The Anxiety category compiles any blog related to anxiety on the North Shore Pediatric Therapy website into one place. The blogs in this category are meant to help educate, inform and encourage parents of children with anxiety. Readers will learn about separation anxiety, other forms of anxiety, school, red flags, what parents can do to help, what teachers can do to help and more! If you are looking for any information related to anxiety, this category will help you get started. IF you need additional assistance, please give us a call at (877) 486-4140.

help your child cope with divorce

How To Help Your Child Cope With Divorce

Now that the dust has settled and the formation of two separate households has emerged, how do you prepare your child to cope with the changes that occur because of divorce? Even though parenting may appear distinct and different, it is important that co-parenting remain a priority. How each parent arranges their day-to-day affairs can be incongruous, however overall expectations for the child must remain consistent.

Consistency is key in terms of helping your child transition in to this new post-divorce arrangement, help your child cope with divorceas it reduces any anxiety about what will happen next. Two households with stark contrasts in terms of routines, structure, and discipline might be confusing for the child and facilitate splitting behaviors as the child develops an awareness into which parent will best meet his needs with the least resistance. This may create a disparity in following directions and engaging in compliant behaviors across contexts. Maintaining similar modes of discipline and expectations will reaffirm that even though both parents are not under the same roof, there is uniformity in parenting which can be comforting to the child and prove effective in instilling parental core values in children.

Here are 3 tips on how to help your child deal with life after divorce:

  1. Maintain open and honest communication. Invite your child to process his feelings, both positive and negative, about the situation at hand. This will allow the child to mourn the loss of his previous perception of “family” and to adopt and transition into a newer version of “family.” Provide your child with creative outlets to draw, communicate, or conceptualize what family means to him now (i.e. a child might draw something that illustrates family equals 2 houses instead of 1 house).
  2. Never bad mouth your ex in front of your child. Maintaining positive sentiments about the child’s other parent will enhance positive feelings of the other parent in the eyes of the child. Just because there is strain in the parental dyad does not mean that child needs to take sides. Also, this ensures the child feels safe to discuss the other parent in your presence. Otherwise, the child might feel anxious about sharing his positive feelings about the other parent to you and feel caught in the middle.
  3. Communicate with your ex. Make sure that you are both on the same page about core values and expectations so you can reinforce each other as challenges arise. If for example, the child has been told at Mom’s house during the week that they cannot go to soccer practice over the weekend if they don’t comply with bedtime routine M-F, Dad would have to uphold that consequence. What is so important too is that Mom approve this consequence with Dad before offering it. If dad is not ok with compromising soccer, Mom and Dad would have to come up with another option. The more the parents are on the same page, the better, as this will reduce stress during the already stressful time brought on by divorce.

Click here to read about dating after divorce.






separation anxiety

Separation Anxiety and the Young Child

 

 

 

Children can encounter many different types of anxieties and fears as they go through early childhood. Separation anxiety is one of these types of fears.

As children enter into preschool and begin the transition into kindergarten, they may begin to have fears about growing up, being away from their parents and losing their parents. It can be very typical for children between the ages of 4 and 6 to start verbalizing and expressing these fears. This age is a time of increased independence and transitions which can lead to increased anxiety for many children. Here are some strategies to help your child deal with these concerns:

Strategies for Managing Separation Anxiety in the Young Child:

  • Empathize with your child and to let them know that you are his/her forever family.
  • Let your child know that they are not alone and that many children have these same concerns and fears.
  • Avoid giving too much reassurance to your child because this can lead to increased anxiety and dependence on you.
  • Use books as a resource. Books that focus on transitions and feelings can be very helpful at this age. The Invisible String by Patrice Karst, The Kissing Hand by Audrey Penn and Llama Llama Misses Mama by Anna Dewdney are great books to use to help ease transitions and to reduce the fears of being separated from parents.

If you notice that your child exhibits worries and fears about growing up and losing his parents and these fears do not subside within several weeks, it is recommended that you seek advice from a mental health professional in order to identify if your child needs assistance from someone to reduce their fears.






medication for mental health in kids

When is it Appropriate to Seek Medication Management for Mental Health Symptom Reduction in Children?

 

 

 

For many families, the conversation about medication management to reduce mental health symptoms in children is off the table before the realities of this intervention can be explored. Medication can be a beneficial intervention, in tandem with therapy, to translate the skill development from the clinical setting into positive behavioral changes in the natural environment.

