Anxiety

Podcast: How to Help Children Cope with Bad News

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Posted on by Leonardo Rocker (Quirky Kid Staff)

Poscast on Helping Kids to make friends by Quirky Kid

We’d love to share our latest podcast recorded by Dr Kimberley O’Brien for a local magazine with you. This weeks topic is helping children cope with bad news.

Quirky Kid has produced a full range of creative and engaging Therapeutic Tools.


 

[00:00:00-00:00:32] Dr. Kimberley O’Brien introduces strategies for parents to help kids cope with traumatic news.

Hello Bonnie. It’s Dr. Kimberley O’Brien here. I’m auto-recording in Japan, so I hope there won’t be any background distractions. I’ll talk for five minutes on strategies to help kids cope when they’ve seen a tragedy, or had some sort of unfortunate event. I’ll have some tips for parents as well – I’ll fill you in on that towards the end of the interview.


 

[00:00:33-00:02:27] Parents shouldn’t shield children from all forms of adversity. Instead, teach them coping strategies for stressful events, since those are an inevitable part of life. 

The first thing you said was about helping kids to deal constructively with bad news, rather than sweeping it under the carpet. I agree that it’s a healthier approach, because it’s really setting them up for life. It’s giving them the skills to overcome adversity, without feeling like a parent is required to shield them from something that’s not appropriate for kids to hear.

From a young age kids are learning how to overcome physical injuries. Like toddlers grazing knees – they hop up and brush themselves off, and then life goes on. They can cope with those sorts of little incidents. And if we do shield the kids from all adversity, then they don’t learn the coping skills they need in certain situations, like if they are not good enough for a sports team, or if they’re excluded from a game at school. Teaching them coping skills is like teaching them life skills that help them to be more resilient. And it gives them confidence to be able to overcome issues moving forward. That’s part of healthy psychological development.

Imagine adults that haven’t learned to overcome adversity. They’re more likely to react negatively, perhaps need a lot more support, and need to take time off work if they haven’t learnt to cope with life’s issues that will come our way. That’s just part of life, isn’t it? Kids will have to change schools, or they may lose a pet or loved one. That stress is a part of living, so it’s something that kids need to learn to cope with.


 

[00:02:27-00:04:08] Encourage children to express their feelings in words, rather than through actions. Praise them for expressing themselves clearly, and empathise with them verbally. When something bad happens, let kids write down questions in a booklet, so you can answer those questions when you feel prepared to remain calm during the discussion. It’s a way to model good coping skills. 

The best way to do this, for parents, is to prepare for question time if it’s something that’s happened for a young person, like the loss of a pet. Have a question booklet that kids can record some questions in. And then make sure you feel prepared emotionally to answer each one of those questions. When I say prepared emotionally, I mean that children often take their cues from their parents. If parents are very emotional, kids will often follow suit and become quite emotional. So being prepared to model good coping skills as a parent is important. Say “these things happen but we will get through it”. Use words to explain those feelings.

Sometimes kids will use actions or behaviour to express their emotions. For example, they may feel disappointed, or upset that they didn’t make the sports team, and they may throw their sports bag across the room. But what we want kids to do is to use their words, and say “I feel so disappointed, I’m so jealous that my best friend was selected and I wasn’t”. Parents should then use verbal praise to say “I’m so glad to hear you express yourself so clearly, now I understand how you feel”. Parents can empathise with young people: “I’ve felt that way before, this must be hard”. Empathising is also part of helping kids to express their feelings in words, rather than in actions.


 

[00:04:08-00:05:01] When it comes to family trauma, such as a separation or a tragedy, it’s better to get professional help because they can remain objective and provide the family with support.   

Just a final point now, for parents on how to help kids through family separation. It’s good to encourage them to see a psychologist, such as someone at the Quirky Kid Clinic or a school counselor, to help them normalize those feelings. Often if parents are involved in situations, like if there’s been a tragedy or trauma within the family, it’s better to get professional help. A professional can remain objective and provide kids and parents with stats on how often these things occur, how long it may take kids to recover, and what the phases of grief and loss may be. It’s good to have an expert when dealing with family separation or similar situations.


 

[00:05:01-00:05:58] When a tragedy happens, stick to the basic facts when relaying the news to the child. Avoid delving into the causes, or exposing them to distressing images, to avoid more of an emotional response. 

