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Kids and Stress

Stress is everywhere in our adult lives, but it is everywhere in our kids’ lives too. As parents, how do we know what is normal and healthy versus when we should be concerned about our kids stress?

February 6, 2020: Sponsored by Annapolis Pediatrics

Full Transcript of the Podcast at the bottom of the page

About our guest, Erin B. Merli:

Erin B. Merli, CPNP, MS, RN, PMHS (Pediatric Primary Care Mental Health Specialist)
Bachelor of Science (Psychology with concentration in Neuroscience) Duke University, 1999
Master of Science in Biotechnology Johns Hopkins University, 2004
Bachelor of Science in Nursing, University of Maryland, 2007
Master of Science, Pediatric Nurse Practitioner, University of Maryland, 2012

Erin Merli has worked extensively, in variety of settings, with patients and families affected by mood disorders and stress for over 16 years. She started her professional career at Johns Hopkins Hospital, researching the genetics of psychiatric disorders, for almost a decade. During this time, she interviewed and helped assess several hundred patients, and families with loved ones, affected by depression, schizophrenia and bipolar disorder. Using data collected through these multi-site, collaborative projects, she co-authored and published 9 peer-reviewed articles in professional journals on the genetics of psychiatric illness.

After receiving a master’s degree in biotechnology from Hopkins, she entered nursing school as a second degree student. Shortly after graduating in 2007 with high honors, Erin was awarded a Fogarty AIDS International Research Fellowship and traveled to Nigeria to lead an independent research project investigating the prevalence of hazardous alcohol use and depressive symptoms in HIV positive patients. She published and presented her findings for an international audience upon her return. Additionally, Erin worked in the pediatric intensive care unit at the University of Maryland for 6 years where she made it a point to care not only for her ill patients, but also for their families during extremely stressful life events. Erin brings her lengthy experience of working with patients and their families, in a myriad of settings, to primary care where she has a special interest in working with teens and young adults who are experiencing difficulty with mood, stress and anxiety symptoms.


About Annapolis Pediatrics: 

For over 70 years, Annapolis Pediatrics has provided superior healthcare to infants, children, adolescents, and young adults in Annapolis and the surrounding communities. In some cases, they have cared for three generations of families. They strive to provide high quality medical care, from excellent clinical care to a positive customer experience for their patients and their parents.

Annapolis Pediatrics has over 30 physicians and nurse practitioners in 5 locations: Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. They also offer Monday through Friday walk-in hours at their Annapolis office for short sick visits.

Visit https://annapolispediatrics.com/ for more information on the practice, providers, free events, and resources.

AnnapPeds logo 01References mentioned during podcast:

Anxietycanada.com, Expert tools and resources to help people manage anxiety.

MindShift™ CBT App, MindShift™ CBT uses scientifically proven strategies based on Cognitive Behavioural Therapy (CBT) to help you learn to relax and be mindful, develop more effective ways of thinking, and use active steps to take charge of your anxiety.

Book – “What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety (What-to-Do Guides for Kids)?”, by Dawn Huebner

Book – “Untangled: Guiding Teenage Girls Through the Seven Transitions into Adulthood”, by Lisa Demour, Ph.D

Book – “Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls”, by Lisa Demour, Ph.D


Janet Jefferson (00:14):
Welcome to Third Floor Views where we at Chesapeake Family Life talk about health, education and living with kids. I’m your host, Janet Jefferson. This podcast episode is sponsored by Annapolis Pediatrics. Today we are talking about kids and stress. Stress is everywhere in our adult lives, but it is everywhere in our kids’ lives too. As parents, how do we know what is normal and healthy versus when we should be concerned about our kids stress? What are some tools we can use to help our kids become more resilient and when should we seek professional help to help manage the stress in our kids’ lives? Our guest today is Erin Merli, certified pediatric nurse practitioner and pediatric mental health specialist from Annapolis Pediatrics. Erin has been in pediatrics for over 16 years. I’m excited to have you here. I’m excited to talk about kids and stress because it’s something I think that we don’t always think about in kids that we think about a lot with adults.

Janet Jefferson (01:11):
Like, I’m stressed, my day is stressful, my work is stressful, but I don’t always think about the stress in my child’s life, but it’s something that all kids experience. So I guess my first question is, are we really talking about babies to teenagers or what, what are we talking about in terms of stress and ages and stages?

