Anxiety symptoms in children
Since I left the National Health Service in 2012, I have been running Everlief, the child psychology clinic I founded with my husband. Everlief now has a large team of over 20 clinical psychologists, educational psychologists and a nurse. Since 2012 we have supported over 3,000 families. I estimate that over 70% of the children we have helped, experienced anxiety. In other words, anxiety is (by a mile) the most common difficulty that families seek help from us for.
In this article I will help you understand what anxiety symptoms in children look like, so you can work out if your child is experiencing anxiety. I will give you tips on what to do and how to seek further help if needed.
Is your child anxious?
Many of us are more stressed, worried and anxious than we have ever been. Children may have worries about the world and its current state, or their future. They may have more pressing worries about school, friendships or growing up. How do you know if your child is so stressed or anxious that she needs help?
If your child’s anxiety is affecting her everyday life, then something needs to change. Is it affecting her sleeping or eating, or interacting with friends? Has she given up things she used to enjoy? Or, is it impacting the family, because emotions are heightened or because you cannot do things as a family that you used to do? If any of these apply, it is time to put some strategies in place to help your child, or to seek further help.
Anxiety symptoms in children: What to look out for
1. Physical symptoms
Physical symptoms of anxiety are real! You may have heard of something called the ‘fight or flight’ response (also sometimes referred to as the stress response). This is a primitive defence mechanism which evolved to enable us to react when faced with danger. To run away, to fight, or sometimes freeze in order to keep ourselves safe.
A series of bodily changes occur when our fight or flight response is triggered. For example, our muscles tense up (ready to run or fight), the heart rate speeds up (helping to circulate oxygen around the body), and digestion is interrupted temporarily. This is so that blood can be diverted to the arms and legs (which can often make us feel sick or feel “butterflies” in the tummy). Many other powerful bodily changes occur. These can seem to come from nowhere and can be scary for children to experience. Watch this video for a summary about the stress response.
2. A “short fuse”
When thinking about anxiety symptoms in children we may not think of anger. But anxiety can regularly present as anger, Let’s imagine our stress as a cup.
When events or worries cause us stress, they trigger the release of the stress hormone cortisol. Anxious children’s stress cups are fuller than they should be. Every event they experience as stressful or scary, and every worry, fills up the cup a little more. And to make matters worse, anxiety can prevent children from getting the restorative sleep they need, to empty the cup ready for the next day. Once the cup is nearly full, it only takes one more small thing – perhaps being told off or a piece of homework not going to plan – for the cup to overflow.
An overflowing cup means that fight or flight (the stress response) is triggered. What does this look like? Anger, irritation, shouting, crying, a full “meltdown”… It will look slightly different for every child but once triggered the child is not in control any more.
3. New or excessive worries, especially at night
Night time is quiet and peaceful, but this can create the perfect condition for worries to run rampant and multiply. If a child has a worry, there is nobody to talk it through with, and no distraction from it. The brain is tired and so it is unable to dismiss the worry as easily as during the daytime. It can snowball and become multiple worries; loose cannons knocking around in your child’s mind. Worries – whether real or imagined – trigger the body’s stress response (fight or flight – see video below). The cortisol and adrenaline this releases are the opposite of what is needed for sleep. These chemicals tell us: “Don’t go to sleep, you must say alert for dangers!” If a child does fall to sleep, it may be a light or fitful sleep.
Therefore, anxiety, worry and sleep difficulties often go hand in hand.
4. Staying inside the comfort zone
Children who are anxious often feel so scared that they stop feeling able to try new things, or attempting things that are even slightly out of their comfort zone. After this they often lose confidence in these abilities, and this can lead them to withdraw even further.
5. Extra reassurance-seeking
When your world feels scary and uncertain, the natural thing to do is seek reassurance from others (usually parents) that everything is okay. The relief that this provides can become addictive, so that children often find themselves seeking reassurance over and over, even when it has already been provided.
6. Restlessness or difficulty focusing
If a child is going through a period of time when they don’t feel safe, her body is primed for spotting danger, not for learning. The prefrontal cortex – the part of the brain which is involved in clear thinking, organisation and planning – will not be working efficiently. As part of the survival response, this area of the brain takes a back seat so that the more primitive survival response (located in the amygdala and more generally in the limbic system) can take over. Your child’s body will be getting ready to run away or fight danger, not to sit down calmly and learn. The result is restlessness, distractibility, difficulty focusing, and probably difficulty in processing instructions.
7. Trying to control certain areas of life
Have you noticed that your child is trying to control her eating? Either restricting her intake, or becoming very rule-bound in when or what she will eat? Or perhaps you have noticed that your child is generally more rigid in her thinking and will not compromise, so the family always ends up bending to her will. Sometimes, when the world seems scary and unpredictable, we try to control what we can.
Anxiety symptoms in children and parent stress: Six tips
Knowledge is power! For example, you are much less likely to have a panic attack if you can understand why your heart rate has sped up and your breathing has become shallow. It is your body doing it’s thing, to protect you from a perceived danger!
The book I have co-written with five of my colleagues, Brighter Futures, will help you feel like a pro in managing anxiety to support your child! It is a step-by-step guide to helping your child in a compassionate and gentle way. In addition, this self help guide written by psychologists focuses entirely on anxiety in children.
