Children and Anxiety

Some types of anxiety are normal in childhood, such as anxiety in the presence of a stranger; separation anxiety, which occurs between 18 months and 3 years of age; fear of monsters, which appears around 4 to 6 years; and phobias (irrational fears of objects or situations), which are common and disappear on their own.

Children may feel anxious when starting school, moving, staying overnight at a relative's home, playing in the "big game" or studying for a test. Events children learn about from newspapers and television can cause them anxiety. Some anxiety is actually healthy because it prevents children from taking unnecessary risks and can prepare them for unsettling events in later life.

Children experience the symptoms of anxiety in many of the same ways as adults, but they react to the symptoms differently. Their reactions depend on their own developmental level. This can make it difficult to determine whether a child's behavior is "just a phase," a normal reaction, or whether it constitutes an anxiety disorder. Some signs of anxiety might be:

• A change in behavior, such as becoming impulsive or clinging

• Problems sleeping

• Faster heart rate

• New problems with headaches, nausea or stomachaches

To help a child cope with a stressful situation or anxiety, experts suggest that parents and caregivers try the following:

• Understand that the fear is real to the child and listen to what he or she says. Learn what frightens her or him.

• Offer comfort and assurance about the child’s specific fears at a level he or she will understand. Don’t belittle the fear or give complicated or technical answers. You don’t have to be able to answer all the child’s questions.

• To find out what your child might be thinking, encourage her or him to ask questions about what is going on in a game he or she plays or in a picture he or she draws.

• Remind your anxious child that most people are kind and caring and that heroes can be ordinary people who help victims of tragedy.

• Develop a family emergency plan that includes a meeting place if something happens in the family or neighborhood, where to find telephone numbers of people to call for help, and where first-aid supplies are located.

When anxious behavior becomes a pattern or children become so afraid, worried or uneasy that they cannot perform normal functions, such as doing well at school or making friends, they could have as an anxiety disorder.

Anxiety disorders are among the most common emotional problems that occur during childhood and adolescence, and about half of the youngsters with these problems also have a second anxiety disorder or other mental or behavioral disorder, such as depression. Although the cause of anxiety disorders is unclear, studies suggest that children or adolescents are more likely to suffer from an anxiety disorder if their parents have them.

Types of Anxiety Disorders

Several kinds of anxiety disorders may affect children:

• Generalized anxiety disorder, characterized by extreme, unrealistic worries that have no relation to any recent event. Children and adolescents with this disorder are typically very self-conscious and tense, and have a strong need for reassurance. They may complain about ailments such as stomachaches that have no physical basis.

• Phobias, which include an unrealistic and excessive fear of an object or situation, such as animals, heights, storms or enclosed spaces.

• Panic disorder, which includes repeated panic attacks (periods of intense fear that come with a pounding heart, sweating, dizziness, nausea or a feeling of imminent death) without apparent cause. The fear of experiencing subsequent panic attacks strongly affects children with this disorder.

• Obsessive-compulsive disorder (OCD), in which children are unable to stop a pattern of repetitive thoughts and behaviors, such as hand washing, counting or rearranging objects.

• Post-traumatic stress disorder (PTSD), which can develop in children or adolescents after a very stressful event (such as violence or sexual abuse) and cause them to repeatedly experience the trauma in strong memories, flashbacks or troublesome thoughts.

Severe anxiety problems in children can be successfully treated. Treatments for anxiety disorders in children include cognitive-behavioral treatment (children learn to deal with fears by modifying how they think and behave); individual therapy; family therapy; parent training; and medication. Some children with anxiety disorders benefit from a single form of treatment; others, from a combination of several treatments, such as individual therapy and short-term anti-anxiety medication or even an antidepressant.

Although some signs of anxiety in younger children are expected, it is important to recognize and address anything more than occasional anxiety in children after age 6. If not identified, severe anxiety may prove long-lasting and greatly affect a child's life. Untreated anxiety disorders in children can negatively affect their school performance and their ability to form friendships. It can also lead to low self-esteem, alcohol or other drug use, adjustment problems in work situations and anxiety disorder in adulthood.

What to Do

If a child experiences anxiety problems, call his or her health care provider and make an appointment to discuss the situation. A health care provider should perform a complete physical examination, since many medical problems produce symptoms that mimic anxiety disorders. When medical disorders are ruled out, the provider should look closely at what may be the root cause of the anxiety, such as problems within the family or with peers. If needed, the provider can refer the child and family to a mental health professional. Look for a mental health provider who has training and experience working with children and adolescents, using cognitive-behavioral or behavior therapy, and prescribing medications for anxiety disorders or cooperating with a physician who prescribes medications.

Use Medicine Effectively

Some treatments for anxiety disorders can include anti-anxiety medication or antidepressants.

The Food and Drug Administration issued a warning in September 2004 that antidepressants cause some children and teenagers to become suicidal. Children and teens who take antidepressants are twice as likely as those given placebos to become suicidal. Still, the overall risk for suicide is low. If 100 patients are given the drugs, two or three more will become suicidal than would have had they been given placebos.