Mindfulness Tips for Teens

Teens’ mental health is as important as their physical health. It’s not always obvious when a teen is struggling emotionally, but recognizing the symptoms and seeking early and effective mental health services are important to prevent more serious mental health issues.

Parents should talk to their teens and foster a relationship based on open communication. Seek to understand how your child is feeling, without judgment, before you try to fix the problem.

As a pediatric psychologist at CHOC Children’s Hospital, Dr. Mery Taylor helps teens and their families who are facing a variety of mental health challenges. Typical concerns or issues teens seek treatment for include:

  • Anxiety
  • Depression
  • Difficulty coping with stressors such as: chronic illness, a life or family change, a social or school concern, and grief and loss
  • Disruptive behavior disorders, including attention deficit/hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD)
  • Eating disorders

“Throughout my ten years at CHOC, a majority of teens I have worked with have come to me for pain issues, anxiety, depression, eating disorders and difficulty coping with stress,” says Taylor. “I have also seen an increase number of transgender youth and parents seeking services.”

mindfulness
Dr. Mery Taylor, pediatric psychologist at CHOC Children’s

What is mindfulness?

Practicing mindfulness, or relaxation techniques can help teens build coping skills to address issues, such as anxiety disorders. It’s very easy to get wrapped up in our emotions and not see our way out of them, says Dr. Taylor.

“The more we attend to the fear, the more power it gets and we can become paralyzed about what to do, or avoid aspects of our life in attempt to manage the anxiety. We can get stuck on a cycle of trying to avoid our anxiety and forget to live life. At times, we allow our negative thoughts and emotions to dictate our actions without stopping to assess if they are valid and irrespective of the consequences. For example, we might avoid going to school because we don’t feel we have studied enough for a test and then end up missing out on important instruction for another class. Mindfulness makes us stop for a minute and check in with ourselves,” says Dr. Taylor. “Mindfulness asks us to be curious of our thoughts and feelings without judgment or action—to just be in the moment. Developing acceptance and compassion for the painful parts of our inner emotional life can weaken the power of the anxiety. Once weakened, we can better manage our fears.”

Tips for practicing mindfulness:

  • When something is bothering you, shift that attention to yourself, rather than what you’re reacting to.
  • Stop for a moment to center yourself, by addressing and labeling those sensations (fear, worry, anger). Validate these feelings to ourselves can help to lessen our fight or flight reaction.
  • Now turn to your attention to your body. Identify the sensations going on in your body. All emotions are experienced as sensations in our body.
  • If you find yourself attending to the thoughts or feeling again, gently bring your focus to your body sensation (e.g., muscle tension, heartbeat, etc.).
  • Practice relaxation techniques to calm the nervous system, to stop the nervous reaction and respond more cognitively. For example:
    • Autogenic relaxation. Autogenic means something that comes from within you. Visualize a peaceful setting. You can repeat a phrase such as, “I am relaxed” to invoke muscle tension release. Focus also on breathing slowly and evenly.
    • Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then relaxing different muscle groups in your body. You can start with clenching your hands into a fist and then relaxing them. Focusing on the difference between muscle tension and relaxation, will help you become more aware of physical sensations.
    • Form a mental image of a place that find to be peaceful and calming. To relax imagine yourself exploring this place. Try to incorporate as many senses as you can, including smell, sight, sound and touch on your journey. If you imagine relaxing at the beach and feel the cool sand on your felt, and sound of the crashing waves
    • You probably already know other things that calm you (e.g., listening to music, taking a shower, walking your dog, etc.). You can do those things too.

Parents can help facilitate mindfulness.

“Being non-judgmental is a big part of mindfulness,” says Taylor. “It’s important to accept that we do what we can, and that we have limitations. It’s important to acknowledge everything you have going on in your life that’s happening at once, and to give yourself a break.”

“A parent might acknowledge and normalize the anxiety associated with college applications as a way to show compassion and thereby minimizing the urgency that the teen feels. Once more calm, the teen can focus on the college application, instead of attending to the distressing thoughts and feelings.”

