Childhood Stress (kidshealth.org)

As providers and caretakers, adults tend to view the world of children as happy and carefree. After all, kids don't have jobs to keep or bills to pay, so what could they possibly have to worry about?

Plenty! Even very young children have worries and feel stress to some degree.

Sources of Stress

Stress is a function of the demands placed on us and our ability to meet them. These demands often come from outside sources, such as family, jobs, friends, or school. But it also can come from within, often related to what we think we should be doing versus what we're actually able to do.

So stress can affect anyone who feels overwhelmed — even kids. In preschoolers, separation from parents can cause anxiety. As kids get older, academic and social pressures (especially from trying to fit in) create stress.

Many kids are too busy to have time to play creatively or relax after school. Kids who complain about all their activities or who refuse to go to them might be overscheduled. Talk with your kids about how they feel about extracurricular activities. If they complain, discuss the pros and cons of stopping one activity. If stopping isn't an option, explore ways to help manage your child's time and responsibilities to lessen the anxiety.

Kids' stress may be intensified by more than just what's happening in their own lives. Do your kids hear you talking about troubles at work, worrying about a relative's illness, or arguing with your spouse about financial matters? Parents should watch how they discuss such issues when their kids are near because children will pick up on their parents' anxieties and start to worry themselves.

World news can cause stress. Kids who see disturbing images on TV or hear talk of natural disasters, war, and terrorism may worry about their own safety and that of the people they love. Talk to your kids about what they see and hear, and monitor what they watch on TV so that you can help them understand what's going on.

Also, be aware of complicating factors, such as an illness, death of a loved one, or a divorce. When these are added to the everyday pressures kids face, the stress is magnified. Even the most amicable divorce can be a difficult experience for kids because their basic security system — their family — is undergoing a tough change. Separated or divorced parents should never put kids in a position of having to choose sides or expose them to negative comments about the other spouse.

Also realize that some things that aren't a big deal to adults can cause significant stress for kids. Let your kids know that you understand they're stressed and don't dismiss their feelings as inappropriate.

Signs and Symptoms

While it's not always easy to recognize when kids are stressed out, short-term behavioral changes — such as mood swings, acting out, changes in sleep patterns, or bedwetting — can be indications. Some kids experience physical effects, including stomachaches and headaches. Others have trouble concentrating or completing schoolwork. Still others become withdrawn or spend a lot of time alone.

Younger children may pick up new habits like thumb sucking, hair twirling, or nose picking; older kids may begin to lie, bully, or defy authority. A child who is stressed may also have nightmares, difficulty leaving you, overreactions to minor problems, and drastic changes in academic performance.

Reducing Stress

How can you help kids cope with stress? Proper rest and good nutrition can boost coping skills, as can good parenting. Make time for your kids each day. Whether they need to talk or just be in the same room with you, make yourself available. Don't try to make them talk, even if you know what they're worried about. Sometimes kids just feel better when you spend time with them on fun activities.

Even as kids get older, quality time is important. It's really hard for some people to come home after work, get down on the floor, and play with their kids or just talk to them about their day — especially if they've had a stressful day themselves. But expressing interest shows that they're important to you.

Help your child cope with stress by talking about what may be causing it. Together, you can come up with a few solutions like cutting back on after-school activities, spending more time talking with parents or teachers, developing an exercise regimen, or keeping a journal.

You can also help by anticipating potentially stressful situations and preparing kids for them. For example, let your son or daughter know ahead of time that a doctor's appointment is coming up and talk about what will happen there. Tailor the information to your child's age — younger kids won't need as much advance preparation or details as older kids or teens.

Remember that some level of stress is normal; let your kids know that it's OK to feel angry, scared, lonely, or anxious and that other people share those feelings. Reassurance is important, so remind them that you're confident that they can handle the situation.

Helping Your Child Cope

When kids can't or won't discuss their stressful issues, try talking about your own. This shows that you're willing to tackle tough topics and are available to talk with when they're ready. If a child shows symptoms that concern you and is unwilling to talk, consult a counselor or other mental health specialist.

Books can help young kids identify with characters in stressful situations and learn how they cope. Check out Alexander and the Terrible, Horrible, No Good, Very Bad Day by Judith Viorst; Tear Soup by Pat Schweibert, Chuck DeKlyen, and Taylor Bills; and Dinosaurs Divorce by Marc Brown and Laurene Krasny Brown.

