What is Anxiety in Childhood?
Anxiety in childhood is worries that are out of proportion to the distressing situation and cause significant difficulties in daily life.
An anxious child often has racing thoughts, restlessness, a need to be in control, and unexplained physical symptoms.
Some children worry so much that they feel they have to be perfect. These children are not satisfied with their art projects or writing assignments. Often, when asked, the child may self-identify as a “perfectionist.” Sometimes, children are completely unaware of their anxiety. They may only tell you about their perfectionism and their physiological symptoms. Children are not always aware that their worries are excessive.
Often, self-proclaimed ‘worry warts’ or ‘Nervous Nellies’ spend a lot of energy on implausible or relatively small events. They might wonder about the zombie apocalypse or the day the sun grows so big that it burns up the earth.
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Symptoms of Anxiety and Stress in Children
- Excessive worrying: your child often asks questions about “what if…”
- Many extreme fears: your child has a fear of burglars, kidnappers, or things that go bump in the night that is severe and impacts life
- Worry about family: your child is excessively concerned about something bad happening to parents or siblings
- Questioning and self-doubt: your child wonders, ‘What if they don’t like me?’
- Spends a lot of time worrying: your child worries for long periods, taking time away from fun or school-related tasks
- Cannot let things go: your child is always ‘sweating the small stuff’
- Irritability: your child seems irritated at times instead of just nervous
- Perfectionism: your child is trying to be perfect, not okay with making mistakes, craves control
- Physical symptoms of nervousness: your child reports feeling butterflies in their stomach, racing heart, restlessness, trouble sleeping, chest pain, or muscle aches
- Experiencing illness: your child seems to often have headaches or stomach aches or sleepiness
- Children may not know worry is excessive: your child is unaware that their worries are out of proportion to the situation
Physical worries…Somatic symptoms are physiological symptoms of emotional distress, like stomach and headaches. Children with somatic symptoms may report that their chest feels tight, they can’t breathe, or their stomach feels upset. Sometimes the child who worries ends up in the nurse’s office because of such complaints. This break from the day may be rewarding because it can remove a child from worries. Getting out of the classroom removes social pressures and performance anxieties.
Social worries…Your child may be very introverted. They might worry for days before a birthday party or playdate. They might fear that everything could go wrong in these social situations. They may worry about ‘little things’ like what if we are late for school or if I forget my snow boots on a snow day? Your child may appear restless or have trouble sleeping. If a friend leaves her out of a game, she may worry that no one likes her.
Implausible worries…If a dog barks, they may worry about being killed by a mauling dog. They may worry the house will catch fire. Your child may check their grades constantly.
Sensitive worries…It may be that your child is very sensitive and rule-following. Even the slightest redirection may lead to sobbing and feelings of regret.
Controlling worries…Your child may be irritable or restless about the slightest thing. He may feel most comfortable at times when he is “in control” and may not like allowing others to make decisions. Some children try to control everything. They want to control what they eat, where they sit, which friends they play with, and even the weather! A very anxious child may cry when it doesn’t snow on Christmas as she had planned.
Causes of Anxiety and Stress in Children
- Genetics: some people, children included, are more genetically inclined to be anxious. This anxiety may be part of who we are, part of our temperament and personality
- Environmental factors: you may have heard ‘anxiety is readily contagious.’ Being in situations marked by uncertainty or unpredictability, being surrounded by anxious people, or having a parent who has very anxious reactions can cause anxiety in a child
- High-pressure environments: highly stressful sports, academics, and other activities can lead to increased anxiety. A combination of genes and environment can increase anxiety in a child. If your child is in a highly stressful or competitive school, sport or activity, keep an eye on how they are managing this emotionally
- Trauma: traumatic events can cause anxiety either temporarily or for very long periods. Children who experience ‘Big T’ traumas like natural disasters, wartime, personal tragedy, severe medical complications, or other crises are much more likely to experience anxiety in the long run. Other seemingly minor events in childhood like a move across town, divorce, or change in friends can cause anxiety too. Psychologists call these “Small t’ traumas, and they can have a significant impact on a child’s worries and mental health
- Other diagnoses or challenges: children with learning disabilities may find that time in the classroom is stressful. Children with autism may struggle with social interaction. These stresses and struggles increase the chances that a child will feel anxious. Anxiety is commonly diagnosed in combination with autism, learning challenges, and ADHD
What to Do About Anxiety and Stress in Childhood
DO acknowledge that you feel worried sometimes yourself. Talk through some worries, like “Traffic was awful, and I was worried I’d be late for work.” Talk about how you handle that worry, noting that everyone makes mistakes and that no one is perfect.
DO share that even though you were worried, it all worked out okay in the end. Explain that most of the things we worry about never come to fruition.
DON’T talk about worries like “I’m worried the local crime spree will hit our neighborhood next.”
