Just like adults, children and young people feel worried and anxious at times.

But if your child’s anxiety is starting to affect their wellbeing, they may need some help to overcome it.

What makes children anxious?

Children tend to feel anxious about different things at different ages. Many of these worries are a normal part of growing up.

• From about eight months to three years, for example, it’s very common for young children to have something called separation anxiety. They may become clingy and cry when separated from their parents or carers. This is a normal stage in children’s development and tends to ease off at around age two to three.
• It’s also common for pre-school children to develop specific fears or phobias. Common fears in early childhood include animals, insects, storms, heights, water, blood, and the dark. These fears usually go away gradually on their own.

Throughout a child’s life there will be other times when they feel anxiety. Lots of children feel anxious when going to a new school, for example, or before tests and exams. Some children feel shy in social situations and may need support with this.

When is anxiety a problem for children?

Anxiety becomes a problem for children when it starts to get in the way of their day-to-day life.

“We all get anxious at times, but some children seem to live a life of anxiety, where it’s not short-term and it’s not just an occasional thing,” says Paul Stallard, Professor of Child and Family Mental Health at the University of Bath.

“For example, if you go into any school at exam time all the kids will be anxious but some may be so anxious that they don’t get into school that morning,” says Professor Stallard.

Severe anxiety like this can harm children’s mental and emotional wellbeing, affecting their self-esteem and confidence. They may become withdrawn and go to great lengths to avoid things or situations that make them feel anxious.

What are the signs of anxiety in children?

When young children feel anxious, they cannot always understand or express what they are feeling. You may notice that they:

• become irritable, tearful or clingy
• have difficulty sleeping
• wake in the night
• start wetting the bed
• have bad dreams

In older children you may notice that they:

• lack the confidence to try new things or seem unable to face simple, everyday challenges
• find it hard to concentrate
• have problems with sleeping or eating
• are prone to angry outbursts
• have negative thoughts going round and round their head, or keep thinking that bad things are going to happen
• start avoiding everyday activities, such as seeing friends, going out in public or attending school

See more about the physical symptoms of anxiety.

Why is my child anxious?

Some children are more prone to worries and anxiety than others.

• Children often find change difficult and may become anxious following a house move or when starting a new school.
• Children who have had a distressing or traumatic experience, such as a car accident or house fire, may suffer with anxiety afterwards.
• Family arguments and conflict can also leave children feeling insecure and anxious.
• Teenagers are more likely to suffer with social anxiety than other age groups, avoiding social gatherings or making excuses to get out of them.

Read more about social anxiety.

How to help your anxious child

If a child is experiencing anxiety, there is plenty parents and carers (*caregivers) can do to help.

• First and foremost, it’s important to talk to your child about their anxiety or worries. Reassure them and show them you understand how they feel.
• If your child is old enough, it may help to explain what anxiety is and the physical effects it has on our bodies. It may be helpful to describe anxiety as being like a wave that builds up and then ebbs away again.

As well as talking to your child about their worries and anxieties, it’s important to help them find solutions, says Professor Stallard.

• “The tendency is to say, if you’re worried about that sleepover, don’t go,” he says. “But what you’re doing is saying, if you get anxious about something, it means you can’t do it.
• “It’s more helpful to say, ‘I hear that you’re worried about this. What can you do that’s going to help?’,” says Professor Stallard. “Focus on exploring solutions with your child, instead of just talking about all the things that could go wrong.”

Other ways to ease anxiety in children

• Teach your child to recognise signs of anxiety in themselves and to ask for help when it strikes.
• Children of all ages find routines reassuring so try to stick to regular daily routines where possible.
• If your child is anxious because of distressing events, such as a bereavement or separation, see if you can find books or films that will help them understand their feelings.
• If you know a change, such as a house move is coming up, prepare your child by talking to them about what is going to happen and why.
• Try not to become anxious yourself or overprotective – rather than doing things for your child or helping them to avoid anxiety-provoking situations, encourage your child to find ways to manage them.
• Practice simple relaxation techniques with your child, such as taking three deep, slow breaths, breathing in for a count of three and out for three. You’ll find more relaxation techniques for children on the Moodcafe website.
• Distraction can be helpful for young children. For example, if they are anxious about going to nursery, play games on the way there, such as seeing who can spot the most red cars.
• Turn an old tissue box into a “worry” box. Get your child to write down or draw their worries and post them into the box. Then you can sort through the box together at the end of the day or week.

When should we get help?

If your child’s anxiety is severe, persists and interferes with their everyday life, it’s a good idea to get some help.

• A visit to your GP (doctor) is a good place to start. If your child’s anxiety is affecting their school life, it’s a good idea to talk to their school as well.
• Parents and carers in the UK** can get help and advice around children’s mental health from Young Minds’ free parent helpline on 0808 802 5544 (Monday to Friday, 9.30am-4pm).

Read more about treating childhood anxiety.

