How To Help A Child Struggling With Anxiety

By Cory Turner| October 29, 2019

"Childhood anxiety is one of the most important mental health challenges of our time. One in five children will experience some kind of clinical-level anxiety by the time they reach adolescence, according to Danny Pine, a child and adolescent psychiatrist at the National Institute of Mental Health and one of the world's top anxiety researchers. Pine says that for most kids, these feelings of worry won't last, but for some, they will — especially if those children don't get help.

Here are six takeaways that all parents, caregivers and teachers can add to their anxiety toolkits, including information on how anxiety works, how parents can spot it and how to know when it's time to get professional help.

1. Anxiety is a fear of the future and all its unpredictability.

"The main thing to know about anxiety is that it involves some level of perception about danger," says Pine, and it thrives on unpredictability. The mind of an anxious child is often on the lookout for some future threat, locked in a state of exhausting vigilance.

We all have some of this hard-wired worry, because we need it. Pine says it's one of the reasons we humans have managed to survive as long as we have. "Young children are naturally afraid of strangers. That's an adaptive thing. They're afraid of separation."

Full-blown anxiety happens when these common fears get amplified — as if someone turned up the volume — and they last longer than they're supposed to. Pine says separation anxiety is quite common at age 3, 4 or 5, but it can be a sign of anxiety if it strikes at age 8 or 9. According to research, 11 is the median age for the onset of all anxiety disorders.

A bundle of factors contributes to a child's likelihood of developing anxiety. Roughly a third to half of the risk is genetic. But environmental factors also play a big part. Exposure to stress, including discord at home, poverty and neighborhood violence, can all lead to anxiety. Research has shown that women are much more likely than men to be diagnosed with an anxiety disorder over their lifetime and that anxiety, as common as it is, appears to be vastly underdiagnosed and undertreated.

That's why it's important for parents, caregivers and teachers to spot it early. Be on the lookout for how long anxious feelings last. A few weeks, Pine says, usually isn't a cause for concern. "It's really when it goes into the one- to two-month range — that's where parents should really start ... worrying about it."

Here's another red flag: "Are there things that the child really wants to do or needs to be doing, and they can't do those things?" asks Krystal Lewis, a colleague of Pine's and a clinical researcher at the National Institute of Mental Health who provides therapy to anxious children. "If you feel you're hitting a wall in terms of trying to get the child to do those things, that might be another indicator that potentially, you know, we should get some help."

We all have some of this hard-wired worry, because we need it. Pine says it's one of the reasons we humans have managed to survive as long as we have. "Young children are naturally afraid of strangers. That's an adaptive thing. They're afraid of separation."

Full-blown anxiety happens when these common fears get amplified — as if someone turned up the volume — and they last longer than they're supposed to. Pine says separation anxiety is quite common at age 3, 4 or 5, but it can be a sign of anxiety if it strikes at age 8 or 9. According to research, 11 is the median age for the onset of all anxiety disorders.

A bundle of factors contributes to a child's likelihood of developing anxiety. Roughly a third to half of the risk is genetic. But environmental factors also play a big part. Exposure to stress, including discord at home, poverty and neighborhood violence, can all lead to anxiety. Research has shown that women are much more likely than men to be diagnosed with an anxiety disorder over their lifetime and that anxiety, as common as it is, appears to be vastly underdiagnosed and undertreated.

That's why it's important for parents, caregivers and teachers to spot it early. Be on the lookout for how long anxious feelings last. A few weeks, Pine says, usually isn't a cause for concern. "It's really when it goes into the one- to two-month range — that's where parents should really start ... worrying about it."
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Here's another red flag: "Are there things that the child really wants to do or needs to be doing, and they can't do those things?" asks Krystal Lewis, a colleague of Pine's and a clinical researcher at the National Institute of Mental Health who provides therapy to anxious children. "If you feel you're hitting a wall in terms of trying to get the child to do those things, that might be another indicator that potentially, you know, we should get some help."

​2. Be on the lookout for the physical signs of anxiety.

The worried feelings that come with anxiety can seem hidden to everyone but the child trapped in the turbulence. That's why it's especially important for grown-ups to pay close attention to a child's behavior and to look for the telltale signs of anxiety in children.

Anna, of Brampton, England, remembers when her 7-year-old son started having trouble at school. (We aren't using parents' full names to protect their children's privacy.)

"He was just coming home and saying his stomach hurt. He was very sick," Anna says. When she followed up with him to try to get to the root of his stomachache, she says, "he did tell me he was worried about school, and he told me specifically it was a teacher that he was worried about."

A stomachache, headache or vomiting can all signal anxious feelings, especially as a child gets closer to the source of the anxiety.

"You'll see that they'll have a rapid heartbeat. They'll get clammy, you know, because their heart is racing," says Rosemarie Truglio, the head of curriculum and content at Sesame Workshop. "They'll become tearful. That's another sign. ... Anxiety is about what's going to be happening in the future. So there's a lot of spinning in their head, which they're not able to articulate."

It's near this point of panic that Pine says a child's anxiety is most visible: "So you can see it in their face. There is a certain way the eyes might look. You can see it in behavior in general. People tend to either freeze, be inhibited not to do things when they're anxious, or they can get quite upset. They can pace. They might run away."

Rachel, of Belgrade, Mont., says her 6-year-old son really doesn't want to swim or go to their local splash park.

"He just says there's too many kids in there. And he cries, and I've tried to go early in the morning when there's no one there. I mean, I've lost count of how many times we've driven by just to see if I could get him out of the car and he won't. And I'm not going to drag him."
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We heard this from so many parents: My child is terrified to do something that I know won't hurt them, that they might actually enjoy. What do I do?"

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