When is medication recommended to manage mental health symptoms in children?

Medication might be recommended as a therapeutic approach early on in treatment depending on the severity of the presented concerns and the impact of these symptoms on the child’s overall quality of life. For instance, if the child struggling with impulsivity and reduced focus/attention is doing poorly in school, if he has challenges reading social cues in peer relationships, and is he is internalizing negative feelings of self as the result, medication may be recommended sooner rather than later to improve client’s overall level of functioning.

The goal of social work intervention is to address the socio-emotional concerns through teaching client awareness into the triggers that precipitate the maladaptive behaviors (i.e. distracting thoughts/stimuli that reduce focus, decisions that elicit anger that snowballs into a meltdown, etc.) and the skills to modify their behavior. In some cases, the client can demonstrate and prove comprehension of the skills presented but in practice, have a hard time implementing the learned coping strategies in real-life scenarios. If the child’s quality of life and overall functioning remain to be negatively impacted despite intellectualization of how to handle their emotions or redirect their behavior, medication might serve as the glue to carry these compensatory strategies into reality.

To decide if a medication consultation is right for you, use this checklist:

  • Does my child struggle with implementing the therapeutic skills they learn in treatment?
  • Despite involvement in therapy, is my child’s quality of life negatively impacted socially, academically, personally?
  • Has there been an increase in the frequency and duration of symptoms (i.e. more meltdowns per week, more redirections to re-regulate body to remain calm, etc.)?
  • Does my (the parent) and my family’s quality of life continue to be negatively impacted with frequent impulsive reactions, mood dysregulation, or hyperactive nature of the child?

Consult with your pediatrician and therapist if you have any questions about if medication would be a right fit for your child. And remember, just because you may decide to try medication does not mean that it is a magic bullet fix or that it has to be a life sentence. Ongoing therapeutic intervention in addition to medication can be the right course of treatment for some children.


girl with bear

The Benefits of a Transitional Object

 

 

 

Often times when children are observed they are carrying something around with them, and at times they are even talking to and playing with that item. With further observation of the same child, it may be noted that he or she is transporting that object with them to multiple places, throughout the day over a span of time. Their toy is likely more than just a toy; they are likely to be carrying what is called a Transitional Object.

girl with bearTransitional objects are possessions that are meaningful to a child and help them to feel comfortable and secure. Transitional Objects can be helpful for young children when entering a situation or environment that is either unfamiliar or challenging. Transitional Objects can be used to help a child have a more seamless time separating from a caregiver. Oftentimes, Transitional Objects are used when going to school for the first time, when starting various groups or activities, when vacationing, and when playing in a new friend’s home. While it is common that a young child is seen with a Transitional Object, older children can also reap the benefits of a Transitional Object—if starting a new school, attending overnight camp, or when participating in a potentially stressful activity such as a an important ball game or singing in a choral concert.
Furthermore, Transitional Objects will also benefit a child who is receiving any type of therapy. Therapy is often challenging and it and takes a child out of his or her comfort-zone. The support and comfort that come with carrying their Transitional Object to  therapy can help a child reach new goals and attempt new tasks. Children can talk about their beloved Transitional Object with their therapist, which allows them to open up and feel a heightened level of comfort and confidence in therapy.

Transitional objects can be blankets from early infancy, dolls, action figures, or a picture of family members or from a special vacation /event. Other common Transitional Objects are “lucky” coins, a rabbit foot, or anything that has special or “lucky” sentiment. A Transitional Object can be anything that is small and light enough to be carried around, the items listed above are merely just examples and can be used to provide a young child with if they do not already have something considered to them as a Transitional Object.

See also:

Top 5 Anxiety Disorders In Children eBook





Child with anxiety

Benefits of a Worry Box

 

What Is A Worry Box?

A worry box is a cognitive-behavioral therapeutic approach to addressing excessive worry and anxiety in children. This modality aims to take the worry and anxiety off of the child, and places it onto a tangible  item such as a box.

Materials Needed

A box (typically, an empty Kleenex box is great for this exercise!)

Art supplies (pending the interests of the child)

How it works

Child with anxietyPending the interest/s of the child, this activity begins with the child decorating the box. This helps the child to feel some sort of ownership over the activity as well as empowerment in dictating the physical appearance of the worry box. Some children feel more comfortable talking and expressing difficult or uncomfortable feelings while either moving their body or by being distracted by something else. Therefore, this initial phase of the project serves as a beneficial time for the parent/therapist and child to discuss, explore, and process concepts and ideas relating to the project.

Next, ‘worries’ that the child is experiencing are written down onto strips of paper which are then folded and added to the worry box. Depending on the child’s abilities and age, adult assistance in writing down worries may be required. If this is the case, it is helpful to also allow the child to draw a picture of whatever is being written down. This allows the child to have that connection and ownership over the ‘worry.’

Every day (or however often is deemed appropriate), an adult and child can check in with each other through the use of the worry box. For example, begin by having the child take out one strip of paper at a time. The strips of paper with worries written on them serve as excellent visuals to spur conversation and processing. Through discussion, the child will indicate whether or not that particular worry is still causing them anxiety. If that is the case, the child can fold the paper back up and place it back into the box. If the child feels as though this is not something that is a worry anymore, the child and adult can discuss a ritual for disposing of the paper. For example, maybe the child would like to rip it into several pieces and throw it away. Other children may want to stomp on the paper and then throw it away. This is also an excellent place in the project for the child to exert some independence and control in deciding the mode of disposal.

Similarly, after the child and adult have processed through each worry, the adult can ask the child if there are any other worries that should be added to the box. Providing the child time and space to think is important.

Kid chewing on a cup

Why Does My Child Chew on Things?

By the age of 3, children have typically completed the teething stage. This is when they chew on objects or fingers to mitigate the pain they’re feeling as teeth break the surface of their gums. Damp sleeves, wet collars on shirts, or constantly chewing on objects that are not typically supposed to be in the mouth can be everyday occurrences for some older children who have difficulties processing sensory information. Many parents wonder “Why do they do it?” and “How can I help?”

While no two children who have challenges processing sensory information are alike, oftentimes, kids who chew on their clothing or other extraneous objects enjoy the input they receive through their jaw bones and oral musculature with the pressure of each “chomp.” As a result, you may notice the Kid chewing on a cupfrequency of “chewing” to increase during exciting situations or during situations that your child perceives to be new, challenging, or stressful. By chewing on their clothing, kids may be attempting to provide their oral musculature and joints with proprioceptive input in order to self-regulate. The concept is very similar to the way adults may squeeze a stress-ball during times of high frustration or angst.

It isn’t uncommon for parents to feel effects of a social stigma when other adults or kids notice their child chewing on objects beyond the typical teething age range. They hope to find other ways for their child to self-regulate in a way that is considered more socially acceptable. Various online shops including www.funandfunction.com sell products that children can more discreetly chew on at home and at school. Products include everyday items such as pencil toppers and jewelry. Other options for kids who chew as a means to improved regulation, include participating in games or activities that provide input to their oral musculature. Examples include drinking through straws, chewing gum, eating crunchy foods, blowing up a balloon, and blowing bubbles.

If you find that these socially appropriate avenues are not meeting your child’s oral needs then contact a speech and language pathologist, occupational therapist or your primary care physician to determine the best possible course of treatment and to eliminate or to eliminate other medical concerns.

Child scared of the dark

How To Deal With Nighttime Anxiety

Try these steps to reduce nighttime anxiety and improve compliance with evening time routine.

At the end of a long and exhausting day, how do you effectively transition your kids from the stimulation of the day to the peace and quiet of the night? Now, combine that tall order with nighttime anxiety. It would appear as though this would be more difficult, but there are simple strategies to integrate into the nighttime routine to reduce anxiety and increase overall compliance with this tricky transition.

1. During non-triggering times, talk with your child about what causes them to feel nervous or anxious with regards to bedtime. Are they afraid of the dark? A monster under their bed? A zombie in the closet? Identify with them what they are afraid of and then problem-solve with them ways to reduce their fear. If they are afraid of the dark, offer to keep their door open with a hall light on in addition to a nightlight. If they are spooked out about creatures living in their room, add an additional step before lights out to go through their room with them and search for these alleged monsters. When they see they are non-existent prior to bedtime and with support of their parent, they can feel more at ease going to sleep. Set up a plan with your child to eradicate irrational thoughts to facilitate more restful nights.