Erin Merli (01:33):
Absolutely. So as kids grow and develop, they’re building different skills to get through different developmental stages. Think back to infancy and they’re learning how to know when a parent is going to be attentive to their needs so they cry and they fuss. And we as parents, our job is to pick them up and handle their needs that is stressful for them and quite honestly stressful for the parents too, as they’re going through that developmental stage. And then our toddlers are learning how to start being a little bit independent. And with that comes a typical development of some fears. Fear that they’re going to be without their parents or fear that they might get lost. Our preschoolers, they’re developing this big, beautiful brain that’s full of imagination and with that comes fear of monsters, fear of the dark. There are some ways that we can utilize that developing skill of independence and imagination to help them through that fear. And the key word here is through the fear, not around it or avoiding it, but through that fear. Our school age kids start becoming more comfortable with increasing academics so increasing demands of academics and with that comes a certain level of fear of failure. You can sometimes see in kids developing this fear of trying something hard because they become fearful that they may “fail” at that particular task.

Erin Merli (03:08):
And our middle schoolers, there’s really important friendships that they’re starting to develop and with that comes a fear of rejection. And so we need to help them figure out how to conflict, how to deal with conflict resolution and how to deal with developing these very intense relationships. As you can see with each age group, fears come naturally and fears and worries and stress are all a part of developing a new skill set. So development and appropriate fears are tied in together and it should be expected that there are going to be periods where kids are stressed and our job as parents are really to model appropriate behavior for handling stresses and guide them, not problem solve for them, but guide them through these developmental steps and fears and worries and also normalize. Talk with them about times when we are scared or we are worried or we feel stressed and what do we do in those situations? Because we don’t want them to avoid, we want them to move through.

Janet Jefferson (04:18):
Stress is totally normal and a great part of development. So it is good. Stress can be good in kids. Is that what I’m hearing?

Erin Merli (04:28):
It is. So a certain level of stress and we’ll talk a little bit about when stress is not good or when it is, when kids are having difficulty developing those coping skills. But I like to think about stress. There’s a saying that stress is the force that turns rocks into diamonds and it really is that particular force in a kid’s life that helps them go from not having a skill set to developing that skill set. It’s a key tenant in resilience building as I start out with a particular type of a situation such as conflict resolution. At first I don’t have the skills, but as I learn and as I practice and I adapt to this situation and I grow through that stressful situation, I then develop and acquire that skill set to then meet that particular situation as I encounter it further on in life. So stress is good. If you think about sort of the stress productivity, if you think about a bell curve, so stress is on the X axis and it’s along the bottom. As different situations become more stressful and they learn how to be more productive in that situation. But there is a tipping point. So at the top of that bell curve, if things are too stressful, so they’re encountering more stress than they’re able to handle or they don’t have sufficient coping skills to work on developing that tool set, then you can see anger and kids that are shutting down or kids that are starting to become avoidant. So, stress is important, but it’s important to also identify when kids are stressed and help them develop those coping skills to move through that situation.

Janet Jefferson (06:23):
What are some tools that parents can use to help them through these normal developmental periods? And it’s definitely going to be different whether you’re dealing with a toddler versus a teenager, but in general, I’m hearing that we want our kids to struggle and that’s a good thing and that’s where they’re going to be able to become fully fledged adults that can handle problems beautifully. But how can we as parents help our kids go through that struggle and finding that balance between wanting to jump in and solve the problem for them, but then also making sure we are there to support them and not just let them continually fall flat on their faces.

Erin Merli (07:01):
Absolutely. I think there are a lot of things that we as parents can do. So first and foremost is modeling effective coping strategies. So, you know, we may come home from a really tough day at work and you know, just want to kind of vent and complain about how difficult that that day was. I think it’s important to let our kids know, “Hey, this day was really tough for me. Here are some of the challenges that I experienced and here are some of the good things that I learned how to do.” For myself, I’ll tell you, I do not like yellow jackets. As a matter of fact, I internally will really freak out anytime I see yellow jackets. So it could go in the direction where I avoid picnics and crab feasts and things like that. But instead, I’m very honest with my kids that I am fearful of these flying demons. And I tell them what my strategy is going to be. “Okay. So when we go on this picnic, what I plan to do is keep our food covered. If I see a yellow jacket, I’m going to calmly back away. And you may see me taking some deep breaths as I reengage in the picnic.” But I think it’s important to talk with them about my own struggles with things that I’m fearful of. Additionally, we do a lot of talking about bravery. Bravery is not the absence of being afraid. It’s the ability to acknowledge that I’m afraid of something and figure out the tools that I need to move through that particular situation. So for instance, when my six year old was learning how to dive off of the high dive, she was fearful and that’s a normal feeling. This is a high dive and it’s pretty far up. So what we talked about was, “Hey, I believe in you. I think that you can do it when you are ready to do it. Go ahead and try and then we will celebrate that success.

Erin Merli (09:00):
So what should we do? Should we do a happy dance? Should we go and get an ice cream cone?” So celebrating bravery, reading books about bravery and talking about times in your life where you’ve needed to be brave, I think are some really important things. The other thing that’s important is acknowledging feelings. So I’m never trying to talk kids out of being afraid or of feeling conflict or feeling stressed in a particular situation. They’re going to feel what they feel. They’re responsible for how they handle that feeling. But trying to take your adult experiences and apply it to something that’s really important for your kids, such as a first love that they’re experiencing that the other person is not returning. That’s painful. And even letting that person know that they have strong feelings for them. They may be very fearful in that situation. So as a parent coming in and saying, Oh, why are you there? There’s going to be a million people that you love some time in your life. A) that’s really belittling and B) that’s invalidating their feelings. That’s not utilizing that as an opportunity to talk about how would you like to handle this situation? What are some opportunities or some options? I know as a parent, sometimes I feel like I want to rush into that situation and problem solve for them. A couple of things that can occur when I do that, first of all, it gives the message that I don’t believe that you have problem solving capability. I as the adult is really the only person in that situation that can solve this and B) it doesn’t allow them to start thinking outside the box and apply that growth mindset to say, all right, these are the things I’ve learned so far in my life. What can I take from those experiences and apply in this new situation? What can I do that may be a little different or require a little bit of bravery to go through that particular situation. So asking them and the key point is asking after they’ve calmed down. So in some of these situations you see kids really kind of having a strong emotional response. We call them big feelings. I have a seven year old and a nine year old and we have big feelings in my household and you’re allowed to have big feelings. You can’t scream or destroy things or slam doors, et cetera. But you can feel what you feel. So we allow first some time to calm down so that we can have that logic part of the brain start making more choices. And then the idea is with younger kids, I ask them to put their thinking cap on. So we make an actual imaginary thinking cap and we put it on our in our head and we talk about some different ways of thinking through the situation. And then sometimes we may play act, so in conflict resolution, for instance, I may be the aggressor and the other kid is themselves and they figure out how they’d like to handle me being the aggressor. And then we flip it. Then I play a role in their role, and they can be the other person that they’re trying to work through a situation with.

Janet Jefferson (12:17):
So perspective taking as well.

Erin Merli (12:19):

Janet Jefferson (12:20):
What I’m hearing is the importance to acknowledge and honor feelings and then take advantage of these moments as teachable moments. But make sure to do that when these kids are calm. And those big feelings have calmed down a little bit. As a mother to a two and a half year old, we have many big feelings in our house on a daily, if not hourly basis. So I am very familiar with some big feelings.

Erin Merli (12:45):
Yeah, absolutely. Just wait until she’s nine.

Janet Jefferson (12:47):
Let’s take a quick break to hear about our sponsors.

Donna Jefferson (12:57):
Thank you to our sponsor, Annapolis Pediatrics. I’m Donna Jefferson, the creator and CEO of Chesapeake Family Life. And I’m happy to tell you that I’m a former patient of Dr. Briscoe, the founder of Annapolis Pediatrics. And both of my kids were seen throughout their childhood by the excellent staff at Annapolis Pediatrics, which started in 1948. They see infants, children, adolescents, and young adults in five locations. Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. And I can tell you from experience that they care as much about the well being of your entire family, including frazzled moms and dads as they do about your children. They’re there when you need them. 24/7, you can find them online at annapolispediatrics.com.

Janet Jefferson (13:43):
Welcome back. We are here with Erin who is a pediatric nurse practitioner talking about kids and stress. We’ve just been talking about normal stress that’s part of developmental stages and kids are going to go through these different steps as they develop. When do parents need to worry that their kid’s behavior is abnormal and what should parents be looking for?

Erin Merli (14:06):
That’s a really good question. You know, when we think about pathologic concerns or situations in which we may have a problem that needs more acute treatment, we’re really looking at functional impairment and that comes down to difficulty sleeping at night for long periods of time, not just a couple of days here and there. Changes in behavior, so withdrawn behaviors or overly avoidance behaviors. If we find that there are significant changes in appetite, changes in energy level, no longer enjoying activities that they typically enjoy and the functional impairment really is the big piece that we’re looking for if we’re concerned. So big changes in friend groups as well may be concerning and worth certainly a conversation with your child.

Janet Jefferson (15:08):
What would the next step be? Is this something that parents should go to their pediatrician about? Is that something that you should seek a specialist? Do we need to buckle down as parents and do some research, do some reading? What do you recommend as sort of a next step if you have started to identify these changes in behavior with your child?

Erin Merli (15:29):
Definitely consult your pediatrician who has kind of been with you already through thick and thin and I think bibliotherapy is always a good thing to do as well. And what I mean by that is looking into some resources, some books that you can read or even read with your children while you’re waiting for this appointment with your pediatric provider, educating yourself about what may be going on and what your options are. I think your pediatric provider would be a great person to help you identify if it’s a typically developing fear or worry or if it really is something that needs additional resources. Always reach out to your kids’ teachers and the guidance counselors at school as well. They are fantastic resources and they know typical development of kids too. So they’re going to be able to help you identify how are they functioning at school. Are there their some concerns? Have they noticed some behavioral changes as well. Coaches, clergy, individuals. So whoever’s in your kid’s sort of trusted group of adults, reach out to them and get some more information. Talk with your kids to ask them if they think that there’s a problem and ask them if there’s anything that’s going on in their lives. Remember that, that sometimes if kids are in distress, there may be an initial knee jerk reaction to kind of side arm you and tell you, “Nope, everything’s fine.” Find some other ways of asking if you really are concerned about something, make sure that you are getting the help that they need and not waiting until things have really become problematic.

Janet Jefferson (17:11):
What age do these bigger issues often manifest? So if we are talking about anxiety, depression, or maybe even other issues like obsessive compulsive disorder, when are you seeing that happen most often? Or is it really dependent on the child?

Erin Merli (17:27):
It is dependent on the child but I will say that we do see a lot of rates of anxiety and other psychopathology significantly increase around puberty. There’s a two fold increase in mood disorders between the ages of 13 and 18. Boys and girls have equal rates of anxiety prior to puberty and after puberty, girls are two times more likely to have an anxiety disorder. Recent research really suggests that one in three adolescents will meet criteria for an anxiety disorder by the age of 18.

Janet Jefferson (18:04):
That’s a huge percentage.

Erin Merli (18:06):
Right? And I guess the take home messages that there are things that we can do to kind of buffer these and strengthen their resilience.

Janet Jefferson (18:16):
All right, let’s talk about that. Since that is such a huge number, the likelihood that your child or at some point your child might experience some of these problems, what can we do as parents to, to prevent it? And then my next question would be, okay, once we’ve identified it, then what?

Erin Merli (18:35):
Yeah. I think that first of all, having conversations with our kids, we talked about bravery and talking up bravery. We talked about allowing kids to have their big feelings and not trying to talk them out of it. Modeling appropriate stress reduction. There are some tools that kids can use to figure out ways of kind of calming down when they are feeling significantly upset. So breathing techniques are fantastic and there’s ways to adapt those breathing techniques to different age groups.

Erin Merli (19:09):
I like for little kids to pretend like they have a big cup of hot chocolate and in their hands they bring it up to their nose and they smell the hot chocolate and then they blow on it cause it’s way too hot. And then they smell it and then they blow on it. Our school aged kids, I like color breathing. I’m using their favorite color to breathe in and a color that they view as really kind of yucky and using that to breathe out. Our teenagers may like to do more of a number system. I call it 7/11 breathing. Breathing in for a count of seven while really having their hand on their abdomen and making sure that their abdomen is going out for that breath and then hold for a count of three and then out for a count of 11 using visual imagery as well.

Erin Merli (19:56):
Using five senses, thinking about a place where they feel very comfortable like being at the beach and when they are at the beach, what are they seeing and hearing and smelling and feeling. That can kind of help them reestablish kind of a feeling of calm. And again, normalizing some of these feelings is important and letting kids know that you expect that there are going to be struggles and you’re always going to be there for them to help them problem solve if they need it. The other thing is monitoring what they’re seeing and hearing on social media and on the news. You know, I always joke, my mom is a therapist in the community and when I was growing up, she saw teenagers and one of the things that she used to like to do is watch shows with us.

Erin Merli (20:41):
So I always tell her that she ruined Beverly Hills 90210. She would sit with us and during commercial breaks or even afterwards she would ask us, “well, what would you do in that situation? How could they have handled that differently?” So you too parents can ruin shows for your kids! But seriously, talking with them about what it is that they’re seeing, what questions do they have? They are exposed to a lot more than we were as kids as we have a lot more 24 hour news cycles and exposure to social media. There are more pieces of world events that they’re being exposed to and we need to know what our kids are watching and have conversations with them. And it doesn’t stop with one conversation. And you know, if you strike out with one particular way of presenting information, try a different way.

Erin Merli (21:34):
With my nine year old, we had some big feelings yesterday morning and my first approach was while she was incredibly ticked off to try to figure out what was going on, which that was strike one. Second approach was when she was in the car with me and a couple of friends and kind of directing my observation to the whole group, saying ‘you know, guys, even when we have rough mornings, we can have the rest of the day.’ Well that was strike two. So my third strike, hopefully it won’t be a strike, but my third approach tonight is going to be, Hey, let’s kind of reevaluate what we can do differently so we don’t have rough mornings or we can minimize your rough mornings. So even if you feel like Oh, well that was a total bust, find a different way of talking with your kids.

Janet Jefferson (22:22):
Do you have any recommended resources? Right there you just listed three different approaches. And as a new parent, I’m like, “Oh man, I gotta write this down so I can reference it later.” Do you have anything that you’re really excited about that you could say yes, I recommend these to help provide tools for parents to help de-stress their kids?

Erin Merli (22:42):
Absolutely. I have a wonderful website that I talk about a lot. It’s called anxietycanada.com, and they have apps that you can use that apply different ways of dealing with different situations. So older teens can download the app and apply different situations. It’s sort of like a mobile cognitive behavioral therapy tool. It’s really great and there’s a lot of resources there for parents for little kids. I love the books by Dawn Huebner. One of the books is ‘What to do When You Worry too Much’ and it’s kind of an illustrated coloring book that you can do with your kids. So that’s really, I would say the intended audiences are kids between the ages of five to eight, sometimes, slightly older kids will enjoy it as well. For adolescent girls. I love anything by Lisa Damour. She has a book called ‘Unwind’ that I think came out about six years ago and her new book ‘Under Pressure’ is fantastic as well. I really encourage parents to pick up books, look at websites, encourage educating yourself about, different ways of handling stress, both for yourself that maybe you have a different way of handling stress, but also for your kids.

Janet Jefferson (24:11):
Why are we talking about this today? As a teacher I feel like I have seen this a lot more throughout the recent years compared to when I started teaching. I see it both in little kids, elementary school kids, even preschool kids, and I see it in high school kids. Why do you think that is and is that something that you are seeing in your practice as well?

Erin Merli (24:32):
Absolutely. We are definitely seeing a lot more stress, really on the pediatric primary care side of things, kind of manifesting in somatic symptoms. So that’s headaches, chronic abdominal pain without a specific source and school avoidance and things like that. I think it’s probably multifactorial. I mentioned before social media, there’s a sense of not being able to escape other people’s opinions. And if you take it back to developmental steps, our middle schoolers who are identifying and really trying to figure out who they are, are constantly getting inundated by everybody’s opinions about who they are. When I was a kid, if there was somebody in middle school who was being a jerk, all I had to do was walk home and I was in a very safe place. I didn’t have to think about or process what that jerk thought about me. Nowadays it follows you home through social media. So I think there are ways that we can use social media in a positive way, but we have to remember the developmental step in the vulnerabilities that are occurring because of those developmental steps. I think as well, we as parents are really inundated with current events from around the world.

Erin Merli (25:52):
We are constantly getting information about what’s happening all over the place. That’s raising our stress levels as adults. And I think that from a nurture standpoint, we are perhaps projecting some of that stress on our kids. There’s also increasing in academic standards and academic, expectations for kids. There’s some good research to support that things we’re expecting our elementary school students to do, were developmentally appropriate for older kids. There’s a real sense not only with academics but athletics as well, that there’s just a much more of a prevalent drive towards perfection and that can be kind of concerning. I don’t know that you can boil it down to one or two things. I think that stress and anxiety disorders are increasing. Taking it back to the good news, there are things that we can do to kind of buffer and provide some tools because stress is unavoidable and it’s an important part of functioning.

Erin Merli (27:02):
If you don’t care at all about your math test, you’re not going to study for right. If you care enough to study for it, then you will do better. If you care too much and get completely stressed out, then it’s much more difficult to study. So there is a fine balance between figuring out how to keep stress in a motivating level versus an inhibiting level.

Janet Jefferson (27:28):
Absolutely. Well, thank you so much to Erin for coming and talking to us today and a big thank you to Annapolis Pediatrics for sponsoring this episode of Third Floor Views. We love to hear your thoughts, comments, and questions. If you enjoyed what you heard today, check out more thirdfloorviews.com. I’m Janet Jefferson. This is Third Floor Views. Thank you for listening.

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