In this article I will help you understand what anxiety symptoms in children look like, so you can work out if your child is experiencing anxiety. I will give you tips on how to help a child with anxiety and how to seek further help if needed.
Since I left the National Health Service in 2012, I have been running Everlief, the child psychology clinic I founded with my husband. Everlief now has a large team of over 20 clinical psychologists, educational psychologists and a nurse specialist.
Since 2012 we have supported over 4,000 families. I estimate that over 70% of the children we have helped experienced anxiety.
In other words, childhood anxiety is (by a mile) the most common difficulty that families seek help from us for.
Is Your Child Anxious?
Many of us are more stressed, worried and anxious than we have ever been. Children may have worries about the world and its current state, or their future. They may have more pressing worries about school, friendships or growing up.
How do you know if your child is so stressed or anxious that they need help?
Causes of Anxiety
The causes of anxiety can be complex or very simple.
Sometimes anxiety follows a traumatic event, but at other times it can build gradually over time. Some children are more sensitive to severe anxiety than others and there is a genetic element.
Take the Next Step
If anxiety is affecting your child’s life on a daily basis, then something needs to change.
Is your child’s fear or worry affecting their sleeping, eating or other daily activities like attending school?
Interacting with friends?
Have they given up things they used to enjoy such as hobbies or social activities?
Or, is anxiety impacting family members, because your child’s feelings are heightened or because you cannot do things as a family that you used to do?
If any of these apply in daily life, the first step is to either:
a) put some strategies in place to help your child, or
b) seek professional help.
Anxiety Symptoms in Children: What to Look Out For
1. Physical Symptoms
Physical symptoms of anxiety are real. You have probably heard of the ‘fight or flight’ response (also sometimes referred to as the stress response). This is a primitive defence mechanism which evolved to enable us to react when faced with danger. To run away, to fight, or sometimes freeze in order to keep ourselves safe.
A series of bodily changes occur when our fight or flight response is triggered. For example, our muscles tense up (ready to run or fight), the heart rate speeds up (helping to circulate oxygen around the body), and digestion is interrupted temporarily. This is so that blood can be diverted to the arms and legs (which can often make us feel sick or feel “butterflies” in the tummy).
Many other powerful bodily changes occur. These can seem to come from nowhere and can cause intense fear for children. It is these exact symptoms that constitute panic attacks when the sensations feel out of control and the brain interprets this as extreme danger. When this occurs repeatedly may be labelled as “panic disorder“.
When these physical symptoms occur more often than you would expect and for triggers which do not actually represent danger (perhaps loud noises or crowded spaces), this is a sign that your child’s anxiety is high.
Watch this video for a summary about the stress response.
2. A “Short Fuse”
Anxiety does not always present itself as anger, but your child might appear angry when in fact they are anxious. Let’s imagine our stress as a cup.
When anxious thoughts or worries cause us stress, they trigger the release of the stress hormone cortisol. Anxious children’s stress cups are fuller than they should be. Every event they experience as stressful or scary, and every worry, fills up the cup a little more.
To make matters worse, anxiety can prevent children from getting the restorative sleep they need, to empty the cup ready for the next day. Once the cup is nearly full, it only takes one more small thing – perhaps being told off or a piece of homework not going to plan – for the cup to overflow.
An overflowing cup means that fight or flight (the stress response) is triggered. What does this look like? Anger, irritation, shouting, crying, a full “meltdown”… It will look slightly different for every child but once triggered the child is not in control any more. All of these can be signs of anxiety.
3. New or Excessive Worries, Especially at Night
Night time is quiet and peaceful, but this can create the perfect condition for worries to run rampant and multiply. If a child has a worry or specific phobias, there is nobody to talk it through with, and no distraction from it. The brain is tired and so it is unable to dismiss the worry as easily as during the daytime.
Night time worries can snowball and become loose cannons knocking around in your child’s mind. Worries – whether real or imagined – trigger the body’s stress response. The cortisol and adrenaline this releases are the opposite of what is needed for sleep. These chemicals tell us: “Don’t go to sleep, you must say alert for dangers!” If a child does fall to sleep, it may be a light or fitful sleep.
Therefore, anxiety, worry and sleep difficulties often go hand in hand.
4. Staying Inside Their Comfort Zone
Children who are anxious often feel so scared that they stop feeling able to try new things, or attempting things that are even slightly out of their comfort zone. For example, meeting new people or trying a new activity. After this they often lose confidence in these abilities, and this can lead them to withdraw even further and mental health problems can begin to form.
It may start with separation anxiety. A child feel at risk unless they are close to someone who makes them feel safe. Separation anxiety is completely normal in young children. But for older children it can hinder their social and emotional development. It is sometimes called separation anxiety disorder.
