“Mommy, There’s a monster under my bed!”; “I saw a man by the window”; …Fears such as these are common and predictable during a child’s development, according to Joanna Kleovoulou, clinical psychologist and founder of PsychMatters Centre®, who says these fearful tendencies are hard-wired and appear to have a purpose.
“Infants, for example, commonly show a fearful response to the sudden loss of physical support or to loud noises, while toddlers who start to walk on their own often have a fear of animals,” she says. “Both of these are adaptive responses.”
Another example of adaptive fear and an indication for developing a healthy attachment in a young child is when they feel hesitant when separating from their carer.
In older children, Joanna adds, “performance anxiety can appear as their sense of esteem is related to how well they do, while anxiety related to social consciousness can occur in adolescence given that they are invested in belonging to a peer group.”
In most cases, these fears tend to disappear over time and are transient occurrences, says Joanna. But for some children, these fears persist and can develop into full-blown anxiety disorders which affect their daily functioning.
Why are our children so anxious?
Approximately 11% of children suffer from anxiety, which affects their ability to get on with their lives. But this is most likely on the increase as children are super aware of the goings-on around them such as the coronavirus and sanitisation. “In South Africa, children as young as the age of 3 can suffer from an anxiety disorder. Since many parents are unaware of this, and therefore don’t reach out for help, the statistics may be much higher.”
There are many contributing factors to childhood anxiety. These include:
- Prenatal or birth trauma (for example, low birth weight, extended time in medical care, foetal alcohol syndrome), and adoptive and foster care circumstances.
- Poor family modelling, which significantly affects children’s sense of security. Ineffective disciplinary methods such as using control and threats can make your child anxious as will the constant fighting between parents, an ill parent, a recent divorce between parents or a death of a significant person.
- Issues with peers such as rejection, bullying and not coping with the academic load.
- The violent crimes families and schools are subjected to in our country (as well as the current Covid-19 pandemic), which can also trigger hypervigilance and a lack of personal and psychological safety in our children.
- The constant negativity in the media and on social media platforms highlighting child kidnappings and economic disasters.
What to look out for
Untreated anxiety takes its toll on normal developmental progress in children and adolescents. It can potentially impact a number of domains, explains specialist child and adolescent psychiatrist Dr Wendy Duncan. “These include social integration (such as making friends), attending social arrangements, school attendance, classroom participation and academic progress, willingness to engage in age-appropriate physical activities, involvement in extra-murals and family functioning.”
Without intervention, Dr Duncan says, ongoing anxiety can result in the future risk of anxiety disorders and depression, illicit drug dependence, educational under-achievement and possible suicide attempts. That’s why, adds Joanna, it’s so important to deal with anxiety as soon as it manifests.
Symptoms of anxiety in children include:
- Struggling to sleep, or disturbed sleep (nightmares, sleep talking, sleep walking)
- Teeth grinding
- Change in eating
- Concentration difficulties
- Refusing to go to school
- Whining and cries easily
- Irritability and outbursts
- Negative thoughts and worries
- Physiological complaints without medical evidence (tummy aches, headaches, nausea)
- Hair/nail pulling
- Skin picking.
How to help your child
There are many ways you can help your child develop the skills and confidence to overcome fears so they don’t evolve into phobic reactions. Joanna advises the following:
- Acknowledge the fear is real. Even if it seems irrational to you, it feels real to your child and is making them afraid. Being able to talk about their fears does help as words often take some of the power out of the negative feeling.
- Never belittle the fear as a way of forcing your child to overcome it. Saying, “Don’t be a baby!” or “There’s no such thing as monsters!” may get your child to go to bed, but it will not make the fear disappear. As a result, your child may not reach out to you for help the next time.
- Teach your child how to rate fear. If your child can visualise the intensity of the fear on a scale of 1 to 10, with 10 being the strongest, they may be able to “see” the fear as less intense than first imagined. Younger children can think about how “full of fear” they are – being full “up to my knees” as not so scared, “up to my stomach” as more frightened, and “up to my head” as truly terrified.
- Role model courage as a parent and share your own experiences of overcoming fears.
- Teach your child to say positive self-statements such as “I can do this” and “I will be OK” when feeling anxious.
