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Your Child

Different Ways for Kids to Handle Stress

2:00

If you’re alive (and of course, you are) then you’ve experienced some form of stress.

Stress can be minor, more like annoyances that add up. There’s mid-level stress that can give you a bad day, but doesn’t hang around much after that. Then there is chronic stress; the kind that can affect your health and wellbeing.  There’s also varying degrees of stress between those three layers.

Experiencing stress begins early in life and for some kids can be devastating, depending on the circumstances.

However, stress isn’t always a bad thing. It can also be a motivator or make you aware of your surroundings. It can help you find solutions to difficult problems. It is normal and even healthy for children to experience some stress, according to the American Academy of Pediatrics (AAP). How well kids handle stress depends on how much support they have from others and strength inside them.

Stress cannot be totally eliminated, but it can be managed.

Sometimes medications are given to kids and adults to help reduce stress – but there are other methods that are definitely worth looking into.

Exercise:  Physical activity is a great stress reducer. The body not only benefits from exercise, but so does the brain. Studies show that it is very effective at reducing fatigue, improving alertness and concentration, and at enhancing overall cognitive function. This can be especially helpful when stress has depleted yours or your child’s energy or ability to concentrate.

Scientists have found that regular participation in aerobic exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem. Even five minutes of aerobic exercise can stimulate anti-anxiety effects.

Yoga: Many children do yoga to get rid of stress, pain and health problems. Yoga uses breathing and body postures to connect the mind and the body. It also helps kids manage feelings and how they act, and yoga is good for kids with anxiety, attention-deficit/hyperactivity disorder and other mental health conditions, according to the AAP.

Yoga is actually good for the whole family. It’s a good way to connect with the body, mind and emotions while sharing some peaceful time together.

Clinical hypnosis: Hypnosis can help children with irritable bowel syndrome, abdominal pain, and anxiety before surgery and cancer. Not to be confused with the act that entertainers use to put people into a trance-like state; trained specialists help children through hypnosis in a medical setting. Kids are asked to tune out their surroundings to change their feelings about something.

Sometimes doctors use clinical hypnosis along with guided imagery. This therapy uses all of the senses: sight, hearing, taste, smell, touch and movement.

Meditation: Children can improve their attention span and learn how to focus better with mediation.  Some schools have found that meditation helps reduce absences and negative behaviors and improves kids’ self-esteem. One study found that students in an urban school were less stressed out after participating in a school mindfulness meditation program.

The AAP has a 10-point “Personal Stress Plan” form that can be downloaded at (http://bit.ly/2aop7IR). It is a series of questions with options for personal development. The questions are a good way for parents and kids to talk about the impact stress is having and what they can do to manage it.

Most of the methods mentioned above for reducing stress, were once tagged as “alternative” medicine. Today, they are much more mainstream and are providing families with good options for reducing the stress in their lives.

Story sources: Trisha Korioth, http://www.aappublications.org/news/2016/08/22/PPMindBody08221616

https://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/physical-activity-reduces-st

 

Daily Dose

Your Child's Emotional Health

1:30 to read

It seems that half of my day in the office was spent with children and their parents who were dealing with anxiety.  I am concerned as I am seeing younger patients who are presenting with symptoms of anxiety which may include difficulty sleeping, recurrent tummy aches or headaches (without physical findings) and school refusal.  While pediatricians are trained in taking care of sore throats, rashes, coughs and colds, there doesn’t seem to be enough training in dealing with mental health issues in children. Unfortunately, mental health issues are becoming more and more prevalent and a part of almost every pediatricians practice.

 

The American Academy of Pediatrics (AAP) has recently released its first policy statement entitled “guidance for nonpharmacologic mental health care”. In other words, looking for methods to help children with emotional and behavioral problems, both of which may impact a child’s growth and development.

 

There is a growing body of evidence that supports “family-focused therapies” for improving emotional, behavioral and relationship problems for all aged children.  Some studies estimate that 7%-10% of children face emotional or behavioral problems, and at times I feel that this number is actually much higher. Regardless, these issues have a huge impact on both a child and their family and if they persist may have long-lasting effects and consequences.  

 

I am so appreciative of parents who are honest with me and are open to discussing nonpharmacologic therapies for addressing initial behavioral and emotional concerns in their children. While some parents are wanting “a drug” to improve (fix) their child’s symptoms, many parents understand that the best way to approach these issues may be with other mental health services. These may be provided by trained counselors and psychologists who use play therapy, cognitive behavioral therapy, and family therapy to improve a child’s mental health and well being.

 

I am a big believer in early interventions to help teach a child how to deal with their feelings and emotions when they are sad, angry, frustrated, anxious or over whelmed. As adults we may “have figured out” how to deal with these emotions, but in many of the children I see, their parents have some of the same issues that may also need to be addressed.  You know, “the apple and the tree” theory is still true…children are a product of their genetic material and mental health issues are often familial. As stated in the AAP guidelines (the airplane analogy), “parents need to put on their oxygen masks first, before they can support their child in a sensitive, patient and consistent  manner.” 

