Anxiety in children and adolescents is one of the most commonly diagnosed mental health conditions, often affecting their ability to focus, socialize, and function day to day. While some anxiety is normal, excessive worry can be overwhelming and sometimes mistaken for behavior problems. Fortunately, there are many ways to manage childhood anxiety through therapy, parenting strategies, and lifestyle changes.
Charlie Health - Therapy Once Per Week Isn’t Always Enough
Charlie Health’s virtual mental health program includes curated groups, individual therapy, and family therapy for teens and adults with serious mental health issues. Insurance accepted. Learn More
What Is Anxiety?
While occasional anxiety is a normal part of life, anxiety disorders are defined by intense feelings of worry that persist and sometimes worsen over time. These feelings can significantly interfere with a person’s life, preventing them from engaging in their daily routines, work commitments, and relationships. Anxiety disorders include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias.1
How Many Kids Have Anxiety?
Millions of children are struggling with an anxiety disorder. According to the CDC, over 9% of all children ages 3-17 had diagnosed anxiety between 2016-2019.2 Rates of anxiety have also increased steadily over time. The NIMH found that nearly 32% of adolescents have an anxiety disorder.3 With anxiety so prevalent in children and teens, it is important to know what signs to look for.
Signs & Symptoms of Anxiety in Children
Anxiety in children can present in various ways, and the signs aren’t always easy to recognize. It’s often mistaken for behavior issues like defiance or inattention. Understanding the full range of symptoms can help identify when a child may be struggling with anxiety.
Below are common signs and symptoms:4, 5
Physical (Somatic) Symptoms
- Headaches, stomachaches, gastrointestinal issues, chest pain, or dizziness with no known medical cause
- Racing heart, clammy hands, sweating, dry mouth, shaky hands or body, warm or flushed face
- Difficulty falling or staying asleep
- Nightmares and/or night terrors
Emotional & Behavioral Symptoms
- Avoidance or extreme panic/distress when encountering feared stimuli
- Persistent and excessive panic or distress when anticipating or experiencing a feared situation
- A persistent and unrelenting need for control and/or perfection
- Unwillingness to be flexible when plans change, sometimes resulting in tantrum-like behavior
- Crying spells or emotional outbursts
- Extreme irritability, especially in unstructured settings
- Recurrent avoidance of the object or experience that causes fear
Cognitive Symptoms
- Worries and fears that feel impossible to control
- Fear that is out of proportion to the actual threat posed
- Need for constant comfort and reassurance
- Difficulty focusing, not paying close attention to detail
- Appearing not to follow directions or interrupting frequently to express worry
Duration & Impact
- Symptoms persist for an extended period of time (often more than six months)
- Experience causes significant distress or impairment in academic, social, or daily functioning
- Symptoms are not better explained by a medical condition or another mental health disorder (e.g., ADHD or autism)6
Help Your Children Develop & Be Happy
Online Therapy & Coaching (ages 1 -17) Bend Health is a virtual mental healthcare provider caring for kids, teens, and their families. Many insurance plans are accepted. Learn More
Charlie Health – Does your teen need additional mental health support? Charlie Health creates personalized treatment plans for young people (ages 11+) that include individual therapy, family therapy & curated groups. 92% of parents & caregivers would recommend Charlie Health to a friend or family member. Insurance accepted. Learn More
Thriveworks – In-person or Online Therapy – Therapy can change your child’s life. Connect with a licensed therapist online or in-person, and cover most of the cost with your insurance. Click here to Find A Therapist or call (877) 314-3813
Types of Anxiety in Children
The most commonly diagnosed anxiety disorders include generalized anxiety disorder, social anxiety, and specific phobias. In younger children, separation anxiety is also very common.9
Additional types of anxiety in children include:
Generalized Anxiety Disorder
Children with generalized anxiety disorder (GAD) are often described by others as general “worriers” and sometimes “perfectionists.” Their worry transcends across various situations, settings, and circumstances and occurs more often and with more intensity than same-aged peers. They also may not always understand that they are “anxious,” but may only be able to notice that they feel better when things are within their control (removing as much ambiguity as possible so they can be prepared).
