5 Things to Know About Anxiety in Children

Sweaty palms before speak­ing to a crowd, feel­ing over­whelmed by a mount­ing pile of work, wor­ry­ing that your friends are silent­ly judg­ing you for that awk­ward fash­ion faux pas you made last week…feeling anx­ious every once in a while is a nor­mal part of life.

But when anx­i­ety is con­stant and starts to take over dai­ly life, it could be a sign of an anx­i­ety dis­or­der. In fact, it’s the most com­mon psy­chi­atric con­di­tion among chil­dren and adolescents.

Anx­i­ety can start at any age. Even young chil­dren, who you might feel have noth­ing to wor­ry about, can expe­ri­ence anx­i­ety. How­ev­er, it’s not always easy to spot anx­i­ety in chil­dren, espe­cial­ly when they are very young. They might not have the words to express how they feel. Anx­i­ety also can be tricky to notice from the out­side since the symp­toms can look a lit­tle dif­fer­ent in children.

Remem­ber, some anx­i­ety is nor­mal, such as ​“stranger dan­ger” and wor­ry­ing about an upcom­ing test or per­for­mance. How­ev­er, if the anx­i­ety neg­a­tive­ly impacts dai­ly func­tion­ing, such as refus­ing to go to school because there is a test com­ing up or avoid­ing engag­ing in sports or oth­er activ­i­ties for fear of being watched dur­ing games or per­for­mances, there might be some­thing more going on. Talk­ing to your child’s pri­ma­ry care provider can help dif­fer­en­ti­ate whether the anx­i­ety is expect­ed in a cer­tain cir­cum­stance or if it is caus­ing prob­lems in func­tion­ing and might require fur­ther eval­u­a­tion and/​or treatment.

Here are 5 things to know about anx­i­ety in children.

1. There Are Sev­er­al Types of Anxiety.

“Anx­i­ety” is a blan­ket term – there are a few dif­fer­ent types of dis­or­ders under the anx­i­ety umbrel­la. Adults can have some of these dis­or­ders, too.

• Gen­er­al­ized anx­i­ety dis­or­der (GAD) con­sists of exces­sive fear about things that hap­pen in every­day life or a con­stant feel­ing of being over­whelmed. The anx­i­ety isn’t always about one thing in par­tic­u­lar – it’s usu­al­ly a wide range of things, such as school/​grades, rela­tion­ships, cur­rent events, the weath­er, or safety.
• Social anx­i­ety dis­or­der (social pho­bia) is an intense fear of being embar­rassed in social sit­u­a­tions or being judged by oth­ers. Chil­dren with social anx­i­ety dis­or­der are often over­ly self-conscious.
• Spe­cif­ic pho­bias are extreme fears about some­thing in par­tic­u­lar, often to the point of going out of one’s way to avoid the object of that fear. These fears are more severe than they should be – the thing your child is afraid of like­ly isn’t as dan­ger­ous as they think it is. 
• Pan­ic dis­or­der con­sists of unpro­voked episodes of intense anx­i­ety with pre­dom­i­nant­ly phys­i­cal symp­toms, such as heart rac­ing, dif­fi­cul­ty catch­ing one’s breath, sweat­ing, and shak­ing, cou­pled with the feel­ing of impend­ing doom.
• Sep­a­ra­tion anx­i­ety dis­or­der is when some­one has anx­i­ety and fear when they’re sep­a­rat­ed from a cer­tain per­son that’s so strong that it inter­feres with every­day life. For exam­ple, a child may cling to their par­ent or hide in the back of the car to avoid going to school. 

Read on Duly Health and Care: Car­ing for Your Child’s Men­tal Health

2. Sep­a­ra­tion Anx­i­ety Dis­or­der Can Hap­pen in Old­er Chil­dren, Too.

It’s nor­mal for babies and young chil­dren to expe­ri­ence sep­a­ra­tion anx­i­ety when they aren’t with their par­ent or care­giv­er. Most chil­dren grow out of this by the time they are 3 years old. If sep­a­ra­tion anx­i­ety con­tin­ues, it could be sep­a­ra­tion anx­i­ety disorder.

Sep­a­ra­tion anx­i­ety dis­or­der can con­tin­ue through­out child­hood and into ado­les­cence and teenage years. Your child may wor­ry exces­sive­ly that some­thing bad will hap­pen to a loved one while they’re away or avoid going to school because they’re afraid of being sep­a­rat­ed. If they are in their ado­les­cent or teen years, they may become dizzy or have heart pal­pi­ta­tions when they are (or antic­i­pate being) apart.