Parents hoping to teach mindfulness practices to their teens are also encouraged to model the behavior themselves, says Taylor. Remind teens that practicing mindfulness can also improve concentration at school and improve performance.

CHOC believes mental health treatment should be fully integrated with physical health treatment. Our psychology team works closely with patients’ medical teams to attend to emotional, behavioral and developmental needs through inpatient and outpatient therapy. Our goal is to foster the whole well-being of the teen and family.

CHOC psychologists have recorded a library of guided imagery audio tracks to help children and teens relax, manage pain, ease fears and anxiety, fall asleep easier and more:

Experience guided imagery as a healing tool

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Meet Dr. Esther Yang

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Esther Yang, a pediatric psychiatrist.

Dr. Esther Yang
Dr. Esther Yang, a pediatric psychiatrist at CHOC Children’s

Q: What is your education and training?

A: I attended UCLA for my undergraduate studies, Loma Linda University for medical school, and University of California, Irvine for both my psychiatric residency and child and adolescent psychiatry fellowship.

Q: How long have you been on staff at CHOC?

A: Two months.

Q: What are your special clinical interests?
A: I am interested in cultural psychiatry, the integration of mental health and spirituality, and implementing a holistic approach in treatment by working with therapists and other providers to integrate care. During fellowship training, I received a grant from the Substance Abuse and Mental Health Services Administration to work with minority communities in building awareness about mental health.

Q: What are your most common diagnoses?

A: Depression, anxiety and ADHD. It seems to be much harder today to be a teen than it was ten years ago with social media, bullying and increased responsibilities.

Q: What would you most like community/referring providers to know about you/your division at CHOC? 

A: In the psychiatry clinic at CHOC, virtually every patient that we see is also seen by a therapist in the same clinic, making it possible to integrate care, and all of our doctors are fellowship trained in child and adolescent psychiatry. There are many resources and more on the horizon with the opening of the inpatient unit and the intensive outpatient program.

Q: What excites you most about CHOC’s mental health initiative

A: It’s an exciting time at CHOC with the upcoming opening of the inpatient mental health unit, programs such as the intensive outpatient program and new clinics – all coming at a time when there continues to be a shortage in providers and services in psychiatric care. It inspires me to work at a place that is committed to the treatment of children and advancing mental health care.

 Q: What inspires you most about the care being delivered at CHOC? 

A: I love the concept of a hospital that is dedicated to the treatment of children and that every single person shares that dedication. I’ve had personal experiences with my children being patients at CHOC prior to working here and it was a very positive experience where we felt genuinely taken care of. I knew that if I ever had the opportunity to work here, it would be a privilege.

Q: Why did you decide to become a pediatric psychiatrist? 

A: I decided to become a pediatric psychiatrist my senior year in high school after hearing a psychiatrist talk about mental health and the great stigma that exists in minority communities during a lecture at our church. I’ve never regretted this decision and it’s been an incredible journey. I enjoy listening to everyone’s unique stories and working to break stigmas and barriers to access to care, which continue to exist.

 Q: If you weren’t a physician, what would you be and why?

A: Honestly, I would probably be a stay-at-home mom. I love spending time with my family, doing crafts with my kids and cooking. I also believe that the key to healthy kids starts in the home, and my skills as a psychiatrist are sometimes useful at home when it comes to training and discipline.

 Q: What are your hobbies and interests outside of psychiatry? 

A: I enjoy reading, baking, and crafting.

 Q: What was the funniest thing a patient told you?

A: I told my therapy patient that I would have to transfer his care to another doctor because I was going on maternity leave. He replied, “Oh, I thought you were fat or something.” I was nine months pregnant.

Download the Let's Talk Guide and start a conversation about mental health

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A Parent’s Guide to Understanding the Teen Brain

The mind of a teenager can be at times mysterious and illusive. A pediatric neurologist, a pediatric neuropsychologist and a pediatrician who works with adolescents at CHOC Children’s offer advice for parents on how to better understand and connect with their teen.

