How to help kids cope with anxiety
"I can't go to school – my stomach hurts.”
Many parents are likely to have heard these words from a child they know is physically fine but emotionally wobbly.
It can turn the morning routine into a daunting challenge, particularly if you see genuine worry in their eyes.
What do you do?
Whether your child is a six-year-old who’s not enjoying school because they’re struggling to make friends or a 13-year-old who’s fretting about an exam that day, seeing a child who’s in a state of anxiety can leave parents feeling helpless and frustrated.
We think of childhood as the carefree stage of life but just like adults, children feel worried and anxious at times – and for some it can be debilitating.
“It’s a myth that children don’t worry,” says Johannesburg-based child psychiatrist Dr David Benn. “They worry at least as much as adults and sometimes more, but they’re far less able to verbalise their feelings and may simply appear angry or upset.”
“There’s tremendous anxiety in kids and we’re definitely seeing an increase,” says Dr Helen Clark, a psychiatrist who works with children and adolescents at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg.
The symptoms of anxiety in kids are often mistaken for something else, she adds. Sometimes they’re seen as just excessively shy or quiet. Boys are often labelled as naughty, disruptive or difficult.
But when anxiety isn’t seen for what it is it can affect a child’s mental and emotional development. Severe anxiety that’s left untreated could develop into an anxiety disorder or lead to depression.
The good news is there are practical ways in which parents can help anxious children cope with their feelings. We asked experts to give their tips and explain when professional help is needed.
What makes children anxious?
Children tend to feel anxious about different things at different ages. A child’s first experience of this uneasy feeling is usually as a toddler when they become upset when separated from their parents or carer.
This so-called separation anxiety is a normal stage of development and tends to ease off around age two or three.
It’s important to understand that anxiety is a normal human emotion and there are times throughout a child’s life when they’ll feel anxious, such as when they go to a new school or before tests and exams.
When is anxiety a problem?
Some anxiety is normal, but it becomes a problem when it starts to interfere with a child’s everyday life. For example, most kids will feel a little anxious before an exam, but if a child is so crippled by worry during an exam they can’t get anything down on paper or don’t even make it to school, it’s time to get help.
“The child is so terribly overcome by anxiety that they can’t get over it themselves,” says Sue van der Spuy, a trauma counsellor from Somerset West near Cape Town.
What causes it?
There are numerous contributing factors. Personality, lifestyle, genes and environmental factors such as crime can all play a role, explains Marita Rademeyer of the Child Trauma Clinic in Gauteng.
Also, these days children are under more pressure to perform academically and in sport than they were even a decade ago, Rademeyer says. “They have to work hard at school from an early age and think about the career they want to follow. It’s not unusual for an 11-year-old to tell you he’s working on his CV for high school.”
Add to this the fact the so-called iGeneration – those younger than 21 – spend a lot of time on smartphones, tablets and computers. This affects their emotional development, Dr Benn says.
A 2015 study by child psychologists at Boston University School of Medicine in the US found children who spent a lot of time using mobile media devices battled to control their emotions. This was linked to the fact that mobile media had reduced the amount of time spent engaging in direct human interaction.
Other factors that can make kids anxious include:
- Not enough sleep: Too little sleep due to a late bedtime or bad sleeping patterns such as not winding down before lights out.
- Their personality: Certain children are just more prone to feeling anxious. This is often hereditary.
- Their self-image: Kids with self-image problems are more susceptible to anxiety.
- An inconsistent routine: Especially young children feel more secure if they have a schedule for the day, so they know there’s a pattern that’s followed regarding when it’s time to eat, nap, bath and go to bed.
- Unclear rules: Rules and boundaries need to be clear. It’s confusing if parents change their minds from one week or month to the next about when kids are allowed to watch TV or use the Xbox or PlayStation. Decide what the rules are, explain them and stick to them.
- Anxious parents: A child’s anxiety can be worsened if the adults around the child are also anxious.
How to spot it
Possible signs a child is struggling with anxiety include excessive caution, physical ailments such as headaches, stomach aches or nausea, regular crying for no reason, anger and aggression, problems concentrating, poor appetite, fear of failure, excessive neediness, frequent soiling or wetting their bed, fidgeting, constantly asking for reassurance and regression.
Be alert to situations where a child’s anxiety levels don’t improve even long after a traumatic experience (such as the death of a beloved grandparent).
If the child repeatedly complains about stomach ache or continues to display other symptoms, there may be an anxiety problem, says Dr Helen Clark.
“In my view medication should be the last resort – especially with young children as their brains are still developing,” says Sue van der Spuy.
Many psychiatric medications aren’t registered in South Africa for use in children, adds Johannesburg-based child psychiatrist Dr David Benn. “Anxiety medication should be prescribed only by doctors who are experts in the field.”
What about medication you can buy over the counter? The fact that something is available over the counter or is a natural preparation doesn’t mean it’s safe for your child, says Dr Clark.
There isn’t enough evidence about how effective they are or what the possible side-effects are in children.