Be careful about sharing stress and anxiety in front of the children
Children need to know that you are human and have different emotions. However, more than anything they need to feel safe. If you are extremely worried or stressed about something, you can limit the effect this has on your child.
Limit discussions about the area that is causing the stress or worry to times when your child is not at home. Keep it as an adults-only discussion where possible.
Change your body language. Children are masters at picking up subtle signs of your distress in your body language, voice and face. When stressed we hunch our shoulders, clench muscles, and have a creased forehead with eyebrows lowered, for example. We also tend to be more monotone in our tone of voice. Try to be aware of these changes, and see if you can alter them when you are aware of them. For example, straighten and relax your shoulders when you notice them hunching. This will provide small but reassuring cues to your child, and also provide “I’m safe” feedback to your brain which will help you to feel less stressed.
Work on supporting yourself to manage your own emotions so you can help your child do the same
When anxiety, worry, stress, or anger take over, one thing you can do is learn techniques to calm your nervous system. Once you have felt the benefits of these, you will be able to teach them to your child with confidence that this stuff really works!
The first approach I recommend is mindfulness. Yes, I know, mindfulness seems to be everywhere at the moment, and it has been touted as a cure for all mental distress. It is not a cure. However, it is a philosophy and set of skills that can change your life by helping you feel more accepting and in control of your thoughts. It is powerful enough to calm the nervous system and cause positive structural changes in the brain. Read this article if you are interested to know more. If you want to give it a try, go for this brilliant four-week online course approved by the NHS, or an app such as Calm or Headspace.
Whether or not you try mindfulness, the most important technique you can practise (then teach your child) is deep, slow breathing. Deliberately slow your breathing, ensuring you breathe into your diaphragm (deep in your tummy rather than your chest). This signals to the nervous system that you are safe. Practise breathing with a few times per day for around five minutes: In for 5 seconds and out for 5 seconds. Set an alarm to ensure you practise two or three times each day. Soon it will become more natural for you to do this as a response to anxiety. Whenever you notice your breathing speeding up, you will think: “Okay, I need to slow my breathing down”.
Posture is also important, as I have mentioned above. Sit upright in a relaxed position with your shoulders back. A relaxed, non-defensive posture (not hunched or clenched up) will automatically lower your blood pressure.
If you are looking for an advanced technique to calm the body immediately, consider trying 4-7-8 breathing. There is some research evidence showing that a longer out-breath can quickly calm the nervous system. This article explains more.
Progressive muscular relaxation
Want another technique for quickly calming the nervous system? Try progressive muscular relaxation (PMR). Start from your forehead. Clench the muscles there and hold for a few seconds, then release. Can you feel a difference? Move on to the next set of muscles (perhaps eyes, then jaw), until you have worked your way down to your toes. With small children I like to do a simplified version, called “Raw Spaghetti, Cooked Spaghetti”. First of all they child pretends to be raw spaghetti – rigid and tense all over. Next, they pretend to be cooked spaghetti – soft and wobbly. It’s great fun!
Gentle stretching can also help to release muscle tension. There is no particular technique to this, just do what your body tells you to do.
Flow activities are any activity you find 100% enjoyable, engaging and absorbing. They can be anything. For me the main one is singing. What are your flow activities?
Flow activities are so absorbing, that whilst you are doing them your brain doesn’t have a chance to feel stressed or to register any worries. They completely change your state of mind and give you a break from worry or stress. Schedule at least one flow activity into your day, and do the same for your child.
Provide the reassurance your child needs – in the short term
There can be some problems with providing too much reassurance to a child over a long period of time. Children can become over-dependent upon it and reassurance-seeking can become a habit which they cannot manage without.
In the short term however, if your child is seeking reassurance she is telling you she needs to feel safe. She may show some regression during periods when she feels worried or vulnerable. This is completely normal. For example, during the transition from primary to secondary school, the new world can feel scary to an eleven-year-old. She may suddenly require more cuddles, want to have her teddies in bed with her even though she had “ditched” them long ago, or even ask for a bedtime story. This is all perfectly normal and okay. Once she feels safe again, it should pass.
Help your child build resilience
When a child has stopped doing things through anxiety, her “comfort zone” becomes very small. This will affect her confidence and make it harder for her to try new things in the future. It is crucial that you put in some time and effort to help her build resilience, so that she can widen her comfort zone and gain confidence in new situations. This article will guide you.
Re-imagine your child’s daily routines and habits
In difficult times I often suggest families go back to basics. Food, nurture, exercise and sleep all need to be in balance, for optimum emotional wellbeing. When extremely anxious or depressed children come into the clinic, I may start by creating a visual planner to ensure a balanced lifestyle. For example, you could create a weekly chart using different colours to show things that need to be built in to your child’s day. Breakfast, lunch and dinner might be represented in purple, exercise in green (perhaps a walk or a bike ride at minimum each day), and nurturing activities in blue. For nurturing activities, include: special things you can do together to increase your bond such as watching a movie, flow activities (see above), and calming activities.
If what you have read resonates with you, my suggestions may be enough to turn things around for your child if the techniques are applied quickly and consistently. However for some children, more intensive support is needed from a health professional such as a psychologist. Your first port of call should be your GP – general practitioner. Your GP will listen to your concerns and may refer you to a specialist NHS service such as CAMHS (Child and Adolescent Mental Health Service), or an independent psychology service.
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