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pediatric-behavioral

Anxiety in Children: What It Can Look Like and When to Seek Help

Anxiety affects roughly 1 in 9 children in the US. It ranges from normal developmental fears to impairing worry that interferes with school and friendships. A pediatrician is a good first call when anxiety seems to be getting in the way.

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Dr. Lena Park — Pediatric NP

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What childhood anxiety commonly looks like

Anxiety in children shows up differently depending on age and the type of anxiety. Common presentations include: persistent stomachaches or headaches before school or social events (children often express anxiety through physical symptoms 1), frequent reassurance-seeking, avoidance of feared situations, sleep difficulties or nighttime fears, irritability or meltdowns triggered by worry, rigid thinking about unlikely worst-case scenarios, and school refusal. Younger children may cling excessively or have separation meltdowns well beyond typical developmental stages. Older children and teens may withdraw, become perfectionistic, or avoid extracurriculars.

Normal fear vs. anxiety worth evaluating

Fear at certain ages is expected and healthy — separation anxiety in toddlers, fear of the dark in preschoolers, worries about performance in school-age children. The line between typical and clinical anxiety generally comes down to three things: intensity (is it out of proportion to the situation?), persistence (does it stay elevated rather than passing?), and impairment (does it prevent the child from doing age-appropriate things like going to school, sleeping alone, or playing with friends?) 2. A pediatrician or child psychologist can help clarify whether what a parent is observing falls within the typical range.

Types of anxiety commonly seen in children

Several distinct anxiety conditions are diagnosed in children. Separation anxiety disorder involves excessive distress at separating from caregivers beyond what is developmentally typical. Generalized anxiety disorder is characterized by widespread, hard-to-control worry about many topics. Social anxiety disorder involves significant fear of social situations or performance. Specific phobias are intense fears of particular things (dogs, vomiting, needles). Selective mutism — not speaking in certain settings, like school — is also classified as an anxiety-related condition. These conditions can overlap, and children can have more than one.

How anxiety in children is typically addressed

Cognitive-behavioral therapy (CBT) is the treatment with the strongest evidence base for childhood anxiety. The landmark Child/Adolescent Anxiety Multimodal Study (CAMS) — a randomized controlled trial of 488 children ages 7–17 — found that combination therapy (CBT plus sertraline) produced an 80% response rate, compared with 60% for CBT alone and 55% for medication alone, all substantially above placebo 3. The American Academy of Pediatrics recommends a stepped-care approach starting with CBT; medication (typically an SSRI) is added for moderate to severe anxiety that does not respond to therapy alone 4. Therapists work with both the child and the family, since parental responses to anxiety can inadvertently reinforce avoidance. School accommodations, parent coaching, and family education are often woven in alongside therapy.

What parents can do at home

Acknowledging a child's feelings without amplifying worry is a consistently recommended approach — validating that something feels scary while conveying confidence that the child can cope. Gradual, supported exposure to feared situations (rather than complete avoidance) is more helpful long-term, though the pace should be guided by a professional when anxiety is significant. Predictable routines, adequate sleep, physical activity, and limiting catastrophic news exposure are all generally supportive. Avoidance in the short term reduces distress but tends to strengthen anxiety over time 4.

Common questions

Can anxiety in children go away on its own?

Some childhood anxieties do resolve as children mature and gain experience. However, moderate to severe anxiety that has been present for a long time and is causing real impairment is less likely to resolve without support. Early intervention generally improves outcomes.

Is anxiety in kids genetic?

Anxiety tends to run in families, suggesting both genetic and environmental contributions. A child with an anxious parent is more likely to develop anxiety — both through biology and through modeled patterns. This does not mean anxiety is inevitable or untreatable.

My child refuses to go to school because of worry. What should I do?

School refusal related to anxiety is best addressed early, since the longer a child is out of school, the harder return tends to be. A pediatrician is a good starting point to rule out physical causes and to get a referral to a therapist who works with anxiety in children. The school counselor can also be a helpful partner.

Can anxiety look like physical symptoms in kids?

Yes — stomachaches, headaches, nausea, and chest tightness are very common physical expressions of anxiety in children. It is always reasonable to rule out a medical cause first, but recurrent physical complaints with no identified medical explanation are often anxiety-related.

Talk to a clinician

Dr. Lena Park — Pediatric NP

kids & families. Gale can match you with a licensed clinician for a visit.

Find care →

When to get care right away

  • —A child or teen expresses thoughts of suicide or self-harm
  • —Panic attacