Recognizing The Signs And Symptoms Of Anxiety In Children

Like adults, most children will experience some anxiety from time to time as a normal part of growth, development, and life. However, anxiety that escalates to a kind of excessive worry that interferes with daily functioning is not considered a normal part of childhood and may indicate an anxiety disorder. 

Learning to recognize the signs of these disorders in children—which can look different than the signs in adults—can help you know when it may be time to seek professional support for your child’s mental health. Read on for more information on how to spot symptoms of anxiety in a child’s behavior and what to do if you notice them.

Anxiety disorders in children: A brief overview

Again, anxiety is a normal human emotion in adults, young people, and children, particularly during transitional periods of life. However, a tendency to feel worried may represent a diagnosable disorder if the anxiety is persistent, excessive for the situation, and interferes with daily functioning.

Comorbidity, or having more than one mental health disorder simultaneously, is also fairly common in children with anxiety. The CDC reports that approximately one in three children with anxiety also experience another mental health concern, such as depression or behavioral problems. 

Childhood anxiety disorders are typically treated through talk therapy, occasionally in combination with medication—same as adults. Therapy in particular may help children learn to understand where their anxiety comes from and how to manage overwhelming feelings when they arise. 

What causes anxiety?

In children, anxiety is believed to be caused by a combination of biological and environmental factors. Stressful events in a child’s life like moving, the loss of someone close to them, or difficulties at school may trigger the onset of an anxiety disorder. However, life stress itself does not cause anxiety disorders. There may be a genetic component as well, and differences in brain structure, personality, and temperament could also play a role. Research into what exactly causes anxiety in both adults and children is ongoing. 

Recognizing anxiety symptoms in children

The symptoms of anxiety in children can sometimes be similar to the symptoms in adults, such as muscle tension and difficulty sleeping. However, some children could present with different symptoms, or they may internalize them completely, making them even harder to notice. Because a child’s cognitive functions are still developing, they may not be able to process intense feelings nor communicate them to their parents, caregivers, other family members, or teachers.  

So while anxiety symptoms can present differently in each child and at different ages, the following list includes some anxiety symptoms in children that are common: 

• Trouble sleeping
• Bad dreams
• Significant changes in appetite
• Frequent complaints of tummy aches, headaches, or generally feeling sick without an identifiable cause
• Actively avoiding certain situations
• Clingy behavior toward parents or caregivers
• Trouble concentrating in school
• Frequent or escalating tantrums or angry outbursts
• Easily triggered irritability
• Being tense and fidgety
• Self-consciousness
• Muscle tension or aches
• Self-injury or self-harm, particularly in older children/adolescents 

If you are experiencing suicidal thoughts or urges, call the National Suicide and Crisis Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support via the crisis lifeline is available 24/7.

Anxiety attacks in children: What to know

Some children with anxiety may also experience anxiety attacks as a symptom of their illness. Note that anxiety attacks are different from panic attacks, though a child with anxiety could have either or both. Both of these involve the intense experience of symptoms related to anxiety and both can significantly interfere with daily life. Signs of the two can be similar: extreme distress, a racing heartbeat, trouble breathing, shaking, and intense fear. However, the way they come about is usually different.

Anxiety attacks may occur as a result of consistent anxiety from specific stressors over a period of time that eventually bubbles to the surface. They often happen after the child has been anxious or stressed for quite some time. Panic attacks, however, may occur as a result of panic disorder and are harder to predict. They often happen unexpectedly, without warning or apparent cause.

If your child experiences panic attacks and/or anxiety attacks, it’s usually recommended that you speak with their doctor or a child psychologist or psychiatrist for treatment advice as needed and tips for supporting them through one. In general, however, speaking to them during calm times about what anxiety/panic attacks are and how they don’t represent real danger can be helpful. During an attack, you might guide them through grounding techniques or relaxation techniques to help them trigger the relaxation response.

Some types of childhood anxiety disorders

There are several different types of anxiety disorders that may affect children, from generalized anxiety disorder to specific phobias. Below, we’ll give a brief overview of a few of the most common to equip you with the knowledge to be able to recognize symptoms in your child.

Separation anxiety disorder

Separation anxiety disorder is when children experience intense worry or extreme fear when separated from their parents, caregivers, or another family member. While many little ones cry when being left at daycare or the child’s school, it usually ends within a few minutes once they’ve been distracted with a toy or a playmate. If the behavior often continues for hours after their parent leaves, however, the child may have separation anxiety disorder. 

