; maybe they’re a straight-A student or a star athlete. Lately, though, they have trouble breathing during very inopportune times, like before a test or a big track meet. You have seen their primary care doctor and you have seen a pulmonologist. Maybe they are put on an inhaler, but it doesn’t seem to be working like you hoped. So what’s going on?

Have you heard of vocal cord dysfunction? Well, there is a new name for it: exercise-induced laryngeal obstruction (EILO) and inducible laryngeal obstruction (ILO). That’s a mouthful.

Whenever there’s a “trigger” (i.e. exercise, stress, certain odors), the vocal cords narrow and it feels like you can’t get a good breath in no matter what you try to do. It isn’t life-threatening because your vocal cords are actually still open, but they aren’t open enough to fill your lungs. It’s scary. Your child is panicking and now you are, too.

What are the symptoms of EILO/ILO?

• Chest/throat tightness
• Difficulty inhaling
• Noisy breathing
• Shortness of breath

That sounds an awful lot like asthma, doesn’t it? You’re right; EILO/ILO and asthma sound very similar, but there are a few differences. Let’s compare the two:

You have ruled out asthma with your physicians and ruled in EILO/ILO. 

What do we know about EILO/ILO?

Onset can occur at any age, but most commonly, EILO and ILO are diagnosed in 12 to 18-year-olds.

It is most prevalent in our young athlete population and it can lead to anxiety about playing sports because of the fear of not being able to breathe. The same thing can happen around stressful situations like an upcoming AP history test or a choir performance.

Speech Therapy

What can be done to help these kids get back into their sports, extracurriculars, and high-demand classes? Speech therapy and/or physical therapy is the answer! And it’s all about breath.

With speech therapy, we look at how the child is breathing and teach them a variety of strategies to make their breathing more efficient.

We work on rescue breathing techniques that will blow the airway open during an active EILO/ILO episode as well as preventative breathing strategies that will keep the airway open during exercise or stressful activities. We also focus on diaphragmatic breathing or belly breathing, so the child can optimize the amount of air they are getting into their lungs at rest and during physical activity.

With physical therapy, we can look at the athlete’s movement patterns, posture, endurance, and strength that may be impacting their breathing. Oftentimes, stiffness or weakness through the trunk and core changes a person’s breathing pattern, causing them to have difficulty controlling their breath (especially during high-intensity activities).

This can lead to increased fatigue, tension around the neck and/or shoulders, and EILO symptoms. Another area of focus is cardiovascular endurance training to avoid the feeling of “hitting a wall” during exercise.

Through guided exercises, improvements can be achieved by reducing compensations or our body’s way of cheating through movements, training the proper muscle groups, and supporting proper muscle use and form during athletic movements.

What is the common goal? To give the child the skills they need to get back to the activities they love. If your child is experiencing any of these symptoms, reach out to their primary physician to discuss a potential referral to an ENT (otolaryngologist) or pulmonologist for further diagnostic testing.

Imagine living through a tornado. The wind howling over the sound of sirens. Lightning illuminates your home. Then, you hear it - the roar. You watch the ceiling start to give way. Fear turns to panic. Running on adrenaline, your body prepares for the worst.

This is what trauma can feel like. While a severe weather event can be traumatic, there are many reasons a person may experience trauma. It is defined as anything that overwhelms a person’s ability to cope. But trauma isn’t always easy to spot, even though its effects can last a lifetime.

“There are three different kinds of trauma. The first is acute, or a one-time event like a dog bite or car wreck,” said Denise Coover, LCSW, a trauma informed care specialist at Cook Children’s Medical Center. “Then there’s chronic trauma, where you may have several things happening at once, like domestic violence at home and bullying at school. Complex trauma happens when traumatic experiences occur within the context of a close relationship, such as sexual abuse committed by a family member, or someone who should keep you safe.”

During a traumatic event, the body releases two major stress hormones: norepinephrine and cortisol. Similar to adrenaline, norepinephrine boosts the heart rate and controls the fight-or-flight response. Cortisol is your body’s main stress hormone and slows non-essential functions, like digestion, when a threat is perceived.

“If your body experiences this stress response on a regular basis, it can cause long-term health problems,” said Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s. “A lot of people don’t realize that chronic exposure to stress hormones can cause high blood pressure, obesity, diabetes, issues with sleep and fatigue, as well as feelings of depression and hopelessness.” 

These hormones can also increase your memory of the event, leading to flashbacks, nightmares and PTSD. But when it comes to memory overall, people who’ve experienced significant trauma may find it hard to remember in general. This is due to the part of the brain that stores memory, the hippocampus, being overexerted.

The amygdala is another part of the brain affected by the stress response. This region controls emotions and can cause someone to react differently to something as simple as a door slamming. You can think of the amygdala as the brain’s ‘watchdog.’

“If someone has experienced something like domestic violence or a shooting, they may be sensitive to loud noises,” said Dr. Carter. “That’s because their amygdala is working overtime to keep them safe. We call this hypervigilance.”

For children, hypervigilance can make it hard for them to concentrate at school and follow directions. Instead of focusing on the classroom, their brain may be trying to anticipate what bad thing is going to happen next.

The prefrontal cortex is connected to the amygdala and is responsible for rational thinking. Chronic stress in childhood can damage the prefrontal cortex, which is still developing, and lead to a survival response being triggered even when there is no danger.

Understanding Trauma

According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That's 223.4 million people. 

“Sometimes, when people experience trauma, they will compare themselves to others. For example, they may say, ‘I’m not a Syrian refugee so I haven’t experienced real trauma,’” said Coover. “But it doesn’t matter, if something overwhelmed your ability to cope, that makes it traumatic for you.”

At Cook Children’s, 94% of hospitalized psychiatry patients in 2020 reported experiencing at least one form of trauma. Untreated trauma in children can cause a number of problems including behavioral issues, mood swings, depression, anxiety, self-injury, hopelessness and thoughts of suicide. Kids may feel isolated because of how the traumatic event has affected them. Coover says it’s important for parents and teachers to be aware of the signs of trauma because they’re not always obvious.