And finally, a tip about how to relay the news to a child. Say it was something that happened in the world, like a tsunami. We often get rising referrals when there’s been a trauma, like a tsunami, and kids have seen it on TV. It’s best to switch off the news when there’s lots of visual, distressing images for kids to catch. Parents have more control when they’re giving the news to the young person. Stick with the facts: what happened, how it happened, when it happened. Avoid going into the whys, because that’s often going to trigger more of an emotional response.


 

[00:05:58-00:06:50] Apart from verbally expressing themselves, it can also be useful for kids to use art or visual props to talk about how they felt before, during, and after an incident. 

I’m going to wrap up now. To help kids deal and process emotions, help them to use their words to understand those feelings, or to seek help from a professional. Sometimes kids will express their feelings using art, so give them an opportunity to draw what happened. Or, they can select images, such as from our “Face It” cards, which are feelings cards with a whole bunch of different facial expressions. Children can use them to talk about what they felt before, during, and after an incident. Visual props can be very helpful.

Bonnie, it’s been a pleasure to answer your questions today, and I look forward to talking to you again in the future. I’m Dr. Kimberley O’Brien from the Quirky Kid Clinic. That’s www.quirkykid.com.au. And keep in touch. Thank you.

Enconpresis in school aged children

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Posted on by Leonardo Rocker (Quirky Kid Staff)

Image with humour about toilet by Quirky Kid

 

Encopresis (or faecal soiling) is one of the most frustrating difficulties of middle childhood, affecting approximately 1.5% of young school children (von Gontard, 2013). It is a debilitating condition to deal with as a parent, as it usually occurs at a stage when children are past the age of toilet training.

Encopresis is a common complaint amongst parents who visit the Quirky Kid Clinic as it often occurs in the context of other behavioural issues such as oppositional defiant disorder (ODD) or separation anxiety.

According to the Diagnostic Statistical Manual (DSM-V) (American Psychiatric Association, 2013) encopresis (or otherwise known as Elimination Disorder) is essentially the repeated passing of stools into inappropriate places, after the age at which toilet training is expected to be accomplished. In order to receive this diagnosis, 4 features should be present:

  • Patients chronological age must be at least 4 years
  • A repeated passage of feces into inappropriate places, which is either intentional or involuntary.
  • At least one such event must occur every month for at least 3 months.
  • The behaviour is not attributed to the effects of substances (e.g., laxative) or any other medical condition.

There are two basic categories of encopresis i) primary encopresis-which refers to children who have never attained bowel control, ii) secondary encopresis-which refers to soiling after successfully attaining toilet control usually brought upon by entering a stressful environment (such as family conflict).

What causes encopresis?

Parents of children with encopresis often feel frustrated as they often believe that their children play an active role in controlling their bowel movements.  While in some cases, soiling may be intentional, in other cases it may be involuntary and beyond the child’s control. It is important to be aware of the many possible causes for this disorder.

  • Biological factors: Functional constipation (persistent constipation with incomplete defecation without evidence of a structural or biochemical explanation) is one of the main causes of encopresis, accounting for 90% of cases amongst children (Har & Croffle, 2010). Children may withhold stools often because he/she is constipated and therefore experiences pain when there is a bowel movement. Chronic withholding of bowel movements causes children to lose the ability to defecate normally, and causes partial bowel movements of which children are often unaware. Other medical causes such as spinal cord damage, celiac disease or damage to the bowel can result in encopresis. Medications may also lead to non-retentive fecal soiling. Tricyclic anti-depressants, narcotics, and iron are likely to cause constipation that is severe enough to lead to encopresis and laxative abuse can cause severe diarrhea and fecal incontinence.
  • Psychological factors: Overall 30-50% of children with encopresis have a comorbid emotional or behavioural disorder (von Gontard, 2012).  In a large population study, school aged children with encopresis had significantly increased rates of separation anxiety (4.3%), specific phobias (4.3%), generalized anxiety (3.4%), ADHD (9.2%) and oppositional defiant disorder (11.9%) (Joinson et al., 2006). Children who present with Oppositional Defiant Disorder or Conduct Disorder (that is, children who are intentionally defiant and non-compliant to their parents or caregivers) may use inappropriate soiling as a form of retaliation, as a means to communicate their anger, or as an attention seeking strategy. There is also evidence to suggest that children who have encopresis experience higher levels of  anxiety and depression as a result, and these symptoms can exacerbate the symptoms of encopresis. A population study by Cox et al., (2002) found that children with encopresis had more anxiety and depression symptoms, exceeding the clinical threshold by 20% compared to control children.
  • Family and social factors: Children may develop delays in toileting due to unsuccessful toilet training as a toddler and intrusive toilet training. It may have been that children recieved discipline for having accidents or have been encouraged into toilet training before they were ready. Negative toilet training practice can cause children to associate using the toilet with punishment. In other cases, encopresis occurs when there is a stressful family situation such as divorce, birth of a sibling or transition to a new school. In severe cases, frequent soiling may occur in a child who has had a traumatic or frightening experience such as a sexual or physical molestation.

What are the potential risk factors for Encopresis?

In western cultures, bowel control is established in 95% of children by age 4 in 99 % of children aged 5 (von Gontard, 2013). Around primary school age (10-12 years old) 1.5% of children develop encopresis. Although every case is different, studies have shown that there are a number of risk factors, which are associated with the development of encopresis including:

  • Gender: encopresis is five times more common in boys than girls.
  • Abuse and/or neglect.
  • Inadequate water intake.
  • Presence of chaos or unpredictability in a child’s life.
  • Lack of physical exercise or a diet that is rich is fat/ sugar.
  • Presence of neurological impairment such as brain damage, autism, developmental delay and intellectual disability.
  • History of constipation or defecation.

What is the impact of encopresis in school aged children?

Encopresis can have a severe effect on the child, family and school environment. Encopresis is often a family preoccupation, as parents and siblings become increasingly frustrated as family activities may be disrupted due to the constant soiling. The family is left fruitlessly battling over the child’s bowel control, and the conflicts may extend to other areas of the child’s life such as school functioning and social circles such as friends. When the child becomes increasingly aware of these difficulties, they may become angry, withdrawn, anxious and depressed and may be a victim of bullying if other peers become aware. Studies have shown that encopresis children experience a greater amount of anxiety and depression symptoms, difficulties with attention, more social problems, disruptive behaviours and lower levels of academic performance (Mosca & Schatz, 2014).

What are the treatment options for encopresis in school aged children?

While encopresis is a chronic and complex problem amongst many families, it is treatable. As a parent, it is important to be aware that there is no quick fix for encopresis, the process might take months and relapse is very common. Sixty-five percent of patients are almost completely cured in 6-months and 30% show improvement (Har & Coffle, 2010).  The majority of children with encopresis can be effectively treated with a combination of medical, psychological and dietary interventions.

  1. Medical treatments: The first step to treating encopresis is to identify the cause behind the condition and seek medical advice from a pediatrician or GP. Medical examinations are important in order to rule out the existence of organic causes. Initially a doctor may prescribe a laxative to ease the passage of the hardened stool through the rectum. Once the stool has passed, substances such as fiber, enemas or laxatives may be used to empty the colon and decrease painful bowel movements.
  2. Behavioural modification with the assistance of a Psychologist is an integral treatment component for encopresis . In order for this to be effective, family tension regarding the symptom should be reduced and a non-punitive atmosphere should be established. Parents should encourage their child to sit on the toilet for 10 minutes after meals 2-3 times a day. The initial aim is to produce a bowel movement by giving the child the chance to get used to using the toilet and to be in tune with bodily cues.  Parents can create a reward system, which provides incentives for the child to use the toilet. He/she may receive a star or sticker on a chart for each day he/she successfully goes to the toilet without soiling and a special reward could be earned after an 80% success rate during the week. A recent meta-analysis by Freeman, Riley, Duke & Fu (2014) found that behavioural intervention is the most effective treatment for encopresis.
  3. Treat other co-morbidities: Comorbid emotional and behavioural disorders should be treated separately according to evidence based recommendations (von Gontard, 2013). If your child is presenting with anxiety, depression, or oppositional defiant disorder, these associated co-morbidities should be treated concurrently to reduce symptoms of encopresis. Untreated co-morbid disorders will reduce adherence and compliance and the outcome of encopresis treatment will not be optimal.

