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Mindfulness and Children, a Useful Tool?

Hilary McClafferty, MD, FAAP

Mindfulness is an ancient practice with modern relevance and has been described by John Kabat-Zinn, PhD, a pioneer in modern mindfulness, as staying in the moment, on purpose, without judgment.

Research shows that children can learn mindfulness, and in fact may be natural teachers of it in some situations. An example comes to mind of a young girl I know who was taken to the zoo by her parents as a toddler. While visiting the zebra enclosure, a large inquisitive zebra approached and stood directly in front of the family. The parents were astonished and asked the girl, “What do you see?”, to which she replied, “I see a little birdy!”.  As the adults looked down in confusion, they saw the little girl transfixed and delighted by a small yellow bird on the path who was staring back at her, both were oblivious of the approaching zebra and fully in the moment. 

Mindfulness in children has many applications and has been used in hospital settings with thousands of young patients to cope with pain, fear, anxiety and a variety of medical symptoms. It has also been used successfully in the outpatient setting as well as in day-to-day life. Rather than limiting the idea of mindfulness to being achievable only in a classic seated meditation practice, mindfulness in children is highly adaptable and can be tailored to the age and developmental stage of the child. 

Sometimes linking mindfulness to a physical activity or game can make the idea more accessible. For example, preschoolers in class have learned to quiet their thoughts using brief breathing exercises linked to simple cue words to help them understand, and feel, even if just for a moment, a sense of calm.  Picture them reclining after lunch with a small soft stuffed animal perched on their bellies. Then given instructions on belly breathing, so when they inhale (take a deep breath!) and let their belly soften and expand,  the animal friend rises up, and as they exhale (blow out your birthday candles!) the animal comes back down, then pause for a moment (wait!) before repeating the cycle. This simple breathing game helps them learn the basics of diaphragmatic breathing while experiencing the relaxation response during the pause. This is the physiologic opposite of the stress response. As they master the game, it provides them an introduction to the idea that the mind and body are connected, and they can create the feeling of calm by using the breath as a tool. It also reinforces the good feeling that comes from relaxing, even for a second. Yoga is another practice growing in popularity in children, in part for its focus on connecting mind and body and introducing mindfulness in a fun and appealing way. 

Other simple introductions to mindfulness might include asking children to describe the difference between a snow globe that has been shaken up and after it’s left to settle, or the difference between a very windy day where leaves are flying around and a still quiet day with no wind. Or how a friendly puppy wriggles and moves and has a hard time sitting still until it is tired and wants to lie down for a nap. The snow, leaves, and wriggling puppy represent our thoughts, always moving and changing until given time to settle. Another good example for children is that of watching clouds pass overhead, with the idea that clouds are like your thoughts, constantly moving and changing, but the blue sky behind them remains steady and calm, no matter what the clouds do. This helps introduce the idea of self-control, that one doesn’t have to chase every cloud (thought) that comes up, but can relax and allow the thought to pass whether it be fluffy white or dark gray, without feeling the need to react to, or even to describe, each one- and all while maintaining the steady calm presence of mindfulness (the blue sky) behind the clouds. 

Once children have mastered the basics of mindfulness, it can be introduced into day-to-day life. Because mindfulness is technology free, portable, and nonintrusive it is well-suited to the variety of experiences a child has on a typical day. It can be used in both acute stress situations (test anxiety, or a disagreement with a friend come to mind) and to reduce the baseline level of chronic stress many children experience. Addressing both acute and chronic stress is important, especially because we know that chronic stress is associated with upregulation of the inflammatory response, which is in turn predisposes to a range of chronic illnesses such as obesity and Type 2 diabetes mellitus, increasingly common in children, and fortunately, largely preventable. 

It’s important for parents to remember that children experience stress for a wide range of reasons. For example, they have some anxiety about being away from home, or being at home without a parent, or starting a new school or day care, or starting swimming lessons, or piano, gymnastics, baseball, or worried about whether their friend likes them or if they’ll be invited to the birthday party, or caught up in the trap of self-judgment dictated by social media, or coping with the fears, disruption, and challenges associated with an invisible virus, or with the deadly impacts of societal racism.  Stress triggers are a moving target and today’s children face challenges that many adults can’t even comprehend. 

One of the first steps in implementing mindfulness is learning to recognize when one is feeling stressed. Children can learn to do this, and over time are able to tune into their stress signals progressively earlier to short circuit a full-blown stress response.  Even preschoolers can learn to recognize early signs of stress and substitute a new action. It’s helpful to talk with the child and have them provide their vocabulary for stress. Words like mad, grumpy, upset, worried, ‘I don’t feel good’, my stomach hurts, I have a headache, tired, and so on are common examples given by children before they have learned the word stress and its implications.  Similarly, have the child, from a young age, develop their vocabulary for feeling relaxed, happy, peaceful, calm, safe, loved, and so on to use as they begin to lower their baseline of stress and start to recognize and describe the physical effects of feeling good. 

