Anxiety in Children
Children experience extremely powerful emotions, fueled by uncertainty and rapid physical and emotional changes, as they move from one milestone to the next, which is especially true for teenagers. Children are by nature, sensitive and intuitive to their surroundings and may therefore react to them emotionally, and may feel miserable, frightened, worried or anxious.
Children can develop worries or anxiety disorders at any stage; however, it may present in various ways, in different age groups.
- Infants: irritability, having trouble sleeping, not feeding properly
- Toddlers: clinging to care givers, timid with people outside the family, not comfortable with new experiences, not willing to play with new people, unable to sleep without the caregiver present.
- School Children: have difficulty interacting with teachers or other children in school, have difficulty sleeping, may have recurring nightmares, have repeated complaints of headaches or tummy aches, constantly ask if things are alright, looking for constant reassurance
- Teenagers: Adolescence is a challenging time because of the extreme changes that occur during that time. Teenage anxiety may present as a change in attitude or behavior, development of eating disorders: overeating or under eating (which may lead to anorexia or bulimia), specific phobias, experiencing panic attacks, having obsessions, turning to self- harming behavior or in extreme cases, suicide.
Reasons for Childhood or Adolescent Anxiety
- Difficult interactions with other children, due to persistent bullying, teasing or name calling, leading to low self-esteem.
- Trouble with schoolwork leads to fear of failure as well as fear of disappointing parents
- Specific fears arising from experiencing or witnessing traumatic experiences (death of a family member, illness in the family, unhealthy home environment due to parental disputes, separations or divorce), abuse or accidents.
Types of Anxiety Disorders common in Children and Adolescents
- Separation Anxiety: This usually occurs in small children where they cannot be apart from their care giver and cannot interact with new people. They are extremely clingy, and this poses a problem when it’s time for them to attend school or interact with teachers and friends independently.
- Social Anxiety: This is seen in school going children and teenagers, where they are afraid of what others will think or say about them. They are constantly scared of being embarrassed and do not like to receive any attention that may make them stand out. They may not be able to participate in discussions and may feel physical manifestations of their anxiety if put in situations that scare them, like shortness of breath, flushing of face, or feeling shaky and lightheaded.
- Phobias: Even though many children are afraid of specific things like imaginary monsters in the dark, big animals, loud sounds like thunder or fireworks, children with phobias experience this fear more intensely and it becomes hard to comfort them.
- General Anxiety Disorders (GAD): This form of anxiety causes children to intensely worry all the time about various things that children that age worry about like school, friends, making mistakes, getting punished, getting approval. They worry about the future and may ask repeatedly if everything will work out. This may make it difficult for them to focus in school or maintain friendships.
- Panic Disorder: is also known as a panic attack. Children experiencing panic attacks may experience an intense period of fear and stress, along with accelerated heart rate , difficulty breathing, chest pain, nausea, shaking, sweating or fainting episodes. Panic attacks are known to last from minutes to hours.
- Obsessive compulsive Disorder (OCD): Children with this anxiety disorder have recurring thoughts (obsessions) that are often linked to specific fears (like touching dirty objects, leaving the door unlocked). In order to control this fear, they use compulsive rituals to ease the anxiety; for example, excessive hand washing or checking a locked door repeatedly.
- Post-Traumatic Stress Disorder (PTSD): Some children face traumatic and stressful events in their young lives which may lead to anxiety. For example, a death or illness in the family, physical, emotional or sexual abuse, natural or manmade disasters changing their way of life, accidents, etc. The child may experience or witness this trauma and may develop long term symptoms which upset or interfere with their activities or relationships. The most common symptoms of are restlessness, inability to focus or pay attention, which can also be mistaken for ADHD (Attention Deficit Hyperactivity Disorder)
Most of the fear and anxieties plaguing children may be dealt with at home, through open and honest communication between parents and their children, while adopting a reassuring and comforting presence around them. Parents may choose to reach out for professional help to counselors, psychiatrists or psychologists who specialize in child and adolescent mental health, who in addition to individual Cognitive- Behavioral Therapy sessions with the child, may have Family Therapy sessions as well, to deal with childhood anxiety.
However, in more severe cases of anxiety where the distress associated with anxiety is overwhelming and causes severe avoidance of triggers leading to impaired functioning or social interactions, medications as interventions may be needed. A multi-faceted team including counsellors, psychiatrists or clinical neurologists, specializing in pediatric care may all be involved in a holistic treatment plan.
In addition to extensive history taking and evaluations, a few common investigations are also done, to ensure that there are no physical causes of the anxiety; for example, tests for endocrine functions like thyroid disorders and diabetes, respiratory problems, or sleep abnormalities.
Medications given for the management of anxiety disorders in children
Along with Cognitive behavior therapy, the most common medication used for anxiety disorders is SSRI (Selective Serotonin Reuptake Inhibitors) which is a type of anti-depressant and works by increasing the level of serotonin, a chemical in the brain, which helps to improve moods and reduce anxiety. Side effects of SSRIs like sertraline, paroxetine and citalopram are insomnia, nausea, diarrhea.
As adjuvants, physicians may also prescribe anti-anxiety medications like alprazolam or clonazepam for older children with more severe symptoms. Side effects of these include fatigue and dizziness.
All medications are given under supervision of treating doctors, in order to evaluate the effectiveness and side effects and to adjust doses accordingly. Medication can be prescribed as short term or long-term options depending on how the child responds to the regimen.
Disclaimer: The above information is for awareness and education purposes only and cannot be used for diagnosis or treatment of any condition. Please consult with a physician for any concerns or questions
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263391/ Kodish I, Rockhill C, Varley C. Pharmacotherapy for anxiety disorders in children and adolescents. Dialogues Clin Neurosci. 2011;13(4):439-452