What is Anxiety?

Anxiety is a feeling of fear or worry about a future threat that is not considered pathological and can be adaptive. It is a common experience across the lifespan and is characterized by a vague state of discomfort, apprehension, and restlessness. However, anxiety disorders are considered pathological and are among the most common disorders in youth, affecting 10 to 20 percent of children and adolescents. These disorders are characterized by excessive and recurrent emotional and physiological arousal in response to perceived threats or dangers, leading to social withdrawal, low self-esteem, academic underachievement, and interference with daily activities.

Normal Anxiety in Children

Anxiety has an identifiable developmental progression for most children

  • 7 – 9 months – Most infants exhibit stranger wariness
  • 10 –18 months Separation anxiety is developmentally normal
  • 3 years – Most children can accept the temporary absence of their mother or primary caregiver
  • Preschoolers – Typically have specific fears related to the dark, thunder, lightning, animals, and imaginary situations
  • School-age children – Have fears of bodily harm or other worries
  • Adolescence – General worrying about school performance and social competence. This generally remits as the teen matures

Signs & Symptoms According to Age

Preschool and Younger

  • Excessive crying, excessive temper tantrums
  • Changes in appetite
  • Regressive behavior (bed wetting, sucking the thumb, use of baby bottle not cup, baby talk, excessive demands for attention)
  • Sleep disturbances (difficulties going to sleep, frequent waking)
  • Excessive clinginess

School Aged

  • Sleep problems (Nightmares, sleepwalking, Night terrors, not sleeping)
  • Express Fears (of world ending, parents dying, getting sick)
  • Difficulty concentrating / unable to study
  • Somatic symptoms (Headaches, stomach aches, sweaty palms, Fainting, Dizziness. Nausea, Sweating, Hyperventilation, Trembling)
  • Say they are worried

Adolescent

  • All of the above
  • Excessive fears and worry
  • Express continual (nervousness, restlessness, extreme stress

Separation Anxiety Disorder

An exaggeration of otherwise developmentally normal anxiety. There is excessive concern, worry, and even dread of the real or anticipated separation from an attachment figure. The child fear something bad will happen to the attachment figure (commonly a parent) when separated. As a result, the child avoids separation from this figure.

Some symptoms include:

  • Dreams or nightmares about separation
  • Refusal to face situations that involve separation:
    • Sleeping away from home
    • Going to school
    • Visiting friends or relatives,
    • Staying at home alone or with sitters.
  • Worry about the consequences of separation including:
    • Fears of being kidnapped or injured while apart
    • The attachment figure being hurt, or killed
  • Physical symptoms when separation is anticipated: vomiting, diarrhea, stomach aches, etc

What to do if you think your child may have Anxiety

Visit your primary care physician if you suspect your child may have this disorder; they will be assessed and referred to the Child Psychiatrist if necessary.

References

  1. Diagnostic and Statistical Manual of Mental Health Disorders. DSM 5 TR 2022
  2. Kaplan and Saddocks. Synopsis of Psychiatry. 12th edition. 2022
  3. Nelson’s Textbook of pediatrics. 21st Edition.2020
  4. Ovidia Rodríguez Méndez. Salud Mental Infanto Juvenil. La Habana: Editorial Ciencias Médicas; 2005

Prepared by:

Dr. Jenese October
Child and Adolescent Psychiatrist. Psychiatry Department. GPHC