Your Child’s Anxiety: When to Worry, When to Relax: Talk to pediatrician if fears are constant, unreasonable

September 2019

Cleveland Clinic Health Essentials

Everyone, including children, has bouts of anxiety once in a while. But when constant fears and anxieties disrupt your child’s day-to-day life, that’s a cause for concern.

Kids of all ages experience fears and worry. For example, your infant may cry when a stranger picks him up. Your toddler may have a fear of clowns or other people in costumes. An elementary school-aged child might complain of a stomach ache on the first day at a new school.

These are all normal fears for children. But some children experience a much higher level of anxiety than others.


When should you worry about your child’s worries?

“The difference between normal anxiety and an actual anxiety disorder involves severity,” says psychologist Amy Lee, PhD. “Having fears and worrying is a natural reaction to stressful or new situations for children, but it’s when the anxiety grows out of proportion that it becomes a real problem.”

Normal childhood anxieties come and go, she says.

Loud noises, new people, new places and fearful experiences can elicit a fear-and-anxiety response from your child that’s quite normal.

Pre-teens and teens sometimes have performance-related anxieties. They may worry about upcoming exams or giving a presentation in front of the class. Older children are more likely to express their anxiety. When they cope with situational anxiety or stress, parents may find that offering support and encouragement helps a great deal.

However, for some children, these approaches just do not seem to help, and they may even bring about an opposite response of increased distress in the child. Pay attention to the effect your responses have on your child to gauge how effective or beneficial it is.


What if your anxious children just can’t relax?

Kids prone to unhealthy anxiety have unrealistic fears. They may move from one area of worry to another as they get older, Dr. Lee says.

For example:

  • Toddlers may move from intense separation anxiety to anxiety over going to elementary school and meeting new children. Then, when the child reaches the teen years, the worry will focus on still another area of life.
  • A young child who has a fear that something bad might happen to her parent may have trouble with falling asleep or separating even past the toddler years.
  • If your child has unrealistic worries about becoming ill or about germs, he may wash his hands excessively or constantly ask you for reassurance that he won’t get sick.

These fears are often crippling. They sometimes include extreme fear of insects, water, darkness, clowns, or just about anything else, Dr. Lee says.

Some children suffer from generalized anxiety disorder(GAD). Teens with GAD may focus their anxiety on performance-related fears that cannot be quelled by a parent’s reassurance and rational discussion. These worries can drive them to extreme study or practice habits or heroic attempts to avoid social situations.

Other children may have an intense fear that they will not or cannot satisfactorily meet the expectations of others and constantly seek reassurance in an attempt to dispel their fears. They may excessively ask questions like: Will we get there on time? Do you think I’ll get into a good college? What if I can’t fall asleep and it makes me too tired for the exam?


Some children can’t function or may ‘worry themselves sick’

Unhealthy and consistently high levels of anxiety can lead your child to experience real physical repercussions, such as fatigue, stomach issues, headaches and even rashes. They may throw tantrums or devise other ploys to avoid things that trigger their distress.

Dr. Lee says that children with a true anxiety disorder exhibit a lasting and consistent pattern of significant disruptions of life activities.

In other words, their anxieties are far out of proportion to any real and significant danger.

Younger children who become overwhelmed with anxiety typically don’t realize they have exaggerated or unrealistic worries. Even teens may not know how to express their fears and verify with a parent or other trusted adult that their anxiety is out of proportion to reality.

Anxiety becomes a problem when it disrupts the child’s normal activities.

If your child gets so bogged down in worry and anxiety that he can’t attend sports practices, join clubs, or go on play dates that signals a problem.

“Take note if your child begins to have major emotional outbursts and comes up with various physical complaints to get out of his or her typical activities. If these continue over a period of time and truly disrupt the child’s life, intervention might be warranted,” she says.


Getting help for your child’s anxiety

When a psychologist or other qualified clinician treats a child’s chronic anxiety, the goal typically isn’t to eliminate the anxiety altogether, but to help your child manage it. “The psychologist will teach your child specific coping skills and likely use a cognitive behavioral therapy approach during therapy sessions,” Dr. Lee says. Some of the tools for coping skills your child will learn may include:

  • Physical calming skills for children and parents to practice together to reduce physical reactions to anxiety and improve relaxation.
  • Thinking skills that teach your child to identify anxious thought patterns and errors in thinking, as well as strategies to change these anxious thoughts.
  • Tips for confronting discomfort or fear by taking small steps toward doing the opposite of the avoidance or fight reactions that often accompany anxiety.

The clinician will typically also work with the entire family so everyone has specific skills to help the child learn to cope with anxiety triggers and assist them in using the tools learned in therapy.

“Although it depends on the individual child, it can take anywhere from six to 10 therapy sessions to see a positive benefit and many times medication, on a temporary basis, is helpful as well,” Dr. Lee says.

If you feel your child’s fears and worries are out of the ordinary or if bouts of anxiety are consistently disrupting your teen’s daily life, discuss your concerns with your pediatrician.

If the pediatrician agrees that intervention may help, he or she can refer you to an experienced child therapist or psychologist.

This article originally appeared on July 2, 2019 in Cleveland Clinic Health Essentials,