Navigating adolescence with a still-developing brain

Adolescents’ brains are not yet fully developed during their current stage of life. Physical development can start as early as 8 years old, but the tail end of brain development doesn’t occur until closer to age 25. The more your child is exposed to new things, skills or experiences, the more connections their brain will develop.

“The brain is constantly developing through young adulthood. Just like we wouldn’t expect a baby to be able to speak or a toddler to be able to understand certain consequences, we have to have appropriate expectations for our adolescents,” says Dr. Sharief Taraman, a pediatric neurologist.

Dr. Sharief Taraman offers advice on the teen brain
Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s

This constant development can lead to experimentation and in turn, a healthy decision making process.

“On the one hand, adolescents are more apt to experiment and make poor choices because their brains are still developing, but they are also more able than adults to learn from their mistakes and alter their perspectives,” says Dr. Jonathan Romain, a pediatric neuropsychologist. “I see adolescence as a period of great potential for growth and development.”

Dr. Jonathan Romain comments on the teen brain
Dr. Jonathan Romain, a pediatric neuropsychologist at CHOC Children’s

A parent’s role in teen brain development

The consequences of teens’ actions can help them link impulsive thinking with facts. This helps the brain make these connections and wires the brain to make this link more often. Parents play a crucial role in helping teens talk through consequences and decision making.

“Part of a parents’ role during this time in their child’s life is understanding that adolescents are practicing new reasoning skills they haven’t used before,” says Dr. Alexandra Roche, a pediatrician who works with adolescents. “Having abstract thinking is one new reasoning skill they need to practice. When they are trying to make a decision, it’s helpful for parents to let them explore various consequences.”

Dr. Alexandra Roche comments on the teen brain
Dr. Alexandra Roche, a pediatrician who works with adolescents at CHOC Children’s

The primary part of the brain developing during this time is the frontal lobe. As this area develops, teens are better equipped for abstract thinking and executive functioning, such as planning their day and making decisions. The frontal lobe is also involved with connections and how we socialize with people as well.

“They’re learning that if A happens, then B or C is going to happen after that. Parents get frustrated at how adolescents handle peer relationships and how extreme their feelings can be, but these may happen because those connections are being formulated. Talking through consequences helps good connections to form,” says Dr. Taraman. “Decision making takes practice. If you want to play guitar, you take lessons and practice, and it makes you better. If you only take one guitar lesson, you’re not going to learn how to play. Decision making is the same thing; it takes practice and it is never too early to start teaching our kids how to make good decisions.”

How to teach decision-making skills to your teen in an interactive way

Remember that you are a role model for your teen’s behavior. When it’s time to make a big decision, show them how to make a matrix, weigh the criteria of what is important to you and them, and teach the decision making process in an interactive way.

Modeling reasoning behavior with your teen will affect how they explore and understand downstream consequences, says Dr. Roche.

“If they approach you and want permission to do something, have them do research via respectable sources and find out what’s appropriate for their age. Involve them in the decision making process. That’s how you can give them good tools instead of just deciding things for them,” says Dr. Taraman.

Talking to your kids is essential in the digital age. It’s common for teens to want to be on their smartphone around-the-clock, but that can spur an extreme fear of missing out. Figuring out how to turn off both the devices and the need to be constantly plugged in is important.

“Try setting technology-free zones or times in your home, such as the dinner table. Take turns going around the table and sharing the highlight of your day. It can spark conversations about other things that happened during your day and how you dealt with them. Teens can learn by example,” says Taraman.

Your teen’s friends also play a crucial role in their development, but peer pressure is not always a bad thing.

“Peer pressure can be positive in many cases, like trying a new sport or joining a new club at school. Experimentation is the way adolescents learn how to interact with their environment and peers,” says Dr. Roche. “Kids should be curious and try different activities.”  Helping them plan ahead for unexpected events, such as being offered drugs or alcohol, can help your teen make the right choice when it counts.

