Child Anxiety: A Guide for Parents

For both children and adults, feeling anxious from time to time is a normal, and even healthy, experience. Anxiety can help us avoid danger or motivate us to solve problems. But an anxiety disorder is different—it’s when anxious feelings become frequent, overwhelming, and start interfering with daily life.

Anxiety disorders are the most common mental health conditions in children and teens, affecting as many as one in five young people before adulthood. If your child is struggling, it’s not a sign of permanent difficulty—children can learn to manage anxiety and overcome these disorders.

“If your child is really anxious, that does not mean that they are doomed to struggle and live a limited life,” says Eli Lebowitz, PhD, co-director of the Anxiety and Mood Disorders Program at the Yale Child Study Center.

With appropriate, evidence-based intervention, most children can learn to manage anxiety and move past it.

While there are several types of anxiety disorders that vary in presentation, this group of disorders shares common characteristics. Wendy Silverman, PhD, co-director of the Anxiety and Mood Disorders Program, refers to the main features of anxiety disorders as the “three As.”

• Arousal: the nervous system is in a heightened state. In children, this often shows up as physical symptoms such as headaches, stomachaches, or nausea.
• Anticipation: a persistent belief that something bad is going to happen. This can lead an anxious child to expect the worst or imagine unlikely negative scenarios.
• Avoidance: the tendency to stay away from situations, places, or people that cause anxiety. Avoidance is especially common in children with anxiety disorders, Dr. Silverman says.

These disorders do not resolve on their own. Without treatment, childhood anxiety can lead to other challenges later on, including depression, substance use problems, and other mental health conditions.

Certain anxiety disorders are especially common in childhood and adolescence. Each involves a different focus of fear or worry, but all share the core features of heightened arousal, persistent anticipation, and a tendency toward avoidance.

Separation anxiety is the most common childhood anxiety disorder Dr. Silverman sees in her practice. Children with separation anxiety become fearful about being apart from their parents—refusing to attend birthday parties, insisting on sleeping in the parents’ bed, or becoming distressed at school drop-off.

Generalized anxiety disorder (GAD) causes intense, uncontrollable worry that the child finds difficult to control—about school, health, family, or future events.

Social anxiety can involve feeling intense concern about what others think, including worrying about feeling embarrassed, judged, or rejected in social situations.

Selective mutism is the inability to speak in specific social situations despite speaking normally in others. It can appear in children as young as two.

Left untreated, childhood anxiety can evolve. “If you are a child with separation anxiety, over time, you’re at risk for other anxiety problems like panic disorder, which we see more in teenagers,” Dr. Silverman says.

What anxiety looks like depends significantly on a child's age and developmental stage.

In very young children, who are unable to voice their anxious thoughts, anxiety often shows up as irritability, frequent temper tantrums, trouble sleeping, or difficulty being soothed. For other children, anxiety manifests as avoidance. These children may come across as shy or hesitant around unfamiliar people or situations.

In school-age children, signs include avoiding activities peers enjoy, clinging to parents, refusing to be alone, and physical symptoms such as rapid breathing or elevated heart rate. “This is when we start to see more core fears emerging,” says Dr. Lebowitz.

In older children and teens, anxious thoughts are more often expressed verbally—worry about what others think, excessive concern about school performance, or a persistent sense that something bad is going to happen.

Across all ages, avoidance is a key signal: when a child consistently steers away from situations that other children their age manage without significant distress, that pattern is worth paying attention to.

Parents wondering whether it’s time to bring in professional help should think about two questions: How long has the anxiety been going on, and how much is it affecting daily life? It is normal for children to have transient fears. During the first week of middle school, for example, a child might experience what looks like social anxiety, but this anxiety often eases as they adjust to their new environment.

But if the anxiety persists, this could be a sign of a disorder. The clinical threshold for diagnosing anxiety disorders is symptoms that last for at least six months. If a child’s symptoms persist for months, it may be time to seek help. “When anxiety has taken hold as a more consistent problem and parents are seeing impairment in a more ongoing way, then the problem does not tend to just go away on its own,” says Dr. Lebowitz.

Parents should also consider how much anxiety is interfering with their child’s life. If anxiety is preventing children from connecting with their peers or performing well in school, they might benefit from seeing a professional. Childhood anxiety can also interfere with the lives of family members. If parents consistently have to share their bed, leave work early, or be unable to travel due to their child’s anxiety, this could be another sign that help is warranted.

“This is the most important thing we think about when trying to figure out if the child needs to be involved in some kind of professional intervention,” Dr. Silverman says.

If symptoms have persisted for more than a couple of months and are noticeably affecting your child's daily life—or your family’s—it is reasonable to seek an evaluation.

Anxiety disorders usually develop because of a combination of factors, and parents should not assume that something they’ve done or failed to do is the sole explanation.

Anxiety disorders can run in families, in part due to genetics. “A lot of this has to do with children’s innate predispositions,” says Dr. Lebowitz. Children can also pick up anxious patterns from the adults around them. “A very anxious parent could also be modeling anxious behavior or struggle to teach effective coping skills.”

Accommodating anxious behaviors can also contribute to the disorder, such as letting children stay home from school due to their anxiety. Dr. Silverman refers to this as “the protection trap.”

“Most parents mean well and they don’t want to see their children upset or overly distressed,” she says. “Our instinct as a parent is to protect our child. And one way we sometimes do that is by removing them from distressing situations.”

While avoidance can relieve stress for both children and parents in the short-term, it also reinforces that anxiety. It also denies the child the opportunity to face their fears and learn that they can handle the things that scare them.

“It is helpful for parents to be aware of their own behaviors,” says Dr. Silverman. “They may be inadvertently promoting the avoidance and staying away, rather than promoting encouragement that children can do the things that make them nervous.”

Before any treatment begins, children should be thoroughly assessed by a professional. Anxiety disorders often occur alongside other conditions such as depression, autism spectrum disorder, and attention-deficit/hyperactivity disorder (ADHD). Psychologists first need to make sure that anxiety is the primary problem that is creating the most disruption in a child’s life.

Once diagnosed, effective, evidence-based treatments exist for childhood anxiety. Most children who receive appropriate care show meaningful improvement. One of the strongest scientifically backed treatments available for children is cognitive behavioral therapy (CBT). CBT teaches children cognitive skills for dealing with anxious thoughts and helps them practice putting themselves in anxiety-inducing situations. Psychologists can conduct CBT either individually or in a group setting.

Although CBT is one of the most effective treatments for childhood anxiety, up to 50 to 60% of children who receive CBT alone do not show sufficient improvement.

Many clinical trials have been conducted to improve CBT outcomes by involving parents; however, most studies have failed to show improvement. An important exception is a large trial led by Dr. Silverman that showed improved CBT outcomes in children when parents are taught to decrease their encouragement of their child’s avoidant behaviors and to increase their child’s feelings of autonomy.

Dr. Lebowitz has also developed Supportive Parenting for Anxious Childhood Emotions (SPACE), a program that teaches parents skills to help their children overcome anxiety. Children do not need to participate in SPACE sessions. “That’s really important because not every child is fit for participating directly themselves—some don’t want to, or they struggle to,” says Dr. Lebowitz.

If CBT, with or without parent involvement, or SPACE fails to provide enough relief, medications can be a helpful tool. The most common drugs for treating anxiety are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). “These have been around for decades and are considered really safe treatments,” says Dr. Lebowitz.

If you recognize signs of anxiety in your child that have persisted for more than a few months and are affecting their daily life, consider reaching out to your child’s pediatrician as a first step. A pediatrician can help rule out medical causes and provide a referral to a mental health professional who specializes in childhood anxiety.

Early intervention matters. The longer anxiety disorders go untreated, the more entrenched avoidance patterns can become—and the harder they are to reverse.

“It’s so motivating to get help and put the work in knowing that this can get so much better,” Dr. Lebowitz says.