Not all children are well equipped to deal with feelings of anxiety and stress. By following some simple breathing and relaxation exercises, you can teach them to control their bodies and help them lead normal lives.
Most adults can recognise anxiety symptoms (a dry mouth, racing heart, sweating, headache, stomach ache, nausea, insomnia, frequent visits to the toilet, feeling faint) for what they are. But anxious children may fear that they herald the beginning of a serious illness and may respond to their symptoms with further anxiety.
Anxiety can make children feel miserable and isolated from their friends because of feeling unwell, and knowing (or believing) they are the only ones that feel like that. Children (over age seven) taught relaxation techniques gain a valuable life skill they can draw on at any stressful time in their lives, allowing them to more fully participate in what is going on around them and grab, rather than avoid, new opportunities that come their way. Stressed children can’t learn effectively so their school performance may also increase.
Anxiety symptoms are caused by hyperventilation, tense muscles and negative thoughts. This article shows you how to address the former two causes (negative thoughts being in the realm of cognitive therapy).
When children hyperventilate they take in too much oxygen, which makes them feel ill and anxious. To stop hyperventilation, children need to be taught to breathe diaphragmatically, and to get into the habit of only breathing through their nose (see below). Find out how the children are breathing now by asking them to put one hand on their tummy and one hand on their chest. If the hand on their chest moves, they are hyperventilating. Children may chest breathe because they have got into a bad habit (or they may have been told to stand up straight and hold their tummies in, which prevents correct breathing) but all babies (and animals) breathe deeply into their abdomen which is a natural and relaxed way of breathing.
Now ask the children whether they are breathing through their mouth or their nose. Mouth breathing also leads to hyperventilation (although is unavoidable when people talk). Nose breathing is especially important for asthma sufferers as hyperventilation can exacerbate their symptoms.
When breathing diaphragmatically, the children should slowly breathe in through their nose (mouth closed) to a count of four. The hand on the chest should not move and the abdominal muscles should push out the hand on the tummy. To help get the hang of it, the children could exaggerate the in breath by pushing out their tummy as far as it will go. As they breathe out, to a count of four, their tummy should fall back to its natural position (the air should not be forced out).
Imagining drawing a circle in their mind where the first half of the circle is for breathing in and the second half for breathing out, may help them to breathe evenly. It is important that the children do not breathe in before they have finished breathing out.
Learning to breathe diaphragmatically takes a while to master and children should not expect instant results. Once they have learned this way of breathing, they should do it all the time and check throughout the day that they are doing it (and doing it with their mouth closed).
Another check for hyperventilation is the number of breathing cycles (breathing in and then out is one cycle) they have in a minute. It is normal to have twelve cycles per minute when at rest (such as sitting in the classroom). If the children are breathing more than this, they should check they are breathing deeply and diaphragmatically and are breathing through their nose (it takes longer than mouth breathing).
This is a great deal for children to remember so the next skill should not be taught until they have had time to practise and master their breathing. To help them remember to monitor their breathing throughout the day, every day (which is very important for anxious children), they could put a tiny blob of correction fluid on the edge of the face of their wristwatch or on the strap close to the face. Every time they look at their watch to check the time, this will remind them to check their breathing. The blob on the watch can also be used as a reminder for the next stage of relaxation, which involves their muscles.
Tense muscles are a consequence of anxiety and also exacerbate anxiety symptoms (for example, a child that feels nauseous or has lost her appetite may have spent the day with tense abdominal muscles). Children become so used to the way their body feels that they may be unconscious of the tension in their muscles and need to be consciously taught to relax them.
Follow the relaxation routine described below before trying to teach relaxation so that you can appreciate what deep relaxation feels like and explain it to the children.
During a relaxation session, the children need to be in an environment where they can be completely relaxed with their bodies fully supported such as lying on the floor (on soft gym mats) or sitting in arm chairs with high backs (to support their heads). Their comfort is an important part of relaxation: if they are lying down, they might like to put their coats over themselves to keep warm.
Before starting a relaxation session, children need to know what a tense muscle feels like. Get them to clench their fists and tighten their arm muscles (to make their upper arm muscles bulge). Then tell them to let go so that they can tell the difference between tension and the releasing of the muscle. Children may need to first practise tensing different muscles groups (as described below) so that they can follow the relaxation session.
