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Manage your child’s stress and anxiety before these feelings become debilitating.

Stress has become such a part of modern society that it’s unsurprising children as young as four are being treated for symptoms of stress and anxiety. The South African Depression and Anxiety Group (SADAG) estimates that as many as 8-11 percent of children and teenagers suffer from some form of anxiety that affects their daily lives.

So when should you become concerned? Port Elizabeth-based clinical psychologist Christine Darney says that while it is normal for children to experience phases of anxiety, persistent and excessive signs could affect relationships and everyday functioning. Shannon Ownhouse, a Durban-based clinical psychologist agrees. “Prolonged periods of stress can cause the breakdown of physical and mental health. This, in turn, could lead to mental health issues such as depression and anxiety.”

Stress or anxiety?

While they may have similar effects on a person’s ability to function, there are clear differences between stress and anxiety. Ownhouse explains that stress is a psychological response to an environmental stimulus. So there is usually a recognised trigger or situation that causes a child to feel stressed. Anxiety, however, is an “exaggerated fear response” to a perceived stressor, even if this stressor is no longer present or never existed at all. Anxiety disorders often emerge earlier than other types of mental illness, with an average onset age of 11. “An anxiety disorder is the more serious of the two conditions, but neither should be taken lightly,” says Ownhouse.


Children face numerous challenges from unrealistic expectations and concerns about safety, peer pressure and bullying to conflict about parenting styles, poor family relationships and unpredictable home and school environments. “Feeling isolated, overwhelmed, powerless, frustrated or inadequate when faced with these challenges elicits an anxious response of fight, flight or freeze within children,” says Darney. She adds that children with a family history of anxiety have a greater risk of developing an anxiety disorder. Ownhouse agrees: “As with all psychological or psychiatric conditions, genetics are a predisposing factor. If  either parent suffers from an anxiety disorder, the child is far more vulnerable to developing one herself.”

Reading the signs

Kerry van Zyl, a Cape Town-based educational psychologist, explains that parents and teachers are usually the key players in a child’s life and often the first to pick up when a child may be struggling. The signs of stress and anxiety are similar, says Ownhouse, but there are subtle differences you can look for. With anxiety, there may be shaking, shortness of breath, heart palpitations, sweating, stomach, neck or back pain, complaints of a tingling sensation and dizziness. Children experiencing stress on the other hand may have a weakened immune system and are susceptible to developing medical conditions such as high blood pressure and cardiac problems. Other physical signs of stress include body aches, tension, frequent colds, nail biting and sleeplessness.

Red flags

While you may think you’re paying attention to possible red flags, stress and anxiety are easy to miss as children experience various states of both, says Darney. While it’s fairly easy to see that a clingy child may be feeling anxious, some children struggle to express their feelings and may “act out” with disruptive behaviour. Others may withdraw or isolate. Children who do the latter often go unnoticed and their anxiety may be overlooked.

Samantha Kitshoff, a HeartMath coach – a programme for reducing stress – says that anxiety is one of the emotional reactions people experience in response to stress. Kitshoff highlights other behavioural changes that may indicate a problem, such as frequent arguments, fighting and bullying. Anxious children may show signs of anger, boredom, frustration, fear, irritation and helplessness. Parents should also look out for mental confusion, difficulty focusing, distraction, poor performance at school and negative thoughts. “What we often don’t realise is that the mental, physical and behavioural signs of stress often indicate a deeper emotional upset such as anxiety,” says Kitshoff.

When to seek help

Ownhouse advises parents monitor their children. If they are still able to function at home, socially and in the classroom, then they are managing to cope with their stress and anxiety. However, if they are struggling in any of these areas, consider seeking psychological help. Darney says a child with five or more of the following symptoms that persist for at least four weeks should be referred for further assessment:

  • pessimism
  • negative thoughts
  • crying frequently
  • constant worrying
  • irritability
  • aggression
  • restlessness
  • frequent complaints of stomach ache or headaches
  • refusal to go to school
  • avoidance behaviours
  • bedwetting and sleep difficulties
  • not wanting to attend social functions
  • nightmares or night terrors
  • perfectionism
  • procrastination
  • poor memory and concentration
  • eating disturbances
  • emotional outbursts such as demanding attention and increased frustration.

Coping mechanisms

According to Ownhouse, “grounding techniques” can help children deal with their anxiety. These techniques focus on using as many senses as possible to distract the brain from the perceived stressor. For example, in a classroom setting, a child can list five things they can see, four things they can hear, three things they can touch, two things they can smell and one thing they can taste. This will help them be more mindful of their “here and now” instead of the cause of their anxiety. Calm, structured environments, both at home and at school, also help to alleviate anxiety. “Anxious children perform best in a calm, supportive and organised classroom environment,” says Darney. “An ideal situation would be for the child’s teacher to maintain authority in a positive manner, using reason and respect rather than fear or punishment.” Van Zyl adds: “Well-adjusted and optimal development is encouraged in an environment that is perceived as safe and secure.”

At home parents can introduce a “worry jar”. Ask your child to draw pictures of things that make her feel anxious and pop these into the jar so that she doesn’t have to “carry” them around with her. Sometimes offering a place where a child can offload their anxieties helps. Another way of managing anxiety is to schedule downtime that encourages mindfulness, such as a walk along the beach.

Read more about mindfulness here and here.

Show support

Anxiety can manifest in various forms and degrees of severity, and should not be dismissed by caregivers and teachers, says Van Zyl. “Children will benefit from a parent, adult or teacher who communicates a level of understanding of what they are feeling, shows empathy and compassion, and indicates that they will walk the path with them to help them manage these feelings.” Van Zyl adds that it’s helpful to keep routine and ensure children get enough sleep, exercise and enjoy a healthy diet. Children must also be taught how to talk to someone if they feel overwhelmed or anxious. “Show children that it is okay to feel stressed, talk through the experience and discuss how best to deal with it as this will give the child effective coping strategies they can eventually implement independently as they develop,” says Van Zyl.

One breath at a time

Kitshoff explains that our emotions have a bigger impact on us than we realise. “Emotions impact our energy levels, our body, thoughts, relationships, behaviour and performance in general.”

HeartMathSA has developed a number of simple, scientifically validated techniques to help children and adults cope with stress. These techniques are based on research that shows how emotions affect heart rhythm patterns. When people experience feelings of anxiety, frustration and anger, their heart rhythm becomes irregular. This causes the three parts of the brain to become out of sync. When that happens, our ability to think clearly, make decisions, recall information or communicate effectively is impaired. Conversely, uplifting emotions such as appreciation, confidence and love create even rhythms. The HeartMath techniques can be used when stress first manifests. They are particularly effective in helping older children cope with exam anxiety and decision-making.

Step one

Refocus your attention on your heart and change how you breathe. Slow and rhythmic breaths create the even heart waves required for calm.

Step two

Inhale for five seconds and exhale for five seconds. Imagine your breath flowing in and out of your heart or chest area as you breathe.

Step three

Imagine a positive feeling, such as appreciation for a loved one or a sense of achievement, and focus on growing that feeling.

For support, contact or beatexamstress

Anél Lewis