Anxiety is a very common emotional problem amongst children. Anxiety can lead to children developing troublesome worries about many things from germs to becoming ill, from social settings to their parents passing away. Anxiety can lead to a variety of behavioural difficulties such as meltdowns, tantrums, shyness or even compulsive rituals such as obsessive hand washing aimed at decreasing the fear. This article will provide you as parent with an overall view of anxiety in children, as well as some practical tips on how to help your little one manage or overcome his anxiety.
Children can suffer from different types of anxiety, depending on what they are struggling with. These can include separation anxiety, social anxiety, selective mutism, generalized anxiety, obsessive-compulsive behaviour and specific phobias. It is important to remember that childhood fears are a normal part of child development, and what may seem non-threatening to you as adult, may pose a perceived threat to a child. Infants for example, can experience stranger anxiety when a new person enters their world. They may cling to a parent upon meeting a new face for the first time. Toddlers may experience separation anxiety between the ages of 10 months – 2 years. They may experience fear form separating from their parents, and would not want to be left at day care or at bedtime. Preschoolers may start to fear ‘pretend’ things. Through the ages of 4 – 6 years, children thrive in their imaginary or pretend world, but they can’t always distinguish what is real or not. The imaginary monster may seem real, and pose a perceived threat to them. Many children this age become afraid of the dark or bedtime. Around the age of 7, children start to distinguish between fantasy and reality, and at this age is where real-life dangers may bring about anxiety in children. Children in the primary school age group may develop fear around real-life events such as car accidents, burglars in their house, the death of loved ones or even natural disasters. As children around this age start their schooling career, some anxiety about schoolwork, grades or fitting in with friends may also develop. The fear of fitting in may increase during the teenage years, where children begin to experience anxiety about how they look, whether they will fit in, how others will perceive them as well as anxiety related to school work such a big exams, big sports events, college acceptance etc.
All these fears are very normal, and healthy to an extent, as fear is the body’s natural way of attempting to keep us safe. Every person experiences some degree of anxiety at some point on their lives. BUT, when any form of anxiety starts getting in the way of everyday life, it is time to seek more professional help.
Below are some types of anxiety in children:
(Please note that for an anxiety to be classified as an anxiety disorder a formal diagnosis from a health care professional is needed – this article does not diagnose any behaviour, it can merely act as a guideline of symptoms to look out for in children).
Children with separation anxiety experience great amounts of stress in being separated from their caregivers, whether it is being dropped off at day care, or being alone in bed at night. Symptoms of separation anxiety may include:
- Worry about losing caregivers;
- Fear of any event that can cause separation (such as being kidnapped);
- Reluctant to leave home/parent;
- Fear of being alone;
- Nightmares about separation, difficulty sleeping alone;
- Physical symptoms, such as headaches, tummy aches, in conjunction with fear of separation.
Children experiencing social anxiety are exceptionally self-conscious, interfering with their ability to socialize with peers, or participate in social settings. Social anxiety encompasses more than merely feeling shy at social gatherings, or being an introverted person. Children with social anxiety may stop doing things they need to (and want to) do for the fear of embarrassing themselves. Children may even seem reluctant to attend social events. Symptoms of social anxiety may include:
- Avoiding, or being reluctant to attend social situations;
- Panic reaction to social situations such as shaking, sweating, shortness of breath or tantrums and crying in younger toddlers.
Children with selective mutism have difficulty speaking in some settings, such as at school with the teacher. This difficulty goes beyond typical shyness, as children with selective mutism are ‘frozen’ with anxiety and feel unable to speak at all. Selective mutism does not include any form of communication delay or disorder.
Children with generalized anxiety worry about a wide variety of everyday things. Generalized anxiety differs from everyday worries, in that it is more excessive, lasts longer and there might be a lack of precipitating events. Children with generalized anxiety may also struggle with perfectionism. Some symptoms of generalized anxiety may include:
- Loss of focus;
- Muscle tension;
- Trouble sleeping;
- Changes in eating patterns.
Children displaying obsessive-compulsive behaviour may have intrusive thoughts and worries that make them extremely anxious, and in attempt to diminish the anxiety, they feel compelled to perform rituals such as hand washing. These obsessions often make children feel upset and anxious. Compulsions are actions or rituals kids feel forced to perform in attempt to get rid of their anxiety.
