Kids worry, but should parents worry about it?
A national survey released in April 2023 by Nemours® KidsHealth® and conducted by the Harris Poll indicates that more than one-third of children worry at least once a week and that the worrying only gets worse as they get older.
As Mental Health Awareness Month draws to a close, we discuss the results of this survey with Meghan Walls, PsyD, pediatric psychologist and Director of External Affairs for Nemours Children’s Health, Delaware Valley, and Rick Raber, Editor-in-Chief of the Center for Health Delivery Innovation at Nemours Children’s Health.
Carol Vassar, producer
Rick Raber, Editor-in-Chief, Center for Health Delivery Innovation, Nemours Children’s Health
Subscribe, review or let your voice be heard at NemoursWellBeyond.org.
Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week, we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you’re here, let’s go.
MUSIC: Well Beyond Medicine (00:21):
Carol Vassar, podcast host/producer (00:27):
A national survey released in April 2023 by Nemours® KidsHealth® and conducted by Harris Poll indicates that more than one-third of children worry at least once a week and that the worrying only gets worse as they get older. As May as Mental Health Awareness Month draws to a close, we discuss the results of this survey with Dr. Meghan Walls, pediatric psychologist and director of external affairs for Nemours Children’s Health, Delaware Valley, and Rick Raber, editor-in-chief for Nemours Children’s Health and KidsHealth.org. So what was the impetus for conducting this survey? Rick Raber has the answer.
Rick Raber, Nemours Children’s Health (01:11):
It’s no secret, Carol, that the mental health of teens has become a growing concern for everyone in recent years. Our survey went into the field in late January. For context, in December, just the month before, in a fairly unusual public advisory, the surgeon general warned of what he called a devastating mental health crisis among adolescents. And at about the same time, the CDC released data that showed some really alarming trends among teens. The numbers showed that almost half of US high schoolers experienced dealing with sadness and hopelessness in the year before, and nearly a quarter seriously considered attempting suicide. So we set out to understand what children worry about during the preteen years, and our view was that understanding what children worry about most often offers an opportunity for parents and caregivers at a crucial period during these preteen years where they can learn more about their children’s concerns and gain insight into how to help them when the worries become too intense or too frequent. So the bottom line, the goal was providing parents and others with someinsight into the worries of children, where they go to for help, and how they cope.
Carol Vassar, podcast host/producer (02:27):
I’m curious as to the overview of the findings of this particular survey. Dr. Walls?
Dr. Meghan Walls, Nemours Children’s Health (02:34):
So I think, as Rick sort of mentioned, we really were looking at what is happening with kids, and kind of we call them kids and tweens, right, especially in the aftermath of a pandemic? So does this landscape look different now? And to really figure out what is happening with our kids and to really think about what can we do with these findings? And so, one of the things that I think we did find is that, not surprisingly, the most common things worried about center around school and friendships. And that’s pretty longstanding for kids, so we know that that’s something that kids worry about. But one of the interesting things, I think, is that 37%, so over a third of kids, worry once a week or more. And I think that’s an interesting one, especially as we look at this data, right?So we know that, nationally, we’re seeing increases in things like anxiety, so are we also seeing increases in just worry? And worry doesn’t have to be a clinical problem, right? But our kids just worried in general more.
The other thing that I think is really important here in the overall picture, and we can talk details as well, is that, despite having this many kids worry, what we actually heard from kids was that they most frequently turn to their parents when they are worried. And I think that’s good news. We have, especially for those younger kids, those younger kids are even more likely to be drawn to their parents as their first resource. And then, not surprisingly, as we get to that 12, 13 age, kids start to go to their friends, right? But I think it’s really important finding that kids are worrying about a lot of the things that we find to be really common, but perhaps they’re worrying a little bit more or they’re identifying worrying more, but they’re going to trusted adults. And that’s a really important piece of this finding, I think.
Carol Vassar, podcast host/producer (04:16):
You talk about worry, and it’s not really a clinical diagnosis. So let’s define the word “worry,” Dr. Walls.
