Helping your child cope with anxiety

Anxiety is a healthy human emotion that helps us detect danger and protect ourselves. Yet, for the children who have an anxiety disorder, anxiety is triggered by routine activities, is disproportional and over time inhibits the child from reaching their full potential.

Dr. John Walkup, is the head of Child and Adolescent Psychiatry at Ann & Robert H. Lurie Children's Hospital of Chicago and an expert in pediatric anxiety. He is interested in promoting healthy conversations about how anxiety affects children's mental health, and how families can support them.

"Rather than being curious and enjoying new things like most kids, anxious kids are supersensitive and react to new activities as if they were threatening," he says. "They routinely scan the outside world as well as their inside world and feel threatened by anything new or different."

For example, a child with an anxiety disorder may be fearful about being away from home and going to school, going to bed alone in their own room, going on a sleepover or to camp, ordering a hamburger at a restaurant, being called on in class, or worry about their health or about being ill.

"While anxiety is uncomfortable for the child, it is the tendency of the child to avoid life experiences which is most problematic and overtime lead to substantial problems with coping and adaptation," says Walkup.

Walkup encourages parents to pay attention to their child's behavior and speak up when they see signs of excessive anxiety.

"It can be as easy as saying, 'We appreciate what you're going through, and we want to understand what you're thinking and feeling,'" he says.

Anxiety disorders come in various shapes and sizes, and Walkup suggests looking for the following signs:

1. Separation anxiety

A child who worries excessively about something bad happening to them or to their caretakers may have separation anxiety. It starts roughly between 6-10 years of age.

These children worry when they separate from their parents for various reasons like school or bedtime. Some even worry when they are in a different room from their caretakers and follow them around the house.

"These kids often don't do sleepovers and may make regular trips to the school nurse," Walkup says.

Symptoms frequently present during back-to-school season, on Monday mornings, or after holiday breaks.

2. Generalized anxiety, or "worry warts"

Children who worry about the past and future, and life and death, seek extra reassurance, and can be hard on themselves could have a generalized anxiety disorder.

"They worry about their performance at school, and sometimes shut down and do poorly when tested," Walkup says.

Generalized anxiety often presents in October, November, or test-taking time.

3. Social anxiety

"These are kids who are behaviorally and socially inhibited and very self-conscious sometimes going back to early childhood," he says.

These children and teens worry that they will embarrass themselves. While 'shyness' in children is commonly accepted, the same behavior in teens strains peer-to-peer relationships, limits new experiences and affects self-esteem.

Because parents are empathic, many modern moms and dads will do anything to keep their kid from being anxious - but this has long-term consequences, Walkup says. While intuitively right, facilitating anxious child avoidance can lead to further problems.

"Child avoidance and parental accommodation of avoidance makes it difficult for kids to develop robust adaptation and coping skills," Walkup says. "Parents have to empower to take on developmental challenges, whatever it is. Kids build confidence and grow more resilient when they face their fears, knowing they have the support of their parents and the people who care about them."

Anxiety is a condition for which there are very good treatments.

"Sometimes kids are so anxious that working on it at home doesn't make it better," Walkup says. After talking to the child's pediatrician, getting a good evaluation is the first step in making a treatment plan.

At Lurie Children's, Walkup aims to incorporate conversations around mental health into children's primary care appointments.

"Pediatricians talk about safety, like bike helmets and car seats. We want to see them bring up mental health issues in the same way, " he said. "If problems are identified early, it is much easier to intervene and make a real difference in the child's life.

"I like to see kids who have anxiety functioning at their very best," he says. "If they have an anxiety disorder and get good treatment they can again function at their personal optimum. Watching these kids grow, develop, form relationships and express their talents almost looks like a miracle."

• Children's Health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. For more information, visit luriechildrens.org.