Most parents have the skills to deal with their child's stress. The time to seek professional attention is when any change in behavior persists, when stress is causing serious anxiety, or when the behavior is causing significant problems in functioning at school or at home.

If you need help finding resources for your child, consult your doctor or the counselors and teachers at school.

Reviewed by: Jennifer Shroff Pendley, PhD
Date reviewed: August 2011

Source:  http://kidshealth.org/parent/emotions/feelings/stress.html#

Sleep Problems in Teens

Most teens don't get enough sleep, usually because their schedules are overloaded or they spend too much time texting or chatting on the computer with friends until the wee hours of the morning. Other teens try to go to sleep early, but sleep problems prevent them from doing so.

Over time, nights of missed sleep (whether they're caused by a sleep disorder or simply not scheduling enough time for the necessary ZZZs) can build into a sleep deficit. Teens with a sleep deficit are unable to concentrate, study, and work effectively. They can also experience emotional problems, like depression.

What Happens During Sleep?

As we sleep, our brains pass through five stages of sleep. Together, stages 1, 2, 3, 4, and REM (rapid eye movement) sleep make up a sleep cycle. One complete sleep cycle lasts about 90 to 100 minutes. So during an average night's sleep, a person will experience about four or five cycles of sleep.

Stages 1 and 2 are periods of light sleep from which a person can easily be awakened. During these stages, eye movements slow down and eventually stop, heart and breathing rates slow down, and body temperature decreases. Stages 3 and 4 are deep sleep stages. It's more difficult to awaken someone during these stages, and when awakened, a person will often feel groggy and disoriented for a few minutes. Stages 3 and 4 are the most refreshing of the sleep stages — it is this type of sleep that we crave when we are very tired.

The final stage of the sleep cycle is known as REM sleep because of the rapid eye movements that occur during this stage. During REM sleep, other physical changes take place — breathing becomes rapid, the heart beats faster, and the limb muscles don't move. This is the stage of sleep when a person has the most vivid dreams.

What Prevents an Early Bedtime?

Research shows that teens need 8½ to 9½ hours of sleep a night. So, a teen who wakes up for school at 6 a.m. would have to go to bed at 9 p.m. to reach the 9-hour mark. Studies have found that many teens have trouble falling asleep that early, though. It's not because they don't want to sleep. It's because their brains naturally work on later schedules and aren't ready for bed.

During adolescence, the body's circadian rhythm (an internal biological clock) is reset, telling a teen to fall asleep later at night and wake up later in the morning. This change in the circadian rhythm seems to be due to the fact that the brain hormone melatonin is produced later at night in teens than it is for kids and adults, making it harder for teens to fall asleep.

Sometimes this delay in the sleep-wake cycle is so severe that it affects a person's daily functioning. In those cases it's called delayed sleep phase syndrome.

Changes in the body clock aren't the only reason teens lose sleep, though. Read on to learn about some of the biggest causes of sleep deprivation.

Insomnia

Lots of us have insomnia (trouble falling or staying asleep). The most common cause of insomnia is stress. But all sorts of things can lead to insomnia, including physical discomfort (the stuffy nose of a cold or the pain of a headache, for example), emotional troubles (like family problems or relationship difficulties), and even an uncomfortable sleeping environment (a room that's too hot, cold, or noisy).

It's common for teenagers to have insomnia from time to time. But if insomnia lasts for a month or longer with no relief, doctors consider it chronic. Chronic insomnia can be caused by a number of different problems, including medical conditions, mental-health problems, medication side effects, or substance abuse. Teens with chronic insomnia can often get help for their condition from a doctor, therapist, or other counselor.

For some, insomnia can be made worse by worrying about the insomnia itself. A brief period of insomnia can build into something longer lasting when someone becomes anxious about not sleeping or worried about feeling tired the next day. Doctors call this psychophysiologic insomnia.

Periodic Limb Movement Disorder and Restless Legs Syndrome

Teens with these conditions find their sleep is disrupted by leg (or, less frequently, arm) movements, leaving them tired or irritable from lack of sleep.

In the case of periodic limb movement disorder (PLMD), these movements are involuntary twitches or jerks: They're called involuntary because the person isn't consciously controlling them and is often unaware of the movement.

Teens with restless legs syndrome (RLS) actually feel physical sensations in their limbs, such as tingling, itching, cramping, or burning. The only way they can relieve these feelings is by moving their legs or arms to get rid of the discomfort.

