How to help a child who feels COVID-19 burnout

By Dr. Diana Graham and Dr. Christopher Min, pediatric psychologists at CHOC

For many of us, the COVID-19 pandemic has created a “new normal” as efforts to curb the spread of the virus have changed what day-to-day life looks like. It can be difficult to balance maintaining our physical and mental health while also supporting one another.

Over the last several months, many parents and guardians have tried their best to think of creative ways to help children understand the dangers of COVID-19 while also trying to limit its interference with their children’s quality of life. Kids and teens alike are struggling with the challenge of increased isolation from friends, barriers to traditional academic instruction, and uncertainty about the current events of the world, all without their usual outlets of fun and stress relief. This may result in children becoming burnt out during the era of COVID-19.

As a parent you may notice signs of the following symptoms in your child who feels burnt out by the COVID-19 pandemic: increased irritability, changes in sleep and/or appetite, less motivation to engage in things that used to interest them, withdrawal from others at home and/or increases in levels of reassurance they need due to uncertainty of current events.

Here are some things you can do to help your child if they are struggling with their mental health during COVID-19.

  1. Help them engage in a consistent routine: Having structure and routine most days can help reduce your child’s reliance on screens, their anxiety related to COVID-19 uncertainty and changes, and increase their feeling of purpose during a time that typical go-to activities may be restricted.
    • Start with thinking about what a typical day looks like for your child. Do they have online schooling or a hybrid of in-person and online schooling? What types of chores do they need to get done? Do you want them to get some physical activity each day?
    • Next, decide whether it would be most helpful to schedule by the hour or in chunks of time (e.g., 9 a.m.-noon) in their routine. Be careful to not overschedule (e.g., every 30 minutes), as this may be too difficult for both you and your child to follow long-term.
    • Scheduling in sleep and meal routines can help your child remain on a schedule similar to the one they follow during a typical school year. Having consistent sleep, wake and meal schedules can also help your child regulate their mood and manage stressful situations.
    • Make these schedules visual for your child to see and follow. Put the schedule in a place that your child will most likely see, such as on the bathroom mirror, making it more likely to become their norm.
  1. Schedule flexibility into your routine: While it is important to have consistency, it is also very important to be flexible with routines because, as we all know, life can get in the way! Having this flexibility allows your child to have an element of control during a very uncertain time, which can often help with managing anxiety. Here are some small ways to build flexibility into your child’s schedule:
    • First, choose a couple of activities in your child’s schedule that allows for several choices to pick from. They can choose what food they want for lunch, or pick what to play during game time. Here’s a roundup of activity ideas for kids during COVID-19.
    • Make lists of a three to four different choices available throughout the day for the activities on your schedule. For example, your child may have lunch at the same time every day but can have a list of different food options to choose from.
  1. Keep your child moving: We are staying at home now more than ever, making it difficult to stay active and get “brain breaks.” However, we know that being more active can have a positive impact on our mood, ability to manage stress, and ability to focus. Here are some tips to include physical activity into your child’s daily schedule:
    • Schedule in time for a physical activity to ensure that your child’s brain is getting the break it needs, especially from screens. Research has shown that recess at school can help children to stay on task and increase sustained attention.
    • Keep a varied list of COVID-19-friendly physical activities that your child can choose from to help decrease sedentary behavior. Examples may include jumping jacks, YouTube yoga, a household dance party, and even taking a walk around the block while listening to music. Remember to practice physical distancing if exercising outdoors.
