Kids and anxiety: What’s normal and when to seek help

The first day of school. The first time at the pool. A surprise meeting with a gigantic dog.

Plenty of situations make kids feel nervous and uncomfortable. But how do parents know when a child is suffering from anxiety that requires professional attention? Here’s how to tell the difference and get your child the care he needs.

When children’s anxiety is normal

Some degree of anxiety in youngsters is appropriate rather than alarming. "It's normal for children to have fears that come and go throughout their life," says Tamar Chansky, PhD, psychologist and author of Freeing Your Child from Anxiety (2014). "Typically what happens is a child encounters a new situation and they need some time to learn about it, to work with it and get used to it." A child who has never met a dog before, for instance, might be fearful of interacting with even a friendly pup.

Sometimes anxiety is useful: It can help both children and adults navigate dangerous scenarios. "Feeling anxious or worried is necessary to be a human being. If you didn't feel anxious when you got to the edge of the cliff, your family line would die out right then," says Deborah Gilboa, MD, a pediatrician and child development expert.

Gilboa adds that anxiety may prove beneficial even in social situations. If a child witnesses a friend being teased, for instance, her anxiety over seeing such mistreatment may compel her to step in to comfort or defend her friend. "We've gotten to a point in society where we think anxiety means that we as parents have done something wrong," Gilboa says. "But there are certain circumstances where I hope my kids will feel anxious."

When parents should be concerned about anxiety

Experts note two red flags of clinical anxiety: avoidance and extreme distress. Texas mom Beth Teliho remembers when her son, Sawyer, now 10, started elementary school. He happily attended for the first couple of days. But then Sawyer started suffering “meltdowns” on the ride to school. "He was gasping for breath and crying, saying, 'I can't, I can't,'" Beth says. "The look on his face was so desperate, like he physically couldn't go into the school."

Sara Farrell Baker’s son August, 5, is on the autism spectrum and has sensory-processing issues. The boy dislikes loud noises, particularly flushing toilets and the hand dryers found in public restrooms. "He would become very distraught if we were going toward a restroom," Sara says. "Just being in an environment where he expected loud noises would get him very anxious."

Childhood anxiety disorders are divided into several types, including generalized, separation, social, and specific phobias, according to the Anxiety and Depression Association of America. Though different disorders may manifest in different ways, here are a few of the most common symptoms:

• Avoidance of specific activities, situations or people
• A tendency to worry about what can go wrong in any scenario
• Worries or fears that interfere with normal daily activities
• Persistent distress despite an adult's reassurances
• Trouble sleeping at night or insisting on sleeping with parents
• Physical symptoms, such as headaches or stomach pain, that don't stem from other medical conditions.

What not to do when a child is anxious

At one time or another, every parent has made a well-meaning mistake that made things worse. For instance, you may be quick to dismiss a youngster's emotions or label them “wrong," Gilboa says. "We're so used to guiding our kids' behavior that we try to guide their feelings as well," she says. "It never works."

Pressuring a child to feel a certain way may cause him to hide his or her real emotions. That can make it more difficult to recognize the seriousness of the problem. "If our kids can't express their feelings to us and know that they'll be heard, we will never know if they're experiencing true anxiety that needs attention," she says.

Other parents may be too ready to accommodate their children by simply avoiding situations that trigger anxiety. That can backfire, too. When children stop going to the pool with friends because they fear water or avoid sleepovers because they’re uncomfortable in the dark, those limitations may add to their anxiety. "It's really stressful not being able to do the things that other people do," Chansky says.

If left undiagnosed and untreated, a child with an anxiety disorder is at increased risk of engaging in dangerous behaviors, such as self-harm, substance abuse and bullying. "They develop negative coping strategies," Gilboa says.

How to address kids’ anxiety

The first step is to acknowledge your child’s condition so you can learn more about it. "Whatever struggles our kids face, we want them to develop positive coping strategies," Gilboa says. "Naming the problem makes that easier."

Typically, it takes a professional to name the problem. That could mean a school psychologist, pediatrician or therapist. Counseling worked wonders for Sawyer. Both he and August now recognize their anxiety and use creative tactics to get through scary situations.

If you're an Aetna member, primary care doctors can provide mental health screenings. Treatment for anxiety is covered by Aetna's Behavioral Health program.

Just as anxiety symptoms vary, so do treatment options. Children may be referred to a talk therapist or require medication. Some kids find comfort in mindfulness exercises or drawing pictures.

Kathryn Leehane’s daughter Mara, now 14, experienced stomach aches in middle school and had crying fits when it was time to do homework. Her anxiety diagnosis came as a relief. "Mara felt validated because she knew something was going on," Kathryn says. "It helped to hear that it was real and have someone say, 'Here's what we can do to help you.'"