What is anxiety in children?

Some fear and anxiety are a normal part of life. Anxiety or stress can help your child stay alert, motivated and safe.

Like many adults, children have fears that can come and go.

For a child, the world can seem scary — they will not understand everything that happens around them. This can cause anxiety. Some children can cope with unknowns better than others. Some children struggle to manage their fears, which can affect their lives.

If you are concerned about your child's fears or anxiety, you can find professional help.

What are normal anxieties and fears for my child's age?

It's normal for children to feel anxious about something new — this could include a new class or activity, or a new person.

It's also normal to fear something after a bad experience — a child might fear dogs after being bitten by one.

Some childhood fears only appear in certain situations. For example, your child might be afraid of a friend's dog, but not a lion at a zoo.

'Normal' anxiety in children is often short-lived and does not typically affect all their daily functioning.

One fear may disappear or replace another. For example, your child who was once afraid of the dark may now enjoy scary stories at sleepovers.

Your child's anxieties and fears will change as they get older. If your child's fear is common for their age, it's a good sign that it will resolve. While you shouldn't ignore 'normal' anxious feelings, you can consider them part of your child's normal development.

Babies and toddlers

Your baby may fear:

• strangers — they may cling to you when meeting someone they don't recognise
• loud noises — for example, they may visibly startle at the sound of a vacuum cleaner
• separation from you — they may become upset when you are out of sight

Like babies, toddlers may also become distressed or throw a tantrum if you leave them alone. This is because they do not yet understand why you've left, when you will come back or if you will come back. This is called separation anxiety.

Toddlers may also be anxious about perceived threats like toy snakes or spiders.

Preschool

At around preschool age, your child will develop more of an imagination. They might be afraid of imaginary things like monsters. They might be afraid of the dark or shadows.

School-age children

As your child gets older, they might develop fears about real-life things that could happen, such as:

• natural disasters
• injury
• illness
• death
• their parents divorcing

They might still have some fears of imaginary things such as monsters and ghosts.

School-age children may also develop generalised anxiety, where they worry about a lot of things. This might happen when they start school.

What are the symptoms of anxiety in children?

When your child is frightened or anxious, they may:

• want to avoid certain places or situations
• become clingy, impulsive or distracted
• need extra reassurance
• panic or have a tantrum
• cry easily or more than you would expect

A child can also develop physical symptoms because of their anxiety, such as:

• feeling sick or have 'butterflies' in their stomach
• headaches
• a fast heartbeat

How can I help my child overcome their fears?

If your child has anxiety, there are ways you can support them.

It is important to find a balance between supporting them, without being too overprotective. Being overprotective can teach your child that they aren't capable of doing things on their own.

You can support your child by:

• listening to their fears and not dismissing them
• letting them know it's normal to fear things
• helping them to understand and name their fear
• encouraging them, but not pressuring them, to face their fears
• helping them to develop skills to cope with their fears

Your support is important to prevent your child's anxiety from becoming severe. Supporting them will also help them gain confidence and build resilience.

Listen to your child's fears

As silly as a fear may seem to others, it feels real to your child.

Listen to your child's worries. Sometimes, just talking with your child about their fear can help them overcome it.

Being judgemental will not help your child. Being judgemental might mean saying something like 'Don't be ridiculous! There are no monsters in your wardrobe!' This may get your child to go to bed, but it won't remove their fear. They will feel unsupported.

Instead, try speaking to your child about their fears using facts and logic. You can say 'I checked in the wardrobe and there are no monsters in it'.

Your child may also worry about things that are real, such as death or things they see on the news. Talk about it with them openly and help them express their feelings.

Remind your child that it is OK to talk about how they are feeling.

Help your child understand their fear

You can help your child understand their fear by asking them how strong their feeling is.

Younger children can think about how 'full of fear' they are, with being full:

• 'up to my knees' as not so scared
• 'up to my stomach' as more frightened
• 'up to my head' as terrified

You can ask an older child to rate the intensity of the fear on a scale of 1 to 10, with 10 being the strongest.

If your child can rate fear, they may be able to see the fear as less intense than first imagined.

Help your child face their fears

Don't avoid your child's fears. This will just reinforce that the object of their worry should be feared and avoided. For example, if your child fears dogs, don't deliberately cross the road to avoid one.

If your child fears the dark, you can set up a night-light. This can help them learn that there is nothing in the dark that is going to hurt them.

Urge your child to have a go at experiencing new and scary things. Provide them with support and gentle encouragement, so that they are in control. You can act as a 'home base' for your child to return to after trying to approach their fear. You can be a role model — tell them about a time you felt scared but were able to manage or overcome your fear.

You can also help them break down their worries into smaller chunks. For example, if your child is scared of swimming, you can help them through these steps:

1. take them to watch other children swim
2. encourage them to touch the water, such as by dangling their feet in
3. help them feel comfortable in the shallow end, using floaties

You can also teach them some positive things to say to themselves when feeling anxious, such as:

• 'I can do this'
• 'It is OK to be afraid'
• 'I can be brave'

Another way you can encourage your child is to face your own fears. This will set a good example for your child. When you get anxious, say out loud 'I'm a bit scared of this, but I'm going to try it anyway'.

When your child tries something new or tries to face a fear, celebrate their effort with them and remind them that you are proud of them.

Teach your child coping strategies

You can teach your child some techniques to manage their anxiety:

• Encourage them to take slow, deep breaths — tell them to imagine that their lungs are balloons and let them slowly deflate (breathe out).
• Set aside a time to worry, rather than worrying all day.
• Tell them to imagine that they are floating on a cloud or lying on a beach, to help them relax.
• Teach them to be mindful — talking about things they can see, hear, smell and touch can help them to calm themselves.

Encourage them not to spend time worrying about the worst-case scenario. Instead, teach them how to plan for when things go wrong.

What if my child's anxiety becomes more serious?

If you think your child is struggling with fears and anxieties, there are some things to look out for. Different children will react to anxiety differently. They may:

• be upset and have tantrums often, sometimes for no clear reason
• struggle to concentrate, have nightmares or trouble sleeping
• show aggressive behaviour or struggle to get along with other children
• regularly avoid certain people, situations or places
• avoid family, friends or school, often with conflict or tantrums about going
• have a change in appetite
• have regular headaches and stomach aches

If your child has severe anxiety, they may experience panic attacks. Panic attacks cause symptoms like:

• a fast heartbeat
• a tight chest or chest pain
• light-headedness
• hot and cold flushes
• strong feelings of distress and discomfort

Signs that your child has an anxiety disorder include if:

• they seem to be constantly anxious and distressed
• they do not outgrow age-appropriate fears
• their anxiety lasts longer than 6 months
• their anxiety interferes with their daily life, such as with school, family or their friendships
• their fear seems more intense than the cause of their fear

Your child may need extra support.

What are the different types of childhood anxiety disorders?

There are several types of anxiety disorders that happen in children. Children with anxiety disorders often need extra support.

Generalised anxiety disorder

Generalised anxiety is when a child worries a lot about many things in everyday life such as:

• how good they are at school
• things they have done in the past
• speaking up or asking questions in class
• their popularity or if people like them
• tests and assignments
• if or when their parents will break up or die

If your child has generalised anxiety disorder, their worries may be:

• intense
• unrealistic
• overwhelming

They may find it difficult to concentrate.

Separation anxiety

When children have separation anxiety, they become distressed when they are away from you. This is common and normal in young children, especially when starting day-care. Often the distress settles quickly.

Separation anxiety usually lessens around school age. If your child has separation anxiety that significantly affects their life, especially as they get older, they may have separation anxiety disorder. Children with separation anxiety disorder may fear that:

• something will happen to you while you're away
• something will happen to them while you're away
• you will not come back

This can also make it difficult for them to go to school.

Social anxiety

Social anxiety disorder is like a severe kind of shyness. It can make your child worry that they will do or say something wrong and be criticised. If your child has a social anxiety disorder, they may feel very worried about talking to new people or participating in school.

They may have low self-confidence and find it hard to make friends.

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) can cause your child to have persistent unwanted thoughts. For example, they may think constantly about dirt and germs. This can lead them to wash their hands more often than necessary to avoid uncomfortable feelings about germs. This can impact their daily life.

Phobias

Some children develop phobias.

A phobia is a strong, irrational fear of a particular situation or thing. Your child's phobia may cause them to feel panic that's more intense than the thing they are afraid of. They will try to avoid the thing that causes their phobia.

In children, phobias are often about:

• dogs
• spiders
• the dark
• storms
• clowns
• heights
• injections

A phobia can be very difficult to tolerate, both for your child and those around them. It can be even more difficult if the cause of the phobia is hard to avoid such as social situations.

Post-traumatic stress disorder

Your child may develop post-traumatic stress disorder (PTSD) if they experience trauma. This could be after:

• violence or abuse
• something life-threatening happening to them or those they love
• distressing things happening repeatedly to them or those they love

A child with PTSD may have flashbacks to traumatising events, which can be stressful and intrusive. They may also:

• have trouble sleeping
• have difficulty concentrating
• struggle to manage their emotions

How is childhood anxiety diagnosed?

Your doctor or child health nurse can connect you with a mental health professional for children, such as a:

• counsellor
• psychologist
• paediatrician (children's doctor)

Mental health professionals can help diagnose the cause of your child's anxiety. They can also give you advice on how to manage it.

When should I see my doctor?

If you are concerned about your child or suspect they may have an anxiety disorder, contact your doctor or child health nurse.

How is childhood anxiety treated?

Treatment for severe anxiety usually involves cognitive behavioural therapy (talking therapy) and counselling. This helps your child to:

• understand what they are feeling
• change the way they think about their fears
• learn why it's important not to avoid fears
• learn tools to face their fears
• achieve their goals

Medicine can help with severe anxiety symptoms, but it is not usually recommended for young children.

Find out more about Australian mental health services on healthdirect.

Resources and support

You can read more about supporting children with anxiety on the Beyond Blue website. You can also chat with a counsellor online or by phone — 1300 22 4636.

The Brave Program is an interactive, online program for the prevention and treatment of childhood anxiety.

Kids Helpline offers counselling for children and parents over email, the web or by phone — 1800 55 1800.

If you or a young person you are caring for needs support, you can visit the ReachOut website.