    • Although physical activity is beneficial throughout the entire day, studies show that exercise between 4 p.m. and 6 p.m. can help a child’s ability to fall asleep and stay asleep. If your child is having sleep difficulties, time your child’s exercise activities to help promote more restful sleep.
    • It can be challenging to motivate your child to be active when they are feeling burnt out. If your child seems uninterested in engaging in a physical activity, try to schedule it at a time when another person in the household can participate so that it can feel more fun and socially engaging rather than punishing. Or, they can take an online yoga class with a friend. As this becomes a more regular part of your child’s routine, it will likely become easier. For school-aged children and teenagers, it can also be helpful to collaborate with them on the list of choices for physical activity to increase their engagement when it becomes time to be active.
  1. Normalize not always being OK: Kids learn from those around them. Let your child know that it’s OK to feel uneasy about how things are right now.
    • You can do this by modeling good coping skills when you make a mistake or don’t have the answer to something and recognizing the uncomfortable emotions that might come along with this experience.
    • Sometimes labeling emotions is enough to help validate your child’s experiences. By showing and discussing all the different emotions you may be experiencing during a difficult situation, it will help normalize this type of emotional processing for your child too.
    • Create opportunities with your child to discuss how challenging COVID-19 is for so many people, the different ways these challenges may show up in our daily lives, and to brainstorm ideas on how to cope. This can build a pattern of communication in which your child notices warning signs of burn out sooner and can let you know when they need help.
  1. Learn how to cope together: Engaging in family activities together can be a good way to decrease the likelihood of experiencing feelings of social isolation and give you and your child shared goals. By learning these coping skills together, it models for your child that it is OK if we do not feel happy all the time and there are ways that we can help manage challenging feelings.
    • Consider regular family game nights where each person gets a turn choosing the game. Other examples may include an at-home scavenger hunt or a puzzle that the family takes time to work on each day. This provides both consistency and flexibility, in addition to social interaction.
    • One fun idea can be to set family challenges each week. You may have a week where each day involves practicing a different coping skill (e.g., deep breathing, guided imagery, stretching or journaling) or a week where each person shares something that they are grateful for. Whoever can complete the most challenges during the week gets a reward, such as choosing Saturday night dinner or the next movie for family movie night. If there is a tie, then you can always split up portions of the fun night that each person gets to choose, such as one person choosing the movie and another choosing the meal.
  1. When is this all not enough? Let’s face it, we don’t always have all the resources to implement every strategy whenever we need it. Or, you may encounter situations where you try every recommendation and still notice concerning changes in your child. Either way, it is OK to ask for help.
    • Be aware that you are only one person and many of us are forced to function without our typical support networks such as extended family and childcare centers because of COVID-19 restrictions. Consider some other avenues of support that may be helpful for you and your child to decrease burn out and help manage coping during the pandemic.
    • Reach out to your child’s teacher or school counselor for support. Are they able to check in with your child more often? Have they noticed any changes in your child’s school engagement beyond what they think is typical right now? They may be able to provide more frequent or regular support.
    • If you become concerned about your child’s mental health, contact your primary care physician. You can also call your insurance company for a list of in-network mental health professionals or do a search online for local mental health providers.

