How parents can recognize and help a child with anxiety

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Anxiety disorders are the most common mental health concern in children. The rates of children with anxiety have been growing dramatically. In 2021, a meta-analysis (translation: a study that combines data from all previous studies) found that 20.5% of children worldwide have symptoms of anxiety.

This post will help parents address many of your common questions on anxiety, including:

• How do you know if your child has anxiety?
• What are the common anxiety disorders in children?
• Is your child’s anxiety your “fault” as a parent?
• What can you do to help your child?
• When and how should you seek professional help for your child?

How do you know if your child has anxiety?

It is very normal for children to have fears that seem irrational or out of proportion to the danger actually posed, such as being afraid of the dark or worried about their parents leaving. However, most children seem to outgrow these fears with age and/or the fears do not interfere with the child’s ability to make friends, go to school, sleep or engage in other activities that are important to the child and the family. Parents should be concerned if the fear or anxiety does not seem typical for their age or if it starts to interfere with important activities for your child, such as sleep, school or important family activities.

Children with anxiety may show some of the following symptoms:

• Complaining of stomach or head problems
• Difficulty falling or staying asleep
• Difficulty concentrating
• Seeming overly tired or on edge
• Excessive worrying
• Avoiding certain things or activities
• Irritability or being more prone to anger

It is also important to note that anxiety can look different in children than in adults. For children, it is common that anxiety involves physical complaints (stomachache, headache or being tired or unable to sleep) or looks more like irritability and anger than nervousness. Young children also may not be able to describe their anxious thoughts or even accept that their thoughts are irrational or unreasonable. Older children may know their thoughts are unreasonable but not be able to control them or still feel anxious.

Anxiety in children can include any of the following diagnoses:

1. Generalized anxiety disorder: Children with generalized anxiety disorder show a general pattern of anxiety that is not specific to a particular object or event. They worry constantly about a variety of topics and show physical signs of anxiety, such as stomaches or a racing heart). Their anxiety is so distressing that it interferes with school and other activities.
2. Separation anxiety disorder: Most children don’t like being separated from their primary caregivers but children with separation anxiety disorder show an extreme response to separation that is more intense or lasts longer than other children their age. They may refuse separation or worry that something may happen to the caregiver while they are away.
3. Social anxiety disorder: Children with social anxiety disorder are very afraid of social situations. Older children may be very worried about being judged or viewed negatively by others. This could result in school avoidance or avoiding other types of social situations.
4. Panic disorder: Panic disorder is diagnosed when children have regular, unpredictable panic attacks and have a persistent worry about having another one. A panic attack may involve a sudden feeling of heart pounding, trouble breathing, dizziness or feeling shaky and sweaty.
5. Specific phobias: A specific phobia is strong fear about a particular situation or object. These fears are so intense that they cause extreme distress and/or stop the child from going places or doing things they want to do. Common examples include going to the doctor or dentist, dogs, thunderstorms and vomit.
6. Selective mutism: Selective mutism occurs when children have trouble talking or refuse to talk in situations that are new or uncomfortable for them. They do not have trouble communicating with familiar people in familiar situations but they only have trouble talking in anxiety-provoking situations.

Is your child’s anxiety your “fault” as a parent?

A meta-analysis (translation: a study which combines data from all previous studies on the topic) found that only 4% of the variance in child anxiety is related to parenting. This means that most cases of childhood anxiety are not caused or made worse by parenting. For most children, there is nothing you did or did not do to cause your child’s anxiety.

However, just because parenting is unlikely to have caused anxiety, it does not mean that there is nothing you can do to help your child learn how to cope with anxiety or reduce their experience of anxiety.

What can I do to help my child?

Research finds that parents may play a clear role in helping their child to cope with anxiety. In fact, a recent study found that training parents in effective ways to manage their child’s anxiety was just as effective in reducing anxiety symptoms as direct child therapy.

So what can you do to help your anxious child, according to research?