“A child who’s falling asleep at school may seem like a problem student, but when you start digging into their history you may realize that they don’t feel safe at home and they’re in survival mode. But when they’re in the classroom, they feel safe so all of the sudden they can sleep,” she explained.

Another sign of trauma in both children and adults is physical pain without a known reason, called somatic symptoms. This is often seen in the form of migraines, stomach aches, and rouge pain the body that is not associated with injury. This phenomenon has been documented by experts such as psychiatrist Bessel van der Kolk in his book ‘The Body Keeps the Score.’ Kolk claims that stress and trauma becomes stored in the body if not addressed, and can eventually lead to illnesses such as autoimmune disorders and cancer.

“Whether you remember the trauma or not, your body always does,” said Coover. “I’ve had parents tell me this or that happened but their child was too young for it to affect them and I have to tell them, “No, that’s not the case.’”

Some examples of childhood trauma include:

• Physical, sexual and emotional abuse
• Neglect
• Domestic violence
• Homelessness
• Parents with untreated mental illness and/or substance abuse
• Divorce
• Bullying
• Losing a parent
• Incarceration of a parent

“Domestic violence is one that seems to surprise people, because they think if the child isn’t being hit it doesn’t affect them,” Coover said. “But it absolutely does, even if they just hear it. Sometimes what they’re imagining is even worse, or maybe it’s spot on. And kids tend to blame themselves for their parents fighting. They take on that guilt even though it’s not theirs to carry.”

Experts like Coover and Dr. Carter also warn that isolation triggered by the COVID-19 pandemic has led to even more traumatic experiences for many kids, especially those growing up in unhealthy environments. With so many students being forced into virtual school last year, their ability to escape and connect with people outside of their home was taken away.

“We are starting to see more kids talk about the effect the pandemic has had on them,” said Dr. Carter. “I had a patient tell me recently they’d been home alone for many months and hadn’t been able to see their friends or other people. They said they were tired of living that way, this patient became hopeless about life changing, which resulted in this patient attempting suicide.” 

The Power of Sharing

Dawn Hood-Patterson, Ph.D., thinks about trauma in the context of her own life. At 17, she was living in Colombia with her family when her trauma story began.

“I lived in Colombia during the time when Pablo Escobar had a grip on many regions in the country—there were car bombs, protests and the sound of gunshots. During that period of unrest, my dad was murdered outside our home,” she said. “So when I think about my trauma story, I think about what fostered my capacity for dealing with that.”

Dr. Hood-Patterson attributes her resilience in part to her parents who gave her a loving and supportive home. She also credits the school counselors who recognized that her frequent stomach aches were not just random pain, but the result of the stress that comes with living in a country experiencing civil unrest.

“It was all the adults who recognized the trauma was bearing impact on my life, and who said, ‘This trauma is real and we see Dawn in the midst of it,’” she said. “These same people gave me tools that helped me make meaning out of the chaos. And they said, ‘Here are some friends around you that have experienced similar things so you don’t feel so alone.’”

As program manager of Community Health and Adverse Childhood Experiences at the Center for Children’s Health, led by Cook Children’s, Dr. Hood-Patterson is using her experience to help people in North Texas. She’s part of the team behind The ACEs Task Force.

Adverse Childhood Experiences (ACEs) is a term based on a study conducted between 1995 and 1997 by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC). The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high-risk behaviors, chronic disease and reduced quality of life in adulthood. In 2019, The ACEs Task Force unveiled their “Blueprint for Safe, Healthy and School-Ready Children”. The plan includes 25 ways pregnant women, families, children and caregivers need to be supported in order to counteract adversity. Access to health care, healthy food, quality, affordable and safe housing are among the top concerns. Transportation, mental health services, substance use disorder treatment and high quality, affordable child care are also priorities for the task force.

Currently, Dr. Hood-Patterson and team are working on a project that would create support groups for parents and caregivers living with adversity. The so-called ‘Caregivers Alliance’ is part of the Build-a-Bridge program, led by Cook Children’s, and is in the early planning phases. It would focus on giving people a chance to share their stories of trauma and connect.

“This was born out of conversations that we had with community partners where we learned that a lot of people who are struggling with adversity often feel like they have a laundry list of things to do,” she said. “For families who receive things like housing assistance or SNAP benefits, every conversation they have is about updating paperwork and not missing deadlines. We envision this alliance to be a space where people can be seen and heard, and support one another.”

The Caregivers Alliance would also include access to education from the Center for Children’s Health for topics like car seat safety, water safety, safe sleep practices and more.

“I’m a believer that something powerful happens when we share out stories with each other,” said Dr. Hood-Patterson. “When we have the opportunity to share our stories, whether they’re of triumph or trauma, it hones our ability to make meaning out of the seemingly meaningless chaos of suffering.”

One year into COVID-19, it’s clear the pandemic is taking a toll on the mental wellbeing of children and teens.

In March, a record 43 patients were admitted to Cook Children’s Medical Center after attempting suicide. This staggering figure is nearly double the number of suicidal patients seen during the same time period of 2020. Even worse, kids are dying. Last year, Cook Children’s recorded seven suicide deaths, marking the first time suicide was the leading cause of trauma deaths at the hospital, surpassing child abuse and car wrecks.

“The mental health crisis was already happening, then it met a global pandemic and these are the consequences,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s.

“They’re less engaged and have less interaction with others, and instead are spending more time online and in virtual settings. And it’s hard for them to be hopeful about anything because so many things, like prom and graduation parties, are canceled.”

The issue is not unique to North Texas. Doctors and nurses from across the nation are reporting similar statistics. In February, NPR released an article titled “Child Psychiatrists Warn That The Pandemic May Be Driving Up Kids' Suicide Risk.” It found that children’s hospitals across the U.S. are seeing up a 250% increase in suicidal patients in emergency rooms since the pandemic began. While there are no nationwide numbers on child suicides in 2020 available yet, experts agree there is reason to be concerned.

The Impact

More children are suffering from stress, anxiety, depression, and suicidal thoughts than at any time in recent memory. Pediatricians like Kathleen Powderly, M.D. from Cook Children’s Pediatrics Magnolia say children as young as 7 are needing help.

“I’ve had a couple of elementary school students, which you don’t see very often, who are actively suicidal or have already had a suicide attempt. I’ve also managed more kids on antidepressants since the pandemic because it’s hard to get into doctors right now,” Dr. Powderly said. “COVID-19 is not as impactful in terms of volume of cases in pediatrics, but our volume of psychiatric patients has increased quite a bit.”

Previously, Dr. Powderly was the medical director of Cook Children’s Hospitalist Group, the attending physicians who care for children in the hospital. She says her team was seeing an increase in suicidal patients before she transitioned into the office setting five years ago and that the pandemic created a perfect storm. On top of the stressors kids were already dealing with, they’re now struggling with isolation, virtual school, and a loss of activities.

“We’re not going to be able to flip the switch and just go back to normal when this is over,” said Dr. Powderly. “This is going to take some time to come out of. I’ve even had patients tell me they’re struggling with being around people.”

Members of Cook Children’s Youth Advisory Council shared similar experiences in a recent meeting. The teens said they feel more anxious being around their friends in person because they’re so used to only seeing people online now. In addition to new stressors, there is a severe lack of mental health resources across the board.

A Growing Need

“There weren’t enough psychiatric beds to begin with, and then COVID happened and the capacity was reduced because you can’t have patients sharing rooms,” said Dr. Pyrc.

The need for more inpatient psychiatric beds for children and teens has been known for years. In 2017, Cook Children’s opened the Rees-Jones Behavioral Health Center to help address the issue. The unit has 15 inpatient beds available for children between the ages of 2 and 12. As we reported when the center opened, the kids who end up here are patients with complex trauma, medical and social needs. They are often suicidal or have tried to hurt someone else. Eight out of 10 have had something traumatic happen to them. They have either been abused physically or sexually, or they have experienced some sort of neglect.

Teenagers who need inpatient psychiatric care have to be treated elsewhere but often end up waiting on the medical floor of Cook Children’s until a bed opens up in the community, which can take days. With more kids needing these services, it’s not uncommon for Cook Children’s to have a dozen or more patients waiting in a regular hospital room for a transfer to a psychiatric facility that can care for them.

“There are just not enough resources in general,” said Dr. Pyrc. “It’s an awful place to be in. This is a national problem, but it affects us here locally. We need more funding and we need more mental health professionals to care for these patients.”

On the outpatient side, finding a licensed therapist to see a child can take months. The waitlist just to see a counselor at Cook Children’s can be as high as 250 days at any given time. Even with easier access to appointments with virtual visits, there are not enough mental health professionals to meet the need.

Kia Carter, M.D., co-medical director of Psychiatry at Cook Children’s, has been a vocal advocate for increased mental health funding. Testifying in front of the Texas Senate’s Committee on Health and Human Services recently, she said early identification, intervention and treatment is essential to preventing further complications from mental illness. But there are roadblocks.

“We get insurances denying a specific level of care saying that a child doesn’t need an inpatient level of care. We also get a lot of pushback about medication,” Dr. Carter said.

She also asked lawmakers for increased support and to consider giving mental health care providers more leverage with insurance companies.

Hoping for JOY

In the meantime, Cook Children’s aims to bring awareness to the mental health crisis affecting children and teens with the launch of a new suicide prevention campaign.

The Joy Campaign is an acronym that stands for:

Just breathe.

Open up.

You matter.

“If we can just get kids to slow down, realize that what they are experiencing is temporary and that they have a long life ahead of them, I think we can make an impact,” said Dr. Powderly.

For the next month, Cook Children’s will be releasing a series of articles on Checkup Newsroom weekly that address many of the issues at play, such as the pandemic, the role of over-the-counter medications, social media, as well as how minorities and LGBTQ+ young people are impacted. We’ll also be speaking with families who have lost a child to suicide to examine the effects on parents and siblings.

If you feel your child might be struggling, here are some of the warning signs to watch for:

• Anger
• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness
• Giving away possessions 

If you’re concerned about your child’s mental health, seek help early. Schedule an appointment with a licensed counselor. If your child is actively suicidal, call 911 or take them to the nearest emergency room.

Read this story in Spanish here.

Centers for Disease Control and Prevention: COVID-19 Related

• Coping 
• Print Resources
• Pregnancy

Texas Department of State Health Services

• Tools
• COVID-19 Info

American Academy of Pediatrics

• Parenting Website
• Critical Updates

Cook Children's 

• COVID-19 Information

United Way of Dallas

• Parenting Tips & Resources

We've written a lot about the stress related to COVID-19. Please visit our other articles:

• Social Isolation and COVID-19 Causing More Anxiety for New Moms
• The Stress of COVID-19 Awareness on Kids with Mental Health Concerns
• Fear, Stress and Sadness: How to Talk to Children about COVID-19
• Parenting is hard. Ask for help.

Reach out for help

Sometimes the pressure can be too much. Reaching out for help is important for you and your family. The following are 24-hour free help lines for different needs.

• For confidential support when you need help with the stresses of parenting, call Child Help:
  • Call or text 1-800-4-A-Child (1-800-422-4453) or live chat at childhelp.org
• For help with teen specific concerns:
  • Call Texas Youth Helpline: 800-989-6884 or text 512-872-5777
• For help with parenting tips, local resources and to learn about family fun:
  • www.helpandhope.org
• For mental health support and crisis care, call iCARE:
  • Call or text iCARE at 817-335-3022
• For access to services through a social service hotline:
  • Dial 2-1-1 or 877-541-7905 or go to 211texas.org

For all other questions/updates on COVID-19, visit cdc.gov.