Here are additional mental health resources for your child during COVID-19

  • CHOC’s mental health toolkit has resources for parents, kids and teens, and schools.
  • CDC Parent Resources are organized by type of activity and age group, including directions for an At-Home Scavenger Hunt.
  • Helplines
    • Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline
      • Toll-Free: 1-800-985-5990 (English and Español)
      • SMS: Text TalkWithUs to 66746
      • SMS (español): Text “Hablanos” al 66746
      • TTY: 1-800-846-8517
      • Website — English| Website — Español
    • National Suicide Prevention Lifeline: 1-800-273-8255
    • Crisis Text Line: Text HOME to 741-741
    • Orange County Crisis Assessment Team:
  • Helpful apps
    • MindShift: a cognitive behavior therapy-based app from Anxiety Canada that helps kids to learn about and track anxiety, as well as coach them through coping skills
    • Headspace: A mindfulness app for everyday life
    • Smiling Mind: An app that guides helpful coping skills based on age
Get more information on Coronavirus (COVID-19)

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What we’re thankful for this year: 2020

Despite the countless challenges brought on by 2020, the physicians, nurses, staff, patients and donors that make CHOC a world-class pediatric healthcare system have retained a sense of gratitude. Several members of the CHOC community share what they are most thankful for this year.

Kim Cripe_CHOC president and CEOKim Cripe, CHOC president and CEO

“There are no words to fully express how thankful I am to the physicians, nurses, and staff who have worked so tirelessly and sacrificed so much these past nine months of the pandemic.  I have always been proud of our team and how well we support one another on a daily basis. Yet, our ability to rally in a crisis, particularly as long as this one has been (and will continue to be), has truly left me in awe. I am enormously grateful to everyone at CHOC across all departments, geographies and locations for the way we are not only tackling this challenge together, but also supporting the children and families we serve.” 

chris-furman

Chris Furman, chairman, CHOC board of directors

“I continue to be grateful for serving as chairman of CHOC’s board of directors.   Especially during these challenging times, I am incredibly honored to help CHOC’s physicians, staff, volunteers and donors protect the health and well-being of children in Orange County and beyond.” 

dr-jasjit-singh

Dr. Jasjit Singh, pediatric infectious disease specialist

“Despite all the challenges and changes this year has presented, I feel grateful to be part of the CHOC community. At the beginning of this experience, when there were still so many unknowns, I saw nurses, doctors and all the staff put aside their own fears and rise to the challenge in order to take care of their patients. And I have been watching them continue to do that every day since. It has been inspiring. I am grateful to my colleagues, and their commitment to implementing the latest guidelines and regulations to serve our patients and their families, and for their much-needed detective work on complicated cases. I’m grateful for CHOC parents and my patients – for sharing their strength, resilience, humor and hope with us every day. And last but not least, I owe gratitude for my wonderful family & the fact that we are in a place that allows us to serve our community.”

Dr. Terrence Sanger, chief scientist at CHOC Children's

Dr. Terence Sanger, vice president for research and chief scientific officer

“In a year that has been filled with unprecedented challenges, I am thankful for the opportunity to have joined CHOC’s mighty brigade in February 2020 to help the organization continue to go beyond. I am grateful to be working alongside such amazing colleagues who are committed to the mission of elevating the cutting-edge work being conducted at CHOC’s Research Institute.” 

CHOC Hospital_Outpatient evaluation center

Kelly Navarro, RN, BSN, CPN, CHOC outdoor evaluation center 

“After working at CHOC for 10 years, I am so grateful to have had the opportunity to serve CHOC patients and families in a new way this year at our outdoor evaluation center. CHOC quickly established these outdoor, drive-through facilities at the onset of the COVID-19 pandemic to offer our patients a safe and convenient way to be evaluated by a pediatric medical provider, receive treatment when necessary, and undergo COVID-19 testing. The center gives us the ability to ensure continuity of care for patients having surgery, as well as those needing sleep studies and many other necessary procedures. I am grateful for the privilege of serving as a constant for our patients and their families: that they can always count on CHOC for safe, high-quality and convenient care.”

Allison, age 12, CHOC patient

Dr. Mike Weiss

Dr. Michael Weiss, vice president of population health

“At a time in our lives when we have never felt more distant from our friends, neighbors and loved ones, I’m grateful that CHOC was able to deepen our “connection” with our patients and families and provide high-quality medical care through telehealth technology. This service has proven to be a true lifesaver for many children and families. From primary care to sub-specialty care and mental health to speech therapy, CHOC has provided over 55,000 telehealth visits since mid-March. Our patient satisfaction scores have remained over 90% and the subjective feedback we receive is overwhelmingly positive. In addition, this technology has allowed us to support a broader community of patients and families as well as our Orange County schools by providing COVID-19 support and education when and where it is most needed. Connecting is always important, but it has never meant more to our community, and to us, than it does now!”

