Anxiety

What is Anxiety?

Anxiety means feeling worried, nervous, or fearful. We all experience anxiety at times and some anxiety can be helpful and helps us function well. For example, feeling anxiety before a test, interview, or public-speaking can help you prepare for it.

When you are threatened or in actual danger, anxiety acts as an alarm system to keep you from harm. It triggers your “flight-fight-freeze” response that helps prepare your body to defend itself. It might have you run from the situation (flight), yell or cry (fight), or become very alert (freeze).

Children and youth often have many more fears than adults do as they try to make sense of their world. Most childhood fears are normal and go away eventually. It is important to think about age and what is common when considering whether anxiety is becoming a problem.  

Anxiety disorders are one of the most common mental health problems among children and youth. Children may be diagnosed with more than one anxiety disorder or with anxiety and other mental health challenges.

Types of Anxiety Disorders

There are  five types of anxiety disorders in children and youth. 

Separation Anxiety Disorder

Children may become scared when they have to separate from a caregiver. It’s normal for young children to have fears about being left with someone new, but they are usually able to get used to the situation. A child with separation anxiety continues to have a hard time being apart. Sometimes even being in a different room in the same home is a challenge. This fear gets in the way of children doing things by themselves.

Children with separation anxiety disorder may:

  • refuse or avoid going to school
  • call many times to be picked up
  • cry and cling to a caregiver
  • throw tantrums
  • avoid going to bed at night
  • avoid play-dates and sleepovers
  • refuse to be babysat
  • worry that something bad will happen to the caregiver
  • complain of physical symptoms before, during, and after separation

Social Anxiety Disorder (or Social Phobia)

A child or youth with social anxiety disorder experiences a lot of worry and fear when they interact with other people. They become anxious when they are the centre of attention (or think they are the centre of attention). These children have a strong fear of embarrassing themselves and of other people thinking badly of them. They may worry about wearing the “wrong clothing” or saying the wrong thing.

Children and youth with social anxiety disorder may avoid:

  • talking to classmates or adults 
  • going to social events like birthday parties or school dances
  • using the telephone
  • making presentations
  • attending school
  • eating in public or using public bathrooms

Specific Phobias

Children or youth with specific phobias are scared of certain situations or objects. Their fear is stronger than the actual danger posed by these situations or objects. They try hard to avoid contact with what they fear, for example:

  • specific situations: bridges, transportation (riding in cars, flying in airplanes), enclosed spaces (elevators, tunnels)
  • environment: dark, storms, heights, water
  • insects or animals: dogs, spiders, snakes, insects (beetles, bees)
  • medical or physical: injections, needles, going to the dentist, hospitals, vomiting, choking

Generalized Anxiety Disorder (GAD)

Children and youth with GAD experience frequent worries that are difficult to control. They will ask a lot of “what if...” questions and look for reassurance (Are you sure I should pick that one? Are you sure my homework is perfect?). People often describe them as “worrywarts.”  They tend to be worried about many things such as:

  • school performance
  • doing things perfectly
  • what people think of them
  • news (disaster, disease, war, environment)
  • health or illness (getting cancer, AIDS, swine flu)
  • safety and well-being of loved ones (family, friends, pets)
  • safety or harm (robbery, accident, death)
  • family finances, everyday stressors (being on time, what to wear, where to go)

Panic Disorder

A child or youth with panic disorder has unexpected panic attacks that include a lot of body symptoms, such as:

  • dizziness
  • racing heart
  • shaking or trembling
  • nausea or upset stomach
  • sweating
  • shortness of breath

 

They may be scared that something bad will happen because of the panic attack. For example, they fear they could die, pass out, or go crazy. A key part of panic disorder is a fear of future unexpected panic attacks. Children and youth with panic disorder may feel extreme fear in certain places or situations that they associate with having panic attacks, like crowded places or enclosed spaces such as elevators. This fear may lead them to avoid those places or situations and is called “agoraphobia”.

 

How do I know if it's an anxiety disorder?

It’s normal to have some anxiety in situations like the first day of school, exams or presentations. Anxiety becomes a problem when a child or youth is anxious in situations in which someone of the same age is not usually afraid. Fear of meeting new people is common among four year-olds, but may be a sign of an anxiety problem in a teenager. Anxiety is also a problem if it does not get better with time and affects the life of the child and family a lot.

What does anxiety look like in children and youth? 

