Anxiety in children: What you need to know

Rates of childhood anxiety are on the rise, as evidenced by a roughly 29% increase in the number of children aged 3 to 17 diagnosed with an anxiety disorder from 2016 to 2020. Learning to spot the signs of anxiety in children and teens is the first step toward getting them effective help in reducing their symptoms and improving their overall well-being.

We don’t fully understand what causes anxiety in childhood—or in adulthood, for that matter. However, researchers believe anxiety is tied to our body’s stress, or fight-or-flight, response. This defense mechanism increases nervous system function, breathing and heart rate to help us fight off or run from threats.

Children with anxiety disorders may have heightened reactions to stress, even when their circumstances are not life threatening. Their bodies may go into fight-or-flight mode more easily or intensely, and they may remain in that state for longer than normal.

Genetics may also play a role in childhood anxiety. Children with a family member who has an anxiety disorder are generally more likely to develop one as well. Stressful life situations, like the death of a loved one, domestic violence, serious illnesses, pressure at school, and the dramatic changes that occurred during the COVID-19 pandemic, could contribute to children’s anxiety disorders.

Children can develop many of the same anxiety disorders that adults do, including:

• Generalized anxiety disorder (GAD): This disorder is marked by a general state of excessive worry.
• Separation anxiety disorder (SAD): Most common in kids aged 7 to 9, this disorder causes children to become unusually upset or anxious when separated from their usual caregivers.
• Social anxiety disorder: This disorder causes anxiety when interacting with people, speaking in front of a group of any size or performing in front of others. For example, a child may become extremely anxious when called on in class.
• Panic disorder: This disorder causes children to experience multiple panic attacks with severe physical symptoms of anxiety, like trembling and shortness of breath. Panic disorder is more common in teens than in younger children.
• Phobias: This is an intense fear of something specific, like the dark or heights. Phobias can cause children to avoid certain activities.
• Selective mutism: This is a disorder where children or teens refuse to talk in certain situations due to fear and worry.

Children and teens may develop more than one anxiety disorder. For example, some children who have social anxiety disorder may also exhibit symptoms of selective mutism.

Signs of anxiety in children may be difficult to separate from ordinary fears and anxiety. Some red flags to look out for include:

• Startling easily
• Worrying excessively about changes or the future
• Frequently having tantrums
• Sleeping poorly
• Headaches
• Stomachaches and diarrhea
• Refusing to participate in activities
• Reluctance to go to school

If a child is having a panic attack, you may observe:

• Jitteriness and shakiness
• Shortness of breath
• Flushed skin on the face
• Clammy hands
• Dry mouth
• Rapid pulse
• Feeling numb or tingly

A single, isolated incident of anxiety may not mean that a child or teen has an anxiety disorder. However, if symptoms persist, it’s possible the child may benefit from anxiety treatment.

Healthcare providers often recommend cognitive behavioral therapy (CBT) as a potentially helpful childhood anxiety treatment. CBT is a type of talk therapy that allows kids and teens to gain a better understanding of their thoughts and feelings. CBT helps them understand where their anxiety comes from and learn strategies for coping when it arises.

In some cases, healthcare providers may prescribe medications to reduce symptoms of anxiety while kids undergo CBT. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed. These medications increase overall levels of serotonin, a “feel-good” chemical in the brain.

SSRIs may cause side effects and some evidence suggests that they may lead to suicidal thoughts in some kids and teens. As a result, healthcare providers usually try to treat anxiety in childhood without medications when possible.

Parents, caregivers, extended family members, and educators can take steps to help anxious teens and children. These tips may help but they’re not intended to replace childhood anxiety treatments like CBT. Here are some tips that may help support a child or teen experiencing anxiety.

Identify triggers

Many children and teens with anxiety experience increased symptoms in particular situations. Keep track of the child’s symptoms in a journal (or with a mobile app) and look for patterns. If you identify a trigger, tell your child’s mental health professional or healthcare provider.

Model deep breathing

When the child is experiencing anxiety or a panic attack, slow down your own breathing, and encourage them to mimic you. Tell them to imagine filling their belly up like a balloon each time they breathe. You can also pretend your fingers are birthday candles, and ask them to blow each one out slowly.

Offer a gentle reality check

Anxiety can make everyday problems feel like a crisis, especially if a child is ruminating on a difficult experience from the past or worries about the future. Remind them that at this moment they are safe and you are here to help them. When the child shares a worry, reframe it for them. For example, if the child says “I am going to look stupid during that presentation, and everyone will hate me,” ask questions like:

• Have you given a presentation before?
  
• How have you prepared for presentations in the past?

After asking these questions, give your child an affirmation, such as, “You worked hard on this presentation and you’re going to do your best. If you make a mistake, it will be okay.”

Practice ahead of time

If the child will be in an unfamiliar situation or setting, or if they need to do something that causes them anxiety, talk through what will happen. Offer to role-play or act out the situation to reduce their fear of the unknown. With younger children, you can also read books about the subject or draw pictures that include images of your child managing their new circumstances well and being surrounded by caring people. For example, if the child gets stressed about the dentist, you could read a children’s book or draw pictures about dental care beforehand.

Don’t downplay feelings

Even if the child’s worries seem silly, they’re very real to them. Children have a limited ability to manage their emotions and cannot process information in the same ways as adults. Saying things like “suck it up” or “it’s not that serious” can lead to feelings of shame and isolation. Instead, ask questions, validate their feelings, and help them put things in perspective without being dismissive.

If your child has symptoms of anxiety that are interfering with their ability to perform well in school, make sure they have time to play, see their friends and family members, keep predictable routines and sleep soundly at night. It’s important to share your concerns with their healthcare provider who can determine whether your child has an anxiety disorder and discuss treatment options if needed. Getting support for children and teens early can help increase the chances of a positive outcome.