Helping a Stressed Child Become Self Aware of Stress

Children who suffer from stress disorders often have lived for so long with their stress symptoms and behaviors that they do not realize that they are different from other children. They take their extreme level of stress and resulting behaviors as a fact of life. One step in treating stress behaviors in children is to help them to become self-aware of their stress, how the stress is cued and triggered, and the levels of their stress.

The first step, of course, is for the adult caregivers to be able to make a list of the stress behaviors that are seen regularly in the child. If you do have a clear idea of what "stress signs in children" looks like, you can read the companion article to this one entitled: "Stress Cluster Descriptions". You should also consult with your treatment specialist to help you make the list.

Once the signs and behaviors have been identified, caregivers can gently make observations to the child about the behaviors once the child has clamed down from the stress episode (upset, or acting out). These observation might be something like: "I notice you seem to get very upset when you are told that you cannot have a food treat...your face gets red, and then you begin to yell and say that I am unfair..."

Children in foster care who have stress disorders often have an increase in stress and stress related behaviors before and after contact with biological family members. When signs are seen prior to a visit, a caregiver can comment on this to the child, once again, very gently: "You seem to be a little bit nervous or worried, I see you pacing around and you can't seem to stay still...I wonder if I am right, are you worried?"

The phrase: "I wonder...", followed by a reflection of what the caregiver thinks the child might be feeling, thinking, or what the cause of the behavior is a very useful phrase. By saying "I wonder...", you are not making a definitive statement or accusation, but leave room for the child to correct you if you are wrong. If you are right, you have just helped the child to recognize their stress source and level, and if you are wrong, the child will likely correct you, and then still become self aware of their stress.

For many children with stress disorders, there are many, many things, people, and situations that may trigger stressful memories of the traumas in their past. When a caregiver gets a clue that something, someone, or a particular kind of situation is triggering to a child, they should ask the child directly about it: "After you saw that big dog, you seemed to get very anxious...I wonder why?" It is important not to lead the child by saying something like: "I wonder if it because something bad happened to you that involved a big dog?" If a child is led in this way, you could very well get a false agreement by the child, because children want to please adults.

Another way you can help a child become aware of their stress is by modeling: talk about your own stress and stressors (when appropriate), and describe how the stress feels to you, such as where in your body you feel the stress, the level of stress, etc. You then can in turn ask the child how and where they feel their stress.

Once it has been established with the child that they have stress problems, a caregiver and child can make a creative chart that will help both the child and caregiver to graphically symbolize the stress level. This could be a big poster of thermometer, with a sliding red line to indicate how high the child feels their stress level is. Finally, children can be taught healthy self-comforting and stress reducing techniques. When the child experiences genuine relaxation, safety, and security, they are better able to come to a better self awareness of their debilitating stress and stress behaviors.

Dealing With Nighttime Enuresis in Children

Dealing With Nighttime Enuresis in Children

Many children have occasional enuresis, or wetting at nighttime, even though they have been toilet trained for years. Quite a few children who have been traumatized by interpersonal violence will have nighttime (and even day time) wetting that is often not effectively treated by medication or restriction of liquids. Even older children may have nighttime wetting; it is not uncommon for the problem to continue to occur in children who are victims of PTSD even into their teen years.

If medication and liquid restrictions do not help, what should you do? The first step is to accept that the wetting issue may not go away quickly or easily. The second thing to remember is that even though it is a frustrating problem, you should refrain from becoming punitive with the child when they wet. Giving consequences will likely only make the situation worse, and begin to erode and damage your relationship with the child. Once you have accepted these basic ideas, you can move on to the practical coping strategies listed below.

If the child is clearly in control of their bladder in the daytime, and the child is above the age of three or four, resist putting nighttime diapers or 'pull-ups' on the child. The reason for this is that when diapers are used, the child is being behaviorally shaped to depend on them. In other words, the longer they wear the diapers, the longer they will wear the diapers. As the child gets older, this is a social embarrassment as bad as wetting the bed. Diapers do not solve the wetting problem. For children to learn how to avoid wetting, they need to be able to feel the wetness on their skin!

Your next step is to get a cover for the child's mattress. Not just a top cover, but an all encasing, heavy plastic cover. In most cases, new mattresses are sealed in a plastic that is perfect. You can find some waterproof encasement covers in mattress stores or on the Internet. Then, be sure to have at least two or three sets of fitted bottom and top sheets, as well as a n extra blanket for the child's bed, so that there will always be a change of sheets available. You can take a regular top sheet and fold into quarters and place it under the area where the child's bottom lies, then put the regular fitted bottom sheet over this. Of course, if the child moves around the bed a lot, this measure may not have the intended absorption effect. It is a good idea to encase the child's pillow in the same fashion, because pillows can get wet too!

If the child wakes in the middle of the night to tell you they are wet, you should help the child first to take a quick shower, not just clean up with wet wipes and change clothes and sheets. The child should strip the bed following the shower, and take the wet sheets to the laundry area to be washed later. The reason for these measures is to make the wetting incidents a bit uncomfortable, not to mention press home to the child that wetting clean up is their responsibility. All of these procedures should be done in a matter of fact manner; try to hide the fact that you are tired and irritated by the problem. By the same token, if the child discovers they are wet in the morning, the same procedure should be done.

If the child sleeps through their wetting and it is not discovered till morning, you might want to try to ascertain when they usually wet. In most cases, this is either during their dreaming (intrusive nightmares about their abuse) or in deep sleep. You can check at intervals throughout the night to try and ascertain a pattern. If a pattern is found, you have a shot at being able to wake the child about thirty to sixty minutes before the known wetting time to use the toilet.

Last of all, there are devices on the market that sound an alarm when the child begins to urinate at night. Some are pads under the bottom sheet, while others clip to the inside of the child's underwear. The child will still wet themselves, but the idea is that the alarm begins to teach the child's sleeping mind how to pay attention to their full bladder, and to wake themselves up, instead of having an annoying alarm do this. Some of these alarms can be fairly costly, and have varying degrees of claimed success.