Stress in children: how fth-year pupils experience stress

in everyday life
Elisabeth Brobeck
1
MSc, RN, Bertil Marklund
1,2
MD, PhD (Assoc Professor), Katarina Haraldsson
1,2
MSc
and Leeni Berntsson
3
PhD, MPH, MSc, RNT
1
Research and Development Unit, Primary Health Care, Country Council Halland, Falkenberg, Halmstad,
2
Department of Primary Health Care,
The Sahlgrenska Academy at Go teborg University, Go teborg, Sweden and
3
Institute of Health and Care Sciences, The Sahlgrenska Academy at
Go teborg University, Go teborg, Sweden
Scand J Caring Sci; 2007; 21; 39
Stress in children: how fth-year pupils experience
stress in everyday life
In many cases, stress in children takes the form of psy-
chosomatic symptoms. The prevalence of headache in
children has increased, as has stomach pain and self-
reported psychological problems. Many children also
experience stress without exhibiting any symptoms, as
children perceive, understand and evaluate stress in a
variety of different ways. The aim of this study was to
describe how fth-year pupils experience stress in every-
day life. An explorative and descriptive design based on
phenomenology was chosen to investigate childrens life-
world and lived experience of the phenomenon of stress.
The data analysis was based on Giorgis method. The study
comprised 29 children, who were interviewed regarding
their experience of stress in everyday life. The results
revealed ve key constituents: fear of being late, not
having sufcient time, physical and mental conse-
quences, both a negative and a positive feeling and
experiencing signicant others stress. Together, these
key constituents form the overall result. This study dem-
onstrates that stress is a part of childrens everyday life. The
children described stress that was often acute and linked to
situations that occur in everyday life. The results can assist
in identifying the factors behind the stress experienced by
children. This in turn will facilitate observation and
intervention when a child exhibits stress symptoms.
Keywords: child, daily hassles, experiences, family health,
interview, phenomenology, psychosomatic stress,
symptoms.
Submitted 26 November 2005, Accepted 5 April 2006
Introduction
In the 1930s, Cannon (1) and Selye (2) studied stress in
terms of a physical reaction to external stressors. In their
studies, which mainly concentrated on physical changes
observed in experiments on animals, Cannon and Selye
to a large extent disregarded psychological factors as
contributing to stress. Lazarus (3) was the rst to
investigate the psychological aspects of stress. When
individuals are faced with a situation, it is always judged
and interpreted, and whether or not a situation is
deemed stressful depends on the meaning attributed to it
by the individual. Each individual experiences a situation
differently and can react in various ways to the same
event.
Childrens stress reactions: a literature review
Every child experiences stressful events at some stage, no
matter how ideal their individual circumstances (4). Stress
often takes the form of various psychosomatic symptoms
(57), i.e. recurrent physical complaints such as head-
aches, stomach pain, neck pain or dizziness, without any
clear organic cause and/or psychological problems such as
depressed mood, irritability, nervousness or sleep distur-
bance (8). The most common psychosomatic symptom in
school children is tiredness (9). The prevalence of psy-
chosomatic symptoms varies according to age, gender and
symptom denition. Psychosomatic symptoms occurring
every week or fortnight have been reported by approxi-
mately 20% of children in the 7- to 12-year age group (6).
Generally, psychosomatic symptoms are more common in
girls than in boys (6, 7, 10). Stomach pain is most common
among 6- to 7-year olds (9), while headache dominates
among older age groups (7, 9, 11). Several studies have
revealed an increase in the prevalence of headache in
children over the past decades (1214). Stomach pain has
also become increasingly common among young people
Correspondence to:
Elisabeth Brobeck, Research and Development Unit, PO Box 113,
SE-311 22 Falkenberg, Sweden.
E-mail: elisabeth.brobeck@telia.com
2007 The Authors. Journal compilation 2007 Nordic College of Caring Science. 3
with mental health problems, which is veried by self-
reports (13). The same applies to the prevalence of other
psychosomatic complaints (5, 9, 11) which, for the most
part, increase sharply from the age of 1012 years, in both
girls and boys (9, 11). Children who suffer from frequent
headaches are at higher risk of suffering recurrent head-
aches and other psychosomatic symptoms as adults (10).
