The happy-go-lucky days of childhood are not always what they seem. Kate Holmquist examines the effects of stress on the young
Children don't live in a happy bubble, ignorant to the normal stresses of life. But while we seem to talk ad nauseum about the stresses of combining parenting and career, rarely do we focus on the stress of being a child in our new, high-speed, high-achievement culture.
"We're seeing worrying increases in anxiety and depression among children," says John Sharry, psychotherapist in the Department of Child and Family Psychiatry at the Mater Hospital, and one of the creators of the Parents Plus programme.
"Children are mirrors to adults. When adults are rushing around from one commitment to the next, it's the same experience for children," he says. In his role as adviser in the VHI, Sharry has found that children's anxiety is the number one concern for parents.
"I think it's a very, very big issue. There are stressed-out children who are able to tell parents how they are feeling, because their parents are tuned in, but some kids just don't know what's wrong."
Even babies and toddlers experience stress reactions. A UK study of children who left full-time care in the home for nursery at the ages of 11-20 months revealed double the normal levels of the stress hormone cortisol in the children's blood, lasting for as long as five months after the transition to nursery. The higher cortisol levels remained long after the children appeared, on the surface, to have adjusted.
An obvious cause of stress in children is grief, whether it is caused by natural disaster, the death of a close family member or their parents' marital separation. But usually parents themselves are so overwrought that they cannot see their children's suffering.
"This isn't another thing for such parents to feel guilty about. We always tell parents that they must look after themselves before they can look after their children," Sharry says.
Children are acutely sensitive to the stress of their caregivers. The World Health Organisation, in its guidelines for adults working with child survivors of Hurricane Katrina and other disasters, warns that children may feel more stressed from seeing the reactions of the adults around them than from the disaster itself.
As Martina Murphy of the National Children's Nurseries Association puts it: "If the parent is stressed when they drop their child to nursery in the morning, they're going to be leaving behind a stressed child."
In ordinary life, the specific causes of stress may be unclear and parents may see children as being "bold" or difficult, when in fact the child is stressed out.
Children aged five years and younger are particularly vulnerable to changes in their day-to-day routines and may respond by becoming disobedient, aggressive, withdrawn or throwing tantrums. Bed-wetting and fear of the dark can arise as part of an ongoing stress reaction, or some time after a stressful event.
Older children, aged five to 11, are more sensitive to the reactions of those around them and tend to regress when they are stressed, becoming either withdrawn or disruptive, experiencing difficulty concentrating in school and even forgetting new skills. From the age of 11 to about 14, children tend to withdraw or rebel, develop irrational fears and have various physical complaints which have no medical basis.
Boys and girls feel similar levels of stress, although they may express it differently.
Stress is a part of life, so helping children learn to manage it is an important skill for parents to pass on, but this can be difficult when the parents themselves do not realise that their own stressful, ambitious lifestyles are part of the problem.
Penny Gundry, a parenting coach and stress management trainer with Parenting Plus, says that many parents she works with resist seeing how their own materialistic values are creating stress in their children.
"These are the anxious parents who can't understand why their children aren't calm. Some parents are rushing around from the moment they get up in the morning until the children are in bed. These are parents who are paragons of organisation and find daily life a real struggle because the house has to be perfect.
"I'll say to these parents, 'something has to go. It would be healthier if you could let the house go a little.' But some parents just can't do that. They want to be the model mother and are desperate to impress."
At meals, such parents may watch every mouthful a child takes, turning what should be enjoyable family time into a food battle. Then, when the children develop eating issues, the parents seek help for the child.
"A key to handling family stress is to turn off the TV and make the meal fun. The food doesn't matter. It's all about enjoying each other's company."
In the good old days, says Sharry, "mother was a homemaker and Dad came home at 5.30pm after a hard day at the office. There was time to chill and relax together. Dad could help with homework."
