How to Recognize Anxiety in Children
Sarah Bauer, MS, MFT is a couple and family therapist, specializing in domestic violence, trauma, grief and loss, depression, anxiety, and substance abuse.
Many children and adults experience anxiety at one time or another. Adults may attribute such feelings of nervousness (“butterflies”), worry, or sleep issues. Children, however, having not yet developed the skills to state what anxiety is and what it looks like, may indicate thoughts of not wanting to attend school or complain of stomachaches. These may be signs of anxiety, medical issues, or another psychological disorder, such as Attention Deficit Hyperactivity Disorder (ADHD). These are two of the more common symptoms that parents or caregivers see in children, but even in the absence of these symptoms, children may still suffer from anxiety. The number of children diagnosed with anxiety or generalized anxiety disorder range from six percent to twenty percent, a worrisome statistic. But if the previously mentioned symptoms are not present, how can parents and caregivers tell if their child is experiencing anxiety?
Here are some the more subtle signs and how parents and caregivers can address them:
Refusal to eat
Children experiencing anxiety may not want to eat or push their food around on their plates during dinner. They may bring home their lunch box from school with their lunch uneaten or give their food away to their friends and other classmates. If a parent or caregiver believes that a child is not eating during school, it is important to contact the school, as they could keep an eye on the child during lunch. With class size increasing, it can be difficult for teachers to notice if a child is eating their whole meal or “trading” their food away.
Parents and caregivers may also want to seek medical advice if a child is refusing to eat; this may also be a sign of a medical issue that warrants attention. Parents and caregivers should not force a child to eat, as this may further increase anxiety. Instead, try giving the child a specific food or foods they like—comfort around getting the same food everyday may help ease anxiety. Ask the child what they want to eat, and if they want to help the parent prepare it. This encourages bonding for child and parent/caregiver as well as promotes conversation and lessens anxiety.
Avoidance of people, places, or things
Children who were eager to go places or to talk people may seem aloof, withdrawn, and/or upset when approached or placed into that environment. Like we discussed at the beginning, children may not have the language or understanding to express what about this situation is bothering them. Don’t force the child to interact with places or people that cause them anxiety, as that could violate a child’s comfort zone and may be sending the message “your opinion does not matter.” Instead, try asking the child why they do not want to see this person or go to this place. Create a safe space for the child to interact and vocalize themselves. Providing a safe space shows the child that they can trust you, and trust is an earned process, not an automatic one.
Morbid or “bad” thoughts
Children consistently experience “good firsts”: first day at school, first pet, first friend. Children also experience “firsts” in other ways too, such as death and other natural events. Often times, children can let go of or “brush off” these thoughts, but some may experience anxiety due to an abundance of these thoughts. For example, if a loved one passes away, children may have difficulty with understanding why this occurs or may begin to fear their own morality. Children may have questions about this or wonder “will I or (insert loved one here) die?” If these thoughts become intrusive, the child may experience anxiety. In this example, the child may be trying to ask, “are you leaving me, too?”
Parents and caregivers can offer reassurance and clarification, such as “are you afraid I am going to leave you?” But be sure to make conversations age appropriate, as confusion can further a child’s anxiety. By offering clarification and reassurance, children can begin to understand these scary thoughts and begin to work through their anxiety.
Children who act out or exhibit other negative behaviors such as talking back or hitting others may be doing so out of anxiety. Consider the “fight or flight” response. When children are feeling anxious and are placed into an uncomfortable situation or feel uncomfortable in general, they may “fight” or otherwise act out inappropriately. This is a negative coping strategy as a result of their anxiety. We all begin developing coping skills as an infant (ex. self-soothing techniques) but children still need assistance to continue to grow and develop self-control and coping mechanisms. Parents and caregivers should validate the child’s emotions and allow the child to vent their feelings, but not tolerate inappropriate behaviors such as hitting or biting.
An example of such may be, “I understand that you are upset. Instead of hitting your brother, which is not okay, let’s take a walk and talk about why you are upset.” In this example, the parent is validating that the child is upset, notifying the child that hitting is not okay, and also providing a positive outlet to work out the issue.
Excessive sweating may be due to a medical condition, such as a hormone imbalance. Sweat is a body’s natural response to an individual under duress or stress. If a child is coming home from school and changing clothes because they are sweaty or changing clothes multiple times a day due to sweating, and the sweating is not due to a medical condition, this may be a sign of anxiety. Children may also exhibit anxiety through excessively sweaty palms and feet. If a parent or caretaker notices this symptom, try to determine when this occurs. For example, if the child comes home from school and is experiencing extreme or more than usual sweating, this may be a sign of bullying or issues at school. It is important to pinpoint when this symptom occurs in order to assist with determining where the anxiety is coming from. Validation of feelings and emotions from the parents and/or caretakers is key, as children may feel embarrassed or ashamed of this issue.