Child's perceived stress: A concept analysis


      • Children perceived stress from a variety of sources including daily struggles
      • Child's perceived stress is any real or imagined stressor specific to childhood
      • Child's perceived stress is a complex concept to measure
      • Consequences of child's perceived stress may be physical, emotional, or behavioral



      Child's perceived stress is a term used widely in literature, yet it is poorly defined. Perceived stress in childhood has been linked to negative health outcomes throughout the lifespan. Therefore, the ability of researchers and healthcare providers to conceptualize child's perceived stress and form accurate measures of the concept is of utmost importance.

      Eligibility criteria

      Following the eight steps identified by Walker and Avant, a literature review was conducted to identify studies that measured perceived stress in school-age children over the last 10 years.


      Of 914 records identified, 136 were screened, and 16 met inclusion criteria.


      Child's perceived stress is best defined as any actual or imagined threat, personal and specific to childhood, which overwhelms the child and leads to changes in emotional, psychological, developmental, and/or physiological domains.


      While the concept of child's perceived stress is understood similarly throughout studies, there is notable variation in the way child's perceived stress is measured. Because of the specificity of perceived stress to childhood, and the wide range of what may be perceived as stressful by the child, the child is the best reporter of child's perceived stress.


      Researchers and clinicians must use child self-report tools to measure the concept of child's perceived stress. Opportunities exist for healthcare workers to intervene, educate, and help children and families recognize and manage child's perceived stress. This concept analysis includes many resources that practitioners may use to help alleviate stress in children.


