“Sometimes there is something that you know isn’t healthy or makes you feel uncomfortable, but you still want to do it anyway because everyone else is going to do it and you don’t want to miss out. It’s really hard.”
It is my best attempt to have the first, of what I expect will be many, many conversations along this line as a parent: Exploring that conflicting feeling of both wanting and not-wanting to do something at the same time. I’m kind of sad that it is starting so young.
I give bad news as a doctor too often. I hate doing it. It makes it no easier to give bad news to my children. The stakes are lower – no life or death here – but somehow, the guilt of discussing unpopular parenting decisions feels the same.
Helping our children/teens make healthy decisions isn’t easy. Not by a long shot. And these conversations are never one-and-done.
If you are wondering where this came from, one of my sons was invited to go see a film which is simply not age appropriate. IFCO is a good guide, but also my parenting view of what is right for my child based on independent film reviews and what I know of my child. Note: It’s obviously an appropriate choice for the other family, who know their own child’s limits. Mine just doesn’t like scary stuff (not yet at least – he’s quite a bit younger than the 12A rating of the film.) He knows doesn’t want to see the film, but he also wants to hang out with his friends.
These aren’t easy conversations to have. However, especially when it comes to media and screen time, it has become more important to consider mental health. And part of that is to look after what are children/teens are exposed to in media: body image, substance use, relationships, sexuality, promoting stereotypes or violence. For those with anxiety, even a limit on media covering news/current events might be recommended.
I have had a good number of adolescent patients in my years of practice, so I promise you it is from experience when I say the influence media can have on so many aspects of physical and especially mental health is big. And too often it is negative effects, unfortunately.
Since it’s on my mind today, let’s Talk Anxiety in Children: what does it look like, what to watch out for, when to ask for help, and what you can do while you are waiting for help? [Note: this is a long read. If you would prefer the audio version, it’s available for free on Spotify.]
Firstly, does anxiety look like in a child?
Sometimes, it’s really obvious: your child is always worrying or having negative thoughts, or is feeling tense or is extra fidgety. Other times, they are finding it hard to concentrate. Some children have trouble sleeping or have nightmares. Your child may also be not eating properly or complain of tummy aches. Anxiety can also look like anger: so your child may be irritable or have out of control outbursts. Some children have change in how often they use the toilet. Your child may be tearful or clingy.
Sometimes, there is a clear reason, like a major life change (moving school or home). But sometimes the reason is less clear.
If you are concerned, always talk to your GP to get expert help.
What are things you can try while you are waiting for help?
Set aside time to be alone, one-on-one, with your child every day. (No screens!) This can be as little as 10 minutes. Any activity that is enjoyable for the child: drawing, going outside, playing.
Make an effort to praise your child.
It’s always worth asking your child what’s worrying them. You can also try setting aside a worry time, especially before bed, can help. Depending on your child and their age, this can be talking, writing, or drawing worries. Sending worries to a worry monster, worry doll, or fairies might help. You can also try telling them that it’s your job as their parent to do the worrying for them.
Get creative. If you are follower for awhile, you might have read about my own experience with this in the bad days of the Pandemic. (SokCorona, btw, is still kicking around our house!)
What else can you try?
Practice deep breathing and muscle relaxation. All of my real life patient know that I recommend Insight Timer. The app is free, and has a children’s section. Try doing it together with your child. This may take repeated tries – it’s not easy even for adults to do!
Model positive self talk for your child. When s/he says “I can’t do this” re-phrase with them “I can try this…”
Help them learn to think of a safe place, such as their bedroom, when they are feeling scared.
Praise them for being brave when they try their best to do something that scares them.
So, these are things I often focus on when supporting my teen patients, but it’s important for all ages. I promise, it makes a difference:
Get moving! Your child – and teen! – needs 60 minutes of vigorous play. Being less active can impact physical and mental health.
Eating healthy meals every day, including fruits and vegetables, whole grains, and protein foods can really help. Reduce processed foods, and foods high in salt/sugar.