Staying inside the comfort zone is perfectly understandable. When you feel vulnerable you sometimes just want to hide away. If your child withdraws socially though, this can have an impact on their social confidence and social skills. You are not seeing people, so you don’t get to practise interacting. This can even lead to social phobia (also known as social anxiety disorder). In extreme cases we may see selective mutism, where a child is so anxious that they are unable or unwilling to communicate in certain settings.
Hopefully you can see how anxiety can lead to actions which contribute to further anxiety, creating a downward spiral. Early treatment helps stop this spiral in its tracks. Mental health professionals will create a treatment plan with your child which often includes cognitive behavioral therapy.
Cognitive behavioral therapy specifically focuses on identifying these spiralling patterns and doing things to break the pattern. For example, if withdrawal from social situations is actually causing further anxiety in the long run, we would look at how the child can gently and gradually approach, rather than avoid, social situations.
5. Extra Reassurance-Seeking
When your world feels scary and uncertain, the natural thing to do is seek reassurance from others (usually parents) that everything is okay. The relief that this provides can become addictive, so that children often find themselves seeking reassurance over and over, even when it has already been provided.
Be careful about providing this reassurance. On one hand, it is vital that your child feels safe, and providing some reassurance is important. However sometimes, you can become part of an overly repetitive (sometimes elaborate) pattern of reassurance-providing, that can actually make the anxiety worse.
In obsessive-compulsive disorder (OCD), a child’s anxiety is relieved by performing certain actions. For example, they may feel they need to switch the light switch on and off three times, and then they will be “safe”. Or they may ring you 20 times when you have just popped out to your neighbour’s house. If you find yourself “colluding” unwittingly with such rituals, then you should definitely seek help from a professional.
TAKE THE QUIZ!
6. Restlessness or Difficulty Focusing
If a child is going through a period of time when they don’t feel safe, their body is primed for spotting danger, not for learning.
The prefrontal cortex – the part of the brain which is involved in clear thinking, organisation and planning – will not be working efficiently.
As part of the survival response, this area of the brain takes a back seat so that the more primitive survival response (located in the amygdala and more generally in the limbic system) can take over. Your child’s body will be getting ready to run away or fight danger, not to sit down calmly and learn. The result is restlessness, distractibility, difficulty focusing, and probably difficulty in processing instructions.
In younger children, this restlessness can look like your child being “all over the place”, not being able to stick with one activity. In older children it can also look like this, or your child may seem “absent” or zoned out.
7. Trying to Control Certain Areas of Life
Have you noticed that your child is trying to control their eating? Either restricting their intake, or becoming very rule-bound in when or what she will eat? Or perhaps you have noticed that your child is generally more rigid in their thinking and will not compromise, so the family always ends up bending to their will. Sometimes, when the world seems scary and unpredictable, we try to control what we can. Underneath it all, the feelings of anxiety can be huge and your child is doing their best to control these.
How to Help Your Child With Anxiety
1. Upskill Yourself
Knowledge is power! For example, you are much less likely to have a panic attack if you can understand why your heart rate has sped up and your breathing has become shallow. It is your body doing it’s thing, to protect you from a perceived danger and keep you alive.
The book I have co-written with five of my colleagues, Brighter Futures, will help you feel like a pro in managing anxiety to support your child. It is a step-by-step guide to helping your child in a compassionate and gentle way. In addition, this self help guide written by psychologists focuses entirely on anxiety in children.
2. Be Careful About Sharing Your Stress and Anxiety in Front of Your Child
Children need to know that you are human and have different emotions. However, more than anything they need to feel safe. If you are extremely worried or stressed about something, you can limit the effect this has on your child.
Limit discussions about the area that is causing the stress or worry to times when your child is not at home. Keep it as an adults-only discussion where possible.
Adapt your body language.
Children are masters at picking up subtle signs of your distress in your body language, voice and face.
When stressed we hunch our shoulders, clench muscles, and have a creased forehead with eyebrows lowered, for example. We also tend to be more monotone in our tone of voice.
Try to be aware of these changes, and see if you can alter them when you are aware of them.
For example, straighten and relax your shoulders when you notice them hunching. This will provide small but reassuring cues to your child, and the good news is it will also provide “I’m safe” feedback to your brain which will help you to feel less stressed.
3. Work on Supporting Yourself to Manage Your Own Emotions So You Can Help Your Child Do The Same
When anxiety, worry, stress, or anger take over, one thing you can do is learn techniques to calm your nervous system.
Start by reading our article on parent self-care. Once you have felt the benefits of these, you will be able to teach them to your child with confidence that this stuff really works!
The first approach I recommend is mindfulness. Yes, I know, mindfulness seems to be everywhere at the moment, and it has been touted as a cure for all mental distress. It is not a cure. However, it is a philosophy and set of skills that can change your life by helping you feel more accepting and in control of your thoughts.
Mindfulness is powerful enough to calm the nervous system and cause positive structural changes in the brain. Read this article about mindfulness if you are interested to know more. If you want to give it a try, go for this brilliant four-week online course approved by the NHS, or an app such as Calm or Headspace.