 

Remember that your pediatrician is “your partner in parenting” and discussing emotional and behavioral concerns is part of the relationship.  Don’t avoid a needed conversation. 

 

 

 

 

 

  

Daily Dose

Anxiety & Kids

1.30 to read

There isn’t a day that goes by that I don’t find myself talking to a patient or a parent about anxiety. I see patients as young as 4 years old who are “anxious” about sleep, school or after school activities. I also see plenty of high school students with the same concerns.  It doesn’t seem to be getting any better either, as I think more and more of my patients visits are often related to stress and anxiety rather than to strep throat or an ear infection. 

This begs two questions: How did stress and anxiety become so prevalent and how do we change it?

If I knew the answers to that I could write a best seller!! But I do think I have some ideas.  Some of the stress and anxiety that our children feel at an early age may have some roots in genetics. Anxiety seems to have a genetic predisposition but is it all inborn?  Can you change some of a child’s early reactions to situations by the way a parent reacts?  I think that the answer is yes. 

Very young children pick up on parental cues. For example, I had a young mother who recently came in and was worried because her 14 month old son was being “pushed” in play group and he would sometimes even fall down. She was tearful while she was talking about this and at the same time she was guarding his every move in the exam room. No falling in here!   

I asked if the other mother’s were appropriately talking to their toddlers who had done the pushing and she said they had, but it was just “too much to bear”. She was not going to go to play group (they might not invite her back) if he was going to get pushed. I could feel her anxiety flowing to her newly walking son.  

Another patient recently brought her child in due to recurrent stomach aches.  After getting a good history and talking about the tummy aches with the child directly, it seemed as if they might be due to stress and anxiety. The mother then began to talk about her own stomach aches and how debilitating they were for her and all of the tests that she thought should be run.  This conversation was in a bit too much detail for an 8 year old to hear. After a minute or so the little boy said, “I think my tummy aches feel better when I talk about them to my feelings doctor”.  Hmmm....wish the Mom would have let me know that bit of information earlier.  Mother’s anxiety being passed to child?

So.... when appropriate try to “down play” the falls or tummy aches of child hood.  Lot’s or reassurance that “it will be okay, or let me kiss it and make it better” often works wonders.     

Daily Dose

Anxiety Can Happen At Any Age

Why are so many kids filled with anxiety and stress?This was a hectic week in my pediatric office. I was busy answering voice mails, emails, "tweets" and it is interesting to me that most of my messages are related to children with anxiety.

Why are we raising such an anxious group of children? Is it that the "gene pool" has changed or is it just societal? I really think that it is due to our society as a whole, we are on the fast track to creating the next generation of "stressed out" adults, even more so than ever, if that is even possible!! I will just walk you through my voice mails, as it really is interesting that my phone messages are from parents with children of all ages. There is the preschooler who won't get dressed in the morning for school due to a constant tummy ache. There is an elementary school child who is having problems sleeping every night, and a tween who is getting tics when she gets anxious at school. I also take care of a large number of college students and I have two patients who left college after their first semester as they were anxious and depressed while being away from home and did not go to class and therefore did not make their grades. In each case the parent is calling to ask what to do? I only wish I had all of the answers!! I will get on that proverbial "soap box" and go out on a limb and say that after practicing pediatrics for 25 years the problems that are related to behaviors in our children are much bigger issues than anything else. We have made great strides in disease prevention, but we are definitely not preventing emotional issues in our children. Being a parent and a child seems to get only more difficult each year. Was that the way it always was? Did our own parents think we were anxious and "stressed out"? I don't even think that was a word in the 60's, 70's or even 80's. Just the same way that everyone now says, "I am busy running errands", (I know I never heard my mother use that term), our kids talk about "stress" from very young ages. Do we as parents put that pressure on them from an early age? I know that my new parents feel "stressed" that their baby does not sleep through the night by two to three weeks, and say "what are we doing wrong?" Answer, nothing, infants are not supposed to sleep through the night at that early age. Don't set the bar so high so early! I have parents of toddlers who worry that their child cannot jump as high as their friend's toddler (I don't even know how high that might be, are their standards for the playground?). I must say it just goes on from there. I know we parents are supposed to worry, but I think that constant worry is creeping right into the skin of very young children and it is "causing" anxious children. Yes, some children are just born that way, but most are not. I am not saying that a little bit of worry cannot be beneficial at times. It is okay to "worry" about doing well in school, or making new friends, or misbehaving and getting punished or eventually how to get into college and "what will I do with the rest of my life". But balancing a little worry with constant anxiety is become more difficult. Most of my referrals are no longer to the orthopedic surgeons for broken bones, but rather to psychologists and psychiatrists to help children and adolescents deal with anxiety. There are even recent articles regarding the fact that there are not enough pediatric psychiatrists to care for the burgeoning needs in the pediatric population. I wish I knew the answers, but I really do think that we can change things, be it ever so slowly. Getting back to the basics of "down" time with family and friends, rather than lessons, tutors, and Kumon math for 3 year olds! How about less time on computers and phones and more time spent face to face talking. How about listening to our children rather than having them watching DVD's on the way to school or while out at dinner with the family. So many little things that we can all change may make a difference. We have to start trying something different, as what I am seeing now is not "the happy go lucky" children of years gone by. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Don't Let Christmas Chaos Overwhelm You

It is the night before Christmas and I think I am feeling like many mothers (and fathers) out there, overwhelmed!! Each year I try to plan to have a “calm” holiday with an organized gift list, and everything wrapped early so that our family may spend quiet time together today in anticipation of Christmas.