Grace Magedman

Grace Magedman, executive director of pharmacy

I am very proud of and extremely grateful for everyone involved in launching our prescription delivery service during the state’s spring lockdown. The flexibility, compassion and innovation demonstrated by staff across multiple departments and by our supporters, Hyundai Motor America and Russell Westbrook Hyundai of Anaheim, resulted in a valued resource that helped safeguard the community we serve, especially the most medically fragile members. 

christopher-min-pediatric-psychologist-choc-childrens

Dr. Christopher Min, pediatric psychologist

Despite the challenges that 2020 has brought, I find myself even more thankful than years past. I am so very thankful for my wife and two little girls, as well as the little furball we recently welcomed into our family. I am also grateful for each of my team members who have come together to offer mental health services in a primary care setting; for fighting the front lines against mental illness in children; and for the way they have grown in their hearts of service, all amidst a global pandemic. I am reminded of the strong bonds that I have with trusted partners at CHOC across mental health, primary care, clinical staff, and CHOC at Mission Hospital. And I am most grateful for the privilege of serving the most vulnerable among us, our children.”

Korbin, age 6, CHOC patient

CHOC clinical associate

Ashlynn Graham, clinical associate

After a year of uncertainties and a new normal, it can be hard to find the good in what 2020 has thrown our way. This year and every year, I am blessed with my family and our health. I am grateful that I have had the ability to work at both CHOC Hospital, and CHOC at Mission Hospital. I am also thankful for all the first responders that have continued to give to those in need during these unthinkable times.

Clavis Foundation

Clavis Foundation’s Tusdi Vopat and Stuart McClure. Tusdi is also a member of CHOC Foundation’s Board of Directors

“We are extremely blessed and grateful for many things, including the privilege to work with CHOC. Their tireless commitment and dedication to the health and well-being of our children is what inspires us all to strive and support such a great institution. Never before has CHOC, or anyone, been met with such extreme challenges as the COVID-19 pandemic. Yet, CHOC and its staff continues to put patients first, keeping families and healthcare workers safe, and understanding the increased challenges of mental health during this time. We are honored to be part of this amazing team and look forward to a stronger and brighter future ahead for all of us.”

Colleen Smith CHOC nurse

Colleen Smith, manager of clinical programs, CHOC at Mission Hospital

“As I walked through the CHOC at Mission Hospital doors the morning of Sept. 11th, 2020 I took out my phone to text my hiring manager, still a longtime friend, to say, ’20 years ago today I walked through these doors for the very first time thanks to you.’ I had no idea all those years ago what my nursing career would look like so many years later. I am filled with gratitude every day, not only for the opportunities I have been given but, also for the joy I feel working at CHOC at Mission. Not everyone can continue to say they love what they do 20 years later. I consider that a true blessing! Thank you, CHOC at Mission and the entire CHOC healthcare system,  for always believing in me and growing me into the nurse I am today. I feel honored to be a pediatric nurse in my community”

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Monitoring your child’s news and social media intake during COVID-19

By Dr. Chris Min, pediatric psychologist at CHOC and Luiza Mali, predoctoral intern at CHOC

Throughout the COVID-19 pandemic, many of us have experienced a thirst for answers and information — especially to help guide our behavior and try to put our worries at ease. Due to social isolation, many of us have looked online and to social media to fulfill those needs. From receiving breaking news on our smartphones regarding updated guidelines to scrolling through our social media feeds to learn about  numbers of infections, we are constantly bombarded with information. As parents, many of us have wondered whether our children’s increased exposure to repetitive and gloomy news is harmful, and whether the information our children consume may come at a cost.

What happens to our minds when we are overexposed to the news

Research shows that continual media coverage of community or health crises — such as COVID-19 — overexposes us to negative information, and this information becomes overrepresented in our minds. This overexposure increases the perception of threat and makes worry more difficult to control.

These psychological risks are particularly true for children, who tend to be more emotionally reactive or have difficulty dealing with uncertainty. For younger children, intaking a huge amount of information may be confusing, overwhelming and raise more questions than answers. For older children and adolescents, particularly those who are worriers, the likelihood of something bad happening may seem like a certainty to them, and that can lead to catastrophic thoughts about the present and future.

Should I isolate my child from the news during COVID-19?

Isolating your child from any information regarding COVID-19 can create a variety of problems. Many times, parents assume that their children are either too young or oblivious to changes in their environment to wonder about why their daily routine looks different. However, children tend to notice these changes, although they may not verbalize their concerns to their parents.