How to calm an overly emotional teen

When teens are overly emotional and fixating on a problem they feel is the end of the world, there are several things parents can do to calm them down so they can start talking through their emotions.

“It’s very common for teens to be very dramatic. Whatever is happening in their world can seem like it’s the most important thing that has ever happened to them,” says Dr. Roche. “Help them identify the emotion they are feeling, and what is making them angry or excited, for example. Identifying the root cause of the emotion and then connecting that back to how that affects their decision making is important.”

Dr. Romain encourages parents to give their teen some space but remind them that you are available to listen.

“Not every problem needs a solution. Sometimes they just need someone to listen to them in a safe space. Encouraging journaling can also be a productive way of getting thoughts and feelings out,” he says.

Listen first and then expand on their statement.

“If they express hurt or disappointment, try to get them to more openly explain why something hurt their feelings,” says Dr. Roche. “Did they misinterpret a conversation?”

Allowing them to solve their own problems teaches independence and prepares them for adulthood.

“If you fix all their problems for them as a teen, then when they go off to college they won’t know how to deal with problems. We don’t just give them a driver’s license and tell them to hit the road. First they drive under supervision of a parent or guardian, and then they gradually gain more independence and responsibility,” says Dr. Taraman.

The power of positive reinforcement

Remind teens that they are resilient and competent. They may have trouble remembering past times they have overcome obstacles.

“Positive reinforcement helps encourage certain behaviors you’d like your teen to model,” says Dr. Taraman. “If they want to go to their friend’s house after school and they ask if that’s ok, say “no problem, thank you for asking.” And if they instead tell you they are going, say “Don’t you need to ask permission first?”

Positive reinforcement will also help them develop strong self-esteem. As they develop their identity, encourage your child to reflect on successes as well as challenges.

“During adolescence kids are coming up with self-identify, personal morals and ethics. This all relates to self-esteem. Comparing yourself to others is common but it can also set unwieldy expectations. Identify their unique strengths (for instance music, but not math) and focus on encouraging them to pursue those,” says Dr. Roche.

When to seek help for your teen

Adolescents are prone to addictive behaviors. If they use certain chemicals such as drugs and alcohol, it can hard wire their brain in a certain way. If they are experiencing anxiety or depression and it is not acknowledged and treated, they are more likely to experience those into adulthood.

“It is important to keep an eye out for symptoms of depression and anxiety that extend beyond normal grief and loss. Check in with your child periodically and be aware of changes in behavior pattern. Persistent irritability, sadness, disrupted sleep, and lack of interest and isolation are some things to look out for that likely warrant a check-in with a counselor or psychologist,” says Dr. Romain.

A few days of emotional outbursts might just be a normal sign of adolescence, but if they are persistently practicing abnormal behavior, it may be a sign to seek additional help. Remind your child that you are there for them, says Dr. Taraman, but also empower your teenager to explore the resources available to them, with or without their parents’ help. Suicide hotlines (1-800-Suicide) or adolescent clinics can help them obtain resources without the help of their parents.

“Because adolescents have so many obvious physical changes, it’s easy to forget the cognitive changes going on in this phase. It’s the most exciting change for kids but can be very frustrating for parents,” says Dr. Roche. “Remember to enjoy the experience of watching your kid develop into an adult.”





Learn more about Adolescent Medicine




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How to Make Shots Less Stressful

Vaccines represent significant breakthroughs in medical research and disease prevention. When the Centers for Disease Control’s recommended immunization schedule is followed according to plan, it is shown to be the most effective and safest way to protect your child from potentially fatal diseases, according to Dr. Jasjit Singh, medical director of infection prevention and control at CHOC Children’s. However, the process of going to the pediatrician and receiving shots can be stressful, or even anxiety-producing, for young children.

A patient’s relationship with their pediatrician is important, and once you have found the right primary care doctor for your family, it can set the stage for their feelings toward medical professionals or clinical settings later in life. Studies show that preparing your children for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Follow these simple steps on how to make shots less stressful.

  • Be honest. Tell children their vaccines may be uncomfortable or bothersome for a second or two, and have them practice slowly counting to two seconds so they get a sense of how long that really is. Tell them what to expect at their appointment, and explain why the procedure is necessary and how it will help them.
  • Use Neutral Language: Request that the health care providers let your child know what will happen and when, using neutral language such as “we’re ready to start,” advises Marni Nagel, a pediatric psychologist.
  • Encourage them to ask questions. Remind them that they can ask any questions they want to of their doctor or nurse.
  • Time the appointment well. For babies and toddlers, scheduling the appointment around their bottle/feeding time may help. Receiving a bottle or feeding right after the shot may help soothe your baby.
  • For infants, engaging in at least 4 of the 5 S’s has been shown to reduce distress after immunizations, says Nagel. These include swaddling, placing on the side/stomach while holding, making shushing sounds, rocking, and sucking. Sucking can be done through breastfeeding, a bottle, or pacifier. For infants, dipping their pacifier in sugar water has been shown to decrease stress associated with immunizations. You can also talk to your doctor about breastfeeding during and/or after the immunization.
  • Topical anesthetics. Ask your pediatrician if topical numbing agents may be appropriate for your child.
  • Control your reaction. Children are increasingly observant as they get older, and they will take careful note of your reaction. Remain calm and be mindful of your demeanor, and it may help send a message to your child that they need not be stressed either.
  • Distraction techniques. These will vary depending on your child’s age and interests, but could include telling stories and jokes, looking at a picture book or finding a hidden picture like “Where’s Waldo,” or blowing bubbles.
  • Positive Rewards/Treats. Consider going out for ice cream, going on a special outing such as to the park or playground, or another small treat after your appointment to encourage good behavior, or to soothe your child.

CHOC Children’s Breaks Ground on Pediatric Mental Health Unit

As part of the transformative mental health initiative that CHOC and other Orange County leaders launched in May 2015, CHOC celebrated the start of construction on the first inpatient mental health center in Orange County.

To commemorate the important milestone, more than 150 leaders from CHOC and the community, including elected officials and members of the mental health task force, gathered for a ceremony at CHOC in support of the initiative, which will ensure children and adolescents with mental illness get the health care services and support they need. Speakers included Kimberly Cripe, CHOC ’s president and chief executive officer, Dr. Heather Huszti, CHOC’s chief psychologist, and Rick and Kay Warren, co-founders of Saddleback Church. The event included a brief tour of the inpatient mental health center currently under construction, highlighted by Kim Cripe breaking down a mock brick wall, as a symbolic display of breaking down barriers associated with mental health.

choc mental health
Designs for CHOC’s inpatient mental health center.

Scheduled to open in early 2018, the center – located on the third floor of CHOC’s Research Building on the main campus in Orange – will provide a safe, nurturing place for children ages 3 to 18, and specialty programming for children younger than 12. The center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs. It will feature 18 private patient rooms in a secure and healing environment including an outdoor playground area to promote exercise and movement. Additional amenities include a multipurpose room, classroom, and a variety of rooms that support activities for children of different ages and needs.

choc mental health
Designs for CHOC’s inpatient mental health center.

Since the announcement of CHOC’s initiative last year, CHOC has made tremendous progress including the launch of an outpatient co-occurring clinic, in conjunction with Orange County Behavioral Health Services, for patients whose physical conditions are complicated by mental health challenges; the launch of mental health screenings for all 12-year-olds at their well child visits in the primary care setting; and through a grant, CHOC’s cystic fibrosis (CF) program expanded its social worker’s availability and has a designated psychologist to help patients and caregivers. CHOC is also completing a pilot in the primary care clinics where a psychologist is present to help the medical team screen for and address mental health issues, and help families address childhood obesity.

Staff training and recruitment is currently underway.

Learn more about how CHOC is changing the way pediatric mental health is treated in Orange County.

