How to Recognize Anxiety and Help Your Anxious Child
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 They may become withdrawn and go to great lengths to avoid things or situations that make them feel anxious.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.
From www.nhs.uk
>
My Twins are Behind in Talking…How Can I Help?
On average, twins are about six months behind single babies in their language development.
Twins may be slower to pick up speech and language skills because:
twins tend to receive less attention in shorter bursts than single babies- parents often speak to one twin while looking at the other, but children need eye contact to help their language development
- twins tend to spend more time with each other, so they pick up each other’s speech rather than that of adults and older children around them
- twins have less time to practise speech as they compete to get themselves heard
- sometimes one twin may answer for the other
Don’t worry if your twins seem to be slow to speak. Just try to make sure they have plenty of time to talk and express themselves.
Talking to twin babies
Nappy changes can be a good opportunity to give twins one-on-one attention. You could bathe each baby separately to give you time to chat with them individually.
You can also:
- turn off the TV and radio for at least 30 minutes each day, so your babies can listen to the noises around them with no distractions
- listen to your babies and respond to them as they experiment with different sounds
- try to play and read books with your babies individually; make time to talk to your babies individually each day, using their name and making eye contact
- encourage older siblings, friends and family to talk to your babies one to one
Read more about how to encourage language skills in children.
Twins & Multiple Births Association (Tamba) has information about twins and language. Tamba also has a free (in the UK) telephone helpline. Twinline** is open every day from 10am to 1pm and 7pm to 10pm on 0800 138 0509.
Talk to your GP (*doctor) or health visitor if you’re concerned about your children’s language skills.
Editor’s Note:
* Clarification Provided for our U.S. Readers
** Resources Outside the UK:
- Multiples of America: US non-profit providing information, research studies and clubs throughout the U.S. for multiple birth families (and families-to-be)
From www.nhs.uk
How Can I Avoid Food Poisoning During Pregnancy?
You can avoid food poisoning during pregnancy by:
not eating some foods – see foods to avoid during pregnancy- washing your hands before handling food
- thoroughly washing all fruit and vegetables, including prepared salads, before eating
- washing your hands, all surfaces and utensils after preparing raw meat
- thoroughly cooking raw meat so there is no trace of pink or blood
- heating ready meals (*pre-packaged meals) until they are piping hot all the way through – this is especially important for meals containing poultry
- keeping leftovers covered in the fridge and using them within 2 days
- eating food before it has passed its “use by” date
- preventing cross-contamination (when harmful bacteria is spread between food, surfaces and equipment)
There are several types of bacteria that can cause food poisoning. These include:
- salmonella
- campylobacter
- listeria
Salmonella
Salmonella is found in:
- raw meat and poultry
- unpasteurised milk
- raw eggs and raw egg products
Although salmonella food poisoning is unlikely to harm your baby, it can cause severe diarrhoea and vomiting.
To reduce your risk of salmonella infection:
- choose British Lion Code of Practice eggs (in the UK) if you want to have raw or partially cooked eggs – these eggs have a red lion logo stamped on their shell and are considered safe to eat runny
- avoid raw or partially cooked eggs that are not part of the lion code, and avoid food that may contain them, such as homemade mayonnaise – cook these eggs until the whites and yolks are solid
- avoid raw or partially cooked meat, especially poultry
Campylobacter
Campylobacter is found in:
- raw and undercooked meat, especially poultry
- unpasteurised milk
- untreated water
You can reduce your risk of campylobacter infection by:
- washing your hands thoroughly before preparing and eating food, and after handling raw food
- not washing raw poultry
- keeping cooked food away from raw food
- cooking food thoroughly, especially meat and poultry, so it’s piping hot
- keeping all kitchen surfaces and equipment clean, such as chopping boards and dish cloths
- not drinking untreated water from lakes, rivers or streams
Listeria
Listeria can cause an infection called listeriosis. Although the infection is rare, even a mild form of listeriosis in a pregnant woman can lead to miscarriage, stillbirth or severe illness in newborn babies.
Listeria can be found in unpasteurised milk and in many chilled foods, including:
- pâté
- mould-ripened soft cheeses and soft blue-veined cheeses
- cooked sliced meats
- smoked salmon
You can reduce your risk of listeriosis by:
- not eating certain foods while pregnant, such as some soft cheeses and all types of pâté – see foods to avoid during pregnancy
- not drinking unpasteurised milk – only drink pasteurised or UHT milk
- heating ready meals or reheated food until they’re piping hot all the way through
- making sure your fridge is set at 5C or below and working correctly
- not using food after its “use by” date
Read the answers to more questions about pregnancy.
