The COVID-19 pandemic has been a rude wake-up call for parents who may have experienced
unemployment, social isolation, financial hardship, fear, stress, and the added pressure of the filling the teacher role in addition to loss of most childcare support. These stressors are significant and sustained, and in effect children have become silent partners in the crisis. As a society, and especially as parents, we are worried about the long- term implications for our children’s mental and physical health.
It’s possible that many parents haven’t spent this much one-on-one time with their children in a while, and as such have developed a new appreciation for teachers, day care staff, coaches, and others whose jobs have been put on hold for the moment. During this time, parents may have had a chance to notice new things about their children, both positive and negative, especially in terms of resilience and coping skills they’ve acquired to meet life’s challenges.
It is a lot to take in and many parents are experiencing fatigue and frustration at the stops and starts of quarantine, mixed recommendations and unknowns, especially with regards to their children’s education. As an initial step in helping their children, adults can do well to simply recognize and acknowledge their own stress, and to realize that children can and do experience stress, even at a very young age.
The problem is that signs and symptoms of stress in children can be tricky to diagnose and seem to be quite personality dependent as well as age dependent. For example, one toddler might act out with temper tantrums while another may retreat to their room. One middle-schooler might demand unending attention while another may turn to risk taking activities, another may become anxious, fearful, and struggle with even slight separation anxiety. All are normal, recognized behavioral stress reactions in children which run the gamut and can change in the same child at varying times.
In addition to behavioral symptoms, children under stress often show physical symptoms. Some of the more common include stomachache, constipation or diarrhea, headache, fatigue, loss of appetite (or the inverse- emotional over-eating). Correct interpretation of these signs and symptoms may require a team approach. Don’t hesitate to contact your child’s pediatrician or health care professional if you feel worried about your child, or out of your depth. One of the most important tools at your disposal as a parent is your inner navigational system, parental instinct. Seek advice if you are worried. Don’t doubt yourself.
An especially confusing element of stress in relation to children is the vocabulary used to describe it. What is stress? How do we explain the concept? In some families, experiencing stress is considered a sign of weakness. How do you approach healthy discussion of a taboo topic? The easy answer is that you start young and ideally the child has acquired a stress-coping skill set from the earliest age – but this is not usually the case.
So, once the radar is up for stress as an explanation for a change in a child’s health or behavior, how do we start to address it? First, examine your own stress behaviors as a parent. What is the typical stress pattern in your family? Did you learn healthy coping skills from your parents, or are you on new territory? Sometimes these patterns can run in families and become the default reaction. An extreme of this example is domestic violence. A less troubling pattern might be headache, or stomachache. Avoidance is common, or missing work, and the child will learn by watching and modeling the parent’s response over time which is worth noting because the opposite is also true. A child will also model healthy behaviors modeled by family from a very early age.
Sometimes rather than trying to explain an intangible like stress to a child, it’s easier to demonstrate the desired opposite outcome. In the case of stress, its opposite is the physiologic relaxation response. By linking the physical sensation of relaxation to an age-appropriate vocabulary, the child can begin, even at a very early age, to associate feeling ‘better’ with certain behaviors. Research has shown this to be true in early preschool children who can learn simple skills such as breath work (belly-breathing, blowing bubbles, counting breaths), brief progressive muscle relaxation or PMR exercises (where muscles are tightened then softened to music or a simple guided script that frames it as an enjoyable game) and other simple interventions that will leave the child feeling happier and more relaxed. This is also a good way to reinforce how thoughts and feelings are tied to the physical body, an early introduction to the power of mind-body medicine. Building a foundation of coping skills well before they’re needed is best, but children are often remarkably quick learners even under duress and can master simple tools quickly at almost any age.
Some parents are challenged by a lack of tools or skills to address their own stress symptoms. They either don’t know what works, or they may feel embarrassed or skeptical learning something unfamiliar like breathwork. This can make it hard to teach new skills to the child, but learning together can be very powerful, especially if approached with a can-do attitude. So, press forward! The research is robust in support of these simple interventions and a parent modeling heathy behavior is the gold standard in triggering behavior change for children. In fact, if a parent recognizes stress in their child it may be the necessary catalyst for addressing it in themselves.
Once the existence of stress is acknowledged and its symptoms recognized, the next step is to do some detective work for triggers. Again, this is very individualized, and the answers may surprise you. Assumptions and guessing are usually less helpful than a simple question and creating space for listening which allows the child time to think and respond in their own way.
“What is worrying you?”, “Can you remember what you were doing when your stomach started hurting?”, “ How is your body feeling right now?”, “Can you tell me more about what was happening when you started feeling bad?” Open-ended questions leading with a ‘how’ or a ‘what’ can be useful and are easy to deliver at an age appropriate level.
