Anxiety Disorders in Children – How to help an Anxious Child

Anxious Children

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How Parents can help children with their anxiety

According to the National Survey of Children’s Health 7.1% of children aged 3-17 years, (approximately 4.4 million) have diagnosed anxiety, so it’s important to remember you are not alone when supporting your loved one with their anxiety disorder. 

The good news is, often a child’s anxiety can be short term, meaning children (and adults) can recover from childhood anxiety disorders. 

There is a range of treatment and support available for parents of anxious children and the information and guidance below, includes the signs, symptoms and possible treatment and support options you may want to explore.

Normal Anxiety or Anxiety Disorder?

A degree of anxiety in children forms a normal part of their life and can in fact motivate them to try harder at certain things or prevent them from doing something that may be dangerous. 

It can be very common, especially with children of pre-school age, to develop certain fears or phobias and from 6 months – 3 years old, they may have a degree of separation anxiety, feeling shy in certain social settings, or when presented with new situations. It is common for children to ‘outgrow’ many of these more common anxieties. 

That said, it’s important for a parent or care-giver to understand the difference between a normal level of anxiety, compared to Childhood Anxiety Disorders

An anxiety disorder is when feelings of fear and danger are present and ongoing, interrupting the child’s ability to take part in normal activities and occupying their thoughts in a continuous and overwhelming way. 

These feelings of heightened anxiety can last long after any threat of fear or danger has moved on and are not at a level relative to the threat faced by the child. Anxiety disorders can, in some cases, lead to depression if left untreated.

anxiety disorders in children
Anxiety Disorders in Children

Causes of Anxiety Disorders in children

According to The National Scientific Council on the Developing Child For young children who perceive the world as a threatening place, a wide range of conditions can trigger anxious behaviors that then impair their ability to learn and to interact socially with others.’

Anxiety disorders can be brought about by both environmental and genetic factors and any number of these can play a part;

  • Learned behavior
  • Certain life situations
  • Past experiences / early childhood
  • Environmental factors
  • Biology
  • Biochemistry 

It is not uncommon for anxious children to have modeled their anxious behaviors from someone close to them (family members, older children) or there may be a genetic link, as anxiety disorders can run in families.

While  these are both possible, they may not be contributing factors to a child’s anxiety disorder. 

Some children can feel a sense of vulnerability in certain situations, being more sensitive to certain family dynamics, changing aspects or circumstances.

Parents and care-givers certainly play a vital role in supporting anxiety disorders in children, but it is important to bear in mind, it isn’t necessarily present because they have or have not done certain things. 

Children may be presenting heightened anxiety when responding to a changing or difficult situation;

  • House move
  • Moving to a new school
  • New sibling
  • Parents/Carers separation
  • Anxious parents
  • Sudden, dramatic changes in the child’s life
  • Family conflict

It may also be possible that a child who has been involved with a traumatic experience could develop an anxiety disorder;

  • Car accident
  • Domestic violence
  • House Fire
  • Bereavement 
  • Witnessing serious injury or illness 
  • Abusive past

Signs of Anxiety

Everyone’s experience of an anxiety disorder is different. Not everyone who suffers from the disorder will experience the same symptoms and how the disorder presents itself can vary, depending on the type of disorder and age of the child.

The best course of action, is always to seek the medical advice of a paediatrician, to rule out the possibility of any separate, underlying health condition that may be present. 

This list contains some of the psychological ways that an anxiety symptom(s) may present themselves during anxiety disorders in children;

  • Uncontrollable over-thinking
  • Difficulties concentrating
  • Problems with sleep
  • Heightened reluctance to be in social situations
  • Feelings of intense fear
  • Drastic changes in appetite (overeating or turning away food to abnormal degrees)
  • Feeling a heightened sense of panic or approaching ‘doom’
  • Feeling irritable
  • Racing thoughts
  • Irrational behavior
  • Heightened alertness
  • Wanting to escape from the situation you are in
  • Dissociation (Feeling like you are disconnected from your own body, watching what is happening around you, without feeling part of it)

This list contains some of the physical symptoms that can present themselves during anxiety disorders in children;

  • Heavy and fast breathing
  • Nervous twitching
  • Panic attacks
  • Increased irritability
  • Excessive crying (More common in toddlers)
  • Dry mouth
  • Shaking
  • More frequent bathroom urges
  • Tantrums 
  • Hair loss
  • Tension (can result in muscle aches and pains)
  • Chest pains
  • Shortness of breath
  • Hot flushes or blushing
  • Sweating 
  • Anxious behaviors (Picking at the face or fingers)
  • High heart-rate 
  • Extreme tiredness or lack of energy
  • Dizzy spells
  • Fainting
  • Stomach aches
  • Headaches
  • Sickness (nausea and vomiting) 

A regression in behaviors, in some cases is not uncommon.

This could be a reduced ability to self sooth or self-regulate their mood, reverting back to bed wetting, or being more clingy than usual. 

Any of the above symptoms may result in the child wanting to miss school, get out of certain social situations or crave additional reassurance, all in a bid to avoid anything that might trigger their anxiety.

Types of Anxiety Disorders

1. Generalised Anxiety Disorder (GAD)

This is one of the most common types of anxiety disorder. The main symptom of GAD, is excessive worrying about potential events, activities or scenarios. 

The child will feel anxious a lot of  the time, being on edge and hyper-aware/alert to their surroundings.

This is very likely to affect their day to day life and their desire to attend school, meet new people or different social situations.

It will also inevitably impact on the child’s concentration and energy levels, impacting their ability to sleep and causing symptoms such as muscle tension, sweating or hyperventilation. 

In some cases, GAD can be harder to diagnose, as unlike other types of anxiety disorder, many of the symptoms are not unique to GAD.

2. Panic Disorder

Panic Disorder can be very scary for a child who experiences it.

The panic attacks themselves can come about without warning and in extreme cases, will feel so intense that the child may be on the verge of passing out. 

Panic attacks can last anywhere from 5-30 minutes, but the child’s fears of the attack can prolong this experience, meaning heightened anxiety can be present before and after the panic attack itself. 

The fear of the panic attack will (understandably), cause the child to avoid any potential triggers and the fear of attack itself, can then trigger an attack.

The fear of experiencing panic attacks can also heighten the child’s heart-rate, resulting in hyperventilation.

3. Separation Anxiety Disorder

Young people worrying excessively when separated from their loved ones (mainly parent or care-giver), is the fundamental sign of a separation anxiety disorder. 

Between 6 months and 3 years old, a degree of anxiety when separated from those they are close to, is not uncommon. This can even be the case when in separate rooms or during brief spells apart.

When this worry becomes irrational, prolonged and has an impact on the child’s ability to function normally, this will likely be due to a separation anxiety disorder and can often spike again (or for the first time), in children aged between 6 and 9 years old.

Severe bouts of separation anxiety disorder in older children, will cause them to avoid going to school, seeing friends or attending any clubs and events.

4. Social Anxiety Disorder

This social phobia will bring about intense fears and worries, sometimes specific to certain scenarios (crowded places, school, new environments, performances).

This fear can happen before, during and/or after the event. 

Social anxiety disorder for children can be due to fears around being judged, making mistakes, feeling embarrassed, getting lost or feeling vulnerable. 

This disorder can play a particularly negative role in the development of children, as it can create an avoidance to attend school and extracurricular activities, or even impact on their ability to make new friends, all of which form vital aspects of a child’s developmental process. 

5. Selective Mutism

Selective Mutism is a slightly less common form of anxiety disorder but can still be quite severe. As its name might suggest, a child may be perfectly comfortable talking in front of people such as parents, carers and close family members, but will not be able to speak outside of this. 

With parents and carers usually being the people who the child talks with, it can come as a shock if a third party informs them of the anxiety disorder.