Further information:
- Why can’t I eat soft cheeses during pregnancy?
- Should I limit caffeine during pregnancy?
- Listeriosis
- Food safety
- Have a healthy diet in pregnancy
- Foods to avoid during pregnancy
Editor’s Note:
* Clarification Provided for our U.S. Readers
From www.nhs.uk
Mirror, Mirror on the Wall – The Kid I See Is Not Me At All
Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.
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:
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.
Editor’s Note:
* Clarification Provided for our U.S. Readers
** Resources Outside the UK:
- IOCDF – Non-Profit Foundation- provides information and support for individuals with OCD and BDD – link is specific to teens and young adults
- Local US Resources for Body Dismorphic Disorder – list of top 1000 cities
- Anxiety and Depression Association of America – online support groups for BDD
From www.nhs.uk
>
How To Manage Atopic Eczema – An Itchy, Scaly Children’s Rash
Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, red, dry and cracked.
Atopic eczema is more common in children, often developing before their first birthday.
However, it may also develop for the first time in adults. It’s usually a long-term (chronic) condition, although it can improve significantly, or even clear completely, in some children as they get older.
Symptoms of atopic eczema
Atopic eczema causes the skin to become itchy, dry, cracked, sore and red. Some people only have small patches of dry skin, but others may experience widespread red, inflamed skin all over the body.
Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.
People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups).
Read about the symptoms of atopic eczema
When to seek medical advice
See your GP (*physician) if you have symptoms of atopic eczema. They’ll usually be able to diagnose atopic eczema by looking at your skin and asking questions such as:
- whether the rash is itchy and where it appears
- when the symptoms first began
- whether it comes and goes over time
- whether there’s a history of atopic eczema in your family
- whether you have any other conditions, such as allergies or asthma
- whether something in your diet or lifestyle may be contributing to your symptoms
Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and three or more of the following:
- visibly irritated red skin in the creases of your skin – such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional
- a history of skin irritation occurring in the same areas mentioned above
- generally dry skin in the last 12 months
- a history of asthma or hay fever – children under four must have an immediate relative, such as a parent, brother or sister, who has one of these conditions
- the condition started before the age of two (this does not apply to children under the age of four)
Causes of atopic eczema
The exact cause of atopic eczema is unknown, but it’s clear it is not down to one single thing. Atopic eczema often occurs in people who get allergies – “atopic” means sensitivity to allergens.
It can run in families, and often develops alongside other conditions, such as asthma and hay fever.
The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema.
You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. Allergy tests aren’t usually needed, although they’re sometimes helpful in identifying whether a food allergy may be triggering symptoms.
Read about the causes of atopic eczema.
Treating atopic eczema
Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time.
However, there’s currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally. There’s also an increased risk of skin infections.
Many different treatments can be used to control symptoms and manage eczema, including:
- self care techniques, such as reducing scratching and avoiding triggers
- emollients (moisturising treatments) – used on a daily basis for dry skin
- topical corticosteroids – used to reduce swelling, redness and itching during flare-ups
Read about treating atopic eczema and complications of atopic eczema.
Other types of eczema
Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:
- discoid eczema – a type of eczema that occurs in circular or oval patches on the skin
- contact dermatitis – a type of eczema that occurs when the body comes into contact with a particular substance
- varicose eczema – a type of eczema that most often affects the lower legs and is caused by problems with the flow of blood through the leg veins
- seborrhoeic eczema – a type of eczema where red, scaly patches develop on the sides of the nose, eyebrows, ears and scalp
- dyshidrotic eczema (pompholyx) – a type of eczema that causes tiny blisters to erupt across the palms of the hands
Editor’s Note:
* Clarification Provided for our U.S. Readers
From www.nhs.uk
>
Study: Bath Oils for Childhood Eczema Provide No Medical Benefit
“Bath oils used to help treat eczema in children offer no meaningful benefit as part of their care, a trial has found,” reports BBC News.
Childhood eczema, also known as atopic eczema, is a common condition that causes redness and soreness of the skin. Treatments include using moisturisers (emollients), which have been shown to work, and using emollients as soap substitutes in the bath or shower.
However, until now, there has been little evidence for a third type of treatment: adding emollient additives to baths.
In the first big study of its kind, researchers found commonly prescribed emollient bath additives – designed to be added to bathwater and leave a thin layer over the skin – made little difference to children’s eczema symptoms.
The study, carried out in England and Wales, involved 483 children aged 1 to 11 years. Half were randomly assigned to use bath additives regularly for a year – in addition to their usual treatments, including standard leave-on emollients – while the other half did not use them.