Below are some examples of what children and youth may experience when they feel anxious:

  • anxious thoughts - usually worry about something bad happening
    • what if Mom doesn’t pick me up from school?
    • what if I throw up?
    • will everyone laugh at me?
  • anxious body symptoms
    • racing or pounding heart
    • stomach “butterflies”
    • sweating
    • headaches
    • dizziness
  • anxious behaviours
    • fighting
    • avoiding situations, people or objects
    • looking for comfort or reassurance
    • throwing temper tantrums
    • crying

When does anxiety become a problem?

Anxiety becomes a problem when children experience fear or worry even when there is no real danger or much less harm than they think. These fears may not make any sense to others or even to themselves.

It is important to think about:

  • the amount of anxiety the child is feeling
  • the level of anxiety
  • how long it’s been going on
  • how much the anxiety is getting in the way of how they function
  • how distressing it is for the child and for the family

When the anxiety happens too often and gets in the way of doing things at home, at school, or with friends, it’s important to seek help.

What can be done? 

Anxiety cannot be cured but children and youth can learn how to manage anxiety effectively. These two treatments can help children or youth with an anxiety disorder. 

1. Cognitive-behavioural therapy (CBT) focuses on how to:

  • relax
  • identify anxious thoughts and behaviours
  • challenge those thoughts and behaviours
  • replace them with more helpful thinking and behaviours

2. Medications can be useful in treating an anxiety disorder. They are mostly used with CBT. To learn more about medications used to treat anxiety, click here.

Parents can help by learning about anxiety and CBT. They can coach their child in ways to relax, be brave and use positive self-talk to get through anxiety.

Tips to help children with anxiety

  • have regular routines (morning, school, homework, bedtime)
  • give clear expectations, limits, and consequences that are realistic for the child’s age
  • pay attention to the child’s feelings and help the child identify them
  • stay calm when the child is anxious
  • give praise and reward even for small accomplishments
  • plan for times that may be difficult (getting to school, returning to school after breaks)
  • show the ways you identify your own feelings and solve problems
  • model and encourage healthy living habits, including:
    • regular physical activity
    • a healthy and balanced diet
    • getting a good night’s sleep
    • stress management and relaxation
    • healthy relationships
    • community involvement
    • social support

Where to from here? 

Talk to your doctor and look for help from a mental health professional by:

For additional information about options for support and treatment in BC, visit the Finding Help section of our site.

Below you will find some key resources. A full list of resources are on the right hand side bar. 

AnxietyBC
Provides information on anxiety disorders and how to support people with anxiety concerns, including self-help toolkits, brochures, personal stories, and newsletters. Also includes a youth and young adult site.

B.C. FRIENDS for Life Parent Program
The online FRIENDS for Life Parent Program was developed for parents by parents in partnership with the FORCE Society For Kids' Mental Health and the BC MCFD. Our goal is to educate parents about the FRIENDS program that is being delivered in BC classrooms and equipping them with parent-friendly tools and information to practice FRIENDS together at home.

MindShift Anxiety App
Struggling with anxiety? Tired of missing out? There are things you can do to stop anxiety and fear from controlling your life. MindShift is an app designed to help teens and young adults cope with anxiety. It can help you change how you think about anxiety. Rather than trying to avoid anxiety, you can make an important shift and face it.

 

 

 

BC Children's Hospital

This is an agency of Provincial Health Services Authority, providing provincial tertiary mental health services to the citizens of British Columbia. Programs include: Adult Tertiary Psychiatry, Geriatric Psychiatry, Forensic Psychiatric Services, Child & Adolescent Mental Health, Women’s Reproductive Mental Health, as well as the Provincial Specialized Eating Disorders Program for children and youth located at the BC Children’s Hospital.

Provincial Health Services Authority

Provincial Health Services Authority (PHSA) is one of six health authorities – the other five health authorities serve geographic regions of BC.

Ministry of Health

British Columbia Ministry of Health

RBC Children's Mental Health Project

RBC Children’s Mental Health Project is RBC's cornerstone “health and wellness” pillar; RBC Children’s Mental Heath Project is a multi-year philanthropic commitment to support community-based and hospital programs that reduce stigma, provide early intervention and increase public awareness about children’s mental health issues.

BC Children's Hospital Foundation

Through a wide range of fundraising events and opportunities, The BC Children's Hospital Foundation is united with its donors by a single, simple passion - to improve the health and the lives of the young people who enter BC Children's Hospital every day.