Mental health in children

Mental health in children
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A young mind has the potential to develop into a masterpiece because of the experiences their significant adults provide. This would include love, reassurance, encouragement, and security etc. BYY’s expert paediatrician, Dr Maraschin sheds lights on mental health in children.

In an article published by Harvard University’s Centre on the Developing Child, I came across this statement: “As early experiences shape the architecture of the developing brain, they also lay the foundations of sound mental health”. Wow! What an incredible picture this statement paints.

The American Association of Psychology explains that a child’s mental well-being is an essential part of a child’s overall health. Just like physical health, mental health will affect how your child thinks, feels, interacts and learns. Our precious children have personalities of their own. Some are shy and withdrawn, others are confident and boisterous, but each one of them will experience fear, anxiety and stress at certain times.

What is important is that we recognise what is age-appropriate and normal and how best to support the child when these feelings arise. The outcome of this insight will help support the architecture of the brain and improve mental well-being through adolescence and into adulthood.

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Why do children experience anxiety?
  • Heightened levels of perceived danger: Fear and anxiety are part of a human’s defence mechanism. We have all heard of the “flight or fight “reaction when we perceive danger. This is a good thing as it often gets us out of difficult situations. In some people, however, this sense is extreme.

For example, one child may spot a spider in their room and simply ask someone to remove it before going to bed. An anxious child may scream and perform while the spider is being removed and then spend the night wide-eyed and terrified that the creature will return and cause serious harm.

  • Circumstances: Other times, circumstances may lead a child to develop anxiety. We saw a lot of this during COVID. Children were taught a lot about COVID, parents listened to devastating reports on the news, they heard of or may have even experienced a loss, and many families suffered financial difficulties. Any one of these factors, even outside of a pandemic, will cause anxiety and trauma in a young child.
  • Genetics: Research shows that children with a parent who suffers from an anxiety disorder are seven times more likely to have anxiety. An anxious parent is more likely to be overprotective and generate fear in children over certain activities. They may also model these behaviours in front of the child, and the child mimics the behaviour.

My mother was the overprotective type. In her world, I would fall out, break my neck and die. Needless to say, I never went near a tree for fear of death. Now, I believe that climbing a tree is a fabulous activity for a child to develop gross motor skills, motor planning, and to get kids away from screens!

  • Social media: Social media is also a major cause of anxiety and depression among children. It is concerning that social platforms have an age restriction of 13 years. Yet, American statistics show that 40% of children 8 to 12 years old are on social media. Brain development is a critical factor to consider when handing a child a cell phone. Social media has been associated with changes in the amygdala, the part of the brain which is crucial for emotional learning and behaviour.

The prefrontal cortex is also affected. Its function is necessary for impulse control, social regulation and moderating behaviour. This means that your pre-teen and teen will be exposed to messages that may increase risk-taking, cause them to experience greater fluctuations in emotions than normal, and cause them to be negatively affected by information, thus damaging their self-worth.

Children aged 10 to 19 are undergoing a highly sensitive period of brain development. It is a time when mental health issues emerge including depression. And as with anything, social media has both positive and negative aspects. It is up to parents to monitor usage and to recognise when their child is isolating themself from real social interaction.

  • Learning difficulties: Learning difficulties are also a major cause of anxiety. Children suffering from a learning difficulty or neurodiverse condition like ADHD or autism will develop anxiety if they do not receive the correct support.
  • Bullying: Please never underestimate the effects of bullying on a child’s anxiety level. It is hard for us to imagine having to go into a situation where we are likely to be physically or emotionally hurt. A child may have to go to school day after day and be confronted with a bully at each break. If bullying continues, it will affect a child into adulthood.

