Childhood Phobias: Treatment and Support
Phobias in children are common.
It’s normal for children to experience intense fear of certain objects or experiences. There is an evolutionary reason for it.
In this article I explore what causes phobias in children, how treatment works if you come to see a child psychologist, and how you can support your child.
Why Are Childhood Phobias So Common?
The brain is built for survival, not happiness.
There used to be many more physical dangers in the world than there are now.
The brain evolved to respond quickly to a perceived threat. Whether the danger is an actual threat or an imagined one, it responds the same.
The brain triggers the sudden release of a number of chemicals including adrenaline and cortisol. This is known as fight or flight, and is also referred to as fight, flight or freeze.
The powerful physical reaction gets us ready to run away, fight the danger or – if neither of those options is feasible – freeze (“play dead”).
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Understanding the Physical Response
Fight, flight or freeze is a survival response.
Once it is triggered it will not be possible for your child to calm themselves without some support from you.
Physical symptoms of phobias in children (whether there is an actual danger or not) include:
- Higher blood pressure.
- Increased heart rate (sometimes the child may notice an irregular heartbeat).
- Rapid, shallow breathing or shortness of breath.
- Irritability or anger (the “fight” part of fight or flight).
- Tense muscles (ready to jump into action for fight or flight).
- Upset stomach, stomach pains or digestive issues (because fight or flight halts digestion temporarily and diverts blood to the limbs).
- Headaches.
- Sweating, trembling or shaking.
Though these physical symptoms can be scary and often cause significant distress, they are not actually dangerous.
Once the feared item or situation is perceived to have passed, the body will gradually return to it’s natural state.
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Avoidance and Phobias in Children
Avoidance is one of the biggest problems.
It maintains or exacerbates the fear.
For example, a child who is scared of lifts will naturally try to avoid lifts at all costs.
Avoidance can act like confirmation to the brain that the feared object or situation is scary. There is no opportunity for the child to gain confidence with lifts, because they avoid them.
Every time the brain is avoided, it’s as though the brain thinks: “That was a close shave. I avoided that danger successfully… until next time!”
The phobia may worsen or stay the same, but avoidance is never helpful.
For this reason, child phobia treatment involves gradually approaching the fear rather than avoiding it.
Development of Phobias in Children
Specific phobias in children often develop in response to a single event.
This might be a real danger, a “near miss”, or something which the brain mistakenly identified as dangerous.
For example, if a child gets locked in a toilet, they may develop a phobia related to entering an enclosed space.
More complex phobias in children such as social phobia may develop more gradually over time, as the brain gradually starts to sensitise to certain specific situations.
Whether the phobia has developed suddenly or over time, the treatment approach will be similar (see below).
Most treatment approaches will be based on CBT (cognitive behavioral therapy).
With a more complex phobia, the cognitive (thinking) aspect of treatment may be addressed in more depth.
The child may have developed shame or critical thinking styles in response to the phobia.
Common Phobias in Younger Children
So-called “simple phobias” in early childhood include fear of a specific object, fear of the dark and animal phobias such as fear of dogs.
Environmental fears such as natural disasters are also common. Children do not have the knowledge or experience to figure out the likelihood of their occurrence.
It’s natural for children to have these fears as the world can feel very scary when you are small, even if you have not had a traumatic event related to the phobia.
If children have had a traumatic experience related to their specific fear, then this object or experience will have been marked by their brain as dangerous. The child will naturally try to avoid repeating the experience.
This creates a vicious cycle, because they never have a chance to see that the feared object or experience is actually okay.
Case Study: James
James, age 8, had a dog run up to him and bark ferociously when he was 5.
In order to avoid exposure to the feared situation again, James’ brain is now powerfully driven to avoid dogs and in fact, to be wary of all animals.
James does not like walking along the street in case he meets a dog, and refuses to go to the park.
This means that James never gets to meet any friendly dogs.
His brain continues to think that all dogs are dangerous and that he must avoid open spaces at all costs.
James’ traumatic experience of a dog has generalised not only to all animals, but to a fear of open spaces.
Common Childhood Phobias in Older Children and Teens
As children get older and demands on them increase from early adolescence, common specific phobias often reflect a sense of increased responsibility or independence.
Social phobia is common in the teenage years, as social nuances and required skills become more and more complex. It is sometimes referred to as social anxiety disorder.
Related to this are similar common phobias such as fear of public speaking or fear of certain social settings – such as large and noisy environments.
Even everyday social situations can cause regular fear or panic.
Coping with such regular emotional responses can be exhausting and overwhelming for young people.
School phobia (sometimes called school refusal or EBSA – emotionally-based school avoidance) is exceptionally common.
It has become even more common since the pandemic.
School life is so demanding, and school phobias are often considered complex phobias because they are caused by a number of factors. These might include academic demands, bullying, social pressure or sensory overwhelm.
Child Phobia Treatment
You should seek professional help if your child’s quality of life and normal activities have become affected by their extreme anxiety.
For example, if your child has a fear of birds and will not leave the house, you need expert support from a child psychologist or a similar professional.
If everyday activities that your child used to enjoy in normal life are no longer possible for them, this should be a red flag.
Phobias can also be debilitating for family members of the affected child. I have worked with many families who have not been able to go out as a family or engage in regular daily activities because of a child’s phobias.
Others find that the quality of family life is severely affected and many parents feel that siblings without the phobia end up being left out.
Child Phobia Treatment Steps
The first step in treating childhood phobias is a thorough assessment to understand what the problem is, when it started and how often it occurs.
The psychologist will then develop a “formulation” (bringing together all the bits of information a bit like a detective), and developing an action plan.
CBT for Childhood Phobias
The psychologist will work with your child (and usually parents as well) and will most commonly use CBT (cognitive-behavioral therapy).
CBT involves gradually exposing your child to the feared object or scenario in a graded and carefully planned manner. This needs to go at your child’s pace, so that we avoid re-traumatizing them.
Often the psychologist will work with your child to design a “hierarchy” or step-ladder, starting with the easiest step and moving slowly upwards.
This part of the treatment is often referred to as exposure therapy. However, exposure should never move too fast for the child as this can make the situation worse.
For this reason it should be carefully managed by a mental health professional.
Here’s a quick video I created about graded exposure.
Older children will also learn to identify their anxious thoughts.
They then begin to develop skills an adapting the thought to make it more accurate or helpful.
Children can also learn how to disengage from a thought or how not to engage with it in the first place.
Children may overcome their phobia in just 1-4 sessions, but the average is probably around 6-12.
In severe cases a child may require many more therapy sessions.
Childhood Phobias: Other Treatment Options
In extreme cases of severe anxiety, a doctor may prescribe children with selective serotonin reuptake inhibitors (SSRIs).
These medicines are anti-depressants but are sometimes used to treat anxiety.
It is rare for SSRIs to be prescribed for children in the UK and almost unheard of for young children. It is much more common in the USA and certain other countries.
This is particularly the case for simple phobias – single phobias – as CBT is such an effective treatment in these cases.
Medications should never be the first strategy for treatment of phobias.
They can have unwanted side effects and they do not solve the underlying cause.
How to Access Child Phobia Treatment
If you do decide to seek therapeutic support for your child’s phobia, contact your doctor or healthcare provider.
In the UK, getting support via the NHS can be tricky given current lengthy waiting lists, but do speak to your child’s GP. You can also find independent clinical psychologists or counselling psychologists who can help through ACHiPPP (the association for child psychologists in private practice).
Phobias in Children: Supporting Your Child at Home
While you are waiting for professional support (or if you decide it isn’t needed at the moment) I recommend the following:
- Try not to get angry with your child about their fear. This risks creating self-criticism and shame.
- The fear is not rational, so trying to rationalise won’t work.
- Instead, look for opportunities – when your child is in a positive state of mind – to gently challenge the fear. Take baby steps. For example if your child is terrified of dogs, you could park near a park and watch some dogs go by at a distance. Your child feels safe in the care but they have taken a tiny step to approach, rather than avoid, the fear.
- Repeat this step (or similar steps) as often as you can. You should see your child’s anxiety start to reduce.
- If you take a baby step and it doesn’t work out, don’t worry. Try again another day. Don’t put pressure on your child.
- When taking steps outside your child’s comfort zone, ask your child to rate their anxiety out of 10. If anxiety is above a 7, then the step is too big. You risk triggering a panic attack. Take a step back and make a less ambitious plan.
- If your child’s anxiety rises too high and they start to panic, keep calm and stay with them, reassuring them that it will pass. You can read more about what to do here.
- If your child has regular panic attacks, you will need a plan. When your child is calm, make a plan together so that you know what works for them.
Related Articles
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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.
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