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Background
Over the past three decades, China has witnessed dramatic socio-economic change, which has had considerable impact on the Chinese experience of childhood. Sustained economic growth has greatly increased the purchasing power of the majority of families. 1 The One Child Policy has resulted in most city-dwellers being only-children, while most of the rural population have only one sibling. 2 The aspirations of many parents, who had limited educational opportunities themselves, are now invested in their only-children. 3 This, together with previously unheard-of possibilities for upward mobility, has led to a highly competitive educational system. 4 In addition, strong traditional ideas of childhood persist, based on the Confucian traditions of respect for parents and elders, filial piety, obedience and discipline. 5
What is already known about this topic
China has a highly competitive educational system from the start of primary school.
What this study adds
Chinese primary school children experience high levels of stress in the school environment and are exposed to frequent physical abuse at home.
Stress is strongly associated with the classic psychosomatic symptoms of headache and abdominal pain in these children.
Measures need to be taken to remove unnecessary stress in the school environment.
There are increasing concerns about the effects of all these pressures on the health and well-being of children. A number of studies in Chinese adolescents have shown high rates of anxiety and depression, which are thought to be related to stress within the educational system. 6 - 8 But the pressure starts in primary school, where, from the outset, there are frequent exams, public ranking of students by exam results, large amounts of homework and intolerance of failure. Children are also often expected to conform to strict discipline for the first time, after being indulged by parents and grandparents in their early years. 9
In children, stress and unhappiness are known to manifest as psychosomatic symptoms, with the most commonly documented symptoms being headache and abdominal pain. 10 - 12 Stress in the school setting has been shown to be significantly associated with psychosomatic symptoms in schoolage children in Norway, Sweden and Finland. 12 - 15 But this relationship has never been explored in a Chinese setting, where there are growing concerns about the stressful school environment.
This...