If you suspect a child is being abused or neglected, please contact the Texas Department of Family and Protective Services (TDFPS) toll free at 1-800-252-5400, 24 hours a day, 7 days a week. You may also file a report using the secure TDFPS website. Reports made through this website take up to 24 hours to process. The Texas Abuse Hotline is 1-800-252-5400.

For more resources:

• The Center for Prevention of Child Abuse and Neglect
• About The Center for Prevention of Child Abuse and Neglect
• Early Detection of Child Abuse and Neglect Training
• Predicting Child Abuse and Neglect
• childhelp.org
• Childhelp National Child Abuse Hotline

Acknowledge All Feelings

• While children express stress in different ways than adults, they may still have many of the same feelings as adults. Sadness, worry, anger and feelings of loss may be common.
• Before moving to conversations about hope, ways to stay safe, and fun activities to pass the time, it is important to meet children right where they are emotionally.
• Validate your child’s emotions, “It is okay to be feel sad.” And let them know that you have felt that way too “I really miss seeing my friends, too.”
• Encourage expression of emotions in age appropriate ways. For example, art for younger children and journaling for older children.

Honesty is Best

• Even though you are doing your best to keep your child’s life feel as “normal” as possible, children can sense the changes going on around them, and they may have overheard adult conversations and news.
• Children also sense adult worry and anxiety.
• Children fear the unknown, and they often imagine things far worse than reality, so avoiding the discussion of Covid-19 with your children could cause more worry.
• To help your children to feel safe, explain Covid-19 in an honest, yet age appropriate way. See the resources below for age specific help.
• Begin by asking your children what they already know about Covid-19 or what they have heard, and build upon this knowledge. Your goal is to dispel misinformation and fears, not to cause more worry.
• For older children, use specific words children might have heard and ask if they understand the meaning (for example: social distancing, coronavirus, quarantine, pandemic)
• You don’t need to overwhelm children with information or great detail, but be willing to answer their questions openly, simply, and honestly.
• Follow your child’s lead. They will let you know when they have had enough information by asking to play or showing disinterest in the conversation.

Reassure Your Children

• Choose the right time to talk to your children. When you are feeling anxious or worried, this is not the best time. Take time to calm yourself before having important conversations with your children.
• Focus on what you are doing as a family to stay safe (washing hands, staying home, not attending social events, keeping distance from others while playing outside, and maintaining a clean home).
• Discuss how healthcare workers are doing their very best to take care of people who do get sick.
• Explain that most children are staying healthy, and most children have mild symptoms even if they get sick with this virus.

Keep Checking In

• As with any stressful topic, emotions and questions may change and develop over time.
• Revisit the conversation as things change, and be willing to discuss with your children when new questions arise.
• Watch children for signs of stress such as, lack of interest in typical play activities, trouble sleeping, or regression in development and contact your healthcare provider if needed.
• Reassure children that you will always be honest with them.
• Calm your children by explaining this will not last forever.

Routines Help

• Routines and predictability help children to feel safe.
• Keep old routines such as mealtimes and bedtimes.
• Create new routines and allow children to have control and choice in developing these routines.

Age Specific Resources

Preschool:

• Explaining Covid-19:
• Online book explaining social distancing

School Age:

• Printable book explaining Covid-19 (young school age)
• Video explaining Covid-19
• Comic explaining Covid-19

For other questions regarding COVID-19 and children, Cook Children's has developed a resource page with information for parents. 

Written by Cara Bozarth, a child life professional and clinical educator at Cook Children's.

L. Frank Baum, The Wonderful Wizard of Oz

Anxiety in children is a normal part of life, just like it is in adulthood. When a child is frightened, for example by a scary movie, they may have trouble getting to sleep. However, when anxiety cannot be comforted and is out of proportion with the given situation that can be a sign of an anxiety disorder in children.

Childhood anxiety occurs in about one-in-four children at sometime between the ages of 13 and 18. However, the lifetime prevalence of a severe anxiety disorder in children 13-18 is about 6 percent. Left untreated, anxiety in children can cause problems in school, at home and continue into adulthood.

Especially during this time of year, you may notice your child feeling anxious in preparation for standardized testing. 

As we approach STAAR tests in our area, we hear a lot about kids becoming anxious.

Sometimes it’s easy to spot: the outward nervousness, nail-biting, jitteriness, moodiness, irritability and outright refusal to participate in a specific activity, like school or when it's test time. Other times anxiety is not as easy to see, but can still be just as debilitating and lead to further behavioral, as well as physical, problems.

Some of the less distinct signs of anxiety can include frequent stomach aches, headaches, trouble sleeping and difficulty concentrating. It can be difficult to discern whether these symptoms are due to some kind of illness, something your child ate or an emotional stressor of some kind. There are things parents can do to better understand anxiety, including learning what is normal and what needs their attention.

“Normal” Anxiety:

Separation anxiety usually begins around 6 to 8 months of age, and we accept it as pretty much a normal stage of development. A child that had previously been happy while getting passed around to anyone and everyone, making funny noises and faces, may suddenly become a little weary of the aunt she doesn’t see regularly. This fear of a parent leaving may not subside until she is 2 to 3 years old. By then, a child will usually cry for a short period and, with some hesitance, calm down and connect with the new person. In order for children to overcome this stage of separation anxiety, they must feel safe in their home environment, trust people other than their parents, and trust that their parents will return. Parents will play a significant role in preparing their children to deal effectively with daily stresses.

Anxiety and Fear

It’s important to remember that fear is a normal human emotion. Fear is an unpleasant feeling of apprehension caused by the presence or anticipation of danger, according to New Source Counseling. But not all fear is bad. A healthy level of fear can protect our children and us from danger.

Anxiety is slightly more broad and pervasive than fear, but can still be useful when within normal levels. Anxiety is feelings of worry, nervousness or agitation, or an uneasiness of mind and body. It’s often about something that is going to happen rather than current threats. Fear is an element of anxiety, and when these emotions get out of hand they can cause serious disturbances in our children’s lives.

Remember the following four “S’s” to assess the extent to which your children’s anxiety or fear is affecting them.

1. Surplus: Is your child’s anxiety exaggerated from what is “developmentally normal”? Is the fear or anxiety there even when the source of danger isn’t? Is it virtually impossible for them to stop the worry?
2. Storm: Does the fear match the level of danger? Are they easily upset and out-of-control and inconsolable? Do they react negatively when you try to help?
3. Spoiler: Is the anxiety or fear significantly interfering with everyday activities? Does it negatively impact sleep, eating, relationships, and/or activities your child used to enjoy?
4. Stuck: Does your child’s fear or anxiety last longer than is expected? Is the fear or worry present all day, or for weeks or months? Are they having feelings like worry, panic, or agitation that will not go away?

If the answer to these questions is “yes,” it may be time to seek some help in treating your child’s anxiety or fear.

Preventive:

I often tell parents they are their child’s most effective preventative therapist. Every child has fear and anxiety from time to time, but a parent can comfort and give kids the skills they need to effectively deal with their worries. At the youngest ages (newborn to 2) it's important to provide a safe, positive and responsive environment. As kids grow up, separation anxiety is normal; but it's still important to prepare kids for changes and for separations from their caregiver, get them used to new people, and reassure them that they are safe and loved. When specific fears arise (fear of spiders, the dark, clowns, etc.) parents can help their children with age-appropriate discussion, educating the child about the object of their fear, precautions they can take, and possible solutions. It is important for parents to validate children’s feelings but still comfort them.

If your child worries persistently or excessively about a specific issue, like a test, teach him or her how to problem solve and take appropriate action to eliminate worries that can be controlled. It is also effective for parents to teach basic relaxation breathing and progressive relaxation or alternating between tensing and relaxing the muscles, at a young age and practice it with your children. This is a great activity to practice at bedtime. Another popular and effective coping skill which can be practiced during times of calm is known as

 “5-4-3-2-1” Coping Technique :

Breathe in for 5 seconds, hold the breath for 5 seconds, and breathe out for 5 seconds. Continue this pattern until you find your thoughts slowing down or until necessary. While focusing on breathing, focus on the following external thoughts:

5: FIVE things you see.

4: FOUR things you can touch

3: THREE things you hear

2:  TWO things you can smell

1: ONE thing you can taste

Of course, sometimes even parents and children need a little help. If these techniques still don’t seem to alleviate the anxiety – get help early!

Be sure to ask your pediatrician if a counselor or a play therapist, or even a psychiatrist or/and medication may be needed, especially if the symptoms are interfering with experiencing a childhood full of life and laughter! Research has shown that the earlier that childhood anxiety is treated, the more successful it is treated!

Assure your kids that everything will be fine and they will do great on their tests. 

Good luck!

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.

PROFESSIONAL HELP

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.

You’re holding your child’s hand on your way to the first day of school. The squeeze on your hand is tighter than usual. Then suddenly your little one sees a friend, smiles, releases your grip and you watch them run to school together without a care in the world.

Everything is great.

But then you notice a tear in your eye. Suddenly, you realize your child isn’t the one nervous about going back to school. It’s you.

The back-to-school transition can be stressful for many parents, and the reasons are valid.

For example, knowing that your child struggles with change can increase your own feelings of tension.

You may worry that your child will struggle to fit in with peers and make friends.

Maybe your child had a bad experience at day care or a previous school year, leaving you both with lingering anxiety.

Some parents are concerned that schoolwork or a tight schedule may be too difficult for their child or that a teacher will not understand their child's unique needs. 

Maybe, you’ve waited until the last minute and just aren’t ready. The need to buy new clothes and school supplies may cause concerns about finances, and a steady stream of demands on your time can leave you feeling pressured and stressed.

Plus, there’s just the feeling that your young child is growing up too darn fast.

If you are stressed about your child's return to school, you may wonder if you should share your concerns. Sam McCage, clinic manager of Behavioral Health Services in Fort Worth and a licensed psychologist,  says that could be a mistake. Your child looks to you for signs that school is fun, exciting and safe and not something to fear, so it's important to discuss school in an upbeat and encouraging way.

"Recognize that children will sense your anxiety and their own will increase if you express your anxiety too much," McCage said. "If they ask about your concerns, tell them that you are excited for them and confident they will do well."

McCage reminds parents that "it's normal to feel anxiety about your child going back to school, but he says there are strategies to help you effectively manage your stress.

Here's how you can calm your concerns and enjoy this annual adventure with your child.:

• Visit the school and connect with your child's teacher and other school staff.
• Make arrangements for car pools, play dates and after-school care well in advance.
• Be patient and give the teachers time to develop a relationship with your child.
• Make sure you have realistic expectations about how your child should perform in school and extracurricular activities.
• Talk with other parents about how they handle their anxiety.
• Use humor to diffuse the stress.
• Schedule fun family activities with your children.

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid  high sugar foods that may keep your child up all night and  make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

I would be very silly and extremely uninhibited in a way that, in other settings, I was not. After all, in the words of one of the songs I liked back then, “We can dance if we want to.”

It can be a hard thing for adults to deal with. Unfortunately, many children suffer the same pain. For some, it’s a genetic condition that’s been passed along to them. But for others, migraines are the result of injury. For 15-year-old Olivia Gillespie, her migraine problems began when she received her third concussion.

“It happened in cheerleading practice, I was kicked in the head,” says Gillespie. “I was fine. I didn’t think it was that big of a deal.”

Then months later, Gillespie was on a ski trip with her youth group when a headache came on and never went away.

“I just kept doing what I was doing and tried to not let it have an effect on me,” she said.

Gillespie tried to ignore the pain for two months before she said anything to anyone, but then the pain got worse.

