What is anxiety?

The word ‘anxiety’ is commonly associated with the experience/feeling of nervousness, distress, apprehension, worry and may even have physical manifestations like sweating, nausea, tremors, headaches etc. Simply put, anxiety is our response to a trigger, which is usually something we are apprehensive about or scared of. The trigger may be real or imaginary.

Interestingly, the physiological responses associated with anxiety are similar to the way our body responds to fear i.e. the flight-or-fight response. These essentially are a set of bodily changes (like increased heartbeat and blood pressure) that assist you in fighting or escaping as soon as a threat or danger is perceived.

Is anxiety normal? Even in children?

Anxiety, to some extent, is not only normal it is adaptive and has functional value. For example, if there is a real, physical threat in front of you then the feeling of anxiety will prompt you to do something about it (fight or escape). The threat may not be physical for example the fear of failure. The anxiety associated with the same pushes the student to work hard for his exams.

It is perfectly normal and expected for children to show fearful and anxious behaviour – especially when they come across new situations and experiences. The fact that it is so normal, may actually distract the care-givers from giving it more serious thought when they must! But then anxiety is expected and normal at specific times in development. Like when a toddler displays signs of being afraid of darkness most parents know intuitively that it’s a normal fear that many children exhibit while growing up. It’s normal!

When to worry about anxiety in children?

Imagine, if the same child who was afraid of the dark at the age 2 refuses to enter a dark room or insists on sleeping with the lights on even at the age of 9 years, he also refuses to enter dark places like a movie hall or wakes up sweating in the middle of the night because of dark dreams. The anxiety now may not seem to be ‘normal’ or ‘natural’.

Anxiety issues in children are often overlooked or commonly misinterpreted as behavioural issues. Children may come across to be clingy, fussy, irritable, nervous, stubborn, argumentative, rude etc. Some may also be quiet, aloof, compliant and their difficulties stand a chance to get missed. Parents need to be aware that anxiety could be the underlying cause behind such “behavioural issues”.

It helps to differentiate between “normal anxieties” from an “anxiety problem”. Some of the key parameters in judging the difference are:

• Appropriateness viz-a-viz age, situation
• Duration
• Intensity
• Impact on day-to-day functioning or quality of life

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Signs of anxiety problem in children

Physical

• Frequent, unexplained headaches or stomach aches
• Difficulty falling and or staying asleep
• Inability to concentrate
• Restless, hyperactive
• Tension in muscles
• Repeated gestures/movements (involuntary) - like sniffing, shoulder shrugging
• Clingy

Emotional

• Extremely sensitive
• Worries about things in future
• Cries easily
• Needs constant reassurance
• Resistance to change

Behavioural

• Refuses to go to school
• Avoids social situations like birthday parties
• Worried about and asks “what if” questions constantly
• Stubborn

As most of these signs are displayed by most children at various stages of growing up it may be very confusing for parents to differentiate. It helps to evaluate on the parameters to differentiate normal from problematic. It is a good idea to maintain a behaviour log in order to observe patterns/associations and to judge frequency.

What causes anxiety problem?

In the present day scenario, the factors that can be attributed to causing anxiety problems in children are multi-dimensional. From environmental pollution to lifestyle to the changing social fabric and informational overload the list is endless. While parents/caregivers may not be in a position to control factors like pollution or genetics, it helps to have a holistic approach to prevent or deal with childhood anxiety problems.

How can parents help?

Anxiety problems in children can be treated – early identification and intervention can help avoid future difficulties like school drop-outs, feeling of low self-esteem, social isolation etc. and even progression into more serious conditions like phobia, panic attacks etc.

Dealing with an anxious child might be an overwhelming experience. Parents often find themselves feeling desperate to help their child not feel anxious. While parents cannot stop the child from feeling anxious, they can help the child manage his anxiety.

• Calm down – watch your own feelings and reactions. A calm parent can not only think through possibilities, for the child who is feeling anxious it serves as a cue that all is under control. On the other hand, your frowned look further reiterates the child’s need to worry.
• Take your child’s fears seriously – encourage children to talk about their thoughts and fears about themselves, home, school, world or anything they want to. Give them reassurance and let them know you understand. Also, discuss their fear in detail to help them deliberate on whether the threat is real or just perceived.
• Avoid ‘avoiding’ – when a child is in a flight-or-fight mode he may find it the easiest to avoid the anxiety trigger. While this may work in the short-term, it only strengthens the possibility that the child would not be able to deal with the situation the next time. For example, if a child is anxious about dogs, staying away from all dogs will only validate the fear. A better way to deal would be to desensitize your child to the trigger gradually.
• Watch what they ‘watch’ – In today’s age, if information overload children are likely to get exposed to all kinds of content that may not be appropriate for their age and little heads. Children need not be exposed to stressful events of the crime, calamities, wars, etc. Such information may lead the child into the “what if” question and hence breed insecurity and anxiety.
• Empower them – introduce simple coping strategies to manage anxiety, like
  • Relaxation techniques like deep breathing – Simple exercise like inhale, hold till the count of 3, exhale count till the count of 3 or similar can easily be taught to even younger kids. Focussing on the breath or deep breathing has a calming effect on the brain.
  • Expression – Encourage the child to write or draw how they feel like.
  • Physical activity – Sports or even some simple physical activity like climbing up the stairs or hopping helps channelize energy
  • Look for your ‘buddy’ - A buddy can be any pre-identified person who can comfort the child, it may be a different person in different situations – Maybe mother at home and a friend in school.
• Focus on the basics – Ensure that the basic needs for a healthy body and mind are not missed out on :
  • Quality sleep
  • Nutrition
  • Hydration
  • Pursuing hobbies
  • Regular physical activity (like outdoor play, riding bicycle etc.)
  • Bonding time with family

Discussed above are a few steps that can help prevent or deal with anxiety in children. However, seek professional help in case the situation is seriously affecting the child’s daily function or well-being. Also, do remember a child struggling with anxiety issues isn’t really an indicator either of poor parenting or of behavioural issues with the child!