Understanding Anxiety in Children
Anxiety is the body’s reaction to a perceived threat of possible danger in the world. Anxiety isn’t always a bad thing. It can be helpful. It puts the body on alert, focusing its resources on the ability to escape in the event of an emergency.
Unfortunately, the body can’t distinguish between a real threat, like a natural disaster, and a stressor that our brain interprets as dangerous, like a big test, and reacts the same way, regardless of the nature of the stressor.
Clinical anxiety differs from typical anxiety in that it is persistent, its intensity goes above and beyond the reaction you would expect from the specific stressor, is uncontrollable despite attempts to reassure, and, most importantly, is distressing to the person and/or negatively impacts their functioning in different areas of their life.
Anxiety can look different in children based on their stage of development and may be difficult to detect, especially in younger children who aren’t yet able to describe their inner thoughts and emotions. Often, children present with physical symptoms of body aches and pains rather than verbalizing racing thoughts or specific fears and worries. Children may also cling to and/or seek out physical proximity to trusted adults, making separation during times of transition or bedtime difficult.
Types of Anxiety Disorders in Children
Anxiety presents in different ways in children. Below are a few of the more common anxiety disorders experienced by children.
Separation Anxiety Disorder
It’s natural for younger children to show some reluctance or distress when transitioning away from their primary caregivers. This typical developmental stage of difficulty separating usually starts around 8 months old and concludes by 24 months old, peaking between 10 to 18 months of age.
Separation Anxiety Disorder differs from this developmentally typical stage. Separation Anxiety Disorder is when the child demonstrates a persistent and exaggerated response when separating from their caregiver, is not responsive to attempts to console them, and these symptoms impair the child and family’s functioning.
The anxiety can present in different ways, including difficulties attending childcare, school, or out-of-home events, difficulty sleeping on their own, and/or voiced concerns about being separated from their caregiver due to a scary event like getting lost or kidnapped.
Specific Phobias
Specific phobias are an extreme fear about a specific object or situation, such as animals, needles, animals, or heights. The child actively avoids the feared object or situation. When presented with the specific feared object or situation, the child immediately experiences fear or anxiety, which may present as crying, tantrums, freezing, or clinging to their caregivers. These symptoms are consistent, presenting almost every time the feared object or situation occurs, and can take place in anticipation of the feared object or situation too.
Importantly, the distress experienced is more intense than to be expected based on the actual danger that the object or situation poses. It is not uncommon for a child to have multiple specific phobias, with 3 out of 4 people experiencing more than one feared object or situation.
Social Anxiety Disorder
With social anxiety disorder, or social phobia, the child demonstrates a persistent fear of judgment or rejection in social or performance situations, especially when unfamiliar people are present. When put in these feared social or performance situations the child may freeze, panic, be unable to speak, or they may outright refuse to participate and avoid these situations altogether. In children, the anxiety must occur not only in interactions with adults, but also in settings with peers.
See When to Worry: Social Anxiety and Back-to-School Season for more information on social anxiety.
Generalized Anxiety Disorder (GAD)
Children with generalized anxiety disorder (GAD) show excessive and persistent worry more days than not. These worries are about a number of things, including things that may happen in the future, things that have occurred in the past, and/or their perception of their own skills or abilities.
Children with GAD are not able to manage these worries on their own and may regularly seek out reassurance and support from their caregivers. GAD can present changes in mood and behavior, including irritability and agitation, distractibility, fatigue, muscle tension, and disrupted sleep.
Panic Disorder
Panic disorder consists of recurrent and unexpected panic attacks. Panic attacks are more than a momentary experience of anxiety. They are sudden, intense fear episodes with physical symptoms that can include increased heart rate, sweating, shaking, difficulty breathing, nausea, dizziness, changes in the body’s temperature, fear of dying, and a sense of being outside one’s body or things not being real.
After panic attacks, children with panic disorder experience worry of future panic attacks and/or may change their behavior in an attempt to avoid future panic attacks. Although panic disorder can occur in children, it is relatively rare before the age of 14 years old with a prevalence of less than 1%.
What Causes Anxiety in Children?
There is no single cause of childhood anxiety. Anxiety results from a combination of characteristics of the individual child paired with the impact of their environment and experiences.
Biological and Genetic Factors
Some children are naturally more sensitive than others and have a heightened startle response, leaving them more prone to anxiety. Children who are shy or behaviorally inhibited are also more likely to have anxiety. A genetic predisposition for anxiety is passed onto children whose family members have anxiety or depression themselves.
