Modern Pediatrics. Ukraine. (2026).4(156): 68-77. doi: 10.15574/SP.2026.4(156).6877
Klets T. D., Mityuryayeva-Korniyko I. O., Odaіskyi O. M.
Bogomolets National Medical University, Kyiv, Ukraine

For citation: Klets TD, Mityuryayeva-Korniyko IO, Odaіskyi OM. (2026). Signs of stress disorders in school-age children with acute respiratory infections depending on the zone of combat activity in Ukraine. Modern Pediatrics. Ukraine. 4(156): 68-77. doi: 10.15574/SP.2026.4(156).6877.
Article received: Jan 26, 2026. Accepted for publication: May 12, 2026.

Aim – to identify markers of stress-induced psychoemotional disorders in children depending on the intensity of war-related impact and age.
Materials and methods. A multicenter randomized study included 254 patients with mild and moderate uncomplicated acute respiratory infections: 125 children aged 6-10 years and 129 children older than 10 years, who had lived under martial law conditions in 16 cities of Ukraine for 1.5 years (the study was conducted at the end of 2023). Parents retrospectively assessed 14 signs of stress disorders over the preceding 3 months using the questionnaire of the Public Health Center of the Ministry of Health of Ukraine. Based on the duration of air raid alert time, regions were stratified by the tertile method into low (≤3,8%), medium (3.9-8.2%), and high (≥8.3%) intensity. The Kruskal-Wallis test and the Benjamini-Krieger-Yekutieli post-hoc analysis were used.
Results. In children aged 6-10 years, most symptoms did not depend on the intensity of hostilities; abdominal pain predominated in the low-intensity zone compared to the medium-intensity zone. In patients older than 10 years, anger and "mistrust of everything" were significant. Anger was higher in the medium zone compared to the high zone, aggression was higher in the high zone compared to the medium zone, and rage and sleep disturbances were higher in the medium zone compared to the low zone.
Conclusions. The psychoemotional response to chronic war-related stress is age-determined: ranging from the predominance of somatization at 6-10 years to emotional and behavioral externalization in older age. In most children, regardless of the zone, sleep disturbances and headaches were detected, which justifies the need for medical and psychological support and rehabilitation.
The authors declare no conflict of interest.
Keywords: school-age children, Ukraine, war-related stress, acute respiratory infections, stress disorders, psychoemotional reactions, somatization, intensity of hostilities, pediatric care, pediatric rehabilitation.

REFERENCES

1. Bilodeau J, Mikutra-Cencora M, Quesnel-Vallée A. (2023). Work-family interface and children's mental health: A systematic review. Child and Adolescent Psychiatry and Mental Health. 17: Article 45. https://doi.org/10.1186/s13034-023-00596-w; PMid:36997939

2. Bosqui TJ, Mayya A, Al-Kadasi A. (2022). Mechanisms of change for child mental health and psychosocial support in conflict settings: A systematic review. Intervention. 20(2): 170-181. https://doi.org/10.4103/intv.intv_25_21

3. Carpiniello B. (2023). The mental health costs of armed conflicts-A review of systematic reviews conducted on refugees, asylum-seekers and people living in war zones. International Journal of Environmental Research and Public Health. 20(4): Article 2840. https://doi.org/10.3390/ijerph20042840; PMid:36833537 PMCid:PMC9957523

4. Easterbrook JA. (1959). The effect of emotion on cue utilization and the organization of behavior. Psychological Review. 66(3): 183-201. https://doi.org/10.1037/h0047707; PMid:13658305

5. Hariyan T, Hariyan T, Boyarchuk O. (2026). Determinants of perceived stress among adolescents during wartime in Ukraine. Frontiers in Pediatrics. 14L Article 1838159. https://doi.org/10.3389/fped.2026.1838159; PMid:42099520 PMCid:PMC13144074

6. Kurapov A, Kalaitzaki A, Keller V, Danyliuk I, Kowatsch T. (2023). The mental health impact of the ongoing Russian-Ukrainian war 6 months after the Russian invasion of Ukraine. Frontiers in Psychiatry. 14: Article 1134780. https://doi.org/10.3389/fpsyt.2023.1134780; PMid:37575573 PMCid:PMC10412819

7. Lebets I, Dynnik V, Matkovskaya T, Medvedovska N, Kashkalda D. (2022). Prevention and rehabilitation of health problems of schoolchildren from the zone of military conflict in Ukraine. Medicni Perspektivi. 27(4): 200-206. https://doi.org/10.26641/2307-0404.2022.4.271225

8. McElroy E, Hyland P, Shevlin M, Karatzias T, Vallières F, Ben-Ezra M et al. (2024). Change in child mental health during the Ukraine war: Evidence from a large sample of parents. European Child & Adolescent Psychiatry. 33(5): 1495-1502. https://doi.org/10.1007/s00787-023-02255-z; PMid:37421462 PMCid:PMC11098962

9. Public Health Center of the Ministry of Health of Ukraine. (2019, Aug 27). Impact of stress on a child's body: How parents can help and when to consult a doctor. URL: https://phc.org.ua/news/vpliv-stresu-na-organizm-ditini-chim-mozhut-dopomogti-batki-i-koli-varto-zvertatisya-do.

10. Salmon M, Sibeoni J, Harf A, Moro MR, Ludot-Grégoire M. (2022). Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur. Frontiers in Psychiatry. 13: Article 897002. https://doi.org/10.3389/fpsyt.2022.897002; PMid:35958663 PMCid:PMC9358691

11. Silwal S, Westerlund M, Osokina O, Ivnyev B, Ahramo K et al. (2026, Mar 9). Mental health of Ukrainian children and youth during the Russian-Ukrainian war: a scoping review. BMJ Glob Health. 11(3): e020506. https://doi.org/10.1136/bmjgh-2025-020506; PMid:41802826 PMCid:PMC12983754

12. Skrypnyk A, Labenko O. (2022). The influence of stress on children's speech in the context of war. East European Journal of Psycholinguistics. 9(2): 116-129. https://doi.org/10.29038/eejpl.2022.9.2.lab

13. Van der Kolk BA. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

14. Willner P. (2017). The chronic mild stress (CMS) model of depression: History, evaluation and usage. Neurobiology of Stress. 6: 78-93. https://doi.org/10.1016/j.ynstr.2016.08.002; PMid:28229111 PMCid:PMC5314424

15. Zawilski ZM. (2022). Somatisation as a manifestation of emotional disturbance in children. Pediatria i Medycyna Rodzinna. 18(1): 40-51. https://doi.org/10.15557/PiMR.2022.0006

16. Zlyvkov VL, Lukomska SO. (2022). Children of war: Theoretical, methodological and practical aspects of psychological assistance. Vydavets Lysenko M.M.