How to Spot and Treat Anxiety in Children

Experts say that kids today are more anxious than ever. Find out why and what to do if you see signs of anxiety in your child.

By Ginny Graves




Marla Booth* thought she was giving her daughter Madison a leg up by sending her to a well-regarded private school. But instead of coming home every day filled with excitement about what she was learning, her third-grader would dissolve into tears as she faced up to three hours of homework each night.

It took time for the Severn, MD, mom to realize it, but the school’s celebrated focus on exceeding standards wasn’t helping her daughter get ahead — rather, it was making her ill. “Madison’s problems stemmed from anxiety,” Booth can today admit.

An Epidemic of Fear?
All kids have their share of concerns. “To a certain extent, anxiety is a normal part of development,” says Stephen Whiteside, Ph.D., a clinical pediatric psychologist at the Mayo Clinic. Some fears, like the ones preschoolers have of monsters, crop up so predictably that they’re considered milestones. But Madison is one of a growing number of kids who are grappling with more serious forms of anxiety that, left unchecked, can have lasting effects, both emotionally and biologically.

“So many children are now experiencing levels of stress that come close to meeting the criteria for an anxiety disorder,” says Tamar E. Chansky, Ph.D., author of Freeing Your Child From Anxiety. Meanwhile, nearly 20 percent of kids have actually been diagnosed with one — everything from minor phobias, like a fear of dogs, to generalized anxiety, which is when kids worry about everything that could go wrong. “Ten years ago, it was 13 percent. That’s a big jump in a decade,” she says.

The Trickle-Down Effect
While better detection plays a part in the rising rates of children’s anxiety (pediatricians now know what symptoms to look for in order to diagnose), experts believe that the numbers also reflect a general societal shift. In other words, adults are stressed, too — and our kids are feeling our pain. “Anxiety has become a way of life, and it’s contagious,” says Madeline Levine, Ph.D., author of Teach Your Children Well.

The weak economy is one pervasive source of stress to families. In tough times, insecurity over money and jobs can unnerve even the steadiest households. Teachers add tension, too, especially during state-wide testing season. Because the results can determine a school’s funding, it’s no surprise that a culture of anxiety springs up around these exams and spills over to the students.

“Doing well in school is a good thing, but when second-graders are so afraid that they freeze up during their math test, something has gone very wrong,” says Chansky.

Anxious parents can also increase kids’ stress by being overprotective or over-controlling, which sends children the message that they’re not capable of handling things on their own. “When your fourth-grader forgets his homework, do you call the teacher or let him handle the situation?” Levine asks. “At that age, a child can explain it to the teacher on his own. It’s a learning experience.”

Even parents’ well-meaning efforts to make sure kids excel can leave them “so overscheduled that they have little time to just play,” something that’s critical for maintaining emotional balance, adds Levine. Instead of feeling prepared for the school day, kids may end up feeling scared, as Madison did.

Over time, such fear doesn’t just take an emotional toll, it affects children biologically, which can have serious long-term consequences. Studies show that the stress hormone cortisol, which floods the body during periods of anxiety, shrinks the brain over time, reducing a kid’s ability to cope. And because anxious kids are often too caught up in their thoughts to concentrate, they tend to struggle in school.

A Problem, Solved
Fortunately, even in an anxious era, parents haven’t doomed their kids to a life of stress. Thanks to more effective therapies, anxiety is more treatable than ever — and awareness is increasing, which means parents and doctors are now better prepared to quickly decode its sneakier signs and take action before those worries begin to spiral out of control.

That’s exactly what Booth did. After months of anguish, she ultimately made the tough decision to pull her daughter out of private school. A less pressure-filled environment, it turns out, was key to raising a star student. Today, “Madison says she loves school again,” Booth happily reports.

How to Spot Signs of Anxiety
Sometimes anxiety doesn’t look like anxiety at all. Symptoms of serious stress can be both behavioral and physical. In little kids, panic often erupts into tantrums. Older kids may act out, using aggressiveness as a way to cover up a fear of being judged by classmates. Physical symptoms can include restlessness, fatigue, back pain, sweating, and — most commonly — head- and stomachaches.

