Helping Kids in Crisis

Many times when a family comes to the pediatrician’s office in crisis, they are distraught and overwhelmed. The crises range significantly in severity.  Serious challenges such as death or significant illness in the family, job loss, escalating problem behavior or mental health concerns are not easy to navigate. At other times, just getting caught up in the business of day-to-day life can leave us feeling unbalanced and overwhelmed.  No matter the cause, helping kids in crisis also means addressing their overall well-being.

An integral component of addressing any type of crisis is to look at the basic needs of a child. Children have physical needs such as healthy (and age-appropriate) foods, sleep, physical movement, shelter and human touch. They also have a need for security. At least initially, children are completely dependent upon the adults in their life to help meet these basic needs. Sometimes, in the business of day-to-day life, we forget about very basic needs; and sometimes, but certainly not always, crises can be quelled by getting back to basics.

Let’s take a closer look at a few of these needs.

Sleep

Sleep requirements for children can be surprising. With our activity-filled lives, it can be difficult to attain these requirements without really trying to make sleep a priority.

• Infants 4 months to 12 months old: 12 to 16 hours (including naps)
• Children 1 to 2 years old: 11 to 14 hours (including naps)
• Children 3 to 5 years old: 10 to 13 hours (including naps)
• Children 6 to 12 years old: 9 to 12 hours
• Teens 13 to 18 years old: 8 to 10 hours

***from the American Academy of Sleep Medicine, endorsed by the American Academy of Pediatrics***

If neglected or unmet, lack of sleep can lead to problems concentrating, difficult behaviors, headaches, obesity, hypertension and other problems. This can even lead to misdiagnoses and treatment that could actually be treated with adequate sleep.

How Do We Get Adequate Sleep?

• Make sleep a priority. Determine what time you child has to wake up in the morning and count backward to determine the appropriate bedtime. For example, if your school age child needs to get up at 6:30 to make it to school on time, she should be asleep by 9:00 at the very latest, and closer to 7:30 to ensure adequate sleep. Teens can be particularly challenging because their school times are earlier despite their biologic shift to stay up later and sleep later.  Regardless, teens require 8-10 hours of sleep, and it is important for sleep to be a priority, especially when life feels hard.
• A bedtime routine.  Be active during the day, but not too close to bedtime, to ensure that your child’s body is tired but has time to relax before sleep.  Ideally no screens at least 2 hours before bedtime, and no screens in the bedroom.
• Relaxing routine—calm activity, snack, perhaps a bath or shower, pajamas, bedtime story read by a parent or independent reading, a goodnight hug, and lights out. No checking social media or having access to phone in the bedroom, as youth are likely to become anxious or worry about missing out on social interactions with peers (or not missing out at the expense of sleep.) If a routine has been developed, once the routine has started for the night, his body and mind will naturally calm and relax and prepare for sleep.

If your child still has a difficult time getting to sleep, talk with your pediatrician about a short course of melatonin to help establish a routine. There may be other interventions your doctor can recommend.

Healthy Nutrition

What constitutes a healthy diet these days can be confusing. It seems to be a constantly moving target. Low fat? Low carbohydrate? High protein? Low sugar? The middle of the road is our best bet. Our bodies need all the building blocks of a healthy diet—protein, carbohydrate and fat in moderate quantities. Any diet that eliminates or severely limits a food group or macronutrient puts a child’s growing body at risk for nutritional deficiency. Things that we especially need to be tuned into with children are adequate calcium and fiber. Children need all this for rapid growth and function of bone, muscle, and brain development.

It is not only what our children eat, it is how.  Ellyn Satter, MS, RD, LCSW, BCD is an internationally recognized family therapist and feeding and eating specialist.  She notes it is actually the “how” that contributes to disordered eating (both excess and restriction) rather than the “what”. Certainly, this is a complicated issue in itself, but in times of crisis, let’s look at some basic strategies:

Simple Nutrition Tips:

• Children should have 3 regular and predictable meals plus 1-2 snacks (perhaps 3 snacks if young.) Children find security in knowing that they will be fed.
• The parent chooses the “what, when and where” of feeding and the child decides “how much and if” they eat what the parent provides. Because the child knows there will up an upcoming snack or meal, she knows that even if this current meal or snack isn’t their “favorite,” she will soon be provided another opportunity to eat with different selections.
• Each meal should have at least one healthy, known option that the child likes and can fill up on. This predictability provides him with the security to be able to tune into his bodily cues of hunger and satiety.

Meals should have components of all the macronutrients. Ideally, there will be a protein, a starch, a vegetable, a fruit and some kind of calcium containing beverage. This can be challenging, but snacks can be used to fill in gaps. Also, nutrition should be looked at on a weekly basis rather than each meal or even daily basis.

Children have an inherent ability to eat what they need to maintain appropriate growth, whether they are a child who tends to grow along a high or low growth percentile on the growth chart. When there is deviation from usual growth of either up or down 2 major percentiles lines, further evaluation is appropriate.

Reminder: Multivitamins should not be relied upon to provide nutrition.  Vitamins are best thought of as an “insurance policy” if a child is struggling to eat variety.

For more on your child’s nutrition, check here and here.

Activity

The American Academy of Pediatrics recommends physical activity for children 6 years and older to be at least 60 minutes of moderate to vigorous activity per day. For younger children, the best activity is unstructured play. Running around the yard, riding bike, and playing at the park are excellent activities. Certainly organized and competitive sports are viable options, but adult-led, structured activity is not imperative and comes with its own limitations.

Simple Strategies for Daily Activity:

• Walking around the neighborhood – after school or dinner are great times to chat and move with a brisk walk.
• Break up activity – a 15 minute walk to and from school, play at recess, and playing outside add up over the day.
• Play together – the opportunity to engage with our children while being active addresses multiple levels of needs simultaneously.  Jump rope, play in the snow, build a fort.

Movement opportunities are everywhere so find a pattern that works even in crisis mode.  It will be a source of calm and integration.

Relationship/Security

A child’s sense of security will largely come from the relationship with their parents or other primary caretaker. Resilience in children is linked to having at least one adult in their life to count on.  Be there, put down the phone, look them in the eye, talk, hug, eat together, have a bedtime routine, and be active together. Let them know you are in this together. No matter what.

Certainly, addressing basic needs will not eliminate all crises, but addressing our foundational needs becomes very important in difficult times. If you still need assistance after meeting basic needs, ask your pediatrician or family doctor to help.  They can help identify resources and support—medical, financial, food assistance, social work, or mental health.

When life throws us surprises, remember to address the foundation.  If our foundation is in tact, we are more equipped to handle stress, change, and trauma.

Additional resources:

National Institute of Mental Health: Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do

Boys Town: A Guide to Parenting Through Crisis