Stress, Connection, and Wellness in Our Kids

Featured Physician: Elizabeth Bech-Vainder, MD

Featured Article: 4 Ways to Create Long-Lasting Friendships and How to Know if Your Child is Just Shy or Is Struggling with Social Anxiety

Dr. Elizabeth Bech-Vainder is a Board-Certified Pediatrician with a special interest in newborn care, obesity, and other disorders in children.  She is a graduate of the University of Miami School of Medicine and completed her residency in Pediatrics at Jackson Memorial Hospital in Miami, Florida. Doctor Vainder also completed a Bachelor’s degree in Psychology and Biology at the University of Miami. 

Dr. Vainder is a well-known pediatrician in South Florida, as well as an acclaimed medical writer. She writes a weekly column in her blog DrVCares.com, where she shares medical topics of interest for pediatric patients and their families. She recently wrote an article about children and the importance of social interactions, and she joins us today to discuss her insights, including the relevance to pandemic-related stress on the pediatric population.

Social Anxiety Disorder or Just Shy?

myDoqter: Dr. Vainder, thank you for joining myDoqter to discuss your recent blog post about children and social anxiety disorder. This topic seems especially relevant today given the Coronavirus pandemic and the extended lockdowns which have had a significant impact on children around the world.  

Can you discuss some of the differences between a child just being shy and true social anxiety disorder?

Dr. Vainder: Yes, let’s look at the differences:

Shy: It is normal for a child to be shy in certain situations. The child might be nervous and feel timid in the company of people they don’t know. They may also be more reserved when confronted with a new setting or task. For some children it is a little more difficult than for others, but eventually they warm up and are able to participate and enjoy their new surroundings. They begin making conversation with the new people they meet. This is normal. 

Social Anxiety Disorder: You should begin to suspect that your child may be suffering from a social anxiety disorder when these symptoms worsen and become more frequent. The child may blush, sweat, tremble, feel nauseous or sick to their stomach when placed in new situations. Other children exhibit little to no eye contact, have a rigid posture and often find it difficult to even speak! These children may have the desire to speak to others, but for some reason they just can’t do it. Oftentimes they are overly concerned with how they look and are worried that others will judge them. They are frequently self-conscious and will avoid places where they know others might be. 

Covid-19 Pandemic Stress and Anxiety in Children

myDoqter: Has the Coronavirus pandemic brought this issue to light even more? What do you think the impact will be for these children suffering from anxiety after prolonged school absences?

Dr. Vainder: It is interesting because for some of the patients I see with anxiety, the pandemic has given them some time to relax away from the usual social pressures that come from school and after-school activities. Many of them have used this time to work with therapists on ways to manage their anxiety. 

It has also allowed parents to spend more time with their kids and see first-hand some of the feelings that they feel and discuss them more freely. These children in some ways have benefitted from this “break” in the routine. 

For other children, the news surrounding the pandemic, the loss of routine, the stress of parents working or becoming ill, has significantly impacted them. These children are having trouble sleeping, difficulty concentrating and feeling unmotivated and hopeless. Many of them are showing physical symptoms like headaches and stomach aches. These psychosomatic symptoms are common in children suffering from anxiety.  We are definitely seeing a rise in these very real symptoms. If parents notice these symptoms, they should discuss their concerns with their pediatrician. 

One of the benefits of the pandemic is the ability for teens to speak to mental health professionals via telehealth. Overall, teens are very comfortable with video calls and in many instances feel safe and comfortable speaking to someone from the comfort of their home or room. It is their safe space. 

This prolonged absence from school will affect children all over the United States in a different way. Some children are still working from home while others are attending school in person with precautions in place. From what I have observed, the majority of children that are back to school in person are happy to be back, even with restrictions like mask-wearing and social distancing. 

I do think that for some children, going back to school will be a stressful experience since they have not seen their classmates in a long time and their ability to be “social” has been so limited. However, I do believe that most of them will adapt quickly and thrive in their new environment. 

I have faith in children and I find them to be much more adaptable than most adults! 

Friendships in Children

myDoqter: What are some strategies children can use to forge friendships? Are these appropriate for any age child?

Dr. Vainder: Some children are friendly by nature and make friends very easily. For others, it takes some time and this can be stressful for both children and parents. Here are some ways that parents can teach kids about friendship. 

Listening: The reality is that we all want someone to really listen to us. Most people, when having conversations, aren’t really listening. They are trying to think about what they will say next. Teaching your child the art of listening is the easiest way to help them develop new friendships. This tactic can also help shy children that find it difficult to speak in new situations.  

Asking Questions: Encourage your child to ask questions! Asking questions is a wonderful way to learn about someone that you’ve just met. Ask about what they like to do, what they think about a certain situation or topic, where they were born, where they live, how many brothers and sisters they have. Teach them to be genuinely curious. It’s much easier to ask a question and listen, than it is to sit in silence or be the center of attention. They might be surprised to learn that they have more in common with the new friend than they originally realized! 

Be yourself: Teaching kids to be who they are is the most important way to make long lasting friendships. Encourage them to find friends that they feel comfortable with, people that they feel relaxed with and they can just be themselves. 

Explain to them that if they find themselves in a group where they are trying to say things just to fit in or doing things that feel wrong to them, then they are probably not in the right friend group. 

Teaching kids the difference between friends and acquaintances is important too. Sometimes knowing who is not a real friend is almost more important than figuring out who is. Remember it’s not the quantity of friends you have, it’s always the quality. 

Be generous: Teach kids to be generous, not in a monetary way, but with their time. If a friend needs help, help them! If they invite you to their house for a party, you show up for the party! If they are upset, you sit with them and let them know you care. Teaching kids the importance of giving others of your time is an easy way to begin teaching empathy. 

The Importance of Friendship and Connection

myDoqter: Why is having friends and a regular social circle important for children? Does this have lasting effects into adulthood?

Dr. Vainder: Many of the problems in the modern world are traced to unhappiness. Research suggests that we are overlooking the importance of friendship in these real-world problems. In fact, studies show that adults with strong social support have a reduced risk of health problems such as depression, high blood pressure and elevated Body Mass Index (BMI) or obesity. Studies have even shown that adults with strong social support, live longer than those who don’t.

So, whether you’re a child or an adult, the importance of friendship is universal and we need to make it a priority. Nurture your friendships, put yourself in situations to meet new people and make the effort to reach out to people that you are interested in getting to know better.

Be open minded too!! Try to meet different kinds of people! Don’t limit your reach to people that look and think like you! Your life will be richer if you broaden your circle and your choice of friends!

Remember, sitting at home waiting for someone to call you or invite you somewhere is not going to work!

Techniques to Help a Shy and Quiet Child

myDoqter: Any other thoughts or ideas for parents that have "shy" or anxious children that can help?

There are many ways that parents can help anxious and/or shy kids. One way is through role playing. Helping kids to practice what they are going to tell a friend, teacher or coach can help with anxiety and build confidence. Encourage your kids to speak up for themselves!

Another way is to show them photos of a new place they are going to visit. Some kids feel more comfortable when they know what to expect. They instantly feel more at ease when they get there. 

Finally, never minimize a child’s feelings. Saying things to them like, “Oh, it’s nothing”, “Why are you so nervous?”, doesn’t help. Instead, validate their feelings and help them take small steps towards overcoming their fears. Small actionable steps build confidence and that’s the best way to overcome anxiety and shyness. 

Elizabeth Vainder, MD

Diplomate, American Board of Pediatrics

To learn more about Dr. Elizabeth Vainder, please visit: www.drvcares.com