Our society seems to be steeped in anxiety – it is the most common mental health problem around the globe.[1] Teenagers and young adults are facing an epidemic of anxiety: 25% of Americans aged 13 to 18 years suffer from anxiety – that is one quarter of all teenagers! In Australia two national studies showed that 15.4% of 16 to 24 year olds[2] and 7% of four to 17 year olds[3] had experienced an anxiety disorder in the previous 12 months. These numbers are staggering. The other side of “not calm” is hyperactivity: almost one in 15 children are diagnosed with attention deficit hyperactivity disorder (ADHD) in Australia and New Zealand. Some children with ADHD are being medicated and many suffer from side effects when the medication wears off and struggle to calm down in the evening and go to sleep – presenting another challenge for the family.

Most people, when asked, admit that they are stressed in one way or another: too many commitments, too little money or time; too much work; too little fun; too many people; too much traffic and noise, or too few friends. Is this an inevitable element of being human or has something happened to our species? It is especially worrying that young children and teenagers suffer from anxiety. Childhood should be a worry-free time – a period when the brain can develop without the adverse effects of stress and fear. Unfortunately, this is not the case. The 2018 Stress in America survey of adults and teenagers found that high school students have higher stress levels than adults.[4]

Let’s take a look at some of the reasons for the rise in anxiety and hyperactivity in children. Our lifestyle has changed drastically from how we were evolved to live. Our ancestors, whose bodies and brains were exactly like ours, lived in close-knit communities, spent about 4-6 hours a day walking in forests or hills, gathering food, occasionally hunting an animal; hung out together, sang, danced, told stories, drew on cave walls. They slept when it got dark and woke up whenever they felt rested (not torn from a deep sleep phase by an alarm clock). They had plenty of leisure time, for socialisation and creative activities (most likely, they played music – a flute-like instrument has been dated to 35,000BC – and danced; a cave painting from 30,000BC shows a dancer), and their daily life involved little stress.

Compare this to how our kids and teenagers live: they wake up too early and rush to an early school start, when their inner clocks are still set on sleep; they are under academic pressure at school, have hours of homework, often lots of after-school activities, spend very little time in nature. Add some peer pressure to this, maybe even bullying, a pinch of conflict with parents and siblings, and you get a very stressed young person.

When you experience anxiety your stress hormones, adrenaline and cortisol, go up, and can cause a “fight or flight” reaction, which from an evolutionary standpoint was helpful to get the body ready to run away or fight the danger: the heart rate and blood sugar levels increase, blood flows to big muscles needed for running, and you breathe faster to prepare for your escape.

We rarely need to run from danger these days and many of the anxiety provoking situations are more in our minds than in our physical world. Therefore, the surge in adrenaline and cortisol is not followed by the expected sprint which would help to release and lower the stress hormones. This can lead to a build-up of stress hormones and can cause symptoms such as shaking and trembling, sweaty palms, a racing heart, difficulty breathing and dizziness. In the long run, stress hormones can inhibit the immune system and program the body to put on layers of fat.

So what can we do to calm our children?

For a holistic approach we need to look at lifestyle, sleep, diet, nutritional deficiencies and environmental toxins.

The first thing to address is lifestyle: does the child get enough exercise and outdoor play during the day? The research on nature in medicine is booming – there are new journals and entire conferences dedicated to this topic. Whether you prefer the Japanese “forest bathing” or just plain playing in the park – the research is clear: time spent in nature calms children, helps them concentrate better, reduces anxiety, and increases creative problem-solving skills.[5] Progressive schools have taken this on board and let primary school kids run outside after every 20 minutes of study time or include classes in nature. These schools report faster academic progress and better attention compared to children who are more sedentary.[6]

Does the child or young person sleep enough? Does he or she need help to go to sleep and sleep soundly and through the night?

Sleep deprivation is a torture method – and many of our young people are chronically sleep- deprived. In order to fall asleep easily, you need to have been active during the day (think of the hours of walking our ancestors did); for optimal melatonin production you need to have sun exposure during the day and avoid bright lights (including screens) in the evening; a calm and predictable night-time routine is key for young children, but may also help teenagers and even adults. If a child struggles to settle into sleep the following is helpful:

Magnesium, as the ultimate calming mineral: either as an Epsom salt bath, in the diet (nuts, seeds and leafy green vegetables are great sources) or as an oral magnesium supplement. This is especially recommended when children have other symptoms of low magnesium, for example, constipation or sore legs (often considered growing pains, but growing does not hurt! Magnesium deficiency does, by causing muscle cramps, constipation, or muscle tics).