6. Obsessive Compulsive Disorder

With this anxiety disorder, children suffer from constant obsessions and compulsion that provoke anxiety and distress. 

Obsession – (from the Latin ‘Obsidere’ meaning ‘To Besiege’)

An unwelcome thought/image that you keep thinking about and is mostly out of your control.

Compulsion – Something you think about or do repeatedly to relieve anxiety.

It is important to realize that the child’s obsessional thoughts are repetitive and are not voluntarily produced. 

By carrying out a series of ritual behaviors or routines, the anxieties are temporarily waylaid.

An example of this could be checking door locks to feel safe, repeating phrases (out loud or in their head), or an obsessive need to wash themselves and other things, in order to prevent perceived harm happening to themselves or to a loved one, or to feel mentally cleansed. 

After carrying out their series of rituals, you may notice their anxiety visibly reduce, (less nervous, less muscle tension), but when the intrusive thoughts begin to return, the process will restart.

In severe cases, this cycle will cause severe physical and mental exhaustion and if for whatever reasons the habitual routines cannot be carried out, the child may begin to panic or present additional physical symptoms of anxiety. 

7. Specific Phobias

While specific phobia anxiety can be manufactured from a past trauma – being stung by a wasp / bitten by a dog / lost in a supermarket etc, it’s also very common for there to be no relation to specific phobias and past events

Children can develop phobias regarding specific people, places or objects. A seemingly irrational fear of thunderstorms, heights, blood and injections, to name a few.

The child’s anxiety of the specific trigger, will cause them to become distressed – crying, shouting, having a tantrum or becoming very afraid.

This fear will lead them to avoid certain situations, becoming clingy or worried if they think they might be exposed to their specific phobia(s).

When Should I seek Professional Help for my Childs Anxiety?

The first step to seeking medical advice, is from your GP or paediatrician. 

You should do this if your child’s anxieties are causing them issues in their day-to-day life, resulting in excessive fear and/or avoidance of certain situations.

Below are 11 signs and symptoms for a parent or carer to seek medical advice for their child’s anxiety disorder;

  1. If your child is worrying and/or asking for reassurance almost every day
  2. Your child consistently avoids age-appropriate situations and/or activities
  3. Your child regularly has problems sleeping for which no physical cause can be found
  4. Regular disruption of household daily activities and life
  5. Your child avoids taking part in age-appropriate activities without a parent or care-giver
  6. Your child experiences bouts of hyperventilation, chest pains and/or palpitations
  7. When the disorder makes it difficult to make or keep friends
  8. Your child has daily, repetitive rituals, such as repeated hand washing, checking things, or verbal confirmations and they become angry or upset when asked to avoid them
  9. Your child frequently has stomach aches or headaches
  10. Your child has intrusive thoughts
  11. Your child experiences vomiting or nausea that isn’t attached to an existing health issue

Treatment For Anxiety Disorders

A medical professional will take a number of things into account when deciding on the best course of effective treatment for a child with an anxiety disorder.

This will include;

  • Any previous treatments already attempted – both successful and unsuccessful
  • What you and your child are looking to achieve from treatment 
  • Any other conditions present, whether physical or mental 
  • The symptoms and their severity 

According to the Agency for Healthcare Research & Quality The combination of medications and cognitive behavioral therapy is more effective than either treatment alone, but the benefits and risks of each need to be considered.’

Cognitive Behavioral Therapy (CBT)

This is often undertaken in a ‘block’ of sessions, where the child will spend time with a therapist on a weekly basis, usually for a 10 – 12 week period.

Through CBT, children will learn that avoidance of a certain trigger will make their anxieties stronger, whereas facing their fears can build resilience. 

According to the Agency for Healthcare Research & Quality ‘Cognitive Behavioural Therapy reduces anxiety symptoms based on child, parent, and clinician reports, improves functioning, and leads to clinical response.’

With the support and guidance of a therapist in their sessions, the child will learn and practice a series of techniques to help them face their worries and in-turn, reduce the associated increase of anxiety. 