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What is considered normal in terms of fears and anxiety?
  • Between the ages of six months and around three years, it’s widespread for a child to experience separation anxiety. I call this “Mommylitis”. The child becomes clingy and cries when they need to separate from the parent or carers. It’s a very normal stage of a child’s development and usually stops around 2 to 3 years of age.
  • Pre-schoolers may develop specific fears or phobias, like certain animals; the neighbour’s dog, thunder, blood, the dark, insects, water and the doctor are all common. These fears gradually improve on their own with the reassurance of adults and maturity.
  • As children get older, their anxiety and fears shift. A toddler may be terrified of the noise the toilet makes when it flushes for fear that a monster is in the tank. An older child begins to worry about real-life issues like natural disasters, not making friends, death or illness. This kind of anxiety spikes around the age of 7 or 8 when children begin to understand their world better, and realise that many things cannot be controlled.

My own daughter had just such an experience. While away on a school camp, one of her classmates lost a sibling. For her, going to school camp became a massive issue in case something happened to a family member while she was away. We couldn’t tell her it wouldn’t happen. She had seen that it could happen. It was out of her control. She had to attend camp, with the understanding of the teachers about her anxiety and be allowed to make contact with us, if necessary, to overcome her fear.

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How can I tell if my child is suffering from anxiety?

Young children are not able to verbalise how they are feeling, and this makes it difficult for adults to identify anxiety. Generally, these children will display feelings through behaviour. These behaviours often include:

  • Irritability
  • Being tearful or clingy
  • Increased difficulty with separating
  • Outbursts or tantrums
  • Aggression
  • Difficulty falling asleep or frequently waking
  • Night terrors
  • Bedwetting

Anxiety in older children presents slightly differently. These signs include:

  • Tummy ache
  • Nausea and vomiting
  • Headaches
  • Fingerpicking
  • Concentration issues (often diagnosed as ADHD)
  • Sleeping or eating problems
  • Reluctance to try new things
  • Negative thoughts
  • Fatigue
  • Avoiding social activities like parties, play dates and so on
  • Frequent visits to the school nurse with complaints of illness

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How can I help my child with anxiety?

There are some dos and don’ts that will help a child who is suffering from an acceptable amount of anxiety:

  • Your aim isn’t to remove the anxiety but rather to teach your child to manage their response – nobody likes to see our children anxious, but we can’t remove all triggers. Instead, we help the child tolerate the anxiety and function as well as they can.

My daughter was timid and really struggled to be among strangers. On a Thursday, the librarian at Sandton Library used to read stories to children. My daughter loved the stories, but the minute she arrived at the library, she would want to leave because of the sea of new faces. Initially, my wife would sit on the carpet with her but, over time, could retreat to the chairs at the back of the room along with the other parents. My daughter has fond memories of those afternoons.

  • Don’t avoid situations that make your child anxious – if you allow them to avoid things that make them anxious, it may help in the short term. But, over time, it will reinforce the anxiety. They will learn that the only coping mechanism for anxiety is running away, and we, as adults, know that we can’t always avoid situations that cause us stress. My daughter learned that just like her, the other children were eager to hear the stories at the library, and actually sitting with new friends was such fun.
  • Think about the language you use. As a paediatrician, I unfortunately have to do things that children don’t like and create anxiety. Checking their throats, putting up a drip or taking blood are very unpleasant. The most important thing is for me to develop trust with my patients.

I need to talk to the child, interact with them, and let them know I am helping. The language I use and that the parent uses is really important. It is what we call focus language. I tell the child, “Dr Rico needs to look in your throat. I know you don’t like the stick, but Mommy can hold you, and I will look to see what is making you sore, or if you prefer, you can lie down on the cushion”.

The language needs to be age-appropriate; if the carer reiterates what I have said, the child accepts it, and we get the job done quickly. The child knows what I am doing and also has a choice in how. The carer doesn’t play down the feelings or force the child; they reassure.