Chamomile, valerian root and lemon balm have a calming and sedative effect. Chamomile tea can be given to children from six months of age, and valerian and lemon balm have been shown to be safe for use in children from three years of age.[7] Valerian reduces the breakdown of Gamma-aminobutyric acid (GABA), the calming neurotransmitter needed for tranquillity. It also contains the antioxidants hesperidin and linarin which have sedative and sleep-enhancing properties.[8] Valerian has been shown to be effective in helping children with intellectual disabilities to get to sleep faster and sleep for longer and more soundly.[9]

L-theanine: a green tea extract that increases calm alpha waves in the brain, reduces anxiety and improves sleep.

Relaxation and breathing exercises may help – children (and adults) who breathe well (i.e. through the nose) sleep better and are calmer.[10] Children’s problems with hyperactivity, anxiety, sleep, and low energy may improve once they learn to breathe properly through the nose. Recommend a breathing assessment and training to every mouth breathing child.

Diet and nutrition

The SAD, or Standard Australian Diet, consists of mostly processed foods that lack necessary vitamins, antioxidants, minerals, and fibre. Instead it provides too many empty calories, sugar, unhealthy fats, and additives – all of which are registered by the body as toxins and need to be eliminated by using up glutathione and zinc. Children with anxiety, hyperactivity and sleep problems are often already low in glutathione and zinc and have strong reactions to additives. The effects of additives like 102 (yellow colouring), 202 (preservative potassium sorbate) and 280 (propionic acid preservative in bread) have been described in many studies[11]: they cause hyperactivity, outbursts, irritability, angry behaviour, and negatively affect coordination and concentration. They do not have any positive effects (apart from prolonging shelf life of the food) and should be avoided.

We are not evolved to eat this kind of diet and there are plenty of studies on the benefits of anti-inflammatory Mediterranean and plant-based diets for health, mood and behaviour. Given that only 20% of Australians eat the minimum recommended five servings of vegetables a day, and the numerous benefits of eating more vegetables, discussion about nutrition should be part of every health consultation. Research on the connection between the microbiome, the metabolome (the chemicals produced by the microbiome) and human health and behaviour has virtually exploded in the last few years.

A healthy, diverse microbiome supports calm and well-functioning immune and nervous systems. The western diet and common medical interventions, like antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), caesarean sections, infant formula use, and reflux medication unfortunately disrupt the establishment of a healthy microbiome. Health practitioners need to be aware of this and help avoid unnecessary medication and interventions and encourage families to do whatever they can to undo the damage: breastfeed, eat probiotic-rich foods and above all plenty of vegetables. The best way to achieve long-term positive changes in the gut flora is to increase vegetables in the diet.[12] Get your patients to eat the colours of the rainbow every day!

Nutrient deficiencies may affect sleep and activity levels and need to be looked for and treated appropriately: children with iron or B12 deficiency may suffer from sleep onset problems, restless legs, and irritability; low magnesium can lead to nightmares and night terrors, anxiety and hyperactivity; low zinc is associated with ADHD and low moods; low omega-3 levels affect behaviour, mood and sleep.

Environmental factors

Since the beginning of the 20th century industrial chemicals have been produced and released indiscriminately into our environment. Most have not undergone safety testing, especially on children and their exquisitely vulnerable, developing bodies and brains. Currently, approximately 10 million tons of toxic chemicals are released into the environment per year. Lead, mercury, arsenic, bisphenol A (BPA), alcohol, and fluoride are well established neurotoxicants that affect children’s behaviour and cognition. A recent study showed that a higher exposure to fluoride during pregnancy increases the risk of the child getting a diagnosis of ADHD.[13] Pesticides in urine (from food) are a predictor of ADHD symptoms in teenagers.[14] Mercury from fish consumption can increase hyperactivity, anxiety and irritability – especially in those with the APOE 4 allele associated with poor detoxification.[15]

Our duty of care should consist in educating parents about the dangers of environmental toxins and helping them to avoid these before and during pregnancy, while breastfeeding and in childhood (and ideally forever).

