Written Dr. Jennifer Gordon, R. Psych.
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It’s normal for children to be anxious about something at one point or another in their development. However, about 1 in 8 children struggle with worry to the point where it impairs aspects of their daily functioning. It has become the number one referral concern in my child therapy practice today.
Anxiety is excessive worry, concern, or fear about real or hypothetical situations where we are uncertain about a future outcome. In a nutshell, anxious kids tend to over-estimate the risk that something bad will happen, while under-estimating their ability to handle stress and adversity.
For many kids, anxiety is obvious – we see the child who freezes, trembles, hides, cries, dreads, and avoids situations that frightens them. However, worry can also be disguised as irritability, defiance, meltdowns, concentration difficulties, rigidity and inflexible thinking, sleep problems, and constant questioning about upcoming events in the day. Some kids are like a swan, appearing on the surface to be gliding along without any struggle at all, but really they are paddling like crazy underneath.
Younger children commonly feel anxious about loud noises, the dark, strangers, and being separated from their parents. By school age, children will often start to shift their worry to more internalized events, such as not being liked by others.
When Does Worrying Become a Problem for Kids?
Worry becomes problematic when it’s persistent, excessive (i.e., beyond what would be expected for the circumstance), out of sync with their stage of development, or when it starts to interfere with their ability to function (e.g., stops them from participating in activities).
Essentially, there are 3 Main Components to Anxiety:
Cognitive: Anxious kids will commonly ask “what if” questions and anticipate worst-case scenarios (i.e., “what if something bad happens”). They also tend to have distorted thinking, such as misinterpreting neutral situations as threatening, and they may engage in negative self-talk (I can’t do it!). Many kids will repeatedly ask questions in an attempt to seek certainty or reassurance from others.
Physical: Symptoms such as stomach and headaches, leg pain, and trouble sleeping are common in children. Your child may also be able to tell you that their heart is racing, or that they are feeling shaky, dizzy, or heavy in their chest. Some kids seem to be prone to physical sensations of anxiety, while others may describe few physical indicators and instead will report more cognitive aspects of anxiety.
Behavioral: When children feel anxious, they will attempt to avoid a situation in order to “get rid” of their distress. This may work in the short-term, but avoidance will actually intensify anxiety over time because there is no opportunity for them to practice healthy coping and to learn that the feared situation can be tolerated. When kids are anxious, they may dig their heels in and become oppositional in an attempt to avoid what makes them uncomfortable, or lash out to express overwhelm. Children may also shut down, tantrum, or have trouble with eating, sleeping, or paying attention when they feel anxious.
7 Ways to Help Children With Anxiety
Helping your child understand these mechanics of worry, as well as teaching them coping strategies can help to build their tolerance and resiliency in the face of anxious feelings.
So what exactly can you say and do to help support your child’s coping in times of uncertainty and struggle? Below are some practical ideas to help you promote just that.
1) We know that talking with kids openly and normalizing feelings of worry can help to set the stage for adaptive coping as they grow up and face the inevitable ups and downs of life. If you’re not sure where to start, children’s books can be great tools for building emotional literacy and helping you start these conversations with your child.
Books provide children with emotional distance, which allows them to really look at their own feelings and experiences as they listen and relate to the characters and situations they face in a story. Below are some books that I commonly use with the kids I work with:
Nora and the Worry Zoot by Dr. Jennifer Gordon
Is a Worry Worrying You? by Ferida Wolff
Take a Deep Breath by Sue Graves
What Does It Mean To Be Brave? by Kelly Shuto
Sometimes I’m Anxious by Poppy O’Neil
What To Do When You Worry Too Much? by Dawn Huebner
2) Ultimately, kids need to know that it’s safe to come to caregivers about their worries. When they do, you don’t need to convince or push your child into feeling okay about a situation when they don’t feel okay. Often, our urge to immediately press the stop button and rescue our kids from worry reflects our own discomfort with these feelings. In order for kids to tolerate feelings of distress, caregivers need to show tolerance for distress. Some also think that by talking about worries, they will reinforce their child’s fear by drawing attention to it. Really, it’s not talking about it that increases anxiety and fears in kids, because they are left alone in the feeling. Wrapping anxious moments with your calm and supportive presence is what contributes to coping, resiliency, and wellbeing.
So next time your child feels anxious, take a deep breath yourself, and remember that anxiety is uncomfortable but not dangerous. Instead of focusing on the content of your child’s worry and trying to convince them to feel better (…“but you always do well on math tests!”), connect to the feeling so that they are not left alone in it. How do we do this? Let your child know that we all feel worried sometimes, and that all feelings are okay to have. Give your child room to talk about their worries without interrupting. This is so much more helpful than trying to convince your child that they are okay or trying to stop their anxiety by solving the problem immediately for them.
Some phrases to help support open communication with your child so that they feel heard:
I’m so happy you’re talking to me about this.
This is so important and I’m here to listen.
Tell me more about it.
That feels really scary for you. I hear you.
It’s not easy trying something new, for me too.
