Anxiety in kids

Pediatrician and a mother of three, Dr. Julie Linderman of Mommy MD shares her tips on how to manage anxiety in kids.

Photo by Syrie Wongkaew

Anxiety permeates my every day… I see it in the eyes of a 9-month old that suddenly recognizes me as a stranger, the 15-month old that wails when my nurses try to measure her head, the 4-year old who’s about to get their booster vaccines. Of course, all of these cases illustrate normal fear; healthy anxiety that recognizes a threat and responds accordingly. Unfortunately, pathologic anxiety – the kind that keeps kids from engaging with others and exploring their worlds also exists, and I have witnessed it in the very young.

What can we do as parents to recognize and support our kids’ natural anxiety while not exacerbating the development of pervasive pathologic anxiety?

It can be really difficult to watch your child suffer, especially if that suffering involves loud crying (as it often does) and you are in a public environment with observers all around you. I had one well-meaning parent in my practice who avoided public restrooms with her toddler because she would burst into tears if anyone activated an automatic hand dryer! I’ve had other parents caved when their preschooler threw a tantrum when he wasn’t allowed to walk along the outer corners of the pavement to the car in a long and laborious fashion and then buckle himself into his carseat in his favorite way.  A well-meaning (and exhausted) parent would often start over and let him dictate his intricate, OCD-like course, which generally alleviates everyone’s short-term anxiety, but can potentiate long-term struggles. Of course, we want to let our kids control some of what comes their way. Letting them have some control can really help to minimize anxiety, but constant avoidance of a meltdown altogether is never the answer.


Management of specific phobias – Baby Steps 


For specific phobias, I recommend that parents stage the exposure. For example, if a child is refusing to go to school, discuss her fear openly with her… really let her tell her story. Then come up with a plan that allows for baby steps of exposure e.g. Today you stay for an hour, tomorrow for two. The parent remains calm and reassuring – which is the antithesis to the child’s angst. I always tell parents in my practice – the more your child ratchets up their emotion, the more you temper yours. Also remember when you come back to get your child at the end of the school day, there is no celebration – you are cool, calm and collected – nice to see you and on with your day. This approach relays to the child that no great feat was achieved, because the fear, although real and supported by you, was out of line with the reality of the situation. The trick as parents, is tracing this fine line between support and indulgence of irrational fear.

The goal should never be to completely eradicate anxiety as this is truly an impossibility, but rather to learn how to move through the fear and to function well despite fear. This is something all of us have to do, whether we are 1 or 100.

Another important mention, as eloquently stated by Clark Goldstein, PhD via the Child Mind Institute, is that it is important as parents to ‘express positive, but realistic expectations’ for our kids. There is no guarantee that you won’t fail a test, or fall in front of your peers, or fail in some form or fashion – in fact, there is some guarantee that your child will fail, and this is totally, wholeheartedly OK!  My middle child really fears performance, every time a piano recital rolls around she has sweaty palms and doesn’t want to eat and practices incessantly, but the older she gets the less she struggles with this very natural fear. Mainly because she has done it so many times now, but also because she did mess up once and everyone still clapped and we all still love her just the same. Nothing really changed. A kid needs to see this – that failure is not final.

Lastly, as parents, we contribute greatly to our kids’ sense of fear. I can always tell when I am examining the 3rd child in a family (especially as a toddler) because almost uniformly they don’t mind my exam – they smile and chat easily. The parent is usually sitting in a chair chatting also, calm and secure. The parent has done this before and the child knows the parent is not concerned about my exam or concerned that the child will overreact to my exam (which of course almost always makes the child overreact to my exam!  Anxiety is contagious from parent to child. So of course we should address our own fears and pathologic anxieties first. Ultimately, this will make such a difference to the future of our kids.