Some other symptoms of separation anxiety disorder can include:

• Common anxiety symptoms like those listed above (muscle tension, persistent worry, etc.)
• Persistent fear or stress when separated from family members
• Refusal to sleep alone
• Repeated nightmares with separation themes
• Worry over caregivers becoming sick or dying
• Being fearful or reluctant to spend time alone
• Clingy behavior, even at home

Social anxiety disorder

Social anxiety disorder in children is more than feeling shy around new people, which is common. Instead, children living with social anxiety disorder may experience intense, debilitating fear or worry that they will be embarrassed, rejected, or ridiculed by others in social settings or social life. As a result, they will typically avoid events or tasks they need or want to do. Symptoms of social anxiety disorder in children can include:

• Common anxiety symptoms like those listed above (muscle tension, persistent worry, etc.)
• Intense avoidance of situations that require social performance
• Fear or anxiety related to school, public situations, new people, or conversations with unfamiliar people
• Shaking, sweating, or shortness of breath when thinking of or faced with social situations
• Showings signs of being upset long before the event they’re anxious about
• Worry about saying or doing something that may cause others to judge them

Generalized anxiety disorder (GAD)

Generalized anxiety disorder is characterized by excessive and uncontrollable worry about various events and situations. While occasional feelings of anxiety and fear are expected emotions, children with GAD tend to experience them in excess compared to their peers. Symptoms can include:

• Common anxiety symptoms like those listed above (muscle tension, persistent worry, etc.)
• Worry over unlikely future events, such as what happens if their caregivers die
• Fixation on past events
• Expecting the worst, even without clear cause for concern
• Extreme concern over performance in school and social situations
• Frequent restlessness, excess energy, or being on edge

Treating anxiety in children

If your child is experiencing the symptoms of an anxiety disorder, know that treatment is available. While anxiety disorders are some of the most common mental health conditions children can have, they are also some of the most treatable. 

Cognitive behavioral therapy (CBT), a form of talk therapy, is one of the most common and effective treatments used to help children and adults with anxiety. For children, CBT typically involves the therapist helping them identify the thoughts that cause anxious feelings and positively modifying these thoughts in a way that’s appropriate for their age. They may also teach them coping mechanisms like mindfulness techniques to help them manage anxiety symptoms when they do arise. In some cases, a healthcare provider may also recommend anti-anxiety medications.

How you can help your child with anxiety

Seeking the care of a local youth counseling service or a licensed mental health professional who specializes in child or adolescent psychiatry is typically the recommended next step if you notice symptoms of anxiety in your child. In addition, there are several tactics parents and caregivers can use at home to support their child, such as: 

• Personify the anxiety. Have your child give their anxiety a name to help your child feel and experience it as something external. Draw pictures of it, giving the anxiety a silly appearance. Then, name it out loud with your child when it arises, such as: “Is that big, mean cloud Shady telling you that the other kids don’t like you?”

• Prepare. If your child is feeling anxiety about an event coming up, you might take steps to help them feel more prepared. For example, you could visit the location beforehand so they can be familiar with the area or watch a video of the type of event you’ll be attending so they’ll know what to expect. If it will be loud, crowded, or their participation will be required, let them know ahead of time.

• Model coping mechanisms. Even if you don’t have an anxiety disorder yourself, you can model what it looks like to healthily cope with occasional anxiety or stress for your child. Remember, kids learn by example. For example, you could engage in deep breathing exercises, take a “time out,” or dance, wiggle, or stretch to release physical tension. 

• Talk about it. Foster open communication that allows your child to express their concerns to you. Talk openly and nonjudgmentally about their worries and help them work through them. Research suggests that having a judgmental attitude towards one’s thoughts and feelings is associated with anxiety and depression in adults, so teaching your child to avoid judgment through your own behaviors can be helpful.   

Seeking therapy for parenting stressors

Again, if you notice symptoms of anxiety or another mental health concern in your child, it’s recommended that you consult with a metal health care provider who specializes in working with children. If you find yourself needing extra support as you go through the potentially stressful process of supporting your child through a mental health challenge, you might consider exploring therapy for yourself as well. A therapist can offer you an outlet for expressing your thoughts and emotions. They can also equip you with coping mechanisms to help you manage the stressors of parenthood or caregiving.

If it seems challenging to fit in-person therapy appointments for yourself into your schedule, you might consider online therapy instead. With a platform like BetterHelp, you can get matched with a licensed therapist who you can meet with virtually from the comfort of home instead of having to travel to offices or treatment facilities. Online therapy is frequently less expensive and involves shorter wait times than treatment in the traditional setting, and flexible appointment formats can be especially helpful for busy parents. Research suggests that online and in-person therapy for adults can typically offer similar benefits.