Use the following instructions (which assume the children can lie down) to guide children through a relaxation session, pausing between each part so that the children are unhurried and they can keep up with each other:
1. Lie down on your back with your eyes closed. (Preferably in a dark and quiet room.)
2. Have your arms by your sides, your fingers gently curled, and your legs slightly apart.
3. Breathe diaphragmatically all the time. (Give a brief reminder.)
4. I’m going to ask you to tense and then let go different muscle groups. We’ll start at the top of your body and move down. Screw up your face and hold for 3 long counts. Then let go and feel the tension leave your face. Notice how it feels to have a relaxed face.
5. Tense your neck and shoulders. Hold for three long counts, and relax. Notice how it feels to have your neck and shoulders relaxed.
6. Tense one arm and hand. Hold for three long counts, and relax. Notice how it feels to have your arm and hand relaxed.
7. Tense the other arm and hand. Hold for three long counts, and relax. Notice how it feels to have your arm and hand relaxed.
8. Tense your chest muscles. Hold for three long counts, and relax. Notice how it feels to have your chest muscles relaxed.
9. Pull your stomach in hard (and pull hard on the muscles that stop you weeing - and pooing). Clench your bottom muscles (buttocks) while still holding the other muscles tight and push the lower part of your back into the floor. Hold for three long counts, and relax. Notice how it feels to have this part of your body relaxed.
10. Tense one leg and foot. Hold for three long counts, and relax. Notice how it feels to have your leg and foot relaxed.
11. Then tense the other leg and foot. Hold for three long counts, and relax. Notice how it feels to have your leg and foot relaxed.
12. Tense your whole body. Make sure your face is tense, your chest is tense, your arms and hands are tense, your tummy, bottom and back are tense. Make sure your legs and your feet are tense. Hold for three long counts, and relax.
13. Concentrate on how your body feels. It feels loose, limp, floppy and relaxed. Your body feels heavy and very relaxed.
14. Keep thinking about your body to check that each muscle group is relaxed. Before you leave one muscle group to check the next one, tell yourself how floppy the muscles are and how you feel your face, arm, leg and so on melt into the floor. Let all your tension go.
15. (The children should stay like this for 20 minutes.)
16. Open your eyes. Now I want you to slowly start getting feeling back into your muscles. Move your arms and your legs. Slowly sit up and look around you. Stretch your body. When you’re ready slowly get up and notice how good you feel. You are now wide awake.
Once this long relaxation technique has been learnt and the children appreciate what relaxation feels like, they can be taught a quick technique that can be done at any time (and does not involve sitting or lying down):
1. Tense all your muscles, including your face muscles, as tight as you can and hold for three seconds.
2. Relax and breathe out imagining hot water trickling down your muscles or imagining that you are as floppy as a rag doll.
3. Remember to breathe diaphragmatically while you feel the floppiness in your muscles.
An alternative relaxation session to the one described can be to follow a relaxation cassette – details of some suitable ones for children are mentioned below.
To get the most out of relaxation techniques, they need to be practised regularly so that they become second nature. A quick checklist of things for children to remember is:
1. Are you breathing diaphragmatically/into your tummy?
2. Is your mouth closed?
3. Are your muscles relaxed?
Every time children see that white spot of correction fluid on their watch, they can check these three points.
The Royal College of Psychiatrists suggests that between five and ten per cent of children and young people have anxiety problems bad enough to affect their ability to live a normal life.
Children of any age are susceptible to anxiety but it is generally recognised that it is not possible to teach relaxation techniques to children aged seven and under.
Teaching relaxation skills to children with Asperger Syndrome can increase their anxiety: they need to learn to deal with their anxiety in other ways such as distraction, time out and physical activity.
Relaxation techniques need to be first learnt and practised by the teacher intending to teach the children.
Everyday breathing should be done through the nose so that the hairs in the nose can filter out dust and other particles, and the air can be warmed and moistened before reaching the lungs.
Diaphragmatic breathing is an excellent way to reduce anxiety as it can be done anywhere and no one can tell that the child is doing it.
The more children breathe diaphragmatically, the more they can reduce their symptoms of anxiety.
Márianna Csóti is the author of School Phobia, Panic Attacks and Anxiety in Children published by Jessica Kingsley Publishers ISBN 1843100916, price £16.95. It is packed with information and guidance for parents, carers, teachers and other child-support professionals, on dealing effectively with the difficulties of children whose lives are being adversely affected by school phobia and related anxieties. Márianna Csóti taught in Brent and for the previous six years was a houseparent at an international sixth form college.
First published in Special summer 2004