Symptoms of Depression

Depression is the most common complaint presented to mental health practitioners. This is not surprising; almost all of us have experienced sadness at some point in our lives, with some episodes being quite intense. However, clinical depression is not just sadness. It is a multifaceted illness that affects every aspect of a person’s functioning. It causes major distress and disrupts the sufferer’s ability to carry on with work, school, or other responsibilities. The illness can occur among the young and old, the rich and poor, the educated and the uneducated, and it can come at any point in a person’s lifetime. The good news is: depression is treatable. When sufferers are trained to spot the early symptoms, the onset of depression can be managed and relapses can be avoided.

What are the Symptoms of Depression?
Symptoms of depression can be classified into four categories: emotional, mental, behavioral and physiological symptoms. Let’s take a closer look at each one:

Emotional Symptoms of Depression
Mood disturbance is the most significant among the symptoms of depression. An individual with depression may be prone to feelings of sadness, emptiness, dejection, helplessness, hopelessness and lack of self-worth. Episodes of crying, irritability and/or of anger are also common. A marked loss of interest in work, relationships and self-care may also be seen.

Mental Symptoms of Depression
There are also cognitive symptoms associated with depression. Psychologist Beck believes that people with depression are tortured by what he calls the cognitive triad: a negative view of one’s self, a negative view of the world and a pessimistic view of the future.

Self-accusation and mental anguish are typical, especially when the obsessions start to come. For instance, a depressed individual may constantly tell himself that he is ugly, incompetent or unwanted; that others do not care about his welfare; and that tomorrow will offer no relief. It is this cognitive triad that keeps a depressed person stuck in the rut, unless some form of therapy is conducted to correct and heal the debilitating thoughts.

Depression can also cause a person to have difficulty making decisions or concentrating on tasks.

Behavioral Symptoms of Depression
Depression may be about an internal state, but symptoms of depression can be objective and observable. In many cases, physical appearance already provides a clue regarding the depressed person’s mental health. People with severe depression may not care much about their appearance or even their hygiene. They may gain or lose significant amounts of weight. Their movements may be slower or faster than those of the average person, and there may be a delay in their communication. They may have difficulty in accomplishing their job or otherwise carrying on their normal tasks. They may withdraw from others.

Physiological Symptoms of Depression 
Depression is an illness that affects the entire person — his or her physicality and biological processes included. People with depression suffer from disturbed patterns of eating and sleeping. They can have loss of appetite or an increase in appetite (what is called emotional eating). They can suffer with various forms of insomnia (trouble falling asleep, staying asleep, waking up in the wee hours, etc. Or, they can end up sleeping much longer than the average person. They may be more prone to ailments such as heart conditions, stomach disturbances, infections, unexplained pain and vague disorders.

If you or loved one has symptoms like those above, consult a doctor or mental health practitioner. Treatment not only provides more rapid relief than “waiting it out,” but also helps prevent recurrences of the disorder.

Wakes Up Too Frequently

Like adults, children can wake up in the night.  They may do so for any number of reasons, depending on their age, health and unique characteristics. However, when a child awakens in the night, other members of the household may be disturbed (i.e. siblings sleeping nearby or parents in their own room). If nighttime awakenings happen only on rare occasions, it’s not a big problem. But what if a child routinely wakens in the night and does so more than one time?

If your child wakes up too frequently, consider the following tips:

Babies Naturally Wake Up Often
Newborns and infants wake to feed every 90 minutes or so. There’s not much that can be done for this age group; they’re SUPPOSED to wake up in the night every couple of hours. The best solution for tired parents is to try to catch a few naps in the daytime. Sleep when the baby sleeps in those early weeks and for as long as you can manage it. Some people are able to afford night nurses so that they can sleep through those night wakings, but many cannot. Some couples trade off in the night, so that each one only loses half the sleep. Some people take the newborn into bed with them, finding this less exhausting than having to get out of bed and walk down the hall to another room, or even to get out of bed and go to the baby’s cradle in the same room. Some folks can afford daytime help that allows them to take a generous snooze in daylight hours. Those who have only the one baby or other kids in school, can and should try to nap when the baby naps. The good news is that this stage of life eventually passes and babies will sleep for longer stretches. Some babies will actually sleep right through the night from 8 or 9 months of age. Some will accomplish this later – say at 14 or 16 months. And some, will not sleep right through the night until they are 6 years old!

Toddlers Still Seek Parental Comfort at Night
While some toddlers sleep through the night without interruption, there are many who don’t. In this latter group, some children awaken just once and then settle back to sleep for the night. Some want a little parental presence, while some want a lot (i.e. they want to climb into the parents’ bed). If parents provide that presence (either by letting him in their bed or by patting him back to sleep), some of these little ones will just go back to sleep for the rest of the night. If you are fine with that, go ahead and let it happen. All kids eventually outgrow the need and desire to sleep in their parents’ bed. However, if you prefer to train your child to stay in his own room for the duration of the night, you will have to do a bit of nighttime sleep training.

To begin with, you need to understand that parental touch and presence is comforting and pleasant for small children. When little kids enter a light sleep cycle, they often call out for this touch or presence. If parents are willing to pat the child back to sleep, or talk to him or hold him and rock him, then the little night-waker may expect this service each time he wakes up in the night. In order not to have to provide it, you will want to create a scenario in which the child must soothe HIMSELF back to sleep. Once you accomplish that, the little one will put himself back to sleep after waking in the night.

Parental Consistency is Key
Put your little one to bed in the usual way. Provide a night light, soft toy and other comforts and then leave the room. If the child wakes up and calls for you, you can come to the room – but do not pick up the child or touch him. Simply tell him that it’s late and he should go back to sleep. Then leave. If he calls again, wait a bit and then come back and tell him the same thing. Don’t stand too close – it’s best to stand in the doorway. Each time he calls for you, wait a little longer before coming. The idea is to provide reassuring presence without providing reinforcing contact. When the child figures out that he’s not going to get much out of this and it’s getting to be hard work for little payoff, he usually stops calling for parents and just stays asleep. Keep in mind that if you decide to do this with your child, you cannot interrupt the process by taking the child into your bed. Some parents make exceptions and let the child come into their bed when he is sick or when he has been crying for a long time or even when THEY are just too tired to deal with it. Providing these exceptions causes the child to learn that it’s worth staying up and screaming for as long as possible because it might just yield some positive results! If you take the child into your room even once in awhile, it can become impossible to get him to stop waking up in the night.

