Stress in childhood

Stress may be a response to a negative change in a child's life. In small amounts, stress can be good. But, excessive stress can affect the way a child thinks, acts, and feels.

Children learn how to respond to stress as they grow and develop. Many stressful events that an adult can manage will cause stress in a child. As a result, even small changes can impact a child's feelings of safety and security.

Pain, injury, illness, and other changes are stressors for children. Stressors may include:

• Worrying about schoolwork or grades
• Juggling responsibilities, such as school and work or sports
• Problems with friends, bullying, or peer group pressures
• Changing schools, moving, or dealing with housing problems or homelessness
• Having negative thoughts about themselves
• Going through body changes, in both boys and girls
• Seeing parents go through a divorce or separation
• Money problems in the family
• Living in an unsafe home or neighborhood

SIGNS OF UNRESOLVED STRESS IN CHILDREN

Children may not recognize that they are stressed. New or worsening symptoms may lead parents to suspect an increased stress level is present.

Physical symptoms can include:

• Decreased appetite, other changes in eating habits
• Headache
• New or recurrent bedwetting
• Nightmares
• Sleep disturbances
• Upset stomach or vague stomach pain
• Other physical symptoms with no physical illness

Emotional or behavioral symptoms may include:

• Anxiety, worry
• Not able to relax
• New or recurring fears (fear of the dark, fear of being alone, fear of strangers)
• Clinging, unwilling to let you out of sight
• Anger, crying, whining
• Not able to control emotions
• Aggressive or stubborn behavior
• Going back to behaviors present at a younger age
• Doesn't want to participate in family or school activities

HOW PARENTS CAN HELP

Parents can help children respond to stress in healthy ways. Following are some tips:

• Provide a safe, secure, and dependable home.
• Family routines can be comforting. Having a family dinner or movie night can help relieve or prevent stress.
• Be a role model. The child looks to you as a model for healthy behavior. Do your best to keep your own stress under control and manage it in healthy ways.
• Be careful about which television programs, books, and games that young children watch, read, and play. News broadcasts and violent shows or games can produce fears and anxiety.
• Keep your child informed of anticipated changes such as in jobs or moving.
• Spend calm, relaxed time with your children.
• Learn to listen. Listen to your child without being critical or trying to solve the problem right away. Instead work with your child to help them understand and solve what is upsetting to them.
• Build your child's feelings of self-worth. Use encouragement and affection. Use rewards, not punishment. Try to involve your child in activities where they can succeed.
• Allow the child opportunities to make choices and have some control in their life. The more your child feels they have control over a situation, the better their response to stress will be.
• Encourage physical activity.
• Recognize signs of unresolved stress in your child.
• Seek help or advice from a health care provider, counselor, or therapist when signs of stress do not decrease or disappear.

WHEN TO CALL THE DOCTOR

Talk to your child's provider if your child:

• Is becoming withdrawn, more unhappy, or depressed
• Is having problems in school or interacting with friends or family
• Is unable to control their behavior or anger

Fear in children; Anxiety - stress; Childhood stress

American Academy of Pediatrics website. Helping children handle stress. www.healthychildren.org/English/healthy-living/emotional-wellness/Pages/Helping-Children-Handle-Stress.aspx. Updated December 29, 2020. Accessed April 29, 2024.

American Psychological Association website. How to help children and teens manage their stress. www.apa.org/topics/children/stress. Updated October 19, 2022. Accessed April 29, 2024.

American Psychological Association website. Identifying signs of stress in your children and teens. www.apa.org/topics/stress/children. Created September 5, 2019. Accessed April 29, 2024.

DiDonato S, Berkowitz SJ. Childhood stress and trauma. In: Driver D, Thomas SS, eds. Complex Disorders in Pediatric Psychiatry: A Clinician's Guide. St Louis, MO: Elsevier; 2018:chap 8.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.