Signs of anxiety in children

It is common for kids to feel anxious sometimes. But with the rise of mental health issues in children and nearly 1 in 3 adolescents being diagnosed with an anxiety disorder, it's important for parents to know what is normal, when to be concerned and how to provide their child with the support they need.

Adrienne Anderson, Ph.D., Pediatric Psychologist at Children's Health℠ and Assistant Professor at UT Southwestern, shares her advice on how to spot signs of anxiety in children and provide them with the support they need.

Signs and symptoms of anxiety in children

There are many signs and symptoms of anxiety. Some are mental and some are physical. Common symptoms of anxiety in kids can include:

• Difficulty breathing
• Avoiding certain people or situations
• Poor concentration
• Trouble sleeping
• Stomachaches
• Headaches
• Abdominal distress and nausea
• Irritability
• Muscle tension
• Restlessness
• Rapid heart rate

Causes of anxiety in children

Many things can contribute to the development of anxiety. However, kids who have a history of or experience any of the following may be more likely to develop an anxiety disorder:

• Family history. Children with a family history of mental health problems can increase the likelihood of mental health diagnoses including anxiety disorders. In addition, the way parents and other adults in a child's life react to stress can affect how anxious a child is.
• Life stressors. Life events, like a move, a divorce, or a big test can all cause increased anxiety, which may or may not be temporary.
• Trauma. Experiencing traumatic events like abuse, neglect, poverty or racism can cause a child to be on “high alert” and feel anxious more often than other children.
• Education and learning challenges. Children who have learning disabilities or other challenges in school are more likely to be anxious.

How much anxiety is normal for my child?

Certain situations – like a test, a big game or a new classroom – are bound to make your child feel more nervous than usual. Feeling anxious is a normal response to fear and uncertainty. But if it affects your child's daily life or if using coping skills fail to help them manage stress, they may need additional support.

Since every child is different, Dr. Anderson advises parents to figure out what is normal for their child by:

• Assessing your child's stress capacity. How well does your child handle the pressures and demands of daily life? Some kids might manage additional pressures while others may not be able to. Every child has their own capacity. Tuning in to your child's unique ability to handle stress can help you understand when they are having a normal stress response or when things are becoming unmanageable.
• Noticing behavior patterns. If you notice that your child is fearful or feeling bodily discomfort in a specific place or around certain people, they could be experiencing anxiety. Paying attention to these behavior patterns may also be helpful in identifying the source of your child's anxiety.

How can I help my child with anxiety?

If you are concerned that your child might be struggling with anxiety, you can start by making an appointment with your child's pediatrician to see what they recommend.

It may also be helpful to check in with your child's teacher or school counselor to see if they have noticed any anxious behaviors. Since children spend many hours a day in school, their teachers can be a great resource for gathering more information about any behavior patterns related to anxiety and recommending accommodations your child may need at school.

If you want to try to help lower anxiety at home, here are a few recommendations:

• Practice relaxation strategies. Deep breathing activities can quickly, effectively calm your child. Experiment with a few different ones to see which one works best for your child. You can find guided activities on YouTube and mindfulness or meditation apps like Calm and Sanvello.
• Model expressing difficult feelings. Don't be afraid to share your struggles with your kids. You can tell them, “I'm feeling really frustrated because I had a hard day at work. My boss yelled at me.” Sharing your struggles can help children open up about theirs.
• Have check-in times. Try scheduling a regular, weekly time that's focused solely on your child sharing how they're doing emotionally.
• Be honest and supportive. You might say something like this: "I want to make sure that you're feeling supported at home. I know things can be hard. I might not understand everything you're going through but I can be there for you and help you through it."

This video about helping your child with anxiety may also give you other ideas.

Does my child need professional help for anxiety?

If you have any reason to be concerned about your child's mental health, it is always best to seek professional support. Professional help may also be needed if you notice that your child is:

• Consistently anxious or irritable
• Having difficulty with daily functioning and activities (e.g., going to school)
• Avoiding or suddenly disinterested in the things they previously enjoyed

Professional support can also be a good idea if your child is having difficulty separating from a caregiver (separation anxiety).

How can a mental health professional help my child with anxiety?

A mental health professional can help to accurately diagnose your child. There are several types of anxiety disorders, including generalized anxiety, social anxiety and panic disorder. Since many of them have similar symptoms, a professional is often the best person to assess which type your child may or may not have. A professional can also help make that important distinction between anxiety and other mental health disorders such as ADHD and depression.

“One of the things that can be useful about going to see a professional is focusing on the tools that work best for your unique child,” says Dr. Anderson.

Mental health professionals not only help to treat the symptoms of anxiety in children but also teach them how to cope. Therapy and medication are often used to treat anxiety.

Therapy to treat anxiety in kids

Cognitive behavioral therapy (CBT) is usually the first line of treatment for anxiety as it can help kids think about their thoughts, feelings, behaviors and how they're all connected. It also gives them concrete tools to face their fears.

Coping strategies your child may learn and practice in CBT include:

• Thought challenging. This is where you replace an unhelpful or untrue thought with a more helpful one.
• Mindfulness. This is learning to be more aware of your thoughts, feelings and sensations in the present moment.
• Deep breathing. This is using the power of slow, deep breaths to feel more relaxed.
• Progressive muscle relaxation. This is a technique where you first tense and then relax many different muscles in your body.
• Having a worry time. This is a dedicated time of day to let your worries run wild and then release them.

Explore more therapies and treatment options

Medication to treat anxiety in children

If your child's anxiety is more severe, a mental health professional may recommend medication as an additional tool.

Medication can treat your child's symptoms and lessen their anxiety so they can engage in daily activities and therapeutic skills. Medication won't teach them skills to cope so it should be coupled with a form of therapy.

Learn more about how to treat anxiety in children

Children's Health can help children and teens manage feelings of loneliness, depression and anxiety. Learn more about programs we offer to support mental, emotional and behavioral health.

You can also access emotional care and support from the comfort of your home with Virtual Visit Behavioral Health. With a behavioral health care appointment, you can speak to a board-certified psychiatrist or licensed therapist using video technology. Learn more about Virtual Visit Behavioral Health.