Coping With Anxiety, Fears, and Phobias
June 9, 2004

Everyone, from the youngest child to the oldest adult, experiences anxieties and fears at one time or another. Feeling anxious in a particularly uncomfortable situation never feels very good. However, with children, such feelings are not only normal, they are also necessary. Experiencing and dealing with anxieties can prepare young people to handle the unsettling experiences and challenging situations of life. Read on to understand the differences between anxieties, fears, and phobias, and how you can help your child deal with them.

Anxieties and Fears Are Normal
Anxiety is defined as "apprehension without apparent cause." It usually occurs when there is no immediate threat to a person's safety or well being, but the threat feels real. Anxiety makes a person want to escape the situation - fast. His heart beats quickly, he may begin to perspire, and "butterflies" in the stomach soon follow. "However," says Katharina Manassis, MD, author of Keys to Parenting Your Anxious Child, "as uncomfortable as it feels, a little bit of anxiety can actually make people perform better because it keeps them alert and focused on what they have to do." Having fears or anxieties about certain things can be helpful too because it makes kids behave in a safe way. For example, a kid with a fear of fire would avoid playing with matches.

The nature of anxieties and fears change as children grow and develop:
o Babies experience stranger anxiety, clinging to parents when confronted by people they don't recognize.
o Toddlers around 10 to 18 months experience separation anxiety, becoming emotionally distressed when one or both parents leave.
o Children ages 2 through 6 have anxiety about things that are not based in reality such as fears of monsters and ghosts.

Kids ages 7 through 12 often have fears that reflect real circumstances that may happen to them, such as bodily injury and natural disaster.
As a child grows, one fear may disappear or replace another; a child who couldn't sleep with the light off at age 5 may enjoy a ghost story at a slumber party years later. And some fears may extend only to one particular kind of stimulus, as in the example of the child who wants to pet a lion at the zoo but wouldn't dream of going near the neighbor's dog.

Recognizing the Signs of Anxiety
Typical childhood fears include fear of strangers, heights, darkness, animals, blood, insects, and being left alone. Children often learn to fear a specific object or situation after having an unpleasant experience, such as a dog bite or an accident. Separation anxiety is common when young children are starting school, whereas adolescents may experience anxiety related to social acceptance and academic achievement.

If anxious feelings persist, they can take a toll on the child's sense of well-being. The anxiety associated with social avoidance, for example, can have long-term effects. "A child who is unable to make friends because she won't dare approach anyone for fear of being rejected can fail to learn important social skills, causing her to become even more isolated," counsels Dr. Manassis.

Many adults are tormented by fears that stem from childhood experiences. An adult's fear of public speaking may be the result of embarrassment in front of his peers many years before. A parent who was bitten by a dog as a child may unconsciously instill a fear of animals in a child by reacting negatively. This is why it is important for parents to recognize and identify the signs and symptoms of their children's anxieties so that fears don't become excessive.

When a child is anxious about something, he may become impulsive or distracted. Nervous movements, such as temporary twitches or problems in getting to sleep and/or staying asleep longer than usual are telltale signs of anxiety. Sweaty hands; accelerated heart rate and breathing; and nausea, headaches, and stomachaches are common. Apart from these signs, parents can usually tell when their child is feeling excessively uneasy about something. Lending a sympathetic ear is always helpful, and sometimes just talking about the fear can help the child move beyond it.

When anxieties and fears persist, problems can arise. As much as a parent hopes the child will grow out of it, the opposite occurs, and the cause of the anxiety looms larger and becomes more prevalent. The anxiety becomes a phobia, or a fear that is extreme, severe, and persistent. A phobia can be very difficult to tolerate, both for the child and those around him, especially if the anxiety-producing stimulus is hard to avoid. But the good news is that unless a child's phobia hinders his everyday ability to function, he will rarely need treatment by a professional because in time the phobia will be resolved.

Focusing on Your Child's Anxieties
When focusing on a child's anxieties, the following questions should be answered honestly: is the child's fear and the behavior he is exhibiting typical for his age?

If the answer to this question is yes, it's a good bet that his fears will resolve before they become serious cause for concern. This is not to say that the anxiety should be discounted or ignored; rather, it should be considered as a factor in the child's normal development. Richard Kingsley, MD, a pediatric psychiatrist, advises, "Many children experience age-appropriate fears, such as being afraid of the dark. Most kids, with some reassurance, and perhaps a night-light, will overcome or outgrow it. However, if they continue to have trouble, or there is anxiety about other things, the intervention may have to be more intensive."

What are the symptoms of the fear? How do they affect my child's personal, social, and academic functioning? If symptoms can be identified and considered in light of the child's everyday activities, adjustments can be made to alleviate some of the stress factors. "Often, however, parents don't pay attention to the child's symptoms," says Dr. Kingsley. "If parents don't recognize the problem, they won't think to do some very simple things, such as helping the child who is afraid of the dark feel more comfortable about falling asleep in a darkened room."

Does the fear seem unreasonable in relation to the reality of the situation? Could it be a sign of a more serious problem? If the child's fear seems out of proportion to the cause of the stress, this may signal the need to seek outside help, such as a counselor, psychiatrist, or psychologist. Dr. Kingsley suggests that parents look for patterns. If an isolated incident is resolved, parents shouldn't make it more significant than it is. "But if a pattern that is persistent or pervasive emerges, then you really do need to intervene," he advises. "If you don't, the phobia will impact a child over time. Your child's doctor can be consulted, as can a mental health professional who has expertise in working with children and adolescents."

How to Help Your Anxious Child
Parents can help children develop the skills and confidence to overcome fears so that they don't evolve into phobic reactions. The following steps will guide you in helping your child deal with his fears and anxieties.

Recognize that the fear is real. As trivial as a fear may seem, it feels real to the child and it is causing him to feel anxious and afraid. "Being able to talk about fears can help," Dr. Manassis says. "Words often take some of the power out of emotion; if you can give the fear a name it becomes more manageable. As with any negative feeling, the more you talk about it, the more it becomes less powerful."

Never belittle the fear as a way of forcing the child to overcome it. Telling a child, "Don't be ridiculous! There are no monsters in your closet!" may get him to go to bed, but it won't make the fear go away.

However, don't cater to fears. If your child doesn't like dogs, don't cross the street deliberately to avoid one. This will reinforce that dogs should be feared and avoided.

Teach the child how to rate fear. If your child can visualize the intensity of the fear on a scale of 1 to 10, with 10 being the strongest, he may be able to "see" the fear as less intense than first imagined. Younger children can think about how "full of fear" they are, with being full "up to my knees" as not so scared, "up to my stomach" as more frightened, and "up to my head" as truly petrified.

Teach coping strategies. Try these easy-to-implement techniques. Using you as "home base," the child can venture out toward the feared object, and then return to you for safety before venturing out again. The child can also learn some positive self-statements, such as "I can do this" and "I will be OK," which he can say to himself when he feels anxious. Relaxation techniques are helpful as well, including visualization (of floating on a cloud or lying on a beach, for example) and deep breathing (imagining that the lungs are balloons and letting them slowly deflate).

The key to resolving fears and anxieties is to overcome them. Using these suggestions, you can help your child better cope with life's situations.