Anxiety, fear and phobias are extremely common in children of all ages.  Some degree of anxiety and fear is normal.  On the other hand, phobias represent extreme or unusual fears that are not normal.  Caregivers should have a basic understanding of normal, healthy behavior and understand when fears are disrupting a child's normal daily activities.  Extreme or persistent symptoms may affect the child's long-term health and should be evaluated by a professional.  In most cases, an empathetic ear and close adult company will make all the difference to a child.

What Is Anxiety?

Anxiety is “apprehension without any apparent cause”. The child feels as if there is some real threat to his or her safety or well being, though apparently there is no such threat. 

The perception of anxiety in children changes as they grow older. 

Babies might suffer from stranger anxiety when they confront people they don’t recognize.

Slightly older children, say those who are between 10 to 18 months, might suffer from separation anxiety when one or both of their parents leave for work. 

Thoughts of things that do not exist in reality, such as ghosts, monsters, devils, might cause anxiety in kids between 4 to 6 years. 

Older kids, through 7 to 12 years, might suffer from anxiety over threats from real things such as physical injuries or bad performance on school tests.

How Do Children Respond To Anxiety?

Usually, children respond to anxiety by escaping the situation fast!  But this attitude is not always possible, nor helpful for development of good coping skills. They must learn, at least up to a certain extent, to face situations, even if they’re adverse.  From this perspective, some amount of anxiety is considered good for children. It helps them to stay mentally alert and better focused. 

What Is Fear?

Fear is also an emotional response to perceived threat. However, there is a slight difference in its perception from anxiety. In fact, anxiety over the long term transforms to fear. Fear makes children avoid doing things they’re afraid of.

So children might be afraid of riding roller coasters, speaking in public, sleeping alone at night, flying in airplanes, or even staying alone with babysitters. However, the perception of fear varies. A particular situation might make a child fearful. The same situation might not be uncomfortable to another child.

The usual reaction to fear is flight or fight – the child either escapes the threat or confronts it.

Again, fear is not always bad. Fear creates in young minds a sense of natural restraint. A child who loves swimming might be afraid to go out to deep waters alone. This resistance might help him avert the risk of drowning from moving without attention too deep in the pool.

Childhood fears usually melt with age. However, if they remain beyond what should be normal to any particular age-group, this could eventually lead to a phobia.

What Is Phobia?

Phobia is essentially a deep-rooted fear. A phobia makes a child perceive the threat as absolutely real. The intense feeling of fear makes children extremely worried, upset, and withdrawn from normal behavior.

A child with phobia of cats might avoid a road with cats in the vicinity.  Someone who has a phobia of speed might avoid riding a bike.

Phobias are bad as they induce the child to show behavior that is not normal.

What Happens During Anxiety, Fear and Phobia?

Anxiety, fear and phobias make a child restless. The brain alerts all the systems of the body to get prepared to cope with some sort of an emergency-like situation. The heartbeat becomes faster, the blood pressure increases, and the breathing becomes more rapid.

The large muscles of the body get charged to prepare the body to respond to the threat. It could be fight or flight, depending on the threat perception of the child, and his disposition towards handling such a situation.  

External manifestations can be intense sweating, wobbling of legs, and a reflection of worry in the eyes.

There can also be symptoms of nausea, headache, stomachaches and sleep disorders.

The child might draw him or her totally in and seek a safe shelter.

How do I handle a child with anxiety, fear and phobias?

Children prone to anxiety, fear and phobia attacks need to be handled with compassion and understanding.

While some amount of anxiety and fear are good, as they help the child to develop a positive attitude towards uncertainties in life, trouble starts when they become uncontrolled.

Anxiety, fear and phobias retard proper development of personality. So parents and caregivers need to give special attention to these issues.

Counseling is of course the best way to help the child. Sometimes fear, anxiety or phobias originate from some bitter personal experience the child might have experienced. It’s nothing unnatural for a little boy or girl who had a dog bite to be afraid of dogs. If he or she had to take painful anti-rabies injections, it could be quite natural for them to have injection phobia.

Usually, these issues have short-term effects and dissipate as the child grows older.

However, if the origins of anxiety, fear or phobias are imaginary subjects, or unrealistic subjects such as ghosts, monsters, demons, the child should be helped with care and patience to develop a rational attitude towards things around her.  She should be made to understand empathetically why weird things have little relevance in our world of science and realism.

The child should be encouraged to read more books of fact than fiction. Parents must talk to those persons with whom the child comes in regular contact, such as caregivers, teachers, friends, and neighbors etc, to figure out what could be the real causes behind any unusual behavior that the child displays. In particular, parents should be on the lookout for patterns. Isolated incidents can be left alone, but persistent or pervasive behavioral changes should never be ignored.

Parents should listen to what the child has to say with lots of sympathy. Sometimes just talking about anxiety, fear or phobias can help a child to overcome them.

Caregivers should help a child develop coping mechanisms. They must know how to deal with situations that are not comfortable to them. However, a child’s concerns of anxiety, fear or phobias should never be belittled.

When To Consult A Professional?

Professional help, such as consulting psychiatrists, psychologists, pediatricians, behavior analysts, must be considered when parental counseling and guidance fail to show results.

The point to drive home is that enough attention should be paid to help the child overcome anxiety, fear or phobias and not to neglect the issues in the hope that things will become all right when the child grows older.

Antidepressants and cognitive behavioral therapy are often indicated for treating children with excessive anxiety, fear and phobia symptoms.

 

Written by: Stephie S.

Edited by: Michael Davis, MD

 

References:

1. What to do when your child refuses to go to school, American Family Physician, Oct, 2003, http://www.aafp.org/afp/2003/1015/p1563.html
2. The Patient with excessive worry, American Family Physician, March, 2006, http://www.aafp.org/afp/2006/0315/p1049.html
3. Living with anxiety – Children, Anxiety Disorders Association of America, http://www.adaa.org/living-with-anxiety/children
4. How families can help children cope with fear and anxiety, National Mental Health Information Center, http://mentalhealth.samhsa.gov/publications/allpubs/Ca-0022/default.asp