“Olivia had an ongoing headache that would not fade. On a scale of one to 10, it was a consistent five," said Amelia Gillespie, the teen's mother. "It wasn't until her pain reached level seven that it really began to affect her.”

When Cynthia Keator, M.D., pediatric neurologist at Cook Children’s, first saw Olivia, she wanted to make sure her headaches could be treated without medication. Together, they worked on her sleep habits and diet. Dr. Keator also suggested supplements such as B2, and Omega 3, which has shown to help with headaches. In addition, Gillespie was referred to the Biofeedback Clinic at Cook Children’s.

“Biofeedback teaches patients how to control their pain by controlling their breathing, heart rate and body temperature,” says Dr. Keator.

Biofeedback specialist Nanny Christie, Ph.D., has been teaching the painless technique for decades.

“We place the child in a reclining chair and use pads to measure their body activity,” says Christie. “The equipment plugs into a laptop so the kids can see everything on the computer screen. If they tighten a muscle, a line goes up. If they relax, the line goes back down.”

Christie says teaching children to harness their breathing and muscle movement this way allows for real time learning. She says about 80 children are seen in her clinic each month. A typical visit is 45 minutes to one hour and each child is seen roughly four times.

While it wasn’t the end-all, be-all cure for Gillespie, it did help. She says she uses the technique to curb her head pain. If she feels a headache becoming worse, she can focus and calm her anxiousness which in turn can help the headache.

Also, ask your doctor about preventative medication. Your doctor may prescribe something prescription strength or a natural supplement to ease the pain.

Make sure you DON’T ask your child this question:

“How’s your headache?”

You may want to, but remember that asking about a headache is like scratching a mosquito bite. By asking, you’re reminding your child about their pain.

Unfortunately, it’s also a troubling trend among today’s high school athletes.

Cook Children’s pediatrician David H. Goff, M.D., FAAP, calls overstressed, busy children a huge problem – both in the classroom and on the playing field. In his Denton office, Dr. Goff sees patients who suffer from a variety of symptoms like chronic abdominal pain, anxiety and depression.

“I see this over and over. I look in the child’s eyes. They are exhausted. I say to the parents, ‘You need to cut back,’” Dr. Goff said. “And it is amazing to me. They say, ‘We can’t. No way. We have a tournament this weekend.’ For any successes we have, we have 100 more burnouts.”

The American Academy of Pediatrics agrees with Dr. Goff. A group of eight organizations, including the AAP, released a consensus statement regarding their concern with today’s high school athlete.

The AAP states, “Student athletes report higher rates of sleep disturbances, loss of appetite, mood disturbances, short tempers and inability to concentrate than non-athletes.”

The recommendations focused on the importance of educating students, parents and coaches on mental disorders in student-athletes; the stress involved with today’s athletes and ways to monitor their behavior.

Concerns of the AAP included the injuries and stress related to student athletes training year round, which doesn’t give them time to rest and recover.

The AAP said these athletes also face stress from poor performance on the playing field, injuries, concerns about getting cut from the team and trouble keeping up with school work, along with their extracurricular activities.

Because of the stress involved, student-athletes may suffer from “a pattern of lack of sleep and under-recovery” and chronic fatigue that puts him or her at risk for anxiety and depression. Other issues include:

• Physical (Physical conditioning, injuries, environmental conditions)
• Mental (Game strategy, meeting coaches’ expectations, attention from media and fellow students, time spent in sport, community-service requirements, and less personal and family time)
• Academic (classes, study time, projects, papers, examinations, attaining and maintaining the required grade point average to remain on the team, and earning and maintaining a collegiate or academic scholarship).

David Gray, M.D., medical director of Cook Children’s Orthopedics and SPORTS, agrees with Dr. Goff that too much activity can simply be harmful to a young person.

With the advent of select sports and recreational leagues, Dr. Gray said children now play the same sport year round without getting a break from those activities. He wants young athletes to have variation in their activities. If not, the repetitive nature of the same sport creates stress and strain especially on growing bones.

Dr. Gray and his colleagues see children who never have a break during the year sometimes playing on two or three different teams during the same season. He said it’s too much stress on their growing skeleton, causing muscle aches, strains and pain.

Both Dr. Gray and Dr. Goff stress children, especially before they reach high school, should focus on participating in several different sports to prevent using the same muscles year round. They say it also helps the child avoid getting burned out on that specific sport.

“For kids, sports are great and you learn a lot from them, but they should be fun,” Dr. Gray said. “Kids need to enjoy them too. You don’t really want a 12 or 13 year old performing to the point where they are having injuries that could actually impact them as an adult.”

Dr. Goff admits this subject quickly places him on his soapbox. But it’s because he sees so many of his patients facing stress and are simply not happy.

He sees them come in with dark circles under their eyes and behind closed doors and just one-on-one with him, they admit to a different story than what they have been telling to their parents.

Far too often, Dr. Goff hears the regrets of parents, but only when it’s too late. The child has gone off to college and the parent wishes they had taken a trip to the Grand Canyon with their family, instead of racing off to another game.

“I ask the parents to leave the room so I can talk to the child,” Dr. Goff said. “I ask, ‘Do you really want to do this?” They say, ‘No I’m tired.”

The scary part of this story is that far too often the parents are trying to do what’s best for their child, but in reality they are doing harm.

Dr. Gray said he is beginning to see injuries in children as young as 8 years old with ACL injuries. Injuries that were once thought not to happen until children were much older.

“Another problem is that the really good, young kids are getting left behind,” Dr. Gray said. “They are burned out because they are pegged to be the superstar and they get over worked, over trained and over pushed. Some get burned out and pushed to the wayside and other kids, who were not as big, catch up by the time they are in middle school. They have more passion and they are not burned out. And they pass them by.”

Both Dr. Gray and Dr. Goff also see phantom injuries – muscle aches or headaches. Anatomically there seems to be nothing wrong with the child. In reality it’s the child hinting he or she needs a break.