Usually younger children express reactions that are purely
physical but, with increasing age, children and young
people become aware that various bodily reactions can
have both a physical and a psychological origin (15).
Several studies have revealed a link between parents
health and the childs psychosomatic problems (6, 10, 16)
and, in particular, the mothers health and sense of well-
being have an inuence on the development of symptoms
in the child (6, 10). There is also an association between
parents health and the adult childs psychosomatic
symptoms (17). Children who suffer recurring headaches
experience more stress and stress-related symptoms, such
as fatigue, difculty in relaxing, and psychological symp-
toms characterized by anxiety, fear and restlessness, as well
as somatic symptoms, for example stomach, neck and back
pain compared with children who do not suffer from
headaches to the same degree (5). In almost half of chil-
dren with recurrent stomach pain, the symptoms can be
explained by exposure to negative stress (18). Studies have
revealed that a strong pressure to achieve good results (19)
and a high sound level at school give rise to stress (20). In
both boys and girls, stress related to schoolwork increases
in line with age (13). Many children express their stress
symptoms openly, but it is important to note that there are
children who experience stress without exhibiting any
symptoms due to the fact that children perceive, under-
stand and evaluate stress in different ways (21). A study
found three types of stressors that affect children. The rst
is a feeling of loss, the second a feeling that ones person is
threatened while the third is a fear of problems and con-
icts, mainly in relation to parents or close friends (4).
Conicts with parents often result in stress, even if the
parents themselves do not experience their conduct as
threatening (4, 21, 22). The number of stressors increases
signicantly in line with age. Among the stressors men-
tioned by 8- to 13-year olds were not having enough time
with mummy and daddy, having nothing to do and the
need to obtain a good report (23).
In summary, few studies have illuminated childrens
experiences of stress. As knowledge of childrens own
experiences of stress is limited at present, it is necessary to
expand our understanding of this phenomenon in order to
prevent stress-related disorders in children.
Aim
The aim of the study was to illuminate how fth-year
pupils experience stress in their everyday life.
Method
An explorative and descriptive design based on phenom-
enology was chosen in order to investigate childrens life-
world and lived experience of the phenomenon of stress.
Husserl developed modern phenomenology into a philo-
sophical research approach. Husserls basic principle was to
turn to the things themselves and focus on the natural
consciousness, i.e. experience as manifested in the life-
world. The lifeworld is the real world in which we live our
daily life, which we experience and take for, granted and
to which the individual is inextricably linked (24).
Participants
The participants were fth-year pupils from two schools in
a medium-sized town in southern Sweden. One of the
schools was situated in the outskirts of town and the other
in a rural community. The interviewer, who was well
known with the town, selected these two schools which
were estimated to be equivalent to the socio-economic
conditions and situated in areas with apparently few social
problems. The idea of this was to obtain children who are
living under as quiet conditions as possible with the aim to
get as generally applicable descriptions as possible of the
phenomenon stress in daily life. In one school 26 fth-year
pupils were asked to participate in the study, nine of whom
agreed (six girls and three boys). In the second school, 38
children in three mixed classes consisting of fourth- and
fth-year pupils were asked to participate, of whom 20
agreed (12 girls and 8 boys). In all, 64 children were asked
to participate and 29 agreed (18 girls and 11 boys), while
35 declined or did not respond to the letter distributed to
them. All of the children had a Swedish cultural back-
ground and were native Swedish speakers. The strategy
chosen for the study of fth-year pupils was based on the
fact that 11- to 12-year olds are starting to move away
from a purely concrete and practical way of thinking to a
more abstract operational or a hypothetically deductive
way of thinking. This implies that children of that age are
starting to experiment with thinking and can reshape
reality. At that age children can devote themselves to
formulating their own problems, i.e. the problems need
not always be grounded in reality. Children can also begin
to see themselves from the outside, leading to an increased
understanding of their own person and recognizing
themselves in others as well as noticing similarities (25).
Data collection
The data collection method was semi-structured tape-
recorded interviews on the phenomenon of stress. The
interviews took place during the months of February and
March 2004. The interviewer is trained in professional
childrens nursing withseveral years experiences of working
2007 The Authors. Journal compilation 2007 Nordic College of Caring Science.
4 E. Brobeck et al.
and talking with sick children in different situations. All
interviews were conducted on the school premises, in a
separate room and during school hours. The interviews,
which were free and open in character (26), began with the
interviewer asking whether the child was familiar with the
term stress, followed by: Could you please describe what
stress means to you? During the interview the children
were asked further questions in order to elucidate the phe-
nomenon under investigation. The children were especially
encouraged to describe stress in their daily life. The inter-
views touched upon deeper sources of stress in the form of
crises associated with relationship problems and loss only
when the children themselves raised the subject. The
interviews lasted 320 minutes. Most of the interviews
lasted 815 minutes. One exception was just 3 minutes
because of the childs short and monosyllabic responses.
The child appeared to be embarrassed of the questions and
to avoid forcing the child the interview was interrupted.
Ethical considerations
The study was approved by the Ethics Committee of Lund
University, Sweden. The children were provided with both
verbal and written information about the study, and their
parents also received written information. This informa-
tion described that participation was voluntary and treated
in strictest condence. Both the children and their parents
agreed in writing to participate.
Data analysis
The interviews were analysed using a method developed by
Giorgi (27), which is based on Husserls phenomenology.
In descriptive phenomenological data analysis, the resear-
cher extracts meaning units and describes them in detail.
Giorgis method is aimed at describing the essence of a
phenomenon. According to Giorgi, the data analysis has to
be conducted with a minimum of ve basic steps. The rst
step was data collection through taped interviews (27). The
second step consisted of recording the collected data and
reading the transcribed text several times for obtaining an
overall impression of the material with the aim of grasping
the meaning of each individual narrative (27, 28). In the
third step, every changeover was noted in the text, i.e.
when the child began to talk about something new. In this
way, it was possible to discriminate meaning units in the
informants own words extracted from each narrative (27,
28). In the fourth step, the meaning units were trans-
formed into scientic language and a search was made for
words that describe the structure of the phenomenon. Data
relevant to the meaning units were grouped and described,
initially for each transcribed text and then for the material
as a whole (27, 28). In this step, the researchers strive as far
as possible to bracket their own preunderstanding and
knowledge. In the fth step, the material was synthesized
in order to ensure scientic rigour. When each meaning
unit and its transformed units have been formulated in
scientic language, the most important aspects of the
phenomenon were determined by describing the essence of
the experiences based on the informants lifeworld (27).
In this study ve key constituents emerged after syn-
thesis from two to three transformations. None of the key
constituents was more important than another, they all
formed a whole together.
Results
The ve key constituents which emerged following a
synthesis of the transformed units were: fear of being late,
not having sufcient time, physical and mental conse-
quences, both a positive and a negative feeling and
experiencing signicant others stress (Table 1).
Fear of being late
The experience of fear of being late was based on the
childrens description of the stress associated with being
late for school or expecting to be late. Being late for class
during the day was also experienced as stressful:
Sometimes when you get up late, when you know
you have to go to school and you know you are going
to be late. You become very nervous, you eat really
quickly, get dressed, you feel a little strange.
The experience of fear of being late for activities or other
important events in their free time was expressed in the
childrens accounts of the stress of knowing that they will
be late for something important, such as a leisure activity
or a meeting:
Sometimes one is about to go to some leisure activity
and ones parents may be slow, so one becomes a little
stressed at the idea of arriving late.
Not having sufcient time
The children stated that they experienced stress when they
had too much to do or too much to think about at the same
time. The majority of the children took part in various
leisure activities, although they expressed that they did not
nd this stressful. Leisure activities are experienced as fun
and relaxing. It was the feeling of not having sufcient
time to do other things the children wanted or had to be
the source of stress:
You havetoo many things in your head, loads of
different things to do, which makes you feel as if you
would like to disappear or.
I dont know for sure, I only notice that I feel stressed
foror so I become like nervous that I will not
manage to do everything I should.
Lagging behind their class mates in terms of school work
was experienced as a major source of stress by the children.
2007 The Authors. Journal compilation 2007 Nordic College of Caring Science.
Stress in children 5
A common reason for the stress when trying to keep up
with their class mates was that they perceived themselves
inferior or that they had too many exercises to do in a
short period of time, which they wanted to nish quickly:
You might haveyou might have a maths exercise to
do, and perhaps your friends took ages to nish it
due to the fact that you did not need so much time
you feel stressed because you think that they are
better than you.
