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Stress refers to any type of change that causes physical, emotional or psychological strain. In relation to child nutrition, stress for caregivers can result from general life stresses, parenting, as well as stresses specific to child nutrition and feeding.

Measures of stress in this toolkit more commonly assess a caregiver’s perceived overall level of stress. Two measures are widely validated tools that assess general perceived stress or symptoms of stress. Two other author-developed measures assess signs of stress or issues that may cause stress for a caregiver: economic stress, partner stress, domestic violence, and community violence.

One measure assesses perceived stress related to parenting through child characteristics, parent characteristics, or situational conditions.

Two measures assess caregiver perceived stress in relation to child nutrition. One assesses the impact of the child's health on parent worry or concern and limitations in meeting their own needs. Another assesses feeding-related stress when feeding children with disabilities.


  • Distress Scale (20 items)
  • Parenting Stress Index Short Form (36 items)
  • PedsQL Family Impact Module, parent worry subscale (36 items)
  • Perceived Stress Scale (14 items)

This toolkit includes 3 measures.

Distress Scale

Vanuatu 20 items

Assesses symptoms of anxiety, depression, nervousness, and stress over the previous week.

Parenting Stress Index Short Form

South Africa 36 items

The index assesses three areas of stress in the parent–child relationship: (a) child characteristics, (b) parent characteristics, and (c) stress stemming from situational or demographic conditions.

PedsQL Family Impact Module

Ghana 36 items

The PedsQL™ Family Impact Module measures parents' self-reported physical, emotional, social, and cognitive functioning; communication; and worry.