Anxiety in Children: Symptoms & Treatment Options

According to the Centers for Disease Control and Prevention (CDC), many children have fears and worries and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical, persistent or extreme forms of fear and sadness could be due to anxiety in children. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders.

When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include

  • Being very afraid when away from parents (separation anxiety)
  • Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
  • Being very afraid of school and other places where there are people (social anxiety)
  • Being very worried about the future and about bad things happening (general anxiety)
  • Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Thumping heart, rapid breathing, sweating, tense muscles, nausea, and dread are familiar symptoms of anxiety that accompany a “fight, flight, or freeze” reaction triggered by real or imagined threats, like a snarling dog or new social experience. Anxious children may be clingy, startle easily, cry or have tantrums, sleep poorly, and have headaches or stomachaches.

But anxiety is not all bad. “It can motivate us, or help us avoid danger,” says Dr. Mona Potter, medical director of McLean Anxiety Mastery Program and McLean Child and Adolescent Outpatient Services. “The problem is when anxiety gets out of hand and makes decisions for us that are no longer helpful — maybe even paralyzing.” By that point, normal anxiety may have become an anxiety disorder.

What makes some children more vulnerable to anxiety?

Anxiety may set deep roots due to a blend of

  1. biological factors, such as genes and brain wiring
  2. psychological factors, such as temperament and coping strategies
  3. environmental factors, such as anxious parenting or troubling early childhood experiences and environment.

Sometimes, anxiety is a side effect of medicine. Ask your doctor about this possibility.

Occasional anxiety is normal. However, it may be a good idea to talk to your pediatrician if anxiety causes your child to limit activities, worry often, or avoid camp or daycare. A severe anxiety disorder can delay or derail child development.

Treatment of anxiety in children

child psychiatry and psychology services

Depending on the developmental stage and level and type of anxiety, treatment may involve changes you and your child work toward yourselves. On the other hand, you might work with child mental health professionals, such as a psychiatrist, psychologist, or social worker. These experts can help parents and children learn to apply cognitive-behavioral therapy (CBT), a highly effective treatment that addresses anxious thoughts and behaviors. “For example, we might encourage children to practice ‘detective-thinking’ to catchcheck, and change anxious thoughts,” says Dr. Potter. “We also encourage them to approach, rather than avoid, anxiety-provoking triggers.”

Mindfulness techniques and antianxiety or antidepressant medicines also may be discussed. Often a combination of approaches works best.

Ways parents can help children learn to manage anxiety

  • Personalize and externalize: Ask your child to give anxiety a name. Your child can draw pictures of anxiety, too. Then, help your child acknowledge anxiety when it rears up: ‘Is that spiky-toothed, purple Bobo telling you no one wants to play with you?’ Labeling and distancing anxiety can help your child learn to be the boss of it.
  • Preview anxiety-provoking situations. Consider meeting camp counselors or touring new places ahead of time.
  • Model confidence: Children are emotional Geiger counters. They register anxiety radiating from parents. Try to be mindful of what you model through words and body language. Work on tempering overanxious reactions when appropriate.
  • Narrate their world: “Children are coding the world. Particularly through early childhood their brains are just sponges, taking everything in,” says Dr. Potter. “We can help them with the narrative they’re constructing: ‘Is the world a safe place or a dangerous place where I have to be on guard all the time?’”
  • Allow distress: Avoiding distressing situations invites anxiety to ease temporarily, only to pop up elsewhere. Rational explanations won’t work, either. The whirring emotional center of the brain known as the limbic system requires time and tools to calm down enough to let the thinking (cognitive) center of the brain come back online. Instead, try distress tolerance tools: one child might splash her face with cold water, another might charge up and downstairs to blow off anxious energy, or tense and relax her muscles, or distract herself by looking around to find every color in the rainbow.
  • Practice exposure: Gradual exposure helps rewire an anxious brain and shows a child he can survive anxious moments. Let’s say your child is anxious about talking in public, ducking his head and squirming if addressed. Pick a pleasant, slow-paced restaurant for a fun weekly date. Then coach your child to take charge of ordering foods he likes in small steps. At first, he might whisper the order to you and you’ll relay it to the waitress. Next, he might order just his drink or dessert, and finally, a full meal as distress tolerance and confidence grows.

If your child has an anxiety disorder, psychotherapy may provide the support your child needs:

  • Find a trained psychotherapist and take your child to all the therapy appointments.
  • Talk often with the psychotherapist and ask how you can best help your child.
  • Help your child face fears. Ask the psychotherapist how you can help your child practice at home. Praise your child for efforts to cope with fears and worry.
  • Help kids talk about feelings. Listen, and let them know you understand, love, and accept them. A caring relationship with you helps your child build inner strengths.
  • Encourage your child to take small steps forward. Don’t let your child give up or avoid what they’re afraid of. Help them take small positive steps forward.
  • Be patient. It takes a while for psychotherapy to work and for kids to feel better.