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What does childhood anxiety look like? Probably not what you think.


A 7-year-old is the perfect student but destroys his bedroom and screams at his siblings after school. A 10-year-old snaps at her mother constantly, criticizing just about everything she does. An 8-year-old cries every morning before school and clings to his parents each time they attempt to drop him off at school, sports events or birthday parties. A 12-year-old experiences headaches that make it difficult to get out the door on time. A 6-year-old can’t fall asleep at night. Though all of these behaviors appear unrelated and present different challenges, they have one common thread: anxiety.

Anxiety disorders are on the rise among children, and anxiety tends to spike during the school year. A study published in the Journal of Developmental and Behavioral Pediatrics estimates that approximately 2 million American children and adolescents have a diagnosable anxiety disorder.

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One of the difficult parts of getting help for children suffering from anxiety is that anxiety often presents as a constellation of negative behaviors. Parents and educators are quick to spot the behavior problem, but they don’t always see the underlying anxiety that drives it. “We tend to think of anxious children as these delicate little butterflies, but when kids are scared, they can be ferocious about trying to escape or avoid anxiety-provoking situations,” explains Eileen Kennedy-Moore, child psychologist and author of “Kid Confidence.”

The challenge often lies in the fact that kids might experience these emotions for the first time, without warning. They don’t necessarily know how to connect the dots between a racing heart, a stomach ache, feeling dizzy and anxiety.

“Children today are stressed on so many fronts: challenged socially, academically, having to cope with physical changes and development, the demands and influence of social media, trying to fit in and be accepted. It’s no wonder they show evidence of anxiety,” says Susan Newman, psychologist and author of “The Book of No.” “Parents should ask questions about anything they notice or want to understand to show their interest and love for their child. Children want to be heard and listened to, even if they tell you to stop being nosy.”

The good news in all of this is that child anxiety is very treatable, especially with early intervention. In learning to spot the sneaky signs of child anxiety, identify triggers of anxiety and teach kids coping skills, parents and educators can empower kids to manage their anxious feelings independently and thrive in social and academic settings.

What does child anxiety look like?

The word “anxiety” may conjure images of a quiet worrier, but childhood anxiety wears many different masks. More often than not, symptoms of child anxiety fall into the following categories:

  • Psychosomatic complaints: Kids don’t usually come home from school saying, “I felt really anxious at school today,” but they do say things like, “I have a terrible stomachache; I can’t go back to school tomorrow.” Frequent stomachaches, headaches and unexplained muscle aches and pains can all be symptoms of anxiety. It’s also important to watch for complaints of chest pain, racing heart, difficulty breathing, dizziness and difficulty swallowing. These can all be symptomatic of a panic attack.
  • Anger and irritability: Most kids have meltdowns at times when they feel exhausted and overwhelmed. Frequent meltdowns that are lengthy and fueled by anger and irritability, on the other hand, are worth taking a second look. Child anxiety often looks like intense anger and a complete lack of emotional regulation.
  • Sadness: Anxious kids can appear clingy, overwhelmed and sad. They are likely to burst into tears without explanation.
  • Isolation and avoidance: Anxious children often engage in social isolation. They avoid additional social interaction beyond school, choosing the safety and comfort of home to recover. They are also master procrastinators and tend to avoid challenges.
  • Fatigue: Coping with anxiety can be exhausting. Chronic fatigue in a previously active child can be a sign of anxiety.
  • Poor concentration: Anxiety can make it difficult to focus.
  • School refusal: School can feel like an exercise in survival for kids with anxiety, and school refusal is often the first red flag parents and educators notice.
  • Frequent questions: Anxious kids tend to be concerned with personal safety and the safety of family and friends. They ask the same questions repeatedly and seek validation from adults often.

Common triggers

Kids will respond differently to various triggers and events. To that end, it’s important to understand your child’s baseline. Most kids experience some anxiety at times.

Anxiety becomes problematic when it interferes with a child’s daily functioning. If anxiety makes it difficult for your child to get to school each day, focus, socialize and function within the family, it might be an anxiety disorder.

Anxiety often has a genetic component, but it can also be triggered by a number of factors.

  • Genetics: Just like your child can inherit your eyes or your complexion, anxiety can also be transmitted from parent to child.
  • Academic/achievement pressure: Sometimes pressure is self-prescribed; sometimes kids feel pressured by the adults in their lives.
  • Learned anxiety: Children can learn anxious responses from the people in their homes. A perfectionist parent, for example, might unintentionally send the message that everything needs to be perfect.
  • Bullying/social issues: Kids who experience chronic bullying can develop symptoms of anxiety. This includes cyberbullying, which is reaching younger and younger children. Kids who struggle with social anxiety can be triggered by large and unfamiliar social situations.
  • Transitions: New homes, new schools and even new teachers can trigger an anxious child.
  • Loss: Divorce, death of a loved one or death of a pet can result in symptoms of anxiety.
  • Violence or abuse: Kids who experience child abuse or witness domestic violence or other acts of violence in the home can experience anxiety disorders.

How to help kids cope

When children experience symptoms of anxiety that interfere with their daily life (symptoms occur more often than not during at least a two-week period), it’s important to seek professional help. A pediatrician is a good first stop to rule out or diagnose possible medical issues and to refer a licensed mental health practitioner who specializes in working with children. Cognitive behavioral therapy and dialectical behavioral therapy can be very effective treatment options for children with anxiety.

There are also strategies that can be implemented at home and in school to help children manage and cope with their anxious thought patterns:

  • Mindful/deep breathing
  • Progressive muscle relaxation (tensing and relaxing muscle groups to release tension)
  • Acknowledging the anxious thought and countering it with a positive one
  • Using a worry box to put worries away for later
  • “Roses and thorns” journal to get worries out and identify positives
  • The basics: healthy eating and sleep habits, plenty of water, and time for free play and exercise

Childhood anxiety can feel all-consuming, but it can be managed, and managed in a way that helps children build resilience. When kids learn how to spot their own symptoms and cope with them independently, they take control.

Katie Hurley is a child and adolescent psychotherapist and parenting educator, and the author of the new book “No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls.” You can find her on Twitter and on her blog, Practical Parenting.

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