Kids and Anxiety

Total Health Radio - boy reading a book

Understanding our kids’ physical health is one thing. Tuning in to their emotions can be quite another. But according to the National Institute of Mental Health, the number of children with a diagnosable anxiety disorder is now up to a staggering 25 percent. So in this episode of Total Health Radio, we explore key questions around anxiety in kids. In what way do symptoms of anxiety look different in a child than in an adult? How do we differentiate between a high level of stress and something more serious? How do we help our kids identify triggers? And importantly, we look at how we can best help our kids by becoming aware of – and getting a handle on – our own anxieties.

About the Guest
Jennifer Whaley, MD, is a psychiatrist with Kaiser Permanente in Atlanta, Georgia.

Episode Host
Joyce Gottesfeld, MD, is an OB/GYN with Kaiser Permanente Colorado, where she’s worked 17 years. She’s a wife, proud mother of three girls, runner and blogger. Read more about Dr. Gottesfeld.

Learn More
For more information on anxiety in kids, check out these links.

DR. GOTTESFELD:  Welcome to Total Health Radio.  I’m Dr. Joyce Gottesfeld.  As parents, we can usually tell when are kids aren’t feeling well physically.  But tuning into a child’s emotional health can be tough.  Dr. Jennifer Whaley is a child psychiatrist with Kaiser Permanente in Georgia.  She joins us today to talk about anxiety in kids: How to know if a child is suffering from anxiety, and how we, as parents, can help them cope.  Dr. Whaley, welcome back. So glad to talk with you again.

DR. WHALEY:  Thank you, very much for having me.

DR. GOTTESFELD:  So, what is anxiety?

DR. WHALEY:  When I explain anxiety to people, I usually start with talking about fear.  If you look up “fear” in the dictionary, what you’re gonna find is something along the lines of, “a sense alarm or disquiet that’s in the face of a threat.”  So for example, I’m walking in the woods,  I see a grizzly bear,  I feel fear.  And some things are gonna happen in my body in addition to what’s happening to me mentally.  My heart rate’s gonna speed up.  I’m gonna breathe faster.  My eyes are gonna dilate.  All those things happen to help me get away from this threat – this grizzly bear.  Anxiety is sort of similar experiences – you know, similar things even happening in the body.  Definitely that sense of disquiet or alarm – but it’s happening without the threat actually being there.  And instead, it’s usually a result of worry about a potential threat.  So I’m walking in the woods.  I see a grizzly bear.  That’s fear.  I’m walking in the woods, and I worry about seeing a grizzly bear, that’s anxiety.

DR. GOTTESFELD:  So I think everybody has anxiety sometimes.  Everybody feels anxious about a test or a job interview or something like that.  When is it a problem?

DR. WHALEY:  For practical purposes, what we say – what our cut off is – is it interfering with your ability to function.  Are you having a hard time getting through your day?  Are you not able to do things you’d like to do because of your anxiety?

DR. GOTTESFELD:  Let’s talk about kids then.  So how does anxiety look different in an adult than a child?

DR. WHALEY:  Two things – I mean the first is there are some specific anxiety disorders that happen in children that don’t necessarily happen in adults.  I mean, the classic case would be separation anxiety, which often happens in school age kids.  And that happens when they have anxiety about being separated their attachment figures, which is usually a parent or whoever’s acting as a parent.  Adults don’t usually have that.  But kids can also have the same kind of anxieties that adults do.  Where it becomes different is the way that it’s expressed.  The older a child becomes, the more likely they are to express it in the way that an adult does – to talk to you about it.  “I’m feeling stressed.  I’m feeling anxious.”  In younger kids – kids who are less verbal, what tends to happen is we see a change in their behavior.

DR. GOTTESFELD:  How do you mean a change in their behavior?  Can you give me an example?

DR. WHALEY:  I think in general any kind of change in behavior for a child that’s different from what – the way they normally behave – I mean, that’s something that you want to pay attention to, although that’s kind of non-specific.  I mean, that could be anxiety.  It could be something else.  The things that are very common with kids when they’re experiencing anxiety would be complaining of physical symptoms – stomach aches, headaches – things of that sort.  Things that are especially kind of non-specific.  Also sometimes kids will try to avoid going to school.  Kids will have problems with sleep.  It might be problems falling asleep, staying asleep, nightmares, crying, being more clingy than they normally would be.  And kids can actually act out as a symptom of anxiety.  So sometimes you see it with them being more defiant than they normally would be.

DR. GOTTESFELD:  And sometimes I’m guessing the symptoms that you see don’t necessarily make the parent immediately think anxiety.  They think – for example the acting out – they think oh, that’s bad behavior.  And it might be hard to know that, wait a minute, there’s something else going on.

DR. WHALEY:  Right, exactly or sometimes they think “Oh, there must be something wrong with my child physically.”  And then several trips to the pediatrician and nothing is actually revealed in labs and physical exam.  And then you think, “Huh, okay.  Well, what else might be going on that could explain this?”

DR. GOTTESFELD:  Let me ask you this:  How common do you think anxiety is in kids?

DR. WHALEY:  It depends on what kind of anxiety you’re talking about.  It tends to be a little bit more common in girls as opposed to boys.  But that’s also true in adulthood as well.  It tends to get progressively more common as kids get older.  And it also gets more common depending on sort of circumstances, right?  So children that have been exposed to trauma, neglect, et cetera – it’s much more common than kids who have not been exposed to that sort of thing.  But it’s a moving target, those statistics.