2. Begin the transition to bed earlier. If it takes a long time for your child to “unplug” and transition to bed, starting earlier can be helpful – even if it is just a conversation about starting the routine soon. If a child has anxiety about nighttime, the more advanced preparation and warning they have, the better. They can begin their thought-process and, in turn, anxiety-reduction process sooner to aid in a smoother transition. Create positive, self-coping talk that you can model for your child about bedtime such as “Sleep is important because it recharges us for the day,” or, “Bedtime is a chance for us to reflect on our high points from the day and set positive goals for the next day,” and, “Everybody sleeps.”

3. Integrate the use of a “worry doll” or “worry journal” that the child can externalize their fears and worries prior to bed to reduce rumination of irrational thoughts or fears. The worry doll can be a doll or figure that can hold the child’s worries while they are asleep. The child can tell the doll what it is worried about and clear their mind before bed. This can also present an opportunity for the parent to listen and hear what is concerning the child. If it is not appropriate for the child to have a doll (i.e. older child or male), encourage the use of a worry journal to either draw or write out concerns prior to bed. The journal will house the worries so the child can clear their mind and focus on positive, coping self-talk prior to bed.





How To Handle Tragedy With Your Children

What happens when tragedy occurs?

When the unthinkable happens, both adults and children access their darkest fears and concerns about national, community and personal safety.  Trauma is an emotional response to a terrible event and can be expressed in a variety of ways. Most kids are resilient and with validation of their feelings, opportunities for them to talk and be listened to, and reassurance that many people are working hard to ensure their safety (i.e. policemen, teachers, doctors, volunteers, parents and teachers) can resume previous levels of functioning. Other kids may display acute signs of anxiety such as excessive worry, school refusal, sleeplessness, nightmares, headaches, stomachaches, loss of interest in previous enjoyed activities, changes in relationships with peers and changes in school performance. It is also important to note that children may appear unhinged by trauma initially, but may demonstrate more delayed symptoms of anxiety after the exposure to the tragedy.

When managing your child’s reaction to tragedy it is imperative for the parent to understand their own thoughts and feelings regarding the event. Getting any parental concerns and anxieties under wraps will be essential prior to managing any child anxieties and concerns. Children, by nature, are dependent and vulnerable and rely on their parents to exude a sense of control, protection and care. If a parent is highly reactive to their own anxieties, children can pick up on this and in turn will mirror their parent’s anxieties. If a parent is calm and objective the child can then have a solid sense that their parent is in control of the situation and give the child permission to feel safe and cared for.

Validate and acknowledge your children’s fears and insecurities regarding the tragedy

This provides outlets and opportunities for your child to express their feelings and insecurities. Brushing over their feelings of sadness, anger, fear, and anxiety with “don’t feel this way” and  “don’t worry, it won’t ever happen to you”  can prove invalidating and deny the child the opportunity to effectively process their responses. Acknowledging your child’s fears and concerns will help them process the event and encourage them to self-express.

Limiting screen time to avoid continued media coverage regarding the event will help to reduce anxiety and re-traumatization. The most important part of dealing with trauma and tragedy is to process both you and your child’s interpretation of the event, not the actual facts and details (i.e. how many people died, who killed them, the severity of this national tragedy, how it compares to other national tragedies, etc.). Exploring with your child how they interpret the event and what they think has happened is more therapeutic than rehashing the gory details. Also, instead of initiating a conversation about what has happened to your child, ask your child what they think has gone on and work from there. Providing too much information that does not fit within their scope of understanding can prove to further confuse them and elicit anxiety.

Uncontrollable tragedies occur and have the power to threaten our perceptions about our safety and understanding of our world around us. Providing a safe space to process the feelings that our children have is the best way to acknowledge the legitimacy of their concerns and regain a sense of normalcy.



How to Encourage Your Shy Child (While Honoring Her Nature)

Do you worry about your child’s ability to socialize with friends and initiate with peers? Does your child demonstrate a shy temperament? Follow these simple strategies to encourage your shy child to improve peer relationships.

Check in with your child about her expectations.

