Childhood Anxiety: Symptoms, Causes, and Treatments

Childhood anxiety appears through a series of disorders, mainly phobias, but there are others. Learn all about them.
Childhood Anxiety: Symptoms, Causes, and Treatments
Laura Ruiz Mitjana

Written and verified by la psicóloga Laura Ruiz Mitjana.

Last update: 01 April, 2023

Childhood anxiety can appear as a symptom in a child’s daily life. Or it can be excessive and interfere with functioning to the point that it becomes an anxiety disorder. There are different types, although, in this article, we’ll focus on three of the most frequent.

Anxiety is a generalized state of overactivation of the body in which physiological symptoms appear, but also cognitive and emotional ones. In children, detecting the latter can be a little more complicated, so treatments focus on training them to learn to identify and manage anxiety.

What symptoms does childhood anxiety entail? What are some of the possible causes? How can you fight it? We’re going to provide all these answers according to the reference manuals in child psychology.

Childhood anxiety: What is it?

Anxiety is defined as a state of overactivation of the body, accompanied by other physical, cognitive, and emotional symptoms. It’s a reaction that occurs without an obvious external threat.

In the case of childhood anxiety, this can be very similar to that of adults, although it also presents differentiating characteristics, depending on the case.

Anxiety versus fear

We mustn’t confuse anxiety with fear. Childhood anxiety is more diffuse and less specific than fear. In addition, it appears without apparent cause.

Anxiety is usually an anticipatory reaction to danger, and may not be real. On the other hand, fear is a normal reaction to possible danger (that is, it’s an adaptive reaction). However, when it’s excessive, we speak of a phobia.

“Your fear ends when your mind realizes that it is she who creates that fear.”


Anxiety vs. Worry

We must also differentiate childhood anxiety from mere worry. Therefore, the anxious reaction is characterized by its physiological component; the cognitive component appears later, as an interpretation of the physical reaction.

On the other hand, in the case of worry, the central component is cognitive and not physiological. Various physiological reactions can be expressed after it.

A little boy crouched down on the floor, covering his ears and closing his eyes tightly.
Anxiety isn’t the same as fear, nor can it be equated with worry.

Childhood anxiety disorders

As in adults, childhood anxiety manifests itself through different disorders. We’re going to see three of the most frequent, although there are more.

Specific phobias

Specific phobias are one of the most frequent manifestations of childhood anxiety. They consist of persistent fears of objects or specific situations that interfere with the functioning of the child. They carry a high discomfort in the presence of the phobic stimulus, as well as the avoidance of the situation.

According to a study by Güerre & Ogando (2014), published in Anales de Pediatría Continuada, the most common phobias and fears in childhood are those that have to do with the following objects or situations:

  • Heights, strangers, and attachment figures (from 6 months)
  • Separation, monsters, and darkness (2.5-6 years)
  • Getting hurt, natural catastrophes, and getting sick (from the age of 6).

A study by Ollendick et al. (2010) and another by Brent et al. (1999) suggest that adults who maintain phobias since childhood will present repercussions in their social, work, and personal lives, with worsening quality.

In fact, any disorder that becomes chronic from childhood to adulthood can have very harmful consequences for health, so early and timely treatment will always be the ideal option.

Panic disorder

Childhood anxiety can also appear through a panic disorder, which, according to the “Diagnostic and Statistical Manual of Mental Disorders” (the DSM-5) involves repeated and unexpected panic attacks without a specific trigger, along with restlessness, anxiety, and fear of the possibility that they’ll appear again.

In this way, the fear of suffering a new crisis limits the person’s daily activities. However, although this disorder can also appear in children, it’s more frequent in adolescents, as the person must have the sufficient cognitive capacity to interpret physiological sensations.

Generalized Anxiety Disorder (GAD)

In childhood GAD, excessive concern appears regarding multiple issues that interfere with the child’s life. It’s a concern that’s very difficult to control that invades the child’s entire mental space.

