Recognizing Stress in Children

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This is an article from our “Doctor’s Corner” series, brought to you by Samitivej Hospital. Make sure to read the entire series!

A disaster is frightening to everyone. Several factors play an important part in a child’s reaction to the event. Children will be affected by the amount of direct exposure they have had to the disaster. If a friend or family member has been killed or seriously injured and/or the child’s school, home or neighborhood has been destroyed or severely damaged, there is a greater chance that the child will experience difficulties. Adults can help children grieve by patiently listening and being able to tolerate feelings. This is a major factor in a child’s perception of adults’ reactions to the disaster. Children are very aware of adults’ worries most of the time but they are particularly sensitive during the period of a disaster. Acknowledging your concerns to the children is important, as is your ability to cope with stress. Another factor that affects a child’s response is his/her developmental age. Talking about the disaster together using words children can understand is important, as is being sensitive to their different responses.

Recognizing stress in children

Preschool children will cling to parents and teachers and will worry about their parents’ whereabouts. School-age children whose homes have been damaged by a fire may express the fear that life isn’t safe or fair, whereas adolescents may minimize their concerns but fight more with parents and spend more time with their friends. It is important to listen to children’s individual concerns and to be alert to signs of difficulty.

Children are the most vulnerable population. Times of disaster and trauma increase their vulnerability. Recognizing children’s symptoms of stress is not easy. Some stress reactions may include the following:

  • Sleep disorders
  • Persistent thoughts of trauma
  • Belief that another bad event will occur
  • Conduct disturbances
  • Hyperalertness
  • Avoidance of stimulus or similar vents, i.e., boating, swimming, baths, traveling
  • Moving
  • Regression, thumb sucking
  • Dependent behaviors
  • Time distortion
  • Obsession about the event
  • Feeling vulnerable
  • Excessive attachment behaviors

Extension professionals, parents and caregivers can work with child care providers to help them understand that parents who are under stress may not be able to provide enough love and affection for their children. Some of this lack of affection can be supplemented in child care settings.

There are multiple factors that determine how to negotiate stress with children.

Child’s developmental level

Elementary school children in the developmental stage of accomplishing and feeling competent may not progress well in school. This is an interference in development. Research indicates that the stage of identity development (usually in adolescent and teen years) can be hampered if fear is pronounced.

Latent reactions observed in children experiencing the Buffalo Creek flood in New York was depression, powerlessness, vulnerability, difficulty distinguishing fact from fantasy, fear of separation, and chronic anxiety.

Child’s perceptions of family reactions

Sometimes, anxiety in children can be attributed to anxiety in parents. Children who realize that their parents are powerless (the inevitability of flood waters for example) are fearful. Erikson suggests a loss in the belief of adults’ power results in the questioning of adult authority in other instances and may manifest itself in juvenile misconduct.

Collaboration between parents, care givers, social workers has worked in the past. Meaningful adaptations in children’s environments will aid in their feelings of security.

Expected Reactions of Children and Adolescents to Disasters

  • Refusal to return to school or child care. This may emerge up to several months after the disaster
  • Fears related to the disaster (i.e. the sound of wind, rain, thunder, sirens, etc.)
  • Sleep disturbances persisting several months after the disaster, manifested by nightmares and bed wetting
  • Misconduct and disobedience related to the disaster reflecting anxieties and losses that the child may not be talking about may appear weeks or months later
  • Physical complaints (stomach aches, fevers, headaches, dizziness) for which no immediate physical cause is apparent
  • Withdrawal from family and friends, listlessness, decreased activity, preoccupations with the events of the disaster. Many children may be confused or upset by their normal grief reaction. Children have reported that they do not feel enough support from adults during a disaster
  • Loss of concentration, irritability
  • Increased susceptibility to infection and physical problems related to the disaster

The most common psychological disturbances found among children who have lived through a disaster include: anxiety disorders, sleep-disturbances, phobias, depression and post-traumatic stress disorder.

Children proceed through a variety of stages following a trauma. The following stages have been identified as stages one might expect following a disaster.

  • Terror – Exhibits for children through crying, vomiting or bodily discharge, becoming mute, loss of temper, or running away
  • Rage, anger – Adrenaline release, tense muscles, heart rate increases
  • Denial – Adults may exhibit denial differently than children. Some behaviors include feeling numb, blocking off pain and emotion, dreaming, feeling removed from experiences, or no feelings at all. Children may withdraw into uncustomary behavior patterns. One study reported avoidance and resistance to participating in art therapy by not drawing anything related to the actual disaster (Newman, 1976). Behaviors may appear non-responsive and be overlooked
  • Unresolved grief – Unresolved grief could move into deep depression or major character changes to adjust to unresolved demands of grief and trauma. A child may stay sad or angry, be passive or resistant
  • Shame and guilt – Children do not believe in randomness and may even feel at fault after a disaster. Shame is one’s public exposure of vulnerabilities. Guilt is private. There is a need to resolve these feelings, regain a sense of control, gain a new sense of independence and feel capable

The effects of trauma in childhood can be found both immediately and after a long period of time. Trauma changes those involved. Knowing what to look for in children can lead caring adults to seek professional assistance.

Behavioral Signals

Generally the world for small children is predictable and stable served by dependable people. Any disruption in stability causes stress. The two most frequent indicators that children are stressed are CHANGE in behaviors and REGRESSION of behaviors. Children can change their behavior and react by doing things that are not in keeping with their usual style. Behaviors seen in earlier phases of development such as thumb sucking and regression in toileting may reappear. Age groups differ in reactions. For example, loss of prized possessions, especially pets, hold greater meaning during middle childhood. Of concern to adolescents during/after a major disaster is the fear related to own body (intactness), disruption of peer relationships and school life. Adolescents feel their growing independence from parents and family is threatened. At this time, it feels different since the family needs to pull together during this time and less independence is allowed.

Samitivej, We Care!

For further information, please contact:

Child Health Institute
Samitivej Sukhumvit Hospital
2st Floor, Building 2
Tel: 66 (0) 2711-8236-7
Call Center: 66 (0) 2711-8181
E-mail: info@samitivej.co.th
Facebook: www.facebook.com/samitivej

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