Last weekend I took my 4 year old to the dentist for the second time. She hopped onto the chair, put the sunglasses on and let the dentist fill a broken tooth at the front of her mouth. She barely squirmed, thanked the dentist, ran off to collect her toy, and chattered away all the way home. Even more importantly: she didn’t have one meltdown that day, even after we got home and she didn’t have to put her brave face on anymore. This may sound like a normal dentist visit to most people, to us this was a major milestone.
If we had tried this even 6 months ago I would have had to hold her shaking body just for a regular check-up, and for days afterwards we would have felt the aftermath. I’ve written about my own anxiety in the past, and also about how I saw the signs of it very early on in my eldest. She was never one of those “easy” kids that you hear about in books… She only started to sleep through the night a few months before she turned 4, and has just recently kind of started sleeping by herself. Doctors’ visits were traumatic events, for all of us, and we had many of them in her first few years due to a congenital heart defect that was detected when she was three months old. There would be days when I would try to leave the house but give up because it was just too stressful and upsetting.
Anxiety displays itself differently in people, especially in children, and as a parent you often wonder if you are either doing something wrong or making a big deal out of nothing. People tend to blow off your concerns because “kids grow out of it”, or because they don’t really understand. As a person who was able to hide my anxiety from many people, I can understand not understanding: it’s only when you start to see patterns and how certain events trigger reactions that you can see that there may be an issue.
I know full well that people have rolled their eyes when I say that I’ve had a tough day with my eldest, or that she’s very anxious. I know that for a long time I really thought that I was overreacting and that it would all pass, like everything else. I have however learnt that a mother’s instinct isn’t often too far off, and when I finally let myself reach out for help it would actually come.
When Luna was a baby she had to be close to me at all times. I learnt how to cook, clean, shower, eat, and work with a little baby attached to me. People told me it would get easier, and in a way it did, we adapted, and little by little she became more independent over time. She started speaking late, so we experienced many, many meltdowns due to her inability to communicate, and often just because she would become overwhelmed by emotion. Anything a little out of the ordinary, such as a doctor’s visit or a long trip outside, would cause days of upset. The arrival of her little sister probably didn’t help, but surprisingly she took that in her stride. My beautiful little firstborn started to learn to share and to wait her turn, as well as how to navigate a new life across the country from where she was born. Some areas got easier, others got harder.
It breaks your heart to see your child shaking with fear in the doctor’s office. Or worrying about something so much that she vomits. Or having such terrible meltdowns that the word “tantrum” seems inadequate, and all you can do is hold her tight and hope that she stops kicking you, because you know that it is all caused by her emotions being too overwhelming, colliding together at a breathtaking pace. Certain behaviors were controlling, a way for her to zone out of the world of noise and movement, and let her brain calm down. Breastfeeding was one, watching the same videos on the iPad or TV another. I always made sure to let her doctor know how she was doing at every visit and about 10 months ago she referred us to the early intervention team for assessments. Some of Luna’s behaviors had become not only extremely controlling, and she was also showing a lot of aggression, especially towards her sister. Funnily enough she was the opposite with her newborn brother: extremely nurturing and gentle, which is how she genuinely is. Kind, funny, gentle, articulate, and smart. This is also what most people see when they meet her, so I know that often I was hesitant to say anything, mainly because I didn’t want to seem like I was making things up, and also because I felt like a failure a lot of the time.
Why are you still breastfeeding your child at three? Why is your child not listening to you? You are a pushover! Stop staying please when you tell her to do something! Why is your child screaming like that?! Why is she still in diapers? What do you mean she still wakes up in the night? Etc etc.
I procrastinated about taking the next step. I admit to waiting a few weeks, worried about what it would mean for us all. We are alone here in this city with just a few friends and no family members, and we don’t drive (in a city where nearly everything requires a car), and the idea of having to juggle yet another appointment with three kids under 4 and a partner who works around the clock worried me. But Luna’s anxiety had really begun to affect us all as a family, and I couldn’t bear for my child to have to suffer like this anymore at such a young age. If we didn’t help her now I feared that it would be harder down the road. So I made the call and within a few weeks we received a home visit from a family therapist from the children’s hospital. She has been a godsend. I will never, ever regret making that call. She provides immense support for all of us.
We started off with about 5 weeks of assessments. Thankfully these assessments took place at home, and while I was afraid Luna would be on her best “outside” behavior, she was very much her natural self during the assessments, including epic meltdowns. I also made a point to be completely honest about everything the therapist asked me during the assessment, including questions on my own mental health and childhood. While it is hard to formally diagnose a preschooler with a condition (and unless the child has suffered trauma most therapists shy away from it), our therapist determined that Luna definitely required services. I’m sure you can imagine the relief I felt when I suddenly had confirmation that I wasn’t making things up.
