ANXIETY IN CHILDHOOD: DEVELOPING TOOLS TO HELP YOUR CHILD COPE

ANXIETY IN CHILDHOOD: DEVELOPING TOOLS TO HELP YOUR CHILD COPE

0 August 22, 2016

ANXIETY IN CHILDHOOD: DEVELOPING TOOLS TO HELP YOUR CHILD COPE: By Dr. Tia Westheimer

Although unpleasant at times, feeling anxious is a very natural part of human existence.  The purpose of anxiety is to alert us to and protect us from true threats of danger.  When danger is perceived our bodies prepare us for immediate action.  Most people have heard of the body’s “fight or flight” response.  This represents a series of changes that take place in our body to prepare us to either fight off or escape from danger.  The sympathetic nervous system is activated and hormones such as adrenaline and cortisol are released into the body.  As a result we may feel dizzy, sweaty, or shaky as we experience increased heart rate, blood pressure, and breathing rate.  Blood flow to major muscle groups is slowed along with slowed digestion, which may result in nausea.

Despite the body’s brilliant design to protect us from danger, the threat of actual danger occurs far less often than one may tend to experience anxiety.  The manner in which we interpret and handle our feelings of anxiety can greatly impact our overall level of stress and eventually our quality of life.

When a child experiences anxiety, caregivers often feel confused, helpless, and even frustrated at times.  It is important to remember that some level of worry in children is normal.  It can even help them to stay alert and focused.  However, excessive worry is likely to become overwhelming and begin to interfere with a child’s mood and ability to enjoy life.  There are many things you can do to help children cope with their level of worry.  First, knowing what is normal for your child’s age and level of development is key.

Are My Child’s Fears Normal?

As children age, the focus of their worry will likely change.  When a child worries, it does not necessarily mean that they are suffering from anxiety.  Ask any child you know, chances are, they can tell you about something that worries them from time to time.  Below is a list of very common fears for children at different developmental stages:

Typical Developmental Sequence of Fears in Children as defined by Chansky (2014).

INFANCY: Babies’ fears are immediate and concrete.  In response to a growing ability to differentiate familiar faces from unfamiliar faces, stranger anxiety (clinging and crying when a stranger approaches) develops around seven to nine months and typically resolves by the end of the first year.  Infants fear separation, loud noises, and sudden movements.

EARLY CHILDHOOD: As a healthy attachment to parents grows, separation anxiety (crying, sadness, fear of desertion upon separation) emerges around one year of age and improves over the next three years, resolving in most children by the end of kindergarten.  As children’s worlds expand, they may fear new and unfamiliar situations as well as real and imagined dangers from such things as big dogs, spiders, the dark, sleeping alone, scary movies, ghosts or monsters.

ELEMENTARY SCHOOL: With access to new information and a growing ability to grasp the gravity of events, children begin to fear real-world dangers—fire, burglars, kidnappers, storms, natural disasters, illness, drugs.  With experience, they normally learn that these risks present remote, rather than imminent, danger.  They continue to struggle with what is real and what is not—so fears of ghosts, witches, and zombies are common.

MIDDLE SCHOOL: The growing importance of social status leads to social comparisons and worries about social acceptance.  Concerns about test grades, crime, social isolation, athletic performance, and social-group identification are normal.

HIGH SCHOOL: Teenagers continue to be focused on social acceptance, but with a greater concern for finding a group that reflects their chosen identities.  They tend to worry about the narrow focus of their social relationships as well as about the larger world. Moral issues, and their future failure or success.

When Worry Turns Into Uncontrollable Anxiety

The following symptoms are likely when a child’s fears and worries have manifested into anxiety that begins to interfere with daily functioning.  If one or more of the following scenarios applies to your child, they are likely suffering from excessive anxiety and find their fears difficult to control.

 

  • Physical symptoms-Such as headaches, stomach aches and even vomiting.
  • Anticipate future events with excessive worry, days or even weeks leading up to the event.
  • Extreme avoidance-avoiding school, outings, vacations, time with friends or family.
    • School refusal-refusal to attend or frequent difficulty returning to school following weekend or holiday breaks.
  • Interference in family, social, academic or daily functioning.
  • The use of logical discussions and reassurance to dispel fears is frequently ineffective.
  • Constant reassurance seeking
  • Symptoms appear to persist and or worsen over time.
  • Sleep disturbance-difficulty falling or staying asleep
  • Avoids safe things or things that were once pleasurable.
  • Exposure or discussions of feared items that results in crying, tantrums or behavioral outbursts.

 

 

So What Can You Do? 

Start talking!

It’s not uncommon for children to not only avoid things they fear, but to avoid discussion related to their fears.  It is much easier to help your children if you can begin to understand what worries them.  Be investigators together to find out what aspects of certain situations are triggering a feared response.  The more we understand the more we can demonstrate compassion for how they are feeling.  If children feel that you do not understand them, they are less likely to buy into the interventions you propose and you are less likely to have a positive impact.

It is important to remember that the situations that feel threatening to your child are very real for them.  Even perceived threats can activate the fight or flight response.  In my clinical work, I often times ask parents to think of something that would be extremely frightening for them, such as holding a rodent or a tarantula, being robbed, or trapped in a box.  I explain that when a child’s fears are causing disruption in their daily routine they may be experiencing the same physical and psychological manifestations of those fears, despite how trivial or illogical those fears may seem to others.