  • Express your belief in them managing difficult situations. “I know you are a little scared about show and tell, but I am sure the other children will be very interested. Once you start telling them, you won’t feel so scared anymore.” Discussions like this don’t deny that your child is anxious, but lets them know you believe in them and know they can manage.
  • Don’t fuel the anxiety but respect the feeling. You do need to understand your child’s anxiety, but it doesn’t mean you have to agree: “I hear you; you don’t want to go swimming, but swimming is something all children need to learn. The teacher will be in the pool with you, and I will also be with you”.
  • Engage in activities that reduce stress. Mindfulness (3 3 3 rule for anxiety. Tell me 3 things you can see; tell me 3 things you can hear; tell me 3 things you can feel), breathing exercises, meditation, visualisation, creativity, journaling, physical activity, and talking about feelings are all activities and tools that you can do with your child in order to teach new skills when anxiety strikes. Once the child is distracted from the anxiety, he or she will feel better. Your child will learn how to control the feelings for themselves.

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If I have tried all these techniques and nothing helps, what then?

Mental health in children - BabyYumYumAs we have said, it is normal for children to have little fears, but in most cases, the anxiety fades with positive experiences and maturity. However, for around 9% of children aged 3 to 17 years, regardless of the parenting and positive experience, the anxiety intensifies. These children most probably suffer from an anxiety disorder.

There are several disorders. These are the most common:

  • Generalised anxiety disorder (GAD) – Children with this disorder worry excessively about everyday things and often talk themselves into a worst-case scenario situation.
  • Social anxiety disorder – These children have a fear of meeting people or having to talk to people. They usually worry about embarrassing themselves or being judged negatively. They may try to avoid school or social situations and, when forced, are likely to throw a tantrum.
  • Selective mutism – A child with this condition may happily speak at home but cannot talk to peers, teachers or other people in authority. The condition creates terrible anxiety as the child won’t be able to ask for simple things like going to the bathroom.
  • Separation anxiety disorder – We have all experienced those awful days when your child literally needs to be peeled off you to go to class. When you call 10 minutes later, the child has forgotten all about you and is having loads of fun. There are other children where the anxiety continues, and they believe that something dreadful has happened. They cannot be cared for by adults other than a parent.
  • Obsessive Compulsive Disorder (OCD) – These children tend to perform repetitive rituals in an attempt to control their anxiety and make it go away. These children may wash their hands repetitively, lock and unlock doors, ask the same question repeatedly, and often try to get the carer to participate in their ritual.

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All of these conditions require medical intervention to help control the anxiety and to teach the child new coping skills. There are so many things which can be done for the anxious child. However, if anxiety goes untreated, it will affect the child’s schooling, result in your child missing important experiences, and place your child at a higher risk for substance abuse. No parent ever wants this for their child.

Please note that your child can also be excessively anxious but could disguise it so it may not be obvious to you. If you suspect anxiety exists, please consult a mental health professional for an assessment.

Anxiety in children is one of the most treatable disorders in psychology. This is excellent news for us all. What I would like to stress is that you, as the parent, have to see anxiety in the same way as you would an ear infection. If your child is tugging at the ear, crying, or complaining of ear pain, you take the child to the doctor for treatment. The same goes for anxiety. Don’t be afraid of the diagnosis. Denial will not make things better.

Parents may find it difficult to accept the possibility of some mental disorder. We need to get past this stigma if we are to build a strong, resilient child. The architecture needs to be sound so that the child can flourish in a stressful world. If you were worried enough to seek advice, you most likely have read the signs already. Be it anxiety, ADHD, autism or any other mental health issue, remember that there is so much help available if you are open to it. Be the gateway to your child’s psychological and physical well-being.

References:

https://www.cdc.gov/childrensmentalhealth/depression.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9650927/
https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html
https://www.jaacap.org/article/S0890-8567(20)30280-X/fulltext
https://www.thecarlatreport.com/articles/3678-treating-anxiety-disorders-in-children-the-new-aacap-clinical-practice-guideline
https://wohum.org/understanding-anxiety-in-children-signs-and-symptoms
https://www.apa.org/topics/children/mental-health
https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/anxiety/

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