Don’t be Afraid of the Big Bad Blizzard

You might be worried about losing power. You might be looking forward to gathering around the fireplace. You might be scrambling to reschedule your afternoon meeting or that early Valentine’s dinner date with your spouse. There’s a lot to think about as this blizzard approaches, but don’t forget that your anxious child maybe struggling with irrational and agonizing fears. Follow these tips to help your anxious child through the snowy weekend.

If your anxious child has never experienced a blizzard, be sure to tell her what to expect. Address rational fears like a power outage, but emphasize positives like family time, adventure, and beautiful snow.

Indicate that you and your family will be safe by acting calm and prepared, even if you’re worried about the storm.

Involve your child in your storm preparations. Explain how each action you’re taking will help keep your family safe.

If you lose power, make it an adventure. Play board games in the dark, tell stories by candlelight, or sing songs together.

Shelter your child from sensationalist media.

Avoid using language that indicates or implies that this storm is the worst storm ever or the end of the world or unlike anything we’ve ever seen. Help your anxious child understand that major storms are common and manageable.

If your child was traumatized by Super-Storm Sandy, explicitly explain that this storm will be different.

Ask your child to voice all his fears, and help your child find reasons to dismiss each fear. Be respectful, empathetic, and calm.

Watch for signs of magical thinking. Children who suffer from Obsessive-compulsive Disorder are particularly vulnerable to irrational self-blame regarding catastrophe.

Put safety first. Make sure you have a plan to keep your family warm even if you lose power, and be careful to avoid fires and carbon monoxide poisoning. Follow these blizzard safety rules for kids and parents.

Stay warm this weekend!

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Asthma and Anxiety

We used to go to the emergency room in the middle of the night. I’d wake up to hear the shower running, and I’d know it meant my baby brother couldn’t breathe. At first, when he was a baby, we didn’t know why. It only really happened when he was sick, so my mom sort of figured he just reacted badly to colds. He’d wake up wheezing, and my mom would hold him in a steamy shower. When that didn’t work, we’d jump into the car and drive half an hour to the nearest ER. My mom and dad would keep all the windows open to let in the cold air. At the hospital, the triage nurse would rush my tiny baby brother into a tent filled with steam. Then they’d give him some medicine, and then he’d breathe normally again. Bizarrely, no one at the hospital ever said asthma. They said he was “croupy.” My mom finally read an article about childhood asthma in the paper and asked her pediatrician if that was what caused her son’s breathing troubles. The pediatrician was so shocked he began to laugh. “They didn’t tell you that at the hospital?” he asked. He couldn’t believe the ER doctors would fail to offer that kind of basic information. “Of course it’s asthma! I thought you knew!” (This was, by the way, the kind of pediatrician who happily woke up at midnight to meet us at the ER and tell us all jokes until we calmed down. He took calls at home at any hour and could make my brother laugh while getting a shot, so I’m not surprised he went on to become an expert in child happiness.)

Asthma is scary. It’s genuinely dangerous, and it triggers primal fear in its victims. There are few things as scary as not being able to breathe. My brother, an active, adventurous, and otherwise healthy kid, spent his childhood cursed with severe asthma that necessitated years of ER trips and a variety of unpleasant drugs. I recently asked him if the attacks terrified him, and his answer surprised me: “The fear I felt from having asthma attacks as a young kid was totally manageable, because mom would take care of me and we had all the equipment and stuff.” Wow, check out mister No-Anxiety-Disorder.

However, even my brother has experienced some mild asthma-related anxiety. “I think I subconsciously associate [anxiety] with asthma, probably because asthma attacks are the most consistently stressful/traumatic thing I’ve gone through in my life,” he told me.

For a child with an anxiety disorder, asthma can be absolutely terrifying. Feeling unable to breathe can easily trigger a panic attack, and the panic may make breathing feel even harder. Anxiety medications can speed your heart and cause shaking, so an anxious child who is having an asthma attack is very likely to experience some degree of panic even after using her inhaler, especially if panicked breathlessness prevents her from realizing that the medicine is working. A student shared her experience:

Twice I has asthma attacks while I was hiking with other families. Both times, I ended up having a panic attack. It felt like my inhaler wasn’t working, so I got more panicked. It was like a snowball.