Environmental and Life Experiences
Stressful life events, such as early medical issues requiring hospitalization and interventions and exposure to violence can contribute to an increased risk for anxiety. Instability in food, shelter, or schooling can also increase the likelihood a child will experience anxiety.
Risk factors can present even before the birth of the child, with maternal smoking during pregnancy as a known prenatal risk factor for childhood anxiety.
Signs of Anxiety in Children by Age
Anxiety presents differently depending on the developmental stage of the child. Key features of anxiety to look out for are broken down by age below, see Common Signs of Anxiety in Children at Every Age | Little Otter Blog for a more detailed breakdown of common signs of anxiety across ages:
- Infants and Toddlers (0-2 Years Old)
- Sleep difficulties
- Trouble eating and/or digestive problems
- Frequent crying, tantrums, or other behaviors carried out as a way to avoid a perceived threat
- Clinginess to primary attachment figure(s) and difficulty establishing relationships with others
- Preschoolers (2-6 Years Old): In addition to the symptoms seen in infants and toddlers described above, anxiety in preschoolers may include symptoms of:
- Body aches and pains
- Fearfulness and reluctance to try new things or interact with others, including peers and adults
- Avoidance of childcare, school, and/or social situations where caregiver is not present
- School-Age Children (6-12 Years Old): In addition to symptoms of sleep difficulties, body aches and pains, trouble eating and/or digestive problems, fearfulness and reluctance to try new things or interact with others (including peers and adults), and avoidance of school and/or social activities where caregiver is not present that are seen in younger children as well, anxiety in school-aged children may include additional symptoms of:
- Excessive worrying, "what if" questions, and/or reassurance seeking from caregivers
- Perfectionism and people-pleasing behavior
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How Parents Can Help Manage Their Child’s Anxiety
Anxiety Management Strategies
Talk About Anxiety
You’ve got to name it to tame it! Help your child understand their feelings by getting curious with them about their experience and giving it a name–anxiety.
Asking What did it feel like in your body? helps your child to connect with their experience. If they are having a hard time talking about their own experience, share what you noticed about their behavior that let you know they were feeling anxious. This will help them begin to recognize signs that they may be beginning to feel anxious.
Normalize anxiety. If your family has seen Inside Out 2 and is familiar with the character of Anxiety, use that shared language and experience to kick off a conversation. You could ask them how their body’s anxiety differs from the movie. Share what anxiety feels like to you to let them know that that anxiety is something that everyone experiences from time to time and to demonstrate how everyone’s experience is a little bit different.
Recognize Anxiety Triggers
Notice patterns and trends in your child’s anxiety. Look at the ABCs of their behavior: The Antecedents, what came before their anxiety, the Behavior, what was their behavioral response, and the Consequences, what happened after the behavior, including things that didn’t happen, which can help you determine if there is any avoidance occurring.
Identifying the ABCs of your child’s expression of anxiety can help you identify the triggers of their anxiety and lets you support your child when these situations or objects present.
Teach Coping Techniques
Relaxation and mindfulness activities are great coping strategies to manage anxiety as they switch off the body’s stress response which is activated by anxiety and bring on the body’s relaxation or rest and digest response.
These skills should be introduced and practiced with your child regularly when they are in a calm and relaxed state so that they can become familiar with them. It can be helpful to build this practice into your daily routine so that these skills are practiced and ready to use when anxiety presents in the future.
Create a Safe, Supportive Environment
Maintaining consistency at home creates a stable environment for your child. This predictability and security in their experience is very grounding for all children, and especially those experiencing anxiety.
Limit Stimulants
The physical effects of stimulants resemble those of anxiety and can be triggering to children with anxiety. Reducing your child’s sugar intake and reducing or eliminating the caffeine in their diet can be helpful for children experiencing anxiety
Spend Quality Time Together
Shared time together can strengthen the parent-child bond and encourage your child to see you as a source of support. By spending time together you’re creating more opportunities to talk and discuss their experiences, including that of anxiety. Allowing your child to speak openly about their experience lets them know that you’re able to handle their big feelings and support them.
Support During High-Intensity Moments
Breathing Exercises
Deep breathing exercises can help to regulate the body during moments of high intensity anxiety or during a panic attack.
