Anxiety In Children
It is normal for children to feel worried or anxious from time to time – such as when they're starting school, during exams or when experiencing problems at home but once the tricky situation is over, they normally calm down and start to feel better. Experiencing some anxiety is part of their development and helps children to learn coping skills and to manage their emotions.
But for some children, anxiety can become a real problem, affecting their behaviour and thoughts every day, interfering with their school, home and social life. Anxiety doesn't just affect adults. Children and teenagers can get it too. The symptoms of anxiety can be complex and can vary widely between different children.
Even some of the most confident people you know may have suffered with anxiety. Recent research suggests that as many as 1 in 6 young people will experience an anxiety condition at some point in their lives, whether that be OCD (obsessive compulsive disorder), social anxiety and shyness, exam stress, worry or panic attacks.
You and your child may need professional help to address it.
Symptoms of anxiety in children
Signs to look out for in your child are:
- finding it hard to concentrate
- not sleeping, or waking in the night with bad dreams
- not eating properly
- quickly getting angry or irritable, and being out of control during outbursts
- constantly worrying or having negative thoughts
- feeling tense and fidgety, or using the toilet often
- always crying
- being clingy
- complaining of tummy aches and feeling unwell
- feeling like you might faint/pass out
- thinking unpleasant thoughts
- thinking that you might “go crazy”
- Palpitations - when your heart feels like its racing
- Dry Mouth
- Stomach aches and/or diarrhoea
Feeling one, some or even most of the above doesn’t necessarily mean you have anxiety. It’s important to talk to a GP to get a full diagnosis.
If you feel your child’s anxiety is not getting any better or is getting worse, and your efforts have not worked, contact your GP to get professional support.
Talk to your child about anxiety, what is happening in their body and why it happens. Many children and young people don’t know what they are feeling when they are anxious, and it can be very frightening and overwhelming. They might even think they are extremely ill.
One of the ways to reduce the anxiety that your child is feeling is to understand it better. It is also extremely useful for parents to understand what their child is going through. By understanding how anxiety works, you can then understand why you feel that way and it will help you to break the vicious circle of anxiety that can makes things worse. The picture below (taken from www.anxietyuk.org.uk) can help to explain what happens when we get anxious.
There are several types of anxiety; you may find that your child is experiencing any one of the following conditions or may have different types of anxiety at the same time.
Most people get some anxiety during exams or tests and this is completely normal. Your child may feel tired, pressured, confused, worried they won’t do well. A certain level of anxiety is designed to keep us aware and focused but too much anxiety and we lose concentration, struggle to sleep and become forgetful (which is exactly what a child doesn’t need at exam time). Exam stress can start when you feel you can't cope with revision or feel pressure from your school or family. You might worry you’re going to fail, or you won't get the grades you need for the course or job you want. Remember, exams are important – but they’re not the only way to a successful future. Lots of people achieve success in life without doing well in school exams.
Helping kids cope with stress.
Click this link to find out more about exam stress and what to do about it.
Chronic worrying or GAD
Generalised Anxiety Disorder (GAD) can be defined as a disorder in which the sufferer feels in a constant state of high anxiety and is often known as ‘chronic worrying’. A key distinguishing factor in GAD is that the anxiety is focused not on exterior triggers like social interaction, but more often, internally. It seems to involve a particular worry about their own personal performance in school, sports or exams etc. They tend to worry more about everyday things, have constant worry about one thing or another and the worry tends to be exaggerated. The symptoms of GAD may be remarkably similar to those of other anxiety disorders so differentiating them may be quite difficult. The anxiety involved here tends to last for more than 6 months and tends to involve thoughts known as ‘catastrophising’ or thinking that the worst is going to happen. There are some genetic factors in developing generalized anxiety disorder. Children who develop the disorder are more likely to be avoidant and have inhibited behaviours and negative temperaments. Girls are also more at risk. GAD is distinguished from general worry in its excessiveness, longer duration and lack of precipitating events. Treatment for GAD usually has a two-pronged approach which includes therapy and medication. In therapy, the family plays a key role in helping the child overcome the anxiety and its effects.
When kids don't outgrow the fear of being apart from a parent, it's called separation anxiety disorder. Separation anxiety is common in younger children, while older children and teenagers tend to worry more about school or have social anxiety. Children with separation anxiety will experience great distress in being separated from their caregivers. To be diagnosed with separation anxiety disorder, the child’s distress should be excessive for his age and also prevent him from taking part in age-appropriate activities.