So what should a parent do? Here’s a start:

• During the year give the child down time and a chance to recuperate. This is the case physically for sports and mentally for school.

• Vary the child’s routine to avoid burnout

• Give your children an opportunity to tell you if they are enjoying themselves.

“It’s easy to succumb to parental peer pressure,” Dr. Gray said. “Parents are afraid if they don’t do something their child will be left behind. What’s most important is that your children enjoy sports, or enjoy their activities and has a good mental outlook on life. It’s hard for parents to not live vicariously through their children. It’s a hard lesson for parents. You want the best for your child and want your child to be successful. But sometimes less is more.”

a) Nails on a chalk board.

b) 6 a.m. alarm clocks.

c) Your child’s teeth grinding.

Sorry that there’s no “all of the above.”

Around 25 percent of kids grind their teeth at some point. It most often occurs at night but can occur during the day (usually they are not conscious that they are doing it.) The most common ages are from 7-10 years and most grow out of it without any problems arising.

We don’t really know the cause of teeth grinding although it has been linked to stress and one study showed it to be more common in kids who talk in their sleep or wet the bed.

Most children do not have complications related to grinding their teeth. Some complications that have been reported are: jaw pain, headaches (more common in adults) and damage to teeth.

Treatment for teeth grinding can be very frustrating as there are no quick fixes. Since stress can be a related factor, try to have open dialogue with your children about factors that could be causing them stress. Mouth guards are not frequently used in children because they are not likely to help and making one to fit is difficult because children grow so quickly.

If the teeth grinding continues, talk with your pediatrician or dentist to see if there are new treatments available.

We have all read books on taking care of ourselves but if you are like me you think that the person who wrote these have no idea what your life is like. Well, I have read some of the latest and greatest coping mechanisms on how to get through this busy season and I can tell you some are pretty farfetched. But one of the most important things I read asked me to look at the holidays through the eyes of a child. Imagine when you were young and the excitement that you felt during this time of year. I wanted to share some of my thoughts on how to accomplish this.

1. Be realistic. Not everything has to be perfect. The memories we want our children to remember are the fun times, not that everything had to be perfect because relatives/friends were coming over. I remember when my parents were coming to visit I cleaned my house from top to bottom. I spent several days making sure everything was spotless and stressed out if things got out of place before they arrived. To tell you the truth my house was never really dirty…it was my issue not theirs. Now that I am older and wiser I would have done things differently.

2. Remember, things don’t have to be the same every year. If in the past few years you spent three days baking because this is “what your mother did,” or because everyone likes your cookies, it’s time to make a change. Think about what cookies people like the most and focus on only one of two different kinds. This is easier than making 10 different batches, and spending days in the kitchen. I was never a baker but I did try every year to bake sugar cookies. This was a fun time for me and my boys. I remember rolling out the dough and them cutting out shapes to put on the cookie sheet. I got smart later and bought store bought dough and icing. We still had as much fun making our cookies as we did making them by scratch.

3. Then there’s holiday shopping. If the thought of fighting traffic and standing in long lines stress you out, remember that the longer you put this off the worse the situation is going to get in the stores. Try to shop early next year, if you can, and maybe go late at night or early in the morning. Most stores have extended hours, but please be careful if you are going out by yourself. Also for next year, some stores now have layaway so even if you can’t afford to purchase all the gifts, you can put them on layaway and get them out closer to Christmas Day. I would put the kids to bed; kiss my husband good bye and head to the store with my good friend. We had so much fun out late at night by ourselves and didn’t have to fight the weekend shopping rush.

4. Please enjoy the season. When you are working at home, play a holiday CD and sing along with it. I remember as a young child my mom playing “I saw mama kissing Santa Clause” and her singing along with it. To this day if I hear this song those childhood memories come flooding back.

5. Decorating our homes can also cause us added stress. Think about what is important to the family, what has always been the family tradition and pick one day and get it done. I always tried to make this a fun time for my family when my boys were young and I hope they have good memories of us putting up the tree. Our tree was never perfect, but it was decorated with love each year.

6. One of the most important things to remember is to take some time for you. We are generally so rushed during the month of December we tend to forget about ourselves and spend all our time and energy focusing on everyone else. One of my favorite things to do during this time of year is to read a Christmas romance novel. These generally are less than 100 pages long and are just “feel good” books. I love to grab a blanket, my book, and a hot cup of coco and lose myself for a few hours. I love a good Christmas romance novel. Just makes me feel good.

7. Now, all that grocery shopping. I am not one who generally makes a list, but this time a year I try to do this. I hate to forget something and have to go back. This takes some planning and thinking ahead. Again, most stores have extended hours and this may be a good time to hit the grocery stores. Preparing for our holiday dinners has always been a stressful time for me. I don’t like to grocery shop, and I get disturbed at the prices of some items. I am a very frugal person so I don’t mind buying the store brand. Most of the times these products work well and nine times out of 10 no one know’s the difference.

8. Now what about holiday cards? This is one area that I am not very good at. I love to get cards from family and friends, but generally find myself writing my cards and not mailing them, or putting it off to the last minute and then it’s too late to get them in the mail. My sisters all write Christmas letters. I generally can’t remember what I did yesterday let alone for the past year. One suggestion that I read is to purchase the cards as soon as they show up in the stores…for me this would be when I need to purchase stamps too. Start by attaching your return address sticker to the cards, and place stamps on them. Now when you have a few minutes address and sign a few cards at a time. You might not want to seal the cards until later. This way you can go back and jot a note if you want to. If you run out of time you just seal the cards and get them in the mail.

9. Now for the hard stuff. Don’t let the holidays become an excuse for you to overeat. I know that when I overdo it I tend to be unhappy with myself, and find that this habit only adds to my stress. Try to remember to get plenty of exercise and drink plenty of water. If you know you are going to a holiday party, try to eat a healthy snack before you arrive, this way you won’t overeat after you get to the party.