Doctors can treat PLMD and RLS with medications. For some teens, treating an iron deficiency can make the conditions go away.

Obstructive Sleep Apnea

This sleep disorder causes a person to stop breathing temporarily during sleep. One common cause of obstructive sleep apnea is enlarged tonsils or adenoids (tissues located in the passage that connects the nose and throat). Being overweight or obese also can lead someone to develop obstructive sleep apnea.

Teens with obstructive sleep apnea might snore, have difficulty breathing, and even sweat heavily during sleep. Because it disrupts sleep, someone with sleep apnea may feel extremely sleepy or irritable during the day.

Treatment is available for teens with sleep apnea. Those who show signs of the condition, such as loud snoring or excessive daytime sleepiness, should be evaluated by a doctor.

Reflux

Gastroesophageal reflux disease (GERD) is another common culprit of sleep loss. With GERD, stomach acids move backward up into the esophagus, producing the uncomfortable, burning sensation known as heartburn.

GERD symptoms can be worse when a person is lying down. Even if someone doesn't notice the feelings of heartburn during sleep, the discomfort it causes can still interfere with the sleep cycle. Some people find they are better able to sleep by lying in an elevated position or by taking medications.

If your teen suffers from GERD, it could be interfering with his or her sleep. Talk to a doctor about treatment options or lifestyle changes, such as changes in diet.

Nightmares

Most teens have nightmares on occasion. But frequent nightmares can disrupt sleep patterns by waking someone during the night.

Some things can trigger more frequent nightmares, including certain medications, drugs, or alcohol. Ironically, sleep deprivation also can be a cause. The most common triggers for more frequent nightmares are emotional, such as stress or anxiety.

If nightmares are interfering with your teen's sleep, consider consulting a doctor, therapist, or other counselor.

Narcolepsy

Teens with narcolepsy are often very sleepy during the day and have sleep "attacks" that may make them suddenly fall asleep, lose muscle control, or see vivid dreamlike images while dozing off or waking up. Nighttime sleep may be disrupted, with frequent awakenings throughout the night.

Narcolepsy can be disturbing because teens fall asleep without warning, making it hazardous to do things like ride a bike or drive. A teens's schooling, work, or social life can be affected by the unusual sleep patterns.

Narcolepsy is not commonly diagnosed in teens, although many cases go unrecognized. People usually begin to have symptoms between the ages of 10 and 25, but might not be properly diagnosed until 10-15 years later. Doctors usually treat narcolepsy with medications and lifestyle changes.

Sleepwalking

It's rare for teens to walk in their sleep; most sleepwalkers are children. Sleepwalking may run in families. It tends to happen most often when a person is sick, has a fever, is not getting enough sleep, or is feeling stress.

Because most sleepwalkers don't sleepwalk often, it's not usually a serious problem. Sleepwalkers tend to go back to bed on their own and don't usually remember sleepwalking. (Sleepwalking often happens during the deeper sleep that takes place during stages 3 and 4 of the sleep cycle.)

Sometimes, though, a sleepwalker will need help moving around obstacles and getting back to bed. It's also true that waking sleepwalkers can startle them (but it isn't harmful), so try to guide a sleepwalker back to bed gently.

How to Help

If your teen seems to be getting enough rest at night but is still feeling tired during the day, it's a good idea to visit the doctor. Excessive tiredness can be caused by all sorts of health problems, not just difficulties with sleep.

If a sleep problem is suspected, the doctor will evaluate your teen's overall health and sleep habits. In addition to doing a physical examination, the doctor will take a medical history by asking about any concerns and symptoms your teen has, and about his or her past health, your family's health, and any medications your teen is taking. The doctor may also do tests to find out whether any conditions — such as obstructive sleep apnea — might be interfering with sleep.

Different sleep problems are treated differently. Some can be treated with medications, whereas others can be helped by special techniques such as light therapy (where someone sits in front of a lightbox for a certain amount of time each day) or other practices that can help reset a person's body clock.

When teens have sleep problems, doctors often encourage them to make lifestyle changes — like turning off the cell phone or computer before bed, cutting down on caffeine, or avoiding violent video games or movies at night — to promote good sleeping habits.

Reviewed by: Mary L. Gavin, MD
Date reviewed: May 2011

Source:  http://kidshealth.org/parent/growth/sleep/sleep_problems.html#