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Meet Dr. Hoang “Wayne” Nguyen

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Hoang “Wayne” Nguyen, a child and adolescent psychiatrist. Dr. Nguyen attended medical school at Texas A&M Health Sciences Center and completed a psychiatry internship at University of California Irvine. He completed his residency training in child and adolescent psychiatry and pediatrics at the University of Utah Health Science Center.  He has been on staff at CHOC for over 16 years and is currently serves as director of psychiatry and the chair of the physician well-being committee.

Dr. Hoang “Wayne” Nguyen
Dr. Hoang “Wayne” Nguyen

Q: What are your special clinical interests?
A: Psychosomatic medicine including eating disorders, psycho-oncology, tic disorders, and Autism spectrum disorder and intellectual disability.

Q: What are some new programs or developments within your specialty?
A: Our most exciting program is the building of an inpatient child and adolescent mental health unit. We are also involved in integrating psychiatric care and mental health in various outpatient specialty clinics.   We are also a provider for the county’s Medi-Cal program for patients with co-occurring medical illnesses and psychiatric disorders.

Q: What are your most common diagnoses?
A: Anxiety, depression, ADHD

Q:  What inspires you most about the care being delivered here at CHOC?
A: It’s comprehensive and we are always striving to do better.

Q: Why did you decide to become a doctor?
A: At the age of 19 and having graduated from college, I was working as a software engineer at a startup, and there was a realization that there was more to life than what I was doing.

Q: If you weren’t a physician, what would you be and why?
A:  Ideally, a rock and roll star, but most likely a software entrepreneur because I like to create new solutions.

Q: What are your hobbies/interests outside of work?
A: I enjoy being with my five children and participating in their activities. I’m also very active in practicing my faith. In my spare time, I enjoy outdoor activities and playing tennis.

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Tips to Encourage Resiliency in Children

Children often surprise us by how resilient they are in many situations. Resiliency – the ability to recover quickly from adversity or disruptive change – is often thought as something that is innate, but in reality it is something that should be taught, says Dr. Mery Taylor, a pediatric psychologist at CHOC Children’s. Resiliency can help children regulate their emotions and lead to an emotionally healthier life into adulthood. It’s a skill that can be encouraged on a daily basis. Parents and caregivers can guide their children on managing common issues that come up at home, school or with peers.

Dr. Mery Taylor, pediatric psychologist at CHOC Children’s
Dr. Mery Taylor, pediatric psychologist at CHOC Children’s

Dr. Taylor offers the following tips to help teach your kids to be resilient:

  • Acknowledge your children’s feelings. Listen carefully to your children’s concerns before you offer your opinion or solution. Keep in mind your child’s personality; some kids may be more anxious to begin with, for example, and may need more support. Let your children know that they are loved. Remind them that they are bigger and stronger than the disappointment they are facing.
  • Allow your children to problem solve. It’s ok to allow your children to try something and fail from time to time. Support your children’s decision or thought process, rather than solving the problem for them. If they fail, let them know that it’s ok to fail or feel disappointed. Talk about lessons learned and what can be done differently next time. This can help your children develop self-confidence.
  • Model resilient behavior. A child’s reaction to his chronic illness, for instance, often depends on the reaction of his parents, Dr. Taylor explains. If you remain optimistic and hopeful, it’s likely your kids will too. Reassure your children that while certain situations may be out of everyone’s control, they are in control of how they react to these situations. This helps your children’s ability to cope and helps reduce their anxiety.
  • Don’t dwell on negative emotions. It’s ok to demonstrate your feelings in front of your children, including sadness, anger or frustration. It’s natural to feel that way in certain situations, especially when it involves your children. It’s important not to dwell on those emotions, however. Follow those emotions with positive messages, such as:
    • I love you and I’m always going to be here for you.
    • We are going to get through this together.
  • Reflect on past challenges. Even when your children are facing painful events, you can remind them of another time in their lives when they overcame adversity. Have them reflect on how much they grew from that experience and how they are stronger and more competent.
  • Teach your child self-care. Start with the basics. Discuss the importance of healthy eating, exercise and rest. Be an example for them. Also, after a tough day, think together about ways they can turn their day around, for example, a good joke, a hug or a visit to the park. In times of prolonged stress, remember to build in time to relax, disconnect from electronics and TV. Find a ritual that works for your family to let go of the worries and challenges, if only for a few minutes. For some, it might be through prayer or meditation, while others may benefit from breathing techniques.

