OHSU physician recommends ways parents can deal with stress

U.S. Surgeon General Dr. Vivek H. Murthy recently issued an advisory saying stress from parenting is a public health issue. The nation’s doctor shared his concerns over the wellbeing of parents, noting overwhelming stressors affecting parents today — from financial pressures to worries around kids’ health and safety. The advisory notes that nearly half of parents say most days their stress is overwhelming and more than 40% say they are so stressed they cannot function. Marlo McIlraith is an associate professor of pediatrics and a pediatrician at OHSU. She joins us to share more on what is causing more parents to be stressed today and ways she recommends they try to help deal with these emotions.

The following transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Stress from parenting is an urgent public health issue. That’s according to a recent advisory from the US Surgeon General Vivek Murthy. It identified a whole series of stressors for parents today from financial pressures to worries about kid’s health and safety. The advisory noted that nearly half of parents say their stress is overwhelming most days. More than 40% say they are so stressed, they can’t function. Marlo McIlraith is a pediatrician and an associate Professor of Pediatrics at OHSU. She joins us to talk about all of this. Welcome to Think Out Loud.

Marlo McIlraith: Thanks so much for having me.

Miller: I want to start with a voicemail because we asked listeners, parents how they’re feeling these days. This is Nicole who called in from Portland;

‘I am a social worker with Portland Public Schools and a parent of three children who are in high school and middle school. And I completely agree with the Surgeon General’s warning about parent mental health and stress. And as a social worker with a school district, I see it in my families every day and also feel it myself in my own family.’

Miller: What went through your mind when you first heard that the Surgeon General had put out this advisory, specifically focused on the mental health and well being of parents?

McIlraith: Well as a pediatrician, I was actually really encouraged and excited to see that value placed on parenting, and also just what we could do as a whole society. It is not just important for parents to know about the stressors and what we can do to alleviate all of that, but really for all of us to pay attention and what we can all do? This is our future and these kids need the support of parents. And if they’re stressed, we need to help support them as well.

Miller: How significant do you think this issue is?

McIlraith: Very significant. I hear over and over in my practice parents, exactly as the Surgeon General says, feeling overwhelmed,

feeling stressed, really trying to figure out how they can really help their kids through their stress as well. So what kind of things can we do to help the parents is a conversation I hear over and over in my practice.

Miller: I’m curious. I mean, one of the amazing things I’ve always imagined about being a pediatrician is the enormous difference between a newborn and a 17 or 18 year old. But you see them all, in some ways, bigger differences then between 18 and, I don’t know, 50 year old. So can you give us a sense for the range of stresses or anxieties you hear from parents, as your patients go through those years?

McIlraith: This really depends on age [as to] why their parents are stressed. So when the kids are young, newborn, infant, even toddler ages, it’s so physical. You may have a parent, just gave birth and is breastfeeding. Sleep is a huge issue, kids not sleeping, parents not sleeping. There’s childcare issues as well as what to do, I do, when my kid’s sick? I still have to go to work. What if I can’t go to work? All those stressors tend to be much more physical, especially with sleep. And parents also sometimes have a lack of support. So if they don’t have the rest of their extended family close by, or friends, or a partner, then those things can be really difficult.

As the kids get older, then we enter into behavior struggles. And technology really starts to be the overwhelming stressor in a lot of families, as well as mental health issues and increasing anxiety, depression, those sorts of things. But I hear over and over, ‘what do I do about cell phones? What do I do about social media? How do I help my kid [for whom] this might be a big issue? Is he addicted? Is she going to follow something on social media or be exposed to something that is going to harm her? So these are those older kid issues.

Miller: Let’s stick with those older ones for a second since that’s where you ended up. How do you talk about social media and technology with your patients or their parents?

McIlraith: This conversation has to start really before the older ages, right? So we talk about delaying, limiting, or restricting screen time and cell phones and social media from the get go. So we try, and the American Academy of Pediatrics really recommends, restricting that time on screens. Then it not only reduces the negative effects that we can see from cell phone use and social media, but it also reduces the stress of managing some of these things.

