Anxiety in children

While summer offers preschool and elementary school children a welcome break and chances to navigate new friendships and activities, it can trigger anxiety in children upset by unstructured time, changes in routine and friend groups, and transitions involving new faces and places. Separation anxiety, social anxiety, and specific phobias are instantly recognizable: a sobbing child clings to a parent, refusing to set foot inside day care; a socially anxious child worries about attending a birthday party because "nobody will play with me;" or a child is so terrified by insects that simple summer fun like a nature stroll, digging in the dirt, or a picnic in the park is impossible.

Common symptoms of anxiety in children

Thumping heart, rapid breathing, sweating, tense muscles, nausea, and dread are familiar symptoms of anxiety that accompany a "fight, flight, or freeze" reaction triggered by real or imagined threats, like a snarling dog or new social experience. Anxious children may be clingy, startle easily, cry or have tantrums, sleep poorly, and have headaches or stomachaches.

But anxiety is not all bad. "It can motivate us, or help us avoid danger," says Dr. Mona Potter, medical director of McLean Anxiety Mastery Program and McLean Child and Adolescent Outpatient Services. "The problem is when anxiety gets out of hand and makes decisions for us that are no longer helpful — maybe even paralyzing." By that point, normal anxiety may have become an anxiety disorder.

What types of anxiety are common in children?

Separation anxiety: Very anxious and upset when parted from parents and caregivers; refusal to attend camp, sleepovers, or play dates; worry that bad things will happen to self or loved ones while separated.
Social anxiety: Strong fear of social situations; very anxious and self-conscious around others; worry about being judged or humiliated.
Specific phobia: Severe, irrational fear set off by a situation or thing, such as thunderstorms, worry about vomiting, or insects.

What makes some children more vulnerable to anxiety?

Anxiety may set deep roots due to a blend of

biological factors, such as genes and brain wiring
psychological factors, such as temperament and coping strategies
environmental factors, such as anxious parenting or troubling early childhood experiences and environment.

Sometimes, anxiety is a side effect of medicine. Ask your doctor about this possibility.

Treating anxiety in children

Occasional anxiety is normal. But talk to your pediatrician if anxiety causes your child to limit activities, worry often, or avoid camp or day care. A severe anxiety disorder can delay or derail child development.

Depending on developmental stage and level and type of anxiety, treatment may involve changes you and your child work toward yourselves. Or you might work with child mental health professionals, such as a psychiatrist, psychologist, or social worker. These experts can help parents and children learn to apply cognitive behavioral therapy (CBT), a highly effective treatment that addresses anxious thoughts and behaviors. "For example, we might encourage children to practice 'detective-thinking' to catch, check, and change anxious thoughts," says Dr. Potter. "We also encourage them to approach, rather than avoid, anxiety-provoking triggers."

Mindfulness techniques and antianxiety or antidepressant medicines also may be discussed. Often a combination of approaches works best.

Ways parents can help children learn to manage anxiety

Personalize and externalize: Ask your child to give anxiety a name. Your child can draw pictures of anxiety, too. Then, help your child acknowledge anxiety when it rears up: 'Is that spiky-toothed, purple Bobo telling you no one wants to play with you?' Labeling and distancing anxiety can help your child learn to be the boss of it.
Preview anxiety-provoking situations. Consider meeting camp counselors or touring new places ahead of time.
Model confidence: Children are emotional Geiger counters. They register anxiety radiating from parents. Try to be mindful of what you model through words and body language. Work on tempering overanxious reactions when appropriate.
Narrate their world: "Children are coding the world. Particularly through early childhood their brains are just sponges, taking everything in," says Dr. Potter. "We can help them with the narrative they're constructing: 'Is the world a safe place or a dangerous place where I have to be on guard all the time?'"
Allow distress: Avoiding distressing situations invites anxiety to ease temporarily, only to pop up elsewhere. Rational explanations won't work, either. The whirring emotional center of the brain known as the limbic system requires time and tools to calm down enough to let the thinking (cognitive) center of the brain come back online. Instead, try distress tolerance tools: one child might splash her face with cold water, another might charge up and down stairs to blow off anxious energy, or tense and relax her muscles, or distract herself by looking around to find every color in the rainbow.
Practice exposure: Gradual exposure helps rewire an anxious brain and shows a child he can survive anxious moments. Let's say your child is anxious about talking in public, ducking his head and squirming if addressed. Pick a pleasant, slow-paced restaurant for a fun weekly date. Then coach your child to take charge of ordering foods he likes in small steps. At first, he might whisper the order to you and you'll relay it to the waitress. Next, he might order just his drink or dessert, and finally a full meal as distress tolerance and confidence grows.