Childhood Anxiety: Recognizing the Signs and Helping Your Child Cope

Anxiety is one of the most common mental health challenges affecting children today, with research suggesting that up to 1 in 8 children experience significant anxiety at some point in childhood. Yet anxiety in children is often misunderstood, overlooked, or dismissed as "just a phase." Understanding what anxiety looks like in children, why it develops, and how to help is essential for every parent—because the good news is that childhood anxiety is highly treatable, especially when addressed early.

Understanding Anxiety: When Worry Becomes a Problem AAP

All children experience worry and fear—these emotions are normal and even protective. A child who feels anxious before a big test might study harder. A child who's nervous about a new situation is being appropriately cautious. Worry becomes problematic when it's persistent, excessive, and interferes with daily life.

Anxiety disorders differ from normal worry in several key ways. The worry is disproportionate to the actual risk or situation. It's difficult or impossible for the child to control, even when they want to. It persists for weeks or months rather than passing. And most importantly, it interferes with the child's ability to function—at school, with friends, or within the family. AAP

Children with anxiety disorders aren't choosing to worry. Their brains are wired to perceive threats more readily and to have a harder time calming down after a threat response is triggered. Understanding this can help parents respond with compassion rather than frustration.

Types of Anxiety in Children AACAP

Anxiety can manifest in different patterns, and children can experience more than one type.

Generalized anxiety disorder (GAD) involves persistent, excessive worry about many different things—school performance, health, world events, family finances, being on time. Children with GAD often ask "what if" questions, seek constant reassurance, and may be perfectionistic. They worry about things most children don't think about and struggle to let go of concerns. AAP

Social anxiety disorder involves intense fear of social situations where the child might be judged, embarrassed, or rejected. This goes beyond normal shyness—children with social anxiety may refuse to speak in class, avoid birthday parties, or be unable to order food at restaurants. The fear can be of specific situations (like performing) or generalized to most social interactions. AACAP

Separation anxiety is normal in very young children but becomes a disorder when it persists past the developmentally appropriate age or is severe. Children with separation anxiety disorder have excessive fear about being apart from parents or caregivers. They may refuse to go to school, be unable to sleep alone, follow parents around the house, or have nightmares about separation.

Specific phobias involve intense, irrational fear of particular things—dogs, insects, storms, needles, vomiting, the dark. The fear is out of proportion to the actual danger and leads to avoidance of the feared object or situation. While many children have fears, phobias are diagnosed when the fear significantly interferes with life.

Panic disorder involves sudden, unexpected episodes of intense fear with physical symptoms like racing heart, shortness of breath, dizziness, and a feeling of losing control. While less common in young children, panic attacks can occur, and some children develop fear of having another attack.

How Anxiety Shows Up in Children AAP

Children often don't have the vocabulary to say "I'm anxious." Instead, anxiety shows up in their behavior and bodies. Learning to recognize these signs is crucial for early intervention.

Physical symptoms are extremely common in anxious children. Frequent stomachaches, headaches, nausea, dizziness, and fatigue—without a medical cause—are often anxiety manifesting in the body. Some children complain of a racing heart, difficulty breathing, or feeling hot. These symptoms are real, not fabricated, even though they're caused by anxiety rather than physical illness. AAP

Behavioral signs include avoidance (refusing to go places or do things), excessive reassurance-seeking, meltdowns or tantrums that seem disproportionate, difficulty separating from parents, trouble falling or staying asleep, and being very rigid about routines or "rules."

Emotional signs include irritability, frequent crying, appearing "keyed up" or on edge, excessive worry about future events, difficulty recovering from upsets, and catastrophizing (assuming the worst will happen).

Cognitive signs include difficulty concentrating, perfectionism, fear of making mistakes, inability to tolerate uncertainty, and repetitive "what if" thinking.

It's worth noting that anxious children don't always look anxious in the stereotypical sense. Some anxious children are well-behaved and high-achieving—their anxiety drives perfectionism that looks like success. Others may appear angry or defiant—anxiety can fuel opposition when a child is pushed toward feared situations. AACAP

Why Do Children Develop Anxiety? AAP

Anxiety develops through a combination of factors—there's rarely a single cause.

Genetics play a significant role. Anxiety runs in families, and children with anxious parents are more likely to develop anxiety themselves. This is partly genetic and partly learned—children model their parents' responses to stress and uncertainty.