Dr. Meghan Walls, Nemours Children’s Health (04:24):
Great question. So one of the things that we’ve talked about a lot is, what is the difference between worry? Why is that normal? And what becomes more of a clinical problem and what we would call anxiety, right? So clinical anxiety. Worry is any kind of thing that a kid thinks about that might make them a little bit nervous or a little bit stressed. And when we think about that, worry is normal. We all worry. I worry, “Where did I put my keys this morning? I can’t find [inaudible 00:04:51] the door.” Kids worry about things like, “Oh, is this shirt look good today?”, right? So worrying is normal, and part of worrying is really developmentally normal. So when we look at some of these age groups that we looked at, right, this nine to 13 age, we actually know that, in that tween/teen age, kids often worry because, in that age, and in that developmental stage, worry is really normal. And what it means is they’re just kind of figuring out the world, right? So if we don’t worry, it means they’re not kind of thinking about, “Well, what are the consequences? What are the outcomes?” So as kids get older, we actually know that this is pretty normal. And as adults, we all worry, right? We all have those moments.
Carol Vassar, podcast host/producer (05:29):
What are the effects of worry, especially on the preteens, the tweens, and then the teens?
Dr. Meghan Walls, Nemours Children’s Health (05:36):
So it’s really interesting. Worry itself, perhaps, is not having any negative outcomes. However, there are what I would call symptoms or ways that kids show they’re worried, right? So kids will say things like, in this survey, even, right, that they feel like they’re a little bit distracted if they feel worried about something, they can’t focus, or maybe they get a little bit more quiet. There are kids who say they need to talk to someone. So if they’re worried, they’re going to be more talkative. And then there are kids who say, “I need to distract myself. I need to go and watch a show or do something to turn my brain off,” and that’s okay too. So we know that kids are doing that.
Another interesting thing that we saw in this study particularly is really around how this sort of manifests in kids. And what I mean by that is we’re also seeing kids who say they actually physically don’t feel great when they’re worried. And that’s pretty normal. We actually know that that’s a normal experience. But things like, “My stomach hurts. My head hurts. Ooh, I don’t really want to eat.” And if we think about those times that we’re worried about giving a presentation or talking to someone new, we can identify with that, right? Those butterflies in your stomach, or feeling like, “Oh, I don’t really want to eat lunch yet because I have a big presentation.” And so, kids are actually able to identify those things. And I actually see this as a positive. I want kids to be insightful and to be able to say, “You know, when I’m worried, I feel a little off, and I probably need to talk to someone, or distract myself, or do something else, because I don’t feel so great when I’m worried.” And really… This study shows that kids can identify those things and also identify things like I mentioned about being distracted, but I think what it also gives opportunity for is, if we know what we feel like when we worry, it actually signals, “Hey, maybe we can do something to help us when we feel worried. Maybe we can use some coping skills.”
Carol Vassar, podcast host/producer (07:26):
As you’ve pointed out, some worry is natural; anxiety, to a certain extent, is natural. At what point should parents be worried that this is tipping into excessive worry and maybe even a clinical diagnosis of some kind, maybe anxiety disorder, in their kids and in their teens?
Dr. Meghan Walls, Nemours Children’s Health (07:49):
Sure. So when we talk about “When should I be concerned, and when should I think, ‘Maybe this is not just that normal worry,'” I look most at kids’ functioning. So not that I have butterflies in my stomach because a test is coming up, but instead, is your child withdrawing? Especially when we look at the age range that we’re talking about here, this nine to 13. This is a pretty social time in life. So if your kids are withdrawing, they don’t want to play with friends anymore. They’re so nervous about school, or appearances, or friendships that they don’t want to even go. They don’t want to go to sports. If they are not eating, right? They’re losing appetite. If they are up all night, not sleeping because they’re worried. So we say when there is a functional change, and it’s noticeable over more than a day or two.
So we know that if kids have a big thing coming up, totally normal. But if we’re really seeing this last, right? So beyond an event or an issue that’s happening in school that day, if we see kids consistently have functional change, sleep behavior, eating, friendships, that’s when I say to parents, “It might be time to say, ‘Hm, do we need to get some extra help here?'” And that’s when it’s really important to turn to your pediatric providers, and even to your pediatrician, and just say, “I’ve noticed this thing’s happening with my child. Can you help us figure out what to do next?”