1. Explain what anxiety is and take away the shame: Explain to your child that there is nothing wrong with them and that anxiety itself is not “bad”— anxiety is there to protect them. You can describe their brain as being more likely to have “false alarms” meaning their brain is telling them there is danger when really they are safe. Explain that this happens to everyone and maybe even give an example of when it happened to you as a child or an adult.
2. When your child is anxious, avoid any “accommodating behaviors”: Be careful not to provide too much reassurance or help the child to avoid what makes them anxious. These are called “accommodating behaviors” by psychologists. Many well-intentioned parents of anxious children get in the pattern of shielding their child or avoiding anything that might trigger anxiety. Yet, we know from research that avoiding anxiety-provoking events only makes anxiety worse and keeps the child reliant on their parents coping with the situation for them so they don’t learn skills for coping with their anxiety independently. It also reinforces that the situation is something they should be afraid of (since even their parents seem worried) and communicates to children that they are not capable of handling it on their own. Examples can include always speaking for a shy child, answering repetitive questions when a child is worried about something or avoiding events that might make your child anxious.
3. Validate and empathize with anxiety: At the same time, parents also do not want to ignore or invalidate their child’s anxiety. They should acknowledge that the child’s anxiety is “real” and is difficult for them, even if it seems irrational to the parent. For example: “I can tell that was really scary for you.”
4. Encourage children to face their fears: After acknowledging and empathizing with their child’s anxiety, parents should then encourage them to gradually and gently face their fears. Parents should work with their children to take “baby steps” to facing their fears. For example: “This really makes you feel nervous but I know you can handle it.”
5. Praise any “brave” behavior: When children successfully face their fears or even when they take a “baby step” toward facing their fears, parents should give children a lot of praise and positive attention. When doing this, parents should acknowledge that the child was anxious and that it was very difficult but they did it anyway, rather than invalidating their experience with something like “See, that wasn’t so bad!”
6. Help your child learn to tolerate uncertainty: Many children and adults with anxiety will try to avoid anxiety by reducing uncertainty in their environment. Help your child to face uncertainty and learn to tolerate uncertainty by gradually exposing them to more uncertainty in their environment. This could include not answering repetitive questions, packing them a slightly different snack every day, trying out new activities even if they are nervous, driving a different way to school or changing the order of a routine.
7. Encourage your child’s independence and ability to make choices on their own: Allow your child the freedom to make mistakes, take risks and even make the “wrong” decision. Research finds that parents who are overly controlling are more likely to have a child with anxiety. Although this parenting practice could reflect the parents’ anxiety themselves, it also makes sense that this behavior may hurt children’s confidence.

When and how do I seek professional help?

Although parents can certainly help their children to cope with anxiety, it is also important to seek professional help when needed for childhood anxiety.

How do you know if you need to seek help? Parents should seek help for any of the following reasons:

• Their child’s anxiety seems to be interfering with important functions such as sleep, eating, school or activities that they used to enjoy
• The strategies they are trying to manage their child’s anxiety don’t seem to be helping or are making the anxiety worse
• The child has been exposed to a traumatic situation which is causing anxiety
• The child’s anxiety seems to be getting worse over time

If you do think your child needs professional help, ask your pediatrician or school counselor for a referral to a psychologist, doctor or other mental health professional. They may conduct an evaluation, which will likely involve some questionnaires and talking to you and your child about their symptoms. After the evaluation, you will be told whether your child meets criteria for an anxiety disorder and what your treatment options might be.

Therapy and medication are very effective for treating childhood anxiety. In particular, a type of therapy called Cognitive Behavioral Therapy (CBT) helps most children with anxiety show improvement in symptoms. Research also finds that therapy with “in-session exposure” (translation: exposing children to what makes them anxious during the therapy session) may help to improve anxiety symptoms. Parents can ask providers whether they have been trained in CBT and use exposure in their sessions in order to determine if their approach is backed by research.

Cara Goodwin, PhD, is a licensed psychologist, a mother of four and the founder of Parenting Translator, a nonprofit newsletter that turns scientific research into information that is accurate, relevant and useful for parents.