3) It’s important to be mindful that excessive reassurances and participation in avoidance can give your child the message that the situation is too much for them to handle or that they aren’t capable of coping. This can intensify their anxiety over time. Instead, imagine you being an anchor in your child’s worry wave. Validate their feeling of worry as real and important, while expressing your confidence that they are safe and can do hard things. You want to give the message: “I’m here, and I’m not scared of your feelings” while offering calm support when your child is feeling out of control.
Some helpful things you can say to your child to help be that anchor:
I am here. You’re safe.
It feels so uncomfortable for you, and I know you can handle this.
You can feel nervous and be brave at the same time.
I’m going to take a deep breath for you (modeling calm when your child can’t).
It feels scary and we have a plan.
4) As mentioned, anxiety occurs when we feel uncertain about the future and doubt our ability to cope. We want to help our child focus on coping strategies, rather than trying to seek certainty (e.g., by asking repeated questions), which doesn’t help to decrease anxiety because we can never confirm the future.
Below are some ideas to help support your child’s coping:
– Practice relaxation with your child to help their body slow down and reset. It’s important to practice when your child is calm, rather than introducing these tools in the peak of an anxious moment, which never works well. Keep relaxation practice short (just a few minutes) if your child loses interest quickly, and make it part of a daily family routine. Your child will be more likely to engage if other family members participate as well.
Here are some of my favorite books to help children learn relaxation and mindfulness activities:
Breathe Like a Bear by Kira Willey
Breathing is my Super Power by Alicia Ortego
Skills for Big Feelings by Casey O’Brien Martin
– You can also collaborate with your child to create a list of activities that your child finds enjoyable. This may include sensory tools such as swinging, a soft blanket, playing with play-doh or warm soapy bubbles in the sink, reading a favorite book, listening to music, or getting a hug. Post this list in a visible spot, and then when your child starts to feel worried, encourage them to pick something from their list. For younger children, you can post pictures of their choices.
– In addition to coping tools, preparing your child for potential trouble spots in the day can help to “pre-regulate” them, so that they feel more prepared to cope in the actual moment of difficulty. Role-playing situations before upcoming events (e.g., going to the doctors, or the first day of school) can be immensely helpful for children. Have characters encounter similar worries and encourage your child to try out different ways to successfully handle a difficult situation in play. For older children, you can also teach them to close their eyes and visualize themselves being successful in a feared situation.
– “Externalizing” worry in the form of a little character can help to give emotional distance so kids can look at their anxiety without shame. Your child can draw their worry character and give it a name (e.g., Ms. Perfect, Worry Wonka, the Worry Zoot etc.). Then, you and your child can work together to shrink their worry character down so it’s not “running the show”. This adds playfulness, which naturally shifts anxious energy and helps to intrinsically motivate kids to engage in activities that worry them. Together, you and your child are on the same team, showing and telling the worry character “who is boss” by having your child practice the things that worry them.
– Create mantras and positive self-talk scripts with your child and encourage your child to use them when their anxiety starts to increase (e.g., “Hi Worry, I can feel you in my stomach. Thanks for trying to help me, but I’m safe. I can handle this”). Have your child write their scripts on a small cue card to keep beside their bed, on the bathroom mirror, or tucked inside their desk at
5) When your child is afraid of something, the goal is to minimize their avoidance because this is what maintains their anxiety. Instead, help your child face their worry in gradual steps over time. You can do this by creating a worry ladder, which is ordering a list of situations from least to most fearful for your child. Then, have your child practice relaxation strategies while engaging in the least anxious experience (i.e., the bottom of the worry ladder). Once your child is used to that situation and it no longer creates anxiety for them (this typically takes multiple times), move up to the next situation on the ladder. This will help your child gain confidence by getting used to each step along the way to overcoming their fear.
6) A worry scale is also a helpful tool to help your child verbalize just how big (or small) their worry feels in the moment. Your child can represent their worry by using an arm length (hands close together or arms stretched wide apart), or by using a visual thermometer ranging from 1 (cool, calm, collected) to 10 (panic mode). This scale is also good to use when your child is practicing calming strategies or working on a worry ladder, as they can visually see and describe how much their worry changes over time (i.e., before, during, and after relaxation practices or exposure challenges).
7) Finally, find time every day to laugh, connect, and have fun with your child. Playfulness can shift and counter anxious feelings, and allows for movement in moments where your child feels stuck. So dance in the kitchen, make up silly songs, and just play. We often under-estimate the power and importance of play, which is essential for kids to process and gain mastery over difficult events and stressors in their world. So make sure your child has time everyday to engage in unstructured, imaginative play. It can really make a difference.
You can get a free copy of a worry scale as well as additional printouts in the free resource library by subscribing to www.wholechildcounseling.com.
Jennifer Gordon is a Registered Clinical Child Psychologist with specialized training in assessment, intervention, and play therapy. She has worked as a psychologist and consultant for both school and clinical mental health settings. Her area of focus is working with children, teens, and parents who are struggling with a wide range of challenges including anxiety and regulation concerns. Dr. Jennifer is founder and Clinical Director of J. Gordon Psychology Group, a private clinic that supports children, families, and schools in Edmonton, Canada. In addition, Dr. Jennifer is the author of the book Nora and the Worry Zoot, which aims to help children better understand anxiety and to find their “inner brave”.