Regulating the Stress Response in Kids: Top Five Takeaways

In the August webinar, ACEs Aware asked a panel of experts to share their tips and best practices for primary care providers to help pediatric patients and parents manage stress.

Read key takeaways from Dr. Dayna Long, Dr. Hilary M. Bowers, and Dr. Pradeep Gidwani below. Watch the full ACEs Aware webinar here.

1. Cool-Down Corner

Parents are familiar with timeouts, especially as disciplinary measures. For example, if your child is out in the middle of the street, or violated a house rule that resulted in a broken window, these actions could result in discipline like a timeout, which is parent-controlled and parent-directed.

Conversely, a cool-down corner is about giving space for social and emotional self-regulation. A child may choose to cool-down for five seconds, five minutes, or an hour – it’s really up to them. The decision is up to the child for when they feel they are ready to come out and resume interacting in a healthy way.

As a provider, you can help educate caregivers to model the behavior they want for their children. To demonstrate how it works, you can recommend for the caregiver to express that they are feeling frustrated or upset, and to ask the child to sit in the cool-down corner. When caregivers see an opportunity to use the cool-down corner, they should also make sure they communicate when it’s cool-down time by saying, “Hey, it’s cool-down time,” and let the child direct the time he or she needs. Children can also use things like crayons, paper, a pinwheel, or items they helped to pick out in advance to help them cool down.

2. Encouraging Conscious Breathing as Mindfulness Practice

Both parents and children have an opportunity to regulate their stress with conscious breathing. Breath work helps us connect our emotions and our mind. By flipping the switch from our sympathetic to our parasympathetic nervous system, which helps to regulate the toxic stress response, we can calm and slow down. Breath work can also be done anywhere, anytime, and anyplace.

Box Breathing

Sit up straight with your feet grounded on the floor, and close your eyes. Breathe in through your nose to the count of four. Hold it a moment, then breathe out through your mouth to the count of five. Like playing a wind instrument, you want to breathe out longer than you breathe in. Using this technique throughout the day can help you maintain focus.

Breath Work for Children

Different children will respond to different techniques. One favorite is drawing a candle on one side of a piece of paper and a flower on the other side. Have the child smell the flower, then turn the paper over and ask them to blow out the candle. The visual helps engage the child and is a fun way for the parent and the child to interact. Blowing bubbles or belly breaths – asking the child to put their hands on their belly and feel it blow up like a balloon when they breathe in through their nose and out through their mouth – are also great ways to facilitate breath work. Again, what you’re trying to do is help them slow down their minds and be more present in their bodies.

3. Journaling for Stress Relief

We often recommend journaling for both children and caregivers. Journaling is a concrete actionable item that patients can take with them as we guide caregivers to adopt these stress management tools for themselves and their children. Similar to how a food diary can uncover health patterns that seemed mysterious and daunting, journaling emotions can help reveal patterns of behavior.

This can be a closed journal for self-reflection or a shared experience of child and caregiver writing back and forth to one another. Often this technique leads to a breakthrough moment when caregivers can understand how much their child, particularly adolescents, has been struggling when they aren’t conveying their feelings with words.

Closed Journal

A closed journal is for your own self-reflection. In this space you are writing your own feelings, thoughts, and pictures, and the journal is kept for yourself with the expectation of privacy from the caregiver.

Open Journal

In an open journal, the child or caregiver writes something down and shares it with the other. Often, it’s hard to say something face to face that’s very important to us. Opening this new communication channel between caregiver and child helps keep the conversation moving. Some families have even created a “mailbox” to share these letters and even decorate the mailbox as a fun arts and crafts activity. Whether these letters or notes are placed in the mailbox or shared in a spiral-bound notebook, this can be a great tool that works across ages.

Color Journaling

In a color journal, the child and/or caregiver uses colors instead of words. To begin, across the top of the page or front of the journal, you can draw a rainbow of colors – or whatever colors you want. Assign each color a mood, such as happy, sad, contemplative, etc. Then draw a calendar and select one or two colors for each day that reflect your mood and continue doing this each day. By the end of the week or month, you have a good visual of what things were like over that period. For some families, this is the breakthrough moment when they understand how much their child has been struggling because sometimes the words might not be conveyed.

4. Incorporating Imagination and Visualization

One of the things we like to do with kids as they get older is ask them to use their imagination when they’re upset and need a little time to collect themselves to get their emotions in check. We also know when we have strong emotions, it takes time to recover. Encouraging children to engage their imagination while their mind is active allows their emotions to remain calm.

Remind patients that they can use visualization techniques anytime – during math class, when lying down on their bed, or walking with a friend – because other people don’t know what’s going on in their head.

Color Visualization

One visualization technique deals with color. For this activity, you need to close your eyes and imagine a red circle. In your mind, trace this circle on your head, on your chest, and on your belly while imagining objects that are red, such as strawberries, apples, fire engines, stop signs, or roses. As you’re breathing in through your nose and out through your mouth, imagine the circles growing bigger and changing to orange. The orange circle could be filled with California poppies and oranges. The circle then changes to yellow, and you continue on naming objects for each color as you move through the rainbow. By the time you get to the color purple, you have this big purple circle that’s covering you, and purple is a much calmer color than red. While you’re doing this activity, you’re also breathing out the stress that has been building up.

Painting Your Happy Place

Imagining and creating a special happy place can be fun and unique to a child. By thinking of a place that makes us calm or a place we would rather be, we can decrease our heart and respiration rates. When we do that, we can step forward and address our stressors. What does the happy place look like, smell like, feel like, taste like, and sound like? Where would you rather be? If a child really likes animals, they could go to a zoo or the forest and talk with the animals. Some kids like castles. Encourage imagination and have a lot of fun with this activity. You can do this exercise out loud, on a piece of paper, or in your own head. Be descriptive with it so you can be transported to that location.

5. Promoting Stress Management During COVID-19

Now more than ever, stress management strategies can help pediatric patients and their caregivers navigate these uncertain times.

Staying Connected with Others

During the COVID-19 pandemic, we must encourage caregivers to get creative with how they can connect with people outside of their household. It is very important to give purpose to children by finding ways for them to share themselves and get outside of their own head. Could they participate in Zoom calls with grandparents or other relatives? Maybe say hi to a friend through a window? Whether it’s baking for others, writing notes, or talking on the phone, it’s never been more important for patients to maintain supportive relationships that mitigate stress.

Teaching Stress Management via Telemedicine

Many of these stress management tips are easy to describe or show on the video screen with patients via telemedicine. Work with patients and their caregivers to identify the ones that work best for their family. Teaching these techniques is an opportunity to have fun and connect with families in a way that lets them know you care about and support them. Telemedicine can be an important tool for staying on track with follow-up visits and ensuring that care is still being delivered.

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For more on discussing behavioral and mental health care strategies with pediatric patients and caregivers, read more from Dr. Bowers on the ACEs Aware blog.

Watch the full ACEs Aware webinar, “Regulating the Stress Response for Kids: Practical Tips for Primary Providers.”

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