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Childhood Anxiety

By Matthew Dobbertin, D.O.

According to the American Academy of Child and Adolescent Psychiatry anxiety disorders affect up to 1 in 5 children and untreated children are at a higher risk to perform poorly in school, miss out on important social experiences and engage in substance abuse. Anxiety is the leading mental health problem facing children and adolescents today, but it is also one of the most treatable.

Childhood anxiety is a normal part of growing up and children can go through different temporary phases. For infants it is typical to fear loud noises, being startled and strangers. For toddlers, fear of the dark, separation anxiety and fear of monsters are normal. For school-aged kids, it is normal to have fears of storms and natural disasters, along with fear of personal injury. In teenagers, normal fears shift to those of school performance, social status and overall health.

Difference between Worrying and Anxiety

Worrying although similar to anxiety, tends to be more typical with simple what-if questions, thoughts about how is this going to go, am I going to be okay, is it going to work out? Anxiety is typically more amplified in terms of unreasonable and problematic worries. Anxiety is a problem when it starts interfering with school, friends or home life.

Common Childhood Anxiety Disorders

  • Generalized Anxiety Disorder–Your child may worry excessively about a variety of things such as grades, family issues, relationships with peers, performance in sports, may tend to be very hard on himself/herself, strive for perfection and seek constant approval or reassurance from others. Common symptoms include sleep impairment, stomachaches and headaches.
  • Panic Disorder–Typically diagnosed if your child suffers at least two unexpected panic or anxiety attacks–followed by at least one month of concern over having another attack and possibly losing control. Common symptoms include shortness of breath, dizziness and fear that something bad is going to happen.
  • Separation Anxiety Disorder–Many children begin to experience separation anxiety between 18–24 months. This is one of the first times when parents may not always be at their child’s side and simultaneously, your child can be experiencing situations independently, such as daycare or sleeping in their own room. It is not uncommon for children to cry or throw a tantrum upon separation.
    • When your child becomes older and is still unable to leave family members and takes longer to calm down, your child could be suffering from this disorder, which is most common between the ages of 7-9. Symptoms include refusing to go to school, sleepovers and demanding a parent stay during bedtime.
    • Children may worry about bad things happening to their parents or friends and may feel something terrible will occur while they are apart. Symptoms include nightmares, stomachaches and headaches.
  • Social Anxiety Disorder–Also known as social phobia, is characterized by an intense fear of social and performance situations and activities, such as being called on in class or starting a conversation with a peer. This can significantly impair your child’s school performance and attendance, as well as the ability to socialize, develop and maintain relationships.
  • Selective Mutism–Occurs when a child refuses to speak in situations where talking is expected or necessary to the extent that their refusal interferes with school and making friends. The average age of diagnosis is around 5 years old or around the time a child enters school. The child may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact or withdraw into a corner to avoid talking. The child can often be talkative and display normal behaviors at home or in places where they feel comfortable and parents are often surprised to learn their child refuses to speak at school.

    Obsessive-Compulsive Disorder (OCD)–Characterized by unwanted and intrusive (obsessive) thoughts, the individual may feel compelled to repeatedly perform rituals and routines compulsively to try and ease anxiety. Most children are diagnosed around age 10 although the disorder can strike children as young as 2 or 3 years. OCD is more likely to develop before puberty in boys and during adolescence in girls. Common compulsions include checking items such as locks, excessive washing, counting, confessing, symmetry and hoarding. OCD is related to other disorders such as ADHD, Tic disorder and depression.

  • Posttraumatic Stress Disorder (PTSD)–A child may have intense fear and anxiety, become emotionally numb or easily irritable and/or avoid places, people or activities after experiencing or witnessing a traumatic or life-threatening event.
    • Not every child who experiences or hears about a traumatic event will develop PTSD. It is common to be fearful, sad or apprehensive after events and many children recover from these feelings after a brief time.
    • Children most at risk are those who witnessed a traumatic event or who suffered directly (such as injury or the death of a loved one), had mental health problems before the event, experienced violence at home, and those who lack a strong support network. Symptoms in school aged or younger children may show up in how they play, whereas in adolescents it can come out as fits of significant anger and aggression.
  • Specific Phobias–Your child may experience intense, irrational fear of a specific object or a situation. Common childhood phobias include animals, storms, heights, water, blood, darkness and medical procedures. Children will avoid situations or objects they fear or upon encounters, the child will feel very anxious sometimes resulting in crying, tantrums, clinging, avoidance, headaches and stomachaches.

How and When to Seek Help

Sometimes parents will try to protect their children by shielding them from situations that can cause anxiety. Shielding children from anxiety situations can sometimes cause more anxiety. To some degree, parents should try to encourage children to gradually face their fears and anxiety, which will help lesson or eliminate anxiety altogether. Gentle and appropriate exposure to a feared stimulus is often part of the treatment of anxiety. However it should only be done by an experienced professional such as a licensed therapist or psychiatrist.

When anxiety become problematic and interferes with a child’s capacity to reach their highest potential, keeping them from experiencing life fully and experiencing important life events like school, socializing, participating in activities and being with family and friends, parents should talk to a healthcare professional.

Anxiety disorders often co-occur with depression, eating disorders, attention-deficit/hyperactivity disorder (ADHD) and others. With treatment and support, your child can learn how to successfully manage the symptoms of an anxiety disorder.

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