One easy breathing technique is box breathing. It is all about the 4’s: Breathe in through the nose for 4 seconds, hold gently for 4 seconds, breathe out through the mouth for 4 seconds, hold gently for 4 seconds, and do this a total of 4 times.
Grounding Techniques
Use sensory-based grounding exercises to help bring your child out of their head that may be filled with cascading worries and anxious thoughts and into the present moment.
Try 5-4-3-2-1 grounding: Prompt your child to identify 5 things they can see, 4 things they can touch, 3 things they can hear, 2 things they can smell, and 1 thing they can taste.
Provide Physical and Emotional Reassurance
Sit with them, hold their hand, and offer comfort by letting them know they are safe and you are there as a support.
Offer co-regulation by modeling box breathing (described above) and encouraging them to join you in the practice.
Encourage Positive Imagery
Ask your child to think of a safe, peaceful place. Prompt them to draw out the sensory experience of this real or imagined peaceful (the sights, the sounds, the physical sensations, etc.) to help them become more fully immersed in the experience. Remind them that they can return to this calming place in their mind whenever they need it.
Redirect to a Favorite Activity
If your child is feeling stuck in a cycle of cascading thoughts and worries, redirecting them to a preferred activity can help them to engage in and focus on something else. Activities that move their body and/or engage their senses can be especially effective distractors.
When to Seek Professional Help
Parents should seek out professional help when their child’s anxiety is:
- Persistent, lasting more than a month
- Disruptive to the child’s daily life and their functioning and/or the functioning of the family. This can include the child’s attendance at school, academic achievement, the child or family’s participation in activities outside the home, establishing and maintaining friendships, and the quality of relationships with family members.
- Interfering with their child’s ability to carry out developmentally-appropriate activities, such as being alone to use the bathroom or participate in an extracurricular activity alone.
- Distressing to their child and/or other family members
- Accompanied by emotional outbursts that put their child or others at risk of harm
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FAQs about Anxiety in Children
How do I know if my child has an anxiety disorder?
Look out for persistent and excessive worrying, avoidance of feared situations or objects, and/or distress that interferes with their daily life and negatively impacts your child or your family’s ability to function.
Not sure if your child is experiencing anxiety or depression? See What’s the Difference Between Anxiety and Depression? to learn more about how to distinguish between anxiety and depression in your child.
Can anxiety in children go away on its own?
Some children may outgrow symptoms of anxiety, but if symptoms begin to impact daily life and functioning, then it is recommended that you seek professional support for your child.
When young children experience anxiety, it increases their risk of experiencing an anxiety disorder, as well as depression and disruptive behavior disorder as they get older, so early identification and intervention is paramount to promoting their healthy development.
Should I talk to my child about their anxiety?
Yes, open conversations help children understand and manage their feelings.
When should I seek professional help?
If your child’s symptoms of anxiety are persistent, disruptive to the child’s daily life and their functioning and/or the functioning of the family, interferes with their ability to carry out developmentally-appropriate tasks, causes distress, and/or is accompanied by emotional outbursts that put them or others at risk of harm then you should seek professional support.
Can anxiety lead to other problems later in life?
Yes, untreated anxiety can increase the risk of other mental health concerns later in life, including depression, disruptive behavior disorder, and substance use in adulthood. Additionally, anxiety can disrupt the establishment of important relationships with family members and friends, negatively impacting overall social functioning.
What treatments are available for childhood anxiety?
The good news is that evidence-based treatments for childhood anxiety exist and are effective.
Cognitive Behavioral Therapy (CBT) with family involvement is the gold standard treatment for anxiety in children under 8 and CBT, exposure-based work, and modeling work are all evidence-based treatments for children 8 and older and teens with anxiety.
Additionally, the Supportive Parenting for Anxious Childhood Emotions (SPACE) program is a parent-facing intervention for parents of children with anxiety that has research support in reducing anxiety through addressing parents’ accommodation of their child’s anxiety. Combined therapy and medication management may be helpful for children who do not respond to therapy alone.
Final Thoughts
Childhood anxiety is a common and treatable issue. Anxiety in children can present in different ways based on their developmental stage and the nature of their anxiety. When untreated childhood anxiety can negatively impact a child’s daily life and functioning.
Parents should be patient and supportive when responding to their child’s anxiety and talk openly with their child about their experience. Parents should seek professional help if their child’s anxiety becomes persistent, disruptive, and distressing. Evidence-based interventions exist and can help children and families manage anxiety effectively.
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