Most children have fears or worries of some kind. In most cases, fears in childhood are fairly transient and short-lived. Nonetheless, anxiety disorders in children are the most common reason for children and adolescents to seek psychological treatment. In the following sections, we answer some of the main questions that parents concerned about childhood anxiety tend to have.

1. What fears do children with anxiety typically display?

Infants and Toddlers: Strangers, loud noises, and especially separation from a key parental or caregiver figure.  Children in this age range usually cry when they get anxious.

Preschoolers:  Insects, animals, darkness, separation from parents or caregiver. Preschoolers may show anxiety by being shy, reluctant to engage in social situations, and by being extremely quiet or tearful. Anxiety may also be expressed as sleep disturbances and complaints of stomach aches, headaches and non-specific pain.

School-age children: While infants and young children don’t generally worry, children over 6 or 7 have the cognitive maturity to anticipate a future in which bad things might happen. School-age children might be afraid and worry about supernatural things (like ghosts), and may occasionally worry about social situations, failure in exams, possible criticism by teachers or parents, and physical harm like getting sick or hurt.

Older childhood and adolescence: The focus of fears becomes less concrete in this age group. For example, they may think a lot about family relationships, war, what their friends think of them, their self-image, and so on.

2. When is child anxiety a problem?

In general, anxiety needs to be addressed if it is stopping the child from doing the things he wants/needs to do, if it is seriously impacting the family’s functioning and if it compares poorly to that of other children of the same age. For example, while it’s common for most children to experience some fears about separation when going to school for the first time, this tends to be far less common for a 9-year-old child, who has been going to the same school since Primary 1.

Nonetheless, the following are some signs indicating that your child may not be coping too well:

• Frequently seeking reassurance or approval
• Nausea, stomachaches  or other vague pains, especially at specific times and occasions
• Intense anxiety way in advance of planned social events
• Excessive shyness
• Perfectionism
• Appearing worried or unusually quiet for extended periods
• Overreaction to criticism
• Reacting badly to routine changes
• Sleep troubles

3. How can parents help an anxious child manage and overcome the anxiety?

• Discuss. Encourage your child to talk about their fears. However, remember that you can’t demand that the child tell you what’s on their mind. Like adults, children only share information when they’re feeling safe, supported and not judged. In children, it helps to initiate discussion while engaged in some other activity like playing with Lego, taking a walk, cleaning or baking.

• Validate. Be sure to validate their experience. Even if the fears sound silly to you, they are very real to your child. Let your child know that you understand that they are frightened by repeating what they said back to them in your own words “It sounds like you feel very scared when Mummy drops you off at school because you worry she won’t come back to get you.”

• Normalize. It is also helpful for children to know that everyone gets scared at times, even parents. Talk to them about how you face your fears.

• Provide coping strategies. Be sure to include some coping strategies in the discussion. This includes breathing and relaxation exercises. Tell the child to take slow deep breaths as if their tummy is a balloon and they are filling it up with air, or tell them to  “go floppy like a puppet with the strings cut lose so all your muscles are loose and relaxed”. Another useful coping strategy is talking through a fear. For example, “It’s just a grasshopper. It can’t hurt me”.

• Help them face their fear. Encourage the child to face their fears gradually. You may want to provide them with a lot of support initially, but you can reduce the support slowly. For example, a child who fears dogs may be exposed at first to pictures and videos about dogs, followed by small dogs behind a fence, on a firm leash and so on. Make sure your child can stay calm at each step before moving on to the next.

• Praise positive efforts. Praise the child for facing their fears. For example, the socially anxious child may be applauded for saying hello to someone in the playground. The experience of a success will make it more likely that they will be able to muster the courage to invite another child at the playground to play the next day.

• Just do it. Sometimes children simply have to do the things they are afraid of such as seeing a doctor or starting a new school. At these times, do not allow your child to avoid the situation as this can exacerbate the fear and prevent your child from learning the truth of their feared situation. For example, a child who has never made a visit to the dentist would not get to learn that a visit to their family dentist is not such a bad experience.  Parents are encouraged to prepare their children for what to expect and then focus on what the child did well.

• Seek professional help for the child’s anxiety. If the fears and anxieties continue despite your best efforts, it may helpful to consult a professional.