- Worrying about losing parents or another significant person
- Unreasonable fear of an event that causes separation (such as getting lost or being kidnapped)
- Reluctance or refusal to leave home for school
- Undue fear of sleeping alone or being alone
- Persistent nightmares about separation
- Physical symptoms (such as headaches or stomach aches) in conjunction with separation or anticipation of separation.
It is very normal for young children to feel scared of the dark, monsters, large animals, or loud noises. Usually, when children feel scared, parents can help them feel safe and calm again. With a phobia the fear is much more intense and lasts longer. It is usually specific to a certain thing which they will try extremely hard to avoid and will panic when faced with whether it’s spiders, the dark or heights for example.
Children with social anxiety disorder are excessively self-conscious, making it difficult for them to socialize with friends and acquaintances and participate in social situations. They don’t like to be the centre of attention and don’t like to be noticed. It is common for individuals to have multiple phobias. Symptoms include:
- Actively avoiding anxiety-inducing social situations or suffering through them with intense distress
- Panic reaction (shaking, sweating, shortness of breath, nausea and/or vomiting) in response to social situations or, among young children, tantrums and crying
- Fear of appearing anxious and being judged negatively for it
- Fear of standing out or being noticed by other people
- They may complain of other body sensations that go with anxiety too. For example, they may feel their heart racing or feel short of breath. They may feel jumpy and feel they can't sit still. They may feel their face get hot or blush. They may feel shaky or lightheaded.
Selective Mutism (SM)
This extreme form of social phobia causes kids to be so afraid they don't talk. Children with selective mutism have a tough time speaking in some settings, for example around adults. It goes much further than typical shyness. For a diagnosis of selective mutism, the following criteria must be met:
- The child must be able to speak in some settings but not in others
- The condition must have lasted for a month (not including the first month of school)
- The inability to speak must interfere with schooling and social activities
- The inability to speak must not be attributable to a communication disorder or a lack of knowledge of the language being spoken
When anxiety gets severe, you might experience what is known as a ‘panic attack’. This is when your body goes into fight, flight (run away) or freeze mode in order to deal with the situation we are facing. This is the body's normal response to danger. It triggers the release of natural chemicals in the body that prepare us to deal with a real danger. The chemicals affect heart rate, breathing, muscles, nerves, and digestion. This response is meant to protect us from danger but with anxiety disorders, it is overactive and happens even when the child is experiencing no real danger. This can be extremely scary to experience, and may be mistaken for a medical emergency, although a panic attack will not hurt you. Children with panic disorder experience repeated, unpredictable panic attacks that can cause feelings that are often misinterpreted as impending death and heart attack-like symptoms and can result in a disconnection from reality. How to help someone with a panic attack. Or click here for more information.
Self-harm is when you hurt yourself on purpose. You usually do it to overcome intense feelings or emotions and may seem like the only way to let those feelings out. Some people self-harm in order to feel ‘something’ because they feel ‘numb’ or ‘empty’. It is a common behaviour in young people and affects around one in 12 people with 10% of 15-16-year olds self-harming. Self-harm can include cutting, burning, bruising, scratching, hair-pulling, poisoning and overdosing. Self-harm isn’t usually a suicide attempt or a cry for attention. Instead, it’s often a way for young people to release overwhelming emotions. It’s a way of coping. There are many reasons why children and young people try to hurt themselves. And once they start, it can become a compulsion. That's why it's so important to spot it as soon as possible and do everything you can to help. Young people will go to great lengths to cover self-harm scars and injuries. If you do spot them, they might be explained away as accidents. Physical signs, mentioned above, are commonly found on the head, wrists, arms, thighs and chest. Young people who self-harm are also highly likely to keep themselves covered up in long-sleeved clothes even when it's really hot. The emotional signs of self-harm are harder to spot but could include the symptoms of depression and/or anxiety. When a person self-harms, chemicals are released into the brain which can soon become very addictive. Self-harm can be a sign of other disorders that you need help with such as depression or anxiety and they can refer you to the right people for treatment.
People who self-harm are at increased risk of attempting suicide. Repeated self-harm can lead to serious injuries, scarring, medical conditions and accidental death. If your child is self-harming, early intervention is important. If you step in early and encourage your child to get professional support, your child can learn positive ways of handling strong feelings. This can break the self-harm cycle and prevent future self-harming.
For more information click this link.
