How to help children and teens manage their stress

In the short term, stress can push a child to practice for her piano recital or inspire a teen to study when he’d rather be out with friends. But chronic stress—for example, from unrelenting pandemic-related pressures, social unrest, or violence—is different. Left unchecked, long-term stress can contribute to a long list of physical and mental health problems. Prolonged stress can cause high blood pressure, weaken the immune system, and contribute to diseases such as obesity and heart disease. It can also lead to mental health problems such as anxiety and depression—disorders that are becoming more common in youth.

More than two full years into the covid-19 pandemic, mental illness is at an all-time high—especially among children. In fact, between 2016 and 2020, the number of children aged 3 to 17 diagnosed with anxiety grew by 29% and those with depression by 27%, according to a study published in 2022 in JAMA Pediatrics. The findings also suggest concerning changes in child and family well-being after the onset of the covid-19 pandemic.

At the extreme end of the stress scale, nearly 270,000 children suffered tragic loss, with covid-19 claiming one or more of their caregivers.

Stress in young people doesn’t always look like stress in adults. But like adults, children and teens—even those with life-altering losses—can find healthy ways to cope. Together, young people and their parents or caregivers can learn to spot the signs of excess stress and, with the right tools, manage it.

For young children, tension at home is a common source of stress. Children may be troubled by family discord, divorce, or loss, for example. Even happy changes, such as a new home, the arrival of a new sibling, or a beloved new stepparent can be hard on a child.

School is another frequent source of concern for kids. Young children might be stressed about making friends, dealing with bullies, or getting along with their teachers. They might also be anxious about tests and grades.

More significant stress is also rising in this cohort. While pediatric emergency department visits declined during the pandemic, the number and proportion of mental health-related emergency department visits increased for children ages 0 to 11, compared to 2019, according to the Centers for Disease Control and Prevention (Radhakrishnan, L., et al., Morbidity and Mortality Weekly Report, Vol. 71, No. 8, 2022).

As children get older, their sources of stress expand. Teens are more likely than young children to be stressed by events or situations outside the home.

Mental health crises are on the rise for this age group as well, with mental health-related emergency department visits increasing for kids ages 12 to 17 compared with 2019 emergency department visits. In particular, emergency departments saw increases in visits related to self-harm, drug poisonings, and eating disorders among this age group since the pandemic’s onset (Radhakrishnan, L., et al., Morbidity and Mortality Weekly Report, Vol. 71, No. 8, 2022).

In addition, during the 2020–2021 school year, more than 60% of college students met the criteria for at least one mental health problem, according to the Healthy Minds Study, which collects data from 373 campuses nationwide (Lipson, S. K., et al., Journal of Affective Disorders, Vol. 306, 2022).

Peers can help buffer stress, but can also be a source of it. Social relationships are especially important in adolescence. Many teens worry about fitting in, their first romantic relationships, and peer pressure around substance use and sex.

Signs of stress in youth can show up in a number of ways:

• Irritability and anger: Children don’t always have the words to describe how they are feeling and sometimes tension bubbles over into a bad mood. Stressed-out kids and teens might be more short-tempered or argumentative than normal.
• Changes in behavior: A young child who used to be a great listener is suddenly acting out. A once-active teen now doesn’t want to leave the house. Sudden changes can be a sign that stress levels are high.
• Trouble sleeping: A child or teen might complain of feeling tired all the time, sleep more than usual, or have trouble falling asleep at night.
• Neglecting responsibilities: If an adolescent suddenly drops the ball on homework, forgets obligations, or starts procrastinating more than usual, stress might be a factor.
• Eating changes: Eating too much or too little can both be reactions to stress.
• Getting sick more often: Stress often shows up as physical symptoms. Children who feel stress often report headaches or stomachaches, and might make frequent trips to the school nurse’s office.

Facing stressors is a fact of life, for children and adults. These strategies can help keep stress in check:

• Sleep well. Sleep is essential for physical and emotional well-being. Experts recommend nine to 12 hours of sleep a night for 6- to 12-year olds. Teens need eight to 10 hours a night. Sleep needs to be a priority to keep stress in check. To protect shut-eye, limit screen use at night and avoid keeping digital devices in the bedroom.
• Exercise. Physical activity is an essential stress reliever for people of all ages. The U.S. Department of Health and Human Services recommends at least 60 minutes a day of activity for children ages 6 to 17.
• Talk it out. Talking about stressful situations with a trusted adult can help kids and teens put things in perspective and find solutions.
• Make time for fun—and quiet. Just like adults, kids and teens need time to do what brings them joy, whether that’s unstructured time to play with building bricks or uninterrupted hours to practice music or art. Also, while some children thrive bouncing from one activity to the next, others need more down time. Find a healthy balance between favorite activities and free time.
• Get outside. Spending time in nature is an effective way to relieve stress and improve overall well-being. Researchers have found that people who live in areas with more green space have less depression, anxiety, and stress.
• Write about it. Research has found that expressing oneself in writing can help reduce mental distress and improve well-being. Some research has found, for example, that writing about positive feelings—such as the things you’re grateful for or proud of—can ease symptoms of anxiety and depression.
• Learn mindfulness. In a study of a 5-week mindfulness training program for 13- to 18-year-olds, researchers found that teens who learned mindfulness experienced significantly less mental distress than teens who did not.

Parents and other caregivers have an important part to play, by adopting their own healthy habits and helping children and teens find stress-managing strategies. Some ways parents can take action:

• Model healthy coping. Caregivers can talk with children about how they’ve thought about and dealt with their own stressful situations.
• Let kids be problem-solvers. It’s natural to want to fix your child’s problems. But when parents swoop in to solve every little glitch, their children don’t have a chance to learn healthy coping skills. Let your children try to solve their low-stakes problems on their own, and they’ll gain confidence that they can deal with stressors and setbacks.
• Promote media literacy. Today’s kids spend a lot of time online, where they can run into questionable content, cyberbullying, or the peer pressures of social media. Parents can help by teaching their children to be savvy digital consumers, and by limiting screen time.
• Combat negative thinking. “I’m terrible at math.” “I hate my hair.” “I’ll never make the team. Why try out?” Children and teens can easily fall into the trap of negative thinking. When children use negative self-talk, though, don’t just disagree. Ask them to really think about whether what they say is true, or remind them of times they worked hard and improved. Learning to frame things positively will help them develop resilience to stress.

Psychologists are experts in helping people manage stress and establish positive mental health habits. Visit APA Division 53 (Society of Clinical Child and Adolescent Psychology) for advice about choosing a psychologist and information about evidence-based treatments.