Anxiety in children: signs, causes and how to help

Anxiety is a natural response to feeling threatened or under pressure. Children, like adults, feel worried at times, and the NHS says many of these worries are a normal part of growing up. It is also common for preschool-age children to develop specific fears or phobias. What changes the picture is when worry is constant, disproportionate or starts to restrict daily life, so that a child avoids school, friends or ordinary activities.

Anxiety does not always look like worry. Younger children may be clingy, tearful or irritable, and may complain of tummy aches. Older children and teenagers may appear angry, avoid things, or struggle to concentrate. The NHS gives the example of exam time, when every child in a school is nervous but some may be so anxious that they cannot get to school at all.

The NHS lists signs including finding it hard to concentrate, not sleeping or waking in the night with bad dreams, eating more or less than usual, getting angry or irritable quickly, constantly worrying or having negative thoughts, feeling tense and fidgety, always crying, being clingy, and complaining of tummy aches and feeling unwell.

It adds that, in younger children, you may also notice bed-wetting, and that older children may lack confidence to try new things, have a lot of negative thoughts or keep thinking bad things will happen, and start avoiding everyday activities such as seeing friends, going out in public or going to school. Separation anxiety is common in younger children, whereas older children and teenagers tend to worry more about school or have social anxiety.

• Trouble getting to sleep, night waking or bad dreams.

• Frequent tummy aches or headaches with no clear medical cause.

• Refusing or struggling to go to school, clubs or sleepovers.

• Needing constant reassurance.

• Outbursts of anger or tears that seem out of proportion.

• Avoiding friends, social events or new activities.

The NHS says that having a close family member with anxiety may increase a child's chance of having it too, and that children can pick up anxious behaviour from being around anxious people. Some develop anxiety after stressful events such as frequently moving house or school, parents fighting or arguing, the death of a close relative or friend, becoming seriously ill or injured in an accident, school-related issues such as exams or bullying, or being abused or neglected.

It also notes that children with attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders are more likely to have problems with anxiety. Some children are naturally more cautious and find change difficult, becoming anxious after a house move or when starting a new school, and at school they may be affected by schoolwork, teachers, bullying, loneliness or noise.

The NHS says that, above all, it is important to talk to your child about their anxiety or worries, and to help them find solutions. For example, if a child is worried about a sleepover, talk to them and make a plan involving a close friend or another parent being there. It is important to acknowledge their anxiety and find helpful ways of dealing with it, and not to force them into a stressful situation without talking about it first.

It also suggests teaching your child to recognise the signs of anxiety in themselves, encouraging them to manage it and ask for help, and keeping to regular routines because children of all ages find them reassuring. Meeting the teacher or special educational needs co-ordinator (SENCO) can help set up adjustments at school, such as support from a peer mentor or avoiding a noisy playground by coming in early to help tidy the classroom.

The NHS says many children have anxieties that go away after a while with reassurance, but it is a good idea to seek professional help if a child is constantly anxious and it is not getting better or is getting worse, self-help is not working, or it is affecting their school or family life or friendships.

A GP appointment is a good place to start. You can speak to the GP on your own or with your child, or your child may be able to have an appointment without you. If the GP thinks your child may have an anxiety disorder, they may refer them to local CYPMHS, which are NHS services for children and young people's mental health. If a child does not want to see a doctor, they may be able to get help directly from a local youth counselling service. A school nurse can also be a first contact.

If your child is in crisis, talks about harming themselves or you are worried about their safety, call NHS 111 and ask for mental health help, or call 999 or go to A&E in an emergency.

The type of treatment depends on the child's age and the cause of their anxiety. The NHS describes counselling, which can help a child understand what is making them anxious and work through the situation, and cognitive behavioural therapy (CBT), a talking therapy that helps a child manage anxiety by changing the way they think and behave, in person or as self-help online.

Anxiety medicines may be offered if anxiety is severe or does not improve with talking therapies, and are usually only prescribed by doctors who specialise in children and young people's mental health.

Most children respond to support, particularly when anxiety is recognised early and the adults around them respond calmly and consistently. Anxiety can ebb and flow with life events, exams or changes of school, so a step back does not mean failure.

Parents also need support. The NHS points to resources such as the Mental Health Foundation booklet The Anxious Child, Royal College of Psychiatrists pages for parents and the YoungMinds Parents Helpline, as well as Childline and YoungMinds information for young people.

The NHS pathway starts with school staff, a GP or school nurse and can lead to CYPMHS assessment and therapy. Waiting times vary across the UK, and many areas also have school-based mental health support teams and youth counselling services.

Some families choose a private child psychologist or CBT therapist to avoid waits. It is sensible to check that the therapist is registered with a professional body and experienced with children, and to keep the school and GP informed so that support is joined up.