Carol Vassar, podcast host/producer (09:03):
In the survey results, did you find that the kids that were surveyed had the coping mechanisms that they needed to deal with and alleviate worry?
Dr. Meghan Walls, Nemours Children’s Health (09:16):
A lot of the kids surveyed said that they actively work to make themselves feel better when they’re worried. So over 90% of kids said that. And about half of those kids talk to someone when they feel that way. Again, I go back to there’s nothing that I think is actually more rewarding than a kid saying, “I go and talk to my parent when I’m worried.” So we know that that’s actually positive, right? And the fact that most kids are trying to find a way to make themselves feel better is a good thing. Now, we also know there are different ways of coping. So there is a proportion of kids who actually turn to technology and distractions in the hopes of stopping their worry. And in that case, about 50% say they might watch something, about 50% say they might play video games, and we saw, actually, that boys are more likely than girls to turn to things like video games to make themselves feel better.
And the kids are also doing other things. So they’re doing things like going outside to play, doing something creative, reading a book. So really kind of taking themselves out of that moment of worry and doing something else. And what we know is that, as long as we’re not avoiding the thing that makes us worried forever, distraction’s a great coping technique. So we actually see that a lot of these kids are doing things. We also know that a pretty small amount of kids, so only about one in 10, say that they have things they do with their mind or body, so things like breathing or those techniques, to make themselves feel better. So I think certainly there’s room for us to look at what kind of coping techniques we can instill in kids, but I think the good news is children are actively trying to do something. They’re not just sitting with this and holding it in. They’re actually trying to engage in behaviors that make it better.
Carol Vassar, podcast host/producer (10:52):
Is there a difference between, say, children, tweens, and the way teens cope with worry?
Dr. Meghan Walls, Nemours Children’s Health (10:59):
So it’s a great question. We didn’t see a huge difference in age breakdown in sort of the way that people cope, except for that those younger kids are more likely to go to their parents. So if we’re looking at kids aged nine to 11 in their survey versus those 12 to 13-year-olds, as I mentioned, those kids are more likely to go to their parents, whereas those older kids are more likely than their younger counterparts to perhaps seek the advice of friends. And again, developmentally appropriate. We expect that those younger kids are with their parents every day, but our 12 and 13-year-olds, I would posit that they might be at sports and activities and in school more independently with friends. And so, I think that really does make sense.
And the other thing is that the older group of kids, so those middle schoolish age kids are more likely to feel adults perhaps don’t understand what they worry about than those younger kids. So I think what we’re seeing here is really developmentally appropriate, but I think also reminds us that perhaps those older kids need either more parental questioning of how we’re doing or more intervening, right? Because they might not come to their adult, trusted adult as much as those younger kids.
Carol Vassar, podcast host/producer (12:09):
Dr. Walls, what role do parents play in all of this? I know they have to be observant. They have to be listening. What tips might you have for parents who are listening today?
Dr. Meghan Walls, Nemours Children’s Health (12:21):
One of the biggest pieces of understanding worry and anxiety for kids for parents is actually understanding that you don’t have to fix it. A lot of times, as parents, and I’m a mom of two, we see our kids worry, and we just want to make it better. We want to bring the book to school they forgot, we want to fix the friendship and invite a friend over for them, but our role as parents is actually to let our kids have little baby failures. Let’s worry about something that might go wrong. And it might go wrong, and that’s okay. And instead of fixing it, our job is to support. And so I think of it like scaffolding on a building, right? You can be there, and you can help hold them up, but you can’t be the building for them. You’re just helping them build their skills along the way until they’re strong enough to do it themselves. And what we know is that parents who are just supportive, right? “I see you’re worrying. That’s a tough day at school. I know you’re going to get through it. Can I help you?” Those are the parents who have kids who then go on to become teenagers and adults who aren’t afraid to problem-solve and who aren’t worried if something small goes wrong.
And so, as parents, the more we can help kids to solve the problem as a kind of joint effort instead of fixing it for them, the better off our kids are. And I think that’s a really important piece for parents to remember.
