August 18, 2022
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. In today’s podcast episode we continue the conversation with CHC clinical services experts, Dr. Glen Elliott and Dr. Natalie Pon on the topic of young children and anxiety. Today’s episode is an all-new continuation with that first one. We know that anxiety in young children is real from separation anxiety to strangers to new experiences. And in today’s episode, Dr. Elliott and Dr. Pon talk more about socialization, starting preschool, listening to your child and utilizing play to help you understand your child’s perspective and emotions. So welcome Dr. Elliott and Dr. Pon and thank you for continuing the conversation with us today.
Dr. Glen Elliott:
My name is Glen Elliott. I am a child and adolescent psychiatrist, and I’ve worked with kids for roughly 50 years, and anxiety is among the most common reasons that parents come to see child psychiatrists. We’re focusing particularly on young kids, so it’s not quite so common to see psychiatry, but we certainly see them, and unfortunately anxiety is present throughout one’s life. So it’s a very important topic, and I’m glad that we’re talking about how parents can get help.
Cindy Lopez:
Thank you, Dr. Elliott. Dr. Pon, would you like to say a few words to our listeners as we get started?
Dr. Natalie Pon:
My name is Natalie Pon. I am a child and adolescent psychiatrist as well, and I actually really specialize in the treatment of young children in providing them and their parents support, and I think that this is a great topic because intervening in early childhood can really make a difference.
Cindy Lopez:
Yeah that early intervention piece is so important. And there probably parents out there who are seeing some behaviors in their young child, and they’re thinking that something’s going on, but they’re not sure what, like some anxious behavior especially around school and socialization. So do you have any comments about that?
Dr. Glen Elliott:
Well, I think it’s reasonable to start with one’s pediatrician and hope that the pediatrician has some experience and training in this. Some do and some don’t, and if the parent doesn’t find the response helpful, frankly they should start lookingfor some other source. If the child is in preschool, preschools are very used to this and may have some references and some recommendations, or if they’re in kindergarten, I think all kindergarten teachers with any experience certainly are going to be good resources as well. This is one where friends and neighbors can be helpful because anxiety is so prevalent, the likelihood that there’s somebody in their friend circle who has a child with anxiety is high.
Dr. Natalie Pon:
Yeah. And I think, you know, following your parental instinct, if there is something that you are concerned about three or six months for a young child is a lengthy amount of time for there to be some struggles, and so I think seeking out an opinion or advice earlier on is better because really one of the best things that can happen is that you hear that actually this is really typical, and I think if you did a few of these extra things, things would be great, but I have a lot of parents that come to me that are like, oh, I really wish I had come 9 or 12 or 18 months ago, and so I think that if you need to go, if you’re concerned, go and check in with somebody and see if there’s anything that could be helpful for you and your child.
Dr. Glen Elliott: There also are some organizations, CHC is actually one that will give sort of a quick assessment and recommendations about what kind of person their family might want to see. Parents Helping Parents, PHP has a very good website, and these are parents with children with all sorts of different problems. Depending on what kind of anxiety we’re dealing with it may take some hunting before you find the right person, and it’s fine if you feel like the first person doesn’t get where you’re talking about to say, “I’m going to look somewhere else.”
Cindy Lopez:
Yeah.
And Dr. Elliott, thank you for bringing that up. We do have at CHC free parent consultations. So, you can call us or find out more on our website, chconline.org, and a free parent consultation just means that you have 30 minutes to talk with a clinician who can help you. You can talk about what’s going on. They can give you advice and maybe guidance regarding next steps.
So as we think about anxious behaviors, let’s talk about school for a few minutes. So some children are starting school without the benefit of much social interaction, especially over the past year and a half as we’ve been dealing with COVID. How can parents really support their kids as they’re just starting school without the practice that they might have had?
Dr. Glen Elliott:
There’s no single answer. It’s more than just socialization. There’s also the masking issue which I’ve been amazed at, how quickly kids adapted going around wearing masks for the whole school day, but if they have a same age peer that they’ve had any chance to sort of interact with, encouraging some play dates beforehand may be helpful. If that’s not possible, then making sure that the parents spend some extra time playing school basically, what’s school gonna be like can be really helpful.
