Young girl holding teddy bear and looking sad
Children's Health Mental & Behavioral Health

How to Know If Your Child Is Stressed Out

By on 10/07/2020

More than six months after COVID-19 up-ended the lives of Americans, many children have returned to school – but things are still not quite normal. For some kids, this has caused increased stress, says Katherine Napalinga, MD, a child psychiatrist at Einstein Medical Center Philadelphia.

Fortunately, there are things parents can do to help ease stress for kids even though their own anxiety may have increased, she says. Parents also can look out for signs that may indicate their children are stressed or may even benefit from counseling.

Much of the stress kids face reflects what’s happening in their families and communities.

“Ever since the COVID pandemic started, my patients have been more stressed out about that specifically,” Dr. Napalinga says. “Kids often pick up on what their parents are going through. If their parents are distressed, then there’s definitely going to be a trickle-down effect.”

The stresses include finances because of economic disruption from the pandemic, and concerns about social isolation, she says. “Or maybe the parents are going through a divorce right now, or separation, and unfortunately it took the pandemic and working from home for them to discover their irreconcilable differences.”

School reopening also is a source of stress for some children, she says. “They’ve been anxious about going into school and getting sick, or if they weren’t afraid for themselves, they were afraid for their elderly family members or those who have high risk pre-existing conditions.”

“The pressures continue for those who go to school online as well. I have some kids who are actually afraid of failing through the online format, especially my kids with learning disabilities.”

Helping Children Cope

Parents can take steps to reassure their children and help them cope with sources of stress, Dr. Napalinga says.

First, do your best to take care of yourselves, she says. Try to take a break if you need it, whether that’s a family vacation or having relatives watch the kids for a few days. For those who have children with disabilities, respite care may be available so parents can get away, even for a short time.

If you are able to take a break, be sure to observe precautions such as social distancing, masks and hand-washing. Before you bring relatives or friends into your home, consider screening for symptoms such as cough or fever to decrease risk.  

Dr. Napalinga recommends taking the following steps as well. Many of them will help parents as well as children cope with a stressful environment.

  • When talking with children about COVID or other sources of stress, use a calm voice and reassuring manner. But don’t go overboard on positivity. Stick to the facts.
  • Focus on controlling what you can. Try to have a regular, though not rigid, schedule. For example, the structure of eating and sleeping at regular times can be reassuring.
  • Do what you can to maintain the family’s overall health. Exercise and eat healthy foods. Try to limit junk food.
  • If news media or social media are a source of stress, limit their use to an hour or two a day.
  • Maintain social relationships as much as possible. Connect with others outdoors, by phone or online, such as Zoom or Skype.
  • Consider mindfulness practices to help focus on the present and avoid excess worry about the future. Meditation or writing in a journal can be helpful. Find out more about mindfulness.

How can you know if stress is affecting a child’s well-being? Napalinga says the stress often will be reflected in sadness, anxiety or an increase in aggressive behavior. The most important indicator is a significant change from how the child normally acts.

Know the Signs

She lists these signs that parents can watch for:

Change of mood (possible depression)

  • Getting more or less sleep than usual, or having nightmares or waking frequently
  • Showing less interest in normal activities, or withdrawal from others
  • Expressing excessive guilt feelings, or blaming others
  • Being more active than usual, or feeling tired and less energetic
  • Having problems with concentration, being more distractible than usual
  • Eating less or more than usual
  • Talking about hurting themselves or feeling worthless


  • Showing a decrease in healthy bodily function, such as less sleep, disturbed sleep or less appetite
  • Becoming more fearful of things that the child didn’t used to be afraid of
  • Demanding more attention from parents or acting clingy
  • Having panic attacks
  • Becoming more isolated or mistrustful
  • Showing obsessive or compulsive behaviors such as excessive handwashing or fear of infection


  • Being destructive
  • Having frequent temper tantrums
  • Showing increased defiance or disrespectful behaviors
  • Engaging in rougher play that may hurt someone
  • Threatening or deliberately attacking someone

When to Call for Help

Sometimes parents are unable to help children cope on their own. Professional help may be needed if changes are so significant they affect children’s health or everyday functioning, Dr. Napalinga says.

For example:

  • Things that they say or do suggest they may be at risk of harming themselves or others.
  • Their health deteriorates because they’re not eating or sleeping properly.
  • They abandon normal grooming habits.
  • There’s a drastic personality change.
  • They’re crying or fearful all the time.
  • Even their friends notice the changes.

Einstein offers individual, group and family counseling that can help children cope with troubling emotions. Call to make an appointment with the Behavioral Health Clinic (215-456-9850) or Einstein Pediatrics Specialties (215-456-7170).

If your child is at urgent risk of harming himself or herself, or someone else, call 911 or contact one of the following community resources. Both are available 24 hours a day, and the response team will come to your home.

  • Children’s Crisis Response Center (215-878-2600)
  • Philadelphia Mobile Emergency Team (215-685-6440)
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