Everything you need to know about Anxiety in Children

Anxiety is one of the most common mental health concerns for children and adults alike. While it is normal for children to feel worried or anxious occasionally, for some children anxiety can be more serious and can impact on their day-to-day lives.

In the UK, nearly 300,000 young people have an anxiety disorder. The condition is estimated to affect 5-19% of all children and adolescents and about 2-5% of children who are younger than 12 years old. Separation anxiety disorder is the most common anxiety disorder in children younger than 12.

In 2021, among children aged 6 to 16 in England, one in six had a probable mental health condition, which is an increase from one in nine children in 2017. In 2021, 24% more patients were in contact with the children and young people’s mental health service (CYPMHS) compared with 2020, and 44% more than in 2019. This included patients who were waiting to be seen.

What is anxiety?

Anxiety is a feeling of unease, a feeling of worry or fear that can range from being mild to severe. Anxiety is usually experienced as a combination of physical sensations, thoughts and feelings. Anxiety can feel like you are constantly worrying about things, have a sense of dread and you may have difficulty concentrating.

Anxiety isn’t necessarily always a bad thing in moderation as it can help us to remain alert, make us aware of risks and motivate us to solve problems. However, anxiety can be a problem if it affects your child’s ability to live their day-to-day life. If anxiety is ongoing, intense, difficult to control or out of proportion to their situation, it can be a sign of a mental health problem.

Everyone experiences feelings of worry occasionally. For children, having worries or feeling anxious is a normal part of growing up. This may happen when starting a new school or during exams but the feelings of worry will usually pass. Anxiety becomes a problem when it overwhelms someone and they become stuck feeling anxious. If the worrying and anxiety go on for a long time, it can leave a young person feeling exhausted, isolated and limited in the things they feel able to do.

People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.

What causes anxiety in children?

Children can experience stressful, traumatic events which can affect their mental health.

These can include:

• A bereavement. For further reading about bereavement, please see our knowledge base.
• Experiencing a serious illness.
• Physical health difficulties or a disability.
• A loved one having a serious illness.
• Witnessing violence or abuse.
• Being abused or neglected.
• Being around adults who are anxious can also influence how a child feels as they will pick up on this.
• Frequently moving house or school.
• School-related issues, for example, exams or bullying.
• Using drugs or alcohol.

Social media use has also been linked to having a negative impact on children’s mental health in some cases. Internet use can expose children to dangers, such as cyberbullying, online grooming and sexual abuse. Children can easily be exposed to unsuitable or harmful materials online which can cause emotional harm. Think U Know provide some helpful online safety advice and resources.

Studies show that experiences like abuse and exposure to violence can cause fear and chronic anxiety in children and that these experiences can trigger extreme and prolonged activation of the body’s stress response system.

The environment that a child is exposed to and any trauma they have experienced is thought to be the most influential thing that affects someone’s mental health. Focussing on this as the root cause is usually more helpful in determining what has caused the anxiety disorder, and therefore being able to successfully treat it.

Other things that may cause a child to develop an anxiety disorder include:

• Genetics – A child who has a family member with an anxiety disorder is more likely to have one as well. Children may inherit genes that make them prone to anxiety.
• Brain chemistry – Genes help direct the way brain chemicals work. If specific brain chemicals are in short supply, or are not working well, it can cause anxiety.

Sometimes there may not seem to be a clear reason why a child has anxiety and it may be difficult to understand why they are suffering this way. The child themselves may also have difficulty understanding why they are feeling anxious, due to their age or ability to understand their emotions.

Types of anxiety children experience

There are different types of anxiety disorders that can affect children and young people.

These include:

• Generalised anxiety disorder – This type of anxiety disorder can make children worry on a daily basis over a variety of things. Children with generalised anxiety disorder can worry about almost everything in their own lives and in the world around them. Children with generalised anxiety disorder may worry excessively about school, friendships, their own or other people’s health or things they see in the news. Generalised anxiety disorder can have a negative impact on a child’s day-to-day life as it is hard for them to relax, have fun, eat well, or fall asleep at night as there is always a worry on their mind. Children with generalised anxiety disorder may miss school on a regular basis. Some children may talk about their worries and others will not; however, children with generalised anxiety disorder are difficult to reassure as their anxiety levels are so high.
• Panic disorder – This can cause overwhelming physical symptoms, such as feeling shaky or jittery, trembling, having a racing heart rate, and shortness of breath. They are usually sudden anxiety attacks and are more common in teenagers than in younger children.
• Separation anxiety disorder – Separation anxiety is common in babies and young children, usually between the ages of 6 months and 3 years and is not unusual to continue beyond this age. In a small number of cases, children beyond the age of toddlerhood will develop separation anxiety disorder (SAD). The symptoms of separation anxiety disorder are more severe, and it is a type of mental health problem. A child with SAD worries excessively about being apart from their family members or other people they are close to. The child has a fear of being lost or of something bad happening to a family member if he or she is not with the person. They usually have worries and fears about being away from home or being separated from family members. These worries and fears are not appropriate for their age or developmental stage. SAD is not something that will go away on its own and support will be needed.
• Social anxiety disorder – Also known as social phobia, this is when a child has extreme anxiety about social situations, for example school. They are usually worried in excess about what other people think about them and they worry that they will embarrass themselves in front of other people. They don’t like to be the centre of attention and they don’t want others to notice them, so they may avoid speaking in class or they may freeze or panic if they are asked a question in front of other people. With social phobia, a class presentation or a group activity with classmates can cause extreme fear. Social anxiety can cause children to want to avoid school and their peers altogether. Children with social anxiety disorder can also experience physical sensations, for example feeling shaky, jittery, light-headed or their heart may be racing.
• Specific phobias – A phobia is an intense, extreme, and longer-lasting fear of a specific thing. A child will dread the thing they fear and try to avoid it. If they are near the thing they fear, they will feel terrified and it will be hard to comfort them. It is normal for young children to feel scared at times as they are learning about the world around them; however, a phobia is a more extreme version of a specific fear of something. To read about different types of phobias, please see our knowledge base.
• Selective mutism – This is an extreme form of social anxiety. Selective mutism is a childhood anxiety disorder leading to the inability to speak or communicate in certain settings. The condition is usually diagnosed in childhood. Children who are selectively mute may not speak in certain social situations; this may be at school, nursery or other community settings. If left untreated, selective mutism can lead to low self-esteem, social anxiety, social isolation and academic problems. It can also persist into adulthood if it is not treated during childhood.

Symptoms of anxiety in children

The signs of anxiety in children include:

• Fear of being away from a parent. This is different from normal separation anxiety which is usually seen in babies and young children.
• Physical symptoms can include panic, feeling shaky, sweating, dizziness, stomach ache or headaches.
• Refusing to go to school or becoming socially isolated.
• Unable to join in activities.
• Difficulties in their relationships with friends and family.
• Worrying that a parent or family member may die or become seriously ill.
• Having anxiety about the future.
• Having difficulty sleeping.
• Waking up often at night after having bad dreams.
• Tiredness and fatigue.
• Difficulty concentrating.
• Being tense, irritable or fidgety.
• Appearing scared or upset.
• Using the toilet often.
• Having panic attacks.

The symptoms of anxiety are the result of what is known as the fight or flight response. This is the body’s normal response to danger. When someone perceives that there is a threat or danger towards them, the brain releases chemicals into the body. These chemicals prepare us to deal with real danger, which may jeopardise our safety.

They affect our heart rate, breathing, muscles, nerves and digestive system. This response is supposed to protect us from danger. However, with anxiety disorders, the fight or flight response is overactive, and can happen even when there is no real danger.

What effects does anxiety disorder have on children?

Anxiety can prevent children from experiencing daily life as a child should. It can impact on their school experience, home life and relationships with other people. It can prevent them from finding enjoyment in the things they used to enjoy and make them socially isolated.

Persistent fear and anxiety can affect a young child’s ability to learn and develop appropriately. To learn more about child development stages, please see our knowledge base.

How is an anxiety disorder diagnosed in children?