An anxious child who suffers from asthma may also sometimes mistake a panic attack for an asthma attack. My student also described a panic attack that was caused by a stressful life event:

I felt a lot like I couldn’t breathe, and I was really really scared. My inhaler didn’t help at all, and I thought I was going to die. My dad told me to use my relaxation techniques. Once I stopped being scared, my breathing felt totally normal. This makes me think that the feeling of breathlessness was “in my head,” not in my throat.

If your anxious child or student has asthma, talk to him before his next attack. Explain that, unlike asthma, anxiety doesn’t really affect breathing ability, and help him practice distinguishing between panic and asthma. Teach him to take complete, slow breaths. Finally, consider using a peak flow meter to help your child determine whether his anxiety is skewing his perception of his breathing ability.

Of course, it’s extremely important for children and adults to follow their doctors’ orders exactly, especially regarding serious illnesses like asthma. Ask your doctor, but I assume you should instruct your child to use his inhaler or other asthma medication even if he’s not sure whether his breathlessness is caused by asthma or anxiety. Cognitive-Behavioral Therapy and relaxation techniques can be used after medication is administered.

As always, the best thing you can do for your anxious student or child is remain calm. It’s very upsetting to watch someone you care about struggle to breathe, especially when that someone is a young child. However, children look to their caregivers for clues about danger, so it’s important to behave as though you are in control of the situation.

Asthma is a serious and life-threatening disease. Children with asthma need to be in the care of a qualified pediatrician or specialist.

My brother’s asthma has gotten much better, and he’s now able to backpack through forests and float wild rivers and play with his band in front of huge crowds. He’s the coolest person I’ve ever met, and tomorrow is his 21st birthday!20130204-134428.jpg

Helping Anxious Students Cope with the Sandy Hook Shooting

Parents and educators are united today in our heartbreak and horror regarding this morning’s shooting at Sandy Hook Elementary School in Newtown, Connecticut.  In place of my planned post, I’d like to provide a few pieces of advice for parents and teachers of anxious students.  In the days following this tragedy, students outside of Newtown will likely maintain their regular school schedule.  However, students across the country, especially those with preexisting anxiety disorders, may have difficulty coping with the confusing and frightening news.  Here are some ways to help your children or students through this crisis:

Turn off the TV!
Adults know the TV news often relies on sensationalism to attract and retain viewers, but this concept can be very difficult for children to understand. Anxious children in particular may be harmed by television news on even a “slow news day.” During a crisis, kids should be nowhere near the news. Keep the TV off in the classroom and at home. If you feel that you need regular updates about a crisis, watch in another room or read Internet coverage to yourself.

Parenting expert Dr. Michele Borba tweeted this earlier today:

MB tweet

Keep Calm
In any crisis, the best thing you can do is show your students or children that you are calm. Children rely on adults for consistency and stability. It’s certainly all right to show your anxious children or students that adults have emotions (this is a crucial element in teaching empathy), but keep your emotions controlled. In order to stay calm, make sure to take care of yourself by finding support with another adult.

Avoid School Refusal by Maintaining Routines
In an earlier post about Hurricane Sandy, I addressed the importance of maintaining routines after a crisis. After hearing about a school shooting, anxious children may refuse to return to their schools. Because we’re all frightened by shootings, it can be tempting to keep students home with you. However, doing so is likely to reinforce your child’s belief that school is dangerous. If your child does begin to exhibit symptoms of school refusal, contact your pediatrician or mental health professional.

Address Guilt and Prevent Magical Thinking
We all have the tendency to blame ourselves when things go wrong. Guilt after a tragedy is normal and not necessarily harmful. Today, older children may feel guilty about laughing, gossiping, or becoming upset about trivial issues while other children have suffered so terribly. Adults certainly experience similar emotions. If your child expresses this type of guilt, reassure her that her feelings are normal, and remind her that she should enjoy her day. Tragedies remind us to enjoy and give thanks for our myriad blessings. They also give us the opportunity to practice perspective when dealing with our daily conflicts. If appropriate, help your child use her guilt as a tool. However, if your child seems preoccupied by guilt, especially about events out of her control, consult a mental health professional.

