Child Anxiety

When your child is experiencing anxiety, it can come in the form of worrying, feeling overwhelmed and shutting down or noncompliance. Many times, it can result in meltdown episodes.

When helping a child who is anxious, the critical step is in identifying what is causing it. There are many reasons why a child will develop anxiety.

Our intake at NPS looks “under every rock” to find the reason(s) of what is triggering your child to be overwhelmed, worried or unable to engage in life freely. We explore a comprehensive birth, developmental, homelife, peers, school, diet, sleep habits, etc since any of these or a combination can trigger anxiety.

Since we take an integrative approach, we know that the answer will be found in the imbalance of the child’s mind, body or soul. We offer alternative approaches to medications first and have many effective mindfulness strategies to help your child. Our goal is to address what is causing the anxiety, not just learn how to cope with it.

Signs of Anxiety In Children

Common Childhood Worries

There are a variety of situations that can cause normal worry and anxiety for kids of different ages. New situations, challenging tasks, and even unfamiliar people can lead to fear and anxiety in children from time to time.

Other age-appropriate fears include:

• Stranger anxiety beginning at 7 to 9 months of age and resolving around age 3
• Fear of the dark, monsters, insects, and animals in preschoolers
• Fear of heights or storms in younger school-age children
• Worry about school and friends in older school-age children and teens

These childhood fears are normal and typically lessen on their own as a child grows older with support and love from a parent. It takes more than occasional anxiety, which can be normal, to indicate true symptoms of an anxiety disorder. 

Signs and Symptoms In Children With Anxiety To Be Concerned About

As much as it is common to have occasional anxiety, it is also common for children to have anxiety disorders. While estimates of the prevalence vary, the Centers for Disease Control and Prevention (CDC) states that 7.1% of children between the ages of 3 and 17 have diagnosable anxiety. 

Children with true anxiety symptoms may experience symptoms that include:

• Anger or aggression toward others
• Avoiding certain situations
• Bedwetting
• Changes in appetite
• Fatigue
• Getting in trouble at school
• Headaches
• Irritability
• Muscle tension
• Nervous habits such as nail-biting, hair, eyebrow, eyelash pulling
• Nightmares
• Refusing to go to school
• Restlessness
• Social withdrawal
• Stomach aches
• Trouble concentrating
• Trouble sleeping (insomnia)

The frequency and appearance of symptoms can vary depending on the nature of the anxiety. Some fears (such as social anxiety or a phobia) may be triggered by specific situations, objects or settings. 

Other types of anxiety, such as generalized anxiety disorder or panic disorder, can lead to symptoms that occur with greater frequency. Children with generalized anxiety disorder (GAD) are overly anxious about routine everyday matters. They usually anticipate catastrophe or worst-case scenarios in a broad range of situations. This makes it very difficult for them to explore and have new experiences with their family or friends. 

The chronic worry experienced by children with GAD is unreasonable and irrational given the actual circumstances. 

Normal childhood fears that persist beyond the age where they are expected to fade (such as being afraid of the dark or being away from parents past the preschool age) are also a point of concern. Other indicators of concern include symptoms that interfere with a child’s ability to learn, interact with peers, sleep at night or function in daily life. 

Common Anxiety Disorders in Childhood

Besides, Generalized Anxiety Disorder, the following are the types of anxiety disorders most often seen in children.

Panic Disorder

Recurring panic attacks are the hallmark features of panic disorder. Panic attacks are sudden and intense feelings of terror, fear, or apprehension, without the presence of actual danger.

A child with panic disorder may appear anxious or upset about being in certain situations or may have frequent physical complaints (i.e: frequent headaches or stomach aches) before or during certain feared activities. They may avoid or refuse to be in situations that they perceive as frightening due to the panic response.

Separation Anxiety Disorder

Separation Anxiety is thought to be a normal part of infant development. It begins when the child is about 8 months old and declines after about 15 months of age.

During this period, the child understands the separation between self and primary caretaker. The child understands that they can be separated from the caretaker, but does not comprehend that the caretaker will return, which leads to anxiety.

Separation anxiety disorder, on the other hand, is not a normal developmental phase. It is characterized by age-inappropriate fear of being away from home, parents, or other family members.

A child with a separation anxiety disorder may be excessively clingy to family members, may fear going to school, or being alone. They may experience frequent physical complaints. (See the above list for signs and symptoms of anxiety.)

Social Anxiety Disorder (SAD)

The features of social anxiety disorder (SAD) include excessive and unreasonable fear of social situations. If forced into a feared situation, the child may become upset and exhibit a temper tantrum.

Children with this disorder may be extremely shy around strangers or groups of people and may express their anxiety by crying or be overly clingy with caregivers. The child may not want to go to school and may avoid interactions with peers.

Symptoms of SAD (can vary by age):

• Preschool Children
  • Fear of new things
  • Irritability, crying, or whining
  • Freezing or clinging
  • Refusing to speak
• School-Aged Children
  • Fear of reading aloud or answering questions in class
  • Fear of talking to other kids
  • Fear of being in front of the class
  • Fear of speaking to adults
  • Fear of musical or athletic performance activities
  • Fear of ordering food in a restaurant
  • Fear of attending birthday parties
  • Fear of having friends visit
  • Worry about being judged by others
  • Refusal to participate in activities or school

 In addition, children with SAD are more likely than adults to experience physical symptoms like headaches, stomach aches, and nausea.

Phobias

A phobia is an intense irrational fear of a particular object (e.g., spiders) or situations (e.g., heights, rain, thunder). If the child comes into contact with the feared object or situation, he/she may become very upset, anxious, and experience panic attacks. Phobias can become disabling and interfere with the child’s usual activities.

Phobic symptoms can occur through exposure to the feared object or situation, or sometimes merely through thinking about the feared object.

Typical symptoms associated with phobias include:

• Breathlessness
• Dizziness, trembling, and increased heart rate
• Fear of dying
• Nausea
• Preoccupation with the feared object
• A sense of unreality

Treatment Options For Children With Anxiety

At NPS, we work with the whole family, not just the child. We understand that when a child is struggling (like a hanging mobile from a ceiling, when one piece moves, all the other pieces move along with it) the whole family can be impacted by one person in a family.

After we complete an evaluation, we can offer insight as to “why” your child struggles. The real question being answered is what happened or what is happening that is making your child struggle.  

Dr. Neal likes to say that he wants to ring 3 bells for the parent(s) in the diagnostic feedback session after completing the evaluation:  

1. Ring the bell in your intellect, that what he is presenting makes sense to your logic/rational/science part of your brain. 
2. Ring the bell in your heart- that someone is finally understanding why your child is struggling and that your child is being “seen” and you are being “heard” as a parent. Many times Dr. Neal will hear from a parent that he must be watching in the back window of their life because he so accurately describes the what and why of their child’s behaviors. 
3. Ring the bell in your gut as a parent. That part of you that intuitively knows that someone has cracked the code on your child’s struggles and can provide a way to help your child be all he or she is meant to be.  

After the diagnostic feedback session, Dr. Neal will lay out a plan of intervention to address the underlying reasons for the struggles and help you and your family move forward. He has a team and many community connections built over 39+ years. He will cover all options and discuss natural alternatives to medications, which is his first go to.

He is always open and well-versed in the conventional, traditional medication approach. Because there are different factors impacting why a child behaves the way he or she does, there are always multiple factors for helping a child be able to self regulate.

Treatment plans for anxiety in children are tailored based on their unique situation. There are a variety of options to choose from. It depends on what is causing your child’s anxiety. Is it situational or biochemically based?

After we complete an intake evaluation, we will know how to direct you and your child. Sometimes, no direct contact with your child is needed. We can coach the parent on what a child needs. If at all possible, we avoid having a child become a client. We prefer, if possible, to team up with the parent(s). 

