DEAR MAYO CLINIC: I have two children, ages 12 and 15. They are both good students, participate in athletics and enjoy spending time with friends. While both kids are back to in-person school after the COVID-19 pandemic, my oldest child seems to have less interest in activities. How do I know if I need to get him help?

ANSWER: Life is full of unpredictable changes. Some can be exciting and motivating, while others can lead to increased stress, poor health and anxious feelings.

Stress is an automatic physical, mental and emotional response to challenging events. It's a normal part of everyone's life, including the lives of children. They have faced many new, potentially stressful, situations during the COVID-19 pandemic. For some, there have been changes in school and activity routines, family changes with moves or parent's career disruptions, and concerns over their health or even the loss of a loved one.

Children, especially teenagers, aren't likely to ask their parents to help them manage their stress. Sometimes, they don't even recognize that they are feeling stressed.

As a caregiver, you might notice something is off before they do. Helping your children manage their stress can lead to more balanced and healthier lives.

Children aren't mini-adults, and they may express stress in different ways than you might expect. Here are a few signs that your children may be stressed out or could use some extra support:

• Emotional outbursts or increased irritability
  Stress leads to stronger feelings of anger and irritability. Your children may have emotional outbursts that are inconsistent with their previous behavior or the current situation.
• Trouble sleeping
  Worries and fears seem to come out at bedtime. Children who are stressed may have trouble falling or staying asleep, or start having nightmares.
• Withdrawing from others
  Children who are stressed may want to spend more time alone and not interact with friends or family.
• Struggles with school
  Significant changes in your children's school performance can be a sign of stress. Stress makes it harder for children to focus during the school day or when doing homework. Additionally, trouble with friends and classmates can cause stress.
• Frequent headaches or stomachaches
  When children are stressed or anxious, their bodies release the hormone cortisol into the blood. This can trigger abdominal cramps and headaches.
• Increased defiance
  Children under stress may feel angry or overwhelmed. They are seeking ways to get out of the situation that is causing them to feel uncomfortable. This can lead to defiant and stubborn behaviors.

Remember that children's signs of stress can vary based on age, personality and coping skills. The key is to watch for drastic or sudden changes from your children's previous behaviors.

While all stress cannot be eliminated, you can prevent excess stress from affecting your children's lives by:

• Establishing and keeping routines.
  Routines are so important. If your family wasn't routine-orientated before, now is a good time to implement daily routines to provide structure and support. You could start a new bedtime habit or strive to have supper together a few nights a week to provide consistency at home for your children.
• Encouraging a return to previous activities.
  During the pandemic, many children's activities were disrupted. Depending on your situation and local health recommendations, encourage your children to try a new or previously favorite activity or sport again.
• Finding humor in daily life.
  A good laugh doesn't just lighten a mood, it also activates and relieves the body's stress response. Find ways to laugh with your kids by watching comedies, reading comics or jokes, playing games, and helping each other find the humor in daily life.
• Playing as a family.
  Get physical with your kids and find ways to play as a family. Put on music and dance in the kitchen, go for a bike ride after dinner, or play games as a family. These activities can reduce how stress affects you and your children.
• Encouraging healthy diet and sleep habits.
  Tired or hungry kids are rarely happy. Make sure that your children's diet includes a mix of fruits and vegetables, whole grains, and lean proteins to keep them full and focused. A lack of sleep can trigger overreaction or emotional outbursts, so follow a bedtime routine to make sure your children get enough sleep each night.
• Practicing deep breathing together.
  Deep breathing is a great way to reduce stress levels. Help your children practice by taking deep breaths in for a count of five seconds, hold for two seconds and release to a count of five seconds. If your children feel anxious, try this simple exercise to unstick the mind from the worry setting.
• Enlisting help of children's teachers.
  Take the opportunity to check in with their teachers. Ask how your children are doing, if they are making friends, or if the teacher is noticing any problems between your children and other students. Often, children won't tell their parents about issues they have at school, as they may feel embarrassed. Sometimes parents are surprised to learn their children are being bullied at school. Teachers and school staff can be your eyes and ears when your children are not with you.
• Managing your mental health.
  It's hard to be an effective parent if you struggle with your mental health. Take steps to keep burnout and stress at bay in your life.

It can be challenging when your child is under stress. If you find that your child's behavior persists or is worsening, consult with your child's primary health care provider for additional resources. — Fiona Swanson, Social Services, Mayo Clinic Health System in Mankato, Minnesota

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Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

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