Why is it that I have failed again? Not only are we in the midst of Christmas preparations, but we also have a wedding in just seven days. If you could see my “office” right now, you would be surprised that I could even blog today. The top of my desk is strewn with journal articles, rehearsal dinner seating charts, year-end CME (continuing medical education), and lots of ribbons and gift enclosure tags. I am not even sure what goes with what; I hope I don’t send in the seating chart for my CME hours! I am also decorating the mantels with fresh garland, arranging flowers and trying to keep the new puppy (old post) from eating the Christmas ornaments and the fresh greenery. While I am doing all of that I must tell you that the sons are either asleep, watching TV or working from home and “cannot be bothered”. It is at this time each year that I know I have “FAILED” as a mother. The visions of family singing carols beside the tree that they helped decorate, are a figment of my imagination. This is when I think it must be different if you have daughters. Do girls rally to help their mothers with the preparation of Christmas? Do they come and ask to help decorate the tree (if they are older than eight), or are they dying to learn to tie a bow on a gift? About this time while I am in a major reflective mood, a precious patient of mine who is now a freshman in college, drops by to deliver a coffee cake and at the same time admires the berries that I am using to decorate. It must be a different world with girls. So, on this Christmas Eve, I wish that I could tell you “all is calm”, but I think I still have a lot to get done before I sleep tonight. I am sure that mothers and fathers everywhere feel the same way, and that is what is wonderful about parenting. We are all in this together. By Christmas morning it will somehow all get finished and the family will get to gather together to open gifts, have Christmas breakfast or lunch or dinner and hopefully appreciate how fortunate we are to be a family. For those precious moments it does seem “perfect’ and I am thankful for that. I will take many pictures to remember these times together. I wish you a Christmas morning of memories after a chaotic week.  Merry Christmas.

Daily Dose

Kids Are Stressed Out!

1:30 to read

Gone are the “lazy days of summer” and with school back in session the words “stress” and “anxiety” slowly creep back into the day to day language of many families.  In fact, a recent national We MD survey about children and stress found “that most parents rate school and friends as the biggest source of stress in their kids’ lives”.  The survey also found that “72% of children have negative behaviors linked to stress, and 62% have physical symptoms such as headaches and stomachaches”.

So, after reading this survey it only served to confirm what I have been seeing in my practice for years….very anxious, worried and stressed children of all ages.  I can attest to the fact that it is definitely affecting younger and younger children. Much of my general practice now involves more psychiatry than infectious disease (thank goodness for immunizations!).

I have watched younger and younger children come into my office and talk to me about “worries” over tests, reading levels and how they will possibly “get to college”.  Remember the days when you did not know what a SAT or ACT was until you were in the 11th grade? There was no test prep either, other than your parents telling you “you need a good night’s sleep and breakfast”, and  then they handed you 2 number 2 pencils as you walked out the door!!  Just last week an 8 year old patient of mine told me about his recent birthday party and playing video games.  He followed up by saying, “school starts in 2 days and my Mom says I cannot play video games of watch TV during the school week this year”.  I really didn’t think that was such a bad idea, but he then told me the reason was that he “had failed his ERB tests!!!”. He then went on to explain, in great detail I might add, that these had just been “practice ERB’s” and that his reading comprehension was “below grade level”.  He said “next year in 2nd grade these tests count so he was worried about doing well then.”  School had not even started yet!

I also received an email this week from a patient who said her son had just started  back to school 2 days previously and he was having anxiety and not wanting to go to school. He is in middle school at a rigorous private school and had already been diagnosed with ADHD when he was younger, and is on medication.  She and her husband were now having “issues” about how to deal with his anxiety, which was causing the entire family stress. They really “did not want to change his school”.  Not a good way to start off the school year. 

Much of the anxiety I see may also be related to just being “over scheduled”.  Children of all ages need some “down-time” to just “chill”, relax, kick back and even get a bit bored.  With schools piling on more and more academics at younger and younger ages, and then throw in competitive sports for 3-4 year olds….what are we thinking?  Of course children will get burned out and stressed…they are just developmentally too young for some of this.  Not all children are ready to read when 4-5 years old, or ready for athletic practices 2-3x/week. Some children as young as 8 have athletic events starting at 8 pm, when they should be in bed.

Sadly, I know that I will begin to see my fair share of headaches, tummy aches, and “I just don’t feel well” in the coming weeks. It may be time to re-evaluate where our society is heading.  

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