“I Can’t Take It Anymore!”
Help for parents on managing childhood stress.
by Sandy Saintonge, M.D.

PARENTGUIDE News May 2006

All of us experience stress when confronted by life’s demands and pressures. Stress is often the result of a perceived negative change or a situation that produces anxiety. As a parent, it is important to be aware of the potential causes of childhood stress in order to anticipate areas where your child may need additional support and guidance. Children are especially vulnerable since they are acutely sensitive to change and do not possess well-developed coping skills and strategies when compared to adults. In addition, they may not be able to adequately identify or verbalize their feelings and solicit help. In very young children, this is compounded by limited comprehension.

The signs and symptoms of stress can vary with the age and developmental stage of the child. The younger the child, the more difficult it may be to recognize signs of stress since the symptoms can be attributed to, and confused with, other causes.

How does stress affect children at varying stages of development?

•From birth to age 3:
When infants and toddlers experience stress, they may become withdrawn, irritable, cry excessively, develop erratic sleep cycles and separation anxiety. Quite often stressors such as a new caregiver, family disruption or parental stress may cause decreased appetite resulting in poor weight gain. Establishing a nurturing environment and consistent routine can help to resolve infant stress.

•Ages 4-11:
Young school-age children may display regressive behaviors such as bedwetting, tantrums and acting out. Parents often respond to these behaviors negatively and may punish their children unnecessarily. If the child had been functioning normally and these behaviors are new, they may be a cry for help. In this age group, declining school performance, inattentiveness and distractibility (which are often associated with stress) can be consumed with attention deficit disorder (ADD). A thorough evaluation by a pediatrician is recommended to differentiate between the two situations. This is important since the diagnosis and treatment of ADD carries long-term implications.

•Pre-teen and teenage years:
Adolescence is a particularly complex and turbulent period as teenagers struggle to define their identity and exert their independence. During this period, normal internal stressors such as the desire for social acceptance, autonomy and emerging sexuality combined with any external stressors can result in a volatile mixture. When adolescents experience stress, they may engage in risk-taking behaviors such as sexual experimentation, alcohol and substance abuse, violence, truancy or become confrontational. This is exacerbated by impulsivity and immature reasoning skills which can be self-destructive. For adolescents, prolonged periods of stress can increase susceptibility to depression. Parents can help their teens navigate through this awkward period by sharing their personal experiences, and providing structure and stability while encouraging incremental steps toward greater autonomy.

•Children of all ages:
Regardless of age, children may show additional stress signs such as changes in mood, sleep habits, appetite and activity level. School-age children and teenagers may have physical complaints such as headaches, stomachaches and chest pains. Although depression occurs less frequently in childhood, it is an important consideration when children exhibit multiple symptoms that cause a significant decline in daily functioning. When symptoms are vague or a specific stressor cannot be identified, a medical evaluation can help exclude an underlying illness or depression.

Children and the different sources of stress
If a parent suspects that their child is experiencing stress, the next step is to have an honest discussion with the child to determine its cause. If an exact cause is not readily identifiable or if the child is incapable of expressing concerns, examine the environment for clues. Some common childhood stressors include:
•attending a new school/moving
•new sibling/sibling rivalry
•divorce/change in family dynamic
•illness/death of loved one
•overscheduling of activities
•unreasonable parental expectations
•peer pressure
•traumatic event/disaster.

How can parents help their children?
In order to manage stress, it is imperative that parents listen to what their child has to say without judgement and be sensitive to their concerns. The parent may have a different perspective and may not agree with the child’s point of view. However, if the child perceives a problem, then it must be addressed. Whenever possible, involve the child in seeking a solution to alleviate stress. Consider engaging in alternative relaxing, fun activities or removing the child from the stressful situation. This can offer a reprieve from the stressor and thereby minimize its effect. If a resolution is unattainable, consider seeking professional help to deal with the issue. The more serious the stressor, the greater the likelihood that counseling may be needed to regain normalcy.

How can childhood stress be prevented?
Parents can help their children avoid excessive stress by providing sufficient resources and support. It can be helpful to encourage relationships that extend beyond the immediate family as a safety net. In the event a difficult circumstance arises, the child has multiple sources for comfort, distraction and reassurance. In addition, it is equally important to encourage a balanced lifestyle that includes healthy nutrition, time for rest, friends and social activities. Activities that improve self-esteem and confidence can help foster optimism in the face of adversity. Maintaining a stable environment and consistent routines, particularly when a change occurs, can be reassuring for a child and make him feel safe and secure.

Many stressors are common and predictable. By anticipating problems, parents can gently prepare their child for new circumstances. For older children, discussing current events can be an effective tool to illicit their fears, giving parents further insight and a forum to practice problem solving. Despite our busy lives and many responsibilities, it is especially important that parents spend quality time with their children in order to remain connected. A strong parent/child relationship with open communication and trust increases the probability that the child will consult a parent during stressful times.

Stress is an unavoidable aspect of life. Overcoming stress contributes to our development and acquisition of problem-solving skills. With some thoughtful effort, parents can guide their children through stressful periods with minimal consequences.

Sandy Saintonge, M.D. is a pediatric attending physician at New York Hospital Queens, the director of the Childhood Obesity Program at NYHQ and Instructor of Clinical Pediatrics at Weill Medical College of Cornell University.