10. My final suggestion is to just have fun. Remember our kids are only young once and the memories we are making today will stay with them always. Please take time and enjoy your family and the holiday activities. Don’t let the outside demands take away your holiday spirit. Readjusting our thinking and taking time for ourselves and families can help you have a less stressful holiday season.

About the author

Allyn Cary is the manager of Social Work. The social worker’s focus is on the family. They work with doctors, nurses and other hospital staff to make sure the patient's and family’s needs and concerns are addressed so that the child’s ongoing health care needs are met. Social Workers have specialized training to assist families in times of physical, emotional, and financial stress. They are well informed about available resources in the community so they can support families in need.

Just in time, a new study released online in Pediatrics (the journal of the AAP) describes the risk of depression in fathers of young children (0-5). They started following males in adolescence and followed them for 23 years using a depression scale to document their level of depression.

The scales asked some fairly pointed questions regarding depression. Here are some examples:

• Were you were bothered by things that do not usually bother you?
• Did you feel depressed?
• Did you feel you were too tired to do things?
• Did you not enjoy life?
• Did you feel that people disliked you?

I found the results very interesting:

During the first 5 years of their child’s lives, fathers showed a 68 percent increase in depressive symptoms.

Does this surprise you or not?

While the study did not specifically describe the rate of depression in the immediate period after the baby was born, I would suspect that many of these depressive symptoms began to emerge during that time.  I have done this new parenting thing a few times (3 times in 5 years).  Having a new baby in the house is incredibly exciting and brings so much unspeakable joy. However, that joy comes with many changes.

I never felt that my symptoms rose to the level of depression but there were, at times, feelings of sadness and loss. Let’s walk through some of the reasons and some potential solutions.
 

Loss of routine
I am a man of routine and consistency.I like waking up, having a cup of coffee, reading and getting ready to go to work. Staying home with my wife for a week after our babies were born was very important to me but I did start to miss my routine.

Try to keep some semblance of your normal routine if possible. Remember that your sleep at night will likely be broken up (I was always the water boy for my breastfeeding wife and the post-feed burper and rocker) so you might want to get to bed earlier than normal so you can keep your morning routine in some form or fashion.

Loss of autonomy
When you got married you might have realized that your decisions were no longer just about yourself anymore. For me, having a baby is that feeling, on steroids. You suddenly feel guilty for wanting to do anything for yourself anymore as if in some way you will miss something or will be needed and not be there.

It sounds like a line from a self-help book, but remember that in order to be a good provider, you have to take care of yourself to some degree first. Find some time to do something by and for yourself at least every few days. For you, that might look like going for a run or going to read a book at Starbucks. But, whatever it is, take a little time for yourself.

Loss of intimacy
Yes, I do mean in the physical way (those OBs and their rules - seriously follow those rules). But, it’s much more than that. All of the sudden, you realize that those deep conversations you had with your wife (that you might not have thought were important) are less frequent. You are both tired and have a singular focus that tends to dominate your conversations (When was the last feed? Did I start on the left or right side last time? Is this yellow, runny stool normal?)

Try to find the time and energy to start one deep conversation per day. One great conversation starter in this time period can be: “How are you doing with all of this?” Don’t settle for, “Fine.” Ask deeper questions. Then, after you’ve taken the time to hear mom out, you’ll probably get a chance to share some things yourself. You’ll be glad you did.

The overlying concern for these feelings is that you might begin to feel guilty about having them. You know in your brain that this time is supposed to be one of the happiest times of your life. This tension is common and normal. It might be helpful to seek out other fathers whose advice you feel you can trust to talk through it. They may have more specific advice that will work better for you. The important thing is to resist the urge to tough it out and do it on your own.

Ultimately, you may feel that you are passing over from feeling a little down to actually feeling depressed.  If you have concerns about this, it’s best to seek out professional help from your doctor or a counselor.

It’s that inevitable time of year where I see news story after news story where children are rewarded Oprah-style for their awesome record of perfect attendance:

“You get a bike and you get a bike and you get a bike.”

Yeah!!  It’s pretty heart-warming and exciting, right?

There are kids (and families) that blew their perfect attendance the first week of school and didn’t think twice about it, but there are some that are holding out hope that maybe this year will be their year to win the drawing for $100 or an iPad or a trip to Hawaii (I haven’t actually seen this one, but I want my kids to go to that school) or whatever their school dreams up.

I do have a question though. Is perfect attendance really the point?

You need to be at school to learn. I get that. Missing school for frivolous reasons is harmful to the student and the school. So incentives to get kids to school make sense from that standpoint. But, at what cost?

There is a tension going on right now in the minds of parents throughout our community. It might go something like this:

“He’s only coughing a little bit.  He did get a few hours sleep last night. His fever is only 101 and if I give him Tylenol® maybe he won’t have fever at school.”

Does this sound right?

Has this line of thought ever happened in your house?

Do you think it really happens at other houses?

I can assure you it does. Parents say something like this all the time, “Well, he was having fever last night, but I gave him some Motrin® this morning so he hopefully wouldn’t have one at school. But sure enough, he did and the nurse called me to pick him up.”

This clearly misunderstands the whole point of not wanting your child at school if he has fever. Not having fever is not the goal. Keeping your child away from others when they are sick is the goal. Whether your child’s fever is masked by medicine or not doesn’t make them less contagious.

What can we do about it?

What if we changed the goal from perfect attendance to responsible attendance?

Perfect attendance implies that you go to school no matter what.

Responsible attendance implies that you go to school when it is appropriate and don’t when it isn’t.

Perfect attendance puts your child’s classmates health at risk.

Responsible attendance puts your child’s and their classmate’s health above another goal.

I am an optimist, but not unrealistic. I’m pretty sure that we can’t change the school’s policies regarding perfect attendance awards.  Besides, how would you reward responsible attendance anyway?  But, we can make a decision to practice responsible attendance with our kids and teach them to do the same.