City paediatricians are busy figuring reasons for stress attacks in four to 10-year-oldsFor two months, eight-year-old Roshan (named changed) had a recurring abdominal pain. Several doctors were consulted and tests conducted (blood, stool, sonography), but no one could fathom what was wrong with the South Mumbai resident, who for all practical purposes, seemed healthy.
In fact, Roshan kept up his daily routine through those months, too. The young boy would wake up at 6 am, attend football class at 6.30 am, and would then head to school from 8 am to 4 pm. Once home, he'd be busy with Hindi and Math tuitions. He would watch television or play on the iPad on a short break, before sitting down to complete his homework. Dinner would be at 9 pm, bed at 9.30 pm.
At their wits end, Roshan's parents took him to Dr Raju Khubchandani, director of paediatrics at Jaslok Hospital and Research Centre in Peddar Road. They were told Roshan's problem was stress-induced. "The pain didn't keep him awake at night. Real abdominal pain doesn't do shift duty. These children need their parents' time, not my prescription," he says.
Roshan's case isn't unique. Dr Khubchandani says that in three decades of practice, he has never seen so many cases of nonspecific abdominal pains, recurring headaches, chronic fatigue, muscular-skeletal pain, and sleep disorders among children, as he does today — nearly three cases a week. Each of these cases is a response to stress, he says.
Other city doctors, too, have noted the phenomenon. Malad-based clinical psychologist Malini Krishnan sees nearly three children with stress-related disorders a week at her clinic, Inner Space. According to psychiatrist Dr Zirak Marker, 60 per cent of his younger clients have stress-related conditions — that's close to 25 cases a week. Marker, who is a consultant at schools like JBCN International and Aditya Birla World Academy, has clients of all ages. His youngest is six.
A stress-induced condition is psychosomatic. It's when the child believes he has a problem and the symptoms, consequently feel real. While both, adults and children face stress, each deals with it differently. Dr Hozefa Bhinderwala, consulting psychiatrist at Saifee Hospital explains that the symptoms vary, too. Stress-induced disorders occur because, "Young kids are unable to express their feelings properly to elders," he points out. Other symptoms of stress include temper tantrums, sleep disorder and loss of immunity, too. (see box).
Both Dr Marker and Dr Bhinderwala remark that most of their cases are of children who have lost interest in studies and perform poorly in academics. "Add extra-curricular activity classes like skating and elocution to that and they would obviously be pressed for time and reel under stress," says Dr Marker. In other words, the kids aren't making things up — the pain is real, it's in their head.
Where are we going wrong?
That was a question that 36-year-old Sewriresident Ritika Kashikar asked herself when her eight-year-old threw a fit over an innocuous chess class. The part-time fitness instructor had enrolled her older son Eshaan in every class that his friends attended. After school, he'd juggle tennis, chess and swimming sessions. "I realised I may him to do what he doesn't like," says Kashikar, whose 'bandwagon parenting' was taking a toll on her son. "I was part of this system, where if so-and-so's child is going for a certain class, so would mine. In the process of wanting our children to learn as much as they can, we fail to see if the child is up for it. If you force a child, he'll quit everything that he wants to do."
And it worked — Eshaan swims because he enjoys it and Kashikar makes sure that both he and his younger sibling, five-year-old Arnav play with other children in their complex on most evenings. "Parenting is a learning process," she smiles. "I am not repeating old mistakes with Arnav."
Dr Vibha Krishnamurthy, developmental paediatrician at Ummeed Child Development Centre, Parel, sympathises with parents like Kashikar. "Keeping up with the Joneses has acquired an altogether different meaning. Life has become more complex for today's children," she says. "They don't have opportunities to interact with other children because they hop between classes and put in more study hours than a corporate executive does at his work."
It is vital for a child to possess a social life that isn't monitored by adults. Time spent on the playground, unsupervised and among peer groups, is vital since it helps a child understand social relationships and learn how to cope.
Dr Krishnamurthy also recommends boredom. "It's only when children feel bored that their imagination flourishes," she explains. Making imaginary friends, playing doctor-doctor, and scribbling on the walls with crayons are all part of growing up.
Schools equip themselves
When Meera Isaacs joined as principal of Fort's Cathedral and John Connon in 1996, there was only one counsellor for all the children, from classes 1 to 12. Today, there are four — one for each level — including an 'infant counsellor'. "We saw that there's a need for children to speak to somebody other than their parent or teacher, whom they could share their anxieties with," she says.