3. Symp­toms of Anx­i­ety in Chil­dren Might Be Dif­fer­ent Than You Would Expect.

There are cer­tain symp­toms that hap­pen across all ages, like feel­ing ner­vous or tense. Oth­ers, like throw­ing tantrums or cry­ing in social sit­u­a­tions, are more com­mon in children.

Many symp­toms, like shak­ing, sweat­ing, or hav­ing heart pal­pi­ta­tions in intim­i­dat­ing sit­u­a­tions, are well-known signs of anx­i­ety. Oth­ers aren’t so obvi­ous. Look out for phys­i­cal, behav­ioral, and emo­tion­al signs.

Phys­i­cal symptoms

• Headaches or upset stom­ach for no med­ical reason
• Dif­fi­cul­ty falling or stay­ing asleep
• Rest­less­ness, hyper­ac­tiv­i­ty, or con­stant­ly being distracted
• Nev­er feel­ing hun­gry or feel­ing hun­gry all the time

Behav­ioral symptoms

• Not par­tic­i­pat­ing in class activ­i­ties like cir­cle time
• Sit­ting by them­selves at lunch or recess
• Refus­ing to go to school
• Tantrums
• Fre­quent­ly say­ing, ​“I can’t do it,” for no reason
• Con­stant­ly ask­ing ​“what if”-questions (like ​“What if it rains?”)

Emo­tion­al symptoms

• Con­stant crying
• Over­sen­si­tiv­i­ty
• Fear of mak­ing mistakes
• Fre­quent night­mares about a loved one dying
• Wor­ry­ing about the future while they’re still very young (e.g., a six-year-old being wor­ried about find­ing a job after college)
• Grouch­i­ness or anger for no reason

You prob­a­bly don’t need to be wor­ried if your child has these symp­toms once in a while. They could sim­ply be hav­ing a run of bad days. But if symp­toms are severe, fre­quent, or inter­fere with how they func­tion in day-to-day life, it’s time to bring them to a med­ical professional.

If you sus­pect that your child has anx­i­ety, or they have already been diag­nosed and need treat­ment, sched­ule an appoint­ment with your child’s South Bend Clin­ic pri­ma­ry care provider to dis­cuss your con­cerns. If appro­pri­ate, they may refer your child to a men­tal health provider. 

Read on Duly Health and Care: How do I Know if I Have an Anx­i­ety Disorder?

4. Child­hood Anx­i­ety Is Treatable.

There are two main types of treat­ment for chil­dren with anx­i­ety, and the type your child needs often depends on the sever­i­ty of their anxiety.

For mild and mod­er­ate anx­i­ety, the most com­mon treat­ment for chil­dren is cog­ni­tive behav­ioral ther­a­py (CBT). Dur­ing CBT, your child will learn about fac­ing their fears, rather than avoid­ing them, in order to dimin­ish the fear. Ther­a­pists can also help kids devel­op and improve social skills and teach relax­ation tech­niques to help them cope when they get anx­ious. CBT isn’t usu­al­ly ongo­ing. Your child’s ther­a­pist and insur­ance provider will help you deter­mine the num­ber of sessions.

When anx­i­ety is severe, or if CBT isn’t enough, your child may also ben­e­fit from med­ica­tion to treat anx­i­ety. It’s usu­al­ly rec­om­mend­ed that chil­dren who take med­ica­tion also do CBT – the treat­ments work best when they’re used together.

Unlike CBT, med­ica­tions are more of a long-term treat­ment. That doesn’t nec­es­sar­i­ly mean that your child will be on them for­ev­er. Many chil­dren can stop tak­ing med­ica­tions when their symp­toms have been in remis­sion for at least 6 to 12 months. This should be dis­cussed with your child’s pre­scrib­ing provider – do not have your child stop med­ica­tion with­out talk­ing to their provider, first.

Also read: Dai­ly Habits That Impact Men­tal Health and How to Improve Them

5. Don’t Assume That Your Child Will Grow Out of Anxiety.

Anx­i­ety dis­or­ders can improve as chil­dren and ado­les­cents grow and learn more cop­ing strate­gies and/​or move on from a stress­ful sit­u­a­tion or envi­ron­ment. How­ev­er, chil­dren who devel­op anx­i­ety dis­or­ders are often at high­er risk of hav­ing anx­i­ety dis­or­ders as adults, even if the spe­cif­ic type of anx­i­ety dis­or­der changes. That’s why it’s impor­tant to rec­og­nize anx­i­ety ear­ly if it is affect­ing their dai­ly func­tion­ing in a neg­a­tive way and get treat­ment if needed.