The experience of not having enough time for school work
was an expression of a general feeling of stress due to fear
of being unable to produce satisfactory results. The chil-
dren also considered that sometimes there were too many
lessons on the same day, which also resulted in stress:
Its stressful when one cannot decide what to do rst,
when one has no idea if one has time for everything,
especially if there is a lot of homework that has to be
nished before a certain day, so if you havent got it
nished it becomes very stressful in the evening when
one comes home and you dont know where to start
and where you will nd the time to do all the work,
and if you have learnt all you need to know.
Physical and mental consequences
The physical consequences of stress took the form of var-
ious symptoms, such as stomach pain, headache and diz-
ziness, which children associated with stress. Even slightly
more diffuse symptoms such as butteries in the stomach,
a tingling sensation in the body or a pounding heart were
mentioned by the children. They were well aware that
their symptoms were due to stress:
You can suffer from a headache and suchlike at times.
When I am really stressed I notice it.
I usually have feelings of dizziness oh so I get stomach
pain oh I cannot no longer. I will do all the work same
time but it does not work. I will..so to say only do it
quickly but it does not work for then it will become
carelessly done oh then I become angry.
The mental consequence of stress was described by the
children as a feeling of sadness, nervousness, resentment
and anger. The children expressed that exposure to stress
could make it difcult to think clearly and that their
thoughts went round in circles. This often was experienced
in a lack of concentration, which in turn leads to mistakes,
forgetfulness or carelessness. The children also described a
mental consequence linked with stress:
Kind of sad when you are like that I must hurry, I
must hurry.
You cant think clearly, it is fullyou just think
unnecessary thoughts.
Both a positive and a negative feeling
The childrens descriptions of negative stress revealed that
they saw stress as something counterproductive, and they
expressed having had negative feelings as a result of stress
on at least one occasion. The children commonly described
stress as an unpleasant feeling. The most negative conse-
quence of stress was described as feeling bad and that stress
was not good for the body:
Its not good for the body. You feel stressed out, with a
headache and such like. Children should not be
exposed to stress, it is not good.
I dont like if youre stressed. Its often something bad
that has happened.
Experiences of positive stress emerged due to the fact that
children who had experienced negative stress also
Table 1 Examples from the analysis
Meaning units
Transformation of the
meaning units
Synthesis of the transformed meaning
to key constituents
Its tough if I havent got enough time to do
something because it may prevent me from
doing other things
It may perhaps be some exercises in a book
that you have to do for school and the
others are far ahead and you have forgotten
to do some pages, so you skip them in order
to be able to follow the lesson then you
feel that you have the time to do it
I dont have the time
Cant do other things
Others are much further ahead
Forgot to do some pages
Not having time for school work
Not having the time
I dont feel very well when Im stressed. You
get its just confused in your head, you
get a headache
You dont feel well, you become sad
Dont feel very well, get a headache
and feel sad
Both physical and mental consequences
Its tough, its not fun
The good thing is that you then hurry up so
that you might just get there on time
Its tough, not fun
Good, then you hurry
Both a positive and a negative feeling
2007 The Authors. Journal compilation 2007 Nordic College of Caring Science.
6 E. Brobeck et al.
experienced that, at times, stress can be positive. Children
primarily considered the positive aspect of stress as some-
thing that drives them to do things and make an extra
effort. They also perceived that it was easier to be on time
when under stress although stress is experienced as pos-
itive only if they could think clearly:
It is dependent on being able to manage it in such a
way that one can think while under stress.
If you know you should do something you feel stres-
sed a little just like that I must do it otherwise I must
do something quite different oh so.
Experiencing signicant others stress
Children described their parents stress by providing
examples. Usually it was the mother who was stressed.
They related that they tried to help their parents, mainly
by offering to help at home. They often experience that it
was difcult to help their parents, as there were many
things that parents could only do themselves:
Well, they are perhaps somewhat confused they say,
perhaps aloud, I have to do this or can you help me
with this at the same time as I am doing that or
something like that.
The children expressed that it was sometimes difcult
when parents were stressed, as they became angry more
quickly, which could be problematic for the children:
How can I describe it? For example, when she is
stressed she runs around and I seem to be in the way.
If I try to help it only makes her more irritated.
