It can be hard to spot a mental health problem among typical everyday anxieties.
If you think of a child, you typically think of silly and playful. They can say the weirdest things and operate without a care in the world. But children can also be hyper and wound-up, afraid of the monster under the bed or other “irrational” things (to our adult minds).
Everyone gets anxious, including children. As a parent, it can be difficult to know whether your child’s behavior is a normal part of development, a personality quirk, or a sign of something more serious. What’s the difference between a passing phase and a real problem? If your child is displaying worrisome signs, are they hinting at an anxiety issue?
Anxiety in Children
Here’s something that may surprise you:
Anxiety is the most common psychiatric disorder among children. According to the National Institute of Mental Health, 31.9% of children have an anxiety disorder. Girls are more likely to have anxiety than boys.
By definition, anxiety is excessive fear or worry. It may have no apparent “trigger” and manifest as a general uneasiness (generalized anxiety disorder) or a very clear one, such as being in public or interacting with people (social anxiety disorder).
Whatever the specific diagnosis, anxiety disorders have some similar calling cards, such as
Not wanting to eat or eating way too much
Persistent nausea, headaches, unexplained sickness
Refusing to go to school, birthday parties, sleepovers
Avoidance of certain things such as places or situations
Being high-strung, jittery, or jumpy- like they are wound too tight
Intense fear about certain things or situations
Excessive worry about school, friends, family, etc.
Parents spend a lot of time with their children and often know them best. While it may not always be clear anxiety is at play, monitoring changes in your child’s behavior and mood can help catch signs something isn’t normal.
Problems at School
Children spend a lot of their time at school, so it makes sense that mental health problems would manifest in the academic environment.
Anxious children may complain they do not feel well right before the school bus arrives. Almost immediately after a parent makes the decision to let them stay home, their symptoms miraculously disappear, only to come back the next morning.
If your child frequently complains of nausea or asks to see the school nurse and no physical reason is found, this may indicate a mental health problem like anxiety.
In addition to refusing to go to school, which usually happens during a transition like entering middle school, children with anxiety may also get poor grades in school. They may have anxiety when it is time to take a test or trouble focusing on their work.
Since anxiety is commonly manifested at school, talking to teachers and administrators about your child’s behavior can alert you to a potential mental health issue.
The idea that children are resilient and good at “bouncing back” from traumatic events is an antiquated one, as research through the Adverse Childhood Experiences (ACE) study and others show trauma has lasting effects on a child’s brain. Although some children may respond appropriately to trauma, such as a divorce, death, bullying, etc., others may experience lasting behavioral changes that can manifest as anxiety. If your child has experienced a traumatizing event and is showing signs of distress, it may indicate a deeper mental health issue that needs addressed.
What to Do If You Think Your Child Might Have Anxiety
1. Talk to Your Kids.
A mother we’ll call Amanda, has a 12-year-old child with anxiety, shares her journey to help other parents. She encourages parents to begin talking to their children about mental health when they are young.
“Talk about how they respond to their own emotions and build awareness of these responses, at age-appropriate levels,” she says, “Begin a mental-health conversation with your kids as early as possible so that there is never any fear or confusion about them coming to you to discuss what's going on in their brains, no matter how big or small.”
2. Ask Yourself These Questions.
This study through the University of British Columbia found just two questions were effective at determining whether a child is struggling with anxiety. These questions are “Is my child more shy or anxious than other children his or her age?” and “Is my child more worried than other children his or her age?”
Although it’s never fun to play the comparison game, this is one comparison that could help you draw the line between behavior that is no big deal and that suggesting anxiety.
In addition to asking yourself this, don’t be afraid to ask your child questions about their mental state. “Ask clinical questions, the same way you might if your kid has a cold,” Amanda advises parents. Answers to questions about how they feel, what events are happening in their lives, how they are sleeping, etc., can be compared with what you are seeing as a parent to determine if help is needed.
3. Normalize Feelings.
Encourage your child to express their feelings, whether good or bad, happy or sad. Assure them it is okay to feel what they are feeling. This is especially critical for young boys, who are often told to repress their feelings.
“Normalizing helps people put their concerns in perspective. Feeling like they are the only person in the world to have a problem is an isolating, shameful feeling,” psychologist David Nathan says.
The more a child is able to freely express their feelings without fear of how a parent will respond, the more likely they will be to tell you if they have feelings that alarm them, such as anxiety.
4. Assume there is a Clear Reason.
It can be tempting to brush off mood or behavior changes as directly related to something happening in your child’s life, such as school stress or issues with friends. By doing this, though, you are telling your child their anxiety must have a rational explanation and those who struggle with anxiety know this is not true.
“Don't try to force a "reason" for a sudden personality change if you see your child is not doing well,” mother Amanda says.
Real Life Example #1
Amanda’s child came home from school one day and told her he felt a weird feeling again that day during class. He described feeling afraid to get up from his chair, afraid to turn around or something "bad" might happen. She began to ask him questions about the experience and found out this feeling lasted the entire class and there was noting that happened before class like confrontation with a bully that could be the cause of this anxiety. "Did you understand, while it was happening, that it was unusual or not rational?” He replied yes, but that he still couldn’t help the feeling or get it to go away. "Okay, sweetie. Thank you for telling me about this symptom,” she said, “I'm sorry you had to deal with that, but glad it went away."
Real Life Example #2
As a child, Lisa* always had trouble sleeping. Throughout the night, she would continually check the clock for the time and worry over not having enough sleep for school the next morning. Her worry got to the point she would become nauseous and wake up her parents. They didn’t understand why she felt sick every night. She also worried about not being able to sleep when going to sleepovers and would feel so sick her parents had to pick her up. It felt out of her control.
Answering: “Is it Just a Phase?”
It’s no secret children go through phases. One day they may be obsessed with dinosaurs and the next, airplanes. These obsessions are fairly harmless and tend to pass, but sometimes what initially seems like “just a phase” may continue month after month and harm your child’s ability to live every day.
The real indicator of a mental health issue is if it persists and impacts a person’s ability to function and do what they want to do. For example, if your child insists on avoiding play dates for months and it is impacting her friendships and self-confidence, anxiety may be a root cause.
The sad reality of children and adolescents living with anxiety is the majority go without getting relief from their symptoms for long periods of time.
A stunning 80% of children with an anxiety disorder don’t receive any treatment, according to a report by the Child Mind Institute. It takes the average child ten years to receive help after their symptoms first appear.
There are many reasons for this, including the negative perception of having a mental health problem. Both child and parent may be understandably wary of the “anxiety” label, so they try to wait it out, believing symptoms will go away on their own.
For Amanda, prior experience with a family member and recognized her child needed help. “Just like if your child had a virus or some painful "physical" issue happening that needed attention, you would not delay a moment to help them find health and comfort immediately.”
If you’re unsure whether your child is dealing with anxiety, it’s always best to air on the side of caution and reach out to a professional who can look at all of the symptoms as a whole. Sometimes a third-party, educated viewpoint is helpful to determine if there is cause for concern.
However you get to the decision to get help for your child, let them know you are on their team. “Assure your child you are working with them to make them feel better and well as soon as you can. Let them know that helping them feel better is critically important and every step you are taking with them is about alleviating their symptoms,” Amanda advises.
Do you have a child with anxiety? Was there a moment you realized their behavior wasn’t “just a phase?” Share your experience to help others!
Rachel Gearinger has her Master’s in Public Health from Ohio State University. She spent two years at the National Alliance of Mental Illness as the Helpline Coordinator before becoming the Associate Director at Ohio Adult Care Facilities.
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