Sleep. Did you know? Studies have shown many Irish school children do not get enough sleep. School-aged children need 9 to 12 hours of sleep every night, and teens need 8 to 10 hours. If you do nothing else – get all screens out of your child/teen’s room at night.
Limit screen time, and carefully consider what your child is watching. It seems obvious to avoid scary or violent TV shows, video games, and movies. However, children less than 7 years old, in particular, can have trouble figuring out exactly what is real and what is imaginary in cartoons. It’s obvious if you think about it: if the amazing sea creatures in Octonauts are real and places in Go-Jetters are real, than why aren’t the story lines that have giant bees or ghosts in Alvin and the Chipmunks? (yes, I’ve really had that discussion with my own children, so…) Also be aware of what is on in the background of the home: The kitchen radio news update may have stories about assault or war to be overheard (often out of context) by little ears. Television ads during sports while you run to the kitchen may depict domestic violence or trauma (for example, that powerful RSA ad depicting 4 y.o. Ciarán’s death is excellent but targeted at adults.).
Set up family routines. Follow a regular schedule. This is key. Routine is security for children, and gives a sense of control. Knowing what to expect can help your child feel more secure.
School anxiety?
Talk to your child why it’s important to go to school. This may not work, but start there anyway. Be gentle, but stay firm. Let’s be honest – this is really non-negotiable even if your 6 year old doesn’t really understand that.
Consider talking to your child’s teacher to make an action plan about what to do if your child asks to go home from school early.
If you know there is disruption in the home, reassure your child that it’s okay if they are struggling in school. Talking to your child’s teacher may really help here. Keep the goals realistic – this includes the goals the child sets for themselves.
Is organisation part of the stress? Always forgetting something? Help your child get more organised, and include double-checking their homework, PE, etc. in your routine. Phone reminders (for you) are a great hack here! (Every week, my phone reminds me when it’s PE day at 7am!)
Reward your child’s brave behaviours at school. Ideally, the rewards for anxiety should not be more screen time or just things. Spending time doing something fun with a parent can be really important when we are talking about anxiety.
When it comes to your child’s health, mental or physical, you are their voice. So whether it’s at school or the doctor’s office, don’t hesitate to speak up on behalf of your child. This also means that your child deserves expert advice and treatment. However, despite advocating, it will remain a fact that CAMHS waitlists are big. Even private play therapists have waiting lists. So…
Do you need to go back to the GP?
Yes, if your child’s anxiety doesn’t go away or gets worse. Your GP might have some other strategies or discuss other resources. You GP can also help support your mental health.
Really Important: Look after your own mental health. This is like the airline safety briefing: always put your own oxygen mask on first before assisting your child. Parenting can be stressful. Children pick up on the stress and worries of adults, so getting support for yourself can help your child too!
Separation anxiety by age? Separation anxiety can start earlier, but really can kick in around 9 months. Some children wait until toddlerhood, so the separation anxiety outbursts can be impressively loud and energetic. Pre-schoolers with separation anxiety are aware that you are upset, so may include begging you not to go.
Expert tips (your child-minder or creche-worker likely will tell you these – they’ve seen it all!)
Kiss me quick: Be creative, be affectionate – but keep the good-bye short and sweet. If you linger, the anxiety lasts longer, it doesn’t get better.
Same ol’, same ol’: Try to do the same ritual at the same time each day.
Put away that phone!!: When saying goodbye, give your child full attention and affection (btw – do this at pick up, too!)
Keep your promises. Don’t say things like “I’ll come back early.” Or “I’ll stop by to visit you.”
Your child can’t tell time: Explain when you will be back on their terms, such as after snack time or after nap time.
Practice being apart. Even short breaks – even an hour – with Nana can help prepare a child to be away from you. Before starting creche or preschool, you can practice going to school and practicing your special good-bye ritual before you even have to part ways. It’s rare that separation anxiety persists on a daily basis after the preschool years. Before going to pre-school, T. and I read Maire Zepf’s Na Gach ar Scoil! Which is available in English and Irish in your library (ask your librarian for help.
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