School-Aged Children Wake for Different Reasons
When bigger children are waking up frequently in the night, there is something wrong. Some kids are fearful of sleeping in their own room or being separated from their parents. Whereas such feelings are common for two and three year-olds, their existence in kids over six might indicate the presence of some anxiety. A mental health professional should be consulted. Some kids wake up because of various health problems. Always have a pediatrician do a full workup to determine if a physical condition is causing the frequent waking. For instance, it is possible that the child suffers from a breathing difficulty known as “sleep apnea.” If doctors have agreed that there is no emotional or physical cause for frequent nighttime awakenings, then you can safely use behavioral interventions to help the child. As for younger children, make it clear that you expect the child to stay in his or her own room. Let the child know that YOU need your sleep and you will NOT be tending to his or her needs once it’s night. Provide the child with books, crayons or puzzles to entertain him or herself with, should awakening occur. Make it clear that no one can be disturbed, including other children in the house. When the child sees that everyone is sleeping and no one is coming to look after him or her, the child usually decides to stay asleep. However, if your child insists on coming into your room and disturbing you, feel free to inform him or her that causing you to wake up will result in a (significant) negative consequence the next day. If necessary, be sure to apply the consequence (show the child you mean business!). Be consistent. Apply the consequence each day that follows night time disturbance. Hopefully, the child will soon get your point. If he or she fails to learn, see a professional counselor for further suggestions.

Sleeping Issues

There are many sleeping issues that babies, children and teens may have. Many of them are the “normal” sleeping issues that almost all parents deal with in the course of raising children: in one way or another, the child isn’t sleeping enough. Perhaps the child isn’t sleeping right through the night, or isn’t going to sleep early enough, or is waking too early. It’s true that some kids wake up too late, but those children usually went to bed too late also. (It’s also true that some kids go to bed on time and get up late, meaning they are getting too much sleep, but this is a relatively rare sleeping problem that is usually attended to by the child’s medical doctor.)

However, there are other fairly common sleeping issues that youngsters may have includiing some of the following:

  • suffering from night terrors (screaming with fear without dreaming, can’t be consoled, forgetting it happened)
  • suffering from nightmares (experiencing scary dreams, usually remembered upon waking)
  • experiencing insomnia (trouble falling asleep or staying asleep)
  • suffering from restless leg syndrome (painful or uncomfortable sensations in the limbs that disturb sleep)
  • breathing problems like sleep apnea (interrupted breathing that causes snoring and/or waking throughout the night)
  • sleep-walking
  • experiencing unrestful sleep
  • tooth grinding

There are also other, more rare, disturbances of sleep that can affect people of all ages. If your child has any sleeping problem whatsoever, consider the following tips:

Common Causes of Sleep Issues
The “normal” sleep issues are caused by childhood! Babies just want to be with their parents 24/7 and suck and snack throughout the night. Toddlers also want to be with their parents and tend to wake with the sun. School-aged and older don’t like to go to bed – they are too enthused by life and all its stimulating activities. Adults also often have that problem! In our modern society, light bulbs give us the opportunity to keep  active all hours of the day and night and with the exception of a small number of children, adolescents and adults, most people want to stay up too long.

In addition, dietary factors may affect sleep. Having too much caffeine in the evening (available in soda as well as chocolate, coffee and tea) can cause excessive wakefulness at bedtime. Sugar can do the same.

Many sleep problems can be caused by physical and emotional issues. For instance, depression, anxiety and ADD/ADHD are just a few of the many disorders that can affect a child’s ability to sleep well througout the night. Depression can cause wakenings between 1 and 3a.m. or early termination of sleep around 4:30 or 5a.m. Anxiety in the form of “separation anxiety” can prevent children from sleeping happily in their own rooms or their own beds. ADHD can cause problems in settling down to sleep, staying asleep, or feeling rested by sleep. Physical conditions such as chronic pain, itching, breathing problems, endocrine and metabloic diseases, neuromuscular disorders and many other conditions can interrupt sleep.  There are also substance-induced sleep disorders caused by alcohol, illegal drugs and medicines.

What can Parents Do?
The normal sleep issues are best addressed by healthy sleep routines (see the articles on “bedtime problems” on this site). Understand that babies and small children normally wake many times in the night and eventually outgrow this practice (with or without help from their parents). You can read all the sleep books you want, but if your child still has waking issues, keep in mind that this is normal in kids up to around 5 years old or so. Nonetheless, always describe your child’s sleeping difficulties to your pediatrician just to rule out medical causes.

Helping Them Fall Asleep
Some babies, kids and teens have trouble getting into sleep mode. They cannot settle down either emotionally or physically or both. It’s as if their “on button” is stuck in the “on” position! These children can benefit from a wide range of interventions that your pediatrician, naturopath and mental health professional can suggest. Be prepared to spend time and effort in experimentation – it takes professionals awhile to diagnose the cause of sleep-onset disturbances and it takes parents time to see which interventions will make a positive difference. Don’t blame your child for having this sort of trouble. He’s probably not very happy with the situation either. Older children and teens may be able to participate in their “cure” by learning relaxation techniques (meditation, visualization, breath work) or modifying their habits (to include more exercise, dietary changes, quieting activities in the evening). Even so, the “how-to” of good sleep hygiene may have to come from a professional rather than the parent. Somehow kids take outside “authorities” more seriously than Mom and Dad.

Getting Them Back to Sleep
It would be less of a problem if those children who woke up didn’t wake their parents up! If they would wake up and then just turn over and go to sleep, it would actually be a totally normal process – humans don’t actually tend to sleep 8 hours straight without interruption. Rather, they wake up frequently during the night but then go quickly back to sleep. Parents work hard to help their youngsters stay asleep all night, but their efforts would be better directed to helping children soothe themselves back to sleep. Again, a team of professionals may be helpful in this regard, offering self-help strategies ranging from relaxation strategies to sniffing essential oils that have been prepared for the occasion. Breathing problems can contribute to frequent waking, as can other physical health conditions, so it is important to talk to your child’s doctor about this symptom. In fact, be sure to tell your child’s doctor everything you can about your child’s sleeping problems. Even if everything checks out fine on the physical front, parents will want to do something up their child’s night time wakefulness. Naturopaths may be of assistance: professional herbalists, for instance, can sometimes create a special tea for the child that will strengthen the youngster’s ability to sleep deeply and steadily through the night. Homeopaths may be able to address the condition as well. Sometimes hypnotherapists or child therapists will have expertise in this area as well. Sometimes nothing will help the child stay asleep, but parents can still help the child to stay in his bed – mental health professionals can provide techniques ranging from positive reinforcement to negative consequences.

Consult a Professional
In any case of sleeping issues, do consider consulting your child’s pediatrician for further advice and guidance.

How to Raise Your Child’s Emotional Intelligence

Emotional Intelligence (E.Q.) refers to “people smarts.” A person with high emotional intelligence understands both himself and others. Not only does the person understand people, but he also knows how to make them feel comfortable – he knows how to bring out the best in others. As a result, the person with high E.Q. experiences more success in relationships and at work. Kids with high E.Q. have better relationships at home and at school, with kids and with adults. Moreover, high E.Q.in children and teens is associated with better academic performance, better physical health, better emotional health and better behavior. In adults, high E.Q. is associated with better performance in every area of life.

What can you do to help foster your child’s emotional intelligence? In this article we will discuss ways one can boost their child’s emotional intelligence.

Adapt an Authoritative, Not an Autocratic Parenting Style
Parenting style has a huge influence on children’s emotional intelligence. When parents can guide their children while still being sensitive to their feelings, children have higher E.Q. Authorative parents are warm, but consistent in setting appropriate limits and boundaries. They will use discipline, but not at the expense of respectful communication and care. Their children will learn how to be sensitive to others and they will also learn how to “talk to themselves” compassionately, modelling after their parents. This gentle self-talk becomes a major aspect of their emotional intelligence, a tool they can use to reduce their stress in a healthy way.

Autocratic parents, on the other hand, don’t care that much about the child’s feelings. Instead, they focus on the rules of the household, what is allowed and what is prohibited, what the child may and may not do. Sensitivity to the child’s inner world is missing. In this case, children fail to experience parental empathy and as a result, fail to learn how to soothe their own upset emotions. They may attempt to relieve their discomfort by becoming aggressive, acting out their feelings. Eventually they may turn to comforts outside of themselves such as addictions (to food, alcohol, drugs, etc.). Acting out and addictive behavior reflects lower E.Q.

The more feeling words used by parents and educators, the more sensitive a child becomes to his inner reality. Most of us tend to use few emotion words in our dealings with children, and when we do, we often use the same few tired ones over and over.  It is important that we move beyond “mad,” “sad,” “glad,” and “scared.”  Shades of feeling are most helpful and can be used when describing our own feelings or the child’s feelings. Words like irritated, annoyed, frustrated, anxious, worried, terrified, alarmed, disappointed, hurt, insulted, embarrassed, uncomfortable, unsure, curious, interested, hopeful, concerned, shocked, elated, excited, enthusiastic, let down, abandoned, deserted, mellow, calm, peaceful, relaxed, bored, withdrawn, furious, enraged, frightened, panicked, and proud can be used DAILY to help provide an emotional education in the home or classroom. These are the regular feelings that children have in facing life, stimulated by everyday experiences, dreams, movies and even novels. Identifying a youngster’s emotional reaction and feeding it back to him, helps him to become aware of his inner processing. This information then forms the core of his emotional intelligence, providing an accurate barometer of his response to his world. From this place of inner certainty, a child is well-equipped to navigate life, knowing what he feels, what he is searching for and when he has attained it. His familiarity with the world of feelings allows him to connect accurately and sensitively with others. This prevents him from hurting other people’s feelings with words and further, permits him to achieve great kindness and sensitivity in his interpersonal transactions.

Here are some practical steps you can take to bring feelings into focus:

  1. Respond to your child. From the time your child is a crying infant to the time she is a young adult, be sure to be responsive. This means that you take her communications seriously. If she cries, try to come (instead of making her cry it out.). If she asks for something, try to answer her promptly. If she talks, you listen and respond appropriately. All of this responsiveness builds emotional intelligence because you are giving your youngster valuable relationship feedback. In the opposite scenario, in which a parent either fails to respond or responds only after a long waiting period, the child learns that people tune each other out. This causes the child to shut down. She assumes that her feelings aren’t that important based on lack of parental responsiveness and from this concludes that people’s feelings aren’t that important – the very OPPOSITE of the conclusions made by emotionally intelligent people. Quick responsiveness gives the message that people’s feelings matter. This is a prerequisite concept for emotional intelligence.
  2. Use a FEELING vocabulary. Pepper your daily conversation with “feeling” words. You can name your own feelings. Let your child know that you feel excited or dismayed or discouraged or resentful or whatever. This gives your child the vital information that everyone – including parents – has feelings and an inner life. Some people do this naturally, of course, but many do not. For instance, when a child is making too much noise, a parent may just say something like, “Can you please quiet down?” However, the Emotional Coach would say something like, “I’m starting to feel overwhelmed with all this noise going on. Can you please quiet down?” Similarly, a regular parent might give positive feedback to a child in this way, “I like the way you waited patiently in line with me at the bank today.” An Emotional Coach, on the other hand, might say something like, “I felt very relaxed with you in the bank today because you were waiting so patiently.” In other words, the Emotional Coach looks for opportunities to describe his or her inner experience. It is this description that helps the child begin to build an emotional vocabularly that will open the doors to Emotional Intelligence.
  3. Name your child’s feelings. Children feel feelings all day long but not all parents comment on them. In fact, many parents are more practical, focusing on solutions to problems. For instance, if a child is upset because there are no more of his favorite cookies left in the jar, the typical parent might say, “I’ll pick up some more for you when I go shopping this week.” While that solves the problem, it doesn’t build emotional intelligence. An Emotional Coach might say, “Oh, that’s so disappointing! You really love those cookies! I’ll pick some up for you when I go shopping this week.” The extra few words acknowledging the child’s inner world (“Oh that’s so disappointing”) make all the difference when it comes to building Emotional Intelligence. Similarly, parents often try to get kids to STOP their feelings or at least SHRINK their feelings by saying things like, “Just calm down – it’s not such a big deal” or “There’s nothing to be afraid of,” of “Don’t make a mountain out of a molehill.” The Emotional Coach, on the other hand, accepts all the child’s feelings, giving the child the name for what is going on inside. “I can see how upset you are,” or “You’re really scared about this,” or “It so important to you,” and so on. By accepting all feelings as they are, the Emotional Coach teaches kids not to be afraid of or overwhelmed by feelings. This is a very important part of becoming emotionally intelligent.
  4. Teach your child how to express emotions appropriately. While all feelings are acceptable, all BEHAVIORS are not. It is not O.K. to hit and scream just because you feel angry. It is not O.K. to cry for an hour at the top of your lungs just because you are disappointed. Parents must teach children – by their example and by their interventions – the appropriate behavioral expression of emotions. For instance, parents can teach children to express their anger in a respectful way by saying things like, “When you are mad at your brother for touching your puzzle, just tell him ‘I don’t want you to touch my puzzle. I’m working hard on it and it bothers me when you move the piece around.’ Don’t slap his hand!” Parents will have to use the normal techniques of positive attention, encouragement and discipline to get the lessons across. It is, of course, essential, that parents are respectful themselves in the way they express their upset, fear and disappointment. See “The Relationship Rule” in Raise Your Kids without Raising Your Voice for details on how to teach the proper way to express negative emotions.
  5. Let them experience failure and disappointment. It’s understandable that parents want to protect their children from disappointment. But know that rescuing children from pain, to the point that they never get to experience life, will backfire in the long run. Children need to know how to bounce back from adversity — resilience muscles need training too! And children won’t know how it is to rebound from disappointment if they aren’t allowed to experience it to begin with. When your child gets a poor mark on a project, don’t rush to the teacher to get the mark raised; instead, use emotional coaching with your child (that is, NAME her feelings). “This mark is so disappointing! You tried really hard and the teacher didn’t appreciate it. That is frustrating!” By naming feelings, you actually help shrink them down to size. Feeling words act as “containers” for feelings. It’s O.K. for the child to be upset, or even to cry. After awhile, she’ll calm down. And this is the important part – learning that calm follows a storm. Everything in life doesn’t need to be perfect. There is such a thing as recovery. “There will be more projects, more chances to get a good grade.” You want to show the child that you yourself aren’t afraid of negative experiences or emotions. This model that life is “survivable” can really help a child cope when the going gets rough.
  6. Expand their social network. Few parents think of other people as possible teaching instruments in promoting emotional intelligence. But kids can learn more from interesting personalities and other people’s life experiences than they can from a classroom lecture. Having to adapt well to different types of people — quiet, assertive, annoying, fun-loving — can teach a child how to regulate their behavior based on the demands of an interaction. The challenges other people go through can also provide insight on how to manage one’s own trials in life. Learning vicariously through the success and failure of other people is a good way to raise a child’s E.Q. So if you can, go ahead and enroll your child in various clubs or organizations. When they’re a bit older, encourage them to volunteer in community service. Send them on mission trips. Let them talk with grandpa or grandma. Every person has a lesson to impart to a child.