This process builds confidence in the child, giving them the tools they need within themselves to be successful in combating their anxiety disorder.

The child will need to participate actively in the sessions and there is usually a requirement for the child to practise the techniques learnt, during their daily life away from therapy, in order for the therapist to gauge the success of certain techniques.

CBT can, at times, be a more complex process for younger children to understand. 

Selective Serotonin Reuptake Inhibitors (SSRIs)

This is widely used anti-depressant, that’s also effective in reducing a number of anxiety symptoms, particularly in persistent or severe cases. They are not often prescribed for children due to some of the potential side-effects, (dizziness, blurred vision). 

According to the National Health Service – It’s thought that SSRIs work by increasing serotonin levels in the brain.

Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It’s thought to have a good influence on mood, emotion and sleep.’

  • SSRIs are usually distributed in tablet form
  • A low dose will likely be the first course of action
  • They can take 2 – 4 weeks for the benefits to be felt
  • Usually, if no benefit is felt after 4 – 6 weeks, your doctor may increase the dosage
  • Treatment can last 6 months+

Talking Therapies

There are various talking therapies available, depending on which Country you live in. They are often used for low to moderate cases of anxiety disorder, but in severe cases, when used alongside other treatments, they can also be effective.

Counselling and guided self-help, are both examples of talking therapies.

For UK residents, the scheme IAPT  (Improving Access to Psychological Therapies) will give access to Counselling and guided self-help. 

You will need to be registered with a GP to follow up a referral for yourself or a child.

Dialectical Behavioural Therapy (DBT)

This is a relatively new therapeutic approach that is used for the treatment of mood disorders and uses similar principles to CBT.

Through time spent with a therapist, children are taught how their thoughts trigger their emotions, which then triggers an action.

This can be a beneficial therapy for children who find it difficult to regulate their emotions, giving them the tools to manage the struggle they may find themselves in internally. 

Applied Relaxation

Applied relaxation teaches the child to focus on the relaxation of their muscles at certain times and in a certain way. 

A therapist will teach them how to relax their muscles so that you are able to manage their tension and anxiety, enabling them to fall asleep easier, and decompress themselves in certain situations when their anxiety is building.

Depending on the anxiety disorder and how the child responds to the treatment, they may attend 10–15 weekly, 1-hour sessions.

How Can You Help Your Child?

It is completely natural (and in fact, hardwired in children’s response system), to respond to fear and anxiety by signalling their parent or carer, in the hope that they will offer protection. 

In turn, parents are similarly hard-wired to want to offer their offspring this protection.

Despite these natural urges, an anxiety disorder is the child’s perception of danger and fear being greater than the reality. These warning signals being produced by the child, will prompt a reaction in a parent to offer support – some examples could be;

  • Speaking on behalf of a nervous child
  • Allowing their  child to avoid certain stressful situations (parties, family gatherings)

While this may create a short-term comfort and ‘piece of mind’ for you and the child, it is in fact enabling the behaviour to continue and potentially worsen, as the child’s confidence and ability to function in these situations will lessen over time.

Instead, look to be supportive without enabling the child’s anxiety.

Here are some ideas around how to support your child with their anxiety disorder;

  • Approach situations that create anxiety with small steps or in stages, appropriate to the child’s age
  • Provide structure and stability for younger children
  • Offer age appropriate explanations on why it can be helpful or in their best interests to take part in activities, despite some feelings it may provoke
  • Support the child, so they know they are safe from harm, but at a slight distance, giving them confidence to try new or anxiety inducing activities
  • Listen to your child when they explain their anxieties, so they know they have support
  • Explaining situations factually, can help dispel any build up of irrational fears 

Ensuring your child is getting enough sleep each night and eating a healthy, balanced diet, plays a large part in their state of mind. We all know how it feels to try and think logically and remain relaxed when we are hungry, tired, or processing spikes in sugar! 

The endorphins released by exercise can also play a large part in increasing natural serotonin levels within your child’s body, lifting their mood and having a huge positive impact on their well-being.