Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And we're joined today by Dr. Andrea Temkin-Yu. She's an attending psychologist and Assistant Professor of Psychology in the Department of psychiatry at Weill Cornell Medicine. And she's here to talk to us today about managing back-to-school anxiety for children and families.

Melanie Cole, MS: Dr. Temkin-Yu, it's such a pleasure to have you join us again. Right off the bat, as children are getting ready or even thinking about going back to school, what can parents do to help lessen their children's anxiety? What can they do during the summer to prepare our kids for the fall?

Andrea Temkin-Yu, Psy.D: Thanks so much for having me back. It's great to be here and talking about this because this comes up so much for the families that we see. There's a little bit of a balancing act here. We want to help our kids prepare. And if we're talking the middle of summer, it can be a little counterproductive to start talking about it every day for the next six weeks. My very first recommendation is just to enjoy summer. It's nice for kids to be kids. It's nice for parents to have a break from all the activities and all the oversight. And keep in mind that letting your child have those moments of joy, find things they're engaged in, that can be a really big buffer for anxiety come fall.

Now, as you get closer to the school year, you know, the handful of weeks right before the school year starts, then I think it's helpful to get a little more specific. So thinking about, "Okay, what is it that really stresses my kid out? Is it academics? Is it social dynamics? Is there a pressure to succeed?" If you can talk with them or if you have a hunch and can sort of narrow down the main source of worry, then you and your child can find a way to build in some practice and plan ahead.

So if you have a child who's really nervous about making friends, it's a good idea to start doubling up on those visits to the playground with other kids or encouraging some extra hangouts with their buddies. You can start to have some short conversations about the types of activities that are happening during the school year that might be good for them to try. We're just sort of planting seeds. And then finally, you can think ahead about what you and your family can do to put in place some good supports and some buffers for your kids. So, this might mean scheduling some really fun outings for the weekends in September, or maybe planning on a little extra special time with close family during that transitional period. Maybe you as a parent say, "Okay. Look, we're just going to ease up on the chores for the first two weeks of school," because we know that's a hard point for our kids. So, finding ways to help your kid get a little bit more breathing room and a little bit of extra support in those early weeks of school can go a really long way. The details of what you do are up to you and your child. But no matter what, we all just feel better when there's a plan in place.

Melanie Cole, MS: Well, that makes excellent sense. And I really agree with you about the chores thing. I didn't always probably do it the right. I was like, "Well, you still have to clean your room." But then, I kind of realized that, yeah, there are those times and exceptions when we can put that aside and just say, "Okay. Now, you get used to school and then we'll worry about you cleaning the bathroom" or whatever it is. So yeah, great advice.

Now, how can we tell if our child is anxious about getting back to activities in school? Are we looking for certain behaviors and symptoms? Are we looking for them as you were pointing out right near the school time or once they get back into school? What are we looking for?

Andrea Temkin-Yu, Psy.D: We can usually start to see some worry popping up before school has even started, and avoidance is really the big signal that we're paying attention to. So by avoidance, I mean any times where our kids seem to be withdrawing from things pulling back from things trying to steer clear of those conversations. For some kids, this might be actually voicing hesitation or doubts. "I don't know about school this year. I wish I could go back to my old classroom. I just want it to be summer forever." Some kids might refuse to talk about school all together. You want to go through the schedule, they say, "No, not now. I never want to talk about it." Some kids might listen to the conversation, but you see they're really agitated or looking a little panicky. Maybe they stall on shopping for school supplies or they won't try on their jeans to see what fits and what they need new of. Some of this is typical kid behavior. But if it's happening really a lot, if you can never get them to try on the jeans, if you can never get them to look at the schedule, you probably want to be on the lookout those first weeks or two of school, because there's a chance that that anxiety is a little higher than we'd want to see.

Melanie Cole, MS: As we think about, and we're going to talk about what we can do to support our children and even maybe what the schools can do to help us with that, I'd like you to point out as we're in the summer, our kids sleep later if they don't have camp or summer school, school performance, sleep, attendance are all interlinked. As they're getting ready, Dr. Temkin-Yu, speak about sleep and why it's such an important issue to begin their routine early and what you would like parents to know about that bedtime routines, especially for our littler kiddos and the ones in elementary school, because they kind of get out of that routine in the summer, but then we got to kick them back into it in the fall.

Andrea Temkin-Yu, Psy.D: Yeah, that transition is so hard. But you're completely right, sleep is really important. There's some research out there that shows that kids who have shorter amounts of sleep or even kids who just think they're getting less sleep than they need, they tend to miss more days of school than kids with average amounts of sleep or who feel like their actual sleep meets their sleep needs.

