Anxiety in children

What causes anxiety in children?

Children can feel anxious about various things at different stages of their lives. Many of these worries are a normal part of growing up. For example, from the age of around 6 months to 3 years it's very common for young children to have separation anxiety - to worry when they are not with their parent or caregiver. It's also common for preschool-age children to develop specific fears or phobias.

Common fears in early childhood include animals (barking dogs), insects, storms or thunder and lightning, heights, water, blood and the dark. These fears usually go away gradually on their own as the child grows and learns more about the world.

There may also be other times in a child's life when they feel anxious. For example, many children feel anxious when going to a new school, moving house, or before tests and exams. Some children feel shy in social situations and may need support with this.

Children who have had a distressing experience, such as being a passenger during a car accident, may have anxiety afterwards. Family arguments (or even just raised voices or shouting) can also make children worry.

Teenagers are more likely to have anxiety in social situations than other age groups. They may try to avoid them, or make excuses to not go.

Types of anxiety

Generalised anxiety disorder

Generalised anxiety disorder (GAD) makes children and young people feel worried and nervous most of the time. The condition can persist long-term. Some of the physical symptoms of anxiety may come and go. The anxiety tends to be about various stresses at home or school. It is often about quite minor things, or they might seem minor to others. Sometimes the child does not know why they are anxious.

The symptoms of GAD cause distress and affect the child's day-to-day activities. You might notice some of the following symptoms: they are restless, on edge, and irritable, or agitated a lot of the time. It is not GAD if the anxiety is only about one specific thing. In this case the child is more likely to have a phobia - see below.

Separation anxiety

This is a normal stage in a child's development and can happen between the age of 6 months and 3 years. It is shown when a young child becomes clingy or cries when they are separated from their parent or caregiver. Viewed positively it demonstrates that the child has bonded well to those adults. It may also be accompanied by a fear of strangers. It should stop at around age 2 to 3.

Social anxiety disorder

With this condition you become very anxious about what other people may think of you, or how they may judge you. As a result you have great difficulty in social situations, which can greatly affect your life. The child may not do as well at school as they might have done, as they tend to avoid any group work, discussions, etc. The child may become socially isolated and find it difficult to make friends.

Fears and phobias

A phobia is strong fear or dread of a thing or event, which is out of proportion to the reality of the situation. When the child or young person comes near to, or into contact with, the feared situation they can become anxious or distressed. They may also have one or more unpleasant physical symptoms. These are partly caused by the brain and also by stress hormones - such as adrenaline. These act on the heart, muscles and other parts of the body to cause symptoms such as a fast heartbeat and sweaty hands.

Someone with a phobia may even become anxious by just thinking of the feared situation. They end up avoiding the feared situation as much as possible, which can restrict their life and cause distress. The most effective treatment is cognitive behavioural therapy - see below.

Panic attacks

A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning. In addition to the anxiety, various other symptoms may also occur during a panic attack. During a panic attack the body can react in the same way as when it faces danger; something known as 'fight or flight' response.

During a panic attack the child tends to breathe very fast and shallow (hyperventilate). When this happens too much carbon dioxide is blown out, which changes the acidity in the blood. This can then cause more symptoms (such as confusion and cramps) and make a 'thumping heart', dizziness and pins and needles worse. This can make the attack seem even more frightening and make the breathing even faster. Over-breathing may make the child feel very light-headed and they may even pass out for a brief period. This is very uncommon.

A panic attack usually lasts 5-10 minutes; however, sometimes panic attacks come in waves for up to two hours.

How common is anxiety in children?

Anxiety in children and young people is quite common. Anxiety is one of the common mental health problems in people generally. It is thought that nearly 300,000 young people in the UK have a problem with anxiety. The number might be higher because lots of people who are anxious do not come forward with their problem.

It is important to recognise children's and young people's problems and ask for advice and support, especially when it starts affecting their everyday life.

What are the signs of anxiety in children?

Signs and symptoms of anxiety in younger children might include:

• Change to bedwetting when previously dry.

• Food refusal.

• Behaviour changes - becoming irritable or clingy, fidgeting.

• Peeing a lot, or tummy aches.

• Waking at night when they were previously sleeping through.

• Bad dreams.

Older children and young people might:

• Lack confidence to try new things, or seem unable to face routine, everyday challenges.

• Find it hard to concentrate.

