Anxiety Symptoms in Children

Children with anxiety may not exhibit symptoms in quite the same way as adults. For example, they may display anger or irritability in addition to fear and worry.

It's understandable that parents would worry about their child's anxiety, but it's important to know that some childhood anxiety is normal and expected. Still, some kids do have anxiety disorders. Fortunately, there are things that parents can do to help their kids get treatment and cope with feelings of anxiety.

Common Childhood Worries

There are a number of things that normally cause worry and anxiety for kids of different ages. New situations, challenging tasks, and even unfamiliar people can lead to fear and anxiety in children from time to time.

Other age-appropriate fears include:

• Stranger anxiety beginning at 7 to 9 months of age and resolving around age 3
• Fear of the dark, monsters, insects, and animals in preschoolers
• Fear of heights or storms in younger school-age children
• Worry about school and friends in older school-age children and teens

These childhood fears are normal and typically lessen on their own as a child grows older. It takes more than occasional anxiety, which can be normal, to indicate true symptoms of an anxiety disorder.

Signs and Symptoms in Children With Anxiety

As much as it is common to have occasional anxiety, it is also common for children to have anxiety disorders. While estimates of the prevalence vary, the Centers for Disease Control and Prevention (CDC) states that 7.1% of children between the ages of 3 and 17 have diagnosable anxiety.

Children with true anxiety symptoms may experience symptoms that include:

• Anger or aggression
• Avoiding certain situations
• Bedwetting
• Changes in appetite
• Fatigue
• Getting in trouble at school
• Headaches
• Irritability
• Muscle tension
• Nervous habits such as nail-biting
• Nightmares
• Refusing to go to school
• Restlessness
• Social withdrawal
• Stomach aches
• Trouble concentrating
• Trouble sleeping (insomnia)

The frequency and appearance of symptoms can vary depending on the nature of the anxiety. Some fears (such as social anxiety or a phobia) may be triggered by specific situations, objects, or settings. Other types of anxiety, such as generalized anxiety disorder or panic disorder, can lead to symptoms that occur with greater frequency.

Normal childhood fears that persist beyond the age where they are expected to fade (such as being afraid of the dark or being away from parents past the preschool age) are also a point of concern.

Types of Childhood Anxiety

Like adults, children can also have other anxiety disorders, which range from separation anxiety and obsessive-compulsive disorder (OCD) to panic attacks. Some signs of anxiety are easier to spot, but other anxiety disorders can be a little harder to detect.

Some of the different types of childhood anxiety include:

Separation Anxiety

Separation anxiety involves an exaggerated fear of being separated from parents and caregivers. This type of anxiety is common in young children but usually begins to abate once a child is around 3 or 4. Symptoms of separation anxiety are usually fairly easy to spot and involve refusing to go anywhere without the parent or caregiver, refusing to sleep alone, or refusing to go to school.

Generalized Anxiety Disorder

As part of a diagnosis of a generalized anxiety disorder (GAD), a child should have evidence of excessive fear and worry (which can appear as the symptoms above) for six months or more, and they should be triggered by more than one thing, such as being anxious about work, school, and friends.

Also, a child with a generalized anxiety disorder will have trouble controlling their feelings of worry and it will cause them distress and some kind of impairment. For example, they may be so irritable from not sleeping that they are having trouble keeping their friends or their grades are dropping because they can't concentrate.

Specific Phobias

In addition to a generalized anxiety disorder, children can have more specific phobias.​ They become anxious and worried, but only about very specific triggers, such as a thunderstorm, spiders, being left alone, or going in a swimming pool, etc.

Although these children may cry and may cling to their parents if they are around or think they will be around something they are really afraid of, fortunately, most kids outgrow this type of anxiety disorder.

Obsessive Compulsive Disorder

Children with OCD may have either recurrent intrusive thoughts (obsessions) about certain things often along with repetitive behaviors or mental acts (compulsions) that they perform, such as washing their hands a lot, checking things over and over, or repeating certain words or phrases to themselves in response to the obsessions.

Panic Attacks

Although uncommon in children, panic attacks are another type of anxiety disorder that does become more common in later teen years. In addition to intense fear or discomfort, the definition of a panic attack requires four or more of the following symptoms:

• A feeling of unreality (derealization) or being detached from oneself (depersonalization)
• Chest pain
• Chills or hot flashes
• Dizziness
• Feeling choked
• Fear of losing control
• Feeling short of breath
• Nausea or abdominal pain
• Numbness or tingling (paresthesias)
• Palpitations or a fast heart rate
• Sweating
• Shaking

Selective Mutism

Of all of the anxiety disorders in children, selective mutism is perhaps the one that is most commonly overlooked, as people think these children are just extremely shy. Children with selective mutism actually refuse to talk and may only talk to close family members at home. At school or in other situations, they often become anxious and very uncomfortable when they are expected to talk.

Help a Child With Anxiety

Fortunately, anxiety disorders are treatable conditions. If anxiety symptoms are interfering with your child's normal daily activities, talk to your child's pediatrician, a child psychologist, and/or a child psychiatrist. For school-age kids, a school guidance counselor can also offer support, advice, and a referral for further evaluation and treatment.

It is also important to note that just as with adult women, girls experience anxiety at about twice the rate as boys. Because anxiety tends to grow worse if left untreated, experts suggest that all girls age 13 and older should be screened for anxiety during routine health exams.

There are also things that parents can do at home to help children learn how to manage their feelings of anxiety. Tactics that may help:

• Don't avoid what your child fears. While this may offer short-term relief, using avoidance as a coping mechanism reinforces the anxiety and worsens it over time.
• Offer comfort and model positive responses. Listen to your child's concerns, but be careful not to reinforce these fears. Instead, help your child practice relaxation techniques while modeling appropriate, non-fearful responses to the source of your child's anxiety.
• Help your child learn to tolerate their fear. Allowing your child to be gradually exposed to the source of their fear while using relaxation techniques to calm their fear response can help them learn to tolerate distress and eventually learn that there is nothing to fear.

The ways that parents cope with anxiety can affect the way children deal with their fears. While parents should not pretend that they don't have anxiety, they should focus on showing kids that it is something that can be calmly tolerated and effectively managed.