This week’s question is from Rosa,
“I’m very concerned about my 5-year-old son. For the past 3 weeks, he has changed his behavior to the point where he doesn’t want to go to school, says he’s having nightmares, doesn’t want to sleep alone, has eyes ‘shaking’, a funny stomach and he’s complaining that his eyes hurt. I’m worried.
He has never had these issues before.
He did have some kind of flu illness about 3 weeks ago, and 2 weeks ago, he started in-person school. I don’t know if those things are related or not, but I need to do something to help him.”
In this episode, I will address a few things that might be going on here. There could be some psychological and/or physiological components to this sudden behavior change. It could stem from the illness she describes, from the anxiety of starting school, or both. I’ll give her some tips on how to talk to her son about what she’s noticing and how to address these issues depending on where they stem from. It’s important to help kids develop coping skills, keep new activities to a minimum while they regulate, and keep an eye on their eating habits and sleep. And finally I’ll explain why it’s important to discuss this with the child’s teacher. I hope many parents find this example and these tips helpful!
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What the parents notice
- Doesn’t want to go to school
- Having nightmares
- Eyes ticks
- Stomach hurts
- Doesn’t want to sleep alone
- Had the flu a few weeks prior
- Just started back at school
- 5 yr old starting school is a big change
- Could be anxiety
- Change in routine can cause anxiety
- Be sure to rule out any traumas when there are sudden changes in behavior like this
- Illnesses in some kids can lead to sudden changes in behavior
- Speak with your child’s doctor about ruling out viruses, strep, Epstein Barr, flu, PANS or PANDAS
Talk to your child about what you notice
- “What do you think might be going on?”
- If they don’t have any insight try giving them examples
- “Some kids might feel nervous or scared about meeting new people at school” “Is that how you feel?”
- When parents make a big deal out of something kids can get even more scared
- Acknowledge their feelings “its hard but I’ll help you get used to it”
Work on some basic coping skills
- Teach them to take big belly breaths
- Blow a cotton ball across the table
- Put a toy on their belly to watch it go up and down
- Yoga poses for kids can help them with uncomfortable feelings, there are lots of videos on YT or apps with kids yoga
- Mindfulness techniques like imagining the scary thoughts floating away into the ski.
Keep activities at home normal and consistent for a few weeks
- Try not to plan too many new things
- Starting school is a big change so other big changes may be too overwhelming
- Keep the schedule consistent
- Find moments at home to sit together and rock in a chair or read books and sing
- Give a little more time and attention during this transitional time
Look at eating habits
- Make sure he’s getting a good breakfast with protein
- Getting a good hearty snack at the end of the day\
- Find out if he’s eating his lunch
- Practice a consistent nighttime routine
- Come up with a plan, together, for how you will handle nightmares
- Maybe you walk to the kitchen together to get a drink of water then come back to bed and read a few books
- Or maybe he first practices his deep breathing to get back to sleep
Share concerns with the teacher and school
- Let them know what you’ve noticed
- Let them know what you are doing in terms of any doctor’s orders etc.
- Ask the teacher what they’ve noticed
- Ask them what kind of support can they offer
Episode Intro … 00:00:30
Psychological clues … 00:02:30
Physiological clues … 00:03:50
How to address these issues … 00:05:20
How to communicate with your child … 00:09:00
Work on coping skills … 00:14:13
Look at diet and sleep … 00:17:30
Talk to the teacher … 00:19:00
Episode Wrap up … 00:21:00
Dr. Nicole Beurkens:
Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, I am answering a question from a listener. I get so many questions each week, and this is a great way to provide answers that many of you will hopefully find helpful. If you have a question you’d like me to consider answering on a future episode, email it to firstname.lastname@example.org and you just might hear me answer it on an upcoming show.
Now, onto today’s question. And this is from Rosa, who writes: “I’m very concerned about my 5 year old son. For about the past 3 weeks, he has changed his behavior to the point where he doesn’t want to go to school, says he’s having nightmares, doesn’t want to sleep alone, has eyes ‘shaking’, a funny stomach and he’s complaining that his eyes hurt. I’m worried.
He has not had these issues before.
He did have some kind of flu illness about 3 weeks ago, and 2 weeks ago, he started in-person school. I don’t know if those things are related or not, but I need to do something to help him. Thank you.”
Rosa, great questions. Very appropriate for you to be concerned. Obviously if your son has had some sudden behavior changes, very appropriate for you to be looking at why that might be going on, and hopefully, I can give you some good things that you can look at here to think about how you might be able to support him.