Research by Sibinga, et al, in a study of underprivileged middle school students in an inner-city population showed that at baseline, a significant number presented with symptoms consistent with post-traumatic stress (PTS), acquired simply through their experience of day-to- day life. This same series of studies has shown the positive power of a mindfulness pilot study in this group, many of whom experienced sustained reductions in anger, anxiety, and depressive feelings. 

The real power of mindfulness comes through consistent practice, even in small doses. Essentially the repetition begins to ‘rewire’ the brain and results in changes in both structure and function of nerve cells over time. Although more studies on children are needed in this area, measurable brain changes have been identified after weeks, not years of practice in adults. Mindfulness also lowers levels of inflammatory markers in the body and has been associated with improvements in blood pressure and cardiovascular health along with reduction in pain, anxiety, depression and overall quality of life in multiple adult studies. 

Much of the research in this area has been done using the 8-week Mindfulness Based Stress Reduction (MBSR) program developed by Kabat-Zinn in adults. The program has been modified to fit children in a variety of situations and provides a useful guide to introducing the skill. 

Steps that can improve consistency have been studied and some of the most effective include starting in small doses, even a few minutes a day at a consistent time. With children some natural openings occur before school, or on the way to school if a car or bus ride is involved, after school quiet time, or before bed. Some families use dinner time as a way to pause before the meal and reflect on a busy day using a mindful approach or use appreciation of the actual meal to hone the skill of being present, in the moment, fully experiencing the act of eating together. Another effective approach to building mindfulness is the practice of gratitude. Planning a few moments daily, or weekly, to pause, focus and have the child record a handful of things they are grateful for has been well associated with improvements in both mental and physical health. This can be done verbally or is even more effective when written. Even a very young child can draw a picture of something they are grateful for and keep a simple journal in a sketchbook or binder to refer to when hitting a rough patch or working on building mindfulness skills. Gratitude practice, like mindfulness, becomes more effective with repetition. 

Mindfulness has many benefits but there are some potential pitfalls to be aware of. Probably the most important is that more children than one might realize live with trauma, either physical, emotional, sexual, or through neglect as some examples. If a child has been impacted in serious ways by trauma, or trauma is uncovered unexpectedly, always consult a trained mental health professional and involve the child’s physician to assure they are properly evaluated before proceeding with any mind-body practice. It is not that mindfulness should be completely avoided- it has been shown to be helpful in those living with high ACE scores (adverse childhood events), but many children require expert guidance and support to return to a state of thriving after trauma, and mindfulness can be a powerful tool to help them. Another pitfall is to rush or force a child into a mindful practice. Some may be too young, not interested, confused, or simply unwilling to try a new thing. That is okay, don’t push. Modeling the desired behavior in a natural way may be the most useful tool at that point. Other children might be embarrassed, fearful of peer ridicule, or prefer to learn mindfulness at school or with a friend, or just on their own. Allowing the child to follow their own pace is the key. Support without pressure may be what’s needed. 

In summary, mindfulness is as straightforward as being present in the moment, with intention and without judgment. It sounds deceptively simple yet takes discipline and repetition to harness its full potential. Even very young children can and do master mindfulness and use it to help them navigate their daily challenges and successes. Learning an age-appropriate vocabulary for both the stress state and the relaxation state is important, as is understanding the link between the mental and physical characteristics of each state. Over time children can learn to detect their earliest stress response signals (tense muscles, increased heart rate, stomachache, feeling like yelling, and so on) and reroute these with fast and easy interventions such as taking three breaths, focusing their attention on a peaceful thought, remembering the examples of the clouds, the leaves, or the puppy to remind themselves that thoughts and feelings can be allowed to pass, and not every emotion requires action. Linking breath with a physical reminder, for example an inhale- exhale with blowing out tension or anger and letting their muscles loosen can be done by school aged-children and is an incredibly useful tool to be used in the moment. Gratitude practice is an accessible and effective exercise for even young children and can help lay rich ground for a mindset of mindfulness. Importantly, practice of the skills discussed helps reduce elevated baseline levels of stress that can be highly detrimental to health and makes the tools easier and more effective to access in the moment of need. Like driving, one could do it in an emergency, but would likely be much more successful at it with repetition and consistent practice. Mindfulness is a useful tool for children, ideally introduced early and practiced often.