- Check out natural remedies which may help (ask your homeopath or pharmacist for advice).
- Seek professional help.
Going the professional route
The key to resolving anxieties is to overcome them, says Joanna, which is why it’s so important for your child to learn how to cope with life’s situations. “Your first port of call should be a psychologist with a special interest in children and will teach your child coping skills and relaxation techniques,” says Joanna.
She explains that play therapy is used for younger children. “This involves getting children to express their feelings indirectly by playing with toys, making up stories and drawing. The therapist then analyses these activities and encourages resolution and insight through further play.”
In older children, Joanna says cognitive behaviour therapy with exposure techniques and social skills training and relaxation therapy have been scientifically proven to be effective. Your psychologist may also refer you to a paediatric psychiatrist to explore what medical options are available.
Should you medicate?
Any form of medical intervention involves a holistic treatment plan, says Dr Duncan. “Each child needs to be individually understood and managed according to their needs with treatment including psychological, scholastic, social and family interventions and involving a number of different professionals. However, before embarking on any specific treatment for anxiety, all co-occurring problems such as ADHD, learning difficulties and sensory issues need to be addressed.”
The most robustly studied medications for childhood-onset anxiety disorders are the SSRIs (selective serotonin reuptake inhibitors), Dr Duncan explains. “These include medications such as fluoxetine, sertraline, citalopram and escitalopram. There’s another group of medications that have also been shown to be useful – the SNRIs (serotonin noradrenaline reuptake inhibitors). These medications include venlafaxine and duoloxetine and are often only used when treatment with one or more SSRIs hasn’t been successful. The old clinical adage of ‘start low and go slow’ applies to treatment with an SSRI, so it’s initiated at a low dose and slowly built up according to each individual child’s clinical response and tolerance of the medication.”
While there’s clear scientific medical evidence to show that medication treatments for anxiety are safe and generally well-tolerated, Dr Duncan confirms it’s often quite alarming for parents to contemplate giving their children medication to help them to cope. “That’s why it’s so important to discuss the pros and cons of the medication with your doctor,” he says.
- Modern medications for anxiety are highly effective.
- Medications sometimes help the child in taking on the more challenging aspects of treatment.
- Medications have been shown to prevent expanding difficulties with anxiety and to reduce the likelihood of later onset mood disorders.
- Side effects such as tummy discomfort, headaches and edginess do still occur, especially early on when treatment with SSRIs is started.
- The long-term impact of medications on the developing brain is still not known.
- There are limited medication options available and it’s sometimes difficult to ensure a “good fit” between patient and medication.
- There’s no magic bullet or overnight result when it comes to medication – getting the balance right takes time and regular monitoring while the dosage is tweaked or changed according to your child’s needs. And while there’s no clear research on how long your child should remain on medication, says Dr Duncan, current wisdom suggests that 6 months to a year of treatment should ensure remission in most children.
More about the experts:
Joanna Kleovoulou is a registered clinical psychologist, workshop facilitator, speaker and founder of PsychMatters Centre™ in Johannesburg. She is passionate about empowering both children and adults to live their lives more masterfully. Her areas of clinical interest include play therapy, individual and couples counselling and through workshops, addressing a wide range of psychiatric disorders such as trauma, bereavement/loss, depression, anxiety disorders, self-esteem and stress at all ages. Learn more about Joanna Kleavoulou here.
Dr Wendy Duncan is a child and adolescent psychiatrist in private practice in Johannesburg. She is the immediate past-president of the SA-ACAPAP (South African Association of Child and Adolescent Psychiatry and Allied Professions) and has been actively involved in SA-ACAPAP and the South African Society of Psychiatry for several years. Dr Duncan has a special interest in early life trauma, childhood-onset anxiety and affect-regulation difficulties in children and adolescents. Learn more about Dr Wendy Duncan here.
Lynne is a freelance journalist and content writer who has worked in the
magazine industry for many years. A regular contributor to Living & Loving,
her main passions are people and health. She holds the Pfizer Mental Health
Journalism award for 2012/2013 and specializes in lifestyle and wellness
topics for both the print and digital worlds.