Childhood Anxiety

By Mary (Faulkner) Luttrell, OTR/L

As carefree as childhood may seem, children can experience anxiety just like adults can. Their fears and worries may seem irrational compared to the hardships of adulthood, but it doesn’t make it any less real for them.  Of course, there are the natural worries that many children experience, such as fear of the dark, strangers, and separation. Worry is also a natural survival instinct that allows us to perceive and navigate potential threats. But sometimes, anxiety persists beyond these phases and interferes with daily function. According to Piacentini & Roblek (2002), childhood anxiety is often predictive of adult anxiety disorder. This factor makes it even more important to give our children the coping tools they need to manage their anxiety and be better equipped for the future.

Here are several strategies to teach and try with your child:

1. Allow your child to express their emotions and worries. Sweeping it under the rug doesn’t make those thoughts go away, or create the space to let them trust you with their tough moments. Sometimes when anxious thoughts stay confined in one’s head, they can feel larger than life. When your child is able to talk about their worry, it helps bring reality to those thoughts and find ways to conquer them.
2. Learn about how worry feels in the body (e.g. sweaty palms, increased heart rate, shallow breathing, etc.). By identifying these body signals, you can implement ways to calm the physiological (and eventually psychological) elements of anxiety. For example, practice belly breathing using a stuffed animal on your child’s stomach. They can watch the stuffed animal move up and down, which is how you know it’s done correctly. If a toy is not available, your child can place their hand on their stomach and feel the movement. By engaging their diaphragm in breathing, your child can lower their heart rate and blood pressure, thus relaxing the body.
3. Teach your child to use positive self-talk and/or talk to the worry. This can sound like, “This seems scary but I am safe”, “My brain is just telling me a scary story”, “I can handle this”, and “Focus on what I can’t control and let go of the things I can’t”. You can also give this kind of encouragement to them as their parent, as well – because what they hear from others becomes their inner dialogue.
4. If your child is old enough, test those anxious thoughts against reality and practice reframing. Have your child ask his/herself “What evidence do I have that this is true? What are some reasons that this is NOT true? Do I have the ability to read someone’s mind or see into the future? Am I using extreme-isms such as ‘always’ or ‘never’?”
5. Talk about their circle of control. What can they control? What is outside their circle of control? This can be especially relevant during the pandemic, as many of us (including our children) may worry about what to expect and those unexpected changes in routine. If there is something within their circle of control, help them problem-solve ways to work past the issue.
6. Set aside a worry time. This ties back into the first point mentioned above, which highlights the importance of expressing these anxious thoughts instead of ignoring. When someone feels anxious, it can feel like a constant dark cloud that looms over everything they do throughout the day. By creating a designated “worry time”, it’s allowing your child to set aside those anxious thoughts and allow them mental space to focus on daily routines and tasks. Then, during the allotted worry time, they can process and work through those anxious thoughts. Be sure to set a time limit (such as 15-30 minutes) for this, and set a timer if you need to.
7. Engage your child in purposeful activities, such as play, hobbies, sports, etc. An idle mind will find ways to keep itself occupied – and often, that means worrying. Participating in activities may not make those anxious thoughts completely disappear, but it will help those thoughts from spiraling and festering.
8. Exercise! And engage your child in proprioceptive input, meaning anything that exerts force through the body or puts pressure on the body. This will have calming physiological results on the body, as well as endorphins!

If you feel that your child is exhibiting signs of pervasive anxiety, talk to your occupational therapist. All of the techniques above are strategies that your child’s therapist can teach them and help you practice at home. An occupational therapist not only addresses the cognitive aspects of anxiety, but the sensory aspect as well. Children with sensory processing issues can exhibit higher levels of anxiety, due to the way they interact with incoming sensory input from their environment. Occupational therapists use a holistic approach, and will address your child’s whole being (including physical, cognitive, sensory, and social/emotional). Addressing a child’s anxiety from this holistic approach can better support them with developing the coping skills they need.

Resources Cited:

Piacentini, J., & Roblek, T. (2002). Recognizing and treating childhood anxiety disorders. The Western journal of medicine, 176(3), 149–151. https://doi.org/10.1136/ewjm.176.3.149