Experiencing their friends stress meant that the children
were aware that their friends could also suffer from stress,
although this was not as common as observing their par-
ents stress:
They hurry I have to do that now, I have to do this
quickly and so on.
The children did not mention that they were negatively
affected by their friends stress, although those children
who recognized and understood that their friends were
stressed considered it important to try to be supportive:
You feel a bit sorry when someone feels so stressed, as
stress is tough.
The essence identied in the key constituents was that the
phenomenon of stress was a part of everyday life. It could
be positive and negative, experienced in different contexts,
and its various expressions were contingent on the indi-
vidual interpretation of each child based on their lifeworld.
Discussion
In an earlier study (4) it was found that the most important
sources of stress among 9- to 11-year-old children were
feelings of loss, feelings of threat to self and feelings of being
hassled. These life events were experienced as enduring
feelings that had an impact on children and they perceived
that they had no options in responding to these feelings.
When we let the children in our study to tell about stress in
their daily life we could not get out this enduring feeling of
stress but the children told us spontaneously specic situa-
tions which came up more or less every day, when they
experienced stress. The situations told by the children in our
study were mainly associated with events in school and the
family. In line with Jacobson (4) we found that the family
was of a great importance for stress experiences when con-
icts and daily hassles are experienced as stressing. Above
this children pointed out that when their parents were
stressed, this also stressed them. In our study it appeared
clearly that many children had feelings of somatic symptoms
as followed by stress in daily life that did not appeared in the
study of Jacobson (4). An earlier questionnaire study (4)
showed that it is difcult to capture childrens symptoms
using existing instruments. Only 3555% of the childrens
cognitive emotional symptoms and 030% of physiologic
symptoms could be assessed. A limitation of the study is that
it was difcult to capture the experiences of children who
were shy and did not talk very much as well as those who
were perhaps aware that they suffer from stress but do not
want to talk about it, whichwas insome cases veried by the
teachers. The duration of the interviews varied greatly,
mainlyduetohowtalkativethechildrenwere. Theinterview
was closed when it proved impossible to enter more deeply
into the subject, in order to ensure that no child felt under
pressure to answer the questions. The interviews that lasted
810 minutes wereoftentheones withthemost substanceas
well as those that maintained the focus on the phenomenon
of stress throughout. The trustworthiness of the result is
strengthened by the fact that saturation was reached, as the
childrens responses to the central questions yielded.
The study did not go through a formal co-assessment, as
Giorgi (29) is of the opinion that co-assessment lacks rele-
vance, as the aim of the study is achieved by understanding
the meaning of the descriptions obtained. The phenome-
nological method according to Giorgi (29) provided the
researchers with a framework within which it was possible
to follow the analysis in detail indicating the steps required
to make the research both scientically and phenomeno-
logically valid. Openness and exibility both during the
interviews and in the analyses proved to be a fruitful
method for capturing the essence of the phenomenon
under study and contributed to a deepening of the know-
ledge of the lived experiences of stress. This increased
knowledge about stress is important in facilitating the
development of a professional stance when meeting chil-
dren who are exposed. The result reveals that the children
who participated in the study are aware of the phenomenon
of stress and are able to describe various situations that they
have experienced as stressful. This is supported by previous
studies that revealed how, from the age of 7, children are
capable of reecting over and describing stressful events in
their life (4, 7). Living with stress is part of the childrens
2007 The Authors. Journal compilation 2007 Nordic College of Caring Science.
Stress in children 7
everyday life (4, 30) but, according to the situations des-
cribed by the children in this study, they experience acute
stress related to specic situations as opposed to chronic
stress. The study also shows that everyday problems can
have a greater impact on health and well-being than a
major life crisis (31). It is obvious that children mainly
experience stressful situations at school due to the fact that
they perceive school work to be more important than
various leisure activities. The fear of not having sufcient
time for school work and lagging behind their friends is the
main source of stress, which in turn can lead to a perception
of being inferior. It was also revealed that it was perceived as
stressful to have to accomplish a great deal in a short space
of time when they are lagging behind their classmates.
There is thus stress caused by fear of being unable to manage
school work in a satisfactory manner. Previous research has
shown that children who are exposed to pressure at school
experience frequent feelings of stress, which indicates that
stress at school can be due to high demands (19). The
children expressed that stress has physical and mental
consequences. They also made a distinct connection be-
tween their symptoms and stress. The children recognized
their parents stress, in particular that of their mother.