Another interesting factor is that kids who have really different bedtimes on weekends versus weekdays are more likely to have school absences. And we see that these same factors are linked to lower GPA, lower academic performance. And there's a lot of reasons why that might be. We know that poor sleep or lack of sleep can really impact mood. It can influence concentration and memory. As we know, as adults, it's just harder to cope with stress when we're tired. So, there's a lot of reasons why we know sleep is going to impact kids and teens and why we want to be motivated to get back on track.

In an ideal world, everyone just goes to bed and wakes up at the exact same time every day, even if it's summer. But of course, that's not very realistic for most people. So, I usually talk to parents about trying to get back on a regular sleep schedule in the two to three weeks before school starts. And this usually means pushing bedtimes earlier and wake up times earlier between like 20 and 30 minutes each day until they're back at the time that your child really needs. For little ones, this can be a little bit easier because their natural sleep cycle isn't so delayed versus teenagers, their internal clock says, "Yes, yes, please stay up until 10:30, 11:00, 12:00." So, that shift is really tricky for them.

But regardless of your child's age, a bedtime routine can be really helpful. And essentially, the idea is that if you do the same routine every single night, it becomes a cue for your brain that it's time to wind down. So over time, just starting the bedtime routine will trigger a sort of sleepy reaction for your kids. There isn't a perfect bedtime routine that everyone has to do. But in general, it should not include screens, which I know is tricky in those evening hours.

Melanie Cole, MS: So tricky.

Andrea Temkin-Yu, Psy.D: It's so hard. Everyone wants it, right? Kids want that last 30 minute show. The official recommendation is actually no screens within two hours of bed. I think that's impossible for families, so I'm usually trying to get kids to commit to maybe like no screens for 30 minutes before bed. That's usually a little bit of an easier pitch.

Besides taking out screens, we also want to think about what we're putting in place instead. So, I really want to work with kids to think about, "Okay. What's going to help your body feel calm? What's going to help your brain feel quiet?" This might be sensory things like washing their face, taking a bath, putting on a lotion or a cream that smells really nice. We know that kids do better when the room is dark and cool. If kids want a white noise machine, that's fine too. And then, we can also think about activities that just help their brains transition from everything that was going on during the day to sleep, so something like a book, doodling, a crossword puzzle, activities that are sort of low key and quiet. I would not recommend like the really thrilling adventure series that is, you know, keeping your kid up later and later, but just something that's sort of a soothing activity they can do every single night. And once you get that consistency going, it'll be easier for your kids to feel tired when it's time to go to bed.

Melanie Cole, MS: Well, that was excellent advice right there. And I can tell you, you know, the kids want to stay up on TikTok until the phone falls on their face, you know, literally because they're holding their phones and it falls on their face because they fall asleep, which does crack me up. But no, I know because it can be upsetting, it can be electrifying. You know, it can really start to stimulate their brains as opposed to settle down. So, that's just really great advice. And parents, I know it's not easy, but we still have to try.

Now, if we find out that our kids really are anxious, all the red flags you pointed out, when do we involve our pediatrician or a mental health professional? What are some things first, Dr. Temkin-Yu, that we can try as parents? You know, you've talked about bedtime routine, you've talked about taking the schedule off the table too early before it gets to school time, trying some outings, trying to ease their anxiety that way. But what else can we try or when do we get you guys involved?

Andrea Temkin-Yu, Psy.D: So, let me start with what the parents can try. So, the first thing you can do is talk to your kids. Validate what they're going through and come up with a plan and I'll walk through those a little bit. So if you're noticing signs that your child is worried, ask them about it. You know, some of them are happy to tell you why they're so concerned and upset. If so, great, you have some good information to work with and you can probably do some problem solving with them. Some kids aren't really sure why they're so worried, and that's okay too. Either way, you can validate how your kid is feeling, which means just acknowledging their experience. It's really tempting to try to minimize the worries, right? We say, "Oh, it's not a big deal. You'll love it after the first week" or, you know, "It's okay. I know you were worried last year, but you got over it. It'll be the same this year." Those comments are totally well intentioned, but for your kid who's really scared in that moment, that doesn't always feel so great. So instead, we can try just saying, "Look, I understand you're worried. Transitions are hard for a lot of people" or "I know you care so much about doing well in school, so it makes sense that you're feeling on edge." It really sends the message that you can see their perspective and you're there for them, and that goes a long way at taking down the stress level.