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Should You Talk to Young Children about Tragic Events?

When it comes to discussing tragedy with young children, honesty might not always be the best policy, a CHOC Children’s psychologist says.

“Shielding them from any exposure should always be the first effort,” Dr. Mery Taylor says. “Children can be unpredictable about how they may respond to information, and even events far away can trigger a stress response.”

Given the potential short- and long-term consequences of coping with a trauma, parents should consider the proximity of the event and whether the child truly must know about specific current events.

But sometimes shielding children from tragic events can be difficult. Dr. Taylor recommends that parents who are considering discussing a tragedy or trauma with a child consider some other factors:

  • Proximity of the event: When a tragedy occurs close to home, it may be more difficult to control what the child might see or hear. And even if unaware, children still might sense tension and anxiety from adults around them.
  • Your partner: Discuss together your concerns and plans to ensure consideration of the different angles, but also so that you both are on the same page and presenting a consistent message. You may want to involve grandparents or caregivers to ensure that your desired approach is followed by those involved in your child’s care.
  • Siblings and older playmates: If your young child is around much older children, consider the likelihood that she may hear something frightening. In these cases, it may be helpful to inoculate her by going ahead and giving her some minimal information while keeping her developmental age in mind. You can always go back and answer more questions as they come. It is not recommended to ask an older child (8 to 12 years old) to not talk about the event with their younger sibling. This would likely only pique their curiosity.
  • Your child’s personality: All children are different. You know your child best. Is she likely to be scared by tragic new more than most children? Or is she the kid who would likely go explain the event to her class? Let her personality help guide your decision.
  • Media: School, other children, television, computers and smartphones may lead to your children knowing more that you think. Be sure to ask about their day; let them know you are there for them; and notice changes in behavior or mood that might be an indication that they may have heard something that doesn’t make sense in their world.

Should parents opt to discuss tragic events with children, or should the child already be aware of the circumstances, Mental Health America offers ways parents can talk to their children about tragedy-related anxiety and help them cope:

Quick tips for parents

  • Children need comforting and frequent reassurance of their safety.
  • Let your child lead the discussion and only answer questions that they ask.
  • Be honest and open about the tragedy or disaster using age-appropriate language. This may take the form of very simple and concise language.
  • Encourage children to express their feelings through talking, drawing or playing.
  • Try to maintain your daily routines as much as possible.
  • Monitor your own anxiety and reactions to the event.

Preschool-aged children

  • Reassure young children that they’re safe. Provide extra comfort and contact by discussing the child’s fears at night, telephoning during the day, and providing extra physical comfort.
  • Get a better understanding of a child’s feelings about the tragedy. Discuss the events with them and find out their fears and concerns. Answer all questions they may ask and provide them loving comfort and care.
  • Structure children’s play so that it remains constructive, serving as an outlet for them to express fear or anger.

Grade school-aged children

  • Answer questions in clear and simple language.
  • False reassurance does not help this age group. Don’t say that tragedies will never happen again; children know this isn’t true. Instead, remind children that tragedies are rare, and say “You’re safe now, and I’ll always try to protect you,” or “Adults are working very hard to make things safe.”
  • Children’s fears often worsen around bedtime, so stay until the child falls asleep so he or she feels protected.
  • Monitor children’s media viewing. Images of the tragedy are extremely frightening to children, so consider significantly limiting the amount of media coverage they see.
  • Allow children to express themselves through play or drawing, and then talk to them about it. This gives you the chance to “retell” the ending of the game or the story they have expressed in pictures with an emphasis on personal safety.
  • Don’t be afraid to say “I don’t know.” Part of keeping discussion of the tragedy open and honest is not being afraid to say you don’t know how to answer a child’s question. When such an occasion arises, explain to your child that tragedies cause feelings that even adults have trouble dealing with. Temper this by explaining that adults will still always work hard to keep children safe and secure.

