When to Worry About Your Child's Worrying

By LAURA PIERCE, Tufts Medical Center Staff

Anxiety is a normal part of childhood and every child goes through phases of worry.  However, according to a 2016 report by the Child Mind Institute, mental health disorders are the most common health issues faced by our nation's school-aged children. One in five children suffers from a mental health or learning disorder, and 80 percent of chronic mental disorders begin in childhood.

These numbers come as no surprise to Christopher Bellonci,MD, a child psychiatrist at Floating Hospital for Children at Tufts Medical Center, who receives multiple calls each week concerning different children suffering from moderate to severe anxiety.

"Anxiety is very prominent among the behavioral health disorders of children, right up there with ADHD; kids can develop really crippling worries – from friendship worries to complete fear of spiders to fear of dying," says Dr. Bellonci. "The worries truly range and it can often be difficult to diagnose because of how it is exhibited in children; parents and pediatricians need to know the warning signs."

Worry Warning Signs

For school-age children, anxiety often manifests through bodily ailments – so a tummy ache or complaint of a headache can often be worry masked as physical pain, Dr. Bellonci says. Understandably, children are unable to interpret the difference and that can lead parents to endless trips to pediatrician appointments searching for a physical diagnosis.

"If your child is complaining of stomach pain or other physical ailments and they have been cleared of anything serious physically, talk with them about any issues they may be having at school – with friends, with school work," notes Dr. Bellonci. "Notice if a new phobia has popped up; take a look at recent grades. Oftentimes, it's not until you look at the entire picture that both you and your child realize they may be extremely anxious."

In addition to physical symptoms, other signs to look out for include excessive tantrums and meltdowns, panic attacks, severe shyness or holding back and not participating in activities they once enjoyed.

"A child can become functionally impaired and so worried that he doesn't want to be a part of what he once loved," says Dr. Bellonci. "The worry and anxiety creates a pattern of avoiding situations that make them anxious – and then a cycle begins."

Getting Help

So then what?  When a child's symptoms become problematic for the child and they are unable to perform day-to-day activities and/or the anxiety is affecting the entire family unit, it's time to seek further help.

"At the heart of anxiety is how functional the child continues to be," notes Dr. Bellonci. "There is a reasonable amount of anxiety that we should have, it's part of how we as humans cope with predators and dangers, but just like an autoimmune disorder, anxiety disorders are the body's instinct running rampant and out of control."

A good place to start, he says, is with a trip to your child's pediatrician or their school counselor to discuss their symptoms. It's also very important that parents realize they may play a role in their child's anxiety.

"Parents often aren't aware of this, but you can actually make worrying more intense for your child if you are constantly reassuring them – this creates a cycle where the child is dependent on the parent rather than developing healthy coping mechanisms like deep breathing and positive self-talk," Dr. Bellonci says.

The good news is that there is a very high success rate in treating children with anxiety disorders, notes Dr. Bellonci.  Today's standard of care starts with most children entering into cognitive behavioral therapy, a type of therapy that helps a young person challenge what is irrational about their worrying and anxiety.  This type of treatment can be adapted to a child's age.

For more severe cases, medications may be a more effective treatment and can help lessen the symptoms.

"The medications used to treat anxiety in children have been effectively and safely used for more than 20 years in both adults and children," remarks Dr. Bellonci.  "They are very well tolerated in children and the goal would be to keep them on a medication for six to 12 months in collaboration with CBT therapy; then slowly wean them off the medication."

In addition to getting their child professional help, parents should also be supportive, nonjudgmental and loving.

"A child's anxiety can be quite challenging and frustrating for the whole family to deal with," notes Dr. Bellonci. "But it's important to be patient and positive as your child works through it.  Remember, the overall goal is not to help children eliminate anxiety, rather help them to manage and tolerate anxiety's uncomfortable feelings – physical and emotional.  They can learn to face the future in a more present and relaxed manner."

The above content is provided for educational purposes by Tufts Medical Center. It is free for educational use. For information about your own health, contact your physician.

Posted May 2017