Whether or not you try mindfulness, the most important technique you can practise (then teach your child) is deep, slow breathing. Deliberately slow your breathing, ensuring you breathe into your diaphragm (deep in your tummy rather than your chest). This is the best way to signal to your nervous system that you are safe.
Practise breathing with a few times per day for around five minutes: In for 5 seconds and out for 5 seconds. Set an alarm to ensure you practise two or three times each day. Soon it will become more natural for you to do this as a response to anxiety.
Whenever you notice your breathing speeding up, you will think: “Okay, I need to slow my breathing down”. Slow breathing will help you to stay calm with your child if you feel frustrated or wound up by them.
Posture is also important, as I have mentioned above. Sit upright in a relaxed position with your shoulders back. A relaxed, non-defensive posture (not hunched or clenched up) will automatically lower your blood pressure.
If you are looking for an advanced technique to calm the body immediately, consider trying 4-7-8 breathing. There is some research evidence showing that a longer out-breath can quickly calm the nervous system. This article about 4-7-8 breathing explains more.
Another technique for quickly calming the nervous system is progressive muscular relaxation (PMR). Start from your forehead. Clench the muscles there and hold for a few seconds, then release. Can you feel a difference? Move on to the next set of muscles (perhaps eyes, then jaw), until you have worked your way down to your toes.
With small children I like to do a simplified version, called “Raw Spaghetti, Cooked Spaghetti”. First of all they child pretends to be raw spaghetti – rigid and tense all over. Next, they pretend to be cooked spaghetti – soft and wobbly. It’s great fun!
Gentle stretching is also a good idea to release muscle tension. There is no particular technique to this, just do what your body tells you to do.
Flow activities are any activity you find 100% enjoyable, engaging and absorbing. They can be anything. For me the main one is singing. What are your flow activities?
Flow activities are so absorbing, that whilst you are doing them your brain doesn’t have a chance to feel stressed or to register any worries. They completely change your state of mind and give you a break from worry or stress. Schedule at least one flow activity into your day, and do the same for your child.
4. Provide the Reassurance Your Child Needs – In the Short Term
As I mentioned above, there can be problems with providing too much reassurance to a child over a long period of time. Children can become over-dependent upon it and reassurance-seeking can become a habit which they cannot manage without.
In the short term however, if your child is seeking reassurance they are telling you they need to feel safe. They may regress a little (e.g. act in a “babyish” way) during periods when they feel worried or vulnerable. This can be part of a normal attachment response and is almost always only temporary and nothing to worry about.
For example, during the transition from primary to secondary school, the new world can feel scary to an eleven-year-old. They may suddenly require more cuddles, want to have their teddies in bed with them even though they had “ditched” them long ago, or even ask for a bedtime story. This is all perfectly normal and okay. Once they feel safe again, it should pass.
5. Help Your Child Build Resilience
When anxious kids doing things through fear, their “comfort zone” becomes very small. This will affect their confidence and make it harder for them to try new things in the future.
It is crucial that you put in some time and effort to help your anxious child build resilience, so that they can widen their comfort zone and gain confidence in new situations by learning to get comfortable with their anxious feelings. This article on resilience will guide you.
6. Re-Imagine Your Child’s Daily Routines and Habits
In difficult times I often suggest families go back to basics. It’s a good idea to think about how you can get eating, social contact, exercise and sleep back in balance, for optimum emotional wellbeing. Focus on just one area at a time, and take small steps using SMART goals.
When extremely anxious or depressed children come into the clinic, I may start by creating a visual planner to ensure a balanced lifestyle.
For example, you could create a weekly chart using different colours to show things that need to be built in to your child’s day.
Breakfast, lunch and dinner might be represented in purple, exercise in green (perhaps a walk or a bike ride at minimum each day), and nurturing activities in blue.
For nurturing activities, include: special things you can do together to increase your bond such as watching a movie, flow activities (see above), and calming activities.
7. Seek Help
If what you have read resonates with you, my suggestions may be enough to turn things around for your child if the techniques are applied consistently.
However for some children and young people, more intensive support is needed from a health professional such as a psychologist.
The first line of treatment is usually talking therapy. Speak to your healthcare provider or family doctor in the first instance. Your child’s school may also be able to make a referral or signpost you to local professionals.
In children under around 10 years of age, parents will be heavily involved in the treatment. Occasionally if the anxiety is severe, medications such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed alongside talking therapy.
You can find more information about accessing child therapy support in the UK in this article: Child Therapist Information.
If you are a UK parent looking for direct online support my course, Outsmart Anxiety, can help you support your child. There are two versions of Outsmart Anxiety, one for parents of teens and one for parents of under 12s.
Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years.
In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.
Lucy is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.
To learn more tips for helping your child manage stress, join my Facebook group, Parent Tips For Positive Child Mental health UK.