Anxiety in Children and Teens

What is anxiety?

Anxiety is the experience of fear, distress, or worry. It often happens in response to a stressful situation. But it can also occur without a specific trigger. Anxiety might involve worry about something that happened in the past or about something bad happening in the future.

In most cases, children and teens cope well. Less often, anxiety causes ongoing problems. This may suggest an anxiety disorder.

Resources and services are available to help people with anxiety and anxiety disorders.

Signs and symptoms of anxiety in children and teens may include:

• Feeling stressed, worried, or scared
• Being irritable
• Getting upset easily
• Trouble thinking or concentrating
• Restlessness, not being able to settle down
• Crying more than usual
• Not wanting to be left alone, clinging to loved ones
• Avoiding activities or situations that cause anxiety
• Increased need for reassurance
• Problems sleeping
• Increased heart rate or fast breathing
• Tense muscles
• Headaches
• Change in eating habits
• Upset stomach, stomach pain, constipation, or diarrhea
• Nervous habits such as nail biting or picking at skin

Many symptoms can occur due to physical illness or as a side effect of living with a difficult medical diagnosis. A mental health provider can help you understand anxiety symptoms and how best to manage them.

Anxiety disorders in children and teens

An anxiety disorder is ongoing fear or worry that negatively affects a person’s daily life or causes extreme distress.

Usually, anxiety is part of a normal range of thoughts and emotions. But symptoms of anxiety that negatively impact daily life or do not improve may also signal an anxiety disorder or other mental illness that needs treatment.

Types of anxiety disorders

Anxiety disorders are diagnosed based on symptoms. Anxiety disorders include:

Diagnosis of anxiety disorders in children and teens

Each anxiety disorder has symptoms that lead to a certain diagnosis. Some anxiety disorders may have similar symptoms and treatments.

Care team members who can help may include:

• Psychologists
• Psychiatrists
• Licensed clinical social workers 
• Licensed professional counselors
• Mental health nurse practitioners

Talking to a trained mental health professional will help make sure your child gets the best possible treatment.

Treatment of anxiety disorders in children and teens

Managing symptoms of anxiety is important.

High levels of anxiety can:

• Cause health problems and physical symptoms such as headaches, stomach pain, nausea, or diarrhea
• Interfere with medical care and procedures
• Affect personal relationships 
• Make it hard to function at school or work
• Increase risk for other problems such as depression, alcohol or substance use, smoking, self-harm, or eating disorders
• Impact nutrition, sleep, physical activity, and other health behaviors

Treatment for anxiety may also help with pain, nausea, and depression.

Main treatments for anxiety disorders include cognitive behavioral therapy (CBT) and medicines.

Cognitive behavioral therapy (CBT)

CBT is a type of therapy that helps a person understand the relationship between thoughts, feelings, and behaviors. A CBT practitioner provides strategies to change thoughts and behaviors to improve well-being.

Your child can learn ways to lessen the effect of stress and anxiety with relaxation techniques. These techniques can include deep breathing, guided imagery, and muscle relaxation. CBT is often the first recommendation for treating anxiety disorders in children and adolescents.

Anxiety medicines for children and teens

A health care provider may prescribe medicine to help with anxiety symptoms. Some patients may need medicine that works over time to treat an anxiety disorder. Some patients may need a combination of medicines.

Patients taking medicines for anxiety need to visit their health care provider regularly to make sure the medicines work properly. The health care team will also monitor any side effects. Always follow medication instructions from your health care provider. Do not take more medicine than prescribed. Do not stop taking the medicine without talking to the care team first.

Talk to your child’s care team before making any dose changes. Also, be sure to store medicines safely. Keep them out of the reach of children.

Tell your health care provider if your child’s anxiety symptoms do not improve or if they get worse.

Coping with anxiety during illness

Managing anxiety is important. There are a variety of strategies that may help. Talk with your care team to make a plan that works best for your child and their specific situation.

Talk openly: It can be hard to talk with children about fears and worries. It might also be difficult for children to share their worries with adults.

• Look for ways to talk about thoughts and feelings on a regular basis. This makes it easier to have hard conversations when they arise.
• Use a variety of feeling words (such as mad, happy, scared, or nervous) to help children process emotions and talk about anxiety.
• Ask instead of assuming. Use open-ended questions to understand your child’s point of view.
• Recognize and respect your child’s concerns, even when you don’t agree.
• Admit that you sometimes have similar anxious thoughts and feelings. This helps your child know that they are not alone.
• Keep a journal to track thoughts and feelings.

Use coping skills and resources to help manage anxiety: Make it a habit to use coping skills even when things are going well. This will make the strategies easier to use when they are needed. Having more than 1 method to deal with anxiety is also important. Sometimes a usual coping strategy cannot be used or does not help.

• Distraction techniques: Engaging in activities they enjoy can distract children from anxiety-causing thoughts. These may include art therapy, music therapy, and play therapy.
• Mindfulness and relaxation strategies: Your child can learn ways to lessen the effect of stress and anxiety. Examples of relaxation techniques include deep breathing, guided imagery, and muscle relaxation.
• Mind and body practices: Some children find help from mind and body practices such as biofeedback, massage therapy, yoga, and physical exercise. Research shows that these therapies can change nerve signals and chemical messages in the brain to help improve anxiety.

Reach out to friends and family: Social support is important for patients and families facing serious illnesses. Help children and teens stay connected to friends and do usual activities that they enjoy.

Consider support groups: Patients and families often find that it is easier to share their experience with someone who has been there. Joining a support group, taking part in group activities, or making new friends in the hospital can give patients a safe place to talk about anxiety and find ways to cope.

Manage your own anxiety and stress: Stay calm when your child is anxious. Children sense the moods of those close to them. They also learn coping strategies from watching others. Parents and caregivers need to take care of their own mental health. Find ways to manage your own anxiety so that your child can know they can do it too.

Encourage your child to face their fears: Children and teens with anxiety often avoid situations they fear. At first, this may decrease their anxiety. But over time avoidance helps maintain or even worsen anxiety. Praise your child for getting through a hard situation.

Offer security without being overprotective: Parents want to protect their children from both physical and emotional hurt. Offer your child age-appropriate ways to be independent. This helps children develop confidence in their own abilities to solve problems.

Seek help for your child or yourself if anxiety symptoms get worse: Medical needs are often the most important concern when a child is seriously ill. But anxiety can have a negative impact on physical health and medical outcomes. Asking for help is not a sign of weakness. Talk to your care team or mental health provider.

Questions to ask your care team about anxiety

• What signs or symptoms of anxiety should I look for in my child?
• What are some ways I can help my child deal with anxiety?
• When should we see a mental health professional?
• What treatments for anxiety do you recommend?
• What coping skills can we use for anxiety?

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