One evening while browsing the internet, my wife brought to my attention an all-too-familiar story. A Facebook post told a story of a bullied 12-year-old-boy who had hung himself. He was resuscitated but his prognosis remained poor due to the extent of his brain injury. His parents later made the difficult decision to terminate his life support.
"Children are resilient" is a frequently shared expression. But stories such as this highlight the dilemma in these statements. Resilience, broadly defined, means a person can weather adversity, trauma, or stress and come back stronger than before.
Yet, what happens when a child is not able to withstand stress? Is that child weak for not being able to overcome trauma? Resilience, viewed through the lens of childhood, is more complicated than simply "dusting yourself off and getting back in the saddle."
The Trouble With Resilience
I once took care of an infant who was diagnosed with bacteremia, a septic joint, and osteomyelitis of the knee. He underwent surgery to drain the infectious fluid. After the procedure I met with his parents, who asked me when he would begin to crawl again.
"He will begin to crawl once the infection has cleared and his pain is under control," I responded.
Casually, his nurse mentioned, "He will bounce back quickly because children are resilient."
I added, "He will recover because of how you will nurture him and support his recovery."
The nurse meant no harm in her statement, but it carries an implication that resilience is somehow innate to childhood. This misconception can be especially troublesome in issues of mental health. It neglects the fact that resilience is learned and not inherent.
Pediatric mental health has always been a challenging issue, but the onset of the pandemic escalated it to a crisis. According to the American Academy of Pediatrics, childhood mental health problems and suicide steadily rose over the past decade, with suicide becoming the second leading cause of death for youths aged 10-24 years.
In Harris County, Texas, where I practice, 2010 data showed that more than 150,000 of the 750,000 youth in the area have a mental illness. With the pandemic, children became more physically isolated. Grief, fear, and uncertainty became ever-present specters.
As parents reflected on their children's future during the pandemic, "resilience" became a buzzword. Mental health stressors were something that children were expected to endure. Data showed the opposite, with the Centers for Disease Control and Prevention reporting an increase of over 66% since April 2020 in the number of emergency room visits for children with a mental health crisis.
Yet mental health is still largely stigmatized, as illustrated by the stories of NBA basketball player Kevin Love, singer Demi Lovato, and Olympic swimmer Michael Phelps. The resilience narrative perpetuates this stigma through the false belief that children should be able to bounce back from challenges naturally and that asking for help is a sign of weakness or, from an adult's perspective, even poor upbringing.
Simply put, resilience places an unrealistic expectation on children's abilities to cope with stress. "The USA has epidemics of anxiety and depression, obesity, heart disease, and diabetes. The rates of these things cover up to 2/3 of adults but it is unclear who has none of these types of problems. I would guess at 1/3 or less. Thus as a nation we are not resilient either," according to Darcia Narvaez, PhD, a psychologist at the University of Notre Dame. If we adults, with all our experience, have trouble remaining resilient, how much more can our children be expected to endure?
How We Can Better Support Our Youth
Licensed social worker and author Katie Hurley described resilience as "a muscle; you work on it little by little as you learn and grow and practice new coping strategies." This shift in perspective promotes a growth mindset in both children when they cope with stressors and parents who guide them. Resilience becomes a lifelong skill that is continuously nurtured rather than a goal to be achieved.
Viewing resilience through a developmental lens destigmatizes mental health and normalizes the fact that everyone has their mental limit. Feelings of inadequacy and being overwhelmed can be addressed more openly. Seeking help is encouraged. The result is an understanding that stress leaves wounds from which many children cannot easily recover.
From a health policy standpoint, resources for mental healthcare are lacking, especially for children. In Harris County, of the 19,300 children with mental illness, 74% did not receive services. Mental health is grossly underfunded and leads to thousands of children not receiving desperately needed care.
Despite the lack of resources, we as parents and health professionals can take small actions to help children navigate through life's challenges. Nurturing empathy in our children can be as simple as asking how they are feeling without judgment or suggestion of a solution. As parents, we can often fall into the cycle of trying to solve our children's problems rather than patiently guiding them as they work out their feelings. Parental guidance allows children to feel their emotions and learn how to cope with difficulties while promoting open communication.
As we help guide our children, we must also recognize our own mental health needs. Checking in with ourselves regularly ensures that we are at a mental state conducive to helping others. Be honest with yourself when things become too overwhelming and help is needed. Self-honesty, particularly when we are at our most vulnerable, demonstrates strength and promotes resilience.
If you are thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. The National Suicide Prevention Lifeline is 1-800-273-8255.
If your child is being bullied resources are available at www.stopbullying.gov.
Join Medscape's new blog initiative! We're looking for physicians, nurses, PAs, specialists, and other healthcare professionals who are willing to share their expertise in one to two paid blog posts per month. Please email Medscape-Blogs@webmd.net for more information.
© 2022 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Giancarlo Toledanes. Stop Calling Children Resilient - Medscape - Mar 07, 2022.