Dr. Natalie Pon:
I totally agree. I think that preparing your child via play with what school is like and have a little stuffy. It could be a little bunny or a dog could go to school and kind of tell them about the general expectations of school, that at school we play with different things. We play with different people. We get to do art. We get to play on a new playground and all of the exciting things that happen at school as well as some of the expectations at school. The teacher gives us directions, and we follow the rules, and some of the rules which parents will know are that we keep our hands and feet to ourselves and maybe if the parent knows what kind of schedule the day will be and that may be from the morning, you know, we get ready in the morning, we have breakfast, we drive in the car to school. Maybe practicing getting in and out of the car and giving mommy a kiss and saying goodbye.” You know, you play, you eat lunch or maybe you don’t eat lunch and then you come home and mommy or daddy or whoever picks you up and really giving them kind of a template for their day in addition to people that they will see there, that really gets to the socialization piece of at school you will make new friends and sing songs together and do this or that and if they know any of the friends going to their school and then their teacher’s name, and if there’s going to be other teachers or rooms that they go to.
Dr. Glen Elliott:
You can even augment it with some real-time activity, so driving them to the school so they can see the building at least, here’s where we’re going to let you off. And if the parents can find out what the routine is at that particular school, that can be really helpful so the child knows what to expect.
Cindy Lopez:
Having been an early childhood educator, it’s been a few years but like, some things are different, so like circle time, right, everybody’s kind of expected to sit and listen and that’s different than being at home or with your peers. So there’s a different kind of structure around school as well and the kinds of things that you do. They get to play and do all that kind of stuff, but they’re also going to start learning how to learn so to speak.
Dr. Glen Elliott:
But again, you can actually practice that at home.
Dr. Natalie Pon:
Exactly, that’s what I was thinking as well Dr. Elliott. So if you’re concerned that your child is struggling with something like circle time, then I would encourage doing circle time at home with your family and with stuffed animals or toys or even just within the toys and having you playing a giraffe and maybe they play a dog or an elephant and really making that like the circle time at school so that they can get used to it in a very calm, safe, developmentally appropriate manner.
Dr. Glen Elliott:
I just wanted to add also do keep in mind that kids this age by definition have short attention spans. So you want to break things up. You don’t want to spend hours. I mean often 5 to 10 minutes is a really appropriate kind of interval. Sometimes there are kids who can’t even handle that. So, it’s another area where parents get quickly taught by their child kind of what they can tolerate and what they can’t.
Obviously, the goal is to expand their ability to tolerate things like sitting in circle time, but you may need to start with just a few minutes once or twice a day.
Dr. Natalie Pon:
Totally. I agree.
Cindy Lopez:
Yeah.
And I think that preschool teachers, kindergarten teachers, experienced teachers, definitely know that starting the year looks different than ending the year, right? Your child is going to learn also, I can’t really talk all the time. You know, I’m going to have to wait for my turn. I’m going to have to learn how to do things in a group, and that is one of the big learnings of school I think.
Dr. Glen Elliott:
And that’s true anyway, but I think the pandemic has made it much, much more difficult because it’s almost a lifetime for some of these kids. A lot of them haven’t had the chance to learn some of those skills in preschool before starting kindergarten. So I think the schools are aware of that and are hopefully accommodating to it, but if they can do it at home and again, if you’ve got a brother or sister that can be really nice to sort of do things together and make it more than just the one person, but if you don’t stuffed toys worked great.
Cindy Lopez:
I’m wondering if you have any advice to parents whose young children have not had the experience of preschool really before going to school?
Dr. Natalie Pon:
Well, you know, if your child has not gone to preschool and is now going to enter kindergarten, I would be interested in exploring, are they eligible for a transitional or a junior kindergarten or some sort of pre-K or something else so that they could get that experience because that jump to kindergarten is tough.
Dr. Glen Elliott:
Yeah and parents may not be aware of those options. And most schools do have them, some sort of transitional kindergarten or pre-kindergarten that may be helpful. The other thing is that there are some basic skills that they begin to work on the preschool, like writing their name and some of that kind of stuff, and that can be done at home. You don’t have to wait for the teacher to do that. So, I confess I haven’t looked, it might be worth doing so, but I would think that some of the school districts are probably offering advice online about how to help get your child ready for kindergarten.
Dr. Natalie Pon:
And I think Cindy too, you’re talking a lot about the social emotional development. And I would say the things that parents can do at home is actually really working on identifying feelings and using maybe different feelings, emojis, or a feelings chart. And taking turns, which we have talked about, taking turns is really, really essential for socialization with other kids, their peers, and in the classroom, you know, really one person talks at a time, or I’m going to play with this for five minutes and then you’re going to play with this for five minutes. And that often is highly structured by the parents at the beginning. So I would say that turn-taking and working on identifying feelings and noticing our bodies in space and what feelings feel like in our bodies are very important for young children.