And for those of you who have kids who deal with similar kinds of things: Refusal to go to school, sudden changes in behavior, having nightmares, sudden physical complaints of stomach aches, eyes hurting, some eye ticks or shaking, hopefully this will be helpful to you as well.
So as always, let’s step back and start with the bigger picture here because there are a few things that it seems could be playing a role.
The first is that there could be some psychologically-based things going on. This is a young child, a 5 year old who has just recently started school. Now, mom is saying that these behavior changes started a bit before school started, but still, the child just started in school 2 weeks ago in person. I don’t know if he was going to school before that or if this is his first time, or if he’s been virtually schooled, I know that certainly has been tough during this pandemic period for kids of this age, many of whom have had to have their first formal school experience with kindergarten online, but regardless, this child has had a major change recently with starting school.
So there certainly could be anxiety playing a role here, and fears and worries about maybe separating from home or from parents, anxieties around being at school, things that are happening there. So there could be some anxiety and things going on there.
Certainly, we can look at it and say there have been lots of changes in routines. I’m sure with now having to get up and go to school, maybe changes in routines with daycare, after-school, those kinds of things.So there has been change in this child’s life. So there could be psychologically rooted issues just with anxiety or adjusting to those types of things.
Now, there also could be some physiological things going on here because mom is saying that her child had some kind of flu illness right around the time when these significant behavior changes started. And we know for some children, when they have an illness, it could be a virus that they get, it could be a bacterial illness, it could be something bacterial like strep throat, it could be a virus, like garden variety cold, flu, it could be something like Epstein-Barr that leads to Mono. We know that these kinds of illnesses in some kids can lead to sudden behavior changes, can cause neuropsychiatric effects that lead to behavior changes, and certainly we can see a very sudden kind of a night and day, overnight sort of escalation in anxiety, in ticks, in obsessive behavior, in rage types of behaviors, in nightmares, those kinds of things.
So certainly, the timing lines up that we could be looking at a physiological root cause of these things or it could be both. It could be the child’s physiological system got disrupted and is having some neuropsychiatric, some brain-based effects from the illness combined with all of the major changes with starting school and dealing with all of that. So it could be both of those things. That’s, in the big picture, what we need to be thinking about here.
Now we get into how we want to think about addressing this. The first thing is to look at the illness or infection-related issues. I don’t know if this parent had their child in to see their healthcare provider, I don’t know — the information that I have just says some kind of flu illness, I don’t know if the child was tested for something like strep, if it was diagnosed as anything in particular, or if it was just something that they waited to see what would happen and it seemed to go away.
It is important if you have a child who is experiencing significant behavioral changes, emotional changes, changes in their development right at the time that they’ve had an illness or shortly thereafter, it’s important to talk with your child’s healthcare provider about that. It may be valuable to get strep testing, to do labs, to look at other types of viral or bacterial illnesses that could be playing a role here. But certainly to raise it with the healthcare practitioner, especially if it is a very, very sudden change.
In my experiences, when kids go from not having issues with anxiety, with mood, with behavior regulation, and then within a period of a day or two are so different with that, it’s something that’s really important to talk about with the healthcare provider and look at what’s going on there that might be infection-related. So that’s the first thing with that, it’s to rule that out and talk with the healthcare provider about that. And I should say too that in those situations, it can be that the physical symptoms of the illness seem to have resolved, but they’re still brain-based issues going on. That can happen, where the child seems better physically, but mentally, brain-wise, they’re still having issues. And of course what we’re looking at here is this realm of what we call PANS or PANDAS, which are specific diagnoses related to acute neuropsychiatric symptoms that happen at the time of some kind of infectious illness. So you definitely want to look at that and rule that out.
We also want to look at the fact that this child is in a major adjustment period and we want to look at it through the lens of a 5 year old dealing with that and the uncomfortable feelings of anxiety or distress or just dealing with the change and having their body even adjust to maybe some changes in sleeping and wake schedules, or some changes to activities that they’re doing during the day. That could certainly be the issue that’s happening here.
We also want to rule out any other sudden traumas or things that happened. There’s nothing in this message from Rosa that says that there’s been anything else, but again, when there are very sudden changes in a child’s mood, behavior, development, sleep, appetite, any of those things, we want to look at what that might be connected to.
Sometimes sudden traumas can include things like: They were in a fender-bender, where the parent goes, “Oh, I didn’t even think about that, it wasn’t a big deal.” But for a 5 year old, that could be a bigger trauma. Or maybe somebody in the family has suddenly been hospitalized or the death of a family member, or the death of a pet. Just things that can happen that maybe as adults we don’t think of as a huge deal, but for little ones can be a trauma that can lead to these sudden changes. So those are some of the things you want to be thinking about.
