She stays in the seat, refusing to budge, and with tears in her eyes, says, “I don’t want to go to school.”

Her mother is getting more and more anxious as the line of cars waiting behind theirs is growing while she tries to coax her daughter Zara to enter the school.

In the end, a teacher has to carry Zara in, wailing and kicking.

Mummy leaves the area feeling frustrated, wondering what is happening with her six-year-old daughter.

Zara has been attending the same kindergarten for three years and never had this problem – until recently. So, what’s going on?

One possible explanation: stress.

We have all experienced stress, starting from the day we were born.

The source of stress can be external, such as family, friends and the environment we are in; or they can be internal, such as our own expectations and the pressure we put upon ourselves.

We react to these stressors through various physical, mental and emotional responses.

A baby, for example, can feel stress when their need for food or comfort is not met. As a toddler, the child may also feel stress when learning to walk, talk or eat by themselves.

Beginning kindergarten can also be overwhelming as a child experiences being away from the comforts of home and their caretakers for the first time in their lifes.

As children grow older, managing the academic and social pressures of school, plus the introduction of more rules and regulations, can be a big source of stress as well.

Now, let us go back to Zara, who is starting primary school soon.

While it may be something that she looks forward to, it is nevertheless a huge change. Leaving the kindergarten, her friends and her teachers can be very distressing.

It should be noted that some stress is actually good. Good stress compels and motivates us to do our best to reach our goals.

However, too much stress for a prolonged period of time can be counter-productive and impact us negatively.

For instance, children who are exposed to high-stress environments such as family conflicts, loss of a loved one or violence through the media, may have difficulties managing all these stressors.

A 2017 study from University of Wisconsin-Madison in the United States showed that children who experience chronic and high levels of stress have a higher risk of having behavioural, psychological and physical problems, even in adulthood.

Child, stress, tantrum, acting out, school, homework, overscheduling, Star2.com

Is your child too overscheduled with school, homework and other activities? Giving them some free time will help them manage their stress. — SPH

Is my child stressed?

The most visible indicator of stress in children is their change in behaviour.

Because children have limited capacity to express their feelings in words, they display their worry or agitation through behavioural outbursts.

In toddlers, these behaviours may include biting, hitting, kicking and thumb-sucking. Young children may become more aggressive or suddenly become excessively lazy.

Stress can also manifest through changes in emotion. Crying spells, being more irritable than usual, and becoming easily angry or anxious, are seen in children experiencing stress.

Zara, for instance, being unable to verbalise her sadness over leaving her favourite place and people, expressed it through her refusal to go to school.

Children may also have difficulty staying asleep (maybe due to nightmares), eat too little or too much with no apparent reason, and start bedwetting.

Physical issues such as complaints of indigestion, pounding heart or palpitations, and breathing difficulties, have been observed in children experiencing multiple stressors, as described by Virginia State University, US, child developmental specialist Dr Novella Ruffin.

The key to identifying the presence of stress in children lies in truly knowing your child’s temperament, strengths and weaknesses.

Understanding what makes your child tick can provide good insight into the situation at hand.

It is also good to remember that siblings may display different signs of stress, compared to one another.

Child, stress, tantrum, acting out, thumbsucking, Star2.com

Sudden thumbsucking in toddlers may be an indication that they are under stress. — TNS

Managing stress

Here are some ways to help manage your child’s stress.

1. Stop overscheduling

For example, seven hours at school, two hours of homework, two hours of tuition and one hour of piano class in a day.

Simplifying a child’s schedule would make space for some down time. Unstructured free time helps children learn to make decisions, manage stress and negotiate.

2. Encourage healthy sleep habits

Sleep is a crucial part of child development and has been known to have an effect on children’s behaviour, learning, school performance and overall growth.

Hence, it is important to have a regular and consistent sleep schedule and bedtime routine.

In addition, gadgets and TV should be kept out of children’s bedrooms.

Bedrooms should also be conducive to sleep, i.e. dark, cool and quiet.

3. Managing your own stress and anxiety

Children are often able to pick up on their parents’ feelings and sense stressful environments. When parents are stressed or anxious, children too may experience their own stress and anxiety.

Hence, it is vital that parents manage their own emotions and model healthy coping strategies.

3. Listen, talk, brainstorm and problem-solve

Encourage your child to speak to you about any difficulties they may be facing and listen in a calm and attentive manner.

Avoid making judgmental comments, blaming and nagging the child. The main idea is to have the child’s emotions and concerns heard.

Then, parent and child can brainstorm possible solutions for the situation.

It is important to encourage active participation by your child to help them build confidence in their own problem-solving and coping skills.

4. Try some stress-relieving activities

Engage in techniques such as deep breathing, stretching, listening to music, drawing and practising mindfulness.

In addition, participate in fun activities both parent and child can enjoy together, such as playing a favourite game, watching a movie or baking.

Stress will always be present in our lives, including in children, but the way in which it is managed makes the biggest difference.

Parents play a big role in helping children to identify and manage their stressful situations.

Having effective coping strategies is essential in preparing children to deal with any future stressors they may encounter.

Do not hesitate to seek professional help should your child’s stress cause serious anxiety or significant behavioural changes.

Dr Dhanya Pillai, Darlina Fadil Azim and Nur Arfah Zaini are from Perdana University–Royal College of Surgeons in Ireland School of Medicine’s Department of Psychology. This article is courtesy of Perdana University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.