In addition, it’s not related to a specific stimulus. As in the previous case, it’s also more common in adolescents than in children, when their cognitive ability allows them to think about future situations.

Causes of childhood anxiety

The causes of childhood anxiety can be very diverse. Generically, we can talk about different types:

  • Death or illness of a loved one or relative: This fact can trigger feelings of insecurity, helplessness, and anxiety in the child who fears that the situation will occur again or who fears losing their parents.
  • Negligent, inconsistent, or overprotective education: The educational styles of parents can also influence the appearance of childhood anxiety.
  • Traumatic experiences: This cause is related to the appearance of specific phobias (for example, when bitten by a dog). Other traumatic experiences are also linked to childhood anxiety, such as an accident or theft.
  • Problems at school: Being bullied can trigger anxiety and other somatic and physiological symptoms in the child.
  • Vulnerability/temperament: Studies have shown that many anxiety disorders have a genetic basis, that is, some people could be more vulnerable to developing them than others.

Treatments for childhood anxiety

According to the Child and Adolescent Clinical Psychology Manual by Caballo et al. (2002), in the treatment of childhood anxiety, there are a series of common elements (techniques), which are the following:

  • Anxiety psychoeducation
  • Cognitive restructuring
  • Live exhibition and in the child’s imagination
  • Relaxation techniques

Each disorder will require more of one of the elements of the treatment, in addition to a specialized and personalized approach. Behavioral strategies are used in children, while cognitive strategies are used in adolescents.

A child hiding under couch cushions.
Phobias are a form of childhood anxiety and have specific treatment.

Approach to each disorder

In GAD, for example, the fundamental element of the treatment will be cognitive restructuring (CR), the intention of which is for the child to modify their negative and catastrophic thoughts for more functional ones. RC is very useful to address excessive worry.

GAD also uses relaxation, reinforced practice (reinforcing the child’s progress), and problem-solving. Another technique widely used in this disorder in childhood is The Coping Cat, a package of sessions of cognitive-behavioral techniques.

On the other hand, in phobias, psychoeducation is used so that parents and children understand how the problem works. It also includes practice in relaxation and coping skills, as well as progressive exposure to phobic stimuli.

In the treatment of a panic disorder, there’s always an educational phase. The key element in this type of intervention will be the exposure of the child to the internal signals that they’re trying to avoid. In addition, relaxation training is carried out through which the child will gradually acquire control of the physiological activation of their body.

What manuals don’t explain

In childhood anxiety, in order for the child to learn to manage it, they must first understand the emotion behind the anxiety (if there’s no emotion, they should at least understand the cause). For this, it’s very useful to carry out exercises in which they externalize anxiety.

An example of this would be to use a drawing: Have them draw a silhouette in which they point out where they feel anxiety (this will allow them to understand physiological reactions as signals of emotion). Finally, when working on anxiety in children, it’s very useful to teach them relaxation techniques through breathing, mindfulness, or security objects (a blanket, a stuffed animal, a book, an amulet).

At the same time, practicing coping in the imagination, with toys, or in a drawing, will allow them to experience feelings of ability and reinforce their self-confidence.

  • American Psychiatric Association (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid: Panamericana.
  • Belloch, A., Sandín, B. y Ramos, F. (2010). Manual de Psicopatología. Volumen I y II. Madrid: McGraw-Hill.
  • Caballo, V. y Simón, M.A. (2002). Manual de Psicología Clínica Infantil y del adolescente. Trastornos generales. Pirámide. Madrid.
  • Colomer-Revuelta, et al. (2004). La salud en la infancia. Gaceta Sanitaria, 18(4).
  • Comeche, M.I. y Vallejo, M.A. (2016). Manual de terapia de conducta en la infancia. Dykinson. Madrid
  • Güerre, M.J. & Ogando, N. (2014). An Pediatr Contin, 12(5): 264-268.

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