What Parents Need to Know About Anxiety in Children

What Parents Need to Know About Anxiety in Children
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Medically Reviewed By:
Mark Arredondo, M.D.

Anxiety disorders are the most common mental health disorders affecting children and adults.

Anxiety is our mind and body’s reaction to a perceived threat. Experiencing some feelings of anxiety is normal and often not concerning. In fact, some anxiety can be helpful, as it can be a signal that we need to attend to something in our environment (e.g., prompting us to work to meet a deadline). Anxiety becomes a concern when it causes a person to experience high levels of distress or interferes with daily functioning. Such interference may include:

  • Avoidance of certain people or places

  • Problems in relationships with family, friends or teachers

  • Difficulties completing day-to-day activities 

Symptoms of anxiety

There are several different types of anxiety. Common anxiety symptoms may include:

  • Intrusive, persistent, distressing thoughts or worries about the feared situation

  • Feeling restless, excessively tired and/or tense and irritable

  • Difficulties falling or staying asleep

  • Concentration problems

  • Pounding or racing heart rate

  • Sweating

  • Nausea

  • Feeling dizzy

In children, anxiety may present in other ways. Because young children may have difficulty articulating their thoughts and feelings and become overwhelmed by their anxiety, their anxiety may come out as:

  • Excessive clinginess

  • Crying

  • Temper tantrums

  • Oppositionality (e.g., refusal to do activities or go to places that cause anxiety)

  • Freezing (being very still, unable to move or numb)

  • Selective mutism (unable to speak when in feared situation or around feared people or places)

  • Behavioral regressions (e.g., acting younger than their age; failing to meet developmental milestones they had already achieved, such as toileting or sleeping on their own)

Why is my child so anxious?

There are many reasons why children may be anxious, and research is continuing to discover factors that cause, maintain or exacerbate anxiety. Some possible reasons include: 

  • Genetics

  • Learned behaviors (such as parents modeling for their children that the world is a scary or threatening place or that situations that are feared can or should be avoided)

  • Exposure to high levels of stress, traumatic events or other uncontrollable negative experiences

Puberty may trigger or exacerbate anxiety symptoms, possibly due to hormonal changes that affect physiology and brain functioning. 

What are the different types of anxiety? 

Anxiety may take various forms, and some anxiety conditions are more common in younger children and others in older children and adults. 

Shyness/behavioral inhibition

Shyness and behavioral inhibition are considered temperament or personality traits that typically are observable from a very young age and are marked by tendencies to be wary or avoidant of new people, places or situations. Children who are shy or behaviorally inhibited may cling to a trusted caregiver when in new situations. After time acclimating, they may become comfortable enough to separate from their caregiver and engage in the environment. At its more extreme end, inhibition may interfere with children’s functioning.

Inhibition to novelty

Inhibition to novelty is a clinical diagnosis in young children and the disorder interferes with children’s functioning, particularly infants and young children, through persistent and pervasive difficulty engaging in new situations, activities and people, along with an impairing level of distress.

Specific phobias

Specific phobias present as high levels of fear or anxiety when in the presence of or anticipation of being in the presence of a specific feared object or situation. The fear is excessive or unreasonable given the actual threat of the feared object or situation. 

Common phobic stimuli in children include:

  • Animals

  • Insects

  • Storms

  • Water

  • The dark

  • Loud sounds

  • Costumed characters

  • Receiving an injection

Other common phobic stimuli include confined spaces (e.g., elevators), public transportation, flying and heights. Specific fears may be developmentally appropriate and expected in early childhood; they become a concern if they interfere with day-to-day functioning, cause a high level of distress or persist for at least 6 months.

Separation anxiety

Separation anxiety and fear of strangers is a typical developmental stage that appears late in the first year of life and presents as distress when separated from the caregiver or while in the presence of strangers. Separation anxiety typically diminishes or resolves by age 2. Separation anxiety becomes concerning when the distress is persistent and excessive or developmentally inappropriate. This form of anxiety may present as excessive worry about losing caregivers (e.g., due to illness, disasters, death) or about being separated from caregivers (e.g., due to kidnapping, getting lost). Separation anxiety often leads to persistent resistance to separating from the caregiver, including refusal to leave the home or attend school.