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        • Allwood M.A.
        • Gaffey A.E.
        • Vergara-Lopez C.
        • Stroud L.R.
        Stress through the mind of the beholder: Preliminary differences in child and maternal perceptions of child stress in relation to child cortisol and cardiovascular activity.
        Stress (Amsterdam, Netherlands). 2017; 20: 341-349
        • American Academy of Child and Adolescent Psychiatry
        News and children.
      1. Stress in America: Generation Z. American Psychological Association, 2018 October
        • American Psychological Association
        How to help children manage their stress.
        2019, October 24 (
        • Bakkum L.
        • Willemen A.M.
        • Zoetebier L.
        • Bouts A.H.
        A longitudinal study on the effects of psychological stress on proteinuria in childhood steroid-sensitive nephrotic syndrome.
        Journal of Psychosomatic Research. 2019; 121: 8-13
        • Bates R.
        • Salsberry P.
        • Ford J.
        Measuring stress in young children using hair cortisol: The state of the science.
        Biological Research for Nursing. 2017; 19: 499-510
        • Bevans K.B.
        • Gardner W.
        • Pajer K.A.
        • Becker B.
        • Carle A.
        • Tucker C.A.
        • Forrest C.B.
        Psychometric evaluation of the PROMIS® pediatric psychological and physical stress experiences measures.
        Journal of Pediatric Psychology. 2018; 43: 678-692
        • Campbell J.A.
        • Walker R.J.
        • Egede L.E.
        Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood.
        American Journal of Preventive Medicine. 2016; 50: 344-352
        • Carlsson E.
        • Frostell A.
        • Ludvigsson J.
        • Faresjö M.
        Psychological stress in children may alter the immune response.
        The Journal of Immunology. 2014; 192: 2071-2081
        • Centers Disease Control and Prevention
        Helping children cope.
        • Chang X.
        • Jiang X.
        • Mkandarwire T.
        • Shen M.
        Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years.
        PLoS One. 2019; 14 (Article: e0211850)
        • Charmandari E.
        • Achermann J.C.
        • Carel J.C.
        • Soder O.
        • Chrousos G.P.
        Stress response and child health.
        Science Signaling. 2012; 5: mr1
        • Coddington R.D.
        The significance of life events as etiologic factors in the diseases of children-II a study of a normal population.
        Journal of Psychosomatic Research. 1972; 16: 205-213
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        Journal of Health and Social Behavior. 1983; 24: 385-396
        • Cohen S.
        • Gianaros P.J.
        • Manuck S.B.
        A stage model of stress and disease.
        Perspectives on Psychological Science: A Journal of the Association for Psychological Science. 2016; 11: 456-463
        • Danese A.
        • Lewis S.J.
        Psychoneuroimmunology of early-life stress: the hidden wounds of childhood trauma?.
        Neuropsychopharmacology. 2017; 42: 99-114
        • Davies D.
        • Troy M.F.
        Child development: A practitioner’s guide.
        4th ed. Guilford Publications, Inc, 2020
        • Davis S.L.
        • Kaulfers A.M.
        • Lochman J.E.
        • Morrison S.A.
        • Pryor E.R.
        • Rice M.
        Depressive symptoms, perceived stress, and cortisol in school-age children with Type 1 diabetes: A pilot study.
        Biological Research for Nursing. 2019; 21: 166-172
        • De Luca Canto G.
        • Singh V.
        • Conti P.
        • Dick B.D.
        • Gozal D.
        • Major P.W.
        • Flores-Mir C.
        Association between sleep bruxism and psychosocial factors in children and adolescents: a systematic review.
        Clinical Pediatrics. 2015; 54: 469-478
        • Douglas R.D.
        • Alvis L.M.
        • Rooney E.E.
        • Busby D.R.
        • Kaplow J.B.
        Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement.
        Journal of Traumatic Stress. 2021; 34: 929-942
        • Dufton L.M.
        • Dunn M.J.
        • Slosky L.S.
        • Compas B.E.
        Self-reported and laboratory-based responses to stress in children with recurrent pain and anxiety.
        Journal of Pediatric Psychology. 2010; 36: 95-105
        • Evans B.E.
        • Greaves-Lord K.
        • Euser A.S.
        • Tulen J.H.
        • Franken I.H.
        • Huizink A.C.
        Determinants of physiological and perceived physiological stress reactivity in children and adolescents.
        PLoS One. 2013; 8 (Article: e61724)
        • Fagundes C.P.
        • Way B.
        Early-life stress and adult inflammation.
        Current Directions in Psychological Science. 2014; 23: 277-283
        • Felton J.W.
        • Banducci A.N.
        • Shadur J.M.
        • Stadnik R.
        • MacPherson L.
        • Lejuez C.W.
        The developmental trajectory of perceived stress mediates the relations between distress tolerance and internalizing symptoms among youth.
        Development and Psychopathology. 2017; 29: 1391-1401
        • Figueroa-Fankhanel F.
        Measurement of stress.
        Psychiatric Clinics. 2014; 37: 455-487
        • Freda M.F.
        • Savarese L.
        • Bova M.
        • Galante A.
        • De Falco R.
        • De Luca Picione R.
        • Triggiani M.
        Stress and psychological factors in the variable clinical phenotype of hereditary angioedema in children: A pilot study.
        Pediatric Allergy, Immunology and Pulmonology. 2016; 29: 6-12
        • Garner A.S.
        Home visiting and the biology of toxic stress: Opportunities to address early childhood adversity.
        Pediatrics. 2013; 132: S65-S73
        • Garner A.
        • Yogman M.
        • Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics, Council on Early Childhood
        Preventing childhood toxic stress: Partnering with families and communities to promote relational health.
        Pediatrics. 2021; 148 (Article: e2021052582)
        • Gilgoff R.
        • Singh L.
        • Koita K.
        • Gentile B.
        • Marques S.S.
        Adverse childhood experiences, outcomes, and interventions.
        Pediatric Clinics of North America. 2020; 67: 259-273
        • Gillespie R.J.
        Screening for adverse childhood experiences in pediatric primary care: pitfalls and possibilities.
        Pediatric Annals. 2019; 48: e257-e261
        • He Z.H.
        • Yin W.G.
        Family environments and children’s executive function: the mediating role of children’s affective state and stress.
        The Journal of Genetic Psychology. 2016; 177: 143-155
        • Hill D.C.
        • Moss R.H.
        • Sykes-Muskett B.
        • Conner M.
        • O’Connor D.B.
        Stress and eating behaviors in children and adolescents: Systematic review and meta-analysis.
        Appetite. 2018; 123: 14-22
        • Hornor G.
        Journal of Pediatric Health Care. 2017; 31: 384-390
        • Johnson A.
        • Rice M.
        • Turner-Henson A.
        • Haase J.E.
        • Azuero A.
        Perceived stress and the fatigue symptom cluster in childhood brain tumor survivors.
        Oncology Nursing Forum. 2018; 45: 775-785
        • Kang D.
        • Rice M.
        • Park N.
        • Turner-Henson A.
        • Downs C.
        Stress and inflammation: A biobehavioral approach for nursing research.
        Western Journal of Nursing Research. 2010; 32: 730-760
        • Kanner A.D.
        • Harrison A.
        • Wertlieb D.
        The development of the children’s hassles and uplifts scales: A preliminary report.
        in: Paper presented at the Annual Meeting of the American Psychological Association, Los Angeles, CA. 1985
        • Kelley M.N.
        • Lowe J.R.
        Strong cultural identity affects stress levels among Native American youth at risk for obesity.
        Journal of Cultural Diversity. 2018; 25: 127-131
        • Kertes D.A.
        • Liu J.
        • Hall N.J.
        • Hadad N.A.
        • Wynne C.D.
        • Bhatt S.S.
        Effect of pet dogs on children’s perceived stress and cortisol stress response.
        Social Development. 2017; 26: 382-401
        • Lazarus R.
        • Folkman S.
        Stress, appraisal, and coping.
        Springer Publishing Company, Inc, 1984
        • Lewis C.E.
        • Siegel J.M.
        • Lewis M.A.
        Feeling bad: Exploring sources of distress among pre-adolescent children.
        American Journal of Public Health. 1984; 74: 117-122
        • Liu C.H.
        • Doan S.N.
        Innovations in biological assessments of chronic stress through hair and nail cortisol: Conceptual, developmental, and methodological issues.
        Developmental Pyschobiology. 2019; 61: 465-476
        • Liu C.H.
        • Doan S.N.
        Psychosocial stress contagion in children and families duringthe COVID-19 pandemic.
        Clinical Pediatrics. 2020; 59: 853-855
        • Lynch T.
        • Azuero A.
        • Lochman J.E.
        • Park N.J.
        • Turner-Henson A.
        • Rice M.
        The influence of psychological stress, depressive symptoms, and cortisol on body mass and central adiposity in 10-to-12-year-old children.
        Journal of Pediatric Nursing. 2019; 44: 42-49
        • Masarik A.S.
        • Conger R.D.
        Stress and child development: A review of the Family Stress Model.
        Current Opinion in Psychology. 2017; 13: 85-90
        • Mason T.B.
        • O’Connor S.G.
        • Schembre S.M.
        • Huh J.
        • Chu D.
        • Dunton G.F.
        Momentary affect, stress coping, and food intake in mother–child dyads.
        Health Psychology. 2019; 38: 238-247
        • McEwen B.
        Physiology and neurobiology of stress and adaptation: Central role of the brain.
        Physiological Reviews. 2007; 87: 873-904
        • McEwen B.S.
        • Gianaros P.J.
        Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease.
        Annals of the New York Academy of Sciences. 2010; 1186: 190-222
        • Miller K.
        • Margolin G.
        • Shapiro L.
        • Timmons A.
        Adolescent life stress and the cortisol awakening response: The moderating roles of attachment and sex.
        Journal of Research on Adolescence. 2017; 27: 34-48
        • Moazzezi M.
        • Moghanloo V.A.
        • Moghanloo R.A.
        • Pishvaei M.
        Impact of acceptance and commitment therapy on perceived stress and special health self-efficacy in seven to fifteen-year-old children with diabetes mellitus.
        Iranian Journal of Psychiatry and Behavioral Sciences. 2015; 9: 31-36
        • Muldoon O.T.
        Perceptions of stressful life events in Northern Irish school children - A longitudinal study.
        Journal of Child Psychology and Psychiatry and Allied Health Disciplines. 2003; 44: 193-201
        • National Institute of Mental Health
        Child and adolescent mental health.
        • Neuman B.
        The neuman systems model.
        in: Neuman B. Fawcett J. The Neuman System Model. 4th ed. Prentice Hall, 2002: 3-42
        • Nijhof S.L.
        • Vinkers C.H.
        • van Geelen S.M.
        • Duijff S.N.
        • Achterberg E.
        • van der Net J.
        • Lesscher H.
        Healthy play, better coping: The importance of play for the development of children in health and disease.
        Neuroscience and Biobehavioral Reviews. 2018; 95: 421-429
        • Oh D.L.
        • Jerman P.
        • Silvério Marques S.
        • Koita K.
        • Purewal Boparai S.K.
        • Burke Harris N.
        • Bucci M.
