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A guide to understanding anxiety in children

By Dr Hayley van Zwanenberg, Child and Adolescent Psychiatrist at Priory Group

Anxiety disorders are amongst the most common mental health issues seen in young people.

A child can feel anxious at different times as they grow up. They may worry about sleeping in the dark and having nightmares, or feel anxious about starting school, doing tests or completing their homework.

If you are concerned that a child’s anxiety is starting to have an effect on their ability to function and enjoy life, we have outlined ways that you can support them so that they can overcome their worries.

We will help you to understand how anxiety starts in a young person, how it may present, and how you can help them recover. We will also look at how to talk to a child about anxiety to help them get a better understanding of what they are going through.

Why do children get symptoms of anxiety?

Our bodies have an instinctive survival response from over 50,000 years ago, when we might have been exposed to daily threats.

When we see something life-threatening, we tell our brains something frightening is happening, so that our body can get ready to run.  Our body prepares to react by doing the following:

  • Pumping blood to important parts of our body– more blood moves to our heart and lungs. This causes our heart to beat faster and our breathing to quicken so that more oxygen can get to our muscles, meaning that we are ready to run fast
  • ‘Brain fog’ – we aren’t able to think clearly as blood moves away from the areas of the brain we use to think, as we need to focus on getting away
  • Nausea and/or butterflies - we stop digesting food, as we don’t need to during that moment. We might get butterflies as a result, feel slightly sick or even be sick
  • Perspiration - we start to sweat due to all these changes

These changes can save our lives in a life threatening situation, as they help us to react quickly and run away.

A child with anxiety may experience all these symptoms, when a danger isn’t present. For example, they may get these feelings at the thought of starting the school day, going to the playground, attending birthday parties, getting lost or losing a parent.

When this happens, they may want to avoid the place or situation that makes them feel this, as they believe something scary will happen.

What symptoms will a child have when they are anxious?

A child will experience physical symptoms of anxiety such as the following:

  1. Their heart beating faster, breathing quickening, butterflies in their stomach, feeling sick, being unable to think clearly and sweating
  2. They may try and avoid doing things or going to certain places as they feel unsafe
  3. They may lie awake at night worrying
  4. They may start wetting the bed or having bad dreams
  5. They may become more irritable, tearful or clingy

What can you do to help?

We have created a series of illustrations to help you explain to a child why anxiety can happen, when it can happen and what they can do if they do feel anxious.

The illustrations can help a child to recognise what is happening to them and understand why they may be feeling a certain way. They can also help you to reaffirm to the child that they are not alone and always have you to turn to.

When going through the images with the child, also make time for the following:   

  • Explain why they’re feeling this way

Be empathetic towards the child’s feelings. Listen to why they’re anxious, and explain to them that their body is made to protect them against dangers, but that they are seeing dangers where they do not exist.  Understanding this can help a child to stay calm when they start to feel the physical symptoms of anxiety.

  • Express confidence that they’ll be okay, with examples from the past

Let the child know that you think they’ll be fine in a situation that they want to avoid. Give them examples of times they have managed well in the past. For example, tell them about the time they went into pre-school knowing no-one but let go of your hand, waved, and enjoyed the day. 

  • Give them evidence as to why they’ll be okay

Give the child lots of evidence against their worry. You will need to feed this to them as they are likely to block out such evidence when anxious, as they pile up their worries instead. For example, when they hear something negative on social media, the news or from a neighbour, show them the other side of the story.  People often focus on gossip and bad news, so balance this with good news.

  • Don’t let them avoid what makes then anxious

Where possible, do not let a child avoid situations that worry them.  If they stop doing something or going somewhere that makes them anxious, they don’t have an opportunity to see that they can actually cope. Their negative connotation of a situation is reinforced and will simply grow as they continue to avoid it.

Are anxiety disorders treatable?

Anxiety disorders are very treatable. The earlier that a child’s receives the correct treatment, the easier it is to manage and ultimately recover from.

People often hope that childhood anxiety will just go away but it tends to grow. Treatment will teach a child helpful skills for life. If they find worries popping up in the future, they will have a ‘toolbox’ to help them to tackle each concern at a time.

At Priory, we can offer education about anxiety to a young person and their family, which may be through family therapy. Family therapy can help everyone’s strengths come to the fore to assist the young person to recover and remain well. We can also offer individual therapy to teach the young person skills to manage their worries; this may be in the form of cognitive behavioural therapy (CBT).

If necessary, we can offer medication prescribed by specialist child and adolescent psychiatrists, who will also help to monitor the young person’s medication, mental health and risks.

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