||Growing up: different types of 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
How common is it?
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
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
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.
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
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.
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
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
What are the signs of anxiety?
What can I do to get help?
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.
What causes these worries and
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
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
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
Do children grow out of
Most children grow out of it, but a few
continue being anxious, and can sometimes become depressed as
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
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
- 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
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.
Where can I get help?
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.
How is it treated?
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
David, aged 12, talks about his phobia
Neela, 15, talks about
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
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
Website by YouthNet UK, a charity provides factsheets and articles
on all the key issues facing young people.
The Child Anxiety
Network - Provides thorough, user-friendly
information about child anxiety.
Website on Social anxiety
Young Minds Parents
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.
National Institute for Health and Clinical
Excellence: Guide to self
help resources for generalised anxiety disorder
Useful CD: 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.
- Ipser JC et al., (2010): Pharmacotherapy for anxiety disorders
in children and adolescents,
Cochrane Depression, Anxiety and Neurosis Group. Intervention
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
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
© Royal College of Psychiatrists March 2017
Due for review March 2020