This leaflet is provided by the Royal College of Psychiatrists, the professional body responsible for education, training, setting and raising standards in psychiatry. They also provide readable, user-friendly and evidence-based information on various mental health problems.
This leaflet describes the different types of anxieties that children might feel and some of the reasons behind these. It also offers practical advice on how to deal with these worries and anxieties.
Why do children worry?
Children, like adults, have all sorts of strong feelings about what is happening to them. It's natural for them to feel fearful or worried from time to time. However, a small group of children and young people have severe anxiety which causes a lot of distress, and can seriously affect their everyday lives.
How common is anxiety in children?
Anxiety is one of the common mental health problems. Nearly 300,000 young people in Britain have an anxiety disorder. Lots of people, however, suffer in silence. It is important to recognise their problems and seek help, especially when it starts affecting their everyday life.
Growing up: different types of anxiety
Anxieties are grouped based on what the fear or worry is about. These groups are helpful in understanding what the difficulties are and how to treat them.
Fears and phobias
Young children often develop fears - for example, of animals or of the dark. A phobia is an extreme fear which causes a lot of distress and affects the child's life significantly. For example, a fear of dogs is called a phobia if it means that a child refuses ever to go to the park to play. Most children either grow out of their fears or learn to manage them with support and encouragement, but it is much more difficult to cope with a phobia without some extra help.
Some youngsters feel anxious most of the time for no apparent reason. It may be part of their temperament, or it may be part of a pattern of behaviour that is shared with other members of the family. If the anxiety becomes very severe, it can mean that the child will not want to go to school, cannot concentrate or learn, and is not confident with other people.
Worry about not being with a child's regular caregiver is a common experience for most children. It normally develops at 6 months, and can go on in some form during the pre-school years. It can make going to sleep, parents leaving for work, or settling at nursery or school very difficult at times. If it is extreme and affects the child's development, education and family life, it may be useful to get some additional help.
It may be helpful to think of this as an extreme, sometimes disabling, type of shyness. It means that although children and young people are not affected in the company of family and people they know, they find it very worrying to be in other social situations. This means that they will usually avoid them. This causes problems for the child in making new friends or dealing with situations at school. Older children describe it as a fear of humiliation or embarrassment which leads them to avoiding social situations.
A small minority of children and young people may develop other specific types of anxiety, such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD). Unlike young people and adults, it is extremely rare for children to have panic attacks.
What are the signs of anxiety?
Anxiety can cause both physical and emotional symptoms. This means it can affect how a person feels in their body and their health. Some of the symptoms are:
- Feeling fearful or panicky.
- Feeling breathless, sweaty, or complaining of ‘butterflies’ or pains in the chest or stomach.
- Feeling tense, fidgety, using the toilet often.
These symptoms may come and go. Young children can't tell you that they are anxious. They become irritable, tearful and clingy, have difficulty sleeping, and can wake in the night or have bad dreams. Anxiety can even cause a child to develop a headache or a stomach ache, or to feel sick.
What causes these worries and anxieties?
We do not really know what causes this condition. However, several things can contribute to anxiety in children, such as genes, where they live, and having upsetting or traumatic experiences.
- Anxiety tends to run in families, so if someone in your family is known to worry a lot, their children may be more likely to worry as well. Some of this will be passed on in the genes, but children may also learn anxious behaviour from being around anxious people.
- Children who are bullied, lack friends or have trouble with their schoolwork often worry a lot.
- A child who has experienced a household fire or a burglary, a car accident or some other frightening or traumatic event, might suffer from anxiety afterwards. They might also develop PTSD.
- Children who have to cope with stressful situations such as bereavement, parental illness or divorce often become anxious and insecure. They may be able to manage one event, but may struggle to cope if several difficult things happen together, such as parents divorcing, moving home, and changing school.
- Children need parents or caregivers to soothe them effectively. Young children can feel worried and anxious if they hear or see their parents arguing or fighting. If children sense their family or friends are anxious or harsh, it can make them feel more anxious. This leaves them feeling unsupported, insecure and lacking in confidence and can also be linked with separation anxiety.
Do children grow out of it?
Most children grow out of it, but a few continue being anxious and can sometimes become depressed as adults.
Even if they do not become anxious adults, anxiety can limit a young person's activities which can affect their development in the long term. Not going to school, for example, means missing out on education and making friends. Loneliness and lack of confidence can be long-term problems. The emotional effects of a traumatic experience can also be long-lasting.
What can I do to help?
A lot can be done to stop children being anxious. Parents and teachers can help by remembering that children, like adults, may get anxious about sudden change.
- It helps if you can prepare children in advance and explain what is going to happen and why.
- Regular routines around bedtime and getting ready for school can help very young children with separation anxiety.
- There may be books or games that can help children to understand upsetting things, such as serious illness, separation or bereavement.
- Children over the age of 5 often find it helpful to talk about their worries to an understanding adult, which could be someone outside the immediate family.
- Children may need comfort, reassurance and practical help with how to cope.
If your child is showing signs of anxiety, it is important that you can show them that you care and want to understand the reason why.
- Is there something going on in the family that could be causing worry?
- Are they picking up on your own worry?
- Is something happening at school or with friends?
All families have times when they have to deal with a lot of stress and worry. At times like these, you or your child might need extra help and support from friends, family members or others.
Where can I get help?
If your child is so anxious that they can't cope with ordinary day-to-day life, more specialist help is needed. Your GP will be able to advise you, and may suggest referral to the local child and adolescent mental health service (CAMHS). The type of specialist help offered here will depend on what is causing the anxiety. Basically, it will involve finding ways of overcoming the worries and building confidence step by step.
How is anxiety treated?
The type of specialist help offered will depend on what is causing the anxiety. Usually it will be a form of talking therapy such as cognitive behavioural therapy (CBT). CBT can help the child understand what causes their anxiety and find strategies for coping. Parents are encouraged to be actively involved in helping their children manage their anxiety and are advised how to do this effectively.
Occasionally, a child might also be given a medicine to help if their anxiety problem has not got much better. A type of antidepressant, called a selective serotonin reuptake inhibitor (SSRI), is usually used. Anxiety can be really difficult to live with for both the young person and family, but it is treatable.
Recommended reading and references
- The Young Mind: An Essential Guide to Mental Health for Young Adults, Parents and Teachers, edited by Sue Bailey and Mike Shooter. Royal College of Psychiatrists (2009)
- Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations. British Association for Psychopharmacology. J Psychopharmacol 2005; 19:567-96
- Green H, McGinnity A, Meltzer H, et al. Mental Health of Children and Young People in Great Britain, 2004. Office for National Statistics, 2005
- Ipser JC, Stein DJ, Hawkridge S, et al. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2009; 3:CD005170
- Anxiety: Guide to Self-Help Resources. NICE, 2011
- O’Kearney RT, Anstey KJ, von Sanden C, et al. Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents. Cochrane Database Syst Rev 2006; 4: CD004856
Content used with permission from the Royal College of Psychiatrists website: Worries and anxieties - helping children to cope: information for parents, carers and anyone who works with young people (March 2012, due for review March 2014). Copyright for this leaflet is with the Royal College of Psychiatrists.