Worries and anxieties

Children, like adults, have all sorts of strong feelings about what is happening to them. It's natural for them to feel fearful or worried from time to time. However, a small group of children and young people have severe anxiety which causes a lot of distress, and can seriously affect the way their everyday lives.

Anxiety is one of the common mental health problems. Nearly 300 thousand young people in Britain have an anxiety disorder. Lots of people, however, suffer in silence. It is important to recognise their problems and seek help especially when it starts affecting their everyday life.

Anxieties are grouped on what the fear or the worry is about. These groups are helpful in understanding what the difficulties are and how to treat them.

Fears and phobias

Young children often develop fears, for example of animals or of the dark. A phobia is an extreme fear which causes a lot of distress and affects the child's life significantly. For example, a fear of dogs would be called a phobia if it means that a child refuses ever to go to the park to play.

Most children either grow out of their fears or learn to manage them with support and encouragement, but it is much more difficult to cope with a phobia without some extra help.

General anxiety

Some youngsters feel anxious most of the time for no apparent reason. It may be part of their temperament, or it may be part of a pattern of behaviour that is shared with other members of the family. If the anxiety becomes very severe, it can mean that the child will not want to go to school, cannot concentrate or learn, and is not confident with other people.

Separation anxiety

Worry about not being with a child's regular care-giver is a common experience for most children. It normally develops at 6 months, and can go on in some form during the pre-school years.

It can make going to sleep, parents leaving for work, or settling at nursery or school very difficult at times. If it is extreme and affects the child's development, education and family life, it may be useful to get some additional help.

Social anxiety

It may be helpful to think of this as an extreme, sometimes disabling, type of shyness. It means that although children and young people are not affected in the company of people they know and family, they find it very worrying to be in other social situations.

This means that they will usually avoid them. This causes problems for the child in making new friends or dealing with situations at school. Older children describe it as a fear of humiliation or embarrassment which leads them to avoiding social situations.

A small minority of children and young people may develop other specific types of anxiety, such as post traumatic stress disorder or obsessive compulsive disorder. Unlike young people and adults, it is extremely rare for children to suffer panic attacks.

Anxiety can cause both physical and emotional symptoms. This means it can affect how a person feels in their body and also health. Some of the symptoms are:

• feeling fearful or panicky
• feeling breathless, sweaty, or complaining of ‘butterflies’ or pains in the chest or stomach
• feeling tense, fidgety, using the toilet often.

These symptoms may come and go. Young children can't tell you that they are anxious. They become irritable, tearful and clingy, have difficulty sleeping, and can wake in the night or have bad dreams. Anxiety can even cause a child to develop a headache, a stomach-ache or to feel sick.

We do not really know what causes this illness. However several things can contribute to their anxiety like genes, where they live, having upsetting or traumatic experiences.

Anxiety tends to run in families, so if someone in your family is known to worry a lot, they may be more likely to worry as well. Some of this will be passed on in the genes, but they may also ‘learn’ anxious behaviour from being around anxious people.

Children who are bullied, lack friends or have trouble with their school work often worry a lot.

Child who have experienced a household fire or a burglary, a car accident or some other frightening or traumatic event, might suffer from anxiety afterwards. They might also develop post-traumatic stress disorder.

Children who have to cope with stressful situations like bereavement, parental illness or divorce often become anxious and insecure. They may be able to manage one event, but may struggle to cope if several difficult things happen together, such as parents divorcing, moving home and changing school.

Children need parents or caregivers to sooth them effectively. Young children can feel worried and anxious if they hear or see their parents arguing or fighting (see our factsheet on good parenting). If children feel their family or friends are anxious or harsh, it can make them feel more anxious. This leaves children feeling unsupported, insecure and lacking in confidence and can also be linked with separation anxiety in children.

Most children grow out of it, but a few continue being anxious, and can sometimes become depressed as adults.

Even if they do not become anxious adults, anxiety can limit a young person's activities which can affect their development in the long-term. Not going to school, for example, means missing out on education and making friends. Loneliness and lack of confidence can be long-term problems. The emotional effects of traumatic experience can also be long-lasting.

A lot can be done to stop children being anxious. Parents and teachers can help by remembering that children, like adults, may get anxious about sudden change.

• It helps if you can prepare them in advance and explain what is going to happen and why.
• Regular routines around bedtime and getting ready for school can help very young children with separation anxiety.
• There may be books or games that can help children to understand upsetting things, such as serious illness, separation or bereavement.
• Children over the age of five often find it helpful to talk about their worries to an understanding adult, which could be someone outside the immediate family.
• They may need comfort, reassurance and practical help with how to cope.

If your child is showing signs of anxiety, it is important that you can show them that you care and want to understand the reason why:

• Think about whether there is something going on in the family that could be causing worry.
• Are they picking up on your own worry?
• Is something happening at school or with friends?

