Childhood anxiety disorders affect one in eight children, making it a condition that many families grapple with. But despite how common they are, anxiety disorders in children aren’t discussed much, leaving many parents unprepared and even helpless when it comes to raising an anxious child.
“Children with anxiety disorders can often be clingy, may have difficulty doing things independently, and may have angry outbursts,” says Tyanna Snider, PsyD, a pediatric psychologist at Nationwide Children’s Hospital. “It can impact the entire family.” Parents face the tough challenge of trying to set boundaries for a child while simultaneously validating her emotions, Snider says.
But psychologists say they regularly help children with anxiety disorders, and part of that treatment involves teaching families how to respond to the condition’s symptoms. While none of them say parenting a child with an anxiety disorder is easy, they have discovered tools that can make life with an anxious child a little smoother. Here’s what they recommend all parents of children with anxiety disorders keep in mind.
Anxiety can seem like a behavioral problem
Tantrums are common in all children of a certain age, but they can also occur in children with anxiety disorders. “Anxiety can manifest itself in yelling or fighting about something,” says Thea Gallagher, PsyD, clinical assistant professor at NYU Langone Health and co-host of the Mind in sight podcasts. “Sometimes it can be difficult to understand whether this is normal child behavior or whether it is caused by something bigger or deeper.”
Those tantrums “may be really difficult for the child with anxiety to control, but it’s still really important to set limits and establish boundaries,” Snider says. This means you don’t want to attribute a tantrum to your child’s anxiety and assume you can’t do anything about it. When your child calms down, Snider recommends reminding him that there are rules and expectations, and that there are consequences when they aren’t followed. “You still need to provide discipline and consequences in a concrete way,” he says.
It is important to acknowledge your child’s feelings
Validating your child’s emotions is an important step when he or she is upset, says Izabela Milaniak, PhD, a licensed psychologist in the Anxiety Behaviors Clinic within the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia. She recommends practicing something called “developmental empathy,” which is when you don’t ignore concerns that might seem like a big deal for your child’s age. “A child’s worry may seem silly to an adult, but it’s proportional to her world,” she says. “Avoid making comments like, ‘It’s no big deal,’ or ‘You have nothing to worry about.’” Instead, Milaniak says it’s important to let your child know that you understand that he’s upset.
She recommends saying something like, “I know the mornings before school are hard for you. I see you are scared and would prefer to stay at home. I get it: sometimes I want to stay home from work because I’m nervous too.
Gallagher emphasizes that “feelings are always real,” even if you don’t understand why your child is having them at a particular time. “We can always recognize how terrible anxiety can be,” he says. Gallagher recommends talking to your child about “bottling up the anxiety,” emphasizing that they can be responsible for their emotions and not let the anxiety take control.
Staying calm is key
Ammon says it’s important to try to stay level-headed with your child. “Sometimes it can be difficult to stay calm when your child is distressed, screaming or crying,” he admits. Gallagher agrees, but stresses the importance of staying calm. “If you can, stay as calm as possible,” he says.
Gallagher points out that moods can be contagious. “If you’re in a crisis situation and someone else starts freaking out, your fight-or-flight response will go to that, too,” she says. If you find that you have trouble staying calm when your child is elevated, he recommends talking to his therapist about tools you can use or considering therapy for yourself. “The best thing you can do with your child when he is upset is to be as calm as possible, reiterate his options and talk about the choices he can make,” he says.
Sometimes you have to let them ride the wave of anxiety
Anxiety can be hard to stop, especially when a child is really upset, Snider says. “If your child is at peak anxiety—a 10 out of 10—sometimes we have to ride that wave,” he says. “You probably won’t make an effective change if they’re already at that high a level.”
This can mean simply being there for your child, hugging him or giving him space to be alone until he calms down, Gallagher says. “If a child is having a tantrum or having an anxiety attack, we want to get them into a safe space so they can express those feelings,” Snider says. This is a good time to help them practice the skills they learned in therapy, such as taking five deep breaths together, counting backwards by threes, or any other techniques their doctor shares. “This can distract them for a moment, relax the body and calm the brain,” Snider says.
Don’t completely avoid things that cause your child anxiety
If something makes your child anxious, it’s understandable that you want to do what you can to help them avoid it. But experts say this can actually make things worse. “The primary mechanism that causes anxiety symptoms to increase over time is avoidance, in which a child escapes experiencing anxiety, embarrassment, uncertainty, distress, or other negative sensations,” says Milaniak. “When an anxiety disorder develops, a child has repeated patterns of avoidant behaviors, such as not raising their hand in class, not attending school, and not speaking.”
But repeatedly avoiding a situation can make anxiety worse, says Hillary Ammon, PsyD, a clinical psychologist at the Center For Anxiety & Women’s Emotional Wellness. “You may have an instinct to protect them and allow them to avoid anything that causes them fear or anxiety,” she says. “Unfortunately, this decision to help them escape sometimes exacerbates those fears for the child.”
Milaniak instead recommends that parents “compassionately foster courage skills” with anxious children. This means reiterating expectations by saying things like, “I know this is hard for you and going to school is one of your responsibilities, just like going to work is mine. What can we do to make going to school easier today?” Milaniak says it’s important to stay steadfast, even if your child starts to get worse. “Remain calm and repeat a constant mantra to show that your child’s emotions don’t scare you,” he says. This may include saying something like, “You’re having a big feeling because you’re scared. I’m not scared of your big feelings. We’ll get through this together. Emotions don’t last forever and this will end soon.”
If your child does things like throw objects, hit others, or run out of a car, it’s important to have consequences for his behavior, Milaniak says. “Emotions are always valid, but we must be responsible for what we do with them,” he emphasizes.
It also highlights the good things
There’s a lot to handle when you have an anxious child, but doctors say it’s important to praise your child when he or she is doing well. “Highlight it when things are going well, don’t just focus on the things that didn’t go well,” says Gallagher.
Snider agrees. “You still want to be a typical parent and let them know you’re proud of them,” he says. Open-ended questions can also be helpful, such as asking your child to share the best and worst parts of his day when you have dinner or are in the car together. “It opens the door to communication and feelings if something isn’t right,” he says.
Overall, Snider recommends reminding yourself that you’re doing your best. “Often, parents of anxious children are really stressed, frustrated and unsure about what to do next,” he says. “But it’s important to remind yourself that you are a good parent and a good caregiver, even if things don’t seem to be going well at the time.”
Other tips for parents: