Supporting Children with Anxiety

Anxiety disorders in children are persistent fears, worries, or anxiety that disrupt their ability to participate in play, school, or typical age-appropriate social situations. Download this resource as a PDF in English and Spanish.

Types of Anxiety

Children can be diagnosed with different kinds of anxiety depending on what they are struggling with. Diagnoses include:

• Separation anxiety: Children experience great distress when they are separated from their parents or caregivers. Symptoms include worrying that they will lose someone through illness or death; fear of a separation event; fear of being alone; and refusal to leave home.
• Social anxiety: Children with social anxiety disorder are excessively self-conscious, making it difficult for them to socialize with others. Symptoms include panic reactions or tantrums in response to social situations; avoiding or suffering through social situations; and fear of being judged or appearing anxious.
• Generalized anxiety: Children with generalized anxiety disorder worry about a wide variety of everyday things. Their anxiety can be distinguished from typical worry in its excessiveness, duration, and lack of precipitating events. 
• Obsessive-compulsive disorder (OCD): Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. OCD can be diagnosed when a child has obsessions, compulsions, or both.
• Phobias: A child with a specific phobia has an excessive and irrational fear of a particular thing, like being afraid of animals or storms. Phobias are classified into five categories: animals, natural environment, blood injection injury, situational, and other stimuli. 
• Selective mutism: Children with selective mutism have a hard time speaking in some settings like school or around strangers. Children become frozen and feel unable to speak. 

According to the Centers for Disease Control and Prevention (CDC), 7.1 percent of children ages three to 17 (approximately 4.4 million) have been diagnosed with anxiety.

Anxiety is best treated with either behavioral therapy or a combination of cognitive behavioral therapy (CBT) and medication. CBT is a form of talk therapy designed to help people recognize unhelpful thoughts and behaviors and learn how to change them. This type of therapy can help your child understand the negativity of their thought patterns and learn how to replace them with more positive ones.

Helping Your Child Manage Anxiety

Parents and caregivers can implement several practices at home to help children cope with their anxiety. When your child is distraught, scared, and unhappy, it might be tempting to remove their stressors. Avoidance will help a child feel better in the short term, but it will only reinforce their fears.

The best way to help a child with anxiety is to help them learn to tolerate their stressors. The goal is to manage anxiety, not to eliminate it.  Here are some things you can do:

• Work with your child to set positive, realistic expectations. If your child is anxious about their soccer game, don’t promise that they are going to win. Instead, express confidence that he/she is going to be ok and that they will be able to manage their fear.
• Listen to your child’s fears. Being actively interested in your child helps them feel listened to and understood. Try to resist the urge to downplay or dismiss what your child is telling you. You can validate their feelings without amplifying their fears by saying things like, “I know you’re feeling scared about _____, and that’s ok. I am here to help you.”
• Talk through their fears. If a child is anxious about a test, talk through the situation with them. What would happen if their fear of failing the test came true? You could talk about getting a tutor, working with them to study more, or creating a plan with their teacher. For some kids, having a plan can reduce uncertainty in a healthy, effective way.

Coping Exercises

• Deep breathing: Help your child relax by practicing belly breathing, and drawing in air by expanding the belly. This slow breathing can reduce the heart rate, blood pressure, and stress hormones. It can also help relax tense stomach muscles.
• Mindfulness exercises: Work with your child to focus on what’s around them. Techniques such as focusing on what they see and hear can help ground them in the moment.
• Preparation: Prepare your child for situations that might cause them anxiety or discomfort. Work with them to plan what they can do to counteract those feelings and push through them.
• Coping statements: Develop some mantras and coping statements with your child. They can repeat these back to themselves when they are struggling with their anxious feelings. Examples include:
  • “I am feeling scared and I can handle it.”
  • “I am bigger than my anxiety.”
  • “Anxiety is not dangerous. It can’t hurt me.”
  • “I will do the best I can.”
  • “Right now, I have some feelings I don’t like but I will be fine.” 

For more information and resources about anxiety in children, visit Nemours KidsHealth at kidshealth.org/en/parents/anxiety-disorders.html.

Journaling Activity

Families can use this journaling activity to have a discussion with their children about their emotions and fears at the end of each day. The prompts can guide the dialogue and give children the opportunity to express themselves while parents and caregivers practice the management responses and coping strategies outlined above.  

• Date:
• How I feel right now:
• Today I am thankful for:
• Something that made me sad today:
• I worried about this today:
• What I did to feel better today:
• This made me happy today:
• I am excited for:

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This resource was reviewed by Pennsylvania Keys Infant Early Childhood Mental Health (IECMH). For additional resources related to childhood mental health, such as social-emotional development or early intervention, please visit tryingtogether.org/parenting-resources.