“I think I’m having a heart attack,” Maryam said calmly to her parents one night. “I can’t breathe.” It had been just a few weeks since ten-year old Maryam found out she would be leaving everything she knew behind and moving to a new country. The routines and monotony of daily life, which she had grown accustomed to, were soon replaced by big brown boxes and talk of their new home in a Kuwaiti desert compound. For Maryam, a shy introvert, the thought of leaving her school and her friends overwhelmed her with sadness. Yet, she was intrigued by her parents’ excitement, so one evening Maryam picked up a booklet they often referred to which described Kuwait, the desert compound and the available amenities. To her horror, she came across a page with the word “Warning” sprawled across the top. She read the text carefully, making a mental note of the instructions to ‘be careful and alert, to report suspicious activity and to stay within designated safe areas to avoid potential land mines and bombs’. It was not long before Maryam lost her appetite, had trouble sleeping, and began experiencing chest pain and distressed breathing.
Maryam ended up in the Emergency Room that night with an oxygen mask covering her mouth and nose. After a thorough check-up, doctors were unable to identify a physical cause for her symptoms and suggested that she was experiencing stress-related panic attacks. Maryam’s story raises a number of questions: Do children experience stress for similar reasons and exhibit similar symptoms as stressed adults? What role does stress play in child development? What can parents do to manage or diffuse the stressors in their children’s lives? To better understand childhood stress, I spoke with Noha Alshugairi, a licensed Marriage and Family Therapist and Certified Positive Discipline Trainer from Newport Beach, California.
JE: Maryam was a healthy child with no prior physical, psychological, or emotional problems. What happened to her and why?
NA: Children ages five to twelve years are concerned with three major questions: Is the world safe and dependable? What am I capable of? How does the world operate? Any causes that lead to negative perceptions in these three major areas will lead to stress. In Maryam’s case, the warnings she read about threatened her sense of safety and further fuelled her anxiety about moving. Another example is if a child is born to a depressed mother who is not taking care of herself and is constantly unavailable; the child may grow up believing the world to be unsafe and undependable because his or her basic needs are not being met.
JE: Do children experience stress for similar reasons as adults?
NA: Children’s needs are concrete and limited to their immediate world. They lack the ability to understand long-term consequences of events and actions, and hence they are not likely to worry about the same issues that worry adults. That being said, children will pick up on their parents’ anxieties or react more strongly to trauma if their parents do. Caregivers send cues to children about what is safe and what is not. It is therefore important that adults monitor the issues they discuss and the manner in which they discuss them when children are present.
JE: Maryam exhibited several physical symptoms of stress. Is this common among children?
NA: Children’s symptoms in reaction to stress manifest in several ways depending on the child and the family context. They include physical symptoms such as stomach and headaches, bedwetting, and loss of appetite. Concentration and behavioural problems, regression in the accomplishment of milestones, nightmares, and feelings of guilt and anxiety are also common. Some children may exhibit intense clinginess when separated from caregivers while in others the opposite will occur in the form of disconnection and detachment from important figures in their lives.
JE: Are there any benefits to childhood stress? For example, does stress help to build resilient children, capable of better coping with future stress?
NA: If what we mean by childhood stress is that which is related to normal child development such as worries about a test, a game, or a relationship with a friend, then these stresses can be a significant source of resilience if parents teach healthy coping skills. Resilience is built when children sometimes succeed and sometimes fail. If a parent is pushing a child to study hard and never finds the child’s efforts satisfactory, then this situation is not conducive to building resilience. If there is an expectation that the child needs to achieve every single time, then this child will grow up seeking perfection which could lead to stress and anxiety. However, if the parent is encouraging the child to study to the best of their ability and then is comforting no matter what the test results are, then this could be a source of resiliency. I must emphasise that defects in basic childhood needs for safety, belonging, and love do not build resilience; they lead to pathological problems.
JE: What three things do you recommend parents do to prevent and manage stress in their children?
NA: First, routines, routines, routines. I cannot emphasise the importance of having a consistent routine. Routines provide structure, safety and dependability. If a child is aware and knows what to expect in his or her daily life, this child is less likely to feel stressed and anxious. Routines are not always easy for parents to follow and implement. Nowadays, parents are so busy scheduling every minute of their child’s day to the detriment of the child. Routines need to include some downtime where kids are free to do what they like to do. Second, consistent care-giving. It is critical for healthy development that a child is cared for primarily (meaning most but not necessarily all of the time) by one adult. Changing the care-giver of a child frequently disrupts his or her sense of security and his ability to attach to people which leads to stress and anxiety. Finally, love and affection. Nothing can reassure a child more than knowing he or she is loved unconditionally. Parents beware: loving them conditionally, meaning “If you do this the way I told you to, I will love you” is a source of anxiety and stress for children, not to mention that it distorts their relationships later in life.
It has been seven years since Maryam’s visit to the Emergency Room. Despite her initial anxiety, Maryam remembers her two years living in Kuwait fondly. “It ended up being one of the best experiences in my life,” she says, “but I could not have known that when I was first told that we were moving. I am glad that my parents took my symptoms seriously, reassured me about the move, and sought professional help. I have grown a lot since then. I know how to recognise and manage my stress now – but I still need the support of family members and friends. I think we all do, regardless of our age.”
Jenna Evans graduated from the University of Toronto in 2014 with a PhD in Health Services Research. She is currently a Post-Doctoral Fellow at the Institute of Health Policy, Management and Evaluation where she enjoys conducting research on how to improve the coordination and quality of health care.