With many changes to their routine and lifestyle — distance learning and social distancing to name a few — that profoundly affect a child’s day-to-day schedule, even young children may notice and wonder why these changes are happening. If parents shield their children from any and all information about why they aren’t going to school or can’t go to their friend’s house, children can feel confused and disappointed.

For older children and teenagers who have unsupervised access to social media and television, parents leave what and how much information is given to their children up to chance. This age group may catch a glimpse of what’s on the news or what friends share on social media, leading to more potential confusion — especially if parents hold back from giving their own accurate take on things.

For these reasons, it is important to ensure that your family is consuming media responsibly and is striking a good balance between absorbing relevant information and protecting your mental health.

Here are some developmentally appropriate ideas to ensure that your family is interacting with media in a careful and helpful way during COVID-19:

Younger children and media

  • Filter the kind of information young children are exposed to.
  • For toddlers and preschoolers, parents will be the ones providing age-appropriate explanations on things like social distancing and hand hygiene on a need-to-know basis.
  • Younger children will benefit from the use of social stories; The National Child Traumatic Stress Network has examples. Children also benefit from informational shows such as the CNN/Sesame Street COVID-19 town hall.
  • Avoid having the TV constantly on to avoid unintended exposure to scary media and inappropriate content.
  • If children ask you questions and you don’t know the answer, look up the answer using trusted sources such as the Centers for Disease Control and Prevention.

Older children/teenagers and media

  • Have a conversation with them about COVID-19.
  • Asking open-ended questions to get their understanding of what the virus is, their opinion on how dangerous it is, and their take on the necessity of social distancing can be a great place to start.
  • Getting an idea of what their friends are saying on social media can be helpful, as adolescents tend to shift their thinking toward opinions from their peer group.
  • Once you have an idea of your teenager’s knowledge base and opinions on COVID-19, confirm the right facts. If you aren’t sure, that’s OK! Look up information on reputable sources like the CDC or World Health Organization.
  • Gently challenge any false notions and provide information from trusted sources as evidence.

Media tips for all children

  • Set boundaries. Excessive use of media is associated with negative psychological and physical consequences including depression and obesity.
  • Set limits for daily use. Encourage active interpersonal exchanges such as video chats with same-age peers, and steer children away from using electronics solely for passive activities such as watching videos.
  • Be sure that your child is also spending time away from electronic devices, engaging in physical activity, and other social and educational activities.
  • Model appropriate consumption of media and reactions to news reports. Obtain critical updates from reliable sources once or twice a day.
  • Avoid sensationalism or repeated coverage of the same information.
  • Check in with yourself – am I distressed or agitated? If so, turn it off and pursue other activities. Although some level of worry, confusion, or sadness is to be expected, if your child senses you are feeling overwhelmed and hopeless, they will be more likely become emotionally dysregulated as well. React calmly and provide reassurance so that your child will follow suit.

If your child is expressing excessive worry, anxiety or hopelessness about COVID-19, it may be a good idea to limit his/her exposure to news and social media. With the flood of potential misinformation from social media as well as repeated exposure to distressing  content on the news, your child may start to think that the future is hopeless and that his/her own health is at serious risk. Combat this impression by focusing on the measures that your family is currently taking to limit risk of infection as well as steps that your child or teenager can take to ensure continued health and safety. Take time to have a discussion about interesting and fun activities that your child can participate in that follow the public health recommendations.

Get more information on Coronavirus (COVID-19)

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How teens can deal with bullying: Teen advisers weigh in

One in five students age 12-18 in the U.S. have experienced bullying, according to the National Center for Education Statistics and Bureau of Justice. More than 70% of young people say they have seen bullying in their schools. Kids and teens who are bullied can experience physical and mental health issues, and problems at school.

CHOC teen advisers share their own experiences observing and dealing with bullying, and what they do to cope. CHOC experts also weigh in on what parents can do to support a child who is being bullied.

