Understanding anxiety in children and teens
As parents, we always desire the best for our children. We want them to be healthy, happy, and resilient when faced with life’s challenges. This is often easier said than done with the daily demands and parenting responsibilities. Anxiety is a common issue in children, adolescents, and teens, often experienced at different phases of development. Anxiety disorders can be first diagnosed in children between the ages of four and eight, while a recent survey found that about 32% of adolescents in the U.S. have an anxiety disorder, a number that has substantially increased over the years. The study also revealed that one in four to five adolescents has a severe disability related to their anxiety disorder.
The COVID-19 pandemic has heightened anxiety in children and teens, with the disruptions in their normal routines in school, family life, and relationships with peers. It’s not always easy to recognize the difference between normal worries and anxiety disorders in children and teens, particularly in these stressful times. For example, young people often worry about their schoolwork or taking exams, but this is usually temporary once the immediate stressor has passed. However, if worrying becomes constant and interferes with a child’s daily functioning, it can negatively affect their overall quality of life.
While coping with your child’s anxiety can be a difficult situation for you as a parent, the good news is that anxiety is a highly treatable condition. There is also a great deal you can do to help your child. Rather than assume that your child will outgrow their anxiety, it’s better to start taking steps as soon as possible to help your child deal with their symptoms and regain control of how they view the world around them.
Symptoms of anxiety in children vs. teens
The symptoms of anxiety vary considerably and often go undiagnosed in children and adolescents. Anxiety disorders in children are characterized by irritability, nervousness, excessive worrying, shyness, sleep problems, and/or physical symptoms, such as headaches or digestive issues.
Kids are greatly affected by what’s happening in the world around them. They may feel drained and isolated from others, as well as being fearful or having feelings of shame. Children with anxiety may also have difficulty making friends or participating in other social activities.
Among the most common symptoms in children are:
- Difficulty concentrating.
- Problems with sleep or nightmares.
- Having tantrums or anger issues.
- Being tense or fidgety.
- Frequent periods of crying.
- Complaining often about not feeling well.
For teenagers, the majority the of their worries are connected with feelings about themselves. These may encompass academic performance and pressures to succeed in school, how they are perceived by others, and concerns about their body image connected with physical development.
Anxiety in teens is not always apparent because they tend to disguise their thoughts and feelings. Some of the signs to look out for are:
- Constant fears or worries about routine aspects of their lives.
- Withdrawal from friends or social activities.
- Irritability or lashing out at others.
- Difficulties in school or sudden poor performance.
- Refusal to go to school.
- Sleep problems.
- Substance abuse.
- Constantly seeking reassurance.
Whatever your child or teen’s specific symptoms, anxiety can have a negative effect on their thoughts, emotions, and physical health. This in turn, can interfere with their ability to function both academically and socially. Helping them deal with the problem starts by recognizing the causes of their anxiety symptoms.
Causes of anxiety in kids
There are many reasons why children become anxious. Anxiety disorders are most likely caused by a combination of environmental and biological factors. Anxiety tends to run in families, and is more common in girls than boys.
Anxiety disorders encompass various types of mental health issues, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and other specific phobias. Some children also have separation anxiety with fear and distress about being away from home.
[Read: Anxiety Disorders and Anxiety Attacks]
Children and adolescents may have more than one type of anxiety at the same time. The three most common types of anxiety in children are separation anxiety, social anxiety, and generalized anxiety.
The onset of an anxiety disorder is often triggered by stressful events, such as abrupt changes in their lives, difficulties in school, having additional responsibilities beyond their level of maturity, stress from family situations, or traumatic experiences, including being bullied or other forms of abuse.
Parents who are anxious themselves or overprotective of their children may also contribute to a child's anxiety. Research conducted in 2021 highlighted how the support of parents was a crucial factor for adolescent mental health. By encouraging your child to develop coping strategies, such as acceptance, distraction, and a positive mindset, you can help to strengthen their well-being and ease their stress and anxiety.
The role of social media in childhood anxiety
Adolescents and teenagers, in particular, spend countless hours on their smartphones texting and messaging friends, and engaging on their Instagram, Facebook, Snapchat, and Twitter accounts. Receiving social media notifications all day long can influence their thoughts and feelings about themselves. In some respects, this can be an enjoyable, positive experience, but in others, it may also heighten anxiety and feelings of isolation and depression.
While social media can help kids and teens stay connected and maintain closer ties to friends and family, it can also promote bullying and negatively impact self-image and self-esteem.
A 2019 study of more than 6,500 12 to 15-year-olds in the U.S. indicated that those who spent more than three hours a day on social media were at increased risk for mental health problems. An internal study conducted on Facebook in 2021 revealed that teens can have difficulties with heightened social comparison and peer pressure, with Instagram cited as one source that may worsen existing mental health issues.
Read: Social Media and Mental Health.
Helping your child with anxiety tip 1: Respond to their anxiety in the right way
This may sound intuitive, but as a parent dealing with a child who has anxiety it’s important you remain as calm and hopeful as possible. The way you respond to your child’s thoughts and behaviors can have a significant impact on their ability to cope.
Talk to your child about their worries
Start a conversation with your child by asking them to express their feelings about their worries. Simply telling a child not to worry or to stop thinking about their problems is neither supportive nor validating. It’s better to reassure your child that it’s okay for them to be scared, and emphasize that you will be there to help them every step of the way.
[Read: How to Stop Worrying]
If your child has difficulty explaining how they feel, ask them to communicate this in the form of a story. By stepping outside of themselves, your child may feel more comfortable and better able to describe their feelings and emotions.
Show concern and understanding
Expressing encouragement and compassion, combined with a collaborative approach to find workable solutions, can be a powerful tool. Research indicates that maternal empathy has a significant impact on alleviating distress in children.
Let your child know that anxiety is nothing to be ashamed of and that you’re there to help them understand what makes them anxious and find ways to manage it. This teamwork approach is a shared bond between you and your child, while also fostering your child’s ability to tolerate their own anxiety.
Be supportive but not controlling
The key is to help your child manage their anxiety but not be too overprotective in an attempt to eliminate it. By listening attentively and expressing empathy, you’re already providing a great deal of support.
You can also talk through ways of handling different situations. If your child has separation anxiety, for example, and was at a friend’s house and feeling worried about getting back home, brainstorm appropriate responses. Your child could ask the friend’s mom what time you’ll be picking them up, for example, or they could ask the mom to call you to find out what time you’ll be there. Having strategies like these in place can help reassure your child and reduce feelings of anxiety.
Build your child’s coping skills
Rather than avoiding your child’s anxiety triggers, you can help them develop effective coping strategies. Giving frequent positive feedback will encourage your child to feel more capable and self-confident. Set small goals that are both realistic and achievable. Each time a goal is reached, you can say “I’m so proud of the way you handled the situation and worked through your anxiety.”
Make a point of praising your child’s effort whenever they exhibit any type of resilience or face their fears. If a setback occurs, reassure your child that this is not a failure but a learning experience that will help them overcome future obstacles. Talk to them about what they could change the next time around to have a better outcome. They’ll feel more empowered as they take control of the situation.
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Tip 2: Be a positive role model for your child
Your child looks up to you and needs your guidance in showing them how to manage stress and anxiety. The way you deal with frustration and express anger is a prime example. Try to remain calm and patient as possible when dealing with problems and challenging situations. The way you speak and what you speak about can also have a huge influence on even a difficult teenager’s values and behavior.
Parents who take care of themselves by getting enough sleep, exercising regularly, and eating a healthy diet can encourage their children to do the same. If you practice yoga, meditation, or other relaxation techniques, your children are likely to pay more attention to their own well-being. Avoid making negative comments about your own body, though, since this can lead to poor self-image and body shaming.
[Read: Body Shaming: Causes, Effects, and Improving Your Body Image]
Modeling a healthy approach to life can also teach your children valuable lessons. We all make mistakes and children should realize that although parents have flaws, they can still successfully overcome adversity. This can help remove unnecessary pressures that may contribute to your child’s anxiety.
Tip 3: Practice relaxation techniques with your child
Offer to do some deep breathing or meditation exercises with your child. This will acknowledge how they are feeling and provide proactive relaxation strategies that you can try together. When children are anxious, their breathing usually becomes shallow. You can try deep belly breathing in which your child places one hand on their chest and the other on their belly. When they inhale their belly should expand and when they exhale, their belly should contract.
Mindful breathing consists of focusing on breathing and bringing attention to the present moment. Have your child close their eyes and breathe slowly in and out. While they breathe, they can scan their body for areas of tension. They can then visualize a feeling of warmth and comfort to ease the discomfort in these areas.
[Listen: Mindful Breathing Meditation]
Older children and teens may also enjoy exploring various types of yoga, meditation, guided imagery, and other relaxation techniques.
Turning off cell phones and social media and tuning into their “happy place” is great skill to practice each day. Your teen can summon up a specific memory or situation that makes them feel calm, secure, and content. Maybe this is associated with spending time on the beach, a vacation spot that was peaceful, or being surrounded by nature. Using visualization of beautiful images or pleasant sounds is an ideal way to tap into this state of relaxation.
Tip 4: Promote good sleep hygiene
Since anxious children often have trouble sleeping, establishing a predictable and relaxing sleep routine is essential. Set a regular sleep schedule, curtailing exercise and reducing exposure to light close to bedtime, and avoiding caffeine.
Make sure your child feels comfortable and safe at bedtime, with minimal distractions to help them fall asleep. Their bedroom should be cool, quiet and cozy. Screen-time on computers, phones, TVs, or video games should be curtailed at least one hour before bedtime. This is an ideal time to read to your child or listen to soft, calming music. A younger child may also feel more secure with a nightlight on or having a stuffed animal or soft blanket to comfort them.
Tip 5: Encourage healthy social media use
Since studies reveal both its beneficial and harmful effects, having discussions with children about the pros and cons of social media is a good place to start.
Instead of simply trying to force your child to put their phone away—which may only add to their anxiety—there are more positive steps you can take:
- Set a good example to your child by limiting your own screen time and involvement with social media.
- Encourage your child to socialize more with friends in person and participate in creative activities rather than focus on the number of “likes” their social media posts attract. If screen exposure doesn’t become a habit early on, children will learn how to occupy themselves in other ways.
- Set aside a designated time when the whole family is screen-free from phones and computers. This can be a daily activity for a short period of time, or over a weekend when you’re occupied with family activities.
- Remind teens especially that the images they see on social media are often digitally altered and not an accurate representation of real-life. Similarly, posts about parties or events they weren’t invited to are often made to look more fun than they really were.
- Encourage your child to cut ties with those who post negative comments about them and urge them to be responsible when posting comments about others. Teens especially can be impulsive and not realize the content they’re sharing may be hurtful or inappropriate.
- Decrease screen time if social media is impacting your child’s schoolwork, sleep, or involvement in outside activities.
Additional tips for helping a teen
Many of the techniques mentioned above can be effective for helping both children and teens with anxiety. Since adolescents and teens often have some degree of knowledge about anxiety and anxiety disorders, though, there are some additional strategies that may help.
Talk to your teen about anxiety
Reassure your teen that anxiety can also serve as a protective emotion under certain circumstances. Anxiety makes us aware of potential dangers and helps keep us safe. That uneasy feeling in the gut that we experience at times may be a signal of a potential threat. Since paying attention to these warning signs is a way to avoid harmful situations, feeling anxious can have a positive purpose. You can also help your teen feel less fearful about their anxiety by talking to them about what they can change to make a particular situation better in the future.
Keep an open dialog with your teen. Maintaining effective communication with teens can be difficult and even uncomfortable at times. Teenagers won’t always confide in their parents as they become more independent. Having a supportive communication style will enhance trust and comfort in sharing their feelings.
It’s imperative to establish regular communication with teenagers and inquire about their day. They may not go into great detail, but they’ll know you’re genuinely interested and concerned about them. A few encouraging words can go a long way. Tell your teen you’re proud of them and the progress they’re making. If they express worry or anxiety about a particular situation, this is an opportunity to initiate a more in-depth conversation. Validate their feelings by saying “I know this is a difficult situation” or “that sounds very hurtful.”
Use active listening skills. Teens look to parents for supportive connections and ways to vent their feelings. By listening attentively and validating their feelings without judgement or criticism, you can help ease their symptoms of anxiety. You can do this by giving your teen your undivided attention, making eye contact to show you’re interested in what they’re saying, and nodding occasionally to show that you’re really listening. Steer away from interrupting your teen while they’re speaking, so they’ll feel comfortable expressing themselves completely.
[Read: Effective Communication]
Prepare how to handle difficult situations. Discuss the rational and irrational responses to the challenges your teen is facing, whether they are related to school, social relationships, or general life concerns. Acknowledge that certain circumstances can be anxiety-provoking, but put them into the proper perspective to avoid having these feelings blown out of proportion and creating further anxiety. Teenagers may purposefully or inadvertently exaggerate their feelings of hurt or anxiety and may also become argumentative if they sense you as a parent don’t understand.
When talking about how they responded to a situation, offer some alternative methods that may be more effective. For example, if your teen received a failing grade on an exam and reacted by labeling themselves as stupid or thinking they’ll never graduate, you can help reframe these irrational thoughts. Help them look at the problem in a more realistic way by emphasizing that it is only one test and they can improve their grades by studying harder or working with a tutor.
Build your teen’s self-esteem
Highlight your teen’s strengths instead of their weaknesses. Rather than focusing on their anxiety, you can emphasize their positive attributes. It can be as simple as complimenting your teen on their thoughtfulness, kindness, or consideration of others. Your teen may also have strong intellectual or character traits that make them stand out as individuals. Point out that their uniqueness is something to be celebrated as opposed to feeling as if they don’t fit in.
- Building resilience and self-confidence can help your teen recognize their ability to problem-solve on their own. If they do well on an exam or school assignment, you can do more than just praise them. You can also remind them about the amount of time they devoted to study and preparation. This will show them the value of their effort to succeed rather than always worrying about the outcome.
- If your teen has a particular interest or aptitude, such as art, music, or athletics, you can use this to help sustain their motivation. Showing how proud you are and acknowledging the rewards of their dedication will bolster their confidence. Mastering any type of skill will build self-esteem and divert attention away from their anxiety. Remember, this is not about trying to be perfect; the goal is to extend their best effort to succeed based on their abilities.
Be aware of the expectations you set. Teens can often feel overwhelmed by high expectations and the pressure to succeed. Keeping goals realistic can help guide them towards academic improvement without adding to their anxieties about grades and test scores.
Show the value of helping others. Becoming involved in worthwhile activities that help others can boost a teen’s self-esteem and be a productive, healthy distraction from their anxiety. Encourage them to look for volunteer opportunities in the community for causes they’re passionate about. Joining a group or club with other teens who share their interests can also improve social skills and provide a sense of belonging.
How to help a child having a panic attack
Panic attacks can be extremely frightening, both for children to experience and parents to observe. The onset often occurs during adolescence, but it may start during childhood, as well. These episodes can last as long as 10 to 15 minutes, with a variety of symptoms, such rapid heartbeat, sweating, chest pain, dizziness, and feelings of choking. You can educate your child about panic attacks so they understand more about why they occur—and reassure them that even though the physical sensations may be scary, they are not harmful or life-threatening.
[Read: Panic Attacks and Panic Disorder]
You can also assist your child or teen while they are having a panic attack. Being a comforting presence and expressing empathy is a key factor. Remind them that the panic attack will be over in a few minutes, and try to shift the focus to more pleasant diversions. Engaging in exercise, playing games, watching TV, or doing breathing and relaxation techniques or other things they enjoy can help.
Kids may try to avoid certain situations, such as going to school or leaving home out of fear of having a panic attack. But encouraging your child to continue their daily routines connected with school and social activities can help ensure the fear of a panic attack will not interfere with their normal development.
When to seek professional help
If you do not see sufficient improvement in your child or teen's anxiety, it may be time to seek additional support from a professional counselor or therapist.
Cognitive behavioral therapy (CBT) is most commonly recommended for treating anxiety in children and teens. CBT works by changing the way your child thinks in order to modify their dysfunctional behaviors and emotions. The treatment works best when you find the most suitable therapist for your child.
While CBT can be effective when working directly with the child, parents may also be included in this approach. CBT with younger children is often most useful when it focuses on the behavioral aspects of anxiety. The skills learned in therapy can provide valuable coping mechanisms for children and teens to rely on throughout their adult life.
[Read: Online Therapy: Is it Right for You?]
Medication can also be used for treating anxiety in children. Serotonin reuptake inhibitors (SSRIs) are a type of antidepressant most often prescribed for this purpose. Anti-anxiety medications may also be used for children and teens who have more severe forms of anxiety that disrupt their daily functioning.
Even when medication is necessary, it’s often recommended that kids and teens also pursue CBT and develop their coping skills in order provide a long-term solution to their anxiety issues.
Last updated or reviewed on June 21, 2023
Hotlines and support
NAMI Helpline – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)
Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)
Anxiety UK – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)
Anxiety Canada – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)
SANE Help Centre – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).
Helpline (India) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation).