Children, like adults, have very strong feelings about what happens to them. It is natural to feel fear or worry from time to time. However, a small number of children and young people suffer from severe anxiety, which causes great anxiety and can seriously affect their daily life.
How common is this phenomenon?
Anxiety is one of the common mental health problems. Almost 300,000 young people in the UK suffer from anxiety disorders. However, many suffer in silence. It's important to recognize your problems and seek help, especially when they start to affect your daily life.
Growing up: Different types of fears
Fears are grouped according to the reason for the fear or concern. These groups are useful for understanding difficulties and how to solve them.
fears and phobias
Fear of animals or the dark is common in young children. A phobia is an extreme fear that causes great anxiety and significantly affects a child's life. For example, a fear of dogs will be called a phobia if it means that the child never wants to go to the park to play.
Most children overcome their fears or learn to control them with support and encouragement, but it is much more difficult to deal with a phobia without additional help.
Some young people feel anxious most of the time for no apparent reason. It could be part of their temperament or a pattern of behavior they share with other family members. If the anxiety gets worse, it may mean your child doesn't want to go to school, can't concentrate or study, and doesn't trust others.
Worrying about not having a permanent caregiver is a common experience for most children. It usually develops around 6 months of age and may continue in some form into the preschool years.
Because of this, it can sometimes be very difficult for them to fall asleep, leave their parents for work, or adjust to kindergarten or school. If this is an extreme situation and affects the development, education and family life of the child, it is worth resorting to additional help.
It can be helpful to think of it as an extreme, sometimes crippling type of shyness. This means that although children and young people do not feel it when they are in the company of people and families they know, being in other social situations is very disturbing for them.
This means that they will generally avoid them. This creates problems for the child when making new friends or dealing with situations at school. Older children describe this as a fear of humiliation or embarrassment that causes them to avoid social situations.
A small minority of children and young people may develop other specific types of anxiety, such as post-traumatic stress disorder or obsessive-compulsive disorder. Unlike young people and adults, panic attacks in children are extremely rare.
Anxiety can cause physical and emotional symptoms. This means that it can affect a person's well-being and health. Some of the symptoms are:
- feeling anxious or panicky
- feeling short of breath, sweating or complaining of "butterflies" or chest or stomach pain
- feeling of tension, anxiety, frequent use of the bathroom.
These symptoms may come and go. Small children cannot say that they are restless. They become irritable, tearful and clingy, have trouble sleeping and may wake up during the night or have nightmares. Anxiety can even cause headaches, stomach upset or nausea.
What causes these worries and anxieties?
We don't really know what causes this disease. However, various factors can contribute to your anxiety, for example, your genes, where you live, unpleasant or traumatic experiences.
Anxiety runs in families, so if someone in your family is very anxious, they are more likely to be anxious too. Some of this will be passed down into their genes, but they can also "learn" anxious behaviors from being surrounded by anxious people.
Children who are bullied, have no friends or have problems at school are often very worried.
A child who has suffered a house fire, theft, car accident, or any other frightening or traumatic event may later suffer from anxiety. They can also develop post-traumatic stress disorder.
Children who have to deal with stressful situations, such as bereavement, parental illness or divorce, are often restless and insecure. They can handle an event, but can have a hard time coping if several difficult things happen at the same time, such as their parents' divorce, moving, or changing schools.
Children need parents or caregivers who can soothe them effectively. Young children can feel anxious and anxious when they hear or see their parents arguing or fighting (see our fact sheet on good parenting). If children sense that family or friends are anxious or rigid, this can make them more anxious. This makes children feel unsupported, insecure and lacking confidence, and can also be linked to separation anxiety in children.
Do children grow out of it?
Most children get over it, but some still feel anxious and sometimes become depressed as adults.
Even if they do not become restless adults, anxiety can limit a young person's activities, which can affect their development in the long term. For example, not going to school means missing out on education and making friends. Loneliness and lack of self-confidence can be long-term problems. The emotional effects of a traumatic experience can also be long-lasting.
What can I do to get help?
There are many things you can do to prevent children from becoming anxious. Parents and teachers can help by remembering that children, like adults, can be anxious about sudden change.
- It will help if you can prepare them in advance and explain what will happen and why.
- Regular bedtime and school preparation activities can help very young children with separation anxiety.
- There are books or games that can help children understand upsetting things like serious illness, separation or bereavement.
- For children over the age of five, it is often helpful to talk about their concerns with an understanding adult, who may be someone outside of your immediate family.
- They may need comfort, reassurance and practical help to cope with the situation.
If your child shows signs of distress, it's important to show them you care and want to understand why:
- Consider whether there is anything going on in your family that might cause concern.
- Do they understand their own concerns?
- Is something going on at school or among friends?
Every family goes through periods when they have to deal with a lot of stress and worries. At times like this, you or your child may need additional help and support from friends, family or others.
Where can I get help?