Luna was three years old when she was assessed. We came up with an individualized plan that includes PCIT for traumatized children (in two parts), and a plan to wean Luna of certain coping techniques she had acquired, while replacing them with healthier ones. This included breastfeeding, because not only was I triandem nursing at this point, Luna was actually demanding to nurse more than the baby. Rather than being a comforting, bonding time, it had become something fraught with control (on her end), and anxiety (on my side). It was still very important to me that we work the weaning process into the therapy plan, which our therapist understood.
You can find out more information on PCIT here (Parent-Child Interaction Therapy), but basically it’s divided into two parts. The first part is mainly child-led and serves to foster confidence and positive communication, and the second part is mainly parent-led and helps develop boundaries and compliance. It all takes place through play every day, with in-home therapist guidance once a week. We have been doing this since November now, and we have noticed HUGE differences in how Luna reacts and processes everything. It’s actually pretty amazing! The dentist visit is just once example, but on a day-to-day basis Luna is just a lot more comfortable voicing her fears and emotions, coping with stressors and changes in routine better, and is a lot less defiant and aggressive than she was last summer. Her confidence is growing slowly, and her siblings are also a lot less on edge nowadays.
That said it hasn’t been easy. This type of therapy demands absolute consistency and patience. Results happen slowly, and definitely not overnight, and each small change is a victory. It’s honestly hard to see differences on a day to day basis, but all of a sudden you notice something that would seem so natural to anyone else and it makes your heart soar. Luna self-weaned in January, and while the reducing part was tough going for all of us, the actual going from one nursing session to zero happened naturally, which was the best result for all of us. It’s also important to remember that there will never be perfection, in the end we are all human beings and all unique, and children tend to push boundaries at the best of times. We are in no way aiming for any kind of perfection here, but for a happy, confident child who can navigate through life despite her condition.
I needed the reassurance that Luna would have the healthy coping skills to deal with the world, not the unhealthy ones that I know I developed. Asking for early intervention help was best thing I could have done for all of us, as it has taught us so much. First of all that we are doing great, and that we have done nothing wrong, and that a lot of my natural parenting and communication habits are actually the same as encouraged during PCIT. We have also learnt so much about ourselves as parents, including our own needs and triggers. It was sometimes hard to read through parts of the assessment tests because I realized that I should have done this a long time ago for myself. There are some studies available that seem to determine that trauma can be passed through generations, and I think it’s something that we need to look into more closely.
This is an ongoing process… It’s still tough to take all three kids out alone. Potty training is still in the air, a process where Luna and I still butt heads every day. She still will only eat certain foods and they have to be presented just so, otherwise they will not be eaten. We still have meltdowns and moments when we just can’t deal with anything anymore, and Luna still fights sleep as if it’s the devil. Luna still brings up things that happened months, even a year or two ago and we have to go through them together in detail. But every small step we take together as a family brings us towards a happier, healthier, and more confident child who is ready to take on the world. Luna will start preschool in September and I think she will embrace it now, and I am also so much less worried about the idea than I was a year ago.
There is no cure for an anxiety disorder, however it is something that you can learn to live with in a healthy manner without letting it take over your life. It took me a long time to figure it out for myself, and to be perfectly honest I still have my moments! The work we are doing with Luna is ongoing, and her future school is well aware of her needs, so that we can continue monitoring her progress, and get her more help if she needs it.
Anxiety can present itself in many different ways, especially in children. That child who lashes out aggressively, the one who says NO defiantly, the one who refuses to listen, the one who vomits in the car, the one who screams uncontrollably in the middle of the supermarket, the one who says “I’m sorry, I’m sorry” over and over again, the one who wets the bed, the one who hides behind others, the one who shakes when placed in a new environment… All of these and many more can be signs of anxiety. We are lucky because mental health and early intervention help was made easily available to us, mainly because we had a pediatrician who listened to my concerns and observed Luna over the course of a year.
A few people have reached out to me over the past few months asking about anxiety in children and how to get help. All I can say is that each child is different, and each state has different evaluation processes, depending on insurance and program. But don’t be afraid to reach out and voice your concerns – I can promise you they are valid. We need to continue to push for mental health awareness and for accessible help and treatment in all areas, and it’s very important to keep talking about it as much as we can.
For more information on anxiety in children here are some helpful articles: