Families For Life | Anxiety and Fears in Children
Fear, worry and anxiety are a part of growing up. In fact, these emotions are experienced at all ages — even babies experience fear! It is normal for children to feel worried or anxious from time to time, especially after a negative event. However, when anxiety begins to affect their daily functioning, it is important to intervene.
Elizabeth Ragen and Fitriani Kwik, Senior Psychologists at the Child Development Unit, National University Hospital explain what anxiety is and share tips on how to manage it.
CLINICAL ANXIETY | DEVELOPMENTALLY NORMAL ANXIETY/FEAR | |
What is it? | • Persistent, intense and excessive fear/anxiety that is hard to control • Simple, minor, everyday situations can trigger anxiety • Typically lasting 6 months or more | • Transient • Manageable • Understandable and definable triggers |
What does it involve? | • Overestimation of the danger • Excessive anticipation of a future threat that may not even happen. A trained professional is required to determine if the fear is excessive, while taking into consideration the cultural and contextual background | • A valid emotional response • There is an actual threat either in the present or near future (e.g. a scheduled visit to the doctor) |
Types/Examples | • Separation anxiety • Selective mutism • Specific phobias • Social anxiety • School refusal | • Stranger anxiety • Anxiety occurring as a result of common triggers such as fear of loud and unfamiliar sounds, new places or experiences, and pain • Negative associations (e.g. doctor = injection = pain) |
Causes of anxiety
•Trauma: Life experiences or traumatic events may trigger brain reactions which can result in anxiety disorders.
• Genetics: Inherited traits may be a factor. A child is more likely to develop anxiety if a family member has clinical anxiety.
• Stress buildup: Consecutive stressful or traumatic experiences may lead to anxiety.
• Underlying medical condition: Anxiety can be a result of an existing health condition (e.g. thyroid issues).
Common signs and symptoms of clinical anxiety
Physical • Changes in appetite • Sleep disturbances • Stomachache • Nausea | Emotional • Crying • Nightmares • Worrying about the future • Oversensitive and grouchy |
Behavioural • Flight: Avoidance of places, people, situations • Seeking reassurance constantly from parents/caregivers • Regression: Loss of acquired skills, being more clingy | Cognitive • Always talking and thinking about things that cause anxiety • Difficulties focusing • Preoccupied with things that could happen in the future |
Strategies
1. Stay calm: Try to remain calm as your anxiety can affect your child’s sense of safety.
2. Safety first: During times of fear, ensure your child's safety first. Remove your child from elements that trigger fear. Comfort and calm him/her. Use distractions as necessary.
3. Listen & reassure: Acknowledge and validate your child's fears or anxieties. Reassure your child that he/she is safe.
4. Psychoeducation: Explore and label emotions. Teach your child about the different emotions, especially anxiety, and how to express them. When appropriate, correct your child's perceived lack of safety. Help your child understand that the intensity of the anxiety may change with application of coping strategies.
5. Coping strategies: Teach your child to get help and talk to someone he/she trusts when feeling anxious. Explore comfort-seeking alternatives (e.g. photo of a calming place), deep breathing or counting slowly if parent is not present.
6. Expressing emotions: Some emotions can be hard to articulate through words. Encourage your child to express his/her emotions through alternative means (e.g. through art, drawing or play).
7. Monitor progress: Coping strategies can help reduce the intensity of anxiety. Monitor your child’s subsequent experiences in anxiety-provoking situations.
When to seek professional help?
1) When anxiety is affecting daily functioning
2) Symptoms persist or worsen even after trying the above strategies
3) Lasts for more than 4 weeks
Contributed by:
Child Development Unit, National University Hospital