Possible treatments include:

• Play therapy
• Coping skills
• Relaxation techniques (e.g. breathing techniques) 
• Mindfulness meditation stress reduction strategies when triggered
• Social connection
• Therapy animal
• Diet free from chemicals to improve neurotransmitter production
• Using nutrition through foods to improve neurotransmitter production
• Supplements
• Essential oils
• Medication if necessary based on urgency of situation

Counseling interventions in the form of play therapy are important in the treatment of anxiety in children. Play therapy offers children a place to share their worries without fear of judgment, rejection or feeling dismissed.

Through the process of play, our counselor will help your child with things such as:

• Developing and using relaxation techniques
• Developing positive self-talk to help reduce anxiety
• Identifying fears and worries
• Increasing coping skills like socialization, physical activity and self-assurance
• Openly sharing thoughts and feelings

Sleep routines, eating habits, and physical activity all contribute to your child's well-being. Your child might struggle in a certain area like sleep or physical activity, especially if they experience restlessness, muscle tension, or fatigue due to their anxiety.

Medicine For Children With Anxiety?

Putting your child on medication is most often a high concern for parents. That is why Dr. Neal has spent decades learning about natural alternatives. Dr. Neal is also willing to discuss medication options if a parent wants to explore this as an option.

He is aware that sometimes medication may be warranted. If a parent decides that they want to go in that direction, NPS has a network of child psychiatrists who can prescribe.  

Alternative Options To Medicine For Children With Anxiety

We embrace an integrative, functional medicine approach to helping a child with anxiety. When treating the mind, body and soul, we do not reach first for medications. Rather we offer many natural alternatives. Please click the link to learn more about our NPS natural approach to anxiety. 

Helping Parents Or Caregivers Of Children With Anxiety

A first step in helping your child manage and overcome anxiety is recognizing it, but this can be difficult. Children struggling with anxiety can sometimes be quiet, shy, and cautious. They may be very compliant and eager to please adults.

On the other hand, an anxious child may "act out" with tantrums, crying, avoidance and disobedience. These behaviors may be misinterpreted as oppositional and "difficult" when they are actually anxiety related.

As a caregiver, you and your family will likely be asked to participate in your child's treatment. Our NPS counselor will often use this time to help educate parents about anxiety, suggest helpful techniques and allow time for the family to process together some of the child's anxious thoughts and feelings in Social Connection. Since we prefer to coach the parent(s) to help the child, some sessions are only with parents.  

Anxiety can make children want to isolate themselves from peers and family members. Help your child feel safe to connect with others, offering opportunities to be with family and enjoy each other's company by playing games, spending time outdoors together, or finding a common interest or hobby.

Volunteering in the community can be another wonderful way to help your child stay connected to others. Allow them to explore and identify something they feel passionate about and help them seek out related opportunities in the community to help.

Child Anxiety FAQs

How To Discipline A Child Whose Anxiety Shows Up As Tantrums Or Defiance

This is a greatly misunderstood and frustrating area for parents. Most parents have tried all kinds of approaches, none of which seem to work and some which only make the child escalate or shut down even more.

Once we address the underlying issue of what is triggering a child’s anxiety triggered noncompliance to following a parent’s guidance or rules, we find that a child can then self regulate and follow through with what is expected of him or her at home or school.

The key is not to focus on trying to change a child’s acting out behaviors to start off with. Rather, we go for the core issue of what is getting in the way of a child complying.  

Bedtime Struggles For Children With Anxiety

Struggling to fall asleep because of specific fears, worries about the next day or the mind racing on all kinds of bothersome negative thinking is common for children with anxiety.

Oftentimes, a child will have the habit of only falling asleep if the parent is present in the room, the child pleads to fall asleep in the parent’s bed or they crawl in the parent’s bed in the middle of the night.

None of these sleeping arrangements options are helpful for the child nor the parent in the long run. We offer a variety of natural techniques to help a child fall asleep so everyone gets a good night's sleep. 

