How to help your stressed or anxious child & when to see a professional

How do you help young children cope with anxiety and distress, and how do you know when it is time to seek professional mental health help?

If children are distracted from talking about their fear and anxiety, they often become preoccupied and feel alone with their worries. Educational psychologist, Junior June Manala explains how caregivers can help children manage distress – as written for The Space Between Us.

Anxiety and distress in young children

Parents and primary caregivers are the most important people in children’s lives in the early dependent years. It logically follows that stressful relationship environments are deeply felt by all children. Unfortunately, emotional distress is not often talked about, yet babies and toddlers (like other children) are highly attuned to shifts in their caregivers’ emotional states, verbal tone, facial expression, and movement.

Infants and young children are immensely affected by stressful situations, and if the stress is chronic, it can impact their developing brain neural connections. In fact, toxic stress can actually change a baby’s brain chemistry and their overall development trajectory. (Graham Music, Sue Gerhardt,)

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Signs & symptoms of anxiety and distress in infants and young children

Signs of distress or anxiety to watch out for in kids may include, but are not limited to, the below. Pay particular attention to these symptoms if they occur suddenly or are out of the ordinary.

• Crying
• Refusal to feed
• Lack of eye contact
• Hiccupping
• Possetting (spitting up small amounts of milk after it has been swallowed)
• Screeching sounds
• Clinginess
• Pale or reddish skin pallor
• Eczema
• Respiratory problems
• Sleeping problems
• Anger

At times, too much activity in the arms and legs of a newborn is an indication of distress. In this case, gathering the infant, wrapping them up nicely and speaking softly to them can have a calming effect.

Adolescents grieve loss just like adults and may hide their vulnerability by isolating themselves or turning outward for peer group support more than usual. Teenagers may also engage in risky behaviour to mask or numb their emotions.

Amazingly too, neuroscientists e.g., Dan Siegel, 2013 writes that adolescence is a period of major brain growth that can enhance creative thinking if adults can engage and listen. If we consider behaviours as the language of children that needs to be translated into words, then we are well on the way to teaching our children to connect their feelings-in-the-body with their behaviour. This helps soothe, calm, or relax the central nervous system that is operating in a fight-or-flight-or-freeze mode.

What are some of the causes of anxiety or distress in children?

Many responsible parents take particularly good care of their children’s practical needs such as feeding, grooming, etc., but what often gets neglected is attention to a child’s emotional needs. As a result of the emotional neglect and unmet attachment needs, distress can arise.

Some situations that may cause anxiety in children are:

• Unrealistic demands of children beyond their age and capability. For example, infants do not understand death but respond to loss and separation of a loved one by protesting it. Some young children might search for the person in their usual places.
• Children aged 7-8 years old may not understand the permanence of death and regard the deceased as sleeping. Seeing the loved one in a coffin and attending a burial leaves the child with worries as to how the loved one will “get out” of the box.
• In many African cultures’ children are protected from seeing corpses. They may come to understand death as an emotionally charged situation, where main caregivers are preoccupied in their grief, which can be overwhelming for children. This leaves memories and experiences that are not processed since adults often find it hard to speak to children about death.

The vast body of knowledge by neuroscientists Antonio Damasio, Jaak Panksepp, Allan Shore among others, indicates that we can intentionally build our children’s brains and resilience to toxic stress from pregnancy through the first two and half years by attending to feelings, naming them, and allowing for their expression.

The way we hold our children, look at them, speak to them and respond to their inborn natural attachment needs is learned and stored in our children’s brains.

What can I do to reduce the risk of distress and anxiety at home?

Parents need to remind themselves that they want the best for their children and that parenting is hard, especially when faced with a pandemic, which brings sudden change and the loss of loved ones.

The idea of “good enough” parenting is quite freeing. Parents might need to be reminded of self-care, which is what they need to recharge their emotional cups. Another reminder is that there is no such thing as perfect parenting. This helps to reduce some of the pressure parents face.

Thoughtfulness and intention to be a good parent includes paying attention to the following:

• Noticing your response is the first step towards being emotionally available to yourself, and creating moments for self-care to refill your emotional energy.
• Having a support system helps in generating a blanket of warmth and care in difficult times.
• Being calm helps you transmit the same calmness to your children.
• Maintaining consistency in caregiving routines such as feeding and bedtimes.
• Asking for help and cooperation from your children, such as tidying and putting away things in the home.
• Avoiding activities that are likely to heighten stress and anxiety i.e., long hours of watching and listening to violent movies or long periods on social media. Create spaces for play or talking or storytelling that soothes rather than arouses anxiety.

What are the key things I should do to help my child with their distress?

Remembering that you are bigger, stronger, and wiser than your child will help you to find your calm. This is contrary to complaints that young children or infants are controlling and manipulating their parents. Remember that infants and young children’s brains are not yet sufficiently developed to “control”.

Love your children for who they are, not for how they behave, and encourage them to come to you when they are distressed.

How to comfort a distressed or anxious child:

• Take in your child’s emotions as if you are in their shoes (show empathy) rather than being dismissive of their emotional pain.
• Find your calm and lend your calm to the child (co-regulate through your face and eye contact), use a soft voice and smooth movements to soothe a fearful or upset child. Holding or gentle touching helps to soothe. Children prefer bodily contact.
• When you are sure that you have the child’s attention, help them find their own words to speak about how they are feeling.

As an example, let’s say Mpho is moving from one activity to another without really thinking about what he is doing and why. This is an example of nervous emotional energy expressed as restlessness or hyperactivity. Supposing mum were to gently say, “Mpho, come here,” and held him kindly, lowering her voice and directing kind eyes to him saying, “I can see that you are telling me that you are unhappy inside.” If mum pauses and allows him to really take this in, over time, he learns to connect how nervousness or fear shows in his body. It is likely that mum will notice relaxation in Mpho and he might be able to respond positively in words. Mum will have succeeded in noticing the distress, understanding the language of his behaviour and translating the behaviour into words. This process is co-regulation and soothing for Mpho.

How do I, as a parent, know when my child needs to see a mental health professional?

When distress disrupts the normal functioning of the child and the family it is a call for help, particularly when the caregivers have tried everything without success. It will then be time to seek professional assistance.

For babies and young children under the age of five, help can be sought from parent-infant psychotherapists such on Gauteng Association for Infant Mental Health South Africa (GAIMHSA); Ububele African Psychotherapy and Training Centre; Grow Great runs Flourish prenatal and postnatal programmes.

For children and adolescents, telephonic help is available from Lifeline or the South African Depression and Anxiety Group. Public schools have school-based support teams that can assist children. Some universities offer counselling services to communities at minimum costs or for free.

Private practitioners such as clinical social workers, counsellors and psychologists are available at a cost.