The night before a big test, Lucy, age 9, can’t sleep. She tosses and turns in her bed until she eventually goes to find her mother. “I can’t sleep,” she says. “I’m worried about tomorrow. What if I fail and can’t move up to the next grade?” Lucy’s mom gives her a big hug and assures Lucy that she has amazing grades and a super smart brain; there’s no way she will fail the test. The next morning at breakfast, Lucy has dark circles under her eyes and she can't eat due to a stomachache. 

During a routine commute to soccer practice, Max, age 7, says from the backseat, “Dad, I don’t want you to die.” Max’s dad looks at Max in the rear view mirror and sees tears in Max’s eyes. He assures Max that he’s in great health and won’t die for a very long time. The more Max’s dad tries to calm Max’s fears, the more worried Max seems to get. 

Do these scenarios sound like your kid? If it does, you wouldn’t be alone. Anxiety is the most common mental health issue facing children and adolescents. It’s important to remember that anxiety is a normal emotion that everyone experiences. It can be a challenge though if it goes unchecked and begins to interfere with our physical or emotional well-being. Anxiety comes in many forms and there are many ways to treat the symptoms. Let’s talk it through.

First, what does anxiety look like? Anxiety often causes a person to feel worried, nervous, or afraid. It’s normal to feel these feelings about new things such as the first day of school, painful things such as vaccines, or high-pressure situations such as tryouts, important tests, or public speaking. Often kids can work through these situations on their own or with the help of friends, caregivers or other trusted adults. 

Other times, worrying and fear become a habit that limits a child’s potential and causes physical symptoms. Starting as early as age 7, but more commonly between ages 10-14 years, some children begin to worry excessively over a variety of issues. This behavior will go on for over six months and it can cause trouble sleeping or relaxing. The child can seem more tired, tense, or restless than usual. Even with caregiver support and reassurance, the child is unable to control the worry or fear. Caregivers might have even let them stay home from school a time or two to help ease the pressure they seem to be under. 

There are several reasons why talking to your pediatrician is a great idea sooner rather than later. Anxiety can persist into adulthood so treating it in childhood can help your child deal effectively with anxiety for their whole life. Treating anxiety in adolescents can reduce the risk of suicide, risk-taking behaviors, poor school performance, and pregnancy in teenage years. 

Your pediatrician along with you and your child form a team to help achieve ways to cope with anxiety. Over time, the goal is to help your child establish helpful patterns of thought and behavior that allow them to solve problems and regulate emotions. 

There are different types of anxiety. Your child may have more than one type of anxiety and your child could have medical causes for these issues. Your pediatrician can recommend testing to identify your child’s specific needs which will help to target the most effective treatment. First line treatment for anxiety includes counseling, medications, or a combination of both. 

There are several things you can try at home as well. A good place to start is awareness. Many children with anxiety belong to families who have a history of anxiety or mood disorders. Not only can anxiety be inherited genetically, but anxious behaviors are often modeled by caretakers. Being aware, as a family, of the anxious behaviors can help the team succeed in modifying those behaviors to more helpful ones. 

Naming the anxious behaviors or thoughts can be helpful to identify and deal with them. For example, you and your child can externalize the anxiety, removing the stigma from the child, by naming it something such as the Worry Bully. This way, the Worry Bully is the opponent for the team to beat. Your child can learn to recognize when the Worry Bully is telling lies about a situation i.e. “You're going to fail the test” or “Your parents are going to leave and never come back.” The team then has the opportunity to tell the Worry Bully that we won’t believe the lies and we will use our thinking brain to know the truth. 

Sometimes, even when we try our hardest, those anxious thoughts linger, multiply, and need a way to escape our thinking brain. A few helpful tools can be a Worry Box and Worry Time. When a worry won’t leave us alone, we can write it down and put it in the Worry Box. During a designated 10-15 minute Worry Time each day, your child can have time with a caregiver or trusted adult, uninterrupted by screen time or siblings, to put out those worries from the Worry Box and discuss them. On days with lots of worries, the discussion may need to pause and continue the next day. This shows your child that worries have a designated place and time and need not interfere with everyday life. On days with very few or no worries, the Worry Time can be used for a casual talk about anything else. This teaches your child that you find all their thoughts valuable, not just the worries, and discourages them from searching for more worries to extend the time. 

If you suspect that you or your child needs help with anxiety or any other mental health issue, we encourage you to seek care that works for your family so that each child can reach their full potential.

Resources:

https://www.cdc.gov/childrensmentalhealth/data.html

https://www.dynamed.com/condition/generalized-anxiety-disorder

Dr. Linda Schmidt