If your child is so restless that he cannot cope with everyday life, more professional help is needed. Your GP will be able to advise you and suggest a referral to your local Child and Adolescent Mental Health Service (CAMHS) (see our 'CAMHS Who's Who' fact sheet). The type of professional help offered here will depend on the cause of the anxiety.
Basically, it's about finding ways to overcome your worries and gradually build your confidence.
How is it treated?
The type of professional help offered here will depend on the cause of the anxiety. This will usually be a form of psychotherapy such ascognitive behavioral therapy(TCC).
Cognitive behavioral therapy can help them understand what is causing their anxiety and find coping strategies. Parents are encouraged to become actively involved in helping their children cope with anxiety and are advised on how to do this effectively.
Sometimes they may also be given medication to help if their anxiety problems do not improve. A type of antidepressant called an SSRI is commonly used.
Anxiety problems can be very difficult for both the young person and the family, but they can be treated.
Case study 1: The story of David, age 12
One of the worst things about my phobia was that I had to keep it a secret. When my friends invited me to their birthday party, I had to admit that I was busy because I couldn't get near the balloons.
I've always hated balloons. But last year I decided that my fear was out of control and I needed to do something about it. I went with my mother to the family doctor, who referred me to a specialist. A few months later we had the first of eight sessions of "cognitive behavioral therapy".
The therapist started by telling me that many people have phobias and that balloon phobia even has a name ("globophobia"). It really helped me to know that other people have the same problem.
She asked me about my origins and tried to understand how my phobia came about. We talked about how I react to various stressful situations, rating how bad I feel on a scale of 1 to 10. She explained that my racing heart, feeling hot and tense, and needing to escape are all normal responses to stress. She taught me how to control my breathing, relax and talk positively to myself to control my anxiety.
Gradually, every week, I had harder and harder things to do - at first I just touched the balloons, but at the end of the course - I popped them. On the way to the sessions I was often nervous because I knew I would have to face my biggest fear. It was hard work and I almost gave up. I still don't like balloons and prefer not to have them with me. But thanks to therapy, I can now accept calls knowing that I can deal with my fears.
Case study 2: Neela's anxiety story, age 15
"I don't know about you, but I've always been more worried, like my grandmother. Every year we would plan our family trip to India and it would start... worrying about flying... worrying about getting sick... and right before take off I would get those "butterflies" "horrible, with sweaty hands and feeling like if I couldn't breathe, I thought I was dying or going crazy.
Last year, before the exam, my worries increased a lot. There was a lot of pressure in high school and everyone in my family was always good and got into college, so I knew I had to study hard. It was so bad I couldn't concentrate. At school I was nervous and irritable and even cried most days. I didn't sleep well because I was too nervous and too ashamed to tell mom and dad.
I ended up confiding in the school nurse, which was the best thing I ever did. She contacted my mother and after consulting with the general practitioner I went to the hospital to see a team of specialists.
Don't worry... I didn't want to be "the girl who goes to the psychiatrist" either, but I don't. The team may include a variety of people, such as doctors, nurses, psychologists and social workers. They put me at ease and helped me and my family see that my symptoms were real (like asthma). So I took a therapy called CBT. This includes a series of weekly sessions with a therapist. I didn't even need to take the medicine. Although I always worry more, I feel much better and look forward to my trip to India this year.”
Anxiety in Great Britain- Charitable provision of information and support to people suffering from anxiety problems.
Network of children's fears- Provides accurate, easy-to-use information about anxiety in children.
Young Minds Parent Helpline- For every adult who is interested in the emotions and behavior of a child or young person. Helpline for parents 0808 802 5544
youth approach- Offers UK information, tips and advice.
National Institute for Health and Clinical Excellence:Guide to Self-Help Resources for Generalized Anxiety Disorder (2011).
Rays of Calm by Christiane Kerr Audio CD/Audiobook: A CD from the "Calm for Kids" series created for teenagers.
He talks about various relaxation techniques and visualizations that aim to promote feelings of calm and well-being and help teenagers cope with stress.
References and credits
- Ipser JC et al., (2010): Pharmacotherapy of anxiety disorders in children and adolescents, Cochrane Depression, Anxiety and Neurosis Group. Review of the intervention.
- O'Kearney RT, Anstey KJ, von Sanden C.Behavioral and cognitive-behavioral therapy of obsessive-compulsive disorders in children and adolescents. Cochrane Database of Systematic Reviews 2006, 4th Edition
- Evidence-based guidelines for the pharmacological treatment of anxiety disorders (2005): British Association for Psychopharmacology.
- Green, H., McGinnity, A., Meltzer, H. et al. (2005). Mental health of children and young people in the UK 2004.
Reviewed by the Royal College of Psychiatrists' (CAFPEB) Editorial Board for Child and Family Public Engagement.
I am grateful to Dr Chris Abbott, Dr Virginia Davies, Dr Vas Balagur and Thomas Kennedy.
These features reflect the best available evidence at the time of writing.