Evenings and sleep are typically most difficult for children with GAD, as it’s the time of day where there are fewer distractions and their minds have the time and space to focus more directly on worries: Did I say/do the wrong thing earlier? What if things go horribly wrong tomorrow? They may look for excess comfort and reassurance and prefer co-sleeping with caregivers or siblings over sleeping alone, though the relief from these accommodations is usually only temporary.
Children with GAD also typically report more physical manifestations of anxiety, such as headaches or stomach issues.
Social Anxiety
Social anxiety involves focused worry about social interactions. Rather than nervousness about a variety of topics like in GAD, the socially anxious child or adolescent attends exclusively to the judgments of others. They are typically terrified of embarrassing themselves in some way, resulting in others perceiving them negatively and/or ridiculing them. A child who is socially anxious will typically defer to others, refrain from having an opinion (lest it be “wrong”), and may potentially avoid social interaction altogether.
It is possible for someone who is socially anxious to engage with others, speak in front of groups, or perform among a crowd, but they often do so under extreme distress. They may sweat excessively, stutter when trying to speak or perform, experience dry mouth, or appear shaky. In younger children, social anxiety may present as selective mutism, which consists of a child’s failure to speak in certain situations despite the expectation for them to do so. They will, however, speak openly and fluently in more comfortable settings.
Specific Phobias
When the idea of being near a feared stimulus (e.g., a bee, medical shot/needle, thunderstorm) is even so much as mentioned and the child reacts with significant distress or upset, they may be exhibiting signs of a specific phobia. They will often go to great lengths to avoid coming into contact with the feared stimulus, which inadvertently reinforces their fear: they are unable to experience any successful coping of exposure to the feared object. That, combined with a temporary feeling of relief from their avoidance of it, ultimately strengthens the phobia.
Children are expected to be afraid of things they first encounter or that are largely unfamiliar to them, especially those that we evolved as a species to fear naturally (e.g., dangerous animals, insects, heights, etc.). However, with an appropriate amount of reassurance and modeling from trusted caregiver(s), and with increased understanding, these fears typically subside. For some children, however, they do not. Further, when a child experiences a severe negative event (e.g., being bit by a dog), they are more likely to develop a fear related to the experience.
Other Less Common Anxiety Disorders
Other anxiety disorders that children may experience include:6
- Separation anxiety occurs when a child experiences the distress symptoms of anxiety (as listed above) in response to being apart from their caregiver(s)/attachment figures.
- Selective mutism is a child’s refusal to speak in certain contexts, despite showing the ability to and freely doing so in more comfortable environments.
- Panic disorder captures a purely physical manifestation of anxiety, when a child experiences panic attacks and becomes fearful of their continued occurrence.
- Obsessive-compulsive disorder, post-traumatic stress disorder, and adjustment disorder include an anxiety component in their presentation, but are not, in fact, considered anxiety disorders. They are now viewed as “Trauma- and Stressor-Related Disorders.”
Online Psychiatry and Medication Management Covered by Insurance
Talkiatry provides online care from real psychiatrists who specialize in treating children and adolescents. Take a short assessment to see if Talkiatry is right for your child.
What Causes Anxiety in Children?
The causes of anxiety disorders are considered a combination of both nature and nurture. One popular theory involves what’s called the “diathesis-stress” model, which suggests that there is an underlying genetic or developed irregularity (“diathesis”) that puts a child at risk. This, in combination with an inability to cope with an acute life event (“stress”), is what leads to the development of an anxiety disorder. Therefore, without the predisposition and/or with successful coping of aversive life stressors, there is less of a chance of acquiring an anxiety disorder.10
Genetics
Genetics and brain chemistry are considered two of the most common factors that contribute to a predisposition for anxiety. Anxiety’s genetic component means that children with close family members who also have an anxiety disorder are more likely to experience one themselves. Genes can also impact the production of certain neurotransmitters in the brain that, when in excess, short supply, or are not functioning properly, can also cause an extreme anxiety response. Children with a behaviorally inhibited temperament or who appear shy may also be at an increased risk.
Stressful Life Events
Significant life events and reinforcement of avoidance behavior can trigger and/or exacerbate existing anxiety.