Talk openly about bullying

One of the best ways to protect your child from bullying is to talk openly about it, says Dr. Heather Huszti, CHOC’s chief psychologist.

Dr. Heather Huszti
Dr. Heather Huszti, chief psychologist at CHOC

“Have a discussion about why some kids might be bullies. You can explain that most bullies have low self-esteem and that they bully other people to try to feel better about themselves,” she says.

CHOC teen adviser Heather Bisset, age 14, has seen this play out firsthand.

“When someone bullies another person, it is often because they are insecure and do not know how to emotionally handle it,” she says. “A bully does and says things to make others feel hurt or down, and if you do not show a response, they will most likely leave you alone.”

choc-childrens-teen-advisor-heather
Heather Bisset, a CHOC teen adviser

Dr. Huszti also recommends parents ask open-ended questions of their children such as, “Is there anything going on at school?” or “Is there anything I can help you with?”

She adds that this approach usually works better than firing off a list of specific questions and can facilitate a bond between parent and child that will encourage them to open up to you when something is affecting them.

Find a trusted adult to talk to

CHOC teen adviser Zoe Borchard, age 15, knows the benefits of having someone to talk to when you have been bullied.

“At a high school football game, a girl that I don’t even know called me stupid along with a bunch of other nasty words behind my back. When I heard what she had said, I thought it wouldn’t affect me at first, but it started to eat away at me. I walked away to a quieter area during halftime and called my mom. I told her what happened, and it made things a million times easier to process and even let go,” she recalls. “To this day, I’ll call my mom every time I need help. If you can find someone you trust to share your problems with, it lightens your emotional load and gives you room to breathe and feel better.”

choc-childrens-teen-advisor-zoe
Zoe Borchard, a CHOC teen adviser

Teens can look beyond their parents in finding someone to talk to.

“The best advice I could give someone who is being bullied is to talk to an adult you trust and know is willing to help you,” says CHOC teen adviser Carina Alvaro, age 16. “This could be a teacher who has openly expressed willingness to help, or another trusted adult who can help you resolve these problems.”

choc-childrens-teen-adviser-carina
Carina, a CHOC teen adviser

Teens and cyberbullying

Nearly 15% of high school students have experienced cyberbullying, according to the Centers for Disease Control. Cyberbullying can include text messages, instant messaging and other apps, social media or gaming.

CHOC teen advisers see a clear link between social media and bullying.

“Social media plays a part in bullying because it’s a lot easier to target someone and attack them online,” says Sanam Sediqi, age 16, a CHOC teen adviser. “On social media, everyone is hiding behind a phone or computer screen, so they more freely throw out hurtful comments towards the victim, often without actual consequences.”

choc-childrens-teen-adviser-sanam
Sanam, a CHOC teen adviser

CHOC teen adviser Layla Valenzuela, age 14, agrees.

“Having the power of technology comes with responsibility. When you send a message, people can’t see your face or hear your voice, so there is no way of conveying sarcasm or playfulness,” she says. “A simple joke could be interpreted in an unintentional, harmful way. Being responsible for everything you do online is a huge part of being considerate and staying away from bullying.”

choc-childrens-teen-advisor-layla
Layla, a CHOC teen adviser

Social media and technology use contributes to a rising number of mental health concerns in young people, says Dr. Christopher Min, a CHOC psychologist.

“Technology is great, but it has consequences, especially on our younger population,” he says. “it’s made teenage culture very unstable.”

Tips for staying safe online

Dr. Min offers the following tips for parents on how to keep kids safe online:

  1. Monitor teens’ social media use
  2. Encourage teens to get together in person
  3. Remember that parents control access to social media

For teens, his advice includes pausing before posting.

