Anxiety in children is not always a bad thing. Dr. Jayne Bellando, a child and adolescent psychologist for 34 years, said it's normal for children to have some anxiety. Being able to handle day-to-day worries helps them to become resilient and confident when bad things happen or to handle the daily stresses of life. But there are warning signs that point to unhealthy anxiety. It can be difficult for families to identify this because children often can't explain their anxiety and tell them they are in distress. Dr. Bellando has worked in the Dennis Developmental Center at Arkansas Children's Hospital (DDC) for 16 years and is a professor in the Department of Pediatrics at the University of Arkansas for Medical Sciences (UAMS). She leads some state programs and is a member of autism diagnostic teams at the DDC. She also sees some therapy patients, primarily children with autism and anxiety.

"One of the challenges for adults is we forget what it's like to be a child. So we may expect a child to come to us and say, 'Mom, I'm feeling anxious. I'm feeling upset,' and being able to talk about it like we might do with our friends. Sometimes that might happen, but it's mostly not going to happen that way," Bellando said, adding that caregivers need to be keen observers of changes in a child's personality. "Many times for children, we see changes in their behavior rather than them being able to tell us with their words."

What is anxiety?

According to the American Psychiatric Association's "The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," (DSM-5) published in 2013, anxiety is traditionally defined as "a strong reaction to anticipated future threats. It can include excessive fear responses, irrational thoughts, behavioral disturbances, avoidance of situations and being over-vigilant. It can also impact sleep, eating and mood."

On Dec. 7, 2021, the U.S. Surgeon General issued an advisory on the mental health of youth, explaining that the COVID-19 pandemic had magnified an existing problem. One in five children between 3 and 17 have a mental, developmental, emotional or behavioral disorder. An Aug. 1, 2021 report from the Children's Hospital Association stated 6.5 percent of youth today have anxiety or obsessive-compulsive disorder, the most common mental health disorders impacting children. However, it stated only about 20 percent receive treatment. Bellando said it's often misunderstood how extreme events in children's lives, like the COVID-19 pandemic, can create anxiety well into the future.

For many children, anxiety goes away with family support and time. But when anxiety stunts development or hinders activities in a child's life, caregivers may consider whether help from a therapist is needed.

Signs of Anxiety

Anxiety manifests itself differently in children, particularly younger children who cannot find the right words to explain it.

Here are some examples of ways anxiety can show up in young children:

  • More fearful
  • Excessive crying, afraid of separation
  • Consistently not wanting to go to school or sports practices
  • Reverting back to bedwetting
  • Nightmares
  • Changes in sleeping and eating patterns
  • Stomachache
  • Headaches
  • Not interested in favorite activities

Some signs of anxiety can be more challenging to pinpoint. They include increased anger, being pouty, behavior problems and fussiness in a way a caregiver assumes a child is just being difficult rather than anxious, Bellando explained. School-age children might say they are feeling "sad" or begin drawing sad pictures. A child may be unable to immediately tell someone why they are sad. But having conversations with them could reveal what is going on.

"We have to be really good listeners of our children's behavior and observe our environment to try to figure out what's going on," she said. "Adults may need to reassure a child they can talk about anything, then make a gentle space for that to occur."

Children can be fearful of things adults may not realize. Bellando gave a fictional example of a young son whose mother had died suddenly. The father then brings the child to a therapist for an emergency session. The child explains he is afraid about who will make his peanut butter and jelly sandwiches for him because only his mother knows how to make them correctly.

In teenagers, anxiety is often related to school or friends. Bullying and cyberbullying are big pressures for teens today. Caregivers should be nurturing and open to talking while also firm with limits and boundaries that keep a child safe. It can be challenging, as teens are more apt to talk to friends than family.

"While your child will not tell you this, it is true that keeping loving but predictable boundaries for them will help them feel safer and less anxious," she said. "That's where we have to be really careful they're not feeling alone and hopeless because that's the age where more serious acting out can happen."

Overall, caregivers need to provide safe listening spaces for their children and not discount what they are feeling

When to seek professional help

If problems with anxiety persist, a caregiver may consider professional therapy. A child's primary care provider (PCP) can refer a patient to a licensed therapist.

"If anxiety continues, parents will want to watch to see if their child is showing more difficulties - overly emotional, refusing certain things (like going to school, etc.), more argumentative, crying. If you see signs of high-risk behaviors or hear words that make you concerned about them harming someone else or themselves, please act to keep them safe and others safe," Bellando said.

It's easier to seek treatment when anxiety issues are small instead of waiting until they grow over time because "that's just more trauma that child has to sort of dig out from underneath," she added.

If there is significant concern, take a child to the local emergency department or talk to their primary care physician or a counselor if therapy has already begun.

In her sessions, Bellando said she tries to normalize anxiety, so her young patients know everyone has worries. That might mean asking parents to share what worries them or sharing their worries. She also asks a child in what ways they are currently coping.

"We always want to start in a place of strength. For most of us, we're not melting down all the time. We've figured out some ways that help us feel better. Whether it's talking to our good friend, taking a walk, petting your dog, listening to music, playing video games - there's something that we do," Bellando said. "I also ask them, 'Tell me about a time that was really stressful for you that you were able to make it through OK?' Because what helps us is when we realize that we have the coping skills, and we can learn those coping skills to help us feel better. The psychological term for that is self-efficacy. So knowing, 'I can do this.'"
Anxiety and Autism

Dr. Jayne Bellando, a child and adolescent psychologist for 34 years, specializes in helping children with autism cope with anxiety in the Dennis Developmental Center at Arkansas Children's Hospital in Little Rock. According to the Centers for Disease Control and Prevention, autism spectrum disorder (ASD) is a developmental disability that can cause challenges in socialization, communication and behavior. The CDC states about one in 44 children has ASD. In the article "Anxiety and Autism Spectrum Disorder: What Does It Look Like and How Do We Intervene?" published in the December 2021 issue of Autism Advocate Parenting Magazine, Bellando explains how anxiety manifests for those with ASD as young children, school-age and college. It's common for those with ASD to experience anxiety. Research shows between 40 to 60 percent of ASD school-aged children and adults have some form of anxiety. Click here to read the article and learn more.

Child Study Center

The Child Study Center, located in the David M. Clark Center for Safe and Healthy Children at Arkansas Children's Hospital, provides evaluation and treatment for a variety of mental health problems in children and families. The center's Outpatient Therapy Clinic, part of the Division of Child and Adolescent Psychiatry program at the UAMS Psychiatric Research Institute, sees patients from infancy to 18 years old. Specialists at the center assess and provide therapy for a variety of common conditions, including:

  • Anxiety
  • Bipolar
  • Depression
  • Obsessive-Compulsive disorders
  • Disruptive, impulse-control and conduct disorders
  • Trauma and stress
  • Attention-Deficit/Hyperactivity disorders
The child’s primary care provider (PCP) can send a referral to 501-603-1860, and a staff member will then contact the family to schedule an appointment. Click here for more information.