Sometimes it’s easy to spot: the outward nervousness, nail biting, jitteriness, moodiness, irritability, and outright refusal to participate in a specific activity, like school. Other times anxiety is not as easy to see, but can still be just as debilitating and lead to further behavioral, as well as physical, problems.

Some of the less distinct signs of anxiety can include frequent stomach aches, headaches, trouble sleeping, and difficulty concentrating. It can be difficult to discern whether these symptoms are due to some kind of illness, something your child ate, an emotional stressor of some kind. There are things parents can do to better understand anxiety, including learning what is normal and what needs their attention.

Normal Development:

Separation anxiety usually begins around six to eight months of age. A child that had previously been happy while getting passed around to anyone and everyone, making funny noises and faces, may suddenly become a little weary of the aunt she doesn’t see regularly. This fear of a parent leaving may not subside until she is two to three years old. By then, a child will usually cry for a short period and, with some hesitance, calm down and connect with the new person. The A.D.A.M. Medical Encyclopedia reports that in order for children to overcome this stage of separation anxiety, they must feel safe in their home environment, trust people other than their parents, and trust that their parents will return. Parents will play a significant role in preparing their child to deal effectively with daily stresses.

Anxiety and Fear

It’s important to remember that fear is a normal human emotion. Fear is an unpleasant feeling of apprehension caused by the presence or anticipation of danger, according to New Source Counseling. But not all fear is bad. A healthy level of fear can protect our children and us from danger.

Anxiety is slightly more broad and pervasive than fear, but can still be useful when within normal levels. Anxiety is feelings of worry, nervousness or agitation, or an uneasiness of mind and body. It’s often about something that is going to happen rather than current threats. Fear is an element of anxiety, and when these emotions get out of hand they can cause serious disturbances in our children’s lives.

David Russ, PhD, and Christopher McCarthy, PhD, are anxiety experts and co-creators of the Turnaround program, which helps children overcome their fears. They suggest the following four points to assess the extent to which your children’s anxiety or fear is affecting them.

Surplus: Is your child’s anxiety exaggerated from what is “developmentally normal”? Is the fear or anxiety there even when the source of danger isn’t? Is it virtually impossible for them to stop the worry? Storm: Does the fear match the level of danger? Are they easily upset and out-of-control and inconsolable? Do they react negatively when you try to help? Spoiler: Is the anxiety or fear significantly interfering with everyday activities? Does it negatively impact sleep, eating, relationships, and/or activities your child used to enjoy? Stuck: Does your child’s fear or anxiety last longer than is expected? Is the fear or worry present all day, or for weeks or months? Are they having feelings like worry, panic, or agitation that will not go away?

If the answer to these questions is “yes,” it may be time to seek some help in treating your child’s anxiety or fear. All emotions happen on a spectrum, and generally intense fears or anxieties start with smaller fears or anxieties. When fears or traumas are not resolved they can grow into a more intense and pervasive problem. This is why it is important to know preventative measures and treatments, as well as corrective options.

Preventative:

I often tell parents they are their child’s most effective preventative therapist. Every child has fear and anxiety from time to time, but a parent can comfort and give kids the skills they need to effectively deal with their worries. At the youngest ages (newborn to two) it is important to provide a safe, positive, and responsive environment. As kids grow up, separation anxiety is normal; but it is still important to prepare kids for changes and for separations from their caregiver, get them used to new people, and reassure them that they are safe and loved. When specific fears arise (fear of spiders, the dark, clowns, etc.) parents can help their children with age-appropriate discussion, educating the child about the object of their fear, precautions they can take, and possible solutions. It is important for parents to validate children’s feelings, but still comfort them.

If your child worries persistently or excessively about a specific issue, teach him or her how to problem solve and take appropriate action to eliminate worries that can be controlled. It is also effective for parents to teach basic relaxation breathing and progressive relaxation, or alternating between tensing and relaxing the muscles, at a young age and practice it with your children. This is a great activity to practice at bedtime. Inconsistent and/or aggressive discipline can cause significant anxiety in children as well. It’s best for parents to create disciplinary plans and to stay consistent in their approach with their children. Order and routines help kids to better regulate their emotions and worries.

Corrective:

Sometimes children’s anxiety stems from serious trauma or has grown to be unmanageable over time. If your child’s answers to the four S’s presented above are “yes,” it may be appropriate to seek out professional help to treat your child’s fear or anxiety.

Research shows that the most effective treatment of anxiety disorders in children is a combination of cognitive behavioral therapy, and medication. EMDR Therapy can also be a effective intervention to help them manage and heal from trauma and anxiety. Parents should be actively engaged in the process of finding a therapist they trust and are comfortable with, and understanding the medications that are prescribed to their children, including side effects. Parents can then make informed decisions about whether or not the medications or other treatments are right for their child. Exposure therapy, which involves exposure to the fear, has been shown to be an effective treatment for specific phobias but EMDR has recently been shown to be as effective or more effective in resolving the same kinds of issues.

Whether our children’s anxiety is intense enough to be considered a diagnosable disorder or not, parents heavily influence how fears, anxieties, and worries develop, how children cope with them, and how they ultimately overcome them.