I think it’s important to him about what might be going on, to say, “Gosh, this is what I’ve noticed, you’re having a hard time, you’re complaining that your stomach hurts or that your eyes are hurting, you’re saying that you can’t sleep, you’re having these nightmares, you’re not wanting to go to school. What do you think might be going on?” Some 5 year olds really have some ideas about that, might be able to share some things that they are thinking and feeling. And others will not be able to do that, and that’s okay, but you want to provide the opening and the opportunity for them to communicate about that, and we can throw some suggestions out there. We can say things like, “Sometimes, when kids’ eyes are hurting, they’re having headaches, their tummy is hurting, their eyes are twitching — sometimes it’s because they’re really scared or nervous about something. I wonder if you’re feeling scared or nervous about something.
That would be a way to approach that, or saying “Hmm, sometimes when kids don’t want to go to school, it’s because they are sad about missing out on all the things that people at home are doing, or they’re feeling nervous about leaving mom and dad, or they’re feeling scared about, maybe the other kids won’t like them.”
So what you’re doing here is you’re throwing out some possibilities for kids who aren’t able to articulate for themselves what’s happening, and that’s a lot of kids, especially at this age. You want to provide some suggestions of what might be happening, for them, they can just nod, they might be able to say yes, you can say “Does that sound like something that’s happening for you? Give me a thumbs up if it is, or you can tell me thumbs down if it’s not.” For kids who really are hesitant to verbally communicate about this. You are throwing some ideas out there to see if you can get to the root from an emotional standpoint and a thinking standpoint, what’s happening for them.
You want to communicate about that, and you want to be clear that “I’m going to help you with this. These are things that happen for kids, lots of kids feel really nervous about going to school for the first time” or “Lots of kids have problems with other kids on the playground/make a mistake in school” or whatever it is that you think is going on. You can say “This goes on for lots of kids, I’m going to help you with this. There are lots of things that we can do.” What’s important from the parent’s side of this is you want to be supportive, but you want to avoid making a big deal out of things. When a child is in an adjustment period, when they’re feeling anxious or unsettled, when they’re going through something like this, of course we want to be observant and we want to be supportive, but when we overdo it and make a really big deal out of it, the message that that unintentionally sends to the child is “Oh my goodness, this is a big deal, this is really a problem, we need to do something about this right away, this isn’t normal” and that’s not the message that we want to send.
We want to send the message that “We can get through this. This is tough, I know it’s tough.” Acknowledge the feelings. “Oh, I know it’s so hard to have to leave me and your younger brother and your dog and go to school, that’s really hard and I know that you can do it. I know that you’re going to get used to it”. So we’re combining acknowledging the feelings and empathizing with how tough it is and how the child is feeling and also expressing confidence that he is going to be able to handle it, that it will get better, that he’s going to be able to do it, and that’s super-important.
So we want to be supportive but not over the top and certainly not barraging the child with questions about “Well, how are you feeling now? How was school today? How did it go?” That’s our own anxiety coming through. We want our kids to be okay, we want them to feel okay, we don’t want them to have any struggle or heartache or anxiety, but when we try to soothe ourselves by just unloading all these questions on them and constantly asking them if they’re doing okay, that creates more anxiety for them.
That also makes them feel like “Oh my gosh, something big is really wrong here,” which is going to fuel that anxiety. So we want to be sort of calm and low key, matter-of-fact, very supportive but not over the top and expressing that you acknowledge the feelings but also communicating the confidence that the child can handle it, whether that is getting out the door for school in the morning, “Ugh, I know that you are feeling so nervous about going to school by yourself, that’s really tough. And I know that you can do it.” Or maybe it’s something like, “Oh, it can feel hard to fall asleep at night, you think about those scary things, I get it. We’re going to do some things to help you with that and I know that you can handle it and that you can get a good night’s sleep.” So that combination of those two things.
I think it’s also important here, even with a 5 year old, to be working on some basic coping and emotional regulation types of skills. So whether that is teaching some basic breathing skills, teaching kids how to take some deep belly breaths to calm and regulate their physiology so that their brain and their mind can calm down.