While guilt is a normal and potentially useful response to tragedy, magical thinking is nearly always harmful. Magical thinking often takes the form of a fallacious belief that one’s thoughts have affected reality. It is common in young children and individuals with some mental illnesses. In eighth grade, my Obsessive-compulsive Disorder caused me to worry that my thoughts had caused the attacks on 9/11. Intellectually, I knew this fear was irrational and narcissistic, but I could not overcome it. Magical thinking should be addressed directly and explicitly. Make sure your child knows that it’s a common symptom of anxiety. Always (lovingly) insist that the fears caused by magical thinking are irrational and impossible.

Offer Extra Support
Immediately after a crisis, some anxious children will regress in order to reduce anxiety. I personally recommend allowing periods of regression (thumb-sucking, sleeping in parents’ bed, etc.) as long as they are brief and seem to be helping your child move past the crisis. If your student or child lingers in a period of regression, lovingly encourage him to incrementally regain his independence. Intense anxiety may prevent a child from overcoming his urge to regress. In this case, consult a mental health professional.

If your child has been directly affected by the shooting at Sandy Hook Elementary School, please contact your pediatrician or a mental health professional regarding the risk of PTSD. If you have already spoken to a professional, you are welcome to contact me for free advice, information, and support regarding anxiety in children. Teachers in Newtown, Connecticut are also welcome to contact me for free tips regarding addressing child anxiety in the classroom.

Here is a list of helpful online resources for helping your students and children cope with this tragedy:

Caring for Kids After a School Shooting (video), Child Mind Institute

Helping Children After a Disaster, American Academy of Child and Adolescent Psychiatry (AACAP)

Talking with Kids about the News, PBS

For New York City parents: Fearless Learning’s school refusal program

Our hearts are with the students, parents, faculty, and staff of Sandy Hook Elementary School, and the community of Newtown, CT.

When a Cold is a Catastrophe

I’m sick.

Over the weekend, I got a fairly nasty cold, and I’m still recovering. To an adult who has control of her anxiety, a cold is an annoyance. For anxious children, however, even minor illnesses can be terrifying.

Children prone to catastrophic thinking are often extremely creative in their fears, especially if they don’t have a good understanding of relevant anatomy.  Sinus pressure is likely to make an anxious young child worry that his head is going to explode, but it may also make him worry that worms have crawled into his nose in the night.  As long as you’re respectful and compassionate, I think it’s okay to sometimes poke gentle fun at your child’s most adorable fears.

To keep things playful instead of traumatizing, acknowledge the child’s fear, explain that the fear itself is a symptom (of anxiety or an anxiety disorder), and make sure the child knows you are on her side and will protect her.  Most importantly, keep even gentle teasing one-on-one; a beloved teacher or parent joking about nose-worms could be comforting and sweet, but additional participants may intentionally or unintentionally humiliate or bully the child.  Also, be careful about joking about plausible consequences of symptoms, such as an ear infection leading to a ruptured eardrum.  Most anxious kids won’t find that sort of “joke” funny.

Below is a list of common cold symptoms and the fears they may inspire in anxious children and adolescents.  Some of the fears are silly, but it’s important to realize that intelligence does not necessarily protect children from anxiety.  A child or teen who knows her fears are unfounded may still be plagued by them.  If your child or student complains of one of the following fears, explicitly disprove his unfounded fears (“sinus pressure will NEVER make your head explode, no matter what) and deemphasize any real risks that don’t require action.

Being able to predict some of your child or student’s fears may help you to better remove those fears.  Just make sure you never inadvertently suggest a new fear: “Ooooh, ear pressure? Don’t worry, I’m sure your eardrums won’t explode!”

Symptom Possible Fears
Cough Suffocation, lung cancer, internal bleeding due to violent cough
Headache Tumor, concussion, meningitis
Pressure, ears Eardrum rupturing, deafness
Pressure, eyes Eyes “popping out”/exploding, blindness
Pressure, sinuses Head exploding, tumors, burst blood vessels
Sore throat Losing the ability to speak
“Stuffy nose” Suffocation, anosmia
Swollen glands Hodgkin’s lymphoma

Parents, note that many over the counter and prescription cold medicines can cause anxiety or panic in individuals with anxiety disorders.  Talk to your pediatrician for more information.  Curious about alternative cold remedies? Read this informative article from Mayo Clinic.

