When you think back to your own childhood, you can probably come up with some times you felt anxious, like going to school for the first time, performing on a stage, trying out for a team or sleeping over at a friend’s house.
“Anxiety in children, as with any human being, is inevitable and a normal part of life,” said Brenner Freeman, MD, a psychiatrist with Banner Health. Anxiety is a normal part of development that can help children navigate unfamiliar or possibly dangerous situations.
“The key to anxiety is not to have too little and not to have too much. There is an appropriate healthy range of anxiety that helps us stay alive, live out our goals and dreams and live a productive, healthy life,” Freeman said.
If your child has anxiety often and it’s interfering with their life and activities, you may need to help them. “Excessive anxiety is when worries and fears lead to an undue amount of emotional stress or behavioral dysfunction in life. Too much anxiety causes dysfunction,” Dr. Freeman said.
Signs of anxiety in children
As a parent, it’s important to watch for signs of anxiety in kids. That way, you can help them cope and navigate their emotions. It's normal for children to have anxiety in certain situations, such as before they take a test or when they are meeting new people. This type of anxiety fades when the stressful situation is over.
Problematic anxiety often doesn’t go away. It might even get more severe and happen more often. It can make it hard for your child to participate in school, social activities or family life.
Anxiety may look different depending on your child’s age and personality. Younger children may be clingy, have tantrums or complain of stomach aches or headaches. Older children may avoid situations that make them anxious, become irritable or have difficulty concentrating.
Anxiety may show up as:
- Physical signs: Stomachaches, headaches, feeling tired, tingling, trouble sleeping, nightmares, muscle tension or pain. “Compared to adults, children often have more physical signs of anxiety,” Dr. Freeman said.
- Psychological or emotional signs: Irritability, panic, feelings of dread or impending doom, fear of the unknown or excessive worry about things like grades, friendships or global issues. The concern is often disproportionate to the actual threat.
- Behavioral signs: Attempts to create certainty, asking for reassurance frequently, temper tantrums, irritability, tearfulness and high emotional reactivity when things do not go as planned.
“The most common behavioral sign of anxiety in children and adults is avoidant behavior — avoiding whatever is causing the anxiety,” Dr. Freeman said. Kids might not want to try new experiences or even activities they used to enjoy.
Children may use the physical manifestations of anxiety or temper tantrums to get out of unwanted situations like school or social activities. “This is usually not a conscious manipulative behavior. It is the body's way of trying to protect itself from what it finds scary or dangerous,” Dr. Freeman said.
Repetitive behaviors can also be signs of anxiety in children. “Whenever a child feels an increasing level of stress, they will usually also have an increase in cognitive rigidity. That might look like black-and-white thinking or seeking certainty or control,” Dr. Freeman said.
“A child might check in with a parent for reassurance over and over or create rituals to try to exert control or create certainty,” he said. For example, a child might insist on an exact bedtime routine, touch or count objects or need things to be arranged a certain way.
Repetitive behaviors may reduce anxiety since they create a sense of control and provide a break from anxious thoughts. But they can worsen anxiety over time. “Repetitive behaviors can also be a sign of OCD or other mental health conditions. A skilled professional can help separate what is an anxious repetitive behavior from other mental health conditions,” Dr. Freeman said.
What can parents do?
“The problem with avoiding things because of anxiety is that often people avoid things that are actually good for them, like healthy recreational activities, work opportunities, building social skills, attending school and so forth,” Dr. Freeman said. “We, of course, want children to avoid actual danger. However, we do not want them to avoid things that appear dangerous to them because of anxiety, but are actually healthy and normal parts of growing up.”
Parents can be well-intentioned, kind and loving, but may make anxiety worse. For example, a child might plead with a parent, cry, have tantrums or talk about physical pains from anxiety. So the parent will accommodate the child's anxiety and not make them face their fears. “This will usually worsen a child's anxiety because the longer you avoid a source of anxiety, usually the anxiety gets worse not better,” Dr. Freeman said.
Instead, he recommends supporting your child who is experiencing anxiety with validation, active listening and understanding, while also being firm in expectations. A parent should show warmth, love and understanding without allowing avoidant behaviors.
“A household expectation that there is a culture of facing fears instead of avoiding them, but doing so in warmth and understanding can be a powerful influence in helping children create a different story about themselves — that they are strong and growing instead of weak and stuck,” Dr. Freeman said.
“There has been a cultural shift in the past 10 to 20 years, where parents are afraid of traumatizing their children through exposure to stress. However, stress is a normal and important part of childhood development. Avoiding stress only makes children more hyper-sensitized to stress. The parent’s job is to keep their child safe, but also to create an atmosphere and expectation to do hard things that are uncomfortable or scary,” Dr. Freeman said.
When should you connect with professional help?
“Professional help can be useful when it becomes apparent that anxiety is causing an undue amount of emotional pain and/or disorder. There is no perfect gauge to measure this. Every family will be a little different,” Dr. Freeman said.
You may want to connect with a professional if:
- Symptoms are interfering with grades, social interactions or family relationships or limiting a child’s ability to be a part of school, activities or daily routines.
- Your child often has headaches, stomachaches or sleep issues without an apparent cause.
- You’re noticing significant changes in behavior.
- You have a family history of anxiety disorders or other mental health conditions, which may put a child at higher risk.
A professional can provide a diagnosis and recommend treatment for the child, as well as guidance and support for parents. “Professional help can come in the form of talk therapy as well as medications, which are evidence-based approaches to overcoming pediatric anxiety,” Dr. Freeman said.
If your child doesn’t want to go to therapy, other options exist. “For example, there is a relatively new form of therapy called SPACE (supportive parenting for anxious childhood emotions), which educates and coaches parents to help children overcome anxiety,” Dr. Freeman said.
Seeking professional help early can help children learn healthy coping skills and manage anxiety more effectively as they grow. Trust your instincts and reach out for support if you think your child needs it.
The bottom line
Some anxiety is normal and overcoming it helps children grow and adjust to new or unfamiliar situations. But sometimes, anxiety happens often or intensely. In those situations, parents can step in and help their child overcome anxiety.
If anxiety is an ongoing problem, your child may need professional help. Reach out to an expert at Banner Health for advice.