Previous studies have shown that it is primarily the mo-
thers health and well-being that has the greatest inuence
on the children (6, 10). The atmosphere within the family
and the quality of the parents relationship has an effect on
the childs health and well-being (6, 32). The children
found it unpleasant when their parents were angry or
irritable as a result of stress. Several studies support the fact
that childrens experience conict with their parents as
stressful, even though the parents do not consider the
conict to be a major one (4, 21, 22). Previous research also
shows that there is a strong connection between relation-
ships with friends and stress (19, 22) and that conict seems
to be a common childhood experience (4). In order to
prevent stress in children nurses must be able to identify
and minimize the risk factors. A study revealed that chil-
dren never considered the possibility of seeking help for
their feelings triggered by stress (4). Although some chil-
dren may require professional counselling, the majority can
cope if adults conrmtheir experiences. Parents are usually
the main ones who notice both barely perceptible and more
obvious changes in their childs behaviour (30).
Relevance to clinical practice
In line with Jacobson (4) we observed the importance of
the family for the childs experience of stress; the results of
both studies show that hassles are experienced as a stressor.
We found that when the parents are stressed, particularly
the mother, they tend to loose their temper and the child
experiences this as unpleasant. Children often will help
their stressed parent but nd it difcult. Therefore, it is
important that healthcare professionals point out this fact
to parents. It is also important that the parents learn to
manage their own stress in order to facilitate for their
children. Hence it can be advantageous to provide help
for the whole family when a child gives expression to stress.
Overall, parents have an important role in building up the
childs resistance to stress. Knowledge about childrens
experiences of stress can facilitate the identication of
factors that give rise to these experiences thus preventing
stress-related health problems during the childs formative
years. Knowledge will also contribute to enhancing par-
ents and childrens understanding of stress, thus making it
easier for them to take decisions regarding their way of life
and to inuence their health and well-being both now and
in future. When healthcare professionals observe stress
symptoms can plans of intervention and prevention be
done. Nurses have an important task in supporting parents
to observe changes in their childs behaviour. They should
also be attentive when the child him/herself and/or parents
notice expressions in the child that are recognized as
sources of stress (30). As stress usually occurs and becomes
visible in school, the school nurse is often the rst to come
into contact with a child who reports experiencing stress or
who, for example, seeks help for recurrent headache. It is
then necessary to be able to identify high-risk situations
and have the motivation to create a good relationship with
the child. In order to help the child, the nurse can allow
him/her to talk about the anxiety and fear. Predominant
emotions may manifest as internalizing disorders, such as
anxiety or depression, or externalizing disorders, such as
poor school performance, antisocial behaviour or delin-
quency (33). Furthermore, it is important that the nurse
develops his/her professional capacity to enable the child to
help him/herself as far as possible. Together with colleagues
and other staff categories, the nurse can discuss howhe/she
can best act in an encounter with a child who is suffering
from stress as a result of various situations. However, in
order to achieve a satisfactory result it is essential that the
nurse has the time and opportunity to implement these
measures (34). This study can serve as a point of departure
for identifying factors that constitute a source of stress for
children. Hereby the nurse who works with children will
have a better opportunity to observe and take action when
a child exhibits any of these factors.
Conclusions
This study reveals that stress is part of childrens everyday
life. The stress expressed was often acute and linked to dif-
ferent situations that occur in everyday life. An important
source of stress is perceived to be pressure to perform well,
especially in a school context. The feeling of being clever
and managing things well is also perceived as stressful.
Parents stress is often recognized by children and has either
a direct or indirect effect on them. Studies are needed to
further illuminate childrens experiences of stress from
2007 The Authors. Journal compilation 2007 Nordic College of Caring Science.
8 E. Brobeck et al.
different perspectives, thus leading to an increased under-
standing of the complex phenomenon of stress in children
Author contribution
The study was conceived and designed by Elisabeth Bro-
beck and Leeni Berntsson, who together analysed the data
and drafted the manuscript. Elisabeth Brobeck collected
the data. All the authors provided critical revisions of the
manuscript for important intellectual content.
Funding
No funding was obtained.
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