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Stress

"My Kid Is Stressed!" An Rx for Stress Without Side Effects

Storytelling has an analgesic effect on pediatric patients.

Key points

  • Storytelling has always been a "common sense" intervention for kids who are in pain or stressed out.
  • New research demonstrates storytelling has an objectively measurable effect on the salivary cortisol, a marker of stress, in pediatric patients.
  • Storytelling also lowered subjective measures of stress, and helped children make more positive associations with their hospital stay.
  • This has implications for parenting all children, especially children stressed out by a global pandemic.

Richer than I you can never be-

I had a Mother who read to me.

Strickland Gillian’s famous poem "The Reading Mother" ends with these lines. We’re in an era of endless entertainment for kids, from the rich fantasies of Pixar to endless hours of YouTube and every permutation of video games out there. Yet something is lost when a child listens to a story from their LeapFrog or finds it on Netflix. I call reading books to kids a lost art, because let’s face it – Netflix is easier, parents are busy, and there’s so much else going on.

Choreograph/123RF
Reading to children is even more powerful than we previously believed, according to new research.
Source: Choreograph/123RF

Something is lost, though, when our kids watch the movie version of the Cat in the Hat, or even watch a read-aloud video of a story book. There’s nothing like sitting down, reading a story, and then using that story to help little humans makes sense of the big challenges and big emotions they deal with every day. This is something I’ve intuitively felt for years, and it’s why I use picture books as a mainstay in my parenting classes. Now, new research has documented just how powerful reading books to children can be.

Analgesic Effect of Reading to Children

Researchers in Brazil investigated whether storytelling has an analgesic effect on children in an ICU. They found that storytelling lowers salivary cortisol levels, raises oxytocin levels, and has a strong effect on patient’s self-reported pain scores. In addition, children exposed to the storytelling intervention spoke more positively about the hospital experience.

We’ve always known that stories are helpful, and that they can provide a distraction for children undergoing uncomfortable procedures. Any parent who has made up a story about a train entering a tunnel to get a child to taste spinach for the first time knows that stories can work. But conventional wisdom sees stories as merely a distraction from discomfort and pain, not an intervention in and of themselves.

This research documented the effects of stories on 81 children in an ICU. Half of the children received a riddle/game-based intervention, in which they were presumably distracted, but not exposed to a story. The other half were provided a storytelling intervention – 30 minutes of stories read by a trained volunteer.

Cortisol and oxytocin are hormones we can use to measure stress levels. High salivary cortisol and low salivary oxytocin indicates stress. Low cortisol and high oxytocin indicate calm. This study was the first of its kind to directly measure cortisol and oxytocin levels as a way of documenting exactly what effect storytelling has on stress levels.

Both prior and after the storytelling intervention, salivary cortisol and oxytocin were measured. Only the children in the storytelling group demonstrated a drop on salivary cortisol and an increase in oxytocin. In addition, the children were asked to rate their pain and stress prior to the intervention and post the intervention. While both groups reported some degree of relief (both groups self-reported a lower stress and pain score), the storytelling group reported much lower levels of pain and stress than the riddle/game group.

Finally, both groups were subjected to a free-association test, to see their attitudes towards doctors, nurses, hospitals, and medicine. The storytelling group associated much more positive and empowered terms with words like “hospital” or “doctor” than the riddle/game group.

Results of the Research: Storytelling vs. Games

Strikingly, the storytelling intervention appeared to be twice as effective as the riddle. Oxytocin levels rose nine times as much after the storytelling intervention, versus a five time increase after the riddle/game intervention. This controls for factors like attention – maybe just having an adult pay the ill child some attention has an analgesic effect? It does, a bit. But not nearly as strong an effect as storytelling does. Cortisol levels dropped by about 60% for the children who heard stories, compared with a drop of 35% for those who worked on riddles. Both are drops, which is a good thing. But one is a significantly stronger effect. Remember, this is an objective measure – the actual levels of cortisol in the children’s saliva decreased.

In terms of subjective measures, children were asked to rate their pain level, from 1-6, with 6 being the most pain possible, and 1 being barely in pain. The children who were in the storytelling intervention rated their pain on average at 3.85 prior to the intervention, and 1.15 after the intervention. That’s a drop of 2.7 points! The children who were in the riddle/game intervention rated their pain on average at 3.72 prior to the intervention, and 2.18 after the intervention. That’s a drop of 1.54 points.

While both groups saw a drop in their subjective pain scores, again, the storytelling intervention was significantly more effective at lowering subjective pain scores. While this measure is more susceptible to bias, as children might not be so accurate at rating their pain, it’s still an encouraging finding. After all, ultimately, only the person suffering pain can truly know exactly how they are feeling.

Finally, in a meaning-making task, a word association game, the children were asked to free-associate to words such as “hospital” or “doctor.” One striking example in the research report was that after the intervention, when asked to free associate to the word “hospital”, a child in the storytelling intervention said “the place people go to get better.” A child in the riddle/game group said “a place people go when they get sick.” Same general meaning, vastly different phenomenology.

Why I Love Stories

On Instagram, I host Dr. K’s Story Club, where I teach parents how to select children’s books, how to read them for maximal benefit, and how to discuss the books they read with their children. I have found that storytelling is one of the most potent tools I have in my arsenal as a child psychologist. When a child is listening to a story about a character undergoing something they have been through, they’re transported to a space where they can listen more reflectively. There’s a certain sense of attunement between reader and child. There’s a sense of co-regulated calmness.

Once we’re in that narrative space, it’s easy to open up a conversation about the challenges that child might be facing. When we’re talking about the monkey that’s feeling grumpy, the balloon who is feeling blah, or the little girl who feels left out, it’s less threatening than talking about those actual situations in our real lives.

In general, stress tends to block learning, especially social and emotional learning. If a child is feeling a strong emotion, it’s difficult to get them to think about it with some distance and calm. But as we saw from the study, storytelling lowers stress. When we’ve lowered stress, we can think more objectively about our lives. Having a conversation with a child about how it’s not OK to take out their bad mood on their siblings is likely to stress the child out all over again. Reading about an animal who did just that will be calming. Once the child is calm, and feels attuned, it’s much easier to open that conversation.

I think we’ve always known that stories are powerful. I think we’ve always known that they’re calming, and that reading to kids is beneficial. Now we have some data to explain exactly how and why it’s so useful. The next time your Little Human is dealing with some Big Challenges, take out a picture book, and see that effect for yourself.

References

Storytelling increases oxytocin and positive emotions and decreases cortisol and pain in hospitalized children Guilherme Brockington, Ana Paula Gomes Moreira, Maria Stephani Buso, Sérgio Gomes da Silva, Edgar Altszyler, Ronald Fischer, Jorge Moll

Proceedings of the National Academy of Sciences Jun 2021, 118 (22) e2018409118; DOI: 10.1073/pnas.2018409118

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