What to know about anxiety in children
Anxiety is a normal response to stress, and it happens in both adults and children. An anxiety disorder is a medical condition that involves regular, high levels of anxiety that are difficult to control.
An anxiety disorder may interfere with a child’s ability to engage in day-to-day activities, such as going to school, socializing, or maintaining relationships.
The Anxiety and Depression Association of America report that 25.1% of young people between the ages of 13 and 18 have an anxiety disorder.
They also note that children living with untreated anxiety disorders are more likely to perform poorly in school, miss out on social experiences, and engage in substance abuse.
In this article, we look into types of anxiety among children. We also explore the signs, symptoms, and available treatments.
Signs and symptoms
A child with anxiety may cry often, want to miss school, or be very reluctant to leave their parents.
They may also seem scared in situations such as social gatherings, or they may refuse to speak to other people or engage in everyday activities.
Physical symptoms of anxiety may include:
- shortness of breath
- butterflies in the stomach
- a hot face
- clammy hands
- dry mouth
- a fast heartbeat
Children may also find it hard to sleep, have bad dreams, struggle to concentrate, and be quick to become angry or annoyed.
Some children want to use the toilet very often or say that they have frequent stomach aches.
Learn more about the signs, symptoms, and effects of anxiety here.
A child could be experiencing various types of anxiety, including:
Generalized anxiety disorder
A child with generalized anxiety disorder (GAD) might be very anxious about a range of issues and situations, including:
- grades and exams
- how well they perform in activities such as music or sports
A child with GAD is also likely to be overly critical of their work and abilities, and they may seek reassurance from others.
A child diagnosed with a panic disorder will have had two or more unexpected panic attacks.
These attacks can happen without any clear triggers. A child may also be worried about having another attack, possibly for more than a month after their first attack.
Separation anxiety disorder
Separation anxiety is common in children aged between 18 months and 3 years. This does not point to a disorder.
This anxiety is a feeling of worry when a parent or guardian either leaves the room or is otherwise no longer visible. Usually, it is possible to distract a child from this feeling.
If an older child becomes upset whenever a family member leaves, and if they take a long time to calm down, they may be experiencing separation anxiety disorder.
This disorder is more common in children aged 7–9, and affects about 4% of children.
A child with separation anxiety disorder may refuse to go to school, camp, or friends’ houses. They may ask for someone to stay with them while they sleep. Also, they might experience severe homesickness when they are not with their family.
Social anxiety disorder
A child with social anxiety disorder will worry excessively about interacting with other people.
They may feel extremely anxious about meeting new people or being called on in class.
Selective mutism is a severe type of social anxiety. A child with selective mutism may be too anxious to talk in specific situations, although they may talk comfortably with people whom they know well.
Sometimes, parents or caregivers only find out that their child has selective mutism when teachers report that the child refuses to speak in class.
How to help at home
It is impossible, and often counterproductive, to remove all sources of anxiety from a child’s life.
A better approach is to help a child learn effective and productive ways to cope with the situations and activities that make them anxious. This will lower their levels of anxiety over time.
When talking to a child about their anxiety, the way a person poses their questions is key. Some phrasing may lead a child to dwell on their anxiety.
Instead of asking whether they are anxious about a situation, a person can ask an open-ended question about how they feel.
A child may also benefit from someone talking through the situations with them. This can help some children feel more in control of the situation and their responses to it.
It may also help to:
- Teach the child to recognize signs of anxiety, including physical symptoms.
- Stick to regular routines whenever possible.
- Practice taking three deep, slow breaths together with the child.
- For young children, distraction can help. For instance, if a child is anxious about going to stay with other family members, playing games such as “I spy” can help.
- Make a “worry box” out of an empty shoebox or tissue box. The child can write down their worries and add them to the box. At the end of the day or week, a caregiver can talk through the concerns with the child.
- Ahead of a big change, such as moving or changing schools, give the child time to adjust to the idea and talk about the reasons that it is happening.
- To calm down a child during a panic attack or anxious moment, give them an object and ask them to describe it in as much detail as possible.
Modeling good coping mechanisms at home can also teach a child how to deal with their own anxiety.
It is not necessary for parents or caregivers to hide all of their anxiety from a child — by managing stress and anxiety in healthy ways, they can lead by example.
When to see a doctor
It may be a good idea to seek advice from a doctor if a child is showing symptoms of anxiety that are not eased with anxiety-management techniques at home.
If anxiety is affecting the child’s school life or relationships, a doctor or therapist can help.
Possible treatment options for childhood anxiety include:
Talking therapies, such as counseling and cognitive behavioral therapy (CBT), are popular and effective treatment options for anxiety in children.
As part of CBT, a mental health professional can teach a child about anxiety and how it affects the body. They can also teach a child to recognize the symptoms and how to manage them.
A child may also learn to restructure their thought processes and use methods such as mindfulness, controlled breathing, and progressive muscle relaxation to ease the symptoms.
Antidepressant medications are common treatments for a wide range of mental health conditions.
Selective serotonin reuptake inhibitors (SSRIs) are one option for treating childhood anxiety, as they do not cause many side effects. They are also nonaddictive.
SSRIs work by increasing the levels of the chemical serotonin in the brain, which is associated with feelings of happiness and well-being.
For a child with severe anxiety, a doctor may recommend benzodiazepines. They are not as common as other options, as they can become addictive. For this reason, a doctor will only prescribe benzodiazepines on a short-term basis.
According to the authors of a 2015 study, a combination of CBT and SSRIs was more effective than treatment with just therapy or medication alone.
Treating an anxiety disorder is a process, and it can take time to find the right approach for a child.
Parents and caregivers can look out for physical and emotional signs and ask the child open-ended questions to find out whether they are likely experiencing anxiety.
Children can learn to manage their anxiety with the support of loved ones and mental health professionals. Talking therapy and medication can be an effective treatment approach if home care strategies do not help.