Children's anxiety disorders and treatment

It's normal for kids to feel anxious sometimes. Children and youth can become anxious about school, social situations or family stress from time to time. But anxiety disorders involve more than temporary feelings of anxiety, worry or fear. Almost 32% of youth, ages 13 to 18 have an anxiety disorder, and 8.3% of youth in that age range experience a severe anxiety disorder. When someone has an anxiety disorder, the anxious feelings do not go away, and over time, they can worsen to the point that the anxiety interferes with daily activities, such as job performance, schoolwork and relationships. This is when clinical intervention should be considered.

There are different types of anxiety disorders in children, including generalized anxiety disorder, panic disorder and social anxiety disorder.

Generalized anxiety disorder (GAD) in children  GAD is characterized by excessive worry about everyday problems for at least six months. Those with GAD have a difficult time controlling their worry, affecting different areas of their lives. This type of anxiety is not the same as occasionally worrying about stressful life events. People who live with GAD experience frequent anxiety for months, if not years. GAD symptoms in children may include restlessness, tiring easily, difficulty focusing on homework or assigned chores, headaches, muscle aches, stomach aches, unexplained pains, irritability and sleep problems.

Panic disorder in children   Children with panic disorder often experience unexpected panic attacks. These are sudden periods of intense fear or the sense of losing control even when there is no clear danger. Symptoms may include sweating, shaking, chest pain, sensations of shortness of breath or a pounding heart, and feelings of impending doom. Those with panic disorder may also worry about when the next panic attack will happen and try to avoid certain places or situations they associate with the panic attacks.

Social anxiety disorder in children   Children with this type of disorder experience intense fear of social situations, especially if the child expects to feel embarrassed, judged or rejected. While many children may feel some degree of this, symptoms of social anxiety disorder include blushing, sweating, shaking, difficulty making eye contact or being around people they don’t know, pounding or racing heart, feeling self-conscious in front of other people, worrying for days or weeks before an event, avoiding social situations and having a hard time making and keeping friends.

Evaluation for an anxiety disorder often begins with a visit to a primary care provider. Some physical health conditions and medications can imitate or worsen an anxiety disorder. A thorough mental health evaluation is also helpful because anxiety disorders often coexist with other conditions, such as depression or obsessive-compulsive disorder.

Usually, anxiety disorders are treated with psychotherapy (such as talk therapy or cognitive behavioral therapy), medication or a combination of both. The most common medications used to manage anxiety disorders are anti-anxiety medications (such as benzodiazepines), beta blockers and antidepressants. Some medications may work better depending on the anxiety disorder diagnosed. The child’s healthcare provider may need to try several medications before finding the right one. There are also different things that can either increase the symptoms or interact with the medication prescribed, so it is important to work closely with the child’s healthcare provider to understand which substances are safe and which to avoid.

There are also a number of things that a parent or family member can do to help. Pay attention, monitor the child closely for signs of worsening anxiety or an increase in nervousness, fears or other symptoms. Promote good health in other ways, including adequate nutrition, sleep and exercise. Parents should promptly seek medical advice and evaluation if their child or adolescent experiences suicidal thoughts or behavior, nervousness, agitation, irritability, mood instability or sleeplessness that either starts or worsens during treatment. Finally, educate others regularly involved in the child’s life, such as teachers, coaches and activity leaders, about the child's needs.

Therapy is a great resource for children and families dealing with anxiety and mental health issues, but there are ways to help your child at home in addition to counseling. Some useful ideas may include:

• Letting your child know you're there to talk about their feelings
• Remaining calm when your child becomes anxious about a situation or event
• Being flexible with the normal routine and expectations during stressful times
• Avoiding punishing mistakes or when your child regresses
• Recognizing and praising small accomplishments
• Planning ahead for transitions, such as allowing extra time to get ready for school in the morning

It's crucial to have the same expectations for a child with anxiety as you would for a child who does not have anxiety, although the routine or process surrounding stressful situations may be different. Talking about potentially triggering situations before they occur may help your child.

Sometimes the most protected children are exposed to traumatic events, which can affect their mental well-being and cause temporary or lasting anxiety. In addition to therapy, parents can help children through these traumatizing events in several ways, including:

• Remaining calm and reassuring your child that you will do everything you can to keep them safe
• Discussing the situation with your child and allowing them to ask questions, but leaving out graphic details that may add to their anxiety
• Answering questions honestly, but giving information on a need-to-know basis
• Avoiding worst-case scenarios that may cause children stress or worry
• Encouraging your child to talk about their feelings

While many therapists offer children's services, it's important to find the healthcare provider or counselor best suited to your family and your child's unique needs. Parents should look for a mental health professional who does not blame the child, the child's family or school, and instead works closely with the child's support system.

Most importantly, listen to your child and observe how they react to therapy and upcoming therapy appointments. If there is any sense of hesitation, dread or anxiety linked to the appointment, or if your child does not trust or open up to the counselor, you may want to find a new provider who will make your child feel more at ease and have a better chance of helping your child.

Learn about the different types of mental health therapy, video chat live with a therapist for an introductory consultation, or visit Mental Health America for a comprehensive list of mental health support organizations and therapists in your area to help you find the care you need.

Clinically reviewed and updated July 2022.