Anxiety in children - How to spot it and how to help

Over the years, my practice has seen more and more children coming through the door. Children as young as seven struggling with feelings of worry so severe that it impacts their everyday. Sometimes, the cause of these emotions is clear - traumatic events such as abuse or the loss of a parent/guardian. Other times though, it’s a real mix, and less clear to see. 

Many parents I’ve spoken to have told me things like “He/she has a great life, I just don’t understand it.” Many don’t even recognise their child’s experience in the first place. This is incredibly common and rarely is it ever a symptom of poor parenting. 

The awareness around mental health in children is still lacking, and that is society-wide. I am a firm believer that if we catch these problems in childhood, we can teach coping mechanisms and change thoughts and behavioural patterns in such a powerful way that it paves the way for a happy, peaceful adult life. 

So, how does anxiety present itself in children? 

Sleep issues:

Many children I’ve treated suffer from sleep issues. Delaying bedtime because they feel sick, have a tummy ache, or their head hurts is incredibly common. These physical symptoms are very much real, but can, if illness is ruled out, stem from anxious thoughts. 

Difficulty in falling or staying asleep is another common theme. As adults, we are often familiar with the brain becoming busy around the time of sleep. Have you ever woken up at odd times during the night, worrying about your to-do list for the following day? Who needs to be dropped where? We often busy ourselves so much during the day that we can somewhat be distracted by the ‘white noise’ thoughts, but come nighttime, with no distraction, it can be harder to do. 

For children, their fears presenting themselves at nighttime can be incredibly loud to the mind, and very difficult to redirect without having any means of distraction or understanding their thoughts and feelings. 

I remember a specific time in my own life as a child, whereby every night as soon as I got into bed I would begin to feel very sick, which would then create a panic scenario of physically being sick - which would then make me feel even more sick because I was panicking! To the mind of a child, this can be frightening and very confusing. 

Separation anxiety:

Many of us will remember when our children were babies, the first moments they began to realise that they are separate beings from their mothers. These are the times that they may begin to cry when you leave the room to flick the kettle on, don’t want to be put down, and cling to you for comfort. Over time, and with reassurance, this phase passes naturally. They become toddlers, and they gain a sense of independence and autonomy over their own bodies, all whilst knowing mum will be there as a soft place to fall. This is all healthy and perfectly natural. 

For some children, separation anxiety comes back, in older children, it can be a big challenge to deal with. Suddenly, seemingly from nowhere, children may be fearful of either one or both of their parents going to work. They may want to start sleeping in your bed again or stop attending playdates and sleepovers for fear of being away from their caregivers. 

School refusal:

This symptom needs little explanation, and can often coincide with separation anxiety. We often draw a very obvious conclusion if our child refuses school that they may be the subject of bullying, or are struggling in lessons. This of course may well be true, but we must factor it into the bigger picture.

Physical illness:

This can be harder to discern, especially during the winter months for school-aged children as there is a multitude of bugs flying around! But if this is the case, have a look for patterns. Does your child feel sick or have a tummy ache at certain times of the day or week? Is there a theme? Have obvious physical causes been ruled out? It could be anxiety. Children cannot yet either understand or effectively communicate their big feelings, and anxiety - even in adults - is often felt in the body.

The link between mind and body is incredibly strong with anxiety. Our nervous system responds - usually inappropriately - to stimuli that may well be difficult to handle, or it could be totally benign. A pattern of the same physical symptoms is often a very strong indicator that a child may be struggling.

The list above is not exhaustive by any means, but these are some of the more common patterns I’ve seen in my clinic work with minors. You can ask yourself questions too, to consider whether your child has been through an event that they’ve found difficult to cope with.

Our minds as parents tend to dramatise this a little - so before you allow yourself to think of worst-case scenarios, scale it back a little and remember that something ‘small’ to our small people, is often actually rather large. I’ve seen anxiety cases stem from minor comments, sometimes even well-meaning jokes, for some reason, this triggers a response in the child which to many may seem disproportionate. 

So, what do we do? 

There are plenty of books on worry for child audiences, but, working with the right CBT therapist is gold-standard care to help nip childhood anxiety in the bud. In CBT we learn the connection between our thoughts, emotions and behaviour. Funnily enough, these often get muddles - well - not so much behaviour - but discerning between thoughts and feelings can be surprisingly tricky, especially when you’re little! 

Once we can identify the above, a good CBT treatment plan should be written by the practitioner which is specifically tailored to your child, with modules focused on each worry they have, and teaching them vital coping mechanisms to calm their bodies and quiet their minds. 

I personally believe that working creatively with CBT content is a particularly powerful way of delivering content to children, allowing them to explore their view of self and the world around them in a safe space can help to build strong self-esteem, a solid sense of who they are and make them feel invincible!

Children, in my experience, also respond very well to taught mindfulness exercises. Repeated during every session for the length of their treatment, will allow them to hear the voice of their therapist guiding them through relaxation exercises even when they aren’t in the room. This can be very, very helpful at bedtime, before a lesson they may be worried about at school, or to help with exam stress. 

Navigating childhood anxiety as a parent can be a tough road, a strain on yourself and your children, but finding the right support really can help the whole family.