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Children as young as four are being treated for symptoms of stress and anxiety.

The South African Depression and Anxiety Group (SADAG) estimates that 8-11 percent of children and teenagers suffer from some form of anxiety that affects their daily lives.

Christine Darney is a clinical psychologist based in Port Elizabeth. She says that while it is normal for children to experience phases of anxiety, persistent and excessive signs of it could affect relationships and everyday functioning. 

Stress or anxiety?

While they may have similar effects on a person’s ability to function, there are clear differences between stress and anxiety.


Shannon Ownhouse, a clinical psychologist, explains that stress is a psychological response to an environmental stimulus. There is usually a recognised trigger or situation that causes a child to feel stressed.


On the other hand, anxiety 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.

Read more about dealing with childhood fears and phobias.


Unrealistic expectations

Children face numerous challenges, from unrealistic expectations at home or school to concerns about safety. They worry about peer pressure, bullying and social exclusion.


Conflict about parenting styles and poor family relationships often trigger stress. Likewise, unpredictable home and school environments, and overloaded extracurricular schedules.

Isolation and being unprepared

“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.


Children with a family history of anxiety have a greater risk of developing an anxiety disorder. Ownhouse agrees, saying: “Genetics are a predisposing factor, so 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 out 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 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

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 themselves. Children who do the latter often go unnoticed and their anxiety may be overlooked.

Samantha Kitshoff of HeartMathSA, a programme for reducing stress, says that anxiety is one of the emotional reactions people experience in response to stress.

Other behavioural signs

Kitshoff highlights other behavioural changes that may indicate a problem. They include 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 coping with their stress and anxiety. However, if they are struggling in any of these areas, professional help should be sought.

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
  • emotional outbursts such as demanding attention and increased frustration.

Coping mechanisms

Grounding techniques

According to Ownhouse, “grounding techniques” can help children deal with their anxiety. These 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 environments

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.”

Worry jar

At home parents can introduce a “worry jar”. Ask your child to draw pictures of things that make her feel anxious. 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. 

For more ways to practice “mindfulness” to cope with stress, read here

Show support

Anxiety can manifest in various forms and degrees of severity. It should not be dismissed by caregivers and teachers, says Van Zyl. 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 emotions impact our energy levels, our body, thoughts, relationships, behaviour and performance in general. With this in mind, 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, which causes the three parts of our brain to become out of sync, impairing our ability to think clearly, make decisions, recall information or communicate effectively.

Conversely, uplifting emotions such as appreciation, confidence and love create even rhythms. Use the HeartMath techniques when stress begins to manifest. 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. Focus on growing that feeling.

Find out how raising children with privilege could lead to anxiety and stress.