Carol Vassar, podcast host/producer (13:35):
You mentioned when we started talking about this, that you wanted to see how kids were doing post-pandemic. What role did the pandemic play in children’s fears and worries?
Dr. Meghan Walls, Nemours Children’s Health (13:48):
It’s a great question, and we don’t have a before-pandemic survey to look at. And so, instead, I think what we’re looking at is just, what is the landscape now? But we did ask questions about if kids are worried about things like things in their world. And I think one of the things that we talk about a lot in the clinical world is, during the pandemic, we saw kids have a lot more access to a lot more information and screens. And this was not reported directly in the survey, but I think, to me, it makes sense that kids are starting to worry about what’s happening in the world. So things like pandemics, some kids are worrying about the environment, and violence, right?
So I think that, while I don’t have a good comparison, and while we didn’t ask directly in the survey, I think what I would say from a clinical perspective is we’re seeing kids during a pandemic when we were stuck home. And also, frankly, they had to use technology more, right? They had to learn it. They had to do schooling in technology. But they got more access to information, and so, the thing that I think is interesting is we might be seeing some outcomes that are based on what kids have exposure to. And again, we don’t have a comparison before and after. We didn’t ask directly in the survey, but I would venture to guess from my clinical work that we certainly know that kids had more access to screens and information, and that’s in play.
Carol Vassar, podcast host/producer (15:00):
So, Rick, the release of the survey also marks the launch of the refreshed Nemours Kids Health, which is KidsHealth.org. How do these two pieces align, this survey and the relaunch?
Rick Raber, Nemours Children’s Health (15:13):
Right. When we released the study as part of it, we provided resources on Nemours KidsHealth to help parents learn ways to help kids when they worry. And that’s what we do at KidsHealth. We provide content to help families make their best health choices. For those who don’t know, KidsHealth is our website, KidsHealth.org, and its related products, such as patient instructions delivered through the electronic health record, and videos, and a lot more. And everything we do at Nemours KidsHealth is about creating doctor-vetted, easy-to-understand information and advice for parents, kids, and teens as separate audiences.
And now KidsHealth.org reaches almost 200 million people a year. It’s one of the most visited pediatric health websites in the world. There’s really no other pediatric health system that comes close in this regard. So when we think about Nemours’ commitment and vision go well beyond medicine, among other things, we talk about going outside our walls to help children everywhere grow into healthy adults and about being one of the world’s most trusted voices for children’s health. So in those ways, Nemours KidsHealth is very much aligned in vision and philosophy with Nemours, really in every way, and it always has been. The problem was it evolved over time to have a different look and feel than the Nemours brand. And that’s what we corrected in this refresh. And so, we thought this survey would be a great opportunity to underscore the consistent approach through everything Nemours does, as well as what a great example KidsHealth is of Nemours reaching beyond its walls to literally every corner of the globe.
Carol Vassar, podcast host/producer (16:49):
Dr. Walls, I’m going to kind of pull on that well-beyond-medicine thread. How does the survey and the work that you do really speak to the idea of well beyond medicine that, as Rick pointed out, has been embedded in everything done at Nemours?
Dr. Meghan Walls, Nemours Children’s Health (17:05):
Our goal, both from a clinical perspective and my goal in my role as director of external affairs, is really, how can we get the best information to families in the most effective way possible? Not every family needs a clinical visit. Not every family needs a psychologist. And so, working with Rick’s team and working with other folks, whether it be at KidsHealth or with you on your podcast, I think our job really is to share information. We need to go well beyond medicine by being beyond the walls of our hospital, and the way we do that is to reach families where they are, right? Whether that is on the internet with KidsHealth and social media, listening to a podcast while Mom’s driving to work versus having to read an article.
And so, my hope when we do surveys like this and when we share outcomes is that we’re giving parents, and we’re giving teachers, and we’re giving other adults this really great, rich information, and then they can do something with it. And so, the most important piece of these surveys and these podcasts to me is that parents can listen or adults can listen and say, “Oh, I should check in with my kids and see what they’re worried about,” or, “Hey, I heard that it’s actually okay if my kid distracts themselves while they’re worried.” And so, I think the more of this we do and the more external communications we do around our surveys and our clinical work, the better off we are. And I really believe, truly, that the best thing we can do to disseminate information is get it into the hands of the public. And if we can do that well, parents, caregivers, and kids in our environments, in our communities, really benefit from it.
