Anxiety in Children

By: Pine Rest Staff

Anxiety is a normal part of childhood and is usually temporary and harmless. However, children who suffer from an anxiety disorder experience fear, nervousness and shyness to the point that they start to avoid places and activities.

One in eight children is affected by an anxiety disorder, with symptoms commonly emerging around age six. Left untreated, children with an anxiety disorder are at higher risk to perform poorly in school, miss out on important social experiences and engage in substance abuse.

Children and teens can experience any type of anxiety disorder. However, separation anxiety disorder and selective mutism are generally diagnosed only in children.

Separation Anxiety Disorder

It’s perfectly natural for a young child to feel anxious when separated from a parent. Crying, clinging behaviors or tantrums are common reactions when a parent goes away or when a child is left at day care or preschool. Usually, these behaviors stop once the child is distracted and engaged in new activity.

This is a normal stage of development for many children aged 18 months to about three or four years old, and symptoms usually fade as the child ages. However, if this fear occurs in an older child, becomes excessive or persists for more than a month, the child may have separation anxiety disorder.


While adults can suffer from separation anxiety, it usually affects children seven to nine years old. Separation anxiety disorder affects about 4% of children and often develops after a significant life event such as death of a parent or pet, move to a new home or school or major illness or hospital stay.

A child with separation anxiety disorder experiences excessive fear and nervousness when away from home or a parent. This fear then interferes with school or other activities. Symptoms may include extreme homesickness, refusal to go to school or camp, complaints of headaches or stomachaches on school days, bedwetting, nightmares or worry that something bad will happen to the child or parent while they are apart.

Tips for Easing Separation Anxiety

Schedule separations after naps or feedings. Babies are more likely to feel anxiety when they are tired or hungry. Practice. Leave your child with a caregiver for a short period of time to get your child slowly more accustomed to your absence. Develop a “goodbye” ritual. This can be as simple as a special hand wave or blowing a kiss. Leave without fanfare. Tell your child that you are leaving and that you’ll return. Then go.


Selective Mutism

Periods of shyness are common in children: they might get very quiet and withdrawn in a new place, when meeting new people or starting school. However, when a child is talkative and behaves normally in familiar surroundings such as their own home, but refuses to speak or has serious difficulty communicating in certain social situations, it may be selective mutism.

Often considered a severe form of social anxiety, selective mutism usually develops in early childhood, often before the age of five. The inability or refusal to speak is not due to a lack of knowledge or comfort with language or due to another communication disorder such as stuttering. Children with Selective Mutism have a fear of social interactions where speaking to others and communicating is expected. Parents frequently first learn about a child’s difficulty from a teacher or other school figure, because the behavior is not apparent when the child is in a comfortable setting or environment.

Symptoms of Selective Mutism

  • “Freezing” in place: standing motionless
  • Blank facial expression
  • Twirling or chewing hair
  • Head turning
  • Avoiding eye contact
  • Withdrawing into a corner to avoid interaction

School Refusal: When Kids Won’t Go to School

Although most children will refuse to go to school occasionally or play hooky, “school refusal” is when a child refuses to go to school or stay at school on a regular basis. Often the child complains of physical symptoms such as a stomachache or headache in order to miss that day of school, arrive late, leave early, or spend a lot of time in the nurse’s office. 

It’s important to follow up with the child’s pediatrician to rule out a medical condition. However, in many cases “school refusal” can be a symptom of an anxiety disorder such as social phobia or separation anxiety.

Starting kindergarten, changing schools, and stressful life events can trigger school refusal. Or, the child may have fear of failure, fitting into a social group, a particular teacher or of another student. School refusal commonly takes place at ages five to six, ages ten to eleven, and when transitioning to junior high or high school.

Getting a comprehensive evaluation from a mental health professional will help to identify the anxiety disorder(s) the child is facing and help determine the best treatment. In the meantime, the child should be kept in school since missing school reinforces anxiety rather than lessens it.

Coping Strategies for School Anxieties

• Expose your child to school in small degrees, increasing exposure slowly over time. Eventually this will help them realize there is nothing to fear and that nothing bad will happen.

• Talk with your child about feelings and fears, which helps reduce them.

• Emphasize the positive aspects of going to school: being with friends, learning a favorite subject, and playing at recess.

• Arrange an informal meeting with your child’s teacher away from the classroom.

• Meet with the school guidance counselor for extra support and direction.

• Try self-help methods with your child. In addition to a therapist’s recommendations, a good self-help book will provide relaxation techniques. Be open to new ideas so that your child is, too.

• Encourage hobbies and interests. Fun is relaxation, and hobbies are good distractions that help build self-confidence.

• Help your child establish a support system. A variety of people should be in your child’s life—other children as well as family members or teachers who are willing to talk with your child should the occasion arise.


Treating Children

Studies on treating childhood anxiety disorders have found that cognitive behavioral therapy can effectively treat anxiety disorders in children. Also, educating children about the nature of anxiety, ways to identify, evaluate and change anxious thoughts plus training in relaxation strategies have all been used with some success. Children are also taught to learn to recognize the physiological symptoms of anxiety and are taught to use positive “self-talk” rather than negative self-talk.

Techniques commonly used include relaxation training, use of imagery techniques, token reinforcement implemented by parents (e.g., praise, sticker charts), and careful self-monitoring of positive behaviors. Through exposure therapy, children are also taught ways to gradually face situations that they formerly avoided due to fear. Exposure therapy should be implemented by a trained therapist.

How Parents Can Help

Recent research suggests that parental involvement in treatment can enhance treatment effectiveness. By learning new ways to interact with their child, the child’s fears are not inadvertently reinforced. Parents can provide praise and positive reinforcement for brave behavior as well as implement and practice new coping skills with their children between sessions. Because children’s anxiety symptoms have been found to have significant impact on the family, many clinicians incorporate family therapy into their treatment protocol.

Need help for your child or teen? Pine Rest provides compassionate, world-class treatment at all care levels for kids.

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