Summer is an important time for us as health care providers to start to help children and their parents prepare for the upcoming school year (at least for those areas that follow the traditional school calendar). It's a time when we do many school physicals, update immunizations, and provide advice and information about many important topics such as safety, nutrition, etc. One area that we must address is how to help children and families handle the pressures of school, peers, etc. Recently, health care providers and researchers have focused attention on stress and the negative effects it can have on children. For example, the NAPNAP KySS campaign has a strong focus on helping prevent psychosocial morbidities in children, and stress is certainly a contributing factor to many of these problems.
One factor that appears to contribute to the stress that many children and families feel is over-scheduling, which is common to many of our families. Families (and children) seem to be constantly multi-tasking; there is not time to relax and just have fun…even “fun” activities get scheduled into the PDAs and the family refrigerator calendar. We constantly hear the families we care for complain that they are “exhausted.” that they are always on the go and there's no time to add/do anything else. For many families, that definitely seems to be true! Just recently I was at a neighborhood event and did a quick survey on family schedules and activities (my poor neighbors…someday they'll quit inviting me to things because I'm always checking out some “notion” I'm investigating). I found each of 8 families had at least one day (and most 2-3 days) a week, excluding weekends, when they were scheduled for some activity from 8 a.m.—9 p.m. These were families with elementary school children, ages 8-11 years. To me that is too much…as an adult I find such days overwhelming, and I find it horrible that this is commonplace for many families. In doing a broader survey in the practice setting, I found my neighbors were not unique; this whole community (and I'm sure yours too) seems to be on this hectic pace. Is it no wonder we are seeing children tired, stressed, and overweight? Something needs to be done!
Different approaches are possible to help address this problem of over-scheduled families and increased stress levels. We can tackle the problem at different levels—the individual child, the family, the school, and the broader community. Probably all areas need to be addressed, but we can focus on the area(s) we can directly affect. For some in the school setting, the school would be the target, for others it's the individual children and families with whom we work. Certainly we need more research to see what stress-relieving approaches work the best, but that doesn't mean we can't try something now and see the results.
First, we need to be aware of efforts in the schools and communities to address this problem and join forces with them. Some schools have instituted “homework and activity-free” nights one night a week, when no homework is given and no after-school events are scheduled. Families are encouraged to spend this after-school and evening time as family time—playing, talking, just relaxing and enjoying being together. If such programs exist in the community we need to encourage our families to take advantage of them, talking about the importance of such an evening and encouraging families to participate and not use that time to schedule all sorts of other activities! If such programs don't exist in schools, we can work to initiate them. This is not an anti-homework approach; rather this is an anti-stress program. Children still have sufficient homework on the other days, and schoolwork need not suffer. After-school sports and activities are not discouraged, rather the time they consume is decreased by one day. We need to help families see that such family time is critically important to the health of their children and the family.
One school-based program you might wish to investigate is “Ready…Set… R.E.L.A.X.” (), a research-based program developed to promote stress-reduction activities in the school setting. Children are taught to relax through music, relaxation, and positive thinking. The program can be used with an individual child, a small group, a class, or a whole school. According to Allen and Klein, the program has been shown to reduce anxiety and depression in children and increase self-esteem. To me, an important part of this particular program is that it's easy to follow and has simple activities that anyone could carry out. Further, this program has a strong research base; there has been research using control and experimental groups, and the children were followed for two years. Further, the program seems to help prevent problems, as well as reduce problems in high-risk population (Allen & Klein).
Of course, we don't always have to initiate a formal program to address the problem of over-scheduled families and children. We can take the time to talk about it… and be sure we don't role model our own over-scheduling to the families we care for! We can give families permission to reduce some of their structured and scheduled activities. Often, parents are taking on these activities with and for their children because they think they are promoting their development. While this may be true to some degree, over-scheduling can do more harm than good. We can help families find activities that will promote development in a non-structured manner. For example, taking a family walk or bike ride can promote all aspects of growth and development. Family members can use their verbal skills as they describe what they saw and play games such as “I spy,” focusing on colors or shapes of objects they see. Siblings can run races or work together on a project, building competition or collaboration skills. These types of activities are free, fun and effective. Families can share their experiences; they can better learn about each other, thus building stronger families. These opportunities enhance family communication, making it easier for the family to talk about all types of topics. Further, such activities include physical activity, helping reduce stress itself, not to mention helping with the obesity issue!
Many families seem to have gotten on a treadmill of structured, scheduled activities and can't get off; they run (well, drive) from activity to activity and find themselves exhausted, thinking something must be wrong with them. Removing some of these scheduled activities and stress is a good beginning. As we meet with families during the summer, it's a good time to begin to think about the busy school year ahead. It may help to have the family, or each child, prioritize activities, placing their sports and other activities in hierarchical order and then focusing on just the first two for each child. Sometimes just making such a list is enough to help families see how much they are taking on, and we can assure them that it's OK to reduce some of the scheduled activities. As with other areas of anticipatory guidance, we can really help families deal with the common problem of over-scheduling and increased stress. We just need to be child advocates. We need to be knowledgeable about existing community and school efforts to address this issue. If there are none, it's a good opportunity to start such a program that can have a very positive impact on the children and families we care for. It truly is time for many children and families (and us, too) to reduce the over-scheduling and just have some fun.
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- Ready…Set…R.E.L.A.X..Inner Coaching, Watertown, WI1996
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© 2004 The National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