The situation now, as Gundry describes it, is that parents rush in the door at 6.30pm or 7pm and, reunited with their children after a long stressful day, they run around like headless chickens as they frantically prepare a meal and school lunches for the next day, do laundry, tidy up, supervise homework and order children into bed.
"All the time, mother is thinking, 'if only they'd go to sleep so I can sit down and watch telly and have a break'," Gundry says.
Such parents wonder why their children are acting up, refusing to go to bed and engaging in all sorts of ingenious attention-seeking behaviour. "It's quite sad, but parents just can't see it," says Gundry.
Her prescription starts with a child-centred routine which includes children in the preparation of a simple meal, talking over the food rather than analysing its consumption, the parents setting the record-button for Coronation Street or whatever else they wish to watch after the children's bedtime. Then a 40-minute bedtime plan follows with teeth-brushing and pyjamas, next a 20-minute fun play period with parents, then parents reading a story.
"In houses that have this routine, you see the children getting all excited about putting their pyjamas on because they know it means some funtime with their parents," Gundry says.
Having everything ready for school the next day in advance, including lunches, uniforms and homework, is an important part of the routine because it makes children feel secure.
"If the child is dropped off to school after a morning of a parent screaming at them to hurry up, of course the child is going to feel stressed," Gundry says.
When children are old enough to articulate the stress they are experiencing, parents taking time to listen and not react in a stressed way is the first priority, says Sharry.
"How parents respond matters from the word go. Naming and appreciating the child's feelings starts with reflecting back feelings at the age of one or two, saying 'you are sad' or 'you are cross'," he says. Usually children are aged five and older before they can describe for themselves how they are feeling.
Whatever the age, the parent can help the child to articulate what they are feeling, by reflecting the child's feelings - not the parent's - back to the child.
The parent needs to determine what the precise issue is and provide support, but this can be overwhelming for an already stressed-out parent.
Rather than jump in with a solution, such as "We're going in to talk to that teacher first thing in the morning!", the parent needs to take a middle ground and think carefully before acting, Sharry advises.
But even in the most child-friendly, relatively stress-free home, a child may experience undue stress due to experiences that are happening outside it.
The Irish Sports Council, in its Code of Ethics of Good Practice for Children's Sport in Ireland, warns that children can experience "burnout" when an activity that was once a source of fun and personal satisfaction, becomes associated with physical and psychological distress.
For example, parents need to watch that children are not pressured to perform at a level beyond their maturity or capacity, that they don't over-train and don't play while injured.
Whatever the cause, an increasing number of children have anxiety which is severe enough for parents to seek help from services such as the Mater's Child and Family therapy unit, which serves the northside of Dublin.
The first stop anywhere should be the GP, who can refer parents to public services or recommend a private therapist. Waiting lists as long as two years in some Health Service Executive areas are a barrier for many families. In other areas, waiting times are five to six weeks.
"Often just one appointment can make a big difference," Sharry says. "The parent who seeks help is a tuned-in parent."
WARNING SIGNS:
Frequent tummy aches, often severe.
Sleep problems.
Fear of going to school.
Irritability and tantrums.
Lack of energy, frequent illness.
No pleasurable anticipation of participation in activities.
Tearfulness, sadness.
Accident proneness.
Nervous mannerisms (foot tapping, teeth grinding, hair pulling, etc).
Changes in eating habits.
Helping children deal with stress
Avoid too many activities and build "down time" into the day.
Tell the school how the child is feeling.
Spend 20-30 minutes per day doing a gentle, fun activity with your child.
Be positive with your child so that they feel more positive about themselves.
Use travel time in the car to listen and talk.
Give plenty of love and physical comfort.
Praise the child for little things as well as big things.
Relaxed meal-times with the TV turned off can be used for sharing feelings
about the day.
Children tend to blame themselves when things go wrong, so need reassurance that when things go wrong, such as family break-up, it's not their fault.
Avoid rushing in the mornings and prepare the child before leaving the house, letting them know five minutes before that it's time to go.