Child Doesn’t Eat Enough

Eating problems are common among people of all ages. One concern that a parent may have is that his or her child is not eating enough food. Let’s look at the reasons behind lack of appetite and learn what parents can do to help.

If your child doesn’t seem to be eating enough food, consider the following tips:

It May be a Matter of Perception
Sometimes the child’s food intake is actually fine, despite appearances to the contrary. In fact, sometimes parents argue over whether there is or isn’t an actual problem. The best way to clarify the issue is to seek a medical opinion. Your pediatrician will compare your child’s weight gain against those of his peers and also against his own developmental curve. Let the doctor know exactly what the child eats (and doesn’t eat). She’ll put all the facts together to determine whether the child is ingesting sufficient calories and nutrients. and to see whether further investigation is warranted.

Consider Possible Medical Causes
A consultation with a doctor is important because, in addition to ascertaining the existence and severity of an eating problem, the doctor can diagnose underlying medical causes.  For example, certain intestinal bacteria might be at the root of the problem. Thyroid conditions and other metabolic problems might exist, making it seem that the child is eating less than he or she actually is. Food sensitivities, mood issues, anxiety and other emotional problems can also play a role in low appetite.

Of course, it might turn out that there are no medical reasons for the lack of interest in food. Sometimes a child just doesn’t enjoy food all that much. In that case, the doctor can speak to the child about the importance of eating breakfast and/or other meals, or eating larger quantities of food or making higher calorie food choices – whatever needs to be addressed. Kids are much more likely to take the doctor seriously than to listen to Mom or Dad on this subject. Many doctors will also refer a child to a nutritionist for specific instruction and support. Nutritionists and dietitians can help design an individualized child-friendly menu plan that provides adequate nutrients and calories.

Consider Alternative Treatment
If the doctor gives the “all clear” parents may still want to enlist the help of an alternative health practitioner. Naturopaths, homeopaths, herbalists and other alternative healers have different methods of assessment and treatment. They may uncover a biological process that the regular doctor doesn’t consider. They also have their own methods of intervention. Sometimes this route can make a positive difference.

Make More Child-Friendly Meals
Even if the doctor doesn’t follow up with professional intervention around menu planning, it may be important for the parent to consider the role of food preferences in the child’s eating problem. Sometimes the child doesn’t like the menu offerings.  Maybe he’d be happy to eat brown-sugar maple-flavored oatmeal for breakfast, but Mom is serving the “healthier” plain oats with a bit of salt added. Or, he might be interested in french fries and burgers, but Dad is making baked potatoes and meatloaf. Let’s face it – almost all children enjoy a different menu than their parents do. If a parent makes sure to offer the kind of food that a child likes – he or she will eat more of it! That doesn’t  mean go ahead and serve generous helpings of junk food! Instead, try using spices and flavoring to make food more enticing. Parents can enlist the help of a dietitian themselves, in order to get ideas on how to make healthy food that kids will actually eat.

Minimize Attention to Eating Patterns
Although parents can make a “mental note” about their child’s eating habits, it’s usually not a good idea to let the child know that you have serious concerns in this area until AFTER a doctor has also expressed such concerns. When arranging for a medical consult for an older child or teen, a parent can just say something like, “I don’t know if it’s me or you – but I’m wondering if your eating patterns are O.K. We’ll let Dr. Smith decide. I’ve made an appointment for Tuesday at 4 p.m. ” Before Dr. Smith’s announces a problem, the parent can just keep records of the child’s eating habits without saying much to the child about it. Children don’t tend to respond positively to parental urges to eat more or differently.

Consider Other Lifestyle Issues
The less your child exercises, the less he needs to eat in order to maintain his weight. The truth is that your child will be more interested in food if he gets out to play some sports, go for a regular walk, ride a bike or otherwise move around at least 30 minutes a day. Turn off the T.V. and computers for a half hour each day and show your child where the skateboard is!