• Guided mindfulness meditation apps for children
• Set an individualized bedtime
• Set an individualized wake up time
• Create a consistent bedtime routine
• Turn off screens 2 hours before bedtime
• Reduce stressors before bedtime
• Create a sleep-inducing environment (dark room, soft sheets, cool temperature)
• Breathing techniques specific for sleep
• Essential oils or supplements that help induce sleep
• Be on the lookout for sleep disorder-restless legs, snoring, grinding teeth

Homeschooling A Child With Anxiety

Sometimes, the best option for a child with anxiety is to consider homeschooling. Whether the child is anxious due stress from school academic expectations or bullying or the child has a high level of stress which is interfering with school performance, homeschooling can be an effective option along with counseling for your child.  

• Combine homeschooling with professional treatment for abnormal anxiety, which may include:
  • Play therapy counseling
  • Stress management techniques
  • Focus on self-care (nutrition, sleep, and exercise)
  • Supplements
• Know that homeschooling brings with it the “power of now”- you can do what's right for your child now, even if that means you prioritize mental health over academics.
• Find support for yourself, the parent. Friends, books, counseling, support group, online groups. Parenting an anxious child is hard, and you need someone who understands and has information about how to do it.

If you remove your anxious child from school to homeschool:

• Remember, removing a child from a negative school situation may reduce stress and thus lower anxiety, but there may be leftover trauma your child might need help with.
• If anxiety was "rational" due to a specific terrible situation related to school, removing a child may be "enough", but you can help your child know about and experience other school and school-type situations that are not negative, so he/she is less likely to overgeneralize. 
• Know that homeschooling does not automatically or by itself fix anxiety so a child can return to school. Remember that not all anxiety is school-related. Some kids who have never been to school have debilitating anxiety. Keep perspective on what homeschooling can do.
• Learn about short-term homeschooling.  
• If returning to school after a period of homeschooling is the goal, gradual but increasing exposure is commonly recommended.
• Spend some time “unschooling.” Some kids just need a break from school. 
• Focus more on connection than a curriculum. 
• Choose a curriculum that is different if school ways were creating too much stress.
• Do not confuse homebound services offered by your school division with independent homeschooling. The laws are quite different, and in many states, you have to file specific paperwork in order to homeschool. Since kids with debilitating anxiety may have missed a lot of school, lack of the correct paperwork (where required) could trigger truancy charges. Sometimes people think the school administration considers homebound instruction to be the same as homeschooling, and therefore additional paperwork is not necessary, but that may not be true.
• Consider whether a return to school makes sense with the school conditions and level of support your child will face in his/her precise circumstance. Some students do well in community college, university, and work, despite having had challenges with anxiety while they were in public school.

Foster Children With Anxiety

Foster children who struggle with anxiety need to work with a professional counselor who is trained and highly experienced with the foster parent experience as well as what the unique emotional journey is for a foster child.

Attachment issues, the birth’s mom’s health during pregnancy, possible past neglect or abuse to the child, are just a few of possible critical factors affecting a child who is being fostered. A therapist trained in this is essential.  

Children With Anxiety In The Classroom

When your child is experiencing anxiety, it is important to let your child’s teacher know. There may be informative observations your teacher relays to you about how your child is doing at school academically, with peers and just his/her overall school experience.

Sometimes, the anxiety is triggered by something happening at school, then by all means you need to talk with the teacher. You will want to collaborate and team up with your child’s teacher. If the anxiety is not school related, you will want the teacher to be aware of this and how they can support your child throughout the day.

While sending an email can be effective as a first introduction for the teacher’s awareness, at NPS, we always recommend you sit down face to face or video chat with the teacher. This allows for the easy flow of much more information to be gathered from the teacher.

Following up with an email with the specific counselor recommendations for helping your child during school hours will most definitely be appreciated and helpful to the teacher. This helps the teacher to set realistic expectations.

Books About Child Anxiety

Books for children

Here is a link on 10 books for children who struggle with anxiety.