What Is a Specific Phobia?

All children (and adults!) get scared from time to time. Thunder and lightning, getting a shot, or the neighbor’s dog can all strike fear into kids’ hearts, but time, experience, and adult encouragement usually help them overcome their anxiety. 

However, some children develop fears so intense that they obsess over a specific object or situation even when they’re not around it, and they go to extreme and debilitating lengths to avoid encountering their fear. If you’ve noticed these extreme reactions in your child, they may have a specific phobia.

A specific phobia is a mental health condition in which a child has an extreme, uncontrollable fear of something that is typically not dangerous. To be diagnosed as a specific phobia, a child’s avoidance and anxiety around the feared object or situation must cause problems in their daily life. The anxiety must happen nearly every time the child encounters the thing they fear, but the amount of fear they show can vary.    

Specific phobias usually fall into one of these categories:

• Animal Type (dogs, bugs, snakes, etc.)
• Natural Environment Type (storms, heights, water, etc.)
• Blood-Injection-Injury Type (getting shots, seeing blood or injuries)
• Situational Type (flying, driving, small spaces)

Signs that a child may have a specific phobia include:

• Extreme fear of a certain object or situation
• Having anxiety attacks when they see or even think about their fear
• Crying or throwing tantrums to avoid the thing they fear
• Trembling, dizziness, sweating, or other physical responses to their fear
• Adult reassurance is not effective

Not all children with a specific phobia are anxious in general. But children who have other anxiety disorders are more prone to having phobias.

Specific phobias usually develop in early childhood, with the majority of cases developing before age 10.

It’s common for children to have more than one specific phobia. For example, a child might be scared of both dogs and heights. Adults and teenagers with a specific phobia usually understand that their fears aren’t logical, but children often don’t understand that.

Specific phobias are more commonly diagnosed in girls than boys.

It’s common for children to exhibit certain developmental fears at different stages. For example, two- to three-year-olds are often afraid of the dark; four- to five-year-olds frequently fear monsters and getting lost; and five- to seven-years-olds often worry about environmental factors such as germs, school, and natural disasters.

According to Alana Cooperman, LCSW, a social worker in the Anxiety Disorders Center at the Child Mind Institute, specific phobias are distinct from developmental fears because of their severe impairment of children’s daily lives and because the fear doesn’t just go away with adult reassurance.

“Avoidance is a big factor in terms of even going certain places or joining certain social situations in which they know they could potentially be in contact with that feared object,” says Cooperman. “For example, refusing to go to an amusement park if they’re afraid of seeing someone throw up.”

Parents might notice their child persistently thinking or talking about their fear, even when they’re not being faced with it. They may find it hard to sleep at night because they’re obsessing over it or nervously anticipate a future event, such as a flight or vaccination. Their teachers may report that they talk about their fear at school. Children often experience their specific phobia through physical symptoms similar to a panic attack, such as crying, increased heart rate, stomachaches, and headaches.

The causes of specific phobias are not always clear. Children can develop a specific phobia after they have a negative experience with an object or situation, such as a phobia of needles and shots that results from a painful injection, or a phobia of dogs after being frightened by an aggressive dog. They can also develop a phobia if they grow up around an adult who expresses intense fear of a certain situation or object.

For many parents, their instinct is to do whatever it takes to avoid seeing their child struggle or suffer. But helping a child avoid their specific phobia can inadvertently reinforce the fear. “We tell parents, ‘Don’t fear the fear!’ because it’s actually making it worse,” says Cooperman. “Often parents can contribute to the problem without even knowing it by avoiding opportunities for their child to practice being near the feared object.”

On the other hand, parents and caregivers also frequently misunderstand and minimize specific phobias in children. “There’s a common misconception that it’s an exaggeration,” says Cooperman. “Parents might think that the child is just trying to get out of something or exaggerating to be dramatic.” While it can be difficult for parents to take their child’s seemingly illogical fear seriously, kids with phobias benefit from knowing that their parents recognize how scared they are. It is helpful to acknowledge a child’s fear, without affirming that they are in danger.

The most important thing a parent can do is not enable the child to avoid the thing they are afraid of. Additionally, Cooperman suggests parents use empathetic and supportive statements to encourage children. “Instead of ‘It’s not scary, come on, don’t cry — this is nothing to be afraid of,’ parents can say: ‘I know you’re really afraid of the dark and I know that we can work together on helping you be brave,’” she explains.

The best treatment for specific phobias is called exposure and response prevention. This treatment works by slowly exposing the child to the thing they are afraid of over and over, until their anxiety recedes. This treatment works very well for most kids with a specific phobia.

It’s critical that exposure and response prevention is done in a gradual, systematic way. “One misconception with exposure therapy is that therapists make a child fear for their life right away,” says Cooperman. “That’s never something we would want to do!” She uses the metaphor of walking into a cold pool to explain how kids build up tolerance to their phobia through treatment: “When you first walk into a cold pool, it feels really cold, and then once you stand there for a moment you can take the next step and go in deeper. It’s cold again, and slowly it gets better. Nothing changed, except your reaction.”

In exposure and response therapy, the clinician and child create a hierarchy of different situations and the child rates each one on a scale of 1–10 based on how anxiety-inducing it is. The child will then face each situation until their fear decreases, moving from the least to most scary. For example, a child who is afraid of dogs would first practice looking at a picture of a dog, until their fear of the picture goes from a 10 to a 2. Then, they would work through different scenarios, such as watching a video of a dog, playing with a stuffed dog, and eventually spending a few minutes with a real dog.

While the child may not end up loving dogs, their fear will substantially decrease. “We don’t necessarily ask them to go to 0, because we want them to know it’s okay to be uncomfortable and still get through it,” says Cooperman. “Through facing their fears using this hierarchy they learn what’s called distress tolerance, which is learning how to be more comfortable with being uncomfortable.”

Additionally, cognitive behavioral therapy (CBT) and mindfulness can be used to help kids manage specific phobias. “In short, CBT teaches children how to catch their negative thoughts and challenge them, in order to help reframe negative thoughts into more positive thoughts. By doing so, it helps them increase their self-awareness that their negative thought was stemming from anxiety,” says Cooperman. Mindfulness techniques such as deep breathing can also help kids reduce physical reactions to their specific phobia.

Parents should be aware that, like all mental health disorders, specific phobias can compound over time if left untreated. While avoidance can be an easy short-term solution, in the long term it’s likely to worsen your child’s fear. That’s why now is the best time to seek treatment so that your child can begin to face and manage their specific phobia.