Anxiety in children shows up in many ways. It is normal for it to appear from time to time with their duties and responsibilities, but the problem comes when it gets out of control, so I want to show you what steps to take.
Causes of anxiety in children
In a 2020 Cochrane review (87 studies, 5,964 participants; the comparison with a waitlist or no treatment included 39 studies and 2,697 children), about 49% of those who received cognitive behavioral therapy no longer met the criteria for their main diagnosis at the end, compared with about 18% of those on a waitlist or receiving no treatment. Each child responds differently.
Anxiety disorders are characterized by fear, worry and phobias that seriously affect functioning and are out of proportion to the surroundings.
- There are many types of anxiety disorders, and their main focus is worry or fear.
- In general, children show school refusal, often turning to physical symptoms, such as a stomachache, to justify refusing school.
- Doctors usually make a diagnosis based on symptoms, but sometimes they run tests to rule out other disorders that cause physical symptoms similar to those caused by anxiety.
- Behavioral therapy is usually enough, but if the anxiety is severe, medication may be needed.
Anxiety in children can happen often, but we can help them.
Sometimes they can freeze and not act.
All children experience anxiety at one time or another. For example, children ages 3 to 4 are often afraid of the dark or of monsters. Older children and teenagers feel anxiety when they have to explain a passage of text in front of their classmates. These fears and anxieties are not symptoms of illness.
However, if a child is too anxious to function normally or is very depressed, they may have an anxiety disorder. According to the CDC (2023 to 2024 data), about 11% of children ages 3 to 17 in the United States had a current diagnosis of anxiety (10% of boys and 13% of girls).
Later in life, children with anxiety disorders may be at higher risk for depression, substance use and academic difficulties. If your child talks about hurting themselves or dying, call or text 988 or call 911 if there is immediate danger.
Anxiety can recur in the same family, both for genetic reasons and because of the environment in which children grow up.
Anxiety disorders include
- Agoraphobia
- Panic disorder
- Generalized anxiety disorder
- Separation anxiety disorder
- Social anxiety disorder
Anxiety disorders are characterized by fear, worry and phobias that seriously affect functioning and are out of proportion to the surroundings.
How it happens in children
You can also see anxiety in children this way:
- There are many types of anxiety disorders, and their main focus is worry or fear.
- In general, children show school refusal, often turning to physical symptoms, such as a stomachache, to justify refusing school.
- Doctors usually make a diagnosis based on symptoms, but sometimes they run tests to rule out other disorders that cause physical symptoms similar to those caused by anxiety.
- Behavioral therapy is usually enough, but if the anxiety is severe, medication may be needed.
Anxiety in children varies according to these points I am showing you
Symptoms
Many children with anxiety disorders refuse to go to school. They may have separation anxiety, social anxiety or panic attacks, or a combination of these.
Some children talk specifically about their anxiety. For example, they might say, “I’m worried I won’t see you again” (separation anxiety disorder) or “I’m worried all the kids will laugh at me” (social anxiety disorder). However, most children complain of physical symptoms, such as a stomachache. These children are often telling the truth, because anxiety often causes an upset stomach, nausea, headaches and trouble sleeping.
Anxiety in children causes different conditions, just as I tell you.
Many children with anxiety disorders still have anxiety disorders as adults. However, with early treatment, many children learn to manage their anxiety.
Symptoms
Doctors usually diagnose anxiety disorders based on reports of typical symptoms from the children or their parents. However, because the physical symptoms caused by anxiety can easily be misread, they check for physical illness before making the diagnosis.
Anxiety in children can be treated.
Treatment
- Sometimes, medication
- Behavioral therapy
If the anxiety is mild, behavioral therapy is usually enough. The therapist places the child in a situation that causes anxiety and guides them to stay in it. As a result, the child gradually becomes desensitized and the level of anxiety goes down. It is generally good to treat the anxiety disorders of both parents, if possible.
When the anxiety is severe, your child’s doctor may consider whether medication is an option. That decision belongs to the pediatrician or the child psychiatrist, who should explain the benefits and risks and closely monitor how the child responds.
Other medications
Anxiety in children can be treated with different medications.
Benzodiazepine sedatives are sometimes given if medication is needed only for a short period (for example, because the child is very anxious before a procedure).
In general, selective serotonin reuptake inhibitors (SSRIs) are more effective at improving symptoms when combined with a type of cognitive therapy called cognitive behavioral therapy (CBT). CBT is a structured, short-term talk therapy designed to help people identify and challenge negative thinking patterns so they can cope with difficult situations more effectively.
When to seek help
Anxiety in children needs attention. Pay attention to what I am about to tell you about when to seek help.
It is normal for children to worry from time to time. If your child’s anxiety grows and starts to affect their school performance or their relationships with friends and family, they may need professional help.
Research shows that cognitive and behavioral interventions help many children with anxiety disorders (Cochrane review, 2020).
What can you do to help a child with excessive anxiety?
- While it is most natural for a parent to want to help the child by avoiding or running away from the distressing situation, this only prolongs the anxiety. Instead of rescuing them, help them face their fears and praise them for every attempt to find a solution.
- Talk with your child about anxiety, about what happens in their body and why. Many children and teenagers don’t know what anxiety feels like, and it can be quite frightening. They may even think they are very sick or having a heart attack. Being able to understand what is happening can reduce anxiety and worry and help them manage it.
- Use a metaphor: describe anxiety as a swell in cycling or sailing.
- Help them breathe slowly and deeply, counting to three through the nose and three through the mouth.
- The art of distracting themselves to focus on other things.
- Give them a hug or hold their hand if they want it and allow it. Touch can be soothing.
- It can help to talk with your child about how to find a place in their mind that feels safe, relaxed and happy.
Treatments for anxiety
Anxiety in children has these treatment options:
Relaxation training for children. It is one of the treatments used for generalized anxiety and separation anxiety disorders. It has two stages: In the first stage, you check that the child has the minimum skills to do the exercises. They are: staying still for 5 seconds, keeping eye contact for 5 seconds, being able to imitate and follow simple instructions. Once the child has shown they can do this, you explain how anxiety arises and teach relaxation techniques. These can be presented in different ways: baby massage, relaxation games (“rag doll robots”) and techniques based on imagination in which stories are told where, at some point, the child tenses an area of the body and then lets it relax.
Self-instructions: The child learns to replace the cognitive component of anxiety with coping language.
If you need help treating anxiety in your child, call now. My team and I can treat it with you.
Would you like to talk with a professional? Call (407) 559-7093 (Monday to Friday, 9 a.m. to 5 p.m. Eastern) or find professional help here. For general questions that are not an emergency, write to drduany@zodugroup.com. Please do not send health information by email.
If you are in crisis or thinking about hurting yourself, do not wait. Call or text 988 (988 Suicide & Crisis Lifeline, 24 hours a day, free and confidential). If there is immediate danger, call 911.
This article is for education only. It does not offer diagnosis or personal advice, does not replace evaluation or treatment by a health professional, and reading it or writing to us through this site does not create a therapeutic or pastoral counseling relationship. This site is not an emergency service and is not monitored continuously: do not send health information through comments or public forms. The author is a licensed psychotherapist and pastor, and is part of ZODU.
Sources
- Cochrane Database of Systematic Reviews, Cognitive behavioural therapy for anxiety disorders in children and adolescents (2020): https://pubmed.ncbi.nlm.nih.gov/33196111/
- Centers for Disease Control and Prevention (CDC), Data and Statistics on Children’s Mental Health: https://www.cdc.gov/children-mental-health/data-research/index.html
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