Editor’s Note:  

* Clarification Provided for our U.S. Readers

** Resources Outside the UK:

• Child Mind Institute: an independent, US nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders
• Association for Children’s Mental Health: ACMH provides information, support, resources, referral and advocacy for children and youth with mental, emotional, or behavioral disorders and their families.

Symptoms of BDD

You might have BDD if you:

• worry a lot about a specific area of your body (particularly your face)
• spend a lot of time comparing your looks with other people’s
• look at yourself in mirrors a lot or avoid mirrors altogether
• go to a lot of effort to conceal flaws – for example, by spending a long time combing your hair, applying make-up or choosing clothes
• pick at your skin to make it “smooth”

BDD can seriously affect your daily life, including your work, social life and relationships. BDD can also lead to depression, self-harm and even thoughts of suicide.

Getting help for BDD

You should visit your GP (*doctor) if you think you might have BDD.

They will probably ask a number of questions about your symptoms and how they affect your life. They may also ask if you have had any thoughts about harming yourself.

Your GP may refer you to a mental health specialist for further assessment and treatment, or you may be treated through your GP.

It can be very difficult to seek help for BDD, but it’s important to remember that you have nothing to feel ashamed or embarrassed about. Seeking help is important because your symptoms probably won’t go away without treatment and may get worse.

Treatments for BDD

The symptoms of BDD can get better with treatment.

• if you have relatively mild symptoms of BDD you should be referred for a type of talking therapy called cognitive behavioural therapy (CBT), which you have either on your own or in a group
• if you have moderate symptoms of BDD you should be offered either CBT or a type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI)
• if you have more severe symptoms of BDD, or other treatments don’t work, you should be offered CBT together with an SSRI

1. Cognitive behavioural therapy (CBT)

CBT can help you manage your BDD symptoms by changing the way you think and behave. It helps you learn what triggers your symptoms, and teaches you different ways of thinking about and dealing with your habits. You and your therapist will agree on goals for the therapy and work together to try to reach them.

CBT for treating BDD will usually include a technique known as exposure and response prevention (ERP). This involves gradually facing situations that would normally make you think obsessively about your appearance and feel anxious. Your therapist will help you to find other ways of dealing with your feelings in these situations so that, over time, you become able to deal with them without feeling self-conscious or afraid.

You may also be given some self-help information to read at home and your CBT might involve group work, depending on your symptoms.

CBT for children and young people will usually also involve their family members or carers.

2. Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant. There are a number of different SSRIs, but the one most commonly used to treat BDD is called fluoxetine.

It may take up to 12 weeks for SSRIs to have an effect on your BDD symptoms. If they work for you, you will probably be asked to keep taking them for several months to improve your symptoms further and stop them coming back.

There are some common side effects of taking SSRIs, but these will often pass within a few weeks. Your doctor will keep a close eye on you over the first few weeks. It’s important to tell them if you’re feeling particularly anxious or emotional, or are having thoughts of harming yourself.

If you are no longer having any symptoms, you will probably be taken off SSRIs. This will be done by slowly reducing your dose over time to help make sure your symptoms don’t come back (relapse) and to avoid any side effects of coming off the drug (withdrawal symptoms), such as anxiety.

Adults younger than 30 will need to be carefully monitored when taking SSRIs as they may have a higher chance of developing suicidal thoughts or trying to hurt themselves in the early stages of treatment.

Children and young people may be offered an SSRI if they are having severe symptoms of BDD. Medication should only be suggested after they have seen a psychiatrist and been offered therapy.

3. Further treatment

If treatment with both CBT and an SSRI has not improved your BDD symptoms after 12 weeks, you may be prescribed a different type of SSRI or another antidepressant called clomipramine.

If you don’t see any improvements in your symptoms, you may be referred to a mental health clinic or hospital that specialises in BDD, such as the National OCD/BDD Service in London**.

These services will probably do a more in-depth assessment of your BDD. They may offer you more CBT or a different kind of therapy, as well as a different kind of antidepressant.

Causes of BDD

We don’t know exactly what causes BDD, but it might be associated with:

• genetics – you may be more likely to develop BDD if you have a relative with BDD, obsessive compulsive disorder (OCD) or depression
• a chemical imbalance in the brain
• a traumatic experience in the past – you may be more likely to develop BDD if you were teased, bullied or abused when you were a child

Some people with BDD also have another mental health condition, such as OCD, generalised anxiety disorder or an eating disorder.

Things you can try yourself

1. Support groups for BDD

Some people may find it helpful to contact or join a support group for information, advice and practical tips on coping with BDD.

You can ask your doctor if there are any groups in your area, and the BDD Foundation** has a (UK based) directory of local and online BDD support groups**.

You may also find the following (UK based)** organisations to be useful sources of information and advice:

• Anxiety UK
• International OCD Foundation
• Mind
• OCD Action
• OCD UK

2. Mental wellbeing

Practising mindfulness exercises may help you if you’re feeling low or anxious.

Some people also find it helpful to get together with friends or family, or to try doing something new to improve their mental wellbeing.

It may also be helpful to try some relaxation and breathing exercises to relieve stress and anxiety.