Temperament matters. Some children are born more reactive to novelty and perceived threats—what researchers call "behavioral inhibition." These children are more easily overwhelmed, slower to warm up to new situations, and more vigilant to potential problems.

Life experiences can trigger or worsen anxiety. Trauma, loss, major transitions (moves, parental divorce, new schools), bullying, or chronic stress can all contribute. However, anxiety can also develop without any obvious trigger.

Parenting patterns can inadvertently reinforce anxiety. When well-meaning parents accommodate a child's fears—letting them avoid anxiety-provoking situations, providing excessive reassurance, doing things for them to prevent distress—the child learns that anxiety is dangerous and that avoidance works. This maintains and often worsens the anxiety.

How to Help Your Anxious Child at Home AAP

You can make a significant difference in how your child manages anxiety. Here's what research shows works.

Validate their feelings without amplifying them. Saying "I can see you're worried about the sleepover. That's a big feeling" acknowledges their experience without feeding the anxiety. Avoid dismissing ("There's nothing to worry about") or catastrophizing ("Oh no, you're so upset!"). AACAP

Help them face fears gradually. Avoidance is the enemy of anxiety recovery. When children avoid feared situations, they never learn that they can handle them. Work together to create a "ladder" of small steps toward facing fears, celebrating each brave step. A child afraid of dogs might start by looking at pictures of dogs, then watching dogs from across the street, then being in the same room as a calm dog, and so on.

Teach coping skills. Deep breathing exercises (like "smell the flower, blow out the candle"), progressive muscle relaxation, and grounding techniques (naming five things you see, four you hear, etc.) give children tools to manage their body's stress response. Practice these when calm so they're available during anxious moments.

Reframe anxious thoughts. Help children identify their worried thoughts and consider alternative perspectives. "What's the evidence for that worry? What's another way to look at this situation? What would you tell a friend who had this worry?" This isn't about dismissing concerns but about developing flexible thinking. AAP

Model calm and coping. Children learn from watching their parents. When you face stressful situations, talk about how you manage them: "I'm a little nervous about this presentation, but I'm going to take some deep breaths and remind myself I've prepared." Don't hide all your stress—show them that everyone feels anxious sometimes and that it's manageable.

Maintain routines and predictability. Anxious children do better with structure. Regular sleep, meals, and routines reduce the uncertainty that fuels anxiety. Give advance notice of changes when possible and prepare children for transitions.

Resist the urge to accommodate. This is perhaps the hardest part. When your child is terrified, every parenting instinct says to make the fear go away—let them skip the activity, answer the same reassurance question for the tenth time, sleep in your bed indefinitely. But accommodation, while providing short-term relief, maintains anxiety long-term. Gradually reducing accommodation is often necessary for improvement. AACAP

When to Seek Professional Help AAP

Home strategies are often sufficient for mild anxiety, but professional help is warranted in certain situations.

Seek help if anxiety is significantly impacting daily functioning—if your child can't attend school, participate in activities, make friends, or enjoy life because of anxiety. Seek help if the anxiety has persisted for weeks or months without improvement. Seek help if you've tried strategies at home and they're not working. Seek help if you're unsure what's going on or how to help. And always seek help if your child is expressing thoughts of self-harm or hopelessness. AAP

The most effective treatment for childhood anxiety is cognitive-behavioral therapy (CBT), which helps children identify anxious thoughts, develop coping skills, and gradually face fears. Many children see significant improvement within 12-20 sessions. Some children also benefit from medication, particularly selective serotonin reuptake inhibitors (SSRIs), which are safe and effective for pediatric anxiety when prescribed appropriately.

Early intervention is key. Untreated anxiety tends to worsen over time and is associated with higher rates of depression, substance use, and ongoing anxiety in adolescence and adulthood. But treated anxiety has excellent outcomes—most children improve substantially with appropriate support. AACAP

The Bottom Line

Anxiety in children is common, often misunderstood, and highly treatable. Learning to recognize anxiety's many faces—from stomachaches to perfectionism to meltdowns—allows you to intervene early. While supporting an anxious child requires patience and sometimes feels counterintuitive (why would I push my terrified child toward what they fear?), gradually helping them face fears while teaching coping skills builds resilience that lasts a lifetime.

Clara is here to help you understand your child's anxiety and find strategies that work for your family!