So you might do a game with taking deep belly breaths and trying to blow a cotton ball across the table, or a ping pong ball. How far can we make it go? You might have the child lie down and practice taking belly breaths, put a little stuffed animal or toy on their tummy and say “Let’s make the toy ride up and down on our belly as we take deep breaths, because that helps our brain to calm down and to manage things better.” So some basic breathing tools as coping strategies, some basic mindfulness tools can be helpful. “Let’s make a picture in our mind of how we’re feeling and then let’s work on doing some deep breathing and let’s see how we can change that picture, make that balloon in our mind with that scary thought, make it float away as we breath.” Or doing some of the many apps or mindfulness stories or things that are available now, even for young kids to help to teach them some of those ways of thinking about those scary thoughts and those uncomfortable feelings that they have and being able to sit with those and know that they can handle them.
So some of those mindfulness kinds of tools, some movement things with mindfulness, some basic yoga kinds of poses can be really helpful and some kids do really well with the movement piece of that for relaxation both in their body and their brain, and there are so many resources available now online, on apps that you can do, in books that you can purchase, decks of cards that have yoga poses and mindfulness things for kids, all of those things are great, even with a 5 year old to start at a basic level with teaching some of those coping skills for how we manage ourselves when we have these uncomfortable feelings.
I think it’s also important to have plenty of opportunities for movement throughout the day, that’s going to be helpful for a 5 year old who maybe is having to sit for longer periods of time now in school, he’s not used to that, lots of opportunities for movement.
And I would also say keeping things as predictable as possible in other parts of his life. So school’s a big, new thing. So not planning a lot of other activities or things that might feel stimulating or overwhelming, just for the next several weeks, keeping things pretty low-key, pretty consistent, building opportunities for him to be able to do things that he enjoys when he’s at home, that’s going to be really helpful as well, and even co-regulatory activities, whether that’s something as basic as you sitting with him if he likes to sit in your lap and you kind of rock back and forth and maybe chat or sing a song together or just having some moments to co-regulate so he can help to match his level of emotional and physical regulation in his body to yours, that’s helpful.
Doing things together when he’s at home, having him maybe playing some games or activities together, even doing some chores and things just giving him some extra time and attention may be helpful as well.
So those are strategies along with being really intentional about making sure that he is eating enough throughout the day, that his blood sugar is not going up and down, especially with being in school. Maybe eating habits have really changed, maybe he’s not eating his lunch or maybe he needs to have a bigger breakfast, kind of sorting that out and seeing from a food standpoint, what you can do about that, making sure that he’s eating a good, hearty, healthy snack at the end of the school day so that his blood sugar stays stable, so looking at some of those kinds of things, and of course with the sleep, seeing you can support the sleep. Rosa says that he is having difficulty with nightmares, and that again, can be anxiety-related.
This assumes, of course, that you’re ruling out any of the infectious or physiological issues that might be happening. But even if that’s going on, that takes some time to address, whether it’s through antibiotics or other medications or supports for the physiological stuff, so you want to have some sleep tools available, they are again, good sleep hygiene, having good, consistent sleep routines, having ways that he can support himself during those times, especially if he wakes up scared, and a plan for how you’re going to support that. So those things are important.
The last piece of this is making sure that you are talking with the teacher and the school about these concerns, meeting with them, sending an email or having a zoom meeting or going in and talking to the teacher and saying: “Here are the changes that I’ve seen in my son since starting school, here are my concerns” and ask about what they’re seeing in the classroom. That might be helpful for you to know too: Is your child totally fine? Once he gets to school and gets going, is he good or is the teacher noticing that he is quite anxious or dysregulated or struggling. That’s very important information, and working with the teacher about the kinds of supports they can offer.
If he is a kid who is going to benefit from more movement, how can we work that in? If he’s not eating his lunch because he is overwhelmed and scared in the cafeteria, what support can they offer for that?
Is there a guidance counselor or somebody at the school who can check in with him to see how he’s doing and provide that check in support on a regular basis.
Teachers and schools are very responsive to these things, especially with a young child who is starting school for the first time, so don’t be afraid to share your concerns and your observations, and to work together with the school on a plan to support your child and to make sure: Is there something that’s happened? Did he get into an altercation with another kid? Or was there a situation that happened with the teacher that made him uncomfortable?
These are things that he might not even recognize or be able to communicate, but that the adults in that environment might be able to share more information with you so that you can then support him. So definitely talk with them about that.
So that’s a variety of things that you can do to support your child in this situation, and also some big picture issues to be thinking about. I hope that this is helpful for Rosa and for any of you who are trying to help your child with very sudden emotional or behavioral changes.
Remember, if you have a question you would like to hear answered on a future show, please go ahead and email it to email@example.com. Thank you, as always, for being here and for listening and I will catch you back here next time.