Consider Psychological Causes
If you suspect that your child doesn’t eat enough in order to round up some concern and attention from you, then experiment with giving that youngster more attention. However, give him or her attention for everything under the sun – except for not eating enough. (As mentioned above, be careful NOT to talk to the child about eating more. When you see him not taking food or not finishing food on his plate, DON’T encourage him to eat just a little more or clean his plate. You are accidentally reinforcing inappropriate behavior when you attend to it.)

Some psychological issues go far deeper than behavioral problems. If your simple behavioral interventions fail to have a positive impact, there may be something else going on. In this case, a mental health professional such as a child psychologist or a child psychiatrist is the best one to diagnose and treat the problem.

Keep in mind too, that all children’s problems are worsened by conflict at home. See if you can “de-stress” your marriage (or divorce) with or without professional help. Also check your parenting skills – if you know that you are expressing excessive anger, take serious steps to address that problem; anger doesn’t cause any one specific developmental problem but certainly contributes to every one. Children can have mental health problems for purely biological reasons, but the emotional environment at home can affect the intensity and course of the problem.

Eats Too Much

The epidemic of obesity and weight-related issues among young people has reached alarming heights. Around 25 million children below the age of seven are believed to be overweight. Experts blame the modern lifestyle of fast food and computer games for the phenomenon, alongside the phenomenon of overworked parents who lack the time and energy to pay close attention to the food they are serving their kids, or those who simply cannot afford to do so. No matter what lifestyle factors are at play, the bottom line is that when kids eat more than they can properly burn off, they will weigh more than they should.

Obesity
Eating too much can lead to being a little overweight or significantly overweight. The term “obese” normally refers to a person who possesses a gross excess of fat in the body. Obese children often suffer harassment at the hands of their peers who may mock or tease them. This experience alone can leave emotional lasting scars. However, obesity also puts youngsters at risk for many serious and even potentially fatal diseases. According to the World Health Organization, childhood obesity increases the likelihood of premature death and disability during adulthood. Obese people are more likely than normal weight people to suffer heart attack, stroke, liver problems, diabetes, osteoarthritis and even cancer. Obesity is also linked to mental health issues, such as low self-esteem, depression and anxiety disorders.

What can Parents Do?
Some children are food addicts. Despite their parents’ best efforts, the children eat too much and too often – with weight issues being the result. Nagging children does not cure their addiction – it just annoys them and makes them feel shame and guilt. Criticizing your child for his or her eating habits will likely just be a waste of time and can even damage the parent-child relationship. So what can parents do?

Avoid Strict Diets
Efforts to strictly limit caloric intake can backfire, turning kids into food thieves and/or rebellious eaters. It’s better to help kids learn to enjoy the right foods in the right amounts. Parents can refrain from serving foods that are rich in fat and sugar such as french fries, fatty cuts of meat, cakes and sodas and other white flour and white sugar products, replacing them with delicious foods that are healthier and less calorie dense. In fact, parents can offer vegetables, fruits, nuts, lean meat, dairy products, legumes and grains – but only when they are prepared in such a way that the kids will actually enjoy them. Foods that are real foods are much more difficult to consume in excessive quantities: they are naturally satisfying and filling. It is far easier to eat too many potato chips than it is to eat too many roasted baby carrots!

Many parents have discovered the secret power of spices: children will actually enjoy healthy foods when they are skillfully spiced; it’s the bland foods that lack appeal. Many international cuisines use spices that may not currently be in your cupboard but that are easily available in your local supermarket. Home-made desserts can be made with nut flours and coconut flours – products that are so nutritionally enriched that they actually reduce cravings. Borrow a few cookbooks from your neighborhood library, look online to get some new ideas for enhancing the flavor of your foods or take a cooking class – do whatever you need to do to introduce your children to nutritious AND delicious foods. If you are short on time (and who isn’t?), you can find amazing food that takes only a couple of ingredients and a couple of minutes to make. You can prepare meals in a crockpot that will cook throughout the day and be ready when you come home from work. The health food store may also carry some ready-made foods – but do read the ingredients; being sold in a health food store does not guarantee that the product is calorie wise or even nutritious.

Everything in the Right Time
In addition, try serving your children junk foods and sugary treats (pastries, sugar cereals and candies) in small quantities and ONLY on specific regular occasions (i.e the weekend or better yet, only on one day of the weekend!). Allowing kids to have a little bit of these treats helps reduce feelings of deprivation. No child should have to feel that any one food or one kind of food is too “fattening” to enjoy on occasion in small portions. Remember: feelings of deprivation tend to sabotage any healthy eating plan,leading to eventual weight gain.

Offer Them a Drink Before Meals
One way to get a child to eat a little less during meal time is to give him a tall glass of water five minutes before eating. The extra fluid can make him feel fuller even before he takes a bite. You may also consider giving a healthy snack before bigger meals in order to lessen your child’s appetite.

Serve Smaller Portions
Although there is no need to have your child track his or her calories, there is also no need to serve enormous quantities of food to your family. Kids get used to whatever their parents provide. Try shifting from the buffet, help-yourself style to fixed servings, preparing small portions already set for each member of the family. Or, go with the buffet style but encourage your child to notice how many servings he has had and how large they are. You can say things like, “You can have as much as you want, but just notice how many helpings you’ve taken,” or “Take as big a serving as you like, but just notice how much of your plate it covers – 1/4 or 1/2 or almost all of it.” Asking the child to notice what he is doing gives him the beginning of inner control. Often “mindless eating” – that is, not noticing – is the culprit behind unwanted extra pounds. You may also encourage your child to chew slower and take his time eating. Research has shown that it takes a while for the “stomach is full” message to reach our brains, so chewing slowly can help this message get to the brain before a person takes the next spoonful. Pausing between bites and waiting a bit between courses also allows the “full” message to get to the brain in time to stop a person from grabbing more food.

Exercise and Movement is Also Important
Try to get the family moving. If possible, enroll the kids in physical activities after school – swimming, karate, gymnastics, dance class, hockey and so on. Or, take them to the park to run around and play. Walk around the block with them if possible; walk wherever you can with them instead of driving. Don’t let them just sit in front of a screen all day. Provide a model for them as well: let them see you doing your stretches and exercises in your home. Remember – don’t nag your child or fight with him or her as this can lead to stress – which in turn leads to over-eating. Try to make physical activity fun and normal rather than some sort of punishment for a child who needs to lose some weight.

