Understanding Childhood Anxiety and How You Can Help

Anxiety is one of the most common childhood mental health concerns and can affect a child’s emotions, behaviors, and body sensations. Anxiety is very much both a physical and psychological reaction as it activates the response system of “fight, flight, or freeze”, and can interfere with thinking patterns, behavior, and emotions. We don’t always know why we are experiencing anxiety or how to minimize it, and it can interfere with many facets of our lives. This includes children and adolescents, not only adults.

When your child is experiencing these symptoms of anxiety, it can be very difficult for parents to witness, and you may feel hopeless. You are not alone. As reported by the CDC in 2021, “11% of children ages 3-17 had current, diagnosed anxiety.” Help is available to you and your child to recognize and properly manage anxiety symptoms before symptoms occur, while experiencing anxiety, and reflection afterwards to ward off future anxiety episodes.

Is My Child’s Anxiety Normal? When to Watch and When to Get Help

You may be thinking, “but how do I know if this is normal anxiety or abnormal childhood anxiety?” Typical anxiety occurs in situations that make us feel uncomfortable, such as public speaking, trying something new, doing something alone, performing for others, taking a big test, etc…. For younger children, anxiety may be displayed in a different way in which an adult would display symptoms, such as avoidance, attachment, or meltdowns.  Abnormal anxiety is anxiety that greatly interferes with daily living and tasks. For example, your child may refuse to go to bed because they claim there is a monster under their bed, causing the parent to take multiple steps to reassure their child that there is no monster, thus taking a substantial amount of time for a bedtime routine.

While anxiety can help us conquer our fears by stimulating that nervous system response and assisting us to safety or pushing us to our highest capabilities, it can be detrimental to our health when we are in a constant “fight or flight” response. Being in a constant state of toxic stress can increase cortisol levels and lead to other health concerns, such as cardiac disease, depression, and diabetes later in life (Harvard University, 2025). It is important to get a grasp on anxiety early to prevent future, possibly avoidable, health concerns.

Some signs that may warrant further investigation include:

• Excessive worrying
• Frequently irritable and/or emotional outbursts
• Having negative feelings about oneself
• Feeling shame or embarrassment
• Easily frustrated
• Emotionally sensitive (crying quickly)
• Constant need for reassurance
• Fear of making mistakes, and difficulty
• Separating from a caregiver

Some other telltale signs I see in practice are schoolwork avoidance, getting into verbal arguments and physical fights, and lack of interest in things they used to be interested in. If there is a behavioral change, especially abruptly, it is worth diving deeper to ensure your child’s mental health is stable.

What to do in the Moment Your Child Feels Anxious

The first thing to do when your child begins to feel anxious is to let them know you are there with them and that you acknowledge and understand they are experiencing these symptoms. I like to say something such as, “I hear what you are saying and can see you are experiencing (insert symptoms). Let’s get through this together.” Do not minimize their feelings by saying, “Oh, you’re fine,” “What could possibly be making you anxious?”, or “Just get over it.” This will only fuel the fire and possibly make the child experience heightened symptoms.

When your child is not actively experiencing anxiety and is in a clear state of mind, this is the optimal time to ask them what makes them feel better when dealing with anxiety and ask how you can support them. With my own children, I find car rides, shower/bath time, and dinnertime to be our less stressful times. I have had children tell me that they like it when their parents hold their hands and sit quietly with them, while some children like to seclude themselves to a quiet place alone, and others like their parents to sing comforting songs and just be there with them until the anxiety passes.

Parenting Strategies for Anxious Children at Home

Firstly, I always recommend engaging in healthy lifestyle choices such as exercise, healthy eating habits, and regular sleep routines. I will often ask my patients what their favorite fruit and vegetable is to start the conversation, to inquire about their food selections, and to encourage “eating the rainbow.” I also like to make sure they are moving their bodies at least 60 minutes a day, minimizing screen time outside of school, and practicing good sleep hygiene for their brain to rest and reset for the next day.

Secondly, I find that most children like routines and they like to be included in the conversation around schedules. Being prepared with a plan often helps children mentally prepare and lessens the amount of anxiety they encounter when it is time to engage in the scheduled activity. There are certain circumstances in which prepping your child may not work, and in fact, worsen anxiety, but this is usually not the case.

Last, but not least, allowing your child to make age-appropriate choices, such as brushing their teeth before putting on their pajamas, or picking spaghetti for dinner tonight and tacos tomorrow, provides your child with independence and autonomy. This gives them confidence and can lessen anxiety symptoms. It can also provide your child with the feeling of inclusion and control, often leading to less tantrums.

How to Talk to an Anxious Child About their Worries

Talking to a child about their worries looks different at every age. Some young children express their fears that may sound silly to an adult, but it is very true in their mind and we must listen with an open ear. For example, many young  children are afraid of getting their hair cut because they believe it is going to hurt due to hearing the word “cut.” Young children have not grasped the concept of abstract thinking yet, and everything is literal or concrete to them. Another example is an older child may have excessive worry about not making a varsity school team and being on the junior varsity team. While this may not seem important to the parent because we, as adults, have lived through the teenage years and have learned from experience and had the chance to reflect, peers are the most influential group in a teen’s life and they base many of their decisions and self-value off of what others think of them and the feeling of acceptance. Whichever way you choose to talk to your child about their worries, make sure it is in a place where your child feels safe and relaxed, and that you approach the subject with an open, nonjudgemental mind.

Coping Skills You Can Practice Together

For best results, coping skills should be practiced before your child experiences anxiety, implemented when anxiety arrives, then discussed after the anxiety episode has passed and the dust has settled. In practice, I often recommend the 5-4-3-2-1 grounding technique that includes the 5 senses (touch, smell, taste, hear, see) and cognitive behavioral therapy (CBT) that can be used in daily practice to help alleviate symptoms. Practicing mindfulness is another coping skill I often incorporate into sessions as it produces awareness and insightfulness to one’s surroundings.

Supporting Anxious Kids at Home and in School

When it comes to helping children thrive both in the home and school setting, there are several interventions that can help. At home, following the recommendations listed above such as following a routine, prepping your child for upcoming events/plans, and allowing them to make simple, age-appropriate choices help in the home setting. Reassuring your child that you love them, are there for them, and offering to help them deal with and overcome anxiety is also helpful. Implementing and putting in to practice what is taught during psychotherapy sessions for consistency is the recipe for success. It takes time and patience, but it does work.

In school, 504 plans and Individualized Education Plans (IEP’s) may be developed and personalized to help your child manage their anxiety in school and with school related activities. In these two legal documents, accommodations are provided to help the student thrive in the academic setting. Some examples of accommodations include the student being able to access a sensory room, quiet location for test taking, extended time to complete assignments, the ability to use noise cancelling headphones in class, preferred seating, and many more. These interventions help students manage symptoms and learn to navigate their optimal learning environment for today and the future.

Caring for Yourself While You Support Your Child

Have you heard the phrase “You cannot fill someone else’s cup if yours is empty?” This metaphor is true. In order for you to be the best version of yourself and to help your child cope with their anxiety, you need to take the appropriate steps to care for yourself. This doesn’t have to be excessive or expensive, such as a weekend vacation or spa day every month (both sound lovely though!). Making time to “fill your cup” may include a daily walk, reading a chapter or two of a book before bed, watching an episode of your favorite series, or grabbing a coffee on the weekend with your friend. Your child’s well-being is closely related to their parents’ mental state of health, so this step is very important and necessary. I once read the quote “Parents have to be ok for the kids to be ok. Parents’ mental health is the foundation for child mental health”(unknown author). I like to reference this as a reminder to parents regarding their own mental health status and journey.

Treatment Options, Insurance, and Getting Help at Fine Tune Psychiatry

If you have read this article and feel your child may be suffering from symptoms of anxiety, we would be happy to discuss treatment options with you (and your child). Numerous treatment options are available and typically include psychotherapy, with the discussion of adding pharmacology if warranted. At Fine Tune Psychiatry, we have several mental health providers specialized in child and adolescent care, and take a multidisciplinary, collaborative approach to meet your child’s needs.

We accept most major commercial insurances including Aetna, United, BCBC, Highmark, IBX and more. We are typically able to schedule your child for an initial appointment within 1-2 weeks. To make an appointment or for any questions, please call us at 484-960-5370 or submit a form on our contact page.