Worried About Your Child’s Anxiety?

Anxiety is, overall, a normal human experience. It can save us from unsafe situations and help us focus in times of stress. However, when anxiety starts to persistently impact daily functioning, further evaluation and treatment may be necessary. 

But, anxiety doesn’t just impact adults – we sat down with Sheppard Pratt child and adolescent psychiatrist Monica Rettenmier, MD, to learn about how to identify anxiety in children, and when and how to take action.

What are the early signs of anxiety in children?

Childhood anxiety can show up in different ways. Some of these signs can include:

• Agitation or irritability
• Trouble focusing at school and/or at home
• Physical symptoms such as headaches or stomach aches
• Easy fatigue
• Disrupted sleep behaviors
• Changes in appetite
• School avoidance/refusal
• Crying or increases in tantrum behaviors
• Withdrawal from social situations

My child is a ‘worrier.’ When should I be concerned?

Some children have a natural predisposition to worry, and often, families will be able to identify this trait in their child. However, when chronic worry and internal anxiety levels are higher overall, it becomes difficult to handle life’s normal ups and downs. It is important to talk with your children about the things they worry about and be mindful if their behaviors start to change when they are faced with new stressors.

Can my child’s pediatrician diagnose anxiety, or should I see a mental health practitioner?

Pediatricians are often the first medical providers who identify anxiety in children. The decision to evaluate and treat is an important discussion to have with your pediatrician; some are comfortable with diagnosing anxiety and trialing a medication, while others prefer to have a mental health specialist evaluate your child and initiate care. Your pediatrician can provide a referral if they would rather involve a specialist.   

Most children with diagnosed anxiety disorders are initially treated with therapeutic interventions that can be provided by a licensed therapist or counselor. Depending on the level of anxiety and degree of impact it is having on a child’s life, different interventions can be used to help them learn to control their emotional response to triggers. However, some children will need to have a combination treatment involving both a medication management provider as well as a therapist. 

Regardless of where you start the diagnostic process, the provider you see will gather information from both you and your child to identify areas where the child may be struggling. During this process, they should also evaluate for other diagnoses that can commonly present in a similar manner to anxiety. Some of the more common diagnoses to look for include depression, ADHD, autism spectrum disorder, obsessive compulsive disorder, and trauma.

How do I know when my child needs treatment?

Anxiety fluctuations occur naturally in most children, just as in adults. The common response to a stressor is for anxiety to rise, but once the stressor is reduced or removed, the anxiety should resolve. When behaviors continue for a period of time without resolving naturally and daily functioning continues to be impacted at home and at school, we recommend you seek help from a mental health professional.

How are child anxiety disorders usually treated?

The first intervention is usually therapy. The type of therapy will be dictated by the type of anxiety your child is struggling with. It is important to discuss the approach with your child’s mental health provider so you can ensure that the anxiety interventions are practiced outside of therapy. 

If medications are recommended, understanding what to expect from the medication is an important discussion to have with your child’s provider. The most commonly prescribed medication for anxiety is a class of medications called SSRIs (serotonin selective re-uptake inhibitors). These medications are not meant to “get rid of anxiety”; however, they can be a helpful tool for reducing anxiety levels in order to effectively implement behavioral changes. 

I’m an anxious person; is it possible that my child inherited my anxiety?

There is a genetic connection between parents with anxiety disorders and their children. This does not mean that if a parent has a diagnosis of generalized anxiety disorder that their children absolutely will, too. Rather, because your child shares part of your genetic makeup, they are at higher risk of experiencing an anxiety disorder than the general population. 

What can I do to help my child?

There are many things that families can do to help their child in the moment when they are struggling. Interventions such as deep breathing and distraction techniques are particularly helpful. It is also imperative to talk to your child about what they are experiencing and areas in life where they are worrying. Sometimes, children will not be able to identify what is worrying them, but being present and talking to them in a calm and supportive manner is an important part of any treatment.  

Tell me about an intervention I can do with my child.

Here’s a deep breathing technique that you can practice with your child:

• Find a quiet space and sit comfortably, keeping the body relaxed. 
• Then, slowly count to four and have your child take a measured breath in over the count. 
• Then slowly breathe out for a count of four. 

It is important to practice this technique when your child is NOT in an acute state of anxiety, as it’s harder to focus during those times.

What are some distraction techniques we can use at home?

Distraction techniques can also be called coping skills. Working with your child to identify things they can do to distract themselves from anxiety is important. Ideas may include coloring, drawing, listening to music, playing a favorite game, and exercise. Exercise is an important technique because it has the potential to lower anxiety levels, not just distract your child from the anxiety they are experiencing in the moment. 

There are also a lot of quality resources you can find online; here are a few organizations that I recommend: 

• American Academy of Child & Adolescent Psychiatry
• National Alliance on Mental Illness