The Worried Child: Recognizing Anxiety in Children

A child’s anxiety is like an iceberg. The behaviors we see on the surface are only the tip of the emotions that lie underneath.

Everyone I know or have ever treated has experienced some degree of anxiety. Anxiety is our body’s natural response to stress. In my practice anxiety is the number one issue I treat in children, teenagers and adults. I most commonly see anxiety that is caused by family conflict, divorce, loss, bullying or peer issues, past trauma, academic issues, unique personality traits and genetics to name a few. Anxiety can be tricky to manage in children because biologically they are in “survival mode” naturally just by being a child. From the moment we are born, we are biologically programmed for survival, and even have several primitive reflexes which help to ensure our safety. It can be scary for kids to learn alternative behaviors and gain new skills because on some level, they may believe that their anxiety is helpful, and often, an automatic response. As parents, it can be hard to know what if anxiety is developmentally appropriate or not.


Most school aged children are able to manage typical day-to-day anxieties that they all face without affecting their functioning or relationships. They may get irritable, scared, sad or frustrated, but generally, they are able to bounce back quickly and move on from those unpleasant thoughts and feelings.  For some children, anxiety builds up if they don’t have the tools to handle it, or if their situation has changed in some way so that now the tools they did have to manage their anxiety are no longer enough. When kids experience anxiety frequently it creates patterns in the way they think and feel and makes it more likely that they will continue to experience anxiety unless they are taught how to recognize and manage their thoughts, feelings, and in turn their stress responses.  First, as parents, we have to recognize that our child’s behaviors may be anxiety.


I want to share some symptoms I frequently see in children with anxiety that can be overlooked or mistaken for other behavioral or developmental issues.


Anger and irritability


Because our autonomic nervous system is responsible for the flight/fight/or freeze response, anger and irritability (fight) are common symptoms of anxiety in children and teenagers. I often see kids who hold their anxiety together throughout the day due to the need to please others (seen later on this list) and then experience anger over seemingly small issues or reasonable requests from others. They are tired from the school day and may not have any emotional reserves left when they get home to manage the day-to-day demands.


Overestimating negative emotions in others


Children who experience anxiety may be on high alert for danger (whether they know it or not). This means that they can overestimate or misread emotion on the faces of others. This may cause children to misread social cues as well which contributes to an increase in social anxiety (seen later on the list). A child may overestimate anger or fear on the faces of their caregivers, whom they look to in order to determine the appropriate way to react to situations. This may cause a child to over-react or internalize feelings of guilt for having “caused” a negative feeling in a caregiver, friend or other adult.




At the root of an anxiety disorder is a faulty way of thinking about yourself and others, with an overemphasis placed on outcomes and safety, whether emotional or physical. A perfectionistic child may believe that their worth is dependent on their ability to perform either academically, in sports, or other extracurricular activities. This pressure they place on themselves to “be perfect” causes anxiety before, during and after an event. Children may worry about how they will perform, if they will make their parents proud, and what it might mean if they are not “the best.” This type of pressure can easily be encouraged by parents who also put emphasis on outcomes such as good grades or top scores. The chronic stress that children feel due to perfectionistic tendencies can affect their immune system, ability to handle emotions and their social development.  


Hanging on the fringe of social situations

Social anxiety is common among children who exhibit symptoms of an anxiety disorder. Children need other people in their lives—we all do. Love and belonging are extremely important to our emotional and psychological wellbeing. The fear of not fitting in with others or fear of rejection can be as intense as a fear of dying or public speaking n adults. Children know how important relationships are, but they are so scared of what others may think or how they may react that they keep themselves hanging on the outside of many social situations. Children may say they don’t like an activity, that it is dumb, or boring  as ways to avoid being uncomfortable in social situations or to avoid trying new things.


Extreme people pleasing


 Children love to please. If you have a child whom you believe does not want to please others, you are mistaken. Again, this is a part of our biological survival and pleasing others allows us to be taken care of, fed, snuggled, and encouraged; all of which are needed for healthy development. Children who have anxiety may be extreme people pleasers which can lead to issues with peers as these children may be seen as “followers” whom others can easily influence. The fear of not being liked or not fitting in with others can cause children to make unhealthy or unsafe decisions for themselves. They may also struggle to find their own identity as they have a hard time discovering themselves outside of the validation from parents, friends, and teachers.


Trouble making decisions


Anxiety is a thought bully who can make us second guess every single decision we make. This is no different for our children. Children with anxiety may worry that they have or will make the wrong choice. They may be afraid of the feeling of missing out on something once the decision is made and may need extra validation from others that they have made the “right choice.” A hallmark of anxiety is black and white thinking in which situations are either all good or all bad Making the “wrong” decision can spur on anger and irritability as well as negative thoughts about themselves.  Some children may be paralyzed by anxiety and may never be able to make the decision, having to have someone else make it for them, and then feeling regret and shame for not being able to have made decision for themselves.


Picky eating


Anxiety can cause an intense fear of new experiences and sensations as well as irrational fear of harm from eating certain foods. This may manifest as a fear of choking, a fear of the way something looks, or fear that a non-preferred taste would be harmful to them. Many things in nature which would be harmful to us have an unpleasant taste or smell. For children who have anxiety, their survival mechanisms are enhanced, causing everyday situations to feel much scarier than the situation warrants.


Concentration and focus issues


From worrying about whether they will make a 100 on their spelling test to who they will sit with at lunch or whether or not their teacher is pleased with them, anxiety effects a child’s ability to concentrate at school and even at home. You may have a child that “zones out” at school, thinking of worries that take them out of the present moment. This can disrupt focus and ability to pay attention. We may see this at home as children who get flustered if overwhelmed by worries about their ability to perform a task (perfectionism) and who may forget or leave out key parts, making parents believe that children are not following directions.


Nightmares or a fear of sleeping alone

Dreams are one of the ways children may process worries and events from the day. For children with anxiety, the worry they experience in waking hours often carries over to their dreams, and sleep disturbances are a common symptom of kids experiencing anxiety. Children may also experience a sleep regression with anxiety and fear sleeping alone, prompting nights in their parents bed. Sleep is vital to our emotional, psychological, and social wellbeing. Helping kids manage their feelings and encouraging healthy sleep hygiene can help to increase sweet dreams.


 Children and their circumstances are all unique and there are multiple factors that influence how anxiety affects children and their behaviors. A child can experience one or all of these challenges simultaneously. Anxiety is like an iceberg, and if your child is experiencing these symptoms, there is likely much more under the surface. Seeing a professional can help children to normalize their emotions, learn to cope with the physical and emotional sensations of anxiety, and can help parents to learn how to better support their anxious child. If your child’s anxiety is causing impairment in any of these ways, reach out to me.