Life events that can increase a child’s risk for developing an anxiety disorder include:
- Loss of a loved one or attachment figure
- Changes in familial structure
- Witnessing or experiencing violence or abuse
These are typically more challenging to cope with and therefore may place a child at an increased risk. However, even seemingly insignificant situations can trigger an anxiety response, such as experiencing pain when receiving a shot or being stung by an insect.11
Learned Behavior From Caregivers
In addition, caregivers often inadvertently reinforce their children’s avoidance of anxiety producing triggers. When a child is acting shy and their caregiver continually speaks for them, a pattern may develop that prevents them from building their confidence in managing their anxiety, perpetuating it instead. Being overprotective, keeping excessive control over their children, and struggling to manage their own anxiety are a few other ways that caregivers can negatively impact their child’s experience of anxiety.
When Is Child Anxiety a Problem?
While everyone experiences some anxiety in life, children suffering from severe, persistent anxiety need help to heal their worries. Parents might wonder how to know if their child’s anxiety is a problem requiring action.
The most important sign to look for when a child is struggling with anxiety is disruption in their daily activities. If a child is unable to maintain their daily lifestyle – personal hygiene, school attendance and performance, social relationships, personal interests, etc. – then it is important to seek professional help.
Here are a few other signs to look for indicating that your child may need professional help to deal with their anxiety:2
- Being very afraid to separate from parents
- Having intense fear about a specific thing or situation (e.g., spiders, doctor visits)
- Avoiding school, extracurricular activities, or playdates
- Expressing worries about the future or bad things happening
- Experiencing intense episodes of anxiety with somatic symptoms like heart pounding, chest pain, trouble breathing, dizziness, sweating or shaking
- Increase in anger or irritability
- Difficulty sleeping
- Ongoing fatigue, headaches, or stomachaches
Managing Symptoms of Anxiety in Children
There are a number of methods to help an anxious child, including modeling healthy behaviors and helping them get to the bottom of what’s causing their anxiety. Children often learn and model directly from their caregivers, who have the opportunity to demonstrate and encourage effective coping strategies.
Free Coping Skills Worksheets for Kids
Here are several ways to help a child cope with anxiety:
Identify Their Triggers & Don’t Minimize Them
The first step in helping a child cope with anxiety is to identify their triggers. Noticing what seems to trigger your child’s anxious feelings can empower them to better understand their anxiety, and begin to think through their worries and find coping strategies that work for them. When parents validate their child’s worries, rather than dismiss or minimize them, it offers children much-needed understanding and compassion for their emotional experience, which is very real for them.
Preview Any Anxiety-Provoking Situations When Possible
For children who struggle with social anxiety or specific phobias, talking through anxiety-provoking situations before they happen can give a child a sense of control and mastery, easing their fears. For a child who is anxious about starting school, for example, visiting the classroom and the teacher ahead of time can be helpful, as can talking through their daily routine and what to expect. Role-playing situations together can also support a child through an anxiety-inducing scenario, equipping them with language and coping tools to help them in the moment.
Communicate Positive (But Realistic) Expectations
Giving your child a “just right” challenge to build self-esteem can communicate your faith in them. Using positive praise and affirmation to acknowledge their efforts helps your child feel supported and seen, regardless of the outcome. When they run into a problem, you can problem-solve together, helping them to build valuable skills.
Try to Limit an Anticipation Period
Anticipatory anxiety can be debilitating for some children, so reducing the anticipation period for triggering tasks or situations can help ease your child’s worries. One way of doing this is to break down big, overwhelming tasks into smaller ones, giving the child a sense of accomplishment and mastery along the way.
Don’t Ask Leading Questions
When you talk with your child about their anxiety, try to stick to open-ended questions that don’t lead a child to a yes or no answer, but instead open up a child-led discussion. Leading questions, like “does [this situation] make you anxious?” might cause your child to feel pressured, embarrassed, or self-conscious. By keeping questions open-ended, your child feels empowered to take the lead on better understanding and sharing their experience of anxiety.
Help Them Relax
Anyone told to “calm down” isn’t likely to do so by command alone; they need to actually be calm before they can make sense of the world. The same is true for children. Sit with them and take deep breaths together. Use a grounding technique and ask them to name all of the things in the room that are one color. Or have them identify 5 things they can see, 4 things they can feel, 3 things they can hear, 2 things they can smell, and 1 thing they can taste. These techniques should be practiced regularly so that the child feels comfortable trying them when they are anxious.
Help Them Think Through the Entire Anxiety-Provoking Situation
Rather than providing logical responses to their fears, ask them to consider these themselves (e.g., what do you think is really likely to happen if you make a mistake when presenting in front of the class?).
Validate Their Worries and Concerns
Even if it’s difficult for you to understand their logic, find their truth. For example, “I know the loud sound of the thunder scares you. It’s a big boom, it really can be startling!” It’s much easier to tell a child why they don’t need to be afraid, but it can leave them feeling like they can’t trust themselves, which can have negative effects.12
Allow Children Control Whenever Possible
If they need to clean up a big mess, ask them which they’d like to clean up first, the crayons or the Legos. Instead of feeling like they have no control over having to clean, they focus on which choice they prefer, giving them a sense of control. When it’s difficult to find two options, resorting to, “Would you like to do it yourself, or would you rather I help you?” is an easy way to build in a choice (and often gets the job done faster!).
Help Children Approach (Not Avoid) Feared Stimuli
Provide them with support by letting them know you love them very much, acknowledging that what they have to do is difficult for them, reminding them that you have complete confidence in their ability to handle what they are faced with (within reason), and letting them know what you will do to support them (other than allow them to avoid it). Celebrate victory. Reward success.
Take Extra Care of Their Physical Health
Regular, moderate exercise has been shown to decrease current anxiety and to prevent future episodes. Anyone who has suffered from too little sleep knows the impact it can have on mood, concentration, and ability to tolerate everyday tasks and events; this is exacerbated in someone who also suffers from anxiety.
Model a Positive outlook and gratitude
Practicing gratitude can help shift a negative experience into at minimum a neutral one. When a child is encouraged to notice and appreciate little things on a regular basis, they develop resilience when faced with challenges.
Help Them Have a Predictable Home Life
The more predictable something is, the easier it is to prepare for, both literally and mentally. Having a regular schedule posted somewhere for all family members to see, keeping living and work spaces tidy with labeled places for items, and getting things ready in advance (e.g. packing a backpack the night before) are just a few ways to provide some relief at home.
Child Anxiety Treatment
There are a number of different approaches to treating anxiety in children and adolescents. For some, their anxiety may be so severe that only medication will reduce their symptoms enough to be able to engage in psychotherapy. Although medications show some effectiveness in treating anxiety, they often do not independently lead to the same long-term effects that psychotherapy and lifestyle changes can produce.
Therapy
The most common evidence-based form of psychotherapy for anxiety in children is CBT for kids. Although the exact structure of the therapy itself is tailored to the individual, manualized protocols for each anxiety disorder are often available to mental health providers.
Therapy is most successful when caregivers are involved because they can reinforce the coping skills for anxiety in kids that are being learned, encourage practice between therapy appointments, and model and support using the skills without compensating for the child’s efforts. Each child and their presentation will differ; however, CBT is generally intended to be a short-term therapy approach with initial results often seen between 3-6 months of weekly sessions.14
Free CBT Worksheets for Kids
Medication
Medication is another intervention some caregivers might consider when attempting to alleviate their child’s anxiety. Anxiety medication is most often prescribed through a primary care pediatrician or psychiatrist. Although a few lesser-prescribed medications (e.g., stimulants, alpha-two agonists, antipsychotics) show some effectiveness in treating specific symptoms, they are less likely to address anxiety as a whole.
How to Get Help for Your Anxious Child
There are various ways to seek support for a child struggling with anxiety. Some families choose to start with their primary care provider or pediatrician to rule out medical causes and get referrals to local therapists or mental health agencies. Others may turn to trusted friends or family members for recommendations.
Increasingly, many caregivers are finding support through online therapy platforms, which offer flexible access to licensed child and adolescent therapists from the comfort of home. These platforms often allow you to filter providers by specialty, approach, and availability—making it easier to find someone who fits your child’s unique needs.
Regardless of how you find a therapist for your child, what matters most is the fit between the therapist and your child. A strong therapeutic relationship is key to effective treatment.
