Managing children's anxiety

Part 1

All children experience some form of anxiety even in the best of situations: stranger anxiety develops between 7 to 9 months, separation anxiety appears around 1 year, kindergartners worry about supernatural characters such as ghosts and witches until they figure out what’s real and what isn’t, older children have real world worries like the loss of a loved one or a friend moving away, and teens worry about social acceptance. Other children experience less typical triggers for anxiety. In all cases, however, it isn’t the stress itself that impacts children negatively, it’s the body’s reaction to it.

The hypothalamus—a small part of the brain that controls the automatic processes—communicates with the body through the sympathetic and parasympathetic pathways of the nervous system. The sympathetic nervous system acts as the “accelerator,” increasing the heart rate, respiratory rate and muscle tension, while the parasympathetic nerves are the “brakes,” slowing down the body. Over time, chronic stress manifests through the interactions of these pathways as headaches, fatigue, suppression of the immune system, and ultimately heart disease.

Teaching children to recognize these physiological symptoms of stress can help them preempt the full onset of an anxiety attack and eventually prevent long term consequences. Once children are able to point to the specific location of these physical sensations within their body they can begin to utilize specific relaxation techniques to counteract them. For example, belly breathing, progressive relaxation (where each muscle group is consciously tightened and then suddenly released) and guided imagery are all relaxation techniques that can be used in stressful circumstances.

Children also often need to be soothed after confronting a difficult situation. Play dough is commonly used with young children to relieve stress and muscle tension simply by squeezing and rolling it repeatedly. It also gives children a sense of control since there are no rules or expectations, especially at times when they feel overwhelmed. Similarly, giving children the freedom to paint (without worrying about being messy) can also be very liberating and therefore, calming. Listening to soothing music or using music with movement can also help redirect a child’s nervous energy.

Although the underlying patterns are common among anxious children, it’s important to tailor these techniques to the kind of anxiety a child may be dealing with and its root cause. It's not always easy to distinguish normal fears that a child may outgrow from anxiety that may require special attention. If a child’s anxiety is interfering with his or her functioning such as academic, social or family functioning or you aren't sure whether it's disrupting his or her day to day life, it might be time to seek professional help. Social and behavioral interventions can reduce chronic anxiety and build brain and body resilience. Occasionally the symptoms of adult anxiety disorders appear in childhood and it may be helpful to seek help when in doubt.

 Part 2

Managing excessive anxiety from an early age is important to avoid long term physiological consequences. Stress involves a two-way communication between the brain and the body through a system called the HPA (hypothalamic-pituitary-adrenal) axis. The HPA axis cannot distinguish between the different types of threat so it activates every response all at once, in response to any threat. Overloading the HPA axis, especially in infancy and childhood, causes structural remodeling of specific regions in the brain. Such changes impact life-long patterns of behavioral and physiological responses to stress and anxiety.

The part of the brain most affected by early stress is the prefrontal cortex which controls a particular set of self-regulatory skills, called ‘executive functions’. These higher order functions refer to the ability to deal with confusing and unpredictable situations and information. The prefrontal cortex is more malleable than other parts of the brain and it stays flexible through young adulthood. Therefore, once children learn to recognize the patterns of anxiety or more simply, “the sound of worry," they can begin to challenge the negative thinking and alter enduring reactions to stressful situations.

Encouraging children to confront their fears rather than avoiding them is an important first step. But merely reassuring children when they are feeling anxious can be counterproductive; it causes them to wonder why they still feel worried if everything is fine. Instead, identifying those feelings—validating and normalizing them—demonstrates that you understand their experience.  Remember that in the anxious state, thinking becomes narrowed and rational explanations are ignored and excluded. Shrink the overwhelming problem to a manageable goal by helping children narrow it down to the one thing that may have been their breaking point. Shift the focus from the worst that can happen to what is most likely to happen. Encourage them to consider an alternate ending to the situation. Once they are able to put things in perspective help them problem solve. Often, creating a story of how they can fight the “worry bug” helps make the process more concrete.

Since the brain plays a key role in recognizing stress and communicating its presence to the body, it essentially needs be ‘trained’ over time to opt for the more rational response. Gently reminding children of the skills they have learned—challenging their negative thinking and counteracting the physiological symptoms of stress—can help them cope when they are feeling anxious. Over time, including with professional help where necessary, undue anxiety among children can be managed and its impact controlled.