Antibiotic Safety Information
Colds are caused by viruses, NOT bacteria.  Therefore, antibiotics will NOT help prevent, mitigate, or cure a cold.  The misuse of antibiotics helps create resistance strains of bacteria (such as MRSA), and taking antibiotics when you don’t need them can sometimes hurt you. Your body is full of “good” bacteria that helps you digest foods and fight off infection. Children and adults should only take antibiotics when they are prescribed by a real medical doctor.  Always take antibiotics exactly as prescribed.

Consistency after a Crisis

The past two weeks have been a challenge. On October 28th, a mandatory evacuation forced me out of my apartment and onto a generous friend’s couch. I packed for one or two nights: extra socks, a flashlight, a toothbrush. I expected to spend that Sunday and Monday finishing some research and maybe taking advantage of my friend’s cable, but unfortunately, the power went out on the second night. What we heard on the emergency radio I’d packed didn’t prepare us for the strange drive down to my building the following morning, or the heartbreaking images and stories that broke in the following days. Nor was I prepared, Tuesday morning, to see the extensive damage Sandy inflicted on my building. My two night sleepover turned into an indefinite and unsettling vacation spent on couches and pull-out beds.

As soon as they heard what happened, my friends and family began offering supplies, assistance, and places to stay. I’m amazed and humbled by the generosity I’ve been shown (even my credit card company called to ask if they could help!), and I’m grateful to have lost so little to the storm. My building is still uninhabitable, but significant progress has been made, and I hope to be allowed home in about a week.

Since nutrition, sleep hygiene, and exercise all have effects on mood and stress, a healthy routine is particularly important for people with mental illnesses. Unfortunately, it’s hard to keep things consistent when you don’t have a permanent place to stay.  To support my own mental wellness, I’m sleeping regular hours, eating vegetables and whole grains, and staying active. I know that my body needs these things in order to function well. Unfortunately, children and even adolescents don’t always realize the importance of routine. Further, children and teens have yet to undergo certain neurological developments that aid in self control. When a crisis or even a real vacation interrupts your anxious child’s routine, look for ways to maintain consistency. Give each day a structure. Get everyone up in the morning even if school is closed, and maintain family dinners even when staying with friends or in a hotel.  Routines are inherently comforting, and they help your anxious child see that the world hasn’t ended.

Magical Thinking in a Hurricane

When I was thirteen, I was struggling with severe Generalized Anxiety Disorder and Obsessive-Compulsive Disorder, neither of which had yet been diagnosed. (I was diagnosed with Separation Anxiety Disorder in first grade, and at thirteen, I still worried excessively about my mom.) I hated school and already felt burned out by the second Tuesday of the year so, as I stepped out of my dad’s car in the morning, I wished that school would be cancelled for the day.

Wishing, even in my own head, was strictly prohibited by the torturous rules enforced by my OCD. But I was exhausted by months of acute anxiety—summer had always been difficult for me and puberty seemed to be exacerbating all my emotional struggles—and the thought slipped through. I did my simplest undoing ritual, which involved whispering “shut up shut up shut up,” and then I dragged myself to class…where a punky girl in an army surplus jacket informed me that the Pentagon had been attacked and New York City was, she thought, being bombed.

I knew I didn’t cause 9/11. I knew the attacks had to have happened hours before I even made that awful wish. I knew that it was disrespectful and narcissistic and absurd to feel responsible for something so horrific. But, in the panic of that day and the consistent anxiety of the following year, I returned again and again to that stupid careless wish.

Magical thinking, the fallacious association between unrelated events, is a significant cognitive symptom of OCD. Humans have evolved to seek out patterns: people who eat this red berry become very ill. Unfortunately, the patterns imaged by sufferers of OCD are typically very frightening. And, although magical thinking is a fallacy, intelligence doesn’t seem to offer much protection. (Imagine any of the many smart people who indulge a few superstitions.)

For healthy adults, a bit of magical thinking can be harmless or even fun. Magical thinking is ubiquitous in young children and rarely causes significant distress. However, anxious children and mentally ill individuals of all ages should avoid magical thinking. If you have an anxious child, be careful when encouraging even benign superstitions. (The weighted risks and benefits of teaching superstition is something that requires its own post.)

Crises like this hurricane can be scary for kids. If your children or students are prone to anxiety, reassure them regularly, shield them from sensationalist news, and show them that your family or school is prepared. Model calmness and optimism. And, if they recently wished for a few days off from school, make sure they know that this hurricane isn’t their fault.