If a child has been exposed to environmental toxins we need to assess the extent of damage and support detoxification. Useful interventions include sweating, while exercising or using saunas (Far Infrared), zinc supplementation, and boosting glutathione production with for example N-acetyl-cysteine, sulforaphane and foods rich in vitamin C, selenium and sulphur.

Supplements

As a specialist in nutritional and environmental medicine, I spend a lot of time ensuring that my patients are getting a wholesome, additive-free and unprocessed diet, with at least five servings of vegetables per day; at least one hour of outdoor exercise; plenty of restful sleep (breathing properly through the nose), and protection from environmental toxins. While working on improving these aspects of their lives I often recommend supplements to help calm the child. My preferred supplements that help to calm hyperactive and anxious children are magnesium (especially Epsom salt baths), zinc, L-theanine, chamomile tea, valerian, and lavender essential oil.

My aim in recommending these supplements is to increase GABA and serotonin production. There are many herbal extracts to choose from, for example, lemon balm and passion flower, both of which are effective and safe.16,17 Valerian is one of the safest choices for children (over three years of age) to induce relaxation, improve sleep and reduce anxiety and hyperactivity.18

In summary: Everyone wants their child to be happy and calm. Living a lifestyle as much in sync with our evolution as possible is a good start and definitely worth the effort. The next step is to address any potential nutrient deficiencies and if needed use supplements, as well as herbs to help calm an anxious or hyperactive child.

References

Ritchie H, Roser M. Mental Health. OurWorldInData.org [Source]
Australian Bureau of Statistics: National survey of mental health and wellbeing, summary of results, 2007. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4326.0Main%20Features32007
Lawrence D, Johnson S, Hafekost J, et al. The mental health of children and adolescents. Report on the second Australian child and adolescent survey of mental Health and Wellbeing. August 2015. [Full text]
American Psychological Association. Stress in America: Generation Z. Stress in AmericaTM Survey. 2018, www.apa.org/news/press/releases/stress/2018/stress-gen-z.pdf
Kuo FE, Taylor AF. Could exposure to everyday green spaces help treat ADHD? Evidence from children's play settings. App Psychol: Health and Well-Being 2011;3:281-303. [Abstract]
Kuo M, Browning M, Penner M. Do lessons in nature boost subsequent classroom engagement? Refueling students in flight. Front Psychol 2017;8:2253. [Full text]
Gromball J, Beschorner F, Wantzen, C, et al. Hyperactivity, concentration difficulties, and impulsiveness improve during seven weeks’ treatment with valerian root and lemon balm extracts in primary school children. Phytomedicine 2014;21(8-9):1093-1103. [Full text]
Fernandez S, Wasawski C, Paladini AC, et al. Sedative and sleep-enhancing properties of linarin, a flavonoid isolated from Valeriana officinalis. Pharmacol Biochem Behav 2004;77(2):399-404. [Abstract]
Francis AJ, Dempster RJ. Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial. Phytomedicine 2002;9(4):273-270. [Abstract]
Ma X, Yue ZQ, Gong ZQ, et al. The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Front Psychol 2017;6;8:874. [Full text]
McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007;370(9598):1560-1567. [Abstract]
Valdes AM, Walter J, Segal E, et al. Role of the gut microbiota in nutrition and health. BMJ 2018;361;k2179. [Full text]
Bashash M et al. Prenatal fluoride exposure and ADHD symptoms in children at 6-12 years of age in Mexico City. Environ Int 2018;121(Pt 1):658-666. [Full text]
Bouchard MF, Bellinger DC, Wright RO, et al. Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics 2010;125(6):e1270-7. [Full text]
Ng S, Lin CC, Jeng SF, et al. Mercury, APOE, and child behavior. Chemosphere 2015;120;123-130. [Abstract]
Fiebich BL, Knörle R, Appel K, et al. Pharmacological studies in an herbal drug combination of St. John's Wort (Hypericum perforatum) and passion flower (Passiflora incarnata): in vitro and in vivo evidence of synergy between Hypericum and Passiflora in antidepressant pharmacological models. Fitoterapia 2011;82(3):474-480. [Abstract]
Weeks B. Formulations of dietary supplements and herbal extracts for relaxation and anxiolytic action: Relarian. Med Sci Monit 2009;15(11):RA256-RA262. [Abstract]
Becker A, Felgentreff F, Schröder H, et al. The anxiolytic effects of a Valerian extract is based on valerenic acid. BMC Complement Altern Med 2014;14:267. [Full text]

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