How to help your little children handle their worries and anxieties
Children need to acknowledge their fears, learning to handle them and not avoid them, before anxiety becomes a big issue, writes Deirdre Rooney
Worries in childhood are a normal part of growing up. When every day introduces something new to a child, fears, doubts and hesitancy are a natural reaction. A neighbour gets a new dog and your child clings on to your leg when they see it; there's a new face at crèche and suddenly they don't want to go; or perhaps something as simple as the loud noise of a blender in the kitchen can trigger small fears in kids. But it is when these worries become excessive and start to interfere with a child's normal day-to-day behaviour that anxiety becomes problematic.
Anxiety is a common condition in children, even young pre-schoolers. It is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen. But the problems arise when anxiety is out of proportion to the actual danger of the situation, or perhaps it is even there when there is no danger at all.
Dr Dawn Huebner is a US-based clinical psychologist, specialising in the treatment of anxious children and their parents. She is the author of award-winning self-help books for children, including the best-selling What To Do When You Worry Too Much. Her book is often cited by other clinical psychologists as a go-to text on the subject, with interactive aids allowing parents to read the book with their child. Dr Huebner says that anxiety can start at any age and tells Mothers & Babies what symptoms concerned parents can look out for in their children.
"In young children, anxiety most often manifests with clinging, avoidance and tears. Little worriers shrink away from things that make them feel unsure or scared, and they clamp on to their parents or other support figures, strenuously avoiding separation," she says.
While fears are a perfectly normal feeling for everyone, including children, when do those fears become something more troublesome? And just how common is anxiety in very young children?
"Fears are common for young children, for understandable reasons: the world can be a scary and unpredictable-seeming place when you are only hip-high and when you are faced with all sorts of experiences you've never had before. But 'normal' fears - the dark, people in costumes, separations - are different from anxiety that becomes problematic. Developmentally normal fears are typically softened by reassurance and they fade naturally over time. Worry - with a capital 'W' - gets in the way much more broadly, making it hard for children to do things their peers are easily doing, like going to school, playing with friends, falling asleep alone. Problematic anxiety affects something like 30pc of children at some point during their childhood."
According to Dr Huebner, the common things that make children anxious are the dark, scary things upstairs (monsters, bad guys, wild animals), separation from parents, being yelled at, medical procedures/shots, insects and animals. But why is it that not all children experience it? Are some children just more prone to anxiety?
"Yes," says Dr Huebner. "There's a hard-wired piece, a genetic piece, and a learned piece to anxiety. Children with the hard-wired and genetic pieces are more likely to develop problems with anxiety, especially if their parents are anxious, too, as anxious parents tend to allow and even foster avoidance, which reduces fear in the moment but makes anxiety worse in the long-run."
Dr Huebner recalls the experience of one child she treated, whose little fear of balloons developed into something altogether more debilitating, not just for her but for the whole family.
"I was seeing a youngster who was afraid of balloons. She was afraid they would pop, which clearly is a risk when you are around balloons. Her parents tried to reassure her that the balloon, wherever she was, was unlikely to pop, and that even if it did pop, the loud noise would be brief and everyone would be OK. But she remained afraid and started scanning places for balloons, refusing to enter a shop, a party, a room, if she saw a balloon and eventually, anywhere if there was a chance there might be a balloon.
"The more her family helped her avoid balloons, the more she needed to avoid balloons until the family was essentially home-bound, because if you think about it, there might be balloons at the market, and in shops, certainly at parties, and possibly at school. As is often the case with anxiety, the focus grows over time so the balloon fear turned into a fear of any loud, sudden noise - fire alarms, dogs barking - and then anything that might be scary in any way. That's when they sought treatment."
Like any problem a child may have, a parent's natural instinct is to want to eliminate it, to ease the hurt or difficulty the child is experiencing. But anxiety is a feeling that can't be fixed with a plaster or a cuddle. Instead, a parent's role is to help their child deal with the feeling, and not try to keep them from it.
