How To Help Children Be Less Anxious

The words “childhood anxiety” can seem like an oxymoron. Isn’t childhood supposed to be the most carefree time of a person’s life?
Yet according to the American Academy of Pediatrics, anxiety is the most common type of mental health disorder in childhood, affecting approximately eight percent of all children and adolescents. During the hectic holiday season, kids can feel even more apprehensive than usual. Here are answers to some of the most commonly asked questions about childhood anxiety.
What is anxiety? 
Anxiety is a sense of worry, distress or unease. It’s a natural human reaction to the common stressors of day-to-day life and a normal part of growing up. A normal anxiety only becomes a disorder when it interferes with a child’s ability to perform routine day-to-day functions such as going to school or engaging in social activities.
At what age are children likely to experience anxiety?  Do fears change as kids get older?
Anxiety can begin as early as infancy, with children experiencing developmentally normal fears throughout every stage of their lives.
Between 6-12 months of age, many babies experience “stranger anxiety.” They become afraid of people they don’t know, including grandparents or other relatives whom they see infrequently. For toddlers, being afraid of the dark or a monster under the bed are common fears. Preschoolers can feel stressed when starting a new school, or suffer separation anxiety when they are away from their parents.
As school-age kids begin to learn about life, they begin to absorb more of the world around them, which can be frightening. An earthquake drill at school or learning about a tornado or a terrorist attack on the news can trigger fears about death and dying.
Much anxiety for kids in elementary school up through the teen years is based around performance – pressure to do well academically, as well as in sports and social activities. “Do I fit in?” or “Am I popular?” are common anxiety-producing reflections. By high school, this apprehension can grow as teens worry about how they look or how their intelligence is perceived when answering a question out loud in class. Bullying and power struggles are common issues kids deal with in this age group, as well as angst around sexuality and sexual identity.
What are some signs that my child is experiencing higher than normal levels of anxiety?
Physically refusing to do usual activities.  Asking your child to go to school, ballet class or even to bed at night is routinely met with tears and tantrums.
Excessively clingy. The child is clingy or tearful when dropped off at a new school or daycare and remains distressed for days or weeks.
Requiring extreme reassurance. The child repeatedly asks many questions such as, “Why do I have to go to the birthday party?” “What if I’m hungry or I have to go to the bathroom?” “When are you coming back?”
Shadowing. Seemingly unable to be alone, the child follows you around the house. He or she waits for you outside the bathroom door, “Where are you, Mommy?”
Appearing distracted or isolated. A child or adolescent may appear exceptionally irritable, have trouble paying attention or try to avoid school or social activities.
Exhibiting physical symptoms. Anxiety can manifest itself in the form of stomachaches, headaches, trouble sleeping or changes in appetite.  
If your child continues to experience undue levels of anxiety, talk to your pediatrician, who may refer your son or daughter to a therapist. The most common treatments are cognitive behavioral therapy (learning to change the way the child thinks about negative emotions) and learning relaxation exercises.
How can I help reduce my child’s stress level?
Try to “unschedule” your child. Let him or her decompress and have down time.
The Bay Area is a high-pressure zone for kids. Here, well-meaning parents, desiring to provide their children with every opportunity to develop their full potential, often pack their child’s schedule with organized sports, advanced placement classes, language courses, music lessons and an array of special coaches and tutors.
The result is the child is constantly “on” and under stress. When are kids allowed to just be bored? Our brains need that kind of release. Boredom is the birthplace of creativity and we often squelch that in our kids. Many children today don’t know how to play pick-up basketball or create their own fun. Instead, an adult is typically organizing everything for them.
Consider slowing your child’s world down and establishing a set routine of school, free play time, regular nutritional meals and an established bedtime. Playing soccer or learning to speak Mandarin can wait. Help your child grow into a healthy, happy person first and you can both work on the rest as you go along.
For shy, nervous kids, the holidays can acerbate their stress with an influx of parties, pageants, activities, visiting relatives, sleeping in strange beds and being coaxed to talk with or perform for extended family members. Help dial down the pressure by purposefully planning quiet nights at home for just you and your family to play a board game or enjoy a movie. At family gatherings, allow your timid youngster to hang out in the kitchen with you as you work on the meal together.
Parents need to be brave. Even though it seems that everyone else’s kid is on the advanced math track or playing virtuoso violin, you may need to just say “no.” Feel confident in your ability to sense and do what’s best for your child.
Rebecca Benton, M.D., MPH, is a pediatrician at the Palo Alto Medical Foundation. Advice is not intended to take the place of an exam or diagnosis by a physician.