Is your child satisfied with the state of her affairs? Does she prefer to be the quiet one in the bunch? Is she content with limited exposure with friends outside of school? Finding out what your child’s goals are is helpful to resolving your own questions as now you can better help her meet her expectations. If your goal is to have your child be the social butterfly and she is telling you she prefers not, it is up to you to reformulate your thinking about what to expect. If you still feel like it would be in her best interest to improve face time with friends, encourage her to set up plans with a friend outside of school at least once a week. She can choose the peer and the activity. This is helping facilitate necessary social skills and interactions as well as meeting both your goals. If your child wishes for more in terms of peer relationships, validate her feelings and provide solutions to help her increase peer interaction.

Role-play scenarios to increase confidence.

Setting up time to practice conversation, initiation, and self-expression in non-triggering environments will allow your child the time to practice these skills. Another fun option would be to set up your child with a more outgoing sibling, cousin, or family friend who she feels comfortable with to practice age-appropriate social skills.

Don’t push but motivate.

Before entering into social gatherings, have a conversation with your child about how she imagines this situation will go. Arm her with options that she can engage in such as a variety of questions she can ask, activities that she can initiate and self-coping strategies she can implement if she does not want to interact with people (spend time with mom, offer to help the host, watch TV, bring a book to read). Preparation and planning is key to reduce any anxiety that may occur when in social situations.

Click here to watch a short video on encouraging your child to make friends.

Relaxation Strategies for Children

How do we teach our children to relax and self-soothe in a society that is inundated with constant stimuli? How do we re-frame the evil term “boredom” into an opportunity to make peace with our inner thoughts and feelings and calm our body? Often times, even adults, need prompting to relax and take a load off.

Here are some examples of activities that both you and your children can engage in to “recharge your batteries” and face the world with a more balanced mindset:

1. Mindfulness—Easier said than done. Mindfulness is the practice of connecting the mind and body to enhance attention and focus to the task at hand.  It means living in the moment and quieting out other “noise” to focus your attention moment to moment. This is a nonjudgmental practice that incorporates all the senses to be fully present. Two of my favorite ways to practice mindfulness are when you are eating or bathing.

  • Eating. We commonly eat in transit, in front of the TV, talking with others, or while multitasking. When we don’t focus on just the act of eating we miss a lot of cues such as satiety, flavor, texture, etc. Practice mindfulness when eating. Prepare your food and sit in a quiet space. Before indulging your food notice your body cues about the food. Are you starving, craving salt, is your stomach growling. Still, before consummation, notice the color of your food, the texture of your sandwich, the way the sandwich smells. We are wanting to eat with all our senses. Take a bite. What does it taste like and smell like? How does the meat and cheese and bread feel in your mouth? How many bites does it take to swallow? What does the sandwich feel like in your stomach? You get the picture. When we focus on the experience of eating in the moment we are more attune to how we feel and our mind and body and in connection.
  • Bathing. The same can be said for bathing. Notice how the water feels on your body, the temperature, the texture. Notice the smells of the product and how it feels to massage your scalp full of shampoo. Remember, use your senses to be present in the experience and try and steer clear of other intrusive thoughts that may enter about your upcoming day.

2. Music—Music can be such a relaxing outlet but make sure that the music matches the mood that you are seeking. Kids commonly want to relax to Top 40 hits, Hip Hop, or other high energy music but this in fact does not aid in relaxation as the body will mirror the energy it is hearing. If you truly want to relax, I recommend jazz or classical in addition to natural noises provided by a sound machine (waves crashing, rain falling, rainforest, etc.). Listening to music can help kids relax in times of transition (after school before homework, after homework and before bed) or when they are emotionally triggered.

3. Deep Breathing and Muscle Relaxation—Relaxing the body and calming our breath can enhance relaxation either when someone is emotionally triggered to be upset or anxious, during transitions, or prior to upcoming stressful events. Deep breathing requires breathing in through your nose for 5 seconds, holding the breath for 5 seconds, and exhaling the breath through the mouth for 5 seconds. Repeat this 5 times. Muscle relaxation includes tightening and then releasing various muscle groups. Sit in a chair or lay down in a quiet space. Start from the bottom of the body and work your way up. Squeeze your feet and toes tightly for 10 seconds and then release. Squeeze your calves for 10 seconds and then release. Squeeze your thigh muscles for 10 seconds and then release. Continue up the body. By isolating each individual large muscle group you are calling your attention to that part of the body and scanning it to release any tension or stress. You can use these strategies when you want to relax or you can make these into habits and incorporate them into a daily routine.

Click here for 10 ways to help your child unwind before bed.