Consider Mood and Anxiety Issues
Is the increased appetite new for your child? If so, consider the possibility that your child is using food as a way to manage emotional issues. Perhaps the child is going through a stressful transition. Or perhaps she feels insecure about something. Understanding emotional triggers to eating can help parents manage their child’s eating habits by addressing the root causes. In some cases, psychological counseling may be more appropriate than a diet.

Get a Physical Check-up
Increased appetite can be a sign of an underlying medical condition; perhaps the body is starving for a particular vitamin or mineral. Consider taking your child to both a medical doctor and a naturopath for a thorough assessment. Dealing  with physical triggers to excess eating as early as possible may  help prevent more serious health issues from developing.

Your Child Needs Your Help
Kids cannot solve their overeating problems on their own. Their parents must help them – not only because the children may already be “food addicts” overwhelmed by their own cravings, but also because they lack skills, knowledge and ability to manage their own weight loss program. It is up to parents to become knowledgeable – whether that is through self-education or through the assistance of weight loss professionals like pediatric specialists or obesity specialists. You are also the one to see to it that your child gets the help he or she may need. If your own interventions are not helping, try to get your child professional help. Possible sources of help include your child’s doctor, a dietician, a nutritionist, a child psychologist or weight-loss clinic that treats kids and teens.

Bed-Wetting

Bed-wetting (also called “nocturnal enuresis”) is not a “behavior problem” – rather it is a physical problem. There are many possible reasons for nighttime accidents, including:

  • Small bladder. If a child’s bladder isn’t fully developed, it may not be big enough to hold all the urine produced during the night.
  • Genetic factors. Parents who were bed-wetters themselves have a higher chance of having children who are bed-wetters. When nocturnal enuresis is genetically inherited, the problem can persist for longer than usual. For instance, it can be a family tendency that the kids still wet their beds past 7 or 8 years of age. Indeed, in some cases bed-wetting can continue right through adolescence (and even into adulthood). Medical treatments can usually provide significant relief.
  • Poor signals. The child fails to awaken when the bladder is full because the brain is not registering the “full” signal.
  • Slow or delayed nervous system development.

Bed-wetting may also be an indication of another medical problem, including sleep apnea, diabetes, urinary tract infection, problems with the urinary system, or constipation. If wet nights are consistent, talking to a doctor about the problem is recommended. Bed-wetting can also result from emotional stress such as occurs when parents are fighting frequently, someone in the family is ill, there are significant changes in the child’s life, he or she is being bullied or abused, a new baby is born into the family, or when any other form of stress is present in the child’s life.

Distinguishing between Normal and Not Normal Bed-Wetting
Bed-wetting is common in households with young children. At which age can parents expect bed-wetting to stop? How can parents tell if their child is going through a normal developmental phase or if their child has some sort of problem that requires professional attention?

Bed-wetting is common and normal for children under the age of 5. However, by the age of 6, bed-wetting should be a rare occurrence. If it is still happening twice per month in this age group, it can be considered a medical problem that should be attended to. Although the doctor may find that everything is perfectly normal and simply prescribe “patience,” it is important to rule out possible medical issues at this stage.

In addition, if a child starts wetting his bed after long periods of dry nights, or if he experiences pink or painful urination, unusual thirst, or snoring, he should be seen by a doctor.

Stopping Bed-Wetting
Bed-wetting in young children usually stops on it’s own so it’s best not to start any treatment until the child is six or seven years-old (although it is sometimes started earlier if the bed-wetting is damaging the child’s self-esteem and/or relationship with family/friends). Helpful treatments and techniques may include:

  • Bed-wetting alarms – these sound a loud tone when they sense moisture and can help by conditioning the child to wake up at the sensation of a full bladder
  • Decreasing the consumption of liquids before bedtime
  • Praising the child when he has a dry night
  • Avoiding punishments, reprimands and other signs of disapproval
  • Waking the child at night  to empty his bladder
  • Encouraging the child to go to the bathroom before bedtime
  • Diapers, pull-ups or absorbent underwear can be helpful in managing bed-wetting (and is especially helpful in avoiding embarrassment at sleepovers or similar activities)

Some medications such as anti-diuretic hormone nasal spray or tricyclic anti-depressants may also help. If the bed-wetting is occurring due to emotional stress, consulting a child or adolescent psychiatrist or psychologist can be helpful.

Natural Treatment for Stress Relief

Bach Flower Remedies are one-ounce bottles of specially prepared water (see below for details). Although they are only water, they can affect the way people feel emotionally. In fact, they can help balance emotions so that a person can release stress, upset, hurt, anger, fear, sadness, irritation, jealousy, impatience  and any other distressed emotion. Indeed,  many people report that they have successfully used Bach Flower Remedies to feel calmer, sleep better, worry less, recover faster from upset and heartache, handle parenting stress and work stress better and so on. Many have also reported that they were able to see a reduction in their child’s tantrums, aggressive behaviors, moodiness  or fears because of the use of the remedies.

But the remedies can do even more than help a transitory bad feeling : they can also help correct the tendency to fall into those feelings in the first place. When the remedies are used to treat a chronic emotional issue (like a tendency to be stubborn or a tendency to be explosive), they might actually be assisting in a processes now referred to as  “epigentic healing” – the healing of the gene that leads one to experience chronically negative emotional states. We now know that genes can be turned on and off and this is what appears to be happening when someone takes a long course of Bach Flower Therapy. This means that a child who tends to be very shy can take the remedies over time to reduce the shy tendency altogether. The Bach Flowers do not change personality, however. What they do is enable a person to be their own best self. A very strong-willed, obstinate child will retain his strength of character but instead of just being difficult to live with he will be his best self: a born leader, a confident person, one who can take appropriate action. When the Flower Remedies help a childhood overcome chronic separation anxiety, they leave the child’s personality intact: it is the same youngster without debilitating fear blocking the expression of his true self.

It’s hard to believe that these little remedies can work and it’s best not to even TRY to believe that they will; rather, just try the remedies yourself and observe how you feel while taking them. Or, offer a remedy to your child and observe the child’s behavior over the next days and weeks to see if there is any difference. Bach Flowers sometimes seem to have a dramatically positive effect on both behavior and mood and other times seem to make little difference. (Of course, there is no medical or psychological treatment either that works equally well for every single person who employs it.) In the latter case, it might be that the wrong mix of remedies is being used, but it can also be that a longer period is necessary before change will occur or even that a particular person is not responsive to the remedies at the particular time that they are being offered (i.e. this could change in the future). It can also be that while the Bach Flowers are having some positive effect, a complete treatment  requires other interventions as well including strategies like nutritional support, exercise, psychotherapy and/or medicine.

How are Bach Flowers Prepared and Used?
Dr. Edward Bach, a prominent physician in Britain who died in 1935, was interested in preventative medicine. In his search for something that could boost the immune system to ward off disease or to help the body recover more quickly and thoroughly from illness, he discovered a water-based method of healing that became known as “Bach Flower Therapy.” Modern physicists use principles of quantum physics to explain how water remedies can affect human emotions. Dr. Bach, however, understood the remedies on a purely intuitive level. He felt their effects and he could see what they were able to do to effectively relieve stress and emotional distress.

Bach Flower Remedies are prepared by taking the head of a certain flowering plant and placing it in a clear bowl of pure water. The water is heated in sunlight or on a stove for several hours (depending on which flower is being used) and then the flower is removed. The water is the remedy. It is bottled (and preserved with a bit of grape alcholol) and – in our times – sold in health food stores throughout the world as well as on-line.

Bach Fower Remedies are a form of vibrational medicine, not herbal medicine. They are NOT medicinal. They do not act on the body at all. They don’t interact with other medicines or foods or health conditions or anything. They are the same as water is to the system. However, if someone cannot have even a minute amount of alcohol in their system, they should look for the newer remedies that are made using glycerin instead. In general, however, anyone can safely use Bach Flower Remedies – babies, children, teens and adults, pregnant women and elderly people. Even plants and animals respond well to the Bach Flowers!

How Does One Take Bach Flowers?
If a person is using only one of the 38 remedies, they can take 2 drops from the remedy bottle in a small amount of liquid. They should do so 4 times a day – morning, mid-day, afternoon and evening.

However, most people take anywhere from 2 to 7 remedies that have been mixed together in a “mixing bottle.” To prepare a mixing bottle, one places water in a glass bottle with a glass dropper – generally a  30 ml  (1oz.) amber bottle. (These bottles are sold wherever Bach Flower Remedies are sold and they are called Bach Mixing Bottles.) Then one adds 2 drops from each desired remedy bottle. If a person was using 7 remedies, they would be adding 14 Bach Remedy drops to their mixing bottle. To ensure that bacteria does not grow inside of the mixing bottle, a teaspoon of brandy or apple cider vinegar should be added to the bottle.

This Bach Flower Remedy Mixture is then taken, 4 drops at a time, in hot or cold liquid, with or without food. Ideally, these 4 drops are taken 4 times a day, for a total of 16 drops daily. A person takes them in the morning, mid-day, afternoon and evening.

Adults can put 4 drops of their Bach Flower mixture into coffee, tea, water, juice, soup or any other liquid. Children can take their drops in water, chocolate milk, juice, cereal or any other beverage.

A person takes their mixture until they start forgetting to take it and they no longer need it. (Or, parents give a mixture to a child until the child’s behavior or mood issues have resolved to the point where the parent is now forgetting to give it to the child)  If symptoms return (and they most likely will), the person starts taking the remedy again. In fact a person may end up using the remedy off and on for a year or two (less time in children) before the problematic tendency  disappears completely.

How Does One Know Which Remedies to Use?
Dr. Bach wanted to keep his healing method very simply. A person should be able to read the description of the 38 remedies and decide which ones he needs. Of course, some people feel that they need all 38! However, no more than 7 should be used at a time.

A person could pick up a book on Bach Flower Remedies and decide which flowers they need based on the description of who the remedy is for and what it can do. Also, most health food stores have a pamphlet that explain what the remedies can too. Alternatively, a person can make an appointment with a Bach Flower Practitioner who will be pleased to help them design a remedy for themselves or their child.

Child Hurts the New Baby

It is common for toddlers and small kids to be rough with a new baby.  They sometimes hug the infant a little too long or a little too hard (or both). Sometimes they pinch, squeeze or even hit the poor little baby. What prompts them to behave this way? What can parents do about it?

If your little one is hurting the new baby, consider the following tips:

Don’t Ask Why
Toddlers don’t know why they hurt the baby, so don’t bother asking them why they are being so rough. For instance, don’t say, “Why do you do that? Don’t you love your new sister?”  Your youngster has no insight into the matter. In fact, when your child approaches the baby to touch her soft skin or look at her big eyes, he generally has no intention of hurting her. However, within moments, “something” overtakes him and his arms lash out as if they are running on their own power. When his parents start yelling at him for hurting the baby, he is often genuinely surprised at the sudden turn of events. Why is everyone mad at him again? Why did his arms do that?

Inner Conflict
Since it isn’t the conscious mind that is misbehaving, there is really no point in talking to the toddler’s conscious mind. That is, don’t waste your time telling him to be nice to the baby or not to hurt the baby. Don’t ask him why he is hurting the baby. None of this will help at all.

Instead, it’s more helpful to work with the unconscious mind. The toddler’s behavior is showing what the unconscious mind is feeling: anger. The youngster has been replaced with a special little bundle that is demanding everyones attention. This is making the toddler feel displaced, ignored, neglected, sad and jealous. But it is also making him mad. He wants to get rid of this intruder who is ruining his party.

Parents can speak directly to the unconscious mind by naming the anger. “Oh, I see that there’s a part of you that is mad at Baby Jenny.” (This statement is very true. Only part of your toddler resents the baby. Other parts of your child are both loving and intensely protective of the infant.) After naming the feeling, you can try to help the mad and hurting part: “We can’t hurt the baby. What we CAN do is make your mad part feel better.  Would you feel better if you could sit in Mommy’s lap for awhile? Do you need some more stories or maybe a treat?” and so on.  Acknowledging, accepting and addressing the pain of the hurting part helps the hurting part to calm down.

Avoid Punishment
Interestingly, direct interventions like punishment generally have no positive effect on rough toddler behavior. In fact, the more the parents punish a toddler for hurting a baby, the more the toddler tends to hurt the baby. Sometimes, giving positive attention for GENTLE behavior can be helpful in reducing rough behavior. Try using the CLeaR Method – comment, label, reward (see Raise Your Kids without Raising Your Voice for details). “You’re touching the baby so softly. That’s so gentle of you – what a good brother you are. I think that deserves a big kiss/extra story/etc.”

Help the Child Bond with the New Baby
Allowing your older child to still be a baby can help reduce feelings of anger, insecurity and jealousy. Refer to your little ones (the new baby and the other children) as “little ones” – as in, “Good Morning, Little Guys! How are all my little people doing this morning?” By linking the other small children with the baby, the children feel that they haven’t lost out – they are still loved in that special baby-love way. In fact, be careful not to promote the small children to “big boy” or “big girl” now that the baby is here – unless they’re teenagers, they aren’t big yet! Let the whole group be little and you’re more likely to see a strong, loving bond forming between the children and the baby and a little less likely to see physical aggression.

Interestingly, it’s best NOT to give an older child more individual attention at this time because this behavior sends the message that there is not enough love to go around. Instead, try to include the older ones with the baby in one big, happy family. “Let’s take the baby to the park with us,” or “Let’s let the baby read the book with us,” or “Let’s let the baby watch us bake today” are all inclusive statements that show the child that you will not abandon the baby and you will not abandon him. Inclusiveness increases the older child’s sense of security and reduces his feelings of insecure competition with the baby.

Consider Bach Flower Remedies
Bach Flower Remedies can often help reduce aggressive and jealous behaviors. Just add two drops of this harmless tincture to a bit of liquid (juice, soda, water, milk, chocolate milk or anything else), 4 times a day until the behavior is no longer a problem. The remedies are available in health food stores and on-line. Of the 38 Remedies in the Bach system, try  Holly (for jealousy) and Vine (for aggressive behavior). If you like, you can mix both together in a Bach Mixing Bottle (an empty glass bottle with a glass dropper, available where the remedies are sold). Put two drops of each remedy in the small mixing bottle along with water and about a tsp of brandy (to help prevent bacteria in the bottle). From the mixing bottle, drop 4 drops in liquid, 4 times a day until the behavior is no longer a problem. Read more about Bach Flower Remedies on this site, online and through self-help books. Alternatively, call a Bach Flower Practitioner to help select individually tailored remedies. Bach Remedies are excellent to try when you are worried that your toddler may really hurt your baby – particularly because toddlers are usually too young for therapy.

What to Do In the Moment
Speak slowly and firmly when correcting your youngster, but refrain from showing real upset. Of course, protect the baby! Try not to allow the older child to be alone with the little one. However, as you probably know all too well, your toddler can hurt the baby even while the baby is being held in your arms! When that happens, stand up and move out of the child’s reach without saying a word.  Withdrawing attention by this quiet move is more effect than looking the little one in the eye and shouting “NO!” Don’t actually ignore your child – just lightly remove yourself and the baby for a few moments. You are trying to keep the infant safe while you are minimizing negative attention to the older one. Make a simple rule and repeat it as necessary: “Gentle with the baby.” Refrain from the negative version (“We don’t hurt the baby”) because this is likely to get translated by the toddler’s highly emotional brain as an instruction TO hurt the baby!

Patience is Required
It’s unpleasant but normal for toddlers and preschoolers to hurt a new baby. Showing your understanding is an important way to help start building your child’s emotional intelligence. Although a child’s rough behavior is very upsetting to parents, it’s important that parents not make matters worse by showing anger or becoming very punitive. Patience is required! With your gentle approach, chances are that your toddler will move through his upset feelings and aggressive behavior much more quickly.

Terminal Illness in the Family

It is hard to have to deal with serious illness in a loved one. However, when the illness is considered to be terminal (fatal or incurable), it is all the harder. Of course there are all the present, practical concerns such as arranging health care, and maintaining the continuing functioning of the family. In the case of terminal illness there is the additional stress of seeing someone you care about battle a disease he or she isn’t likely to win, along with the anticipated grief of loss and unresolved issues from the past. There is no way to make terminal illness in the family easy to bear. But there are some things that can be done to help lighten everyone’s load.

If you are dealing with terminal illness in the family, consider the following tips:

Educate Yourself about the Illness
When dealing with terminal illness in the family it is helpful to get to know the disease as well possible. Understanding the symptoms to expect, having an approximate timeline for the unfolding of the illness and learning about experimental treatment options available to the patient, can help the family maintain some sense of control amidst a chaotic situation. Grounding the family in sound medical opinion can help in making plans and decisions.

Talk about the Terminal Illness, Even with Your Sick Family Member
When there’s a heavy emotional issue in a household, it’s very tempting to pretend the problem doesn’t exist. This denial may be well-intentioned; perhaps you don’t want to upset your sick loved one by discussing an obviously painful subject, or perhaps the family wants to protect its younger members from any further trauma. But keeping silent on the issue just forces everyone to repress negative emotions.

The best support system for family members of a terminally ill patient are fellow family members who understand what is going on. Let the crisis be an opportunity for everyone to bond together, and offer each other much needed care and understanding. Families have been known to find grace in troubled times, grace that helps make members be closer and more resilient.

This may also be the opportunity to say to your sick loved one the positive things you haven’t said before, to express love, gratitude and forgiveness. Get to know your sick loved one’s wishes; wishes for both for immediate concerns like the treatment plan and arrangements for care, as well as future plans for the surviving family.

Share Responsibilities
There are many things that need to be done when there is terminal illness in the family. There’s caring 24/7 for the sick loved one, making sure that household duties such as getting dinner on the table is still happening and looking for additional finances to meet incoming large medical bills. If possible, don’t assign just one caretaker to help prevent care-provider burns out. Instead, look for ways everyone can contribute to manage the crisis. Even younger kids can have a role to play; in fact, new responsibilities can ease feelings of helplessness about the situation.

Make Sure Everyone Takes Self-Care Seriously
Terminal illness in a family causes serious stress, which is why it’s important that everyone — even the youngest family member — knows how to stop for a while and take care of one’s self.

Having a friend or professional outside the family to talk  to can help; during a crisis issues and emotions can get so messed up, it helps to get a fresh perspective. Making sure that everyone gets ample “me” time for rest, relaxation, fu, normal life and maybe a bit of meditation and prayer is also a good thing. Similarly, keeping the entire family’s good health in mind, through proper diet and exercise ensures the family members get a new start everyday.

If it’s an available option, joining a community support group is a good way to aim for self-care. Support groups are made up of people going through the same experience, which helps in removing the feeling of aloneness and intense stress that comes with terminal illness. If a support group is not available in one’s state or area, an online support group may work just as well.