Help children to understand that fear is a normal and natural feeling state that we all experience from time to time.  Let them know that anxiety helps to warn us of real danger and therefore, we don’t want to eliminate it completely.  However, we can learn to tolerate and cope with it.  Share some age appropriate things you have worried about in the past and since overcome.

 

Validation and reflection are key.  Do not confuse validation with agreement and encouragement of fears, as they are much different.  You can respect your child’s feelings without reinforcing their fears.  Let your child know that you understand that this is very frightening for them and that you are there to help him get through it. Reflect how he is thinking and feeling back to him to be sure your understanding is accurate.

Educate your child.  Help your child to understand how anxiety can make our bodies feel certain ways.  Explain to your child that anxiety can confuse us by acting as somewhat of a bully sometimes, creeping in at the wrong times.  Make sure they understand that it will get better over time.

Model healthy ways to handle anxiety for your children by managing your own stress in a positive way.

Challenging Thoughts

Begin to assist your child in challenging his current way of thinking.  Ask questions that allow the child think critically and realistically about their struggles.

  • How likely is it that your fears will come true? Examine the evidence.
  • What is the worst thing that could happen?
  • What would (someone you admire or look up to) say about this fear?
  • What other outcomes are likely?

Progressive Muscle Relaxation (PMR)

This method has been around for almost one hundred years.  It involves systematically tensing and relaxing various muscle groups.  Children, and adults, have a tendency to tense their muscles when they feel stressed or anxious.  This can result in more anxiety just as the opposite can be true.  Muscle relaxation has been demonstrated to support the tolerance of anxiety.  If you can teach your child to recognize when they tense their muscles, they can then learn to relax those muscle groups in an effort to reduce their worry and begin to feel calm.

There are countless free PMR scripts that can be found online for various age groups.  One of my favorites is http://www.yourfamilyclinic.com/adhd/relax.htm

Begin by finding a quiet and comfortable place to practice together, such as the child’s bedroom or the living room.  Be sure that you will not be interrupted.  When reading your script, speak slowly to allow your child to complete each task.  Use a calm and soothing voice.  Practicing daily will be most effective in allowing this technique to become second nature.  If you practice this method prior to bedtime, it may assist your child in relaxing and falling asleep more easily.

Diaphragmatic Breathing

Also referred to as belly breathing, diaphragmatic breathing is a practice that uses your diaphragm to provide your body with adequate amounts of oxygen and carbon dioxide.  We tend to take shallow breaths when we are feeling anxious which can increase our overall level of anxiety.  If tension is mild, belly breathing may be just the right prescription for reducing our stress level.  If anxiety is high, belly breathing can assist in calming the body in an effort to begin to think clearly.  Belly breathing also allows us to better tolerate anxiety and be able to return to a calm state in a more efficient manner.

Practice this technique WITH your child.

  1. Begin in a comfortable lying or sitting position.
  2. Check to be sure that your child’s chest and shoulders are relaxed. The belly should be the only visible movement.
  3. Ask your child to place a book, or their hand, on their stomach to provide a visual reminder that the stomach should move.
  4. Tell your child to imagine that a balloon is in his belly that he needs to fill up completely with each inhale and deflate completely with each exhale.
  5. Teach your child to breathe in through his nose and out through his mouth.
  6. Ask that your child repeat a comforting phrase such as “relax” or “calm” upon exhalation.
  7. Have your child inhale for 3 seconds and exhale for 6 seconds
  8. Practice two times a day, ten breaths in a row.
  9. You can also encourage your child to imagine a relaxing scene while breathing.

Other Methods:

Unfortunately there is no “one size fits all” solution for anxiety.  Children respond to different techniques and it is important to get creative and remain open minded when attempting to assist them in managing their fears.

Yoga practices especially created for children have been demonstrated to be an effective method in reducing anxiety for children (Weaver & Darragh, 2015).  To learn some simple and basic yoga practices to use with your children, checkout Harvard health blogger Dr. Marylynn Wei’s site.  http://www.health.harvard.edu/blog/more-than-just-a-game-yoga-for-school-age-children-201601299055

In addition to the proposed methods above, guided imagery and imaginal exposure are also methods that have been found to be effective in reducing anxiety in children.  Whatever method you choose, it is important to keep in mind that it requires work and persistence for children to overcome their fears.  With that in mind be generous when providing positive reinforcement and rewards for hard work or any movement in a positive direction.

It may be time to seek professional help if you feel that your child’s anxiety is affecting his mood or self-esteem or if your child asks for additional help.  If your child’s anxiety appears excessive, as detailed above and your attempts to help do not seem to reduce his symptoms it is most likely time to enlist the help of a professional.

Early intervention is key, along with proper support from caregivers, school officials, and loved ones.  Anxiety can be treated effectively and with the right support, children can go on live happy and successful lives.

 

References

Chansky, E., Tamar (2014). Freeing your child from anxiety: Practical strategies to overcome fears, worries, and phobias and be prepared for life-from toddlers to teens. New York: Harmony Books

Weaver, L., & Darragh, A. (2015) Systematic Review of Yoga Interventions for Anxiety Reduction Among Children and Adolescents. American Journal of Occupational Therapy, 69.

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