“When you’re ready to post something, pause for five to 10 seconds to consider your actions, the post’s meaning and the possible consequences,” he says. “This will help you avoid posting things you don’t want cemented on the internet forever.”

psychologist-tips-back-to-school-anxiety
Dr. Christopher Min, a pediatric psychologist at CHOC

What to do if your child is being bullied

There are several things parents can do if they learn their child is being bullied, Huszti says, including:

  1. Inform your child’s school about bullying
  2. Talk to the bully’s parents about the behavior
  3. Help your child build up their self-esteem. The more solid their self-esteem, the less impact a bully’s behavior will have on their overall well-being.
  4. Monitor your child’s online activity.
  5. Remind your child of the trusted adults in their lives in whom they can confide.
  6. Pay attention to signs in your child that show something is wrong, such as acting withdrawn, irritable or sad; or changes in appetite or sleep. Some children will show none of these signs, so an open dialogue with your child is key.
  7. If your child needs additional support, ask your pediatrician for a referral to a pediatric psychologist.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts..



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Back-to-school anxiety remedies

Transitioning from carefree summer days into a structured school day can be stressful for children. From a change in environment to new names and faces, heading back to school can be a stomachache-inducing, palms-sweating time for many kids and teens.

Many parents wonder if kids are faking these feelings to get out of going, but back-to-school anxiety is a real phenomenon, says Dr. Christopher Min, a pediatric psychologist at CHOC. Back to school anxiety occurs when nervousness goes into overdrive, causing physical, behavioral or cognitive consequences that can impact a child’s mindset and ability to perform in school.

“It’s easy for us as adults to forget what it’s like to be a kid,” Min says. “It can be really scary.”

psychologist-tips-back-to-school-anxiety
Dr. Christopher Min, a pediatric psychologist at CHOC

A child’s job is to go to school, Min says, and their workload doesn’t simply include academics. School is where they learn and practice everything from social skills with peers and authority figures, to learning boundaries and appropriate behavior, to practicing physical activity, to selecting food on their own and eating without their parents.

“The likelihood that at least one of these things will create apprehension or anxiety in kids is great,” Min says. “So many things are packed into one environment.”

It’s important for parents to remember that children are just starting to learn these life skills when they’re in school.

“Not only are kids asked to encounter a multitude of new situations at school, but they’re still developing the skills necessary to succeed,” Min says. “They don’t have mastery of these skills yet; they’re still learning them.”

For parents struggling to determine whether their child is creatively avoiding school responsibilities or dealing with legitimate back-to-school anxiety, Min suggests looking for patterns in behavior.

Look back at their history with school, he says. What tends to happen in the weeks or days leading up to a new school year? How does your child adapt to changes? Does the behavior dissipate as the school year progresses?

“I like to empower parents and remind them that they are the expert on their children,” Min says. “Parents know their own children best. They know what their children do in provoking situations.”

Children are at increased risk for anxiety-based school refusal during periods of transition, such as when they start kindergarten, or move to a new school for junior high or high school, Min says.

“Every kid deals with school-based anxiety differently,” Min says. “However, boys tend to externalize their behavioral, such as acting out. Girls tend to internalize their behavior, which can be interpreted as being moody.”

Once their behaviors are identified, Min encourages parents to help their children cope with their anxiety by practicing easing into the school year.

“As adults, we wouldn’t go into a presentation at work, or show up for a marathon without preparing,” he says.

Kids tend to have a different sleep schedules and less structure during summer months, so in the weeks leading up to the first day of school, start to adjust their sleep and wake schedules.

Min also encourages graduated exposure, where parents can slowly introduce new routines in their child’s day.

“Practice their morning routine before school starts. You can even practice driving to school and show them where you will drop them off and pick them up,” he says.

Making small adjustments at home to help them prepare for the new school year will help them ease into the other transitions that come when school starts.

Although it can be stressful for parents to see their child struggling with a school transition, they shouldn’t immediately jump in to “rescue them,” Min says.

“With school avoidance, if you “rescue” a child or keep them home, that is detrimental because it reinforces their anxiety, and teaches their brain that school is a threat and something to be avoided.”

He encourages parents to partner with their child in managing their anxiety— while still going to school —and over time the anxiety will decrease with repeated exposure.

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