Sometimes having school aged-children and teens review their day in ‘detective mode’ can be eye-opening to the parent who is often unaware of the details of how the child spends their time and therefore unaware of major recurring stressors. Some examples are the child who is being bullied in gym class, or who is participating in a daily after school text group chat where anonymity and lack of filters can allow truly vicious social behavior if unsupervised. Identifying triggers is essential and may take some time- but is well worth the effort.
The impact of how adults in the child’s orbit are dealing with the pandemic and other significant societal events in the country, such as racism, is also very important. What information, in what mode and frequency is the child absorbing? Is the radio, television, internet news on non-stop? Is the parent gripped by the newsfeed on their phone? Are family and friends communicating in language a child might take literally, for example “The world is ending”, “The world is on fire”, and so on? If the parent isn’t aware of, or in control of, their own behavior with regard to news and media, the dose of information their child is receiving may be far higher and more harmful than they realize.
So, recognition, awareness, and identification of stress triggers are crucial. The next step is understanding the high-impact behaviors you can substitute to help reduce the level of chronic stress the child is experiencing.
In the case of the COVID-19 pandemic, the answer isn’t to ignore world events, but to be aware of how and what information the child is receiving, then address elements within their control in a confident and positive manner. An example here might be “We are wearing our masks to help keep ourselves and our friends safe and healthy” rather than “We are wearing masks so we don’t get really sick and have to go into the hospital”. Normalizing healthy behaviors, even if they are a departure for all of us such as mask-wearing, is one of the easiest and quickest ways to help a child adapt. We are doing this to be safe and healthy, we care about each other, we are looking out for our neighbors are prosocial behaviors and attitudes that teach and comfort the child and also convey a sense of self-efficacy that helps to counteract the uncomfortable helpless feeling present when uncertainty is high. Introducing a sense of gentle humor can also help normalize a stressful situation, as long as it isn’t used to make an individual uncomfortable. For example, the American Academy of Pediatrics recently suggested putting a cloth face covering on a child’s favorite stuffed animal, decorating masks so they’re more personalized and drawing a mask on your child’s favorite book character as some ways to lighten the mood and make the idea of mask wearing less frightening and more acceptable to children.
Other simple, concrete steps that can anchor the child and counteract anxiety include introduction of a simple routine and rhythm to the day so the child or teen has a ‘blueprint ‘and can manage expectations and fears. This has of course been made exponentially harder by the reality of many parents needing to work from home, and yet is doable in age-appropriate ways and most children crave a sense of routine that conveys safety and security. Non-stop entertainment, unrestricted screen time, or endless activity are not necessary. It is important for children, even from a young age, to learn to savor breaks or ‘quiet time’ where they can learn to relax, read a book or play quietly. This can be associated early on with the vocabulary of relaxation, so the child learns what it means and how it feels to experience the physiologic relaxation response- even at pre-school age.
If possible, try to mirror the routine of the school day and reinforce the sense of growing autonomy the child was likely feeling as they approached the end of the school year - and maintain the expectation that the child will continue to learn and develop in their new normal routine. Of course, a balance of physical activity, healthy use of technology, and outdoor time are included, but there are opportunities now to redirect children and recapture important skills like entertaining oneself, reading, creative projects and exploring the natural world that may have fallen to the side in the rush of modern life.
Involving children in the rhythm of the day is also important so they feel firmly included in the family and provides an opening for learning new age-appropriate skills. For example, simple meal preparation, expanding their repertoire of chores, or involvement in planning or execution of a larger project (cleaning out the garage, planting a garden, caring for animals and so on) can give children a sense of enhanced belonging and pride. Caring for other family members in simple ways such as sending cards or letters, shared games over video chat, story time, helping adults organize grocery delivery to a grandparent, and so on can reinforce the idea that everyone is being creative and resourceful together right now- ‘this is how our family copes with unexpected events- we figure it out and move forward together’. A powerful message to a child looking to parents for reassurance.
In summary, recognizing and correctly diagnosing stress is the first step in counteracting it in children of all ages. And recognizing it in oneself is necessary so that a parent can address unhelpful behaviors the child may be mirroring. Introducing a vocabulary to describe stress and relaxation in age appropriate terms is helpful and teaching simple relaxation skills is achievable even in the very young. Substituting identified stress triggers with high value actions such as creating a routine, building in quiet time, learning new skills, expecting participation in family chores and activities, and encouraging self-efficacy and prosocial behaviors that model strength and resilience will all contribute to a child’s sense of belonging and security. This will help them navigate this, and future, challenges with a greater sense of confidence and optimism. Kids are incredibly resilient, sometimes they just have to be reminded how strong, brave, and capable they already are.