Also read Not all self-harm looks like self-harm.
selfharmUK provides information and advice about self-harm. You can ask a question to their expert panel or share your story. 5 things to do if someone tells you they are self-harming
Selfinjurysupport.org.uk : Run by the Bristol Crisis Service for Women, they support girls in distress and have a text and email service too. Text: 0780 047 2908 Mon-Fri 7am-9pm
OCD is an anxiety disorder, and kids who have it struggle with either obsessions or compulsions or both. Children with OCD have intrusive thoughts and worries that make them extremely anxious. They develop rituals that they feel compelled to perform in order to keep those anxieties at bay. OCD can be diagnosed when a child has obsessions, compulsions or both.
- Obsessions are unwanted and intrusive thoughts, images or impulses. Obsessions make kids feel upset and anxious.
- Compulsions are actions or rituals kids are driven to perform to get rid of their anxiety.
OCD often first develops around ages six to nine. The disorder can manifest as early as five. OCD is commonly found in young people with Tourette syndrome, particularly in pupils of late primary school and secondary school age. Around 35 per cent of young people with Tourette syndrome also show obsessive-compulsive tendencies. Young children experience the disorder differently than adolescents and adults do. A young child may not recognize that his thoughts and fears are exaggerated or unrealistic, and he may not be fully aware of why he is compelled to perform a ritual; he just knows that it gives him a “just right” feeling, at least momentarily. Over time, in the 9-12 range, it evolves into magical thinking and becomes more superstitious in nature.
In either case, a child with OCD will respond to his anxiety in a way that is very rigid and rule-bound and interferes with normal functioning. Parents might notice signs such as:
- Repeated hand washing, locking and relocking doors or touching things in a certain order
- Extreme or exaggerated fears of contamination, fears of family members being hurt or harmed or doing harm themselves
- Use of magical thinking, such as, “If I touch everything in the room, Mum won’t be killed in a car accident”
- Repeatedly seeking assurances about the future
- Intolerance for certain words or sounds
- Repeatedly confessing “bad thoughts” such as thoughts that are mean (thinking a family friend is ugly), thoughts that are sexual (imagining a classmate naked) or violent (thinking about killing someone)
Children with OCD are also at higher risk of depression, usually due to the effects of the OCD. Click here for more information on OCD in children.
Treatments for anxiety disorders in children
Your child needs good mental health to develop in a healthy way, build strong relationships and deal with challenges.
- A strong and loving relationship with you can have a direct and positive impact on your child’s mental health.
- Physical health is key to mental health. Encourage your child to stay active, eat well, sleep, and avoid alcohol and other drugs.
- If you’re concerned about your child’s mental health, start by talking with your child.
If you have a child diagnosed with an anxiety disorder, their GP will discuss all of the available treatment options with you, including self-help, talking therapies and antidepressants. The type of treatment offered will depend on your child's age and the cause of their anxiety.
- Above all, it's important to talk to your child about their anxiety or worries. Help kids talk about feelings. Listen, and let them know you understand, love, and accept them. A caring relationship with you helps your child build inner strengths.
- Encourage your child to take small positive steps forward. Don't let your child give up or avoid what they're afraid of.
- Be patient. It takes a while for therapy to work and for children to feel better.
You can talk to a GP on your own or with your child, or your child might be able to have an appointment without you.
If the GP diagnoses your child with an anxiety disorder, they may refer them to the local child and adolescent mental health service (CAMHS). CAMHS workers are trained to help young people with a wide range of problems, including anxiety. Child and Adolescent Mental Health Services (CAMHS) is used as a term for all services that work with children and young people who have difficulties with their emotional or behavioural wellbeing. Getting help from a specialist CAMHS service is different depending on where you live. Waiting times can vary, too. Most CAHMS have their own website, which will have information about access, referrals and more, including phone numbers, so you can get in touch directly for detailed advice.
Specialist CAMHS are NHS mental health services that focus on the needs of children and young people. They are multidisciplinary teams that often consist of:
- social workers
- support workers
- occupational therapists
- psychological therapists – this may include child psychotherapists, family psychotherapists, play therapists and creative art therapists
- primary mental health link workers
- specialist substance misuse workers
See more about CAMHS and a guide to CAMHS. See also other sources of help below. If your child doesn't want to see a doctor, they may be able to get help directly from a local youth counselling service. For more information, visit Youth Access.
Teaching children self-help techniques is beneficial for many areas of life and sets them up for adult life and the emotions and difficulties that come with it.
Life changes, such as getting a regular good night's sleep, eating a healthy diet, reducing any alcohol intake and getting regular exercise, can help children feel more in control and more able to cope. Self-help techniques can include activities such as meditation, breathing exercises and learning ways to think about problems differently, such as Mindfulness. Self-help books, apps and online websites for mental health can provide or signpost you to diverse types of information and support. For older children, point them towards websites or helplines that can give them information on depression, drugs and self-harm so they can find out the facts themselves.
Combat isolation by helping to keep connections and communication going. Make opportunities for seeing friends and family; make time to chat regularly; do physical activities such as sports, silly and fun things; go for a walk; try to get them involved and interested in something.
Counselling or talking therapy can help your child understand what's making them anxious and allow them to work through the situation.
Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their anxiety by changing the way they think and behave. CBT teaches kids that what they think and do affects how they feel. Learn more about CBT. Remember, the goal isn’t always to eliminate the anxiety (because this isn’t always possible) but to help the child cope with it. By changing thinking that is distorted, and behaviour that is dysfunctional, we can change our emotions.
Your child may be offered medication if their anxiety is severe or doesn't get better with talking therapies. They are usually only prescribed by doctors who specialise in child and adolescent mental health.
What causes anxiety disorders in children?
Some children are simply born more anxious and less able to cope with stress than others while others pick up anxious behaviour from other people. It can be a single reason or a variety of reasons which include:
Genetics. A child who has a family member with an anxiety disorder is more likely to have one too. Kids may inherit genes that make them more prone to anxiety.
Brain chemistry. Genes help direct the way brain chemicals (called neurotransmitters) work. If specific brain chemicals, such as Serotonin, are in short supply, or not working well, it can cause anxiety.
Life situations. Things that happen in a child's life can be stressful and difficult to cope with. Stressful situations, serious illness, death of a loved one, violence, or abuse can lead some to develop anxiety.
Learned behaviours. Growing up in a family where others are fearful or anxious also can ‘teach’ a child to respond in the same way.
Some children develop anxiety after stressful events, such as:
- frequently moving to a new house or school
- parents fighting or arguing
- the death of a close relative or friend
- becoming seriously ill or getting injured in an accident
- school-related issues like exams or bullying
- being abused or neglected
Where can I get help?
- Call us for free 0808 802 5544 (Mon-Fri 9:30 - 16:00).
- Available in England, Scotland, Wales and Northern Ireland.
The YoungMinds website also has mental health support and advice for your child.
Are you a young person in crisis?
- Text the YoungMinds Crisis Messenger, for free 24/7 support across the UK if you are experiencing a mental health crisis.
- If you need urgent help text YM to 85258
- All texts are answered by trained volunteers, with support from experienced clinical supervisors
- Texts are free from EE, O2, Vodafone, 3, Virgin Mobile, BT Mobile, GiffGaff, Tesco Mobile and Telecom Plus.
18 or under? Childline offers free, confidential advice and support whatever your worry, whenever you need help. 0800 1111
- Support for people struggling with panic attacks, OCD, phobias, and other related anxiety disorders.
- Also provides support for carers of sufferers.
- Helpline: 0844 967 4848 (Daily 10:00–22:00). Charges apply.
- Youth Helpline for 13-20-year olds: 0330 606 1174 (Mon-Fri 15:00–18:00). Charges apply.
- Having a panic attack? Crisis Number with recording of a breathing technique: 01952 680835 (24 hours)
- The national charity that provides support and information to anybody affected by OCD.
- Helpline: 0845 390 6232 (Mon - Fri 09:30-17:00)
- Email: email@example.com
Triumph over Phobia (TOP UK)
- The OCD and Phobia Charity runs a network of self-help therapy groups.
- Anxiety UK is a national charity with local services all over the UK. The website includes resources for parents concerned about their child’s anxiety.
Lists of local services for young people’s mental health and wellbeing.
A guide to counselling services for young people and families.
Offers information about advice and counselling services in the UK for young people aged 12-25 years.
Confidential advice and support for young people who feel suicidal.
HOPELine UK: 0800 068 41 41
Text: 07786 209 697
Offers support to young men in the UK who are down or in a crisis.
Helpline: 0800 58 58 58 (Daily 17:00 - 0:00)
- Anxiety Factsheet: Worries and Anxieties, Helping Children to Cope: Information for Parents