• Have problems with sleeping or eating.

• Have angry outbursts.

• Have a lot of negative thoughts, or keep thinking that bad things are going to happen.

• Start avoiding normal activities, such as seeing friends, going out in public or going to school.

Do children grow out of it?

Most children grow out of it, but a few continue being anxious, and may also become depressed as adults.

Just because they are likely to grow out of it does not mean we can dismiss it as not a serious problem. 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 lifelong problems. The effects of traumatic experience can also be long-lasting.

How to help anxiety in children

If a child is feeling anxious, there are things that parents or caregivers can do to help.

It is very important to talk to your child about their fears or worries. Encourage your child to tell you about their worries, rather than keeping them to themselves. Reassure them that others also have these fears and show them you understand how they feel. Try not to suggest their worries are silly.

If your child is able to understand, it may help to explain what anxiety is and the physical effects it has on our bodies. You can explain it is the worry that makes your hands sweaty, makes your heart race and gives you butterflies in your tummy. They may be reassured to know that anxiety usually settles after a while and that there are ways to cope.

As well as talking to your child about their worries and anxiety, it's important to help them find solutions that they can manage themselves.

For example, if your child is worried about going to a sleepover, it is natural to want to tell them not to go. However, as well as missing out on the experience this could mean your child learns that their anxiety can be controlling.

It's better to recognise their anxiety, find out what exactly they fear might happen (such as wetting the bed) and suggest solutions to help them. That way they can go to the sleepover safe in the knowledge that there is a plan in place.

Tips for parents of anxious children

Where possible:

• Try not to become overprotective or anxious yourself.

• Teach your child to recognise signs of anxiety in themselves.

• Encourage your child to manage their own anxiety and ask for help when they need it.

• Try to stick to a daily routine when you can because children of all ages find routines reassuring.

• Look for books or films that will help them to understand their feelings if your child is anxious because of distressing events, such as a bereavement or separation.

• If you know a big upheaval is coming, such as a house move, talk to your child about what is going to happen and why.

• Practise relaxation techniques with your child before they come to difficult situations. If they become used to doing these in a calm way, it will be easier for them when they are in a stressful situation. A simple example is taking three deep, slow breaths, breathing in for a count of three and out for three.

• Distraction techniques can be helpful for young children. For example, if they are anxious about going to nursery, play games on the way there, such as 'I spy' or sing along to music together.

• Make a "worry" box out of any old box you have, like a cereal or shoe box. Ask your child to write about or draw their worries on a piece of paper and "post" them into the box. Then you can look through the box together and talk about what they have written.

When to see a doctor

If your child's anxiety is severe, persists and interferes with their everyday life, it's a good idea to ask for some help.

A visit to a GP is a good place to start. If your child's anxiety is affecting their school life, it's a good idea to talk to their school as well.

Parents and carers can get help and advice about children's mental health from Young Minds' free parent helpline on 0808 802 5544, from Monday to Friday, 9.30 am to 4 pm.

Treatments for anxiety in children

If their anxiety is affecting their day-to-day life there are a number of options for treating anxiety in children and young people. The treatment offered will depend on a number of factors such as their age and what has already been tried. Some treatments are offered by local child mental health services and some might be offered by support organisations such as Barnado's or MIND (a mental health charity).

Family therapy

The whole family unit is important in this talking therapy. How the family works togther and relationships between family members are considered. The therapist supports family members to express difficult thoughts and emotions in a safe way. This helps each member understand others' experiences and points of view. It can be useful for addressing issues that are affecting the whole family.

Cognitive behavioural therapy (CBT)

CBT is a type of talking therapy that is often used to help people cope with their anxiety. It helps the anxious person manage their problems by changing the way they feel, think and act. The therapy aims to find practical ways to help deal with problems in a more positive way by breaking them down into smaller parts - situations, thoughts, emotions, physical feelings and actions. A level of communication skill and maturity will be needed for a child or young person to engage successfully with this type of therapy.

Mindfulness

Mindfulness is about paying moment-by-moment attention to what's happening inside your body, and what's going on around you. That sounds simple, but it's amazingly easy to get distracted.

Medication

Medication is only considered when there is little, or no improvement to psychological treatments. The medication used is the same as for adults and is usually one of the selective serotonin reuptake inhibitors (SSRIs). These are prescribed by specialist doctors in child mental health services.