Anxiety disorders can be diagnosed by a trained therapist. They will want to take your child’s history and also a full family history. They will talk to your child about their specific anxiety in order to gain a good understanding of their situation.

If you are worried about your child’s mental health, you should make an appointment to see your GP. Your GP can refer your child to a local children and young people’s mental health service (CYPMHS) that are able to provide specialist help.

CYPMHS is used as a term for all services that work with children and young people who have difficulties with their mental health or wellbeing. You may also be able to refer your child directly to this service without seeing your GP. Specialist CYPMHS are NHS mental health services that focus on the needs of children and young people.

They are multi-agency teams that often consist of:

• Psychiatrists.
• Psychologists.
• Social workers.
• Nurses.
• Occupational therapists.
• Support workers.
• Specialist substance misuse workers.
• Education mental health practitioners – who work in mental health support teams in schools and colleges.
• Children’s wellbeing practitioners.
• Primary mental health workers.

Accessing support from a specialist CYPMHS is different depending on where you live, and waiting times can also vary. Most CYPMHS have their own website, which will have information about how to access the service, including phone numbers, so you can get in touch directly to ask for advice.

You may also find it helpful to speak to someone at your child’s school.

If you or your child is being supported by social services or the youth offending team, your key worker will also be able to refer your child to CYPMHS.

Supporting a child with anxiety

Talking to a child is the most effective way to ensure that they feel supported and understood. If a child opens up to you about how they are feeling, whatever is causing the problem, you should take it seriously, even if it seems trivial to you. If your child does not want to talk to you, let them know that you’re concerned about them and that you are there if they need you.

You should encourage them to talk to someone else they trust, such as another family member, a friend or someone at school. It may be helpful for you to talk to other people who know your child and speak to your child’s school so that they can offer some support.

It is important to remember that the anxiety in your child’s body is real and validating how your child feels will let them know that you understand how anxious they are feeling. While it is important to reassure your child that you are there to support them, and that they are safe, it is also important not to minimise how they are feeling.

Children often express themselves through play and this can be an important way of engaging with a child who finds it difficult to talk about how they are feeling.

If you are worried about any aspect of your child’s mental health, you can call the charity Young Minds free parents helpline for advice on 0808 802 5544. Their lines are open Monday to Friday from 9.30am until 4pm.

If you are worried that any child is being abused, or if a child discloses something to you that you are worried about, you can speak to the NSPCC who will be able to offer advice and tell you how you can report your concerns.

Treatments for anxiety in children

For children with anxiety disorders, the most effective types of treatment are:

• Cognitive behavioural therapy (CBT) – This type of treatment helps a person focus on how they think about themselves, the world around them and other people and how their perception of things affects their thoughts and feelings. This type of treatment is led by health professionals and is more appropriate for older children and adolescents. It is usually effective for those experiencing symptoms of social anxiety. CBT can also be an effective treatment for younger children in some cases. An important part of CBT in the treatment for anxiety is called exposure and response prevention. In exposure and response prevention, the therapist helps the child to face the thing that they’re afraid of a little bit at a time. By dealing with their fear slowly in a safe space, children can learn to deal with their complex feelings. For more information about cognitive behaviour therapy, please see our knowledge base.
• Behavioural therapy – This type of therapy works towards replacing bad habits with good ones. Behavioural therapy does not focus on someone’s past or thought processes, it focuses on current difficulties in order to help conquer their fears.
• Play therapy – This is a form of therapy used mainly for children. Children may not be able to process their own emotions or articulate problems to parents or other adults. A trained therapist can use playtime to observe and gain insights into a child’s problems. The therapist can then help the child to explore their emotions and deal with unresolved trauma. Through play, children can learn new coping mechanisms and how to redirect inappropriate behaviours.

When therapy alone isn’t enough, children can also take medication for anxiety. A psychiatrist can prescribe medication. If medication is prescribed, this will usually be recommended alongside therapy. Anxiety medicines will only usually be offered to your child if their anxiety is severe.

Whether you are a young person who is struggling with anxiety or you are a parent or someone working with a young person who is struggling with anxiety, Young Minds offer some helpful advice and resources on their website.