A guide to understanding toddler anxiety

Anxiety is a natural emotion we learn to experience as early as infancy. But what happens when a toddler's anxiety is beginning to impede his or her daily life?

Lurie Children's psychologists Caroline E. Kerns and Miller Shivers break down signs of an anxiety disorder by age, share advice on how parents can help their toddler through feelings of anxiety, and point out signs that professional help might be beneficial.

Years 1-3

Preschool jitters and bedtime fears

During this period, a child commonly begins to spend more time away from parents, especially if they attend day care or preschool. This can cause a spike in anxiety, some typical symptoms of which include crying and clinging during goodbyes. A toddler may also feel anxious before and during bedtime, and experience a common fear of the dark or a fear of being apart from parents.

"To help parents deal with these normal fears, we recommend parents have their child practice being away from them for short period of time," Kerns says. "If a child is anxious about starting day care or preschool, ease into the routine by asking a grandparent or family member to babysit the child for a couple hours, then extend it to longer periods of time."

A parent may also do a trial run in the classroom before the child spends a full day there to help them get familiar with the situation and practice a healthy goodbye and reunion. Rather than prolong the goodbye or "sneak away" when the child is distracted, let your toddler know you are leaving, when you will return, then share a quick hug and kiss before leaving.

Years 3-4

Wild imaginations - and tantrums

This is the age when imaginations go wild. In addition to realistic fears such as loud noises, it's common for toddlers to fear ghosts, monsters and other figures from their imaginations. Anxiety can also be expressed as a tantrum, crying, freezing behavior, anger, avoidance, or irritability, because toddlers lack the language and emotional regulation skills to explain and cope with how they're feeling.

One key is to establish a soothing, predictable bedtime routine - including checking under the bed together for monsters, if need be, Kerns says.

Pay attention to whether the routine seems to help calm your toddler's anxiety. If weeks go by without improvement, it may be a sign of an anxiety disorder starting to develop, Kerns advises. If your toddler has difficulty staying in his or her own bed throughout the night, do your best to stay neutral.

"Offer gentle encouragement for the child to stay in bed. Say, 'I'll walk you back to your bed now,' and institute a check system where you check on the child every five minutes. Then extend that time as the child gets comfortable being in their own space," she says.

When a tantrum strikes, cooler heads prevail. Try to model a calm approach to the anxiety-provoking situation. "If it feels like the tantrums are very frequent and it's getting to the point where it's impairing child or parent function, we recommend seeking help," Kerns says.

Years 4-5

More rational fears set in

By this age, your toddler will have an easier time distinguishing between reality and make-believe, but still some fears of ghosts may coexist with anxiety about more realistic things, such as school, family and health. The general guidelines for dealing with normative anxiety in this period are providing comfort and reassurance, while helping your toddler face the situation that is making him or her anxious.

"Help your child label and verbalize the feelings before, during and after they experience them," Kerns says. "This helps them build an emotional vocabulary as they age, and helps them understand you can have more than one feeling in any given situation."

In doing this, you will help provide a foundation for healthy emotional development and normalize anxiety as an emotion we all experience. Let your toddler talk about his or her fears, and share some of your own when appropriate. You may also read stories about children who feel anxious for fictional but helpful examples of how they face fear and feel brave doing so.

In addition to promoting healthy conversations, it's important to limit the amount of scary content kids are exposed to during this period. Take advantage of parental controls online and monitor the news you listen to in the car or at home. If your child hears unsettling things at school, allow them to share their response, discuss it with them, and reassure them that they are safe in the moment.

When should you worry?

While every child will experience anxiety from time to time, be aware of heightened, prolonged distress at the prospect of an unsettling experience, Kerns warns. "As an example, a child with normative anxiety will go to a doctor's appointment and start to feel anxious when he or she realizes they are about to get a shot. A child with an anxiety disorder, on the other hand, will realize they are going to the doctor's office next week, and fixate on their anxious feelings before, during and after it happens."

Parents should also pay attention to any functional impairment caused by a child's anxiety at school or at day care, with peers or in the family. Generally, toddlers can be expected to be engaged at school or day care, play with their peers and coexist with their family's routines. In the case of an early childhood anxiety disorder, however, parents typically have to go to greater lengths to help their child avoid triggers, such as large social gatherings.

If day-to-day life is impaired by anxiety, a mental health expert may be able to help parents find coping strategies and develop a step-by-step plan for families to function in the face of anxiety.

• Children's health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. To check out more information, please visit www.luriechildrens.org.