- Anxiety disorders affect up to 30% of children and adolescents, but can be difficult to spot—especially in young children.
- Anxious young children may feel panic and shame and may show phobic behavior in response to certain stimuli.
- Caregivers who help children avoid the sources of typical fears may impede the child's development of important coping skills.
This post was co-authored by Sarah MacLaughlin, LSW, and Rahil Briggs, Psy.D.
It’s Mental Health Awareness month, COVID-19 cases are once again on the rise in many states, and it’s time to focus on young children and anxiety. Anxiety can be difficult to identify in children, especially young children. Young children who suffer from anxiety are often “silent sufferers” and can be misunderstood as “just shy” or “too attached to Mom.” While all children feel nervous or scared from time to time—and separation anxiety is almost universal in babies and toddlers—pervasive anxiety that doesn’t let up or seems to interfere with daily life may be indicative of a more severe problem.
Anxiety disorders affect up to 30% of children and adolescents and contribute to social and academic problems (CDC, 2022). While sufferers are primarily school-age and adolescent children, approximately 10% of younger children between the ages of 2 and 5 show signs of an anxiety disorder (Hirshfeld-Becker, 2019).
What anxiety looks like in young children
Anxiety looks different depending on the child and their age. Anxious young children may feel panic and shame and may show phobic behavior in response to certain stimuli. Some behaviors that could signify anxiety tend to be present in many children, so look for these signs of potential anxiety as more of a constellation than individually, with special attention to frequency, duration, and intensity.
- Has difficulty sleeping, frequent night waking, bad dreams, and/or night terrors.
- Expresses frequent fears and worries around various activities (e.g., going out, going to child care) or specific things (e.g., spiders, elevators, dogs).
- Displays a short fuse with strong emotions—doesn’t have space between an upset and a full-blown tantrum.
- Is clingy and fussy beyond what seems typical for their age.
- Has a need to use the bathroom excessively once toilet trained, and/or other toileting struggles.
- Frequently complains of stomachaches and not feeling well.
The importance of the caregiver-child dyad dynamic
Sometimes, well-meaning caregivers who are anxious themselves can perpetuate a tendency toward anxiety, via avoidance. They may respond to a child’s distress around separation or other typical fears with avoidance, which typically decreases child tolerance and skill-building (Hirschfeld-Becker et al, 2019). For example, if a child expresses fear about going to the park to play, the grown-up may stop taking them there. Or if a child becomes very upset with the separation at child care drop-off, the caregiver may discontinue the caregiving arrangement. When caregivers avoid opportunities for children to face positive stress (Toxic Stress, n.d.), they are also potentially impeding the growth of important coping skills and strategies that help to mitigate anxiety.
Another challenging dynamic is when a child displays anxiety and the caregiver is not attuned to these emotions and behaviors and/or cannot relate, creating a mismatch. In this instance, it is important for the adult to adjust their style to meet the needs of the young child. The back-and-forth feedback loop between caregiver and child is essential for soothing babies and toddlers to mitigate their stress and anxiety. Caregiving adults can bolster their ability to provide a buffer to stress by focusing on the following three areas that promote caregiver wellness:
- Emphasis on the basics for staying healthy overall: good nutrition, avoiding or reducing intake of alcohol and tobacco, sleep hygiene, adequate exercise, enough social interactions, and spending time outdoors.
- Mental health care and awareness around their own stress and anxiety that helps caregivers practice self-reflection and emotion regulation to interrupt anxious patterns within the caregiver-child dyad.
- Mindfulness for caregivers, including practices they can do with young children.
During this Mental Health Awareness month, our focus must include prevention and recognition that toddlers and young children can and do suffer from mental health concerns, including anxiety. As early childhood experiences predict much of the wiring and functioning of the brain, we need to prioritize understanding early signs of anxiety, depression, and other mental health concerns. Evidence suggests that the wiring and functioning of the amygdala—often regarded as the fear response center of the brain—could be impacted in the first months of life and in turn increase the risk of symptoms by age 2 (Rogers et al, 2017).
Surgeon General Dr. Vivek Murthy, during a recent Senate Finance Committee meeting, noted that it can take an average of 11 years from first symptoms to treatment when talking about children’s mental health (United States, 2022). We have to focus on prevention and continue to help caregivers better understand the signs and symptoms of anxiety so they can be as supportive as possible, as early as possible, for their young children.
Centers for Disease Control and Prevention (CDC). (2022, April 13). Anxiety and depression in children: Get the facts. cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html
Hirshfeld-Becker, D. R., Henin, A., Rapoport, S. J., Wilens, T. E., & Carter, A. S. (2019). Very early family-based intervention for anxiety: two case studies with toddlers. General psychiatry, 32(6), e100156. https://doi.org/10.1136/gpsych-2019-100156
Rogers, C.E., Sylvester, C.M., Mintz, C., Kenley, J.K., Shimony, J.S., Barch, D.M., Smyser, C.D. (2017). Neonatal amygdala functional connectivity at rest in healthy and preterm infants and early internalizing symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 157-166 http://dx.doi.org/10.1016/j.jaac.2016.11.005
Toxic Stress (n.d.). Harvard Center on the Developing Child. https://developingchild.harvard.edu/science/key-concepts/toxic-stress/
United States. Public Health Service. Office of the Surgeon General. (2022). Vice Admiral Vivek H. Murthy, M.D., MBA, Statement before the Committee on Finance, United States Senate. U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. https://www.finance.senate.gov/imo/media/doc/Dr.%20Murthy%20SFC%20Testi…