Stress has been coined as a national health crisis in America, and children, unfortunately, are not immune to this. Childhood and adolescent stress can be expected to an extent. When kids have changes in routines, such as starting grade school, a sibling joining the family, or they are trying out new sports, there may be some level of stress in these unique aspects of life. It’s when stress becomes chronic and unresolved and impacts the child's ability to cope that it really can have a profound impact on their health and well-being. 

We are seeing rising stress levels in children today due to the COVID-19 pandemic, in addition to the academic, social, and environmental factors that children are faced with. With this heightened stress level, we need additional resources for primary care providers. Integrative medicine offers a multifaceted approach that can assist children who are dealing with stress. From family life dynamics to academic demands and social constructs, the pediatric population could greatly benefit from the complementary and holistic approach of integrative medicine. 

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What Are The Sources of Stress in Children?

Children may not experience the stress that accompanies adulthood, but many of them do experience various mental and emotional factors that can impact their coping skills. Everyday stressors in modern-day children’s lives include family situations, academic pressure, social dynamics, and digital influences and influxes. Today’s kids live in a fast-paced world, with access to information at their fingertips. This instant access to entertainment and data can be an excessive amount of information to process and integrate into a developing brain. In addition to the information overload, many families live a very active lifestyle. 

While these are well-intentioned family and social dynamics, such as sports, music lessons, and other extracurricular activities, they can add to the mental capacity a child can manage. On average, American children spend 19% of their day in school, with an added 3% for enrichment activities. While this may not seem like a large percentage of their day, it does not consider the hours spent doing homework or preparing for the school day. The impact these full schedules can have on kids was best explained in this article, showcasing how a day of school and responsibilities may lead to burnout in kids. 

Academic pressure is a valid concern amongst children worldwide. In the UK, the Good Childhood Report revealed that 11-12% of children ages 9-13 years old reported they were unhappy with school and schoolwork due to the stress related to academic pressure. A systemic review from this year also found in Asia and Europe that depression and anxiety are correlated to academic pressure. In addition to school work pressure, some kids notoriously have difficulty with social dynamics. Some examples of social stress are- stress from forming relationships, peer pressure in their social engagements, or sensory overload in social environments. Evidence in these areas revealed that while not all kids will experience stress in these circumstances, it's essential to know the warning signs of stress in children. 

Symptoms and Manifestations of Stress in Children

Kids can express physical, emotional, and behavioral signs indicative of stress. Children may not have the capacity, communication skills, or even awareness that what they are experiencing is stress. This is why parents, caregivers, and educators must pick up on signs and symptoms that can be telling of overwhelmed and stressed kids. These are vital features that you may see in kids stressed-out children. 

Physical signs of stress in children include:

• Headaches
• Stomach aches
• Shallow breaking
• Racing heart
• Excess sweating
• Nausea or indigestion
• Weight loss or gain 
• Aches and pains 
• FIlling sick often
• Changes in bowel movement habits
• Sleep disturbances
• Hyperactivity

Emotional signs of stress in children include:

• Isolation
• More frequent outburst
• Feeling sad or being tearful
• Irritability 
• Neglecting responsibilities 
• Depression
• Anxiety

Behavior indicators of childhood stress include:

• Short-tempered
• Argumentative
• Acting out or not listening
• Temper outburst
• Neglecting responsibilities 
• Difficulty staying on task or concentrating
• Defiant behaviors

The Role of Integrative Medicine in Relieving Stress in Children

Integrative medicine for children’s health care aims to address the root cause of health disturbances. A child’s mental and emotional well-being is a crucial component of their overall health. Practitioners in this field do a thorough clinical assessment, which considers physical, mental, emotional, and environmental factors. Through this, they can make holistic health treatment plans, which may combine conventional medicine and complementary care. In those expressing signs of stress, an integrative medicine’s holistic approach for children may include lifestyle modification recommendations, a referral for therapy, nervous system support, or mind-body medicine like acupuncture. Each child is treated as an individual, and intervention is geared toward meeting the child where they are without adding additional stress to their everyday life. 

One aspect of integrative medicine is that it can reduce the frequency and longevity of pediatric prescription medication use. This avenue is a valuable resource for children with chronic illnesses, as reports have shown that the use of integrative, complementary therapies is prevalent in more than 50% of chronic illnesses in pediatrics. While the benefits of integrative medicine are evident in children’s medicine, there are healthcare disparities that make this field less accessible. Bridging the gap between access and affordability amongst all socioeconomic statuses’ would help the children who are, on average, most vulnerable to stress in their lives. 

Lab Testing: Identifying Underlying Causes of Pediatric Stress

Obtaining laboratory testing can help determine the root cause of problems. It can also be an opportunity to optimize a child’s health, as labs may indicate physiological indications of stress.  Depending on the child’s age and symptoms picture, labs may vary. Standard lab testing for childhood stress includes- cortisol levels, adrenal function tests, melatonin testing, and micronutrient status. 

Cortisol Testing

Stress can impact many areas of a child’s health, including the brain, immune system, and inflammatory processes in the body. Over time, excessive stress can affect the hypothalamic pituitary and adrenal (HPA) axis, which leads to increased levels of cortisol. Cortisol is often referred to as the “stress hormone” and, in the long run, has negative health implications. The most accurate testing method is to collect multiple saliva samples throughout the day, which are used to analyze cortisol levels. ZRT Laboratory has a Diurnal Cortisol test that will asses four separate collections taken over 24 hours. This depicts how your body is releasing this hormone throughout the day. 

Melatonin Profile

A well-operating sleep /wake cycle for a child can set the stage for processing information and coping with everyday stressors. Research has correlated how insufficient sleep in children can impact their behavior, critical thinking, and stress response. An at-home salivary Melatonin Profile test by Doctor’s Data provides a snapshot of a child’s melatonin release throughout the day. Results will reveal whether melatonin release impacts their sleep, which could provide a target area for treatment.

Micronutrient Testing 

Vitamins, minerals, and other functional nutrients are essential in executing many physiological processes in the body. Obtaining adequate and more optimal levels of micronutrients, as with SpectraCell Laboratories Micronutrient Test, can benefit an individual's stress capacity, sleep, anxiety, and cognitive function.

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Integrative Interventions for Stress Relief

Complementary and integrative medicine includes various therapeutic interventions that can help support your child’s stress response and relieve how the stress impacts their overall health and wellness. The following is a list of integrative therapies used for childhood stress.

Acupuncture for Stress Relief

Acupuncture is a safe and effective treatment for many childhood conditions and health concerns. This integrative modality can help alleviate anxiety, sleep disturbances, and stress that a child may be experiencing. One pathway in which acupuncture is beneficial is to regulate the autonomic nervous system, which plays an integral part in stress response.  

Biofeedback for Stress Relief

Biofeedback is a technique that uses electrical pads to gather data about a person's physiological processes, such as heart rate, breathing, brain waves, and body temperature. The therapist can then use the information to help the patient incorporate breathing, posture, and muscle relaxation techniques that can help modulate the stress response in the body. Eventually, the child would be able to integrate this technique on their own without the need for data and guidance. 

Meditation for Stress Relief

Mind-body practices like meditation are beneficial as a stress reduction tool, but they can also improve focus, increase confidence, and bolster compassion and self-esteem. Meditation brings awareness to thoughts, which gives a child’s brain time to calm down and process feelings, emotions, and the world around them. Once a child knows how to meditate, it can become an excellent tool whenever needed. 

Nutritional Support for Stress Relief

Diet and nutrition are determinants of health for people of all ages. Optimal nutrient is even more vital in kids going through brain development. When the brain is starving of maco or micronutrients, that can cause both physical and mental-emotional stress. Deficiencies in vitamins and minerals can impact brain function, mood regulation, and energy levels, all of which can increase the stress response in a child. Supporting brain development and health through nutrient-dense foods that have a full spectrum of nutrients is vital. In general, maintaining a whole-food diet rich in vegetables, fruits, protein, and fats will provide the nutrients a child needs. A Mediterranean-style diet that limits processed, artificial, and inflammatory foods is an evidence-based protocol for mental and emotional well-being. 

The Power of Communication and Emotional Support

Communication is critical at all ages and stages. Beginning in childhood, we should hold space to nurture a child's emotions. Creating a space in your home where your child feels comfortable to share challenges and discomfort in their life is a preventative health measure. Children can be great at masking their stress, which can cause it to go unseen while the child is suffering inside. Open dialogue and regular inquiries by the parent are essential in building trust, and it shows kids that their thoughts and feelings are important and valued by you. 

In some cases, children may need support from a trained mental health professional. Therapy and counseling options vary depending on the stress the child is managing. This can range from parent-child therapies, cognitive behavior therapy, or trauma-focused psychotherapy for toxic stress. The ultimate goal for each therapy is to help the child obtain tools to shut down their stress response and build resiliency. Many therapies incorporate biofeedback, guided imagery, or breathing exercises as a mindfulness component. 

Practical Steps for Parents and Caregivers

Assisting children in processing their feelings and providing them with tools to manage stress starts with creating a space that offers comfort, security, and reassurance. While a tight ship at home may contribute to a child’s stress meter, providing structure can help reduce their stress response. Here are some practical tips and daily routines for stress-free children: 

1. Reduce the stress in the home- this takes a concerted effort by each member of the household. The adults should lead by example, providing a stable home financially, behaviorally, and emotionally. 
2. Improve sleep routines- this includes predictable and regimented routines for bedtime and wake-up time. Getting 9-12 hours of sleep per night is necessary for optimal mental, emotional, and physical well-being in kids.
3. Reduce screen time- evidence points to social media, with screen time on tablets, TV, and phones contributing to stress. Setting healthy limitations around these areas can support a child’s mental and emotional well-being. 
4. Increase physical activity- children must expel energy for brain development and motor skills. Movement has been shown to support not only physical health but also improve mood. Great ways to increase movement are to take trips to the playground, go on family hikes, play in the backyard, or bike ride.     
5. Include children in your household activities- making dinner, cleaning the house, and incorporating family downtime can help establish routines and teach them how to relax. Kids are like sponges and will absorb what you are showing them.    

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Summary 

Childhood stress is a factor that parents, caregivers, and healthcare professionals should be monitoring as a proactive approach to childhood wellness. If your child is showing signs, or you are concerned for their well-being, utilizing these interventions mentioned as soon as possible can help course correct their mental and emotional health. Integrative medicine offers various services and resources that can make prioritizing children’s mental health more efficient and healing.