Don’t hesitate to:
- Request consultations
- Ask questions about the therapist’s experience with child anxiety
- Arrange a brief meet-and-greet between your child and the therapist
It’s okay to “shop around” until you find the right match—one that makes both you and your child feel supported, comfortable, and hopeful.
School Support for Children With Anxiety
At times, a teacher will notice anxious behavior and reach out, either directly or through a school counselor. Some schools provide adjustment counselors for children who struggle with mental health challenges in the academic setting. Many schools promote social and emotional learning to help children build confidence and manage interpersonal relationships, which can result in decreased symptoms of anxiety. If they feel a child would benefit from additional interventions, they typically reach out to the caregiver(s) to discuss options.
Can Anxiety in Children Be Prevented?
While some factors that come to play in the development of childhood anxiety cannot be prevented, like biology and temperament, there are some things parents can do to help protect their children from anxiety. Research shows that children who are the victims of trauma, abuse, or chronic stress are more likely to experience anxiety. This includes children who experience bullying and social rejection from peers. Parental anxiety also puts children at risk of developing an anxiety disorder of their own. Protecting children from as many adverse childhood events as possible, while modeling healthy coping strategies when faced with stress or anxiety of their own, can empower parents to give their children the healthiest emotional advantage against anxiety.2
For children who are at risk, early intervention is key. Some parenting programs help those with young children to gain valuable insight and skills to prevent anxiety from developing later on.16 Seeking professional help right away for children who may be experiencing an anxiety disorder, and working together as a family to support them in identifying their anxiety triggers and practicing positive coping strategies in a supportive, nurturing home environment, will set any child up for success in managing their feelings of anxiety.
Childhood Anxiety Statistics
The National Institute of Mental Health (NIMH) estimates that close to 32% of adolescents (age 13-18) experience an anxiety disorder at one point during their adolescent years, with a higher rate for females (38%) than males (26.1%). Of all psychiatric diagnoses among this population, anxiety is the most common.3
Overall, research has shown that with children in the United States aged 3-17:8
- 7.1% (approximately 4.4 million) experience an anxiety disorder
- Of those with anxiety, more than 1 in 3 experience behavior issues (37.9%) or depression (32.3%)
- Being diagnosed with an anxiety disorder has been increasing over time (5.5% in 2007; 6.4% in 2011-2012)
- When broken down by age, only 1.5% are age 3-5, just over 6% are age 6-11, and more than 10% are between the ages of 12 and 17
- Six out of ten (59.3%) receive treatment for their anxiety
Anxiety in Children Infographics
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
Online Therapy & Coaching (ages 1 -17)
Bend Health is a virtual mental healthcare provider caring for kids, teens, and their families. Many insurance plans are accepted. Learn More
Virtual Therapy For Teens
Charlie Health creates personalized treatment plans for young people (ages 11+) that include individual therapy, family therapy & curated groups. 92% of parents & caregivers would recommend Charlie Health to a friend or family member. Insurance accepted. Learn More
In-person Or Online Therapy For Children & Teens
Thriveworks – Therapy can change your child’s life. Connect with a licensed therapist online or in-person, and cover most of the cost with your insurance. Click here to Find A Therapist or call (877) 314-3813
Online Therapy
TeenCounseling (ages 13 -19) – Help your child thrive with professional counseling. Get matched with a licensed therapist who specializes in teens. Discuss your child’s issues and situation. When you approve, the therapist is connected with your child. The therapist interacts with your child over text, phone, and video. Starting for as little as $65 per week. Get Started
How to Find & Choose the Right Therapist for Your Child
Discovering and selecting the right therapist for your child often comes down to two things: research and persistence. Be willing to put in the time and effort to call around to different therapists or therapy organizations in your area. Read through therapist profiles to see if their style, approach, and expertise resonate with you and your child.
Depression in Children: Signs, Symptoms, & Treatments
If you or someone you know is concerned about symptoms related to depression, seeking professional help from a mental health provider is highly recommended. Licensed professional counselors, social workers, psychologists, or psychiatric medication prescribers are able to determine whether a person is experiencing depression and the best methods of treatment.