The results showed that bath additives made too small a difference to symptoms to be considered clinically important.
Find out more about treating childhood eczema.
Where did the story come from?
The study was commissioned by the UK National Institute for Health Research as part of a programme to investigate which treatments are effective and provide value for money, and carried out by researchers from Cardiff University, the University of Bristol, the University of Southampton and the University of Nottingham.
It was published in the peer-reviewed British Medical Journal and is free to read online.
The UK media reports were generally accurate and balanced.
What kind of research was this?
This was a randomised controlled trial, which is often the best way to investigate whether a treatment works.
To make results more accurate, many trials like this use a dummy treatment (placebo) so that patients don’t know if they are receiving the real treatment. However, in this case, the researchers decided they could not make a convincing placebo for emollient bath additives so did not include one in the study.
What did the research involve?
Researchers used records from 96 general practices in Wales, south England and west England to identify children diagnosed with eczema. The children’s parents or carers were then contacted and invited to take part.
After screening, half the children were prescribed bath emollient additives for a year and the other half were asked not to use them. Most of the experimental group were prescribed Oilatum, Balneum or Aveeno bath products.
All children continued their usual eczema treatments, which included using emollients as creams and soap substitutes, and using steroid creams where needed.
Parents or carers recorded children’s eczema symptoms – weekly for the first 16 weeks and then monthly for a year – using the standard patient oriented eczema measure (POEM). In children, this is usually assessed on how severe parents or guardians think a child’s eczema is.
POEM gives a score of 0 to 28, with 0 to 7 being no or mild eczema, 8 to 16 moderate eczema and 17 to 28 severe eczema. A drop of 3 points on the scale is considered enough to represent a clinically meaningful improvement in symptoms.
The parents or carers also recorded how often the children bathed and how often they used the bath emollient additives.
The researchers compared symptom scores for the 2 groups, adjusting for eczema severity at the start of the study, use of steroid creams and soap substitutes, and ethnic group.
What were the basic results?
The average symptom score at the start of the study was 9.5 in the bath-additives group and 10.1 in the no-bath-additives group, meaning most children had moderate eczema.
Over 16 weeks, the average symptom score was:
- 7.5 in the bath-additives group
- 8.4 in the no-bath-additives group
After controlling for confounding factors, such as use of other eczema medication, the average symptom score was 0.41 points lower in the bath-additives group (95% confidence interval [CI]-2.7 to +1.10). This was not a statistically significant difference and was well below the 3-point difference considered to be clinically important.
The researchers also looked at subgroups to see if any particular group of children were more likely to benefit from the bath additives. While they did find some effect for children under 5 years old, it still did not reach the 3-point threshold.
They did find a possibly clinically meaningful benefit for children who bathed 5 times or more a week (2.27-point improvement, 95% CI 0.63 to 3.91), but this analysis was based on fewer children, making it less reliable.
How did the researchers interpret the results?
The researchers said the trial “provides strong evidence that emollient bath additives provide minimal or no additional benefit beyond standard eczema care in the management of eczema in children”.
Conclusion
The study shows that bath emollient additives may not be a useful part of eczema care for children.
But it’s important to be clear this does not apply to the use of leave-on emollient creams and lotions, or to the use of emollients instead of soap. There’s evidence that leave-on emollient creams work, and doctors agree using emollients instead of soap is helpful.
This study’s results only apply to emollient products added to the bathwater. If you’re not sure of the difference, speak to a pharmacist or your GP.
If your child has been prescribed bath emollient additives and is happy with them, there’s no reason to stop using them. The study found no increased risk of side effects – such as slipping in the bath, soreness or redness – among children who used them.
However, they may not make much difference to your child’s eczema, and it’s possible the NHS may decide to recommend that doctors stop prescribing these products in future.
The study was well conducted but had a few limitations, the main one being that, unusually for research of this type, there was no placebo. Placebos are normally included to control for the placebo effect – where people tend to feel better if they are taking a treatment because they expect it to work.
However, in this case, people that did receive the bath additives did not report symptoms significantly different from those not using the additives, which suggests the placebo effect did not have much influence in this study.
The study looked at lots of subgroups among the 483 children to see if any showed different results. However, this increases the likelihood that some of the results are due to chance.
We therefore cannot put too much stock in the finding that children bathing 5 times or more a week may get some benefit from emollient bath additives, as this analysis included just 143 children.
If your child isn’t responding well to a particular treatment for eczema, there are other treatments that may be more effective. Find out more about treating childhood eczema.
From www.nhs.uk