Other tips include:

  • Never tease or embarrass your child and do not show anger. Supporting your child’s self-esteem is essential. Name calling and teasing are frequent results when a child soils at school/and/or smells of feces so it is important that their self esteem is not affected as a result. While it may seem like purposeful behaviour at times, it may not be within your child’s control (as in the case of functional encopresis).
  • Encourage your child to drink lots of water, eat fiber rich foods such as fruits, vegetables and whole grains
  • Consider scheduling evidence based psychological intervention if your child feels shame, guilt, depression or low self esteem related to encopresis.
  • If your child shows no improvement after 6 months they should be referred to a gastroenterologist for additional assessment.

References:

American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Cox, D., Morris, J., Borowitz,S., & Sutphen, J. (2002). Psychological differences between children with and without chronic encopresis. Journal of Pediatric Psychology, 27,7, 585-591.

Freeman,K.A., Riley, A., Duke,D.C., & Fu, R. (2014). Systematic review and meta-analysis of behavioural interventions for fecal incontinence and constipation. Journal of Pediatric Psychology. 39, 8, 887-902.

Har, A.F., & Croffle, J.M. (2010). Encopresis. Paediatrics in review. 31,9,368-3754.

Joinson, C., Heron, J., Butler, U., et al. (2006). Psychological differences between children with and without soiling problems. Pediatrics, 117, 1575-1584.

Mosca, N., & Schatz, M. (2014). Encopresis: Not just an accident. NASN School Nurse. 28,5,218-221.

U.S. National Library of Medicine, MedlinePlus (2012). Encoporesis. nlm.nih.gov. Retrieved 12 September 2014 fromhttp://www.nlm.nih.gov/medlineplus/ency/article/001570.htm

von Gontard A.(2012). Encopresis. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva:

von Gontard, A. (2013). The impact of the DSM-5 and guidelines for assessment and treatment of elimination disorders. Eur Child Psychiatry, 22,61-67.

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Perfectionism in Children: Top 8 Strategies

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Posted on by Leonardo Rocker (Quirky Kid Staff)

 

Imagine a child who keeps a perfectly neat desk in class, a super tidy room at home, spends afternoons ensuring their homework is meticulous and correct and who expects the very best of themselves at all times. What could possibly be awry here you ask?

Well, at the Quirky Kid Clinic, we know how important it is to foster the hopes and aspirations of children and awaken and strengthen a desire for children to strive to be their best, however, we know that for some children, this desire can become an all-encompassing, all-consuming striving for flawlessness, which can become a difficult load for children to carry (Hibbard & Walton, 2014).

Perfectionism, characterised by the setting very high, even impossible, standards for oneself and becoming self-critical if these standards are not reached, is a common feature of many of the children we see at our clinic. While it is well established that many children can manage perfectionistic characteristics adaptively to help them stay motivated, organised and on task to meet high personal standards, perfectionism can also lead to high levels of avoidance, anxiety, depression, low self-esteem and exaggerated reactions to mistakes, all of which can interfere with a child’s functioning (Gnilka, Ashby & Nobel, 2012). We frequently see perfectionism getting in the way of a child participating in class, being able to complete assignments and homework, having a go at new activities and gaining pleasure from social and sporting activities.

How perfectionism in children starts?

A common question we are asked is where does children’s perfectionism come from? The research is quite mixed when talking about the developmental roots of perfectionism. It appears that a child’s early experiences play a role, such as the messages children receive and hear about success, achievement, and failure. For example, children with highly critical parents and who seem to perceive their parents as expecting them to be perfect,  show a greater likelihood of showing perfectionistic traits (Hibbard & Walton, 2014). Additionally, we know the temperament of a child also plays an important role, with children who are highly sensitive and prone to anxiety, becoming more likely to express perfectionism.

Features of perfectionism in children?

One of the hallmark features of children who are perfectionistic is the distorted and rigid ways in which they tend think (Fletcher & Neumeister, 2012). Perfectionistic children commonly think they must adhere to meeting impossibly high standards (eg. “I must get 90% in my exam, I must make sure I am the best in my class”). They may also overgeneralise when they fail (“this bad mark means I’ll never do well”), display black and white thinking (“if I make an error, I will be a complete failure”) and focus on the negatives while discounting the positives (“I messed up every ball in that game, I played terribly”). These distorted thinking patterns act like filters, such that these children tend to see the world quite differently to their peers, honing in on information and experiences that confirm underlying fears that their best efforts will never be good enough and filtering out more positive experiences. This can fuel self-critical beliefs and exacerbate avoidance behaviours as children become more unsure of themselves over time.

So, how can we best support our children who appear to be setting impossibly high standards for themselves?

  • Take care of yourself:    Setting high standards for ourselves, whether it be in our parenting, career or sporting achievements can have a multitude of benefits for children, however, be mindful of the pitfalls. Are we constantly frustrated? are we constantly comparing rather than focusing on our unique capabilities? are we avoiding things for fear of failure? Children learn greatly about developing resilience, perseverance, enjoyment of a challenge and their own strengths and weaknesses from watching us as parents set goals, shift the goal posts and cope when things don’t quite go to plan. Showing your children a ‘have a go’ attitude and the enjoyment and learning that it brings will help them navigate and cope with their own challenges in life (Greblo & Bratko, 2014).
  • Support High Achievers early on: It is important to support high achiever early on with the right messages, instructions and education. With this in mind, The Quirky Kid Clinic has published a unique online program called Power Up: Using Performance Psychology to do your best. This rich and engaging online program covers key areas of performance to assist children and young people aged 10 to 16 to perform at their best.  See http://powerup.quirkykid.com.au
  • Seek additional assistance from your school counsellor or psychologist: There can be times when perfectionism can really get in the way of your child’s ability to function at school and home. If your child is avoiding things for a fear of failure or making a mistake and is showing exaggerated reactions and changes which may signal anxiety or depression, it is recommended you seek further opinion from your school counsellor or psychologist.
  • Focus on coping skills: Help your child develop positive coping strategies for managing their fears and worries about achievement. Two practical strategies to help your child are breaking down goals and developing a problem solving approach (Gnilka et al., 2012). Often, children avoid tasks like homework or writing in their books, speaking out in front of classmates and playing in team sports because the task at hand appears so daunting and thus is avoided altogether. Help your child break their goals down into more achievable goals, like completing smaller amounts of homework at more regular intervals for example. Helping children problem solve is also important. We know problem solving capabilities are learnt, and, important to the development of children’s resilience-skills. Help children define the ‘problem’ they have and explore and test out possible solutions. Over time, children will be better equipped to confront problems and hurdles with greater flexibility and be better able to generate a range of possible solutions rather than feeling overwhelmed as soon as an issue is presented.
  • Challenge distorted and unhelpful thinking styles: One of the central factors which appears to perpetuate the anxiety and avoidance so frequently associated with perfectionistic children is the distorted and unhelpful ways in which they think. What is often frustrating for parents, teachers and coaches, is that perfectionistic children rarely have experiences in which, given attempt and effort, they fail. Helping children develop more helpful and realistic self-talk is the key. Some key questions to ask children are: what evidence do they have for their fear or negative thought being true? What is helpful about their negative thought and what is unhelpful about it? What is the worst that could happen if their feared outcome occurred and how terrible is this on a scale of life events? What could be more realistic and helpful to say to themselves? Challenging children’s cognitive distortions and replacing them with more realistic and helpful self talk is central to children understanding and knowing they are not defined by their mark or mistake and realising how unhelpful rigid patterns of thinking can be (Fletcher & Neumeister, 2012).  Great activities are also covered on the Power Up Program
  • Set the scene: Set the language in your household and with your child’s school and interest groups, to demonstrate to your child that mistakes are ok, everyone makes them and having your best go is more important than the outcome. Where appropriate, talk openly about your own mistakes and encourage teachers and coaches to do the same. Model making mistakes and your own coping reactions in response. Discuss with your child the positives which come from making mistakes and focus on the positives of situations that were gained despite of, or in light of, a mistake. Encourage enjoyment of activities and make this a focus with your child. Set limits on things which need to be limited, such as how long your child spends on their homework, and use words of encouragement for effort.
  • Find a positive role model: Find a healthy role-model for your child, a person who can take an interest in your child’s hobbies and skills and who can strengthen the language of ‘effort over success’ , ‘everyone makes mistakes’ and the ‘have a go’ attitude with your child.
  • Foster a ‘growth mindset’: Recently, there was a very good article published in the New Scientist about how to raise successful children and core to the article was the idea that we need to foster a ‘growth mindset’ with our children. In essence, we need to move away from thinking in rigid and fixed ways about our talents, intelligence and personalities (eg. “I am no good at sport”, “I can’t change this”) to a flexible mindset focused on the possibilities of growth, benefits of effort and development through perseverance and support. For our children who are perfectionistic, this can help children move from “I can’t” or “I will never” to “I will have a go”, with this effort and attempt being praised from the sidelines to see these children not only fulfill their potential in their focus area, but also branch out to find meaning and joy in activities and pursuits which aren’t being done perfectly.