Mike:
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Cindy Lopez:
So what might parents be observing if their child is anxious about starting school or just school in general?
Dr. Glen Elliott:
Well, it could be fairly mild. My grandson actually when he heard he was going to kindergarten last April admitted that he was really quite worried about that. He knew he was going to be not seeing the friends that he’d had in preschool. The idea of losing the people who had become his friends in preschool and going to a different school was hard for him and sort of acknowledging that rather than there’s nothing to worry about. And encouraging the child to talk about what specifically they’re worried about and how the parents or the teachers might be able to help with that and letting the parents talk to the teachers about my child is worried about not having any friends or about knowing how to write his or her name, whatever it is that the parents think that the child is specifically concerned about, letting the teacher know in advance can be really helpful.
Dr. Natalie Pon:
Definitely. I agree with both of those. I think, you know, the other thing is really kind of hearing your child out and really thinking about this as a huge change. And, you know, this is one time that I actually really encourage parents to talk about their own kindergarten experience or their own going to preschool experience. If they have those memories, a lot of parents don’t and so I wouldn’t encourage you to make up new stories, but really picturing you’re a small child, and you’re going to this brand new place. And maybe you can tell them some things that are going to be the same as at home and different, and that’s where it gets back to like giving them a sense of structure and knowing something, cause I kind of think about it as the same way as like say you were starting at a new job. And you had not had an interview there, and you weren’t given a first day agenda and that’s really tough. You know, you have no idea what this place is going to be like. So if you know that there’s going to be 10 other kids in the class, tell them. And you know, maybe you’ve met the teacher. Your teacher’s name is going to be miss so-and-so or Mr. so-and-so, that really helps kids to have developmentally appropriate information.
Dr. Glen Elliott:
Right. Yeah. The more information you can get from the school about what the hours are going to be, what the teacher’s name is, how many kids are going to be in the class, the better. Most kids really thrive on concrete information.
Cindy Lopez:
As we have said, young children may not have all of the words to talk about how they feel, but their behavior communicates for them. So are there behaviors that parents might be seeing if kids are anxious about starting school?
Dr. Glen Elliott:
Well, there’s a phenomenon that we actually haven’t touched on that I think is important to mention. In our field, we call it regression, which is if you hit a stressful point and it’s true for adults as well as for kids, there’s a tendency to go back to old habits or sort of feel like you’re at a younger age. So, if a kid had separation problems in the past that might reemerge, the child might start wetting the bed again, or having daytime accidents. These are usually going to be transient, and it really just reflects how anxious the child is. And if the parent can keep cool about what’s going on and not assume that that’s going to be disastrous. Usually they pass as the anxiety begins to resolve.
Dr. Natalie Pon:
Yeah, definitely and, you know, I think one thing we can always remember is that anxiety is a feeling, right? It’s an emotion. So there’s a feeling of feeling anxious. And then there’s the behaviors that we see associated, and they can look like anxious behaviors, like, “don’t leave me, mommy. I don’t want to go here, I’m scared.” And they can also be these other behaviors that might take some pieces to put together like regression or like tantrums. I see a lot of kids refusing to go to school or saying that they have tummy aches or pretending that they’re sick at school saying that their body hurts and really they’re just feeling overwhelmingly scared or anxious.
I also see a lot of children really wanting to control everything like it could be the color of plate that they eat off of. It could be that they want to control the play. It could be that they are just refusing to do all of these things that are a typical part of their routines, such as getting dressed or brushing their teeth. And so I really encourage parents to look at if this is something that was previously not challenging for your child and is now challenging, you know, what might that be saying about their feeling state or how they’re experiencing things right now and what might be different? Because young children are very sensitive to changes and transitions.
Dr. Glen Elliott:
Even something like helping the child pick out what outfit they’re going to wear the first day of school and this can be hard for parents because parents have separation anxiety at kindergarten as well, but being excited about it, and sort of making an event as opposed to sharing the child’s concern that this is gonna turn out horribly. It can be really helpful for the child. And this is one of those fake it till you make it kind of situations, particularly if it’s your first child and you haven’t actually had to have to do this before, particularly if you’ve missed preschool, the idea of handing over your child to a perfect stranger or imperfect stranger as the case may be can be itself anxiety producing for the parent, and that gets transmitted to the child.