        Systematic review of pediatric health outcomes associated with childhood adversity.
        BMC Pediatrics. 2018; 18: 83
        • Ortiz R.
        • Sibinga E.M.
        The role of mindfulness in reducing the adverse effects of childhood stress and trauma.
        Children. 2017; 4: 16
        • Osório C.
        • Probert T.
        • Jones E.
        • Young A.H.
        • Robbins I.
        Adapting to stress: understanding the neurobiology of resilience.
        Behavioral Medicine (Washington D.C.). 2017; 43: 307-322
        • Parfenoff S.H.
        • Jose P.E.
        Measuring daily stress in children.
        in: Paper presented at the Biennial Meeting of the Society for Research in Child Development. Kansas City, MO. 1989
        • Pascoe M.C.
        • Hetrick S.E.
        • Parker A.G.
        The impact of stress on students in secondary school and higher education.
        International Journal of Adolescence and Youth. 2020; 25: 104-112
        • Pervanidou P.
        • Chrousos G.P.
        Metabolic consequences of stress during childhood and adolescence.
        Metabolism, Clinical and Experimental. 2012; 61: 611-619
        • Rew L.
        • Principe C.
        • Hannah D.
        Changes in stress and coping curing late childhood and preadolescence.
        Journal of Child and Adolescent Psychiatric Nursing. 2012; 25: 130-140
        • Ricker A.A.
        • Corley R.
        • DeFries J.C.
        • Wadsworth S.J.
        • Reynolds C.A.
        Examining the influence of perceived stress on developmental change in memory and perceptual speed for adopted and nonadopted individuals.
        Developmental Psychology. 2018; 54: 138-150
        • Rodriguez E.M.
        • Dunn M.J.
        • Zuckerman T.
        • Vannatta K.
        • Gerhardt C.A.
        • Compas B.E.
        Cancer-related sources of stress for children with cancer and their parents.
        Journal of Pediatric Psychology. 2012; 37: 185-197
        • Ryan-Wenger N.A.
        • Sharrer V.W.
        • Campbell K.K.
        Changes in children’s stressors over the past 30 years.
        Pediatric Nursing. 2005; 31: 282-291
        • Ryan-Wenger N.A.
        • Wilson V.L.
        • Broussard A.G.
        Stress, coping, and health in children.
        in: Rice V.H. Handbook of stress, coping, and health: Implications for nursing research, theory, and practice. Sage Publications, Inc, 2012: 226-253
        • Sarkissian M.
        • Trent N.L.
        • Huchting K.
        • Khalsa S.B.S.
        Effects of a Kundalini yoga program on elementary and middle school students’ stress, affect, and resilience.
        Journal of Developmental & Behavioral Pediatrics. 2018; 39: 210-216
        • Saxe G.N.
        • Bosquet M.
        Child Stress Disorders Checklist-Screening Form (CSDC-SF) (v. 1.0-3/04).
        National Child Traumatic Stress Network and Boston University School of Medicine, 2004
        • Selye H.
        A syndrome produced by diverse nocuous agents.
        Nature. 1936; 138: 32
        • Selye H.
        Stress and the general adaptation syndrome.
        British Medical Journal. 1950; 1: 1383-1392
        • Selye H.
        The stress of life.
        McGraw-Hill Book Co., 1956
        • Selye H.
        The evolution of the stress concept. Stress and cardiovascular disease.
        American Journal of Cardiology. 1970; 26: 289-299
        • Shonkoff J.P.
        • Garner A.S.
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
        • Skinner E.A.
        The development of coping: Stress, neurophysiology, social relationships, and resilience during childhood and adolescence.
        Springer, 2016
        • Snoeren F.
        • Hoefnagels C.
        Measuring perceived social support and perceived stress among primary school children in the Netherlands.
        Child Indicators Research. 2014; 7: 473-486
        • Substance Abuse and Mental Health Services Administration
        Why you should talk with your child about alcohol and other drugs.
        • Terzian M.
        • Moore K.A.
        • Nguyen H.N.
        Assessing stress in children and youth: A guide for out-of-school time program practitioners.
        Child Trends. 2010; (October): 1-6
        • Van Ryzin M.J.
        • Roseth C.J.
        Cooperative learning in middle school: A means to improve peer relations and reduce victimization, bullying, and related outcomes.
        Journal of Educational Psychology. 2018; 110: 1192-1201
        • Walker L.
        • Avant K.
        Strategies for theory construction in nursing.
        5th ed. Prentice Hall, 2011
        • Walker L.S.
        • Beck J.E.
        • Garber J.
        • Lambert W.
        Children’s Somatization Inventory: Psychometric properties of the revised form (CSI-24).
        Journal of Pediatric Psychology. 2009; 34: 430-440
        • Wen C.K.F.
        • Liao Y.
        • Maher J.P.
        • Huh J.
        • Belcher B.R.
        • Dzubur E.
        • Dunton G.F.
        Relationships among affective states, physical activity, and sedentary behavior in children: Moderation by perceived stress.
        Health Psychology. 2018; 37: 904-914
        • Werner E.E.
        Protective factors and individual resilience.
        in: Shonkoff J.P. Meisels S.J. Handbook of early childhood intervention. 2nd ed. Cambridge University Press, 2011: 115-132
        • Williamson D.E.
        • Birmaher B.
        • Ryan N.D.
        • Shiffrin T.P.
        • Lusky J.A.
        • Protopapa J.
        • Brent D.A.
        The stressful life events schedule for children and adolescents: development and validation.
        Psychiatry Research. 2003; 119: 225-241
        • Zengin-Bolatkale H.
        • Conture E.G.
        • Walden T.A.
        • Jones R.M.
        Sympathetic arousal as a marker of chronicity in childhood stuttering.
        Developmental Neuropsychology. 2018; 43: 135-151