  Adolescents

  • Adolescents may try to downplay their worries, so encourage them to work out their concerns about the tragedy.
  • Children with existing emotional problems such as depression may require careful supervision and additional support.
  • Monitor their media exposure to the event and information they receive on the Internet.
  • Adolescents may turn to their friends for support. Encourage friends and families to get together and discuss the event to allay fears.

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What to Say to Your Kids About Politics

With election season here, it’s hard to miss the onslaught of media coverage and chatter about political issues and candidates. While this is an important time for our country, it can be a bit overwhelming for parents and even children.

According to KidsHealth.org, if you think your child is probably not interested in these issues, think again. More than 2,000 kids and teens throughout the United States were asked what they thought about recent presidential elections and how they might affect them. A whopping 75 percent of kids and 79 percent of teens answered “yes” when asked whether they thought that the outcome of an election would change their lives.

Mery Taylor, a CHOC Children’s pediatric psychologist, says it’s important to talk openly about the election with your kids in an age-appropriate way.

“Ask your kids what’s important to them,” says Dr. Taylor. “Above all, it’s important to be loving and reassuring.”

Dr. Taylor offers the following tips when talking about politics:

  • Acknowledge your children’s feelings. Ask what they feel and why. Listen closely and try to connect with your child’s emotions before problem solving. If they have concerns or fears about a particular issue or how it may affect your family, reassure them that they are safe and that your family will work out any issue together.
  • Keep the conversation light and positive. Focus on the positive aspects of a candidate or an issue. Take this opportunity to explain to your kids how to voice their opinions with respect, even when he/she doesn’t agree with someone else. Talk about what you believe and why in a respectful way, too.
  • Talk about the election process. Talk to your kids about the importance of voting and how the process works. Explain to them that everyone has a voice. While they may not be able to vote, encourage your kids to get involved at school or in the community, with issues that are important to them, such as the environment or the economy, for example. Let them know their contributions can make a big difference.

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Warnings Signs of Depression and Suicide in Children

All children experience days or periods of sadness or other deep emotion. It’s when those feelings are persistent and last longer than a several weeks that it may be time to seek professional help, according to mental health experts at CHOC Children’s.

Suicide is the second leading cause of death for individuals ages 10-24 in the United States. Suicidal children and adolescents may have depression, or a combination of other mental illnesses such as anxiety disorder, attention deficit disorder, bipolar disorder, or child-onset schizophrenia, says Dr. Heather Huszti, chief psychologist at CHOC Children’s.

Dr. Heather Huszti

Other signs that children may be depressed include:

  • Changes in behavior, including appetite
  • No longer enjoying activities they used to like
  • Changes in sleeping pattern
  • Always feeling tired,
  • Isolating themselves socially
  • These changes may be especially concerning if connected to a significant loss or change

“It’s difficult to imagine that children as young as 10 could attempt to end their lives, but unfortunately it can happen,” says Huszti. “The first thing parents can do to help their children is talking openly about mental health issues and any concerns they might have, including talking about the potential warning signs.”

Download your copy of CHOC’s “Let’s Talk About It” guide and learn how you can help start a conversation about mental health.

Warning signs that a child may be considering suicide include:

  • Giving away possessions or making a will
  • Threatening, planning, or joking about suicide
  • Sending despairing texts or online messages
  • Expressing feelings of failure or shame
  • Avoiding friends and social situations
  • Engaging in risky behavior

Always take warning signs seriously, advises Huszti. If your child, or anyone else, is in immediate danger of self-harm, call 911. Other local and nationwide resources are available, such as 24/7 suicide prevention lines and 24/7 crisis response services.

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