Selective mutism

Selective mutism involves consistent and persistent failure to speak in social situations (e.g., school) despite having the ability and willingness to speak in other situations (e.g., at home).

Social anxiety

Social anxiety involves high levels of fear when in social situations, particularly where social interactions are expected (e.g., meeting new people), one’s behaviors may be observed (e.g., when eating) or when one is performing in front of others (e.g., public speaking). For children, anxiety in such situations is only considered social anxiety when it is in a peer setting, not just during interactions with adults. While some anxiety in such situations is typical, social anxiety becomes problematic when it leads to feelings of intense fear or persistent avoidance of such situations. Social anxiety in children may become more common as they develop the cognitive skills to be able to compare their performance to those of their peers and fear judgment.

Generalized anxiety

As the name implies, generalized anxiety is not specific to a certain set of situations or stimuli, but is marked by excessive, persistent, difficult-to-control worry and apprehension around a range of activities or situations. This form of anxiety is accompanied by physical symptoms, including:

  • Restlessness

  • Tiredness

  • Concentration difficulties

  • Irritability

  • Muscle tension

  • Sleep difficulties

Generalized anxiety is common in children and adults.

Panic attacks and agoraphobia

Panic attacks involve a rapid surge in intense fear or discomfort, typically occurring over several minutes. Panic attacks may involve a number of symptoms, including:

  • Chest pain and/or heart changes (palpitations, pounding, accelerated beating)

  • Sweating

  • Trembling/shaking

  • Shortness of breath

  • Nausea

  • Dizziness/light-headedness

  • Changes in body temperature

  • Numbness or tingling sensations

  • Fear of losing control or dying 

Panic attacks are not common in very young children. Recurrent panic attacks may be accompanied by agoraphobia, which is a significant level of anxiety around being in situations (e.g., away from home, in enclosed spaces) where escaping or getting help in the event of a panic attack or other embarrassing situation (e.g., incontinence) may be difficult or impossible. 

How can I tell if my child is overly anxious?

Anxiety is potentially problematic if it interferes with your child’s ability to complete their day-to-day activities and/or is causing them to experience persistent distress. This may include:

  • Refusal to attend daycare or school

  • Inability or unwillingness to engage in peer relationships/friendships

  • Social isolation

  • Somatic symptoms without a known medical cause (e.g., frequent headaches, stomachaches)

  • Excessive mood swings

  • Frequent temper tantrums, crying or panic attacks

When should I get help for my child's anxiety?

You should seek help for your child’s anxiety if your child:

  • Expresses distressing thoughts, feelings or behaviors that persist

  • Is unable to consistently complete developmentally expected day-to-day activities

  • Is showing regressions in their developmental milestones

  • Refuses to separate from their caregiver and/or attend daycare or school (after a reasonable period of adjustment)

  • Does not return to their regular level of functioning after a stressful event

  • Has physical complaints that have no known medical cause and are not self-resolving

How to help a child with anxiety

There are many ways to help a child with anxiety. Your child’s pediatrician or healthcare providers may be able to help you identify appropriate resources.

There are several forms of therapy that can be helpful by assisting the child to: 

  • Change their patterns of thinking that keep them hypervigilant to threat or overreactive to perceived threat

  • Learn methods of calming their mind and body so that they do not experience anxious thoughts or feelings or experience them at a manageable level 

Parent-focused treatments can help caregivers learn how to:

  • Model effective coping behaviors

  • Encourage their child not to engage in avoidance behaviors, which can maintain and magnify the feelings of anxiety 

A number of medications are available for treating anxiety in children, when indicated. Medications may be most effective when used in conjunction with therapy. Symptoms of anxiety may appear in response to the effects of a substance or medication or a general medical condition. It is important to determine if a substance/medication or medical condition is the cause of anxiety so that appropriate treatment can be provided. 

Ongoing research, like that being done at Boston Children's Hospital, is helping to discover new risk factors and biomarkers that can help identify children who may be prone to developing anxiety prior to the onset of symptoms. This information may be used to introduce early interventions, thereby preventing the child from developing an anxiety condition. 

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