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School Blues

By Dr. Scott Hamilton
February 21, 2020

On my first day of medical school, the dean gave a little speech about how it's stressful, and that the school had a counseling center for students when their anxiety got overwhelming. Though the course work is intense, the dean said, most visits to the center "are about a girl."  Everybody laughed- relationship trouble worse than medical school?  I laughed too, until 2 years later, when I found out my girlfriend at the time was seeing someone else; two weeks before a major exam that if you didn't pass, you got held back a whole year.  Turns out the counseling center was pretty cool. We see lots of anxiety, and anxiety-related symptoms, in the Pediatric Emergency Department.  Sometimes the kids come right out and say, "I've got anxiety," and describe their depression, negative thoughts they can't control, their feelings of impending doom.  Often though, they come in with symptoms that freak everyone out: trembling, shortness of breath, complaints of chest and throat tightness, even seizure-like activity.  Everyone is concerned that the teen is having an asthma attack or severe allergic reaction, when these symptoms are actually how he's experiencing a panic attack. We usually see these kids coming from school.  The child starts having these worrisome symptoms, a school nurse isn't available to calm everyone down, and the ambulance is called.  By the time the stretcher wheels through our door, the kid's back to normal, and it's time for us to determine if this was a real allergic or asthmatic episode, or was it anxiety-related behavior. Schools are a stressful place for children.  For most of their day, kids are immersed in multiple, continuing, unrelenting social interactions.  Often those interactions are good: laughing with friends, learning cool things with a favorite teacher, horsing around at PE or recess.  Sometimes they're not so good.  Bullying is still mostly a school phenomenon, when a strong-willed kid and her group gang up on someone vulnerable.  Maybe the child's having trouble with academic achievement, maybe add an unpleasant teacher, or a break-up..  All kids struggle with their sense of self-worth; put them in this pressure-cooker environment, and sometimes bad things happen in their heads.  It's a wonder ambulances don't get called more often. My son’s college transcript showed that he failed Business Law, a bad start for a kid thinking of going into…business law.  After emailing his professor, he stumbled through the day in a haze of misery.  When he found himself enjoying something- a joke or nice weather, the happiness was quickly extinguished by the thought, “I’ve failed.” Later that afternoon his professor replied- it was a mistake. My son’s final exam grade hadn't been entered into the system, triggering the fail.  It would be fixed, and he breathed an enormous sigh of relief.  But it still took some time to shake that dread that had haunted him.  Anxiety can be sticky. We're born with a need to be anxious.  It's an ancient motivator from evolution, keeping us from getting eaten.  Worried about that sabre-toothed tiger eyeing you? Good, run away!  Even animals as primitive as lizards have anxiety.  Just approach one, watch it twitch and scuttle about, before tearing off. Anxiety has been rising in past decades. Most families worry about money. Despite corporate economic gains, people's buying power has declined, as their wages remain stagnant against rising costs.  There's also growing distrust in institutions meant to protect us, like law, medicine, and government.  Finally, there's the 24/7 news cycle, the channels and websites finding more bad news (crime, war, injustice, political bickering) to keep us glued to them and their advertisers. Children get anxiety too.  Not only do they get it at school, as we described above, but it's fed by their parents' anxieties too.  When parents hear that the world is spiraling to destruction, kids hear that too.  Sometimes they get symptoms like we discussed above- palpitations, trembling, tight chests- and come to the Emergency Department. When kids' anxieties interfere with their lives, counseling and sometimes medication  help.  However, prevention is always better.  The world's actually a safe for you and your kids. I've visited countries that, in news stories, are constantly violent.  Yet I see people instead living in peace. New York City used to be portrayed that way, but really wasn't more dangerous than Disneyworld.  And institutions like government, medicine, and law, still work quite well.  Teach your kids that the world's okay.  And maybe turn off the cable news.

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