Isaacs squarely blames the number of activity classes that children are put into, as the reason for their stress. "How will it hurt if the child doesn't go for them?" Competition among parents is ridiculous, she adds. Dr Bhinderwala offers the example of a seven-year-old patient who told him, 'If my cousin is so good at his studies, why doesn't my mother adopt him?' "Can you imagine what the child must have gone through to say that?" he asks.
Principal of Santacruz-based Podar International School, Dr Vandana Lulla says schools need to organise support groups for children, given the wide range of stressful factors that kids today deal with, parental competition, packed schedules that don't allow rest and decreased family time, included.
She recalls an incident when a seven-year-old told her that his mother doesn't love him. "He said, 'My mother is always talking on the phone or working on her iPad. She doesn't feed me, my maid does; she doesn't teach me, my tuition teacher does'." Decreased face time between parent and child is a leading cause for stress among children.
Parents are stressed too
Working parents spend money on activity classes to keep their children occupied, Isaacs observes, but there is no substitute for family time. Part of the child psychologist's job is to counsel parents, as well. For instance, Dr Khubchandani asked Roshan's parents, "Are you raising a man, or a machine?" and offered them a simple tip, when they put their heads down and asked what they could possibly do. Free up his schedule, he told them. (See box for tips.)
A 2011 global survey conducted by AC Neilson among 6,500 women found that Indian women are the most stressed in the world. The results of the polls, conducted across 21 developed and developing countries, showed that 87 per cent of Indian women claimed feeling stressed most of the time, with an additional 82 per cent of them asserting they had insufficient time to relax.
According to Dr Marker, stressed parents — fathers and mothers — lead to stressed children. "Kids (of this age) model themselves on their parents in every way, even picking up their anxiety and stress-driven behaviour. We underestimate their comprehension of stress," he says. Such parents fail to be good listeners or hands-on with their kids' troubles. Couples who fail to cope with marital discord exert a toll on their child's mental health, too.
Actor Tara Sharma who hosts a parenting show on television puts it succinctly, "If the parent is relaxed, the child feels relaxed."
Stress can be normal
One of the things that experts tell parents is not to aim for a stress-free life for their child. Stress is normal — what's essential is that the child learns how to cope with it.
Harvard University's Center on the Developing Child conducts research on how coping with adversity is an important part of a healthy child's development. Its website explains the need for supportive relationships: "When we are threatened, our bodies prepare us to respond by increasing our heart rate, blood pressure, and stress hormones, such as cortisol. When a young child's stress response systems are activated within an environment of supportive relationships with adults, these physiological effects are buffered and brought back down to baseline. The result is the development of healthy stress response systems."
"Going to playschool is stressful. A sibling snatching a toy was stressful. But this is in the realm of normal stress, and a child can cope with it by holding a comfort object like a teddy bear or blanket" reasons Krishnamurthy. It's when the child is exposed to stress that he cannot cope with that it becomes "toxic for their health".
Sensible parenting
-Let your child have spare time
-Be a filter to the child's world. If the newspapers have reported about a terrible accident on the front page, turn it upside down
-If you are an overachiever, don't have unrealistic goals for your children. Be realistic
-Leave your child be. Learning to navigate the playground and playing with peer groups helps him figure social relationships
-Have at least one meal with your child. Remember the ageold adage — a family that eats together, stays together
Tackling violence around them
Dr Krishnamurthy saw several cases of post trauma stress disorder after the 26/11 Mumbai attacks. Children's age and individual personality influenced their reactions to violent images they saw in newspapers and on television. Soon after the attacks, Ummeed sent out handouts to several families that explained how parents can help mitigate the stress their children may be feeling. It contained tips that could apply in most situations, such as, 'In addition to the tragic things they see, help children identify good things, such as heroic actions, families who are grateful for being reunited, and the assistance offered by people throughout the country and the world'.
Signs your baby is stressed
-Infants and preschoolers demonstrate stress by clinging on to their parents and crying often
-Regressive behaviour like thumb sucking, bedwetting, and fear from darkness -Temper tantrums, extreme aggression, making unreasonable demands, and being overly fussy
-School-going children complain of stomach aches or other body-aches
-Nail biting, continuously picking their nose, grinding their teeth, poor appetite, sleep disorders, loss of immunity
