Quick Guide to Anxiety in Children

Anxiety is a very general term used to describe a feeling of extreme worry or unease. Feeling anxious is natural after something upsetting happens. But when a child feels anxiety that lasts a long time and prevents them from doing things like going to school or seeing friends, then it becomes an anxiety disorder. Children can be diagnosed with several different anxiety disorders. The specific disorder depends on what the child is struggling with most, but many of the symptoms overlap. 

Anxiety has many symptoms and can look very different from child to child. Here are some common signs that a child might have an anxiety disorder: 

• Trouble sleeping 
• Excessive worry or nervousness
• Complaining about stomachaches or other physical problems 
• Avoiding certain situations 
• Being clingy around parents or caregivers 
• Trouble concentrating in class or being very fidgety 
• Tantrums 
• Being very self-conscious 

Children can be diagnosed with different kinds of anxiety depending on what they are most worried about. 

Separation anxiety disorder: Children feel extremely upset when they have to be away from parents or caregivers. This anxiety goes beyond what other kids their age normally feel. 

Symptoms of separation anxiety include: 

• Worry about parents or caregivers getting sick or dying 
• Refusing to leave home or go to school 
• Fear of sleeping or being alone 
• Nightmares about separation 
• Physical symptoms (such as headaches or stomachaches) before an upcoming separation 

Children with separation anxiety disorder show symptoms for at least four weeks. 
 

Social anxiety disorder: Children with social anxiety disorder feel extremely self-conscious around other people. They are so afraid of being embarrassed that they avoid social situations and even speaking in class. 

Symptoms of social anxiety disorder in children include: 

• Avoiding most social situations or feeling terrible when they have to participate in them 
• Physical symptoms like shaking, sweating or trouble breathing in social situations 
• In young children, tantrums and crying in social situations 
• Fear of others seeing their anxiety and judging them for it  

For a child to be diagnosed with social anxiety disorder, their worry must be so extreme that it interferes with daily life. 

Selective mutism: Children with selective mutism have a hard time speaking in some situations, like at school. These kids aren’t just shy. Their anxiety is so bad that they feel frozen and are not able to speak.  

To get a diagnosis of selective mutism, the child must: 

• Be able to speak in some situations but not others 
• Have had the problem for at least a month  
• Have problems with school and social activities as a result 

Children are not diagnosed with selective mutism if their trouble speaking is caused by a communication disorder or language barrier. 

Generalized anxiety disorder: Children with generalized anxiety disorder worry about a lot of everyday things. Their worry is not caused by anything specific and it is bad enough to get in the way of daily life.  
 
Symptoms of generalized anxiety disorder in children include: 

• Restlessness 
• Feeling on edge 
• Feeling tired much of the time 
• Problems concentrating 
• Feeling angry 
• Trouble sleeping 

To be diagnosed with generalized anxiety disorder, children must experience symptoms most days for at least six months. 

Panic disorder: Children with panic disorder have frequent, unexpected panic attacks. Panic attacks cause physical feelings that can make kids think they are dying or having a heart attack. Children are diagnosed with panic disorder when they experience at least one panic attack and show other signs including: 

• Constant fear of more panic attacks 
• A big change from normal behavior after the panic attacks, like avoiding places that remind them of an attack 

When diagnosing a child with panic disorder, a professional also rules out medical causes and other disorders like PTSD.  

Obsessive-compulsive disorder (OCD): Children with OCD have thoughts and worries that make them very anxious. They may develop rules for themselves or engage in repetitive behavior to control the anxiety.  

• Obsessions are the unwanted thoughts that make kids feel upset and anxious. 
• Compulsions are the rules kids feel they have to follow to get rid of their anxiety. 

Children can be diagnosed with OCD when they have obsessions, compulsions or both. 

Specific phobia: Kids with specific phobias are very afraid of one or more specific things. This fear is out of proportion to the actual danger. Phobias disrupt kids’ lives when they go out of their way to avoid the things they’re afraid of. 

Common phobias in children include: 

• Animals or insects 
• Parts of the natural world, like water or heights 
• Blood or shots 
• Specific situations, like crowds or tight spaces 
• Others including vomiting, choking or loud sounds 

Almost all types of anxiety are best treated with cognitive behavioral therapy (CBT). CBT is based on the idea that how we think and act both affect how we feel. By learning to change negative thoughts and unhealthy actions, kids can change their bad feelings.  

An important part of CBT in treatment for anxiety is called exposure and response prevention. In exposure and response prevention, the therapist helps the child face the thing they’re afraid of a little at a time. By dealing with their fear in small amounts in a safe space, kids learn to deal with the big feelings that come up. 

For some children, taking medication for anxiety in addition to going through therapy makes treatment more effective.