Ella was a worrier. Every morning, she worried that she wouldn't make the bus on time, even though she hadn't missed it once all year. And every afternoon, she worried that she wouldn't get her favorite spot at the lunch table, or that she might have a pop quiz in science class and wouldn't be prepared. At night, she worried about getting her homework done and whether her clothes would look right at school the next day.

Ella's parents thought this behavior was a typical part of growing up. But when their daughter's teacher said that Ella's anxiety was starting to affect her grades in school and relationships with classmates, they decided it was time to talk to a doctor about finding ways to help Ella deal with her worries.

What Is Anxiety?

Anxiety is really just a form of stress. It can be experienced in many different ways — physically, emotionally, and in the way people view the world around them. Anxiety mainly relates to worry about what might happen — worrying about things going wrong or feeling like you're in some kind of danger.

Anxiety is a natural human reaction, and it serves an important biological function: It's an alarm system that's activated whenever we perceive danger or a threat. When the body and mind react, we can feel physical sensations, like dizziness, a rapid heartbeat, difficulty breathing, and sweaty or shaky hands and feet. These sensations — called the fight-flight response — are caused by a rush of adrenaline and other stress hormones that prepare the body to make a quick getaway or "flight" from danger.

The fight-flight response happens instantly. But it usually takes a few seconds longer for the thinking part of the brain (the cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. When the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system starts to calm down.

Normal Anxiety

Everyone experiences feelings of anxiety from time to time. These feelings can range from a mild sense of uneasiness to full-blown panic (or anywhere in between), depending on the person and the situation.

It's natural for unfamiliar or challenging situations to prompt feelings of anxiety or nervousness in people of all ages. You may feel it when you have a big presentation at work, for example, or when life gets overly hectic.

Kids might feel it, too, in similar situations — when facing an important test or switching schools, for example. These experiences can trigger normal anxiety because they cause us to focus on the "what if's": What if I mess up? What if things don't go as I planned?

Some amount of anxiety is normal and can even be motivating. It helps us stay alert, focused, and ready to do our best. But anxiety that's too strong or too frequent can become overwhelming. It can interfere with someone's ability to get things done and, in severe cases, can start taking over the good and enjoyable parts of life.

Anxiety Disorders

Anxiety disorders are among the most common mental health conditions. That's partly because everyone experiences stress and worry. There are many different types of anxiety disorders, with different symptoms. But they all share one common trait — prolonged, intense anxiety that is out of proportion to the present situation and affects a person's daily life and happiness.

Symptoms of an anxiety disorder can come on suddenly or can build gradually and linger. Sometimes worry creates a sense of doom and foreboding that seems to come out of nowhere. Kids with anxiety problems may not even know what's causing the emotions, worries, and sensations they have.

Disorders that kids can get include:

• Generalized anxiety. With this common anxiety disorder, children worry excessively about many things, such as school, the health or safety of family members, or the future in general. They may always think of the worst that could happen. Along with the worry and dread, kids may have physical symptoms, such as headaches, stomachaches, muscle tension, or tiredness. Their worries might cause them to miss school or avoid social activities. With generalized anxiety, worries can feel like a burden, making life feel overwhelming or out of control.
• Obsessive compulsive disorder (OCD). For a person with OCD, anxiety takes the form of obsessions (excessively preoccupying thoughts) and compulsions (repetitive actions to try to relieve anxiety).
• Phobias. These are intense fears of specific things or situations that are not inherently dangerous, such as heights, dogs, or flying in an airplane. Phobias usually cause people to avoid the things they fear.
• Social phobia (social anxiety). This anxiety is triggered by social situations or speaking in front of others. A less common form called selective mutism causes some kids and teens to be too fearful to talk at all in certain situations.
• Panic attacks. These episodes of anxiety can occur for no apparent reason. During a panic attack, a child typically has sudden and intense physical symptoms that can include a pounding heart, shortness of breath, dizziness, numbness, or tingling feelings. Agoraphobia is an intense fear of panic attacks that causes a person to avoid going anywhere a panic attack could possibly occur.
• Posttraumatic stress disorder (PTSD). This type of anxiety disorder results from a traumatic past experience. Symptoms include flashbacks, nightmares, fear, and avoidance of the traumatic event that caused the anxiety.

Causes

Experts don't know exactly what causes anxiety disorders. Several things seem to play a role, including genetics, brain biochemistry, an overactive fight-flight response, stressful life circumstances, and learned behavior.

A child with a family member who has an anxiety disorder has a greater chance of developing one, too. This may be related to genes that can affect brain chemistry and the regulation of chemicals called neurotransmitters. But not everyone with a family member who has an anxiety disorder will develop problems with anxiety.

Things that happen in a child's life can set the stage for anxiety disorders in childhood or later in life. Loss (like the death of a loved one or parents' divorce) and major life transitions (like moving to a new town) are common triggers. Kids with a history of abuse are also more vulnerable to anxiety.

Growing up in a family where others are fearful or anxious also can "teach" a child to view the world as a dangerous place. Likewise, a child who grows up in an environment that is actually dangerous (if there is violence in the child's family or community, for example) may learn to be fearful or expect the worst.

Signs & Symptoms

Although all kids experience anxiety in certain situations, most (even those who live through traumatic events) don't develop anxiety disorders. Those who do, however, will seem anxious and have one or more of the following signs:

• excessive worry most days of the week, for weeks on end
• trouble sleeping at night or sleepiness during the day
• restlessness or fatigue during waking hours
• trouble concentrating
• irritability

These problems can affect a child's day-to-day functioning, especially when it comes to concentrating in school, sleeping, and eating.

And it's common for kids to avoid talking about how they feel, because they're worried that others (especially their parents) might not understand. They may fear being judged or considered weak, scared, or "babyish." And although girls are more likely to express their anxiety, boys experience these feelings, too, and sometimes find it hard to talk about. This leads many kids to feel alone or misunderstood.

The good news is that doctors and therapists today understand anxiety disorders better than ever before and, with treatment, can help kids feel better.

Treatment

A child's anxiety disorder can be treated by a mental health professional. A therapist can look at the symptoms, diagnose the specific anxiety disorder, and create a plan to help a child cope.

A type of talk therapy called cognitive-behavior therapy (CBT) is often used. In CBT, kids try out new ways to think and act in situations that can cause anxiety, and to manage and deal with stress. The therapist provides support and guidance and teaches new coping skills, such as relaxation techniques or breathing exercises. Sometimes, but not always, medication is used as part of the treatment for anxiety.

Helping Your Child Cope

The best way to help your child is to acknowledge the problem in a supportive, nonjudgmental way. Talk openly about your child's symptoms and really try to understand how they are affecting everyday life. It can also help to talk to other adults in your child's life, such as teachers and coaches.

Be patient and positive as your child undergoes treatment and finds new ways to cope. Sometimes it helps to talk to your child about your own stresses and how you've been able to overcome them. Remind your child that letting go of worry allows space for more happiness and fun.

Rest assured that with the right care, your child can overcome anxiety and learn to face the future ready and relaxed.

Reviewed by: Michelle New, PhD
Date reviewed: May 2011