Recommended Resources: 

Purchasing Power up 

References

  1. Fletcher, K. & Neumeister, K. (2012). Research on Perfectionism and Achievement Motivation: Implications for Gifted Students. Psychology in the Schools, 49 (7), 668-677.
  2. Gnilka, P., Ashby, J. & Noble, C. (2012). Multidimensional Perfectionism and Anxiety: Differences Among Individuals With Perfectionism and Tests of a Coping-Mediation Model. Journal of Counseling & Development, 90, 427-436.
  3. Greblo, Z. & Bratko, D. (2014). Parents’ perfectionism and its relation to child rearing behaviours. Scandinavian Journal of Psychology, 55 (2), 180-185.
  4. Hibbard, D. & Walton, G. (2014). Exploring the Development of Perfectionism: The Influence of Parenting Style and Gender. Social Behavior and Personality, 42 (2), 269-278.
  5. New Scientist (2014), March Issue. The Secret of Success by Michael Bond.
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Promoting Healthy Sleep Patterns in Children

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Posted on by Leonardo Rocker (Quirky Kid Staff)

Image of a house, dark with starts by The Quirky Kid Clinic

Challenges with sleep, whether it be difficulties with settling, night-time wakefulness, or fears and worries about sleeping independently, are some of the most common reasons children are referred to the Quirky Kid Clinic. Many families relate to feeling exhausted, frustrated and confused when they have a child or children who have difficulties with their sleep. Naturally, while sleeping can be a significant issue when our children are very young, many parents hope and expect children will grow into healthy sleeping patterns as they grow, however, for around a third of Australian school-aged children, this is not the case (Sleep Health Foundation).

Impact of poor sleeping patterns in children

Poor sleeping patterns can have a wide ranging impact on children and their family. Children who do not get enough sleep find it more difficult to function during the day and may be more prone to behavioural issues and feeling worried and not themselves (Wells & Vaughn, 2012). Children at the Quirky Kid Clinic who experience sleeping difficulties commonly report that they find it hard to concentrate and learn at school and often feel more agitated and frustrated. Parents also report increased stress and frustration at home and frequently report that they cycle between feeling sympathetic and angry towards their child.

How much sleep should a child have?

One of the most frequently asked questions raised by parents is how much sleep does their child need. While we know that sleep needs vary from individual to individual and that many aspects of sleep are related to our genetic makeup (such as how well we function after a bad night’s sleep), as a general guideline, school-aged children (5-12 years) require between 9-11 hours of sleep a night-time and that as children get older, they need less sleep (Sleep Health Foundation). Generally speaking, our sleep needs stabilise around the age of 20 years, meaning that prior to this age, our sleep needs can be quite variable.

What causes poor sleep in children?

While we know that there can be many causes of sleep-related problems, which can include underlying physical issues (such as Obstructive Sleep Apnoea and Restless Leg Syndrome), the Australian Sleep Health Foundation reports that the majority of sleep-related challenges among school-aged children are related to more psychological and behavioural issues. Some of the psychological factors which may make it difficult for children to sleep include feeling anxious or depressed and some of the behavioural issues include having an inconsistent bedtime routine and a bedroom environment which is not conducive to sleep (Yang, Lin & Cheng, 2013).

One of the most common issues for children who find it difficult to sleep is that they worry, which often escalates upon bed-time. While night-time fears are very common and part of development, some children worry more often and more intensely than others, which can result in poor quality sleep (Kushnir & Sadeh, 2012). Children often also find themselves worrying about not being able to sleep, which creates a cycle of sleeplessness as they body’s anxiety-reaction creates physiological changes which are contrary to a calm, sleep-focused state.