DON’T turn on the local news at night if your child tends to worry. Be honest and clear when she asks you a question, but keep in mind that children do not need to be privy to everything. Try to bring up positive things happening in your community. Make statements about safety and security.
DO remember good self-care and get treatment for your own anxiety. The healthier you are, the healthier your child will be.
Many great resources are available for parents and kids to read when children struggle with anxiety . Parents are also advised to read about ‘taming the worry monster’  and to learn more about what anxiety is in ‘the worried child’ .
When to Seek Help For Anxiety & Stress in Childhood
Get help if your child is really struggling. Generalized anxiety is characterized by worries that occur across settings and have an impact on day-to-day functioning. Everyone worries sometimes, and in fact, a reasonable amount of worry can be helpful. Some people worry, for example, “I might fail the test.” A bit of worry may mean she is more likely to study, which may have a positive outcome.
On the contrary, a child might be focusing on their mom’s work trip when they should be focusing on school work. Here, the worries are getting in the way of day-to-day life. Worry can lead to stomach aches, distractibility, racing thoughts and negative self-statements like, “I’m not good enough.” Eventually, excessive worry can lead to feelings of depression due to plummeting self-esteem or the strain on a person’s coping skills.
If you are concerned about your child, seeking a cognitive behavioral therapist may be your first step to getting help. This type of therapist meets one-on-one with your child. Together, they work on emotional awareness and coping skills through communication and play. The therapist will develop a treatment plan. They will look at negative thoughts and beliefs with your child. Your child will learn to recognize anxiety and accept it. They will practice different strategies and tactics (like relaxation techniques). These skills can decrease their anxiety. You can be part of the plan too. You can help your child practice the skills they have learned in therapy and apply them to daily life.
Professional Resources on Anxiety and Stress in Children
A professional or mental health expert might help you better understand these anxiety symptoms and causes.
A mental health professional can also help rule out other kinds of anxiety that are more specific. Examples include Post Traumatic Stress Disorder, Panic Disorder, Separation Anxiety Disorder, Specific Phobia, or Social Phobia. This information might help you decide on the best course of treatment to better your child’s life.
- Consultation with a psychologist or neuropsychologist: to consider a full assessment, to look at stress and worry symptoms in mental health context
- Cognitive-behavioral therapist or play therapist: to treat anxiety or stress symptoms with cognitive-behavioral or play therapy approaches, depending on the age and needs of each child
- School psychologist: to support a child with excessive worries in the school setting; to provide a social group; to look at ways to adjust the setting to lessen anxiety
- Child psychiatrist: to manage medications if needed. Sometimes a therapist will recommend a consult with a psychiatrist support your child medically in hopes of encouraging their long term wellness
Similar Conditions to Anxiety
- Somatization: anxiety can have physiological symptoms that accompany excessive worrying; children may be aware of the tummy aches but not attribute them to worry
- Performance or social anxiety: anxiety can occur in situations where a child must perform; this anxiety can be related to fears of being on “stage”
- Self-esteem: anxiety can result from low self-concept and may cause prolonged mental health issues
- Phobias: anxiety can come from an overwhelming fear. Someone who dissolves into tears whenever a dog comes near may have a phobia of dogs
References for Anxiety and Stress in Children
Culbert, Timothy & Kajander, Rebecca. (2007) Be the Boss of Your Stress (Be The Boss Of Your Body®).
Foxman (2003). Recognizing anxiety in children and helping them heal.
Huebner, D. (2005). What to do when you worry too much: A kid’s guide to overcoming anxiety.
Peters, D.B. (2013). From worrier to warrior: A guide to conquering your fears. Great Potential Press: Tucson, AZ
Books for kids on anxiety
Bender, Janet M (2004). Tyler Tames the Testing Tiger.
Cook, Julia (2012). Wilma jean and the worry machine.
Cook, Julia (2012) Wilma jean and the worry machine: Activity and idea book.
Freeland PhD, Claire A. B., and Toner PhD, Jacqueline B. (2016). What to do When You Feel Too Shy: A Kid’s Guide to Overcoming Social Anxiety
Green, Andi (2011) Don’t Feed The WorryBug.
Helsley, Donalisa (2012). The worry glasses: Overcoming anxiety.
Meiners, Cheri J. (2003). When I Feel Afraid (Learning to Get Along).
Zelinger, Laurie & Zelinger, Jordan (2014). Please explain anxiety to me.
Books for kids on perfectionism
McCumbee, Stephie (2014). Priscilla & the perfect storm.
McCumbee, Stephie (2014). Priscilla & the perfect storm activity guide: Classroom ideas for teaching the skills of staying calm and dealing with frustration…
McDonnell, Patrick (2014). A perfectly messed up story.
Mulcahy, William (2016). Zach makes mistakes.
Pett, Mark & Rubinstein, Gary (2011). The girl who never made mistakes.
Satlzberg, Barney (2010) Beautiful oops!
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