Kids and anxiety: What’s normal and when to seek help

Lots of things make kids feel nervous and uncomfortable. But how do parents know when their child may need professional help with anxiety? Here are some signs and ways to get help.

When children’s anxiety is normal

"It's normal for children to have fears that come and go throughout their life," says Tamar Chansky, PhD, psychologist and author of Freeing Your Child from Anxiety (2014). "Typically what happens is a child encounters a new situation and they need some time to learn about it, to work with it and get used to it." For example, children who first meet a large dog might be fearful of it.

Sometimes anxiety is even useful.  It alerts us to danger. "Feeling anxious or worried is necessary to be a human being. If you didn't feel anxious when you got to the edge of the cliff, your family line would die out right then," says Deborah Gilboa, MD, a pediatrician and child development expert.

Gilboa adds that anxiety may even be helpful in social situations. If a child sees a friend being teased, their anxiety may cause them to step in and to comfort or defend  them. "We've gotten to a point in society where we think anxiety means that we as parents have done something wrong," she says. "But there are certain circumstances where I hope my kids will feel anxious."

When parents should worry about anxiety

Experts note there are two red flags of clinical anxiety — avoidance and extreme distress. In addition, the Anxiety and Depression Association of America divides childhood anxiety disorders into types. These include generalized, separation, social, and specific phobias. They each manifest in different ways, but here are some of the most common symptoms. The child:

• Avoids specific activities, situations or people
• Tends to focus on what can go wrong
• Has fears that interfere with daily activities
• Is distressed despite an adult's reassurances
• Has trouble sleeping at night or insists on sleeping with parents
• Has headaches or stomach pains (or other physical symptoms) that don't stem from other medical conditions.

*Source: CDC; Materials developed by CDC. Reference to specific commercial products, manufacturers, companies, or trademarks does not constitute its endorsement or recommendation by the U.S. Government, Department of Health and Human Services, or Centers for Disease Control and Prevention. This information is available on the agency website for no charge. Last accessed November 9, 2022.

What not to do when a child is anxious

Even if you mean well, there are things you may do that might make the child feel worse. For instance, you may be quick to dismiss a child’s emotions or label them “wrong," Gilboa says. "We're so used to guiding our kids' behavior that we try to guide their feelings as well," she says. "It never works."

Pressuring a child to feel a certain way may cause them to hide their real emotions. That can make it more difficult to recognize the seriousness of the problem. "If our kids can't express their feelings to us and know that they'll be heard, we will never know if they're experiencing true anxiety that needs attention," she says.

Other parents may be too ready to accommodate their children. Simply avoiding situations that trigger anxiety can backfire, too. When children stop going to the pool because they fear water, or avoid sleepovers because they’re scared of the dark, those limitations may add to their anxiety. "It's really stressful not being able to do the things that other people do," Chansky says.

If left undiagnosed and untreated, a child with an anxiety disorder is at increased risk of engaging in dangerous behaviors. These include self-harm, substance abuse and bullying. "They develop negative coping strategies," Gilboa says.

How to address anxiety

The first step is to acknowledge your child’s condition so you can learn more about it. "Whatever struggles our kids face, we want them to develop positive coping strategies," Gilboa says. "Naming the problem makes that easier." Diagnosis can even be a relief for some. It can help validate why they may be feeling a certain way.

Typically, it takes a professional to name the problem. That could mean a school psychologist, pediatrician or therapist. And just as anxiety symptoms vary, so do treatment options. Some children may be referred to a talk therapist or require medication. Others may find comfort in mindfulness exercises or drawing pictures. Professionals are there to help support the right care plan for your child.  Often, talking with your child’s pediatrician is the best first step.