If we can delay the introduction of social media, delay cell phone use in kids where they have their own cell phones, the parents actually don’t have to constantly be worried about monitoring what the kids are seeing, what their friends are doing, what kind of cyber bullying is going on. If we can delay some of this then that helps the parent’s stress. But even more it helps with prevention of some of these negative side effects that we see with screens and social media.

Miller: It’s interesting, even for this example I can think of, and I can feel, myself, a counterexample. I’m sure that every parent listening now understands what you’re saying. We have heard this before. At the same time, ipads and screens can be a kind of savior at times when you cannot actively parent your kid or you’re traveling or whatever, which itself can then add another layer of stress. We know as parents, we are not supposed to be exposing our kids to this stuff. But sometimes we feel like we have no other choice. How do you deal with that stuff?

McIlraith: I have three kids of my own. I have a 14 year old boy right now. I’m constantly sort of looking at his use. I’m not saying we don’t use it at all. I think there’s very clear times when the use of an ipad, the use of mom’s phone, those sorts of things, are very helpful. It’s really all about what’s on it and how much volume. And so you can manage that and set guidelines for your family.

I encourage families to sit down together and decide what’s reasonable for us. What are our rules gonna be about cell phones? How do we [take] even small steps? We keep the cell phone or the ipad out of the kids’ bedroom at night. We limit and set timers where it stops so that it’s not hours and hours of exposure. So there are little things that end up being big that we can do in order to limit some of these negative effects.

Because there are positives, right? So there’s connecting to a wider social community, especially as you know, the teenagers. So there are some good things and we don’t want to completely restrict them to a point where they don’t get to experience those things. But it’s moderation and paying attention to what they’re watching, what they’re on.

Miller: I want to read an excerpt from the Surgeon General’s advisory because it ties in some ways to this. He wrote;

‘One response to a world in which success and fulfillment feel increasingly out of reach has been an intensifying culture of comparison, often propagated by influencers and online trends with unrealistic expectations about the milestones, parenting strategies, achievements and status symbols that kids and parents must pursue.’

If we have this culture of comparison now that can be destructive, what would a healthier relationship with expectations look like?

McIlraith: I definitely see this in that pressure to be the perfect parent, with perfect children, as you see on social media. That leads to these parents really isolating and pulling back, not being vulnerable about what’s really going on in their family and the challenges they’re facing. And so the families or parents end up feeling like ‘I’m completely alone. I don’t think I’m doing anything right. I don’t think my kids are normal, but I can’t talk about it.’

What if instead, and this is what I try to do because I have the blessing of being able to see lots of parents, lots of kids. And so I hear over and over, ‘Oh, I’m struggling with this. I’m struggling with that.’ What if we were more vulnerable? What if we tried to take away this fear of being vulnerable with others close to you, in your circles, so that parents could share, find connection, support, and know that they’re not alone in these struggles.

I think the Surgeon General’s essay goes a long way towards hopefully normalizing that and making it okay to reach out, okay

to be vulnerable.

Miller: If you’re just tuning in, we’re talking right now about the stresses that many parents face these days and ways to alleviate that stress. Marlo McIlraith is our guest. She’s a pediatrician and an Associate Professor of Pediatrics at OHSU. Let’s listen to another voicemail that came in from a listener. This is Hope from Hillsboro;

‘We’d love to provide a sibling for our daughter and we’d love to have another kid. But financially, with student loans, just cost of living, child care costs, things like that, especially with us not having any family nearby to help take care of our kids when we need it. Yeah, we’re just not in a position where we can afford it. And healthwise, I mean, especially with the gun violence that continues to happen in this country, especially in schools and childcare facilities. It’s terrifying. I’m scared every single day for my child’s safety and health. The state of the climate, microplastic pollution. It’s all terrifying. Yeah, to say that I am stressed is probably an understatement. But you know, gotta keep it going for my kids.’

