When people say, “It is not a big deal,” one has to believe them. The problem is, with kids, a little deal may be a big deal. For that matter, who is to say what a big or a little deal is for grown-ups?

Perhaps what is a little deal to an adult can be huge by proportion to a child, due to their diminutive stature. Children suffer the same biochemical effects of post-traumatic stress disorder as grown-ups. Fear models the brain. Hormones surge, telling the developing cells where to go as they build the mind. With calm, they head up to the right. With fearful stimuli, they head down and to the left.

For children, little is big because their young neurons are connecting at a faster rate. Their brains are under construction. This is neural plasticity. Kids assemble the brain cells to brain cells synapsis at the speed of light compared to big people. The outcome is little is big. The more the connections, the bigger the deals.

“Little is big” not only because of the numbers but also because yesterday’s memories create today’s perceptions. When trauma starts early, the impact only keeps growing. The motto for brain cells is: “The more we fire, the more we fire.”

It is not only the smaller size of the child that explains why little is big. It also depends upon the sensitivity of the inborn wiring. Our mind’s blueprints start from genetics and the environment of the womb. They are modified like change orders in a new house. A newborn shows the temperament of threshold from the start. For some, a simple touch is a big deal. Others sleep through the doctor’s physical exam, including the shock of a cold stethoscope.

Experience is another definer of little and big deals. For a child without the life opportunities to say otherwise, a noise in the dark is a big deal. Only when they grow up do they realize there are always noises in the dark.

Knowledge also transforms little into big or big into little. Information is like those traveling antique dealers on TV who value Aunt Verlin’s punch bowl as a priceless vase from the Ming Dynasty. Before, it was just old and no big deal. On the other hand, the painting above the mantel that was thought to be an original Picasso is really a cover from an art magazine.

We often say something is not a big deal when it really is. It is a means of protection. A child hopes that a parent will show up to hear him or her play the solo in the school band, or to watch the final game of the season. When the parent fails to show, the kid’s answer is often, “It is not big deal.”

The pain is supposed to diminish when it is not a big deal, but it still hurts. It is a huge deal when a parent is not there in times of overwhelming need. It is not just the physical presence; it is what Dr. Zeynep Biringen, a professor of human development and family studies at Colorado State University, calls “emotional availability.”

A person covers fear, shame and disappointment by making something big little. There is less damage that way. Little is good if it is helpful to our mind.

Worry escalates much into larger dimensions. It is the little molehill and the big mountain problem. An anxious grandmother recounts an incident of a nervous daughter and her critically ill child. There was even a “Code Blue” called to save the child’s life. When one retrieves the medical records, there was no such danger or excitement. Was big little or was it little became big?

We enlarge deals for a lot of reasons. Some are conscious acts of inflation. Others may be overt but with the reason unknown. The opposite can also be part of our mental repertoire: By making something little, we feel big.

Feigning humility through self-deprecation is risky, especially if we start to believe we are nothing, not even a little deal.

Knowing what is really a big deal and what is really a little deal is a super big deal.

Joseph Cramer, M.D., is a board-certified pediatrician, fellow of the American Academy of Pediatrics, practicing physician for 30 years and a hospitalist.
Email: jgcramermd@yahoo.com