A recent study by Mindell, Meltzer, Carskadon and Chervin (2009) examined the sleeping habits of children up to ten years old and highlighted environmental and behavioural factors which appear to be impacting on a range of sleep-related measures, such as how resistant children are going to bed, how long it takes to fall asleep, how long children sleep for and how disturbed sleep is during the night. Overall, the study found that going to bed late (after 9pm) and having a parent present upon falling asleep was related to more time taken to fall asleep, less overall sleep and more night-time wakening. Additionally, the presence of a TV in the bedroom and having caffeine, interfered with children getting off to sleep and getting enough overall sleep. This study points to the importance of facilitating predictable bedtime routines for children as a way of ensuring children get a good quality sleep and enough sleep.

So What can we do about improving sleep patterns in children?

  1. See your family doctor 
    If your child is having difficulty sleeping, the first point of call is to see your local GP for a thorough examination to ensure the sleep-related difficulty is not caused by any underlying physical problem.
  2. See your psychologist 
    Behavioural and psychological factors related to sleep issues in children can often be addressed by a Psychologist. A Psychologist may help a family put in place a more consistent nighttime routine, address any fears or worries that may be impeding sleep and provide support to the family with what can be a very frustrating and challenging issue.
  3. Make some changes to the family’s sleeping habits
    Having good sleeping habits is typically referred to as having good sleep hygiene. There are some important things that can help to set up the best environment for your child to enjoy a peaceful nights sleep, which include:
  • Have a routine: Having consistent bed times and wake times can help set the internal body clock and develop healthy sleep-wake patterns. Ensure your child ‘winds down’ for an hour before bedtime (eg. reads quietly, has a bath) and is not overstimulated by TV, music and/or a busy household. While staying up late has been shown to significantly impact on the quantity and quality of children’s sleep, trying to put your child to bed too early can also disturb their sleep. Listen to your child and look for the signs that they are ready for bed (rubbing their eyes, yawning). Help your child wake at a regular time each morning, this will help their body clock re-adjust and learn to fall asleep more efficiently in the evenings.

  • Have a ‘before-bed’ routine: Things that our children do in the afternoons can also impact on their sleep. Avoid caffeine in the afternoons (beware that many soft drinks and chocolates contain caffeine) and time dinner so children are not going to bed with full tummies but are also not going to bed hungry. Research is also suggesting that the exposure to bright blue light from computers, devices and phones can reduce the levels and delay the onset of melatonin, a sleep-promoting hormone, so plenty of time between computer/device use and bed is important.

  • Set up their room: Ensure your child’s room is not too hot or cold and that their mattress, blankets and pillow comfortable. Take out any distractions from their room (eg. TV’s, devices, computer, pets) and cover their clock so they are not clock-watching. Avoid using your child’s room as a time-out area, so as not to develop any negative associations with their room.

  • Develop an action plan if your child cannot get to sleep: Help your child know what to do if they can’t sleep. Kids from the Quirky Kid Clinic report that they find using relaxation and imagery exercises helpful as well as games they can play from bed that are designed to tire their minds out. One such game involves using a torch to find objects starting with each letter of the alphabet, in their room. Discuss the nature of sleep with your child and explain how getting up, going into bright light, watching TV, eating etc can wake their bodies up so it is important to try and remain in their bedroom where it is peaceful for their bodies. Remember to reward your child for utilising their action plan and help them problem solve any difficulties they may be having.

Setup Worry Time: If your child worries in bed and has difficulty switching their minds ‘off’, it can be helpful to set aside some time to talk about their worries in the afternoon, well before bedtime. This ensures your child feels heard and can help children debrief and problem solve around their worries so they are not doing it in bed. If children start to worry in bed, gently remind children to let their thoughts ‘float’ away and that they will be discussed during worry time the next day.

Assess your own expectations and reactions: Be realistic about your child’s sleep needs and remember that children’s sleep needs can very extremely variable. Remember that sleep challenges are very common and are treatable and that feeling frustrated and angry are normal and common reactions. Develop a support network of people you can debrief with and who can help you remain calm and consistent with your child.

Recommended Resources:

  1. Good Night Giants
  2. What to do When you dread your bed

References:

http://www.sleephealthfoundation.org.au/

Kushnir, J & Sadeh, A. (2012). Assessment of brief interventions for nighttime fears in preschool children. European Journal of Pediatrics, 171, 67-75.

Mindell, J., Meltzer, L., Carskadon, M & Chervin, R. (2009). Developmental aspects pf sleep hygeine: Findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Medicine, 10, 771-779.

Ng, A., Dodd, H., Gamble., A. & Hudson, J. (2013). The Relationship Between Parent and Child Dysfunctional Beliefs About Sleep and Child Sleep. Journal of Child Family Studies, 22, 827-835.

Wells, M. & Vaughn, B. (2012). Poor Sleep Challenging the Health of a Nation. Neurodiagn Journal, 52, 233-249.

Yang, C., Lin, S & Cheng, C. (2013)/ Transient Insomnia Versus Chronic Insomnia: A Comparison Study of Sleep-Related Psychological/Behavioral Characteristics. Journal of Clinical Psychology, 69 (10), 1094-1107.

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Grief and Loss at Christmas

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Posted on by Dr. Kimberley O'Brien

Grief and Loss Image

While Christmas is a time of excitement and joy for many – others would prefer to sleep through a family gatherings, avoiding triggers of grief following a particularly painful year.

People grieve for different reasons – the loss of a grandparent, the loss of a business, a string of miscarriages or a recent divorce. Christmas may be the first public airing to family about the events of the year, and the anxiety associated with the potential outpouring of emotions can stifle the Christmas joy. Knowing how to emotionally prepare for Christmas may be the difference between hiding out in the bedroom and joining your family for an afternoon of fun in the sun.

Firstly, be aware of your triggers. A family overcoming the loss of a grandparent may wish to avoid having an empty seat ‘where grandpa used to sit’. For others, the empty seat may be a symbol of respect for the missing family member. Take a quick vote among the adult family members to decide if a move outdoors may be a welcome change of scene for grieving family members. Set up a picnic rug under a tree to avoid triggers of grief and loss before Christmas lunch. While missing family members are likely to be remembered on special occasions, for the majority of people grief is best processed in the most comfortable setting available. That is, raising your glasses to grandpa in the garden may symbolize the celebration of life, while sitting in the presence of his empty chair is more aligned with sadness and loss. Being mindful of the different stages of grief impacting on others, such as denial, anger or acceptance, may also help to acknowledge the perspectives of others during sensitive discussions relating to lost loved ones.

Secondly, be aware of the discussion topics you’re exposed following a recent loss. For example, listening to people talk about their pregnancies and newborns may trigger grief for a couple overcoming a series of miscarriages. Similarly, any reference to the word, “work” may be perceived as an insult to a young entrepreneur following a failed business venture. In fact, many innocent questions or conversations can give rise to defensive responses at Christmas. Taking offense to others is one symptom of grief. At this point, consider refilling your glass of water or checking on the kids for some light-hearted relief. It is natural for family members to show an interest in the lives of each other and asking questions is part of the annual catch-up for many relatives living apart. If anyone asks a question, you’d rather not answer, it’s ok to say, “Hey, enough about me – Let’s talk about you!” or “Hang on a second, I’ll be back” and head to the bedroom to regroup (AKA “losing it”).

The following strategies have been devised to prepare you for the onslaught of questions at Christmas and to help manage common grief responses, such as crying, taking offense, getting angry or rapidly leaving the room.

  • Step 1: Be prepared – Write or draw about the topic you would most like to avoid at least 24 hrs before your family gathering to clarify the issues for yourself.

  • Step 2: Develop a plan – Find the place you feel most relaxed and settle there. Try not to make it in front of the TV. Think outdoors, think shade and comfort. Being antisocial won’t help – It will only increase your anxiety about being perceived as rude.

  • Step 3: Bring props and distractions – Photos from your holiday, a good book or some massage oil. You may give or receive a massage that will completely change your outlook on the day ahead.

  • Step 4: Share your thoughts – Like children, adults are more likely to share their thoughts and feeling when they’re relaxed. A good conversation on Christmas Day may reveal you’re not alone in your grief – Most people have experienced loss in one form or another.

  • Step 5: Be kind to yourself – If you need to have a quiet Christmas, do it. We all need time to reflect and recharge. Write a note, go for a walk…and consider leaving early. There’s always next year.

For books on grief and loss, see the Quirky Kid Shoppe.

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