Anxiety in Children

Anxiety is a term that we toss around quite a bit, especially in the mental health profession. But what does it REALLYmean? The dictionary definition is: a feeling of worry, nervousness or unease, typically about an imminent event or something with an uncertain outcome.

That doesn’t sound so bad, does it? Every single person on this earth has probably experienced situational anxiety at some point in their life. Anxiety before a big test, about a big event or about going to the doctor are just some examples that pop into my head. But what happens when anxiety is persistent, intense and something that you experience on a regular basis? How many children can verbalize the feelings that they have about trying something new, going somewhere different or being separated from their parents? 

What if you aren’t aware that the symptoms you feel are anxiety? What if your anxiety is something that happens to you, but you don’t remember or recall the triggers that caused your anxiety? What if you just think you have chronic stomach problems, headaches or nausea? Most adults don’t recognize the symptoms of anxiety, much less children who have little to no memories of the first months or years of their lives. How can we expect children to VERBALIZE their worries if we can’t do it ourselves?

So, let’s try again. What is anxiety and what does it really mean?

I’ve learned that it’s different for each person who experiences it. Being aware of what’s happening with our body, though, will help to identify this.

Some common symptoms of anxiety include a racing heart, upset stomach or nausea, irritability, frustration, difficulty breathing, chest pains and difficulty sleeping. Some people notice that they are very impatient and short with people close to them. Physical and somatic symptoms are extremely common with anxiety.

Here’s an example of anxiety and how it might present in children:

Sophia sat in my office talking about her recent experience at her first overnight camp. She described having fun and enjoyed laughing with her friends, but also fell ill while she was there. She talked about having an upset stomach and headache. Sophia reported that she went to see the camp nurse for help, but there wasn’t much she could do since she didn’t have a fever. The nurse left it up to Sophia’s parents to decide whether she should stay at camp or they should pick her up. It was decided that they would pick her up the next day, but that meant she would miss two days of camp.

Sophia was able to process her experience by walking through the events leading up to camp, what happened while she was there and then when she began to feel sick. I helped Sophia recognize that anxiety isn’t necessarily about our thoughts — “I feel nervous, I don’t know if I’m going to know anyone, I wonder if I’ll have fun” — but more about our feelings and experiences.

So, even though she didn’t have nervous “thoughts,” her body was responding to her anxiety with an upset stomach and headache. Sophia was then able to identify that she was in fact anxious about camp because she didn’t know what to expect. She had also never been separated from her parents for an extended amount of time, except with relatives. It was a very different experience.

Other children may present in more unusual and frustrating ways. I have observed children pulling on their parents clothing or even “banging” into their parents or hitting them as a way to communicate their anxiety or feelings of discomfort. This can be due to an overstimulating sensory environment and the child’s inability to verbalize their feelings.

Has your child ever asked you to sign them up for an activity, only to refuse to go once it starts?

That’s most likely anxiety. Anxiety about the unknown, the unexpected, or lack of self-confidence and lack of felt safety. Children thrive on routine, structure, feeling safe and knowing what to expect.

Wait, actually adults do too!

Have you ever made plans to do something fun and exciting only to back out at the last minute because of your own fears or anxiety? Do you get nervous traveling by yourself? Do you feel anxious when you start a new job or meet someone new for the first time?

Anxiety is common and normal. It actually functions as a protective coping tool for most of us. As it becomes more crippling and intense, we then need to identify it and use healthy coping tools to manage it. For those who have an organic chemical imbalance, psychotropic medication may be needed (please consult with a pediatrician or psychiatrist).

Here are some great anxiety coping tools that can be used for children and adults:

  • Deep Breathing
    1. Bert and Ernie’s “Up Goes the Castle”
    2. Square breathing
    3. The Flower Breath: Imagine smelling a flower. Breathe in through your nose, out through your mouth.
    4. The Bunny Breath: Take three quick sniffs through the nose and one long exhale through the nose. (As he starts to get the hang of it, have your little bunny focus on making the exhale slower and slower.)
    5. The Snake Breath:Inhale slowly through the nose and breathe out through the mouth with a long, slow hissing sound.
    6. Blow Out the Candle: Imagine a birthday candle. Take in a deep breath through the nose and then exhale through the mouth to blow out the candle.
    7. Smell the Rose/Blow Out the Candle:Combine the Flower Breath (on the inhale) with the Blow Out the Candle Breath (on the exhale), holding up your pointer finger to your nose as “you smell the rose,” and dropping your finger to your mouth as you “blow out the candle.”
  • Yoga Pretzels
  • Remove yourself and/or your child from the anxiety-provoking situation for a few minutes and take a walk, do some jumping jacks, do a “wall push” or read a book.
  • Turn off bright lights or use noise-reducing headphones in overstimulating environments.
  • Talk about the event ahead of time and adequately prepare your child, but not in too much detail that may instill more fear or anxiety (find a healthy balance!).
  • Identify a safe item for the child to have with them (something small in their pocket, a favorite stuffed animal, “squishies,” fidgets, etc). Identify a safe place or a safe word, symbol or sign that they can use if they are having difficulty verbalizing their anxiety.
  • Use mindfulness or grounding techniques.
  • Download mindfulness or deep breathing apps on your phone or your child’s phone.
  • Use trauma-informed tools at home and other places you frequent.

Parents, identify your own anxiety and practice healthy coping tools. Children learn best by observing, modeling, teaching and practicing.

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