Stressed-Out Kids

Ulcers. Migraines. Panic attacks. Are today’s pressures slowly killing our children?

Every day in my practice I see at least one child suffering from physical symptoms of chronic stress. Teens with chronic headaches, eight year-olds with recurrent abdominal pain, a three year-old with a bleeding ulcer. What’s going on?

Some have blamed our society’s new obsession with over-scheduling young ones. Judith Warner’s recently hot treatise on turbo-charged moms, Perfect Madness, takes parents to task for pushing their children too hard as a side-effect of martyred motherhood. School and travel sports teams have year-long seasons now, kids are booked several weeks ahead for play-dates, and kindergarteners have homework every night. Whatever happened to play? We used to come home after school, have a snack, and just play. We had time, as children, to settle and relax. Now towns like the one I live in must resort to setting aside one special night a year called, “Ready, Set, Relax.” I encourage you to examine psychologist Kathy Hirsh-Pasek’s work (Einstein Never Used Flash Cards: How Our Children Really Learn – And Why They Need to Play More and Memorize Less) demonstrating the importance of play in child development.

I know, I know, it’s a different world now. As noted in a fascinating commentary in MIT’s Technology Review, the ability to pay “partial continuous attention” is a highly valued skill these days. Parents feel the pressure to prepare their children for the “real world” they’ll face. Globalization forces us to compare our educational systems not only to those of neighboring towns but to those of other countries half-way across the world. I am not so naive as to believe we can turn back the clock and remove all stress from life. Indeed, as Hans Selye noted, stress is not necessarily a bad thing; it is simply “the nonspecific response of the body to any demand.” So we must focus on teaching our children not how to avoid demands per se but how to develop better coping mechanisms.

A few of my favorite mind-body relaxation therapies for kids? One of the most promising and appealing modalities is Mindfulness-Based Stress Reduction, developed by Jon Kabat-Zinn. Jon and his wife Myla have also published a wonderful book on mindful parenting, Everyday Blessings. Goldie Hawn’s Bright Light Foundation provides grant support for programs teaching children the ways of mindfulness. Yoga, guided imagery, biofeedback, music therapy – these too have solid evidence supporting their use in the pediatric population. I’ve included below a small sampling of the robust and rapidly-growing pediatric mind-body literature.

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Anbar RD: Self-hypnosis for management of chronic dyspnea in pediatric patients. Pediatrics 107: e21, 2001.

Anbar RD, Geisler SC: Identification of children who may benefit from self-hypnosis at a pediatric pulmonary center. BMC Pediatrics 5:6, 2005 (www.biomedcentral.com/1471-2431/5/6).

Anbar RD, Hall HR: Child habit cough treated with self-hypnosis. J Peds 144: 213-217, 2004.

Ball TM, et al: A pilot study of the use of guided imagery for the treatment of recurrent abdominal pain in children. Clin Pediatr 42: 527-532, 2003.

Barnes VA, et al: Impact of transcendental meditation on ambulatory blood pressure in African-American adolescents. AJH 17: 366-369, 2004.

Barnes VA, et al: Impact of stress reduction on negative school behavior in adolescents. Health Qual Life Outcomes 1:10 (1-7), 2003.

Barnes VA, et al: Impact of transcendental meditation on cardiovascular function at rest and during acute stress in adolescents with high normal blood pressure. J Psychosom Res 51: 597-605, 2001.

Butler LD, et al: Hypnosis reduces distress and duration of an invasive medical procedure for children. Pediatrics 115: e77-e85, 2005.

Dikel W, Olness K: Self-hypnosis, biofeedback, and voluntary peripheral temperature control in children. Pediatrics 66: 335-340, 1980.

Huth MM, et al: Imagery reduces children’s post-operative pain. Pain 110: 439-448, 2004.

Kohen DP: Applications of relaxation/mental imagery (self-hypnosis) in pediatric emergencies. Int J Clin Hypnosis 34: 283-294, 1985.

Kohen DP, Olness KN: The use of relaxation-mental imagery (self-hypnosis) in the management of 505 pediatric behavioral encounters. J Dev Behav Pediatr 5: 21-25, 1984.

Kuttner L: Favorite stories: a hypnotic pain-reduction technique for children in acute pain. Amer J Clin Hypnosis 30: 289-295, 1988.

Lambert SA: The effects of hypnosis/guided imagery on the post-operative course of children. J Dev Behav Pediatr 17: 307-310, 1996.

Olness K, et al: Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine. Pediatrics 79: 593-597, 1987.

Pederson C: Effect of imagery on children’s pain and anxiety during cardiac catheterization. Journal of Pediatric Nursing 10: 365-374, 1995.

Sahler OJ, et al: The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation. Alternative Therapies 9: 70-74, 2003.

Scharff L, et al: A controlled study of minimal-contact thermal biofeedback treatment in children with migraine. J Pediatr Psychol 27: 109-119, 2002.

Sugarman LI: Hypnosis: helping children help themselves. Contemp Pediatr, November 1996.

Wild MR, et al: The efficacy of hypnosis in the reduction of procedural pain and distress in pediatric oncology: a systematic review. J Dev Behav Pediatr 25: 207-213, 2004.

Youseff NN, et al: Treatment of functional abdominal pain in childhood with cognitive behavioral strategies. JPGN 39: 192-196, 2004.

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  1. Addendum:
    I just rediscovered this article from the Archives of Pediatric and Adolescent Medicine estimating a whopping 25% drop in free-play time for today’s children compared to kids twenty-odd years ago.
    ABSTRACT:
    Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect.
    (Burdette HL, Whitaker RC: Arch Pediatr Adolesc Med 159:46-50, 2005)
    We have observed that the nature and amount of free play in young children has changed. Our purpose in this article is to demonstrate why play, and particularly active, unstructured, outdoor play, needs to be restored in children’s lives. We propose that efforts to increase physical activity in young children might be more successful if physical activity is promoted using different language-encouraging play-and if a different set of outcomes are emphasized-aspects of child well-being other than physical health. Because most physical activity in preschoolers is equivalent to gross motor play, we suggest that the term “play” be used to encourage movement in preschoolers. The benefits of play on children’s social, emotional, and cognitive development are explored.
    PMID: 15630057

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