Thousands of children and teens returned to or started school for the first time on Monday. Most were fresh-faced and bright-eyed. However, how happy are they?

School stress hits children in Singapore for a variety of reasons. These include having to endure the pressures of homework and examinations, being victims of bullying, facing difficulties in making friends and, for some, being unable to cope with the transition from preschool to primary school, or from primary to secondary school.

In their book, Helping Your Child To Cope - Understanding Childhood Stress, the authors, Dr Cai Yiming and Dr Daniel Fung, who are both senior consultant psychiatrists at the Institute of Mental Health, discuss what they term 'critical ages", when stress levels peak for children in Singapore.

These stress periods are at the ages of seven - when children enter Primary 1 - and 12 and 16 - when children and teens sit for major exams like the PSLE and GCE O levels and when they move to a different academic system.

According to a 1996 study by the Child Guidance Clinic cited in the book, the number of new cases at the clinic was highest for seven-year-olds.

Latest figures for this are not available, but an informal check with parents, schoolteachers and mental health experts found that children do seem more stressed in the transition stages of school and also during major examination years.

Dr Brian Yeo, a consultant psychiatrist at Mount Elizabeth Medical Centre, said: 'Children entering Primary 1 can have problems adjusting from a very laissez-faire preschool to a structured primary school context, with more academic demands."

Children also need to adapt to a different physical environment when they go to a new school.

Schools recognise that moving from preschool to primary school can be difficult for the little ones.

Mrs Lynn Fong, a teacher who has taught Primary 1 pupils for the past seven years, said: 'If there's a very timid child in class, we will try to reassure him and seat him next to a child who is gentle and friendly."

Her school, a neighbourhood one in Jurong West, also has a buddy system where, for two weeks, a Primary 5 pupil will help a child in Primary 1 become familiar with recess routines.

In addition, parents are allowed to be with their child during the first three days of school. However, not all schools practise this.

In extreme cases of a Primary 1 pupil having problems, schools may allow him to switch classes.

Schools are now more aware of how children can exhibit stress-related emotional and behavioural problems. Every school has at least one full-time counsellor and most schools take a team approach in helping troubled students.

At secondary school level, the pressures come from boy-girl relationships, family fall-outs or, more frequently, from exam stress, particularly in the better classes or schools.

A full-time school counsellor, who is currently in a secondary girls' school, said: 'Students are very competitive and there can be self-imposed pressure to do well." Sometimes, stress manifests itself in physical ways - a student may lose his appetite, become thin and listless or experience severe headaches.

Some students may also have suicidal thoughts. Such students are usually referred to professional help agencies and parental involvement is essential.

CASE 1: HER TUMMY HURT EVERY MORNING

In January last year, seven-year old Shenelle Tan (not her real name) started primary school.

She seemed well prepared. Her mother, hospital manager Kan Ee Kuen, 41, had taken her to her new school a few times. It was a series of large, cream-coloured buildings that looked quite grand.

Shenelle loved her beige and brown school uniform and her new school bag and matching pencil case in her favourite colour - pink.

Within a month of starting school, however, Shenelle was dreading it. Madam Kan recounted: 'Every morning, she'd say she couldn't go to school and that her tummy hurt.

'It was a battle to get her out of the house and onto the school bus. She did not sleep well and would often wake up crying in the middle of the night."

The situation was so stressful that Madam Kan had to take Shenelle out of school for almost two weeks while she tried to resolve the problem.

In the end, Shenelle was moved to a different class after Madam Kan spoke to her teachers.

'One of Shenelle's former preschool friends was in a different class in her school and I asked for Shenelle to be with her." It also helped that the same friend took Shenelle's school bus.

With a familiar friend, Shenelle was able to overcome her anxieties and go back to school.

CASE 2: STRESS MADE HIM BEDWET

Administrative officer Salbiah Daud said that her son, Muhammad Danial (not his real name), who is now in Primary 3, had tremendous problems settling down in Primary 1.

'Danial didn't like the girl he was sitting next to in class and he didn't like the school toilets," she said. He refused to go to school and when he did, the teacher would often call her to report that he was crying in class, she said.

Danial's preschool was a small one where all the children interacted warmly with the teachers and even the cleaning lady.

Madam Salbiah now feels that the switch for Danial 'from a cosy double-storey schoolhouse filled with sunflower cut-outs to a big school with so many floors and classrooms" was too overwhelming for him.

'Primary schools are way too big," she said.

When Danial started bedwetting at night, she knew it was a serious problem and sought help from the Institute of Mental Health.

Her son received some counselling and she was also given practical tips to help him, such as reducing his fluid intake at night and waking him up at regular times to go to the toilet. Most importantly, she learnt that she had to be calm and positive and not scold him for wetting the bed.

Madam Salbiah also spoke to his school teachers.

'When they realised that he was having trouble coping in school, they gave him more attention and were very positive and encouraging,' she said.

Eventually, with support from both his family and the school, Danial was able to cope well.

This article was first published in Mind Your Body, The Straits Times.