Carol Vassar, podcast host/producer (18:32):
Let me ask each of you this, and Rick, I’m going to start with you. As parents listen to this podcast, as parents review the survey, as caregivers take a look at the information provided, what’s the one big takeaway from this particular survey on worring that you want them to really remember?
Rick Raber, Nemours Children’s Health (18:51):
Well, I think I would play on something Meghan said earlier, which is one of the good things about the survey. Some point of good news was that children said they turned to parents first when they’re worrying. Parents are caregivers. But Meghan also noted that tends to decline, according to our survey, as the kids hedge toward the teen years, probably further when they’re in the teen years. So I think the great message out of this is for parents to realize they have an opportunity now with their kids in this age, this nine to 13 age, to open up the lines of communication if they aren’t already open and to establish healthy habits that can lead to better mental health with time. Whether that’s spending time with them, or asking what’s on their minds, or listening patiently, it’s just a good time to do it, and that’s a big, big reason we undertook this survey because it’s really a crucial juncture. And it doesn’t mean worrying is always bad. It’s something that naturally happens, as Meghan said. But to learn more about it, and to talk to kids more, and to start getting that relationship as strong as it can be, leading into teen years, is a great idea.
Carol Vassar, podcast host/producer (20:02):
Dr. Walls, I see you nodding. What are your thoughts? What would you like parents to really take away from this survey?
Dr. Meghan Walls, Nemours Children’s Health (20:09):
So I think a few things. Rick hit on, I think, the concept and where I was going, but I’ll add a few details. When we talk about kids going to their parents, I mentioned how important I think that is, but I also think it’s important that parents know that kids want to come to them. And so, sometimes it’s just asking that question, instead of, “How was your day today?”, is, “Hey, did anything bother you today? What worried you today?” Clearly, kids are worrying, right? We want parents to ask. And I think part of this survey is so nice because it shows what a variable way kids experience worry and normalizes that. So if we can acknowledge some kids get a belly ache, and some kids feel like they can’t eat dinner, and some kids feel like they can’t concentrate, I think it gives parents that information of, “Hey, this all could be worry, right? Let’s figure out what it looks like for your kid.”
And then the last thing I hope that they take away here is something that I think comes from what Rick said about opening those doors, and that is, we know from so much research that the number one predictor and the number one variable in resilient kids is actually just one consistent caregiver. You don’t have to be perfect, right? But look at this survey and look at what kids are worrying about, and it gives you a little bit of information to touch base with your kids and ask about, and you don’t feel so unarmed going in, right? You feel like, “All right, I have a few things I could probably ask about. I don’t just have to ask a yes or no question.” And I hope that parents take some of that information and really use it to have those good conversations with their kids and to validate that worry is normal. “Look at this,” even sharing a survey with those older kids. “I saw this survey. 12 and 13-year-olds are going to their friends more. I hope you know you can still come to me.” Right? And I think it gives parents that tool to have that conversation with their kids.
MUSIC (21:53): Well Beyond Medicine
Carol Vassar, podcast host/producer (21:53):
Thanks for listening to our conversation on what’s worrying our kids with me, Carol Vassar, and our guests, Dr. Meghan Walls and Rick Raber.
From doing homework to being left out of a group to changing family dynamics, kids worry. What do the kids in your life worry about? How do you help support them when they’re worried? Continue the conversation by leaving us a voicemail at NemoursWellBeyond.org. That’s NemoursWellBeyond.org. You might even hear your voice on an upcoming episode of the Well Beyond Medicine Podcast. And while you’re there, check out our other episodes, subscribe to the podcast, and please leave a review.
Thanks, as always, to Che Parker, Cheryl Munn, and Susan Masucci for production assistance. Join us next week as we dive into the recent announcement from the Office of US Surgeon General Dr. Vivek Murthy, highlighting the dangers of social media to the health and well-being of children and adolescents. Until then, remember, together, we can change children’s health for good, well beyond medicine.
MUSIC (23:06): Well Beyond Medicine!