After that, you can try to do some problem-solving if there is a specific worry like, "I think that teacher's really hard" or "I won't have time to see my friends and get my homework done." And if there isn't a solution to be had, you can help figure out ways for them to cope ahead of time. So, what are some helpful thoughts they can use that help them feel calm or happy or in control? Do they have activities that soothe their body like deep breathing or picturing a safe space? Can we brainstorm a list of supportive people they can talk to during the day, like a guidance counselor or a favorite teacher, their best friend? And does the family need some sort of daily routine that either helps their kid feel up and ready in the morning and then calm and relaxed when they get home? So, parents have a whole bunch of options that they can try on their own.

You're also more than welcome to reach out to a pediatrician or mental health professional at any point where you feel like it might be important to. So, this can happen at a few different points. One is if that avoidance that we talked about before starts to really tick up. So if they're starting to not do the stuff they're supposed to do, they're not seeing friends, they're refusing to try those new things that you actually think would be really cool, that tells me that we probably want to get some extra support. If your kid is doing all the things they have to do, but they're just really stressed, they come home every day and they seem overwhelmed, that's a good sign that we might want to get support. And then, even if you or your child doesn't feel like there's anything totally awful yet, but they just want a little extra help, another great reason to go. Some parents are really worried about wasting their pediatricians time or maybe it's not bad enough yet, it's not a problem to go in and get support if you're just not quite sure where your child is landing. And I, myself, would be more than happy to talk to someone who just doesn't know, rather than feeling like they have to wait for a crisis.

Melanie Cole, MS: I agree with you and our pediatricians are really our medical home. That is they help us raise our kids and that is so, so important. So, I know that we should not hesitate. Oh, you should have heard my pediatrician. I go there all the time. But I mean, that's really what it's all about. And you're so sweet and caring, Dr. Temkin-Yu, that I just imagine the parents, they feel so at ease with you working with their children. Before we wrap up, what about involvement in extracurricular activities? If we have children that we know are already a little bit anxious, how do we help them find something that they will enjoy? Because we know that this can help bolster their self-esteem, make friends, give them a sense of team, satisfaction, all of these things. But if they're an anxious child, then sometimes that seems to be like a push that maybe we shouldn't be doing. What are we supposed to do there?

Andrea Temkin-Yu, Psy.D: Great question. It's really hard because we never want to feel like we're forcing our kids to do something and making the stress worse. And we also know that there's really big potential for these activities to go over well with our kids if they just give it a try. I think it's a good idea to encourage some involvement in extracurriculars. Those could be a lot of different things. It could just be more socializing, it could be volunteer work, it could be hobbies they do on their own at home, it could be school clubs. So, one thing is just to keep an open mind about what kind of activity might be a good fit for your kid. Sometimes parents have pictures in their brain of what's the right activity and it doesn't always match their child's strengths or preferences. But once you've picked an activity or two that they think they might be interested in trying, really trying to give them some good validation and encouragement. So, I know it's hard to try new things and you do such a good job of challenging yourself. It's really scary to start new stuff and you've done a beautiful job in the past when you put yourself out there. So, we're sort of holding the fact that this is hard for them and we know that they can do it.

And the other thing I think is really helpful for parents is to talk with their kids about what their kids want. What's their kid's long-term goal? Do they care about having more friends? Do they want to feel more in control rather than letting anxiety make decisions? If we can help them see how trying new activities or participating in clubs or hobbies can help them meet their goal, then we usually get a little less pushback. It doesn't mean it goes away entirely, but we're aligning with what they care about rather than just pushing what we care about on them.

Melanie Cole, MS: Well, that's certainly true. And I know a lot of parents or some parents really do have that vision for their child. They want them to play soccer or baseball or whatever it is. And we can't really push them if it's not something that they're-- we could do a whole show on that, Dr. Temkin-Yu, and whether we're supposed to leave our kids if they don't like a sport and make them finish out the season. You know, that's a whole podcast in itself. But as we wrap up, best advice for parents right now as our kids are going to get ready to go back to school and what you want us to know about helping them along and helping them so they're not so anxious.

Andrea Temkin-Yu, Psy.D: I think really trying to be there for your child when they need it, which of course we all want to do, but sitting with them when they feel worried or stressed, validating the emotion that they're experiencing goes such a long way, and then trying to come up with plans ahead of time. Rather than waiting for that first day of school when they come home bawling, figure out the week or two before, "What are my options going to be to support my child?" You'll feel more prepared, more ahead of the game, and you'll be able to make sort of strategic parenting choices that align with your values, rather than feeling like you have to make a, you know, rushed, in-the-moment reactive decision, because now your child is really upset or worried.

Melanie Cole, MS: Thank you so much. What a great guest as always that you are. Thank you so much for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate and review Kids Health Cast on Apple Podcasts, Spotify and Google Podcasts. For more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole. Thanks so much for joining us today.

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