DR. GOTTESFELD:  What are some of the things that cause kids to have anxiety in childhood?

DR. WHALEY:  I think that anxiety in anyone not just children is often caused by some kind of transition — you know, some amount of change.  So for kids, the things that they often experience would be things like going to school for the first time, you know, changing schools, going through puberty and all the things that go along with that and the changes in the body. Divorce, bullying and child abuse.

DR. GOTTESFELD:  I guess one of the things – I wonder about this, I mean, I have this question in my own adult patients. When is it sort of a pathological anxiety?  When is it a diagnostic issue I guess, you know, that someone actually has anxiety versus just sort of overreacting to something or stressing more than they should be?  How do you tell the difference?  I would think in kids it would be hard.

DR. WHALEY:  Well, again, it sort of goes back to, “When it does it start interfering with level of function?”  I mean, that’s really sort of the cut off point.  And to your point there are some people who are just more anxious than the average person, right?  There are people who are less anxious than the average person.  So I mean, we – we’re not all alike, which is one of the fabulous parts about being human, right, is that we have differences, otherwise we’d be really boring.  So the cut off is, is this preventing me from going to school?  Is this preventing me from making friends?  Is this making it difficult for me to be on the debate team, which I really am interested in, but I’m so scared of talking in front of people? Right?  So it comes down to function.

DR. GOTTESFELD:  Interesting.  You know, when you talk to kids about anything really you get a lot of push back or they have black and white thinking or whatever.  It’s not always easy to convince them to eat their vegetables for goodness sakes let alone sort of accept that “Hey, you know what?  Something’s going on.  And we probably need to deal with this.”  How do you have that conversation with a kid? An elementary age child or maybe a high school aged child – how do you talk the kid about what’s going on?

DR. WHALEY:  Talking to them about it and convincing them to do what you want them to do are two sort of different things – though obviously interrelated, right?  I think that the first thing whenever you’re talking to a child is you want to make sure that you’re speaking to them on their developmental level.  So you’re not gonna be able to go to five year old and say you seem anxious.  They’re not gonna really understand what you mean by that.  So you would want to say things like, “Are you worried about anything?  Do you feel stressed out??  You want to use their terms. “Does your tummy hurt more than it normally does?” That’s the first thing is sort of approaching them on their level.  I think you also want to empathize, you know?  Show them that you’re actually listening. Because often times – and this is not just for parents, but for people in general, when we have someone that we care about and they seem to be suffering, we’re often very quick to sort of go to the solution, right?  So this is what you need to do.  I know exactly how to fix this.  And when that happens, often times the person who is talking to us doesn’t feel heard, doesn’t feel listened to, doesn’t feel like we really understand.  And so before you go to solutions you want to say, “Help me understand what you’re going through.  Wow, you must have – that must have really hurt your feelings when she said this to you.”  And then I think it can be helpful to offer to help and ask how you can help as opposed to saying, “This is what we need to do.”  Say, “I’d like to help you.  Would you like some advice?”  And I think that’s a good way to sort of start it out. Obviously there are some situations, for example, in child abuse, where if you’re not gonna just let the child entirely dictate, right?  So you may have to say, “Look, it’s my job as your parent to protect you.  But sometimes in order to do that I’m gonna have to make some decisions for you, right?”  It’s a complicated sort of thing depending on the specific situation. And there’s always people there that can help you if you’re not really sure how to handle it.  A pediatrician is often the first, best person to consult.

DR. GOTTESFELD:  What are some other things that parents can do to help support an anxious child?

DR. WHALEY:  Well, I think the first thing in addition to what we were talking about already with ways to communicate is, you have to look at yourself and your own anxiety.  Anxiety is a tremendously contagious emotion, right?  So it’s very common when the child is anxious for the parent to become anxious or if the parent is anxious for the child to become anxious.  And so when your child is suffering, most parents get anxious.  And so in that moment it’s well worth your while to sort of take a few seconds, take some deep breaths, sort of center yourself, so that you can approach the situation from a place of calm.  And if you’re finding that anxiety is a problem for you in an ongoing way, it might be even worthwhile seeing somebody yourself to sort of get a handle on that because you’ll be much better able to help your child if you’re not putting that anxiety out there.

DR. GOTTESFELD:  Yeah, that’s good advice.  I can imagine difficult for parents, too.  I mean, kids sort of make you face this stuff about yourself, don’t they?

DR. WHALEY:  Absolutely.  Yeah, they bring up stuff, absolutely.

DR. GOTTESFELD:  So let’s just start from the beginning.  If a parent is listening to this and you listed some symptoms and triggers and stuff and they feel like, “You know, I wonder if this is my kid.  I think you’re talking about my kid.”  What should they do?

DR. WHALEY:  So I think the first thing is, you want to gather data.  So talk to your child.  Get a sense from them about how they’re feeling, what’s going on in their life.  It’s okay to talk to their teachers, talk to the guidance counselor at the school.  Have you noticed anything different?  Is there anything going on at school that maybe I should know about?  And if you’re finding out things that are sort of raising those warning flags I would then go to the pediatrician. Because the pediatricians are sort of the experts in what is normal childhood behavior and what is not.  And so they can help you have a sense of how big a problem this is and what the next steps are to take.

DR. GOTTESFELD:  Well, I think if the patients I talk to – my friends, my relatives are any indication – this is a common problem.  So I really appreciate your information.  It’s always great to have you on the show.  And thank you so much for being on with us today.

DR. WHALEY:  My pleasure.


This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.