Stress and Kids

It is clear that everyday stress in the 21st-century Western world is high. As adults, we often think of “stress” as a reaction to a traumatic event such as losing a loved one or being fired from a job, as well as from the pressures of everyday life including meeting deadlines in a high-paced work environment, personal relationship difficulties, and the all too common “glorification of busy.” In children, stress also presents from different situations including traumatic life events, difficulties with family and home life, and pressures from school and social life.

In a recent publication on childhood stress by the National Center for Injury Prevention and Control and the Centers for Disease Control and Prevention, stress is described as “internal or external influences that disrupt an individual’s normal state of wellbeing. These influences are capable of affecting health by causing emotional distress and leading to a variety of physiological changes. These changes include increased heart rate, elevated blood pressure and a dramatic rise in hormone levels.”^[1] The primary hormone that is considered in the stress response is cortisol, a hormone released from the adrenal glands. Cortisol has a positive function in our bodies and is essential for many physiological mechanisms. However, harm arises when cortisol becomes too high, remains high for too long, or does not appropriately decrease during the day. High levels of stress and cortisol have been associated with many adverse health outcomes including:

• Suppression of the immune system, increasing risk of infection and other health conditions.^[1]
• Mental health disorders, such as anxiety and depression.^[1]
• Metabolic syndrome and type 2 diabetes.^[2]
• Damage to the part of the brain called the hippocampus, which is responsible for learning and memory.^[1]
• Headaches, indigestion, fatigue, and muscular tension.^[3]

In young girls, high cortisol is associated with anxious behaviour, while in boys it is associated with more aggressive behaviour.^[4] Many of these conditions are on the rise in the pediatric population, and this may be in part due to stress levels. It is important to realize that not all stress is bad. The term “positive stress,” as it relates to children, often involves a new experience such as meeting new people or starting at a new school, and can manifest in feelings of anxiety and physical symptoms such as an increase in heart rate. With the help and guidance of adult caregivers, the child should be able to appropriately manage and overcome the situation, which teaches the child situational management and coping techniques. This is positive stress and is essential for normal childhood development.^[1] Starting the discussion about stress when children are young is essential, as it helps to acknowledge and normalize these unpleasant feelings, and it provides a gateway to learn healthy coping mechanisms which can be carried into adulthood. There are many techniques that can be used to reduce stress in children, some of which are discussed here.

Yoga

Yoga is a physical and spiritual practice that has multiple components including physical postures, breathing techniques, and spirituality. The practice was started in India over 2000 years ago, but has only gained significant popularity in Western society in the last 20 years, and is now being used an adjunctive therapy for various medical conditions. For children, it can be used as a way to connect with their body, cultivate mindfulness, as well as teach breathing techniques that can then be applied to other areas of life.^[2] Significant research showing the benefits of yoga for adults exists; however, as we often see, similar research in children is lacking. However, one recent study examined the impacts on stress of a ten-week yoga program implemented in a second- and thirdgrade classroom, consisting of thirty minutes of yoga from a qualified practitioner once a week, for a total of ten weeks.^[5] Salivary cortisol was collected and measured for each student at each session. After 10 weeks of the weekly yoga sessions, there was a statistically significant improvement in salivary cortisol levels in the second-graders. In addition, subjective questionnaires by the classroom teacher showed improvements in children’s behaviour including attention span, self-esteem, and ability to deal with stress. Although this was an isolated program and may not be generalizable to all pediatric populations, it’s groundwork that yoga is not only beneficial for adults, but can be adapted well for children and shows positive outcomes. Many yoga studios are now offering specific children’s classes, and some even offer more specific classes that focus on different health conditions. If a parent is familiar with yoga, practicing basic breathing exercises and postures, and helping children implement them during specific times of stress, can also be a way of incorporating yoga principles into a child’s life.

