Dealing with anxiety in children

Written by Dr. Joshua Harwood

Josh is a chartered clinical psychologist specialising in working with children and families.

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Anxiety is the feeling of worry or fear we experience as a natural response to something in our environment we deem threatening, a bit like a human car alarm. Just as adults do, all children and young people experience anxiety from time to time, especially when they go through big life transitions like starting at a new school or undertaking an important exam.

Some anxiety is normal and healthy, warning us that we might be getting into danger. However, when anxiety is triggered easily or lasts a long period of time, it may be a sign that something is not quite right. Constant anxiety can be very distressing and isolating for children and for those who care for them. It can lead to issues at school, in their home lives and with their friendships, causing problems with their wider health and well-being.

If you are worried that your child may be struggling with their anxiety, it’s important to seek appropriate professional support. This may be your GP in the first instance, or our 24/7 health support line for members can provide health information and support.

You may also find it helpful to learn a bit more about this topic and some tips and tools you can use to help your child manage their anxiety.

Why might my child be struggling with anxiety?

There are many reasons why your child may be struggling to manage their anxiety. It’s important to look closely at your child’s particular circumstances, as anxieties will often change depending on the age of onset or what’s going on in their lives at the time. 

If your child is younger, anxiety may occur when separated from you or other loved ones. If their worry or distress becomes excessive or occurs at a level that is abnormal for their age group, they may require further support. It is not always easy to define what excessive means. Before the age of 3 years, separation anxiety is normal. If, for example, your child is 10 years old and refuses to go to school because they are scared of leaving you, or if they are 12 years old and will not sleep alone, and this causes your family distress, then this might be considered excessive.

Their anxiety could also be centred around a particular object, event, or situation. This is commonly known as a phobia and involves an intense fear of things such as insects, heights, darkness, flying and injury. If your child is older, they may be more susceptible to anxiety in social situations, which makes conversations, meeting people they are not familiar with or being watched by others extremely fear-provoking for them. 

Their problems with anxiety may not be specific. It may feel like your child’s worries and anxieties float from one thing to the next, or can attach themselves to just about anything. This is sometimes called generalised anxiety disorder.

If your child has experienced a traumatic event in their life, they may develop a type of anxiety reaction, referred to as Post Traumatic Stress Disorder, which causes them to re-experience the event. This can include experiencing a scary accident, witnessing domestic abuse or being assaulted.

What does anxiety look like?

There are many different signs and symptoms of anxiety that can be both mental and physical.

You might notice that your child is exhibiting behaviours, such as:

• Appearing to be on edge or restless
• Extreme tiredness or fatigue
• Difficulty concentrating 
• Increased irritability
• Issues with sleeping, such as difficulty falling asleep, frequently waking in the night and struggling to get back to sleep
• Changes in appetite and eating patterns 
• If they have anxiety of social situations, they may become very quiet around unfamiliar people or avoid social situations altogether
• Night terrors
• Flashbacks to stressful events

Panic attacks 

In some cases, their anxiety could develop into panic attacks. Panic attacks occur when there is a sudden experience of anxiety, which may cause your child to hyperventilate. For the child, panic attacks are very scary to experience and are often associated with thoughts and feelings similar to suffocating or difficulty breathing.

It’s comforting to know that your body has a good in-built mechanism for regulating breathing if it gets too out of control, but it’s still very scary for your child in the moment.

Signs of a panic attack for your child include:

• A faster heart beat
• Sweating
• Trembling or shaking of the body
• Difficulty breathing      
• Pain in their chest and/or stomach 
• Feeling dizzy, sick or light-headed
• Numbness or tingling 
• Chills or hot flushes
• Loss of reality and feeling detached from the world 
• Fear of “going crazy” or dying 

Prolonged anxiety

If your child has been experiencing intense or prolonged anxiety, they may try to avoid certain situations that trigger their anxiety or adopt other coping behaviours, for example:

• Refusing to go to school or do activities 
• Attempting to isolate themselves
• Changing their eating patterns 
• Self-harming      

Anxiety in younger children

If your child is younger, for example less than 8 years old, they may demonstrate different signs as they have less of an understanding about their feelings and emotions than older children. For example, they may:     

• Cry or throw tantrums more frequently 
• Cling more to you
• Have issues wetting the bed
• Freeze when they feel scared

When to seek more urgent help:

If your child is demonstrating any of the following, you may need to seek help more urgently:

• Thoughts about suicide or harming themselves
• Withdrawing completely to their room
• Rapid deterioration of symptoms 
• Frequent flashbacks about a traumatic or scary event
• Using drugs or alcohol to manage their anxiety.

You should seek immediate care if you believe your child is in danger. This may mean getting an emergency appointment with your GP, phoning 111 or 999, or taking them to the nearest emergency department. 

For more information and advice from the NHS go to their website.

What can you do? 

It can be upsetting to see your child struggling with anxiety, and you may be unsure of the best way to support them. There are, however, many useful tips and tools available that you can use to help your child with managing their anxiety.

Here are some examples that clinicians use when treating their patients’ anxiety: 

Encourage your child to write a list (or you write it for them) of all of their worries, and then to share it with you. Better to get the worries out of their head and on to a bit of paper.

It might be useful to track these worries across the week by completing a worry diary. Identifying the times when they feel anxious may help to pinpoint to events, situations or objects that trigger their anxiety. Parents can help support with the completion of these which can then be used as tool within a therapy session by the clinician. 

Educating your child about anxiety may help them to understand what they are experiencing. Explaining the fight or flight response and the changes that happen to their body when it feels under threat may help them to recognise the feelings of anxiety as they arise and leave them feeling better able to cope.

Try using this video from Anxiety Canada: Fight Flight Freeze – A Guide to Anxiety for Kids¹     

It may also be useful to teach your child what a thought is, try showing them a video on thoughts such as Mindfulness for Kids - Learning about our thoughts². It can help to remind your child that thoughts are just thoughts, just because they think something, it does not mean it will come true. Your child needs to be aware of these thoughts floating around their heads without getting lost in them.     

Many people experiencing anxiety describe entering into a vicious cycle of negative thoughts, uncomfortable physical sensations and avoidant behaviour. Work with your child to help identify their vicious cycles.

Start with a recent situation where your child felt anxious and describe it in detail. Then write down what thoughts were going through your child’s mind when they were feeling anxious. Next write down the physical sensations they were experiencing, followed by the behaviours that their anxiety encouraged them to do, e.g. ‘not go to the party’ or ‘make mum and dad sleep in my bedroom’.

The goal is to help your child to realise that thoughts, feelings and behaviours are linked and then to identify areas where you can break the vicious cycle.

One place to intervene is with the avoidant behaviour that often occurs with anxiety. You can do this by confronting your child’s fears. Remember though, when doing this, it’s important to work through their fears slowly at a pace your child is comfortable with.

A tool called a ‘fear hierarchy’ can be used to help with this. Your child can write down what bits of their anxiety they would find difficult to face, going from least difficult to most difficult. Rewarding each step your child faces can encourage them and build their confidence in managing their anxiety. 

It is not easy to tackle these fears straight away and there are likely to be many challenges along the road, it can be beneficial to take note of what these challenges may be. Reminding your child that the process is much like running a marathon or climbing a mountain can help express that it is important to keep going even if it does feel difficult at times. It also highlights that you need to practice to master something and you’re unlikely to be good at it first time round.

If your child is a bit older, approximately 11 or 12 years plus, you might be able to help them to question some of the uncontrollable automatic anxious thoughts. Once your child has written the anxious thought down, encourage them to make a list of the objective evidence for and against this thought coming true.

Imagine you are “taking the thought to court”. Just because you feel and think something bad will happen, does not mean it will. Remember to always validate your child’s worries. This is not the same as agreeing with them but will make them feel understood.

Practicing methods of relaxation can help calm down some of the more physical aspects of anxiety. Good ways to do this are progressive muscle relaxation, calm breathing, mindfulness and exercise. This advice from the BBC might help with teaching these techniques to children: Seven techniques for helping kids keep calm³ 

Further resources

If you would like to read more about childhood anxiety and how to manage it, here are some reliable resources: 

Websites:

• The NHS – Anxiety in children
• Young Minds – Supporting your child with anxiety 

Looking after yourself as a parent:

It can be difficult caring for someone with anxiety, if you would like support there are organisations available for carers of children with mental health difficulties:

• Mind - Parenting with a mental health problem  
• Young Minds - Parent Helpline

References

1. Fight Flight Freeze, A Guide to Anxiety for Kids - Anxiety Canada
2. Mindfulness for Kids - Learning about our thoughts - Fablefly
3. Seven techniques for helping kids keep calm - Cbeebies

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