All families have times when they have to deal with a lot of stress and worry. At times like these, you or your child might need extra help and support from friends, family members or others.

If your child is so anxious that they can't cope with ordinary day-to-day life, more specialist help is needed. Your GP will be able to advise you, and may suggest referral to the local child and adolescent mental health service (CAMHS) (see our factsheet on Who’s Who in CAMHS). The type of specialist help offered here will depend on what is causing the anxiety.

Basically, it will involve finding ways of overcoming the worries and building confidence step by step.

The type of specialist help offered here will depend on what is causing the anxiety. Usually it will be a form of talking therapy, like cognitive behavioural therapy (CBT).

CBT can help them understand what causes their anxiety and find strategies for coping. Parents are encouraged to be actively involved in helping their children manage their anxiety and are advised how to do this effectively.

Occasionally, they might also be given a medicine to help if their anxiety problem has not got much better. A type of antidepressant, called an SSRI, is usually used.

Anxiety problems can be really difficult to live with for both the young person and family, but it is treatable.

One of the worst things about my phobia was that I had to keep it secret. When my friends invited me to their birthdays, I had to say I was busy, because I couldn’t go anywhere near balloons.

I’ve always disliked balloons. But last year I decided that my fear was out of control, and I had to do something about it. I went with my mum to see our GP, who sent me to a specialist. A couple of months later, we had the first of a course of eight “cognitive behavioural therapy” sessions.

The therapist began by telling me that plenty of people have phobias and that balloon phobia even had a name (“globophobia”). It really helped to know that other people had the same problem.

She asked me about my early life and tried to work out how my phobia had started. We talked about how I react to different stressful situations, marking how bad I’d feel on a scale of 1 to 10. She explained that my fast pulse rate, and my feeling hot and tense, and needing to escape were a normal response to stress. She taught me how to control my breathing, relax and talk to myself positively to control my anxiety.

Gradually, each week, I had harder things to do – at first just touching balloons, but by the end of the course - bursting them. On the way to the sessions I often got quite upset, because I knew I was going to have to face my greatest fear. It was hard work, and I nearly gave up.I still don’t like balloons, and would rather not have them near me. But thanks to the therapy, I can now accept invitations knowing that I can deal with my fears.

"I don’t know about you, but I have always been a worrier, like my grandmother. Every year, we would plan our family trip to India and it would start … worrying about the plane journey … worrying about falling ill, … and just before take off I would get those horrible “butterflies”, sweaty hands and the feeling that I couldn’t breathe. Sometimes I would feel my heart beating and I thought I was dying or going “crazy”.

Last year, before my exams, my worrying got really bad. The pressure in secondary school has been high and everyone in my family has always done well and gone on to University, so I knew I had to study extra hard. It got so bad that I couldn’t concentrate. I felt shaky and nervous at school and even started to cry most days. I wasn’t sleeping well because I was so nervous and was too embarrassed to tell mum and dad.

I ended up pouring my heart out to the school nurse which was the best thing I ever did. She got in touch with my mum, and after seeing the GP, I went to see a team of specialists at the hospital.

Don’t worry…I didn’t want to be the “girl who sees the shrink” either but it’s not like that. The team can have all sorts of people like doctors, nurses, psychologists and social workers. They reassured me and helped me and my family to see that my symptoms were real (just like when you have asthma). I went on to have a talking therapy called CBT. This involves a number of weekly sessions with the therapist. I didn’t even need to take medication. Although, I will always be a worrier I feel so much better, and I’m even looking forward to this year's India trip."

Anxiety UK - A charity providing information and support for people suffering with anxiety problems.

The Child Anxiety Network - Provides thorough, user-friendly information about child anxiety.

Website on Social anxiety disorder

Young Minds Parents Helpline - For any adult concerned about the emotions and behaviour of a child or young person. Parents' helpline 0808 802 5544

Youth Access - Offers information, advice and counselling in the UK.

Reading

National Institute for Health and Clinical Excellence: Guide to self help resources for generalised anxiety disorder (2011).

Listening

Rays of Calm, Christiane Kerr, Audio CD/Audiobook: CD from the "Calm for Kids" range created for teenagers.

It talks through various relaxation techniques and visualisations designed to promote a sense of calm and wellbeing and to help teenagers deal with stress.

References

• Ipser JC et al., (2010): Pharmacotherapy for anxiety disorders in children and adolescents, Cochrane Depression, Anxiety and Neurosis Group. Intervention review.
• O'Kearney RT, Anstey KJ, von Sanden C. Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents. Cochrane Database of Systematic Reviews 2006, Issue 4
• Evidence-based guidelines for the pharmacological treatment of anxiety disorders, (2005): British Association for Psychopharmacology.
• Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and young people in Great Britain 2004.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Chris Abbott, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

This resource reflects the best possible evidence at the time of writing.