Pediatric Reflections: Summer 2022

Wendy Wallace, DO, is a pediatrician in the CHOP Care Network, Primary Care — West Chester practice and Director of CHOP Primary Care Behavioral Health.

Anxiety is a normal bodily response to everyday situations. Anxiety gives you the oomph to get out of the way of danger and the extra blast for studying before a big test. However, anxiety that interferes with daily life and brings on intense fear, sweating, increased heart rate, fatigue, or persistent worry can be an anxiety disorder.

Why are we seeing more anxiety issues now? A combination of internal balance, genetic and cultural input, and external stimuli can push our brains to dysfunction.

Here’s a partial list of COVID-19 situations that have triggered anxiety: Unpredictable circumstances such as canceled vacations, family gatherings, and birthday parties. Uncertainty with trust in relationships: Are they vaccinated? Do they have COVID? Work invading our personal space—work from home, virtual school from home, interruptions to personal interactions, texting alerts, and multiple devices on at the same time. Information about the disease coming from around the world.

When Normal Tips to Dysfunction

Anxiety is normal, but chronic, unrelenting anxiety can lead to dysfunction. A baby cries for its needs: nutrition, clean diapers, and snuggles. Having those needs met reassures us the world is safe and we are important. As we get older, we separate but look back to make sure mom or dad are OK with our venturing.

This ebb and flow of internal growth then checks for reassurance create the internal dialogue of anxiety. It’s a way our brains can be reassured we are going in the right direction—that we are loved, that we are safe. We are all programmed for this journey into the world, and anxiety is our safety net. But how do we take care of our brains when the inputs are overwhelming?

You know the airplane guideline: “Put your mask on first then assist your children.” It may seem simple, but modeling self-care and protecting boundaries can be first steps to our children’s lifetime management of anxiety.

Unpredictable responses, vulnerable situations, and recurrent interruptions raise sensitivity to the loss of internal quiet and reassurance we use to reset our internal sense of calm. We all have a variable level of how much we can “take” before we shut down and put up our boundaries.

Our world today is fraught with boundary breakers—text messages, pictures taken and later found on social media, friends who hurt and retaliate publicly, school and work from home, schedules that sneak into our nights and weekends, and more.

Ways to Manage Our Anxiety

So how do we fix this and bring our anxiety meters back to a functionable level? How can we lower that irritability so we can take care of ourselves, trust relationships again, and find joy?

My ideas: Shut off phones, turn off computers, say “no” to invitations and requests for extra work, don’t check social media, mute the ding, and take a break. Go to that safe spot where you listen to waves, read a book, curl up in a warm blanket, or take a nap. Maybe your safe spot is a walk along a creek, listening to birds chirping and breathing in the fresh air, or maybe it’s the beach, toes in the sand and sun on your face. Just picturing yourself in one of these locations brought your blood pressure down, right?

Now transpose your functioning and handling of the pandemic to your child’s functioning and you can see how quickly their little brains can get disorganized and irritable, disrupt sleep, interfere with school, and land you in your pediatrician’s office worried about your child’s behavior.

A consultation with your pediatrician can provide an idea of the depth of anxiety and what type (separation, social, performance, obsessive, or general) and what steps are next. It can be frustrating for a parent: What can we do?

I would suggest taking a step back and looking at your child’s safe spot (usually their room) and their schedule: bedtime, wake time, eating healthy, social life, sports, lessons—maybe too many obligations. Recreate a safe spot with hugs, cuddles, simple giggles, eye contact, and listening. The most important thing is to be present, which also means no electronics.

I cannot guarantee that making a nesting spot for your child will eliminate all their behaviors, but it will model an action they can do whenever and wherever they are in life. You teach them boundaries and model those boundaries. Let them see you exercising, meditating or praying, reading a book, taking that vacation, delving into a hobby, and spending time with friends and family. As parents we must walk the talk.

Your children will initially model themselves after you. And, hopefully, over time they will understand themselves enough to manage their own anxiety about a new situation with some deep breathing, slowing down thoughts, and even taking a step back. There will be times when that is not enough, and they need help. A therapist, pediatrician, and psychiatrist are trained to recognize when a little more is needed. All you need to do is ask.