Children with a specific phobia have an excessive and irrational fear of a specific thing, such as animals, bathing etc. The object of a specific phobia is something that is not generally considered as fear-inducing or dangerous, and avoiding that object may cause impairment in the child’s ordinary functioning. It is common for individuals to have multiple phobias. Categories of specific phobias include animal type; natural environment type; blood-injection-injury type; situational type and other type.
Children often display behaviour in their daily lives that might be mistaken for a variety of other problems or diagnoses but in fact stem from a form of anxiety:
- Inattention and restlessness triggered by anxiety;
- Clingy behaviour;
- Disruptive behaviour (aggression, irritability, repetitive reassurance seeking behaviour);
- Frequent complaints about feeling ill (especially headaches and tummy aches).
Every child’s anxiety might differ, and so will their needs. You as parent know your child best, and will know what might, and might not work for your child. In attempt to assist your child, you have to remember the aim is not necessarily to eliminate the fear, but rather help the child escape the cycle of anxiety. It is important to respect your child’s feelings, without empowering the fears. Clark Goldstein (PhD) writes about a variety of pointers to utilise in assisting your child manage their anxieties:
- The goal is not to eliminate anxiety, but to help your child manage it. Removing the stressor every time your child experience anxiety, won’t help her overcome the fear in the long run. You as parent can assist your child to learn to tolerate their anxiety and function as well as they can, even when they feel anxious.
- Don’t avoid things that make your child anxious. This might make your child feel better in the short term, but reinforce the anxiety on the long run. As soon as a child learns that when she feels anxious and cries and her parents remove her from the situation, she learns that as a coping mechanism.
- Express positive, but realistic expectations for your child. Don’t make promises that you are uncertain you can keep (such as she won’t fail a test), or unreachable expectations for your child, but express confidence that she will be okay, she will be able to manage it, and as she face her fears, her anxiety levels may decrease over time.
- Respect and validate anxious feelings, but don’t empower them. You do not have to agree with the anxious feelings, but showing your child that you believe her feelings and respecting them may reduce some anxiety. You want your child to understand you believe her feelings, and you will be there with her to help her face her fear.
- Encourage your child to talk about her feelings, but don’t ask leading questions. To avoid feeding the cycle of anxiety, attempt to ask “How are you feeling about your exam” rather than asking “Are you anxious about the exam”. Opening the door to other feelings, may decrease the level of perceived anxiety.
- Encourage your child to tolerate her anxiety by showing that you appreciate her effort of facing her fears in attempt to do what she needs to do. In showing that you appreciate her effort (even if it’s only little steps at a time), might give her the encouragement needed to carry on facing the fear, and eventually overcoming or partially overcoming her fear.
- Talk things through with your child, talk about what would happen if the fear comes true, how she can handle it. The more a situation is talked through, and the child is comfortable with what will happen, and having a plan, the anxiety might decrease to a healthy extent. You can make this very visual for your child, depending on her age. If your child is anxious about a trip to the doctor, explain how the scenario will play out, use ‘doctor’ toys to show what will happen, and allow her to practice the scenario until she feels more comfortable.
- The most important aspect to help your anxious child is to model healthy ways of handling anxiety. By showing your child how you cope with anxiety might be the most important way in assisting your child to manage anxiety. Attempt to show your child how you manage anxiety calmly, tolerating it and feeling good about getting through it.
- Practice some self-care and relaxing activities. Children need self-care as much as adults do. Guide your child to engage in an activity that she enjoys in order to reduce the anxiety or feelings experienced. Physical activity such as running, playing with a ball, riding a bicycle all contribute to stress relieve. Other self-care activities can include taking a hot bath, having a cup of tea, reading or playing with toys such as Lego or puzzle to take her mind off the troublesome thoughts. Encouraging your child to engage in such activities, and joining her in these self-care activities might even have a positive impact on your relationship, which can in turn, reduce anxiety in certain situations.
This article has outlined some types as well as signs and symptoms of anxiety in children. Should the anxiety increase to a level where your child struggles to function in their day-to-day activities due to a possible anxiety, it is necessary to seek professional help. Treatment for anxiety in children may include pharmaceutical treatment in attempt to manage physical symptoms, as well as therapy (such as Cognitive-behavioural therapy) in attempt to diminish the anxiety, or a combination of both.
Please note that for an anxiety to be classified as an anxiety disorder a formal diagnosis from a health care professional is needed – this article does not diagnose any behaviour, it can merely act as a guideline of symptoms to look out for in children. Should you be concerned about any form of behaviour or anxiety in your child, it is recommended that you seek professional help.