"It's important to have an understanding of anxiety and how it works," says Dr Huebner. "Anxiety is all about having a nervous, uneasy feeling and not being able to tolerate that feeling. We know, logically, that being afraid is not the same as being in danger, but when you are afraid, it feels like you are in danger. Parents need to be sure to not in any way reinforce that notion; that fear equals danger. When parents check under their children's beds, or give them 'monster spray', or allow them to skip the party because there might be a balloon, that is in essence saying, 'Yes, you're right, the danger does exist and it's more than you can handle'. Overcoming anxiety is all about stepping towards the scary thing, not away from it."
Stella O'Malley, psychotherapist and author of Cotton Wool Kids, points out a pitfall parents can sometimes fall into when faced with an anxious child.
"While the parents should provide ready reassurance, detailed and emotional conversations about the source of the worries seldom work," she says. "Usually what happens in these situations is that the child succeeds in making the parents more anxious instead of the parents making the children less anxious. Parents need to be wary of excessive emotionality as they can be triggered into feeling incredibly anxious themselves, and that won't help anyone."
So what can parents actively do to help an anxious child? For starters, they can help their child overcome the anxiety by being empathetic without enabling the fear.
"The main objective when you are trying to help a .child get over a worry or fear is to help them get used to whatever they are afraid of," explains Dr Huebner, "which means you have to do one thing on purpose, over and over again."
The child Dr Huebner treated for the fear of balloons needed to be exposed to balloons, first deflated balloons (with no chance of popping at all), then partially inflated balloons, then more fully inflated balloons, then jumbo balloons. She needed to be in rooms with balloons, approach them, touch them, and ultimately play with them. And towards the end of her treatment, she needed to pop a balloon on purpose, to see that she could survive it.
"Parents tend to reassure their children that the bad thing isn't going to happen, like the balloon isn't going to pop. But with anxious children, reassurance isn't enough because the balloon might pop, and it feels too risky for them to take the chance.
"Certainly we can and should reassure young children about things that are extremely unlikely to happen, and we can assure them that we will protect them, but at the same time, parents need to make sure that their children are moving towards, and ultimately mastering, the things that make them scared, like being near dogs, going upstairs alone or staying at an activity without a parent."
One of the most important things Dr Huebner does when working with children and parents is to externalise the worry or fear, to help children think of it as a little creature or pest.
"I want children to learn to talk back to their 'worry', and to challenge it. Parents can remind their children that they're not going to let Miss Oh No (or whatever they're calling the worry) be in charge, that it's important to fight back," she says.
Sometimes, however, professional help is needed. Stella O'Malley believes more should be done, for both the children and parents, when confronted with this situation.
"We readily give extra support to kids with dyslexia, ADHD, etc, and I think we should seriously consider giving extra help to kids who find intense socialising difficult or the kids who have a more melancholic disposition," she says.
"And when parents realise that their emotional upset is impacting their children, it is often time to seek some support. I wish that counselling was a more natural go-to when we feel stressed instead of a huge decision that involves feelings of failure and overwhelms."
Dr Huebner also advises seeking help when reassurance isn't enough, when fears are getting in the way of day-to-day life, when fears last more than a few weeks and when parents feel like they don't know how to help their child.
"There are some great self-help resources for parents to use with their children, and if these aren't enough, parents can seek help from a mental health professional," she says.
Ways to ease anxiety in children
● If you know a change is coming up, for example moving house, prepare your child by talking to them about what is going to happen, and why.
● Practise simple relaxation techniques with your child, such as taking three deep breaths, breathing in for a count of three and out for three.
● For very young children suffering from extreme separation anxiety, lots of games of peek-a-boo and very obvious hiding can introduce the baby to the concept of being there but not visible.
● Distraction can be helpful for young children. If your child is anxious about going to crèche, play games on the way there, such as seeing who can spot the most red cars.
● A visit to the crèche when it's not open and talking about what they do there can also help children anxious about attending crèche for the first time.
● Children of all ages find routines reassuring, so try to stick to regular daily routines where possible.
● Try not to become anxious yourself or overprotective.
Sources: NHS/Stella O'Malley