Signs your child may have an anxiety disorder

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It’s perfectly normal for children to feel anxious occasionally. They may be nervous about an upcoming test at school, worried about who they’ll sit with at lunch, apprehensive about a change in their routine or stressed about a situation at home. However, anxiety in kids and teenagers doesn't always look how you'd expect.

“Physical symptoms are sometimes easier to identify in adolescents,” said Dr. Matt Stanley, D.O., DLFAPA, senior medical director of behavioral health at Wellmark Blue Cross and Blue Shield.

“With younger [kids], you may see things like stomachaches, headaches and nausea,” said Dr. Stanley. “They have more sleep problems like nightmares and difficulty falling asleep."

If you notice one or two of these signs every so often, it’s likely nothing to worry about — everyone has off days. But, if a child appears to be struggling daily with multiple signs of anxiety, it may be time for them to see a mental health professional about the possibility of a chronic anxiety disorder.

What is an anxiety disorder?

According to the Anxiety and Depression Association of America (ADAA), the term "anxiety disorder" groups together several mental health conditions, such as obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder and specific phobias. Children are not immune from these conditions and other mental health struggles. Anxiety disorders affect one in eight children, according to the ADAA.

These disorders often develop in children after stressful life changes or events, like the loss of a loved one or switching schools. Though they can be hereditary, it’s rare to see a purely biological mental health condition in children, especially younger children. “Anxiety is the anticipation of things not going well and can often lead to avoidance. Fear of being judged, bullied or embarrassed for example," said Dr. Stanley. “Biologic, genetic, environmental and learned factors all have a component to anxiety."

Signs of anxiety in children

Anxiety in kids and teenagers can present itself in many ways. The main difference between anxiety and an anxiety disorder is that one is a temporary phase that goes away, and the other is persistent and constantly interfering with how the child functions day-to-day. While anxiety can usually be addressed with reassurance and comfort about a situation, an anxiety disorder cannot.

Emotional signs of anxiety in children:

• Increased sensitivity
• Fear of making minor mistakes
• Excessive worry
• Frequent nightmares about loss

Physical signs of anxiety in children:

• Headaches or stomachaches with no medical cause
• Refusing to eat at school
• Appearing restless, fidgety or distracted
• Difficulty falling asleep

Behavioral signs of anxiety in children:

• Refusing to go to school
• Avoiding social situations with other kids
• Increased meltdowns or temper tantrums
• Constantly seeking approval for actions

If you’ve noticed a few of these signs recently, start a journal to keep track of the child’s behavior. This can help you find patterns and determine if there are situations that might be leading to certain behaviors or causing anxiety.

If the anxious behavior goes on for longer than two weeks, or the child begins avoiding activities they once enjoyed, having issues connecting with friends, or doesn't want to leave the house, consider reaching out to their doctor with your concerns. “One of the hallmarks of when you should seek treatment is when you see functioning drop off,” said Dr. Stanley. “The sooner you address it, the better the outcome and the better the long-term expectation of recovery.”

How are anxiety disorders in children treated?

Luckily, anxiety disorders in children can be treated once diagnosed. Cognitive-behavioral therapy (CBT) is often the first treatment to try before starting any medication, and it’s important for parents to be supportive during the treatment process. You may want to consider a therapist who has post-graduate training or special certifications in therapy for young children, like play therapy or art therapy.

Just like with any treatment, patience is key. "For general anxiety, you’ll often see progress in two to three months,” said Dr. Stanley. “Typically [kids] can rebound pretty quickly."

Whether through therapy or medication, seeking treatment for a child’s anxiety disorder is important. "Any illness can become chronic. The problem with not treating and addressing it is that the symptoms can get stronger and become self-reinforcing," said Dr. Stanley.

Get the resources for childhood anxiety treatment

If you’re concerned about your child’s anxious behavior, you can talk to their pediatrician for recommendations before deciding how to — or if you should — move forward with treatment. You can also use the following resources for help:

• myWellmark: Wellmark members can log in to myWellmark to find a nearby mental health provider who is in-network.
• Doctor On Demand^®: If the child feels more comfortable opening up to a doctor while they’re at home, a virtual visit may be an option. Doctor On Demand is a covered benefit under many Wellmark Blue Cross and Blue Shield health plans — all you have to do is download the app or visit Doctor On Demand to create an account.
• BeWell 24/7^®: For quick questions like “Is this behavior normal?,” you can connect with a real person, day or night (when we say 24/7, we mean it!) for answers. Just call 844-842-3935.

Remember: Many symptoms of anxiety in kids and teenagers can look like normal behavior, so it can be a challenge to determine if your child is just going through a phase or experiencing anxiety. But, you know your child best. If they have been acting "off" for more than a week or two, have complained of physical ailments, and have seemed extra irritable or upset lately for seemingly no reason, it may be time to consult a health care professional.