So she talked later about gun violence and climate change and pollution, but started by talking about money. How does economics play into what we’re talking about today?

McIlraith: I see it a lot, in terms of childcare, cost of childcare, even being able to take time off after having a baby. Many of my moms have to go back to work so early just to be able to pay the bills. So what could we as a society do about childcare costs, parental leave, those sorts of things, to alleviate some of those pressures? I think that’s a great highlight in the essay as well.

Miller: I’m curious about the differences you’ve seen over the course of your professional career. You finished your pediatric residency, if I’m not mistaken, if LinkedIn was accurate, about 25 years ago which is, you know, a chunk of time at this point. How much has parenting changed? One thing we’ve already talked about is social media. That, literally, did not exist 25 years ago. But comparing yourself to other parents, babies not sleeping very well sometimes. That obviously existed 25 years ago. Not all of this is new. I’m wondering what you’ve seen that is truly different about life now for parents?

McIlraith: I think social media and screens aside, I think that in general, the mental health issues that parents are facing in their kids and perhaps in themselves as well is probably the biggest difference from when I graduated residency till now. The rise in anxiety and depression rates, the difficulty in getting mental health services for families. That is definitely recently, in the last 10 years, it’s so difficult to find a therapist, find a psychiatrist if needed. I think those are probably the biggest issues. There’s definitely changes and trends in parenting that may add to some of this. But overall, the mental health side of things, even emotional behavioral dysregulation in the elementary school age. So even before we get to the high rates of anxiety and depression, these are things that we did not deal with in the same volume 25 years ago.

Miller: As we’re talking here we keep, for understandable reasons, pinging back and forth between the challenges that kids are facing, the challenges that parents are facing, the mental health struggles that everybody is dealing with. I’m curious about how they literally affect one another. I mean, specifically how does a stressed out parent affect a child?

McIlraith: It kind of depends on how much support that parent has. right? But a stressed out parent who’s not sleeping or has a short fuse, has difficulty being very patient or intentional as a parent, that [person] parents differently. It’s hard to parent. I think everyone can agree on it being hard to respond in a calm way, in a patient way, in a consistent way. We talk about this with discipline.

But when you’re tired and you haven’t had sleep or you’re stressed about finances or your kid’s really acting up in school, it’s even harder. And so then, the kid doesn’t get a calm and intentional response when they misbehave or even when they’re doing well that day. So that can really affect their whole day. In addition it’s modeling. If the parent is stressed and clearly doing things that we all do to try to feel better, the kid might be doing the same types of things.

So instead of being able to respond to his or her environment in a healthy way, they’re not. And there’s then less time too for things that we know can be really helpful to a kid - sleep and getting outdoors and moving their bodies. So being a stressed parent is hard to begin with. A stressed parent, it’s really difficult for them to give their kids those opportunities to live a healthier life.

Miller: We asked folks on Facebook if they’ve been dealing with parenting stress. Maya Poo Von Geldern wrote,

‘The pace of life has changed, completely expectations for families, expectations for children. Everything has changed and so much more is expected of us than ever before.’

Miles De Bastian wrote,

‘It takes a village to raise kids and we’ve lost our villages and the trust in fellow humans to look out for our kiddos.’

McIlraith: Mmhmm.

Miller: I heard an ‘mmhmm’ there, for sure. Why?

McIlraith: People are living away from their extended families, right? We don’t have the same sort of community bonds that perhaps we did 25 years ago, especially with COVID. That really broke a lot of community bonds that were helpful to families, and that they could lean on. They had another parent or another friend that could pick their kid up when they’re late at work. Or what if a kid is sick can they stay over at someone else’s house while they go to work? Those sorts of things. COVID definitely disrupted a lot of that as well. But before COVID, we definitely had some disintegration of that real bond that parents work together and try to raise their kids together.

Miller: Let’s hear another voicemail. This is Dave who called in from Portland;

‘I got a full time job. My wife’s got a full time job. We got two small kids at home and I would say things have been pretty challenging. But I consider myself pretty lucky in that our kids are healthy. Can only imagine what it would be like having to deal with some kids that have some serious health issues because just working full time to pay for everything and still trying to have the quality time that I think is required to raise conscientious human beings that treat people, it just takes everything out of you, takes everything you got. So I would say managing stress is probably one of the top priorities we have. Getting out into nature and getting the kids out in nature and doing everything we can to try to maintain a less stressful lifestyle is one of our top priorities, but it certainly isn’t easy.’

Miller: So, Dave’s approach to stress relief involves, as we’re hearing, their exercise and outdoor time, which you mentioned before. What advice do you find that you offer most often?

McIlraith: I think again, it depends on age. But as a pediatrician, it’s always thinking about prevention. So getting kids on a regular sleep schedule, and getting them regular time to move their bodies, exercise outside time. I definitely, at pretty much every visit, will talk about those things in order to encourage families. And then kind of brainstorming. Okay, what if that doesn’t work? We live in Oregon. In the winter, it gets cold and rainy. So how else can we get their bodies moving and how else can we work on some of these just basic things when both parents work, when there’s not a lot of time or there’s just exhaustion. But certainly talking about it early, from the newborn stage. And really trying to get everyone good sleep is probably what I focus on most. Sleep and exercise.

Miller: A little more than a year ago, the Surgeon General put out a different advisory that got a lot of attention. This one was about what he called, ‘an epidemic of loneliness and isolation.’ Do you see a connection between these two advisories?

McIlraith: Definitely. I think that a lonely parent is definitely more stressed than a parent who has those community connections. They second guess themselves way more. Is this normal? I hear that question so much. Is this normal? Am I doing it right? What could I do differently? And so when you’re isolated and cut off from community, you don’t get a chance to see that other kids are doing similar things, that you’re not alone, and it’s okay to share that and to get the response of, ‘oh, yeah, no, my kid did that. It’s okay. You’ll get through it.’

Recently I was having breakfast with friends and we were talking about how hard teenage girls can be, when they just enter that stage where they don’t love their mom so much. And how great it felt, even though mine are all grown, how great though it felt to really be able to share and get the response of, ‘oh, yeah. Yeah. But now it’s great.’ Or, ‘oh, it’s ok. You’re gonna be fine.’ Get suggestions and just feel not so alone.

Miller: One of the things the Surgeon General wrote is that, ‘in modern society, parenting is often portrayed as a less important, less valued pursuit.’ Do you think that’s true?

McIlraith: Not at all. It’s not that way.

Miller: That’s not his argument in that it’s vital but it’s denigrated popularly?

McIlraith: Well, I think that we talk a lot about valuing kids and valuing parenting. But then we don’t always put our energy and money into those things. So, we don’t necessarily, in this country anyway, give appropriate and sufficient parental leave. We don’t reimburse for pediatric care and health care and mental health care at the same rate as adults. We don’t spend all the money on cancer research for kids that we should. And so even though we’re saying, ‘oh, kids are the most important thing,’ which by extension would mean that parenting is really important for all of us, we don’t always put our money where our mouth is.

And just briefly, because I know you’re almost out of time, what’s at stake in this for people who aren’t parents, say, for a childless dog guy out there. Yeah. I mean, these kids, they have so much potential. And these are the kids that, when the dog guy is retiring or even later in the workforce, are going to be the majority of who’s gonna really do something in our society. So if we’re not paying attention and not supporting the parents that are raising them and not jumping in to be part of that, then we’re missing out on their potential really. And that’s just a shame. That’s something that I don’t think we can afford to do.

Miller: Marlo McIlraith, thanks very much.

McIlraith: Thank you.

Miller: Marlo McIlraith is an Associate Professor of Pediatrics and a pediatrician at OHSU.

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