When Your Child's Anxiety Is Worth Worrying About — and How to Help

We all have anxious moments — and it’s normal and healthy for kids to have some age-appropriate worries about how they’ll do on tomorrow’s test or why they weren’t invited to the party their other friends were. Learning coping skills for those moments is a key life skill.

Sometimes, those worries cross the line into something a little more serious: anxiety. Especially in the wake of all the changes wrought by COVID-19, anxiety among children and adults has skyrocketed. Fortunately, if your child has anxiety, there are numerous ways to help them learn to manage it.

What does anxiety look like in children?

The first step in helping your child is identifying the issue. Children often can’t articulate when (or why) they feel anxious; anxiety in children can look different from adults — and kids at different ages will have different indicators as well.

Some things to watch for that could indicate a younger child is having anxious thoughts include:

• irritability
• avoiding specific places or activities (for example: they may want to skip school or not want to play outside)
• needing significant reassurance from their parent/caregiver or not wanting to separate from them
• physical symptoms such as recurring headaches or upset stomachs, especially if it tends to happen in relation to a specific situation that could cause worry

Older kids are more likely to be able express when/why they feel anxious, but you could still see some indicators of anxiety, such as irritability, physical symptoms, shakiness or having trouble concentrating — which can be mistaken for ADHD.

Changes to a child’s schedule — even “good” things like going on vacation or moving up to the next grade — can create some anxiety for kids.

If you think your child is showing signs of anxiety, you’ll want to learn more about what they’re thinking and feeling. For younger kids, it can be helpful to use words like “being worried” or “scared” that will be more meaningful to them and are more likely to garner useful information about what’s bothering them.

If anything, noted Consuelo C. Cagande, MD, of CHOP’s Department of Child and Adolescent Psychiatry and Behavioral Sciences, it might be a little easier now to talk to kids about anxiety. “We virtually all had anxiety together during the pandemic,” she noted. “It’s almost become the new normal to talk about. We’re all a little more vigilant about it, but you also don’t want to hover over them or ask them if they feel this or that after a stressful situation. Just be aware and monitor your child and any changes.”

Teach them coping mechanisms

For lower level, more “everyday” anxiety, parents and caregivers have a lot of options for helping children learn to recognize their anxiety and find their own ways to calm themselves. Naline Lai, MD, a pediatrician at CHOP Primary Care, Doylestown, and John Grove, LCSW, therapist with CHOP Healthy Minds Healthy Kids Program, offered the following techniques to share with kids.

1. Set the stage. Children tend to mirror their parents’ feelings. You can help reduce their anxiety by cheering them on for their math exam or acknowledging that getting a shot isn’t fun but will keep them from getting sick later.
2. Create opportunities for communication. It’s especially helpful for tweens and teens to have special time set aside to spend with their parent. This can be as simple as a standing monthly or weekly “date” to engage in an activity you both enjoy. And then don’t bring up any potentially anxiety-provoking topics. The goal is to give your child some supportive, nonjudgmental time with you so that they can open up to you when they need to.
3. Rehearse and role play. If your child is anticipating having trouble in a specific situation, help them visualize what to expect and how they can respond. For example, if they’re going to overnight camp for the first time, look at pictures or visit the site, have them make a packing list and rehearse things like their bedtime routine.
   The rehearsal technique can also be used to minimize worrisome thoughts. Dr. Lai suggested finding a time when the child is calm to play the following game. First, attribute an untrue but worrisome thought to a “worry bully” played by the parent; the child will chase away the bully with a positive affirmation.
   Example: The “bully” might say, “No matter what you do, you’re going to fail the test.” In response, the child could say, “If I work hard, it'll make a difference. And even if I get a bad grade, I’ll be OK.” Then have your child tell the worry bully to get out.
4. Share self-calming techniques. Deep breathing techniques such as belly breathing (you can find many more online) can be done virtually anywhere and can help kids calm themselves — and gain confidence from knowing that they have the power to do so.

Another version of self-calming, called grounding is particularly helpful if your child is prone to panic. One effective and easy-to-remember grounding method is to have a child name five things they can see, four things they can touch, three things they hear, two things they can smell and one thing they can taste. The process of focusing on their sensations helps center children and reduce their immediate anxiety.

When to worry about their worries

Anxiety can be a normal reaction to certain circumstances. An acute moment of anxiety in one stressful situation isn’t something to be concerned about. And your child might not have anxious symptoms even during more chronically stressful times.

But sometimes common, everyday anxiety becomes something a little more troublesome. “When it impairs their functioning, we start to be concerned,” says Dr. Cagande. For children, that could mean frequently missing school, failing grades, avoiding social activities or not wanting to leave the house, etc. “Taking a ‘mental health day’ from school isn’t impairment — missing two weeks without a medical reason would be,” Dr. Cagande said.

She advised that if parents see this kind of behavior in a child that goes on for even a few weeks, it may be time to see a mental health professional. A good first step is to see your child’s primary care pediatrician to rule out any medical issues that might be affecting their mental health and, if needed, to get a recommendation for a therapist.

What to expect during treatment

For many children with anxiety, the symptoms are relatively mild, and they may benefit from therapy alone. For children who are more severely impaired by their anxiety, medication combined with therapy is the best option.

Let’s face it: Not all parents love the idea of seeking mental health care for their kids. They may worry about being stigmatized or have concerns about taking medication. It’s a typical concern, but one that Dr. Cagande said was based on misconceptions.

“One idea we promote is that mental health is health. It’s part of routine care to ask about it,” says Dr. Cagande. “Mental illness is common, especially in kids, and the pandemic has only amplified this. Anxiety and other mental health issues are illnesses that can be treated with medications or lifestyle changes just like asthma or diabetes.”

For your child’s overall good health, helping them take care of their mind and body are equally important.