Guided Imagery

Guided imagery is a mind-body technique that is used to help the participant generate a mental image or visualization for a specific health outcome. It is typically led by a qualified practitioner, either in a one-on-one or group setting, and often used as a series of sessions. Images generated by the participant can either be general relaxation images, or more specific such as an image of healthy eating habits or positive behavioural changes. Research using guided imagery has been conducted in adults, with positive outcomes on work-related stress, anxiety, pain, and infertility. One recent study used guided imagery in obese adolescents, and looked at markers of stress as well as blood-sugar control.^[2] During a twelve-week program of weekly guided imagery sessions, salivary cortisol was significantly reduced by approximately 38% after each relaxation session. Interestingly, this study also showed that the greater the cortisol reduction, the greater the reduction in insulin, an important marker for blood sugar regulation, as well as the sessions resulting in a decrease in sedentary activity and increase in moderate physical activity. From a practical standpoint, this study also demonstrated that this type of intervention was well-received by adolescents. They enjoyed the exercises, and many applied the technique to acute situations in other aspects of their life; a very promising point for future research. Despite the sparse research in children, the use of guided imagery in adults as well as the promising results of the study discussed above show that this technique can be very beneficial for stress reduction in children. Guided imagery teaches children a very specific tool that can be transferred to other types of settings, particularly acutely stressful situations.

Nature Therapy

Surveys have shown that kids spend about 50 hours a week on an electronic device, and almost 90% of their time indoors.^[6] “Nature deficit disorder” is a term coined by Richard Louv in the book “Last Child in the Woods.”^[7] Although not a medically diagnosable condition, it is the idea that humans’ shift to increased time indoors with less time spent in outdoor green space is contributing to a number of different health conditions including behavioural and attention difficulties as well as emotional distress. “Vitamin N” (N is for “nature”) incorporates many different types of exposure to nature, including simply time spent outdoors, time in parks and green spaces, contact with plants, having plants inside the home, and even viewing images of nature.

Nature seems to act as a buffer for stress in children. When children experience a high stress life event, levels of psychological distress are 30% lower in children that live in a “high-nature” environment compared to children who experience a similar stressful situation but live in a “low-nature” environment.^[8] A high-nature environment includes the indoor environment such as outdoor views from within the home, as well as live plants inside and the immediate outdoor environment surrounding the home. This is an important study, because it shows that children do not need to live in the country surrounded by acres of forest to receive the benefits of nature, but small changes such as having plants in the home are also very beneficial. Here are some other highlights of research on the connection of nature and stress:^[9]

• Completing a stressful mental task while in a garden environment produces lower levels of cortisol than when the same activity is done indoors.
• Having plants in a room reduced stress response in subjects that watched an emotionally stressful video. The results were even greater with flowering plants.
• Going for a walk in a forest showed greater reductions in cortisol levels following the exercise, compared to a walk of the same duration on a treadmill. Improvements were also seen in blood pressure, mood, and fatigue.
• Doing activities in green spaces has repeatedly been shown to improve attention and concentration in children diagnosed with attention deficit disorder.
• Further information on other health benefits of nature can be found at http://www.naturopathiccurrents.com/articles/health-and-nature

Incorporating Stress-Management Techniques

Stress in children is often overlooked and downplayed by adults; however, stress is very present in the pediatric population and is associated with significant health implications. It is important for parents, health-care providers, and educators to recognize and address the role of stress in children. By starting this conversation when children are young, we can begin to foster the idea of the mind-body connection and teach our children healthy ways of managing stress that will serve them well in the future. In addition to incorporating yoga, guided meditation, and nature therapy into children’s lives, many other ways of reducing stress not discussed here also show significant benefits. These include—but are not limited to—professional counseling/therapy, recreational sport, art therapy, progressive muscle relaxation, and music therapy. Not all children will resonate with every technique, so it is important to try different approaches and nurture what seems to work well for each individual child. By beginning early, we will provide tools to handle stress in children’s current lives while providing life skills to manage stress in a healthy way in the future, and ultimately lead to healthier, happier adults.