When 4-year-old Lucas Fonovich started melting down every time anyone mentioned visiting Grandma, his mom, Nicole, was mystified: They’d been traveling on planes since he was a baby. She and her husband did some digging, and eventually, “we realized he was afraid of the plane going too fast,” recalls the Chandler, AZ, mom. They read books and talked up the joys of travel. As they boarded their next flight, the pilot overheard Lucas mentioning his concerns and invited him to sit in the cockpit. “The pilot explained that he only went fast at takeoff,” says Fonovich. “Lucas hasn’t been afraid to fly since.”

When to Go to the Pros
If anxiety prevents kids from going to school and making friends, it’s time to see an expert, says Rachel Busman, Psy.D., a therapist in New York City. Cognitive behavior therapy (CBT), which replaces negative thoughts with targeted coping strategies, is typically the first line of treatment. But when a child is so anxious she can’t focus on the therapy, clinicians may also turn to medication.

Eight-year-old Grace Cohen* was born cautious — slow to try new activities or play with new kids, says her mom, Dina, of Scarsdale, NY. But when Grace started school, her natural reserve morphed into something more concerning. First, she became so afraid of dogs she’d do anything to avoid one. Then her fears multiplied: separation anxiety, “mean” friends, bees. “By second grade, the teacher was pulling her off my body when I dropped her off in the morning,” Cohen recalls. That’s when she took her daughter for an evaluation. For Grace, the combination of an antidepressant and CBT was a game-changer. Within months, “people commented how Grace seemed happier and more relaxed,” says Cohen. “Now, Grace is learning to face her fears and that is giving her confidence in every aspect of her life.”

* Names have been changed.

Anxious Behavior: What's Normal and What's Not
It’s perfectly okay when kids . . .

  • worry about an upcoming test
  • want to be tucked in at night
  • hang back for the first half-hour of a party
  • keep an eye out for bees or dogs

It’s a red flag when they . . .

  • vomit, lose sleep, or cry from stress
  • wind up in your bed every night
  • refuse to go to parties or leave your side
  • need to be coaxed outside because they’re afraid of being stung or attacked

Helping Your Child Cope
These long-term strategies teach kids that things aren’t as scary as they seem.

  1. Keep calm. Overreacting spooks kids even more, so take the long view: “If you don’t give kids the chance to confront their fears, they’ll be anxious every time there’s a challenge,” says Stephen Whiteside, Ph.D., of the Mayo Clinic.
  2. Be empathetic. Explain that anxiety is normal, and share your story: “When I was a kid, I was terrified of tests. But I learned that the best way to get rid of my fear was to face it.” Then, help him do it. Say, “I see you’re scared about going to school. I’ll hold you, then walk into class with you,” says Lawrence Cohen, Ph.D., author of The Opposite of Worry.
  3. Take small steps. Break down challenges so they’re more manageable. “If your child is afraid to sleep alone, check in every few minutes before she nods off, slowly extending the time between check-ins over days or weeks,” advises Whiteside. This method, known as gradual supportive exposure, is one of the best ways to extinguish a specific fear.

6 Anxiety Soothers to Try Now

1. Have your kid tense and relax each muscle group, working up from the toes.
Why it works: Your child releases tension, and when the body relaxes, the brain does, too.

2. Tell your child to pay attention to the noises around him until he hears five different sounds.
Why it works: Focusing his thoughts helps your child stay in the moment rather than worry about the future.

3. Grade-schoolers can write down (or dictate) their fears and stash them in a shoebox.
Why it works: Writing worries helps minimize them and gives kids permission to let ’em go.

4. Tell your child to remember a time he faced a scary situation and overcame it or learned something hard.
Why it works: Picturing a previous success makes anyone feel more confident.

5. Tell your kid to pretend she’s holding a slice of pizza. Have her inhale the aroma by breathing in deeply through the nose and cool the pizza by blowing out through the mouth.
Why it works: Focused breathing sends the brain a message that it’s time to relax.

6. Download some anti-anxiety apps. Try the Meditation Jar (iTunes, free). Set the timer, shake the phone, and watch the particles settle.
Why it works: This app gives kids something to gaze at as they quiet down (or breathe).

Problem Solving
Social Skills
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Confronting and Resolving Fears
Anxiety and Stress
Social and Emotional Development
Illnesses and Conditions