In my clinic I get many children referred through with worry or anxiety. Sometimes this is in the realm of normal child brain development and sometimes it is something that needs looked into further...
Why do children get anxious?
Practically from birth, humans are capable of feeling a wide range of emotions from positive to negative.
Anxiety seems to stem from fear, one of the basic emotions. In many situations being fearful can be advantageous in terms of keeping a child out of harm’s way, almost an instinctive survival strategy. However, if it prevents your child availing of new experiences it can become maladaptive. If we think about a child’s brain development and how the growing child forms an understanding of the world around them, this can help us understand why anxiety happens.
Normal experiences and anxiety problems
Most children will go through phases of being scared or anxious; the most common examples include fear of animals, monsters and the dark. Some fears are part of normal development for instance, fear of darkness at two to four-years-old and fear of death at four to five-years-old. These fears often relate to the interplay of children’s vivid imaginations and distinguishing what is real from what is fantasy. Reassuringly children tend to grow out of these fears and they become less intense as time passes.
The more common anxiety disorders among children include separation anxiety disorder, specific or isolated phobias, and social phobias. Separation anxiety can normally occur from around six months old and the separation from parent or normal care giver can lead to problems with going to bed, parents leaving for work and going to nursery school. For it to be a disorder it should usually extend beyond the expected age period (pre-school years) and significantly impact the child's function.
A specific phobia is different and represents an extreme fear often leading to marked distress and avoidance of a situation. For example, if a child is frightened of dogs they may refuse to play outdoors, have disrupted sleep and can even get frightened at the mere mention of a dog, then this would represent a phobia. Social phobia, meanwhile, usually refers to fear and avoidance of being the focus of attention or behaving in a way that would cause embarrassment. In short, it is almost a severe form of shyness.
What causes anxiety in children?
Some children in their nature tend to worry more than others and this is often put down to temperament or the child’s individual character. Research also suggests genes causing an increased risk of anxiety disorders, in other words, that anxiety problems run in families. Remember that children can model parental reactions to situations – so if they see you reacting as scared or anxious they may be scared or anxious too. Stress in a child’s environment can also be implicated for example, distressing life events like parental ill-health, divorce, bullying, school issues, moving house and so on.
How can you tell if your child is anxious?
There are lots of parenting guides offering advice about children’s social and emotional development, sometimes these say different things and as a result parents can feel less ‘expert’ in managing an anxious child. In my experience the parent knows their child best and is usually able to pick up on subtle indicators that something is the matter. The fear emotion is often accompanied by tell-tale signs of anxiety in the child’s physical body including tummy ache or butterflies, feeling short of breath, feeling their heart beating fast in their chest, sweatiness and headaches. Additionally the child’s temperament may change and many parents experience their child as more clingy, short-tempered, agitated, crying or unable to sit still. Older children can sometimes articulate that they feel anxious but not know the specific reason.
What can you do if your child is anxious?
Firstly, a lot can be done without having to see a doctor or specialist. Don’t ignore the issue. Talk about it, remembering to keep the talk appropriate for your child’s stage of development. Sometimes we recommend stories to communicate information in a more fun and less intimidating way. Stories can also talk about things like monsters and ghosts which in stories are potentially less frightening. It is sometimes helpful to use storybooks to distinguish fantasy from reality – for example monsters exist in stories but not in the real world.
Think to yourself is there a recent event that may have caused your child to be anxious? If you can identify the trigger this is often the first step to sorting the problem. Always be mindful of your own behaviour and reactions to anxiety provoking situations or stress. Is it possible your child is modelling or picking up on that? If so try being more calm, relaxed and logical in your approach to a fearful situation thus setting an example for your child.
If you know your child tends to worry about certain things or events try normalising the emotion, in other words, that a certain amount of anxiety is okay. Give encouragement and reassurance when they manage their anxiety. Show that you are interested in helping, perhaps by trying simple relaxation techniques with them, like counting to ten or deep breathing.
In more severe cases you may wish to speak to your GP who, if necessary, may take the decision to refer your child for talking therapy with a counsellor or child mental health professional.
Dr Mark Rodgers is an award-winning Consultant Child and Adolescent Psychiatrist. If you have a question for Mark, or a suggestion for a topic which you would like to see covered in this magazine email email@example.com
The content of this column is for general information only. The information is not for diagnostic purposes and should not be treated as such. You must not rely on the information in this column as an alternative to medical advice from your GP or other professional healthcare provider. You must never disregard medical advice given to you personally or your child, or discontinue medical treatment because of information provided in this column.
Photo by Elaine Hill Photography