Cindy Lopez:
So let’s talk about socialization for a minute. What kinds of things would parents and/or educators observe that are signs of socialization issues with young children? And I’m assuming that anxiety could play a role in that as well.
Dr. Glen Elliott:
Oh, absolutely, either secondarily or primarily. I mean the situation can make you anxious or because you’re anxious you may have more trouble, or it’s hard to sort through. It shows up in ways that kids may isolate themselves. They may not really want to participate in circle time or group activities. They are kids who if they’re in the playground, they’re the ones that wander around the perimeter of the playground and don’t really come in and interact, hopefully the staff is going to be aware of that and sort of encourage more interactions. Sometimes getting two shy kids together even if they’re just doing parallel play can begin to break through that. Having a friend makes a huge difference. And they may not even realize that’s what they were hoping for, but it’s important.
Dr. Natalie Pon:
Another strategy that a lot of preschool teachers and kinder teachers use can be making the child a helper, and this can give a sense of control and empowerment to an anxious child. And so that can often be very helpful with increasing socialization, such as you’re the one to collect all the markers and that can really help some children with their social skills.
There are certain social kinds of norms that more or less would be expected in the classroom. And these are things like following the teacher’s directions, you know, 80 to 90% of the time possibly and playing safely with other kids and sharing. And I would say if that is a concern at school, I bet that the teacher will tell you or that will come up at some point in time. But if you are really worried, you know, you can always ask how does my child share or have reciprocal play? And if that is an issue, that’s something that I would encourage practice at home because home is really where all of these skills can develop the most and emerge. And so I would say with this age group, you’re still in more or less charge of helping facilitate these skills.
Cindy Lopez:
As an educator I’ve seen certainly school-aged kids talking about or telling their parents, I don’t have any friends, and being sad about that. Is that also something that happens with young children?
Dr. Natalie Pon:
I think the better question in this age group is really what is a friend? And I hear more kids saying, you know, so-and-so doesn’t like me and that’s hard for a parent to hear, that breaks your heart. Especially if this is a kid that yesterday she told your child that they were best friends. And so I would really encourage parents to hear their child out, like really ask, and I would use a reflection. A reflection is essentially a mirror of what your child says and then see if your child responds. Young children respond beautifully to this sort of reflection. And if they don’t, you know, I would say, tell me more about what you mean. And then if they say, “so-and-so isn’t my friend anymore,” I would be like, “tell me more about what that means” really before we respond to the content because young children use words that they hear from adults in different ways than we’re hearing them. So maybe this kid said that they weren’t friends anymore because she wouldn’t give her a part of her lunch, but maybe she knew that that was a COVID rule, you know? And then you can really talk to your child once you have a better sense of the information instead of responding to kind of just one line of, you know, maybe charged affect.
Cindy Lopez:
So Dr. Elliott and Dr. Pon, thank you so much for joining us today. As we wrap this up, I’m wondering what advice you have for parents or what you really hope they hear from you today.
Dr. Glen Elliott:
So I hope two things come across. One is that anxiety is a real thing and it’s very pervasive, and it’s not always bad, but it can get so that it interferes with daily living, and then the parent needs to step in and try to help reduce the child’s anxiety.
Dr. Natalie Pon:
I would really want parents to take away really listening and hearing your child out. And if there are questions or concerns seeking out a provider, but also utilizing play, that is their language, that is the way that they can share things with you, express their feelings, put the unspeakable into action. You know, young children have a hard time saying exactly what’s bothering them, but they can show us, and that is the beauty of working with them and their play. And so I would encourage any parent you’re worried about something and your child is in this age range, set it up during play, set something similar up, and I would be very curious to hear what parents see or hear.
Cindy Lopez:
Thank you so much both of you for joining us today, and thank you for sharing your expertise and your experience and to our listeners if you’re wondering where you can go for help, please feel free to reach out to us at chconline.org. You can ask for a free parent consultation if you’re just not quite sure where to start, that’s a good place. And as Dr. Elliott already mentioned, there are other resources as well in our community, Parents Helping Parents is one and there are resources listed in our show notes and on our website. To our listeners, thank you so much for joining us, and we hope you’ll listen to it again next week.
Dr. Glen Elliott:
It was a pleasure.
Dr. Natalie Pon:
Thank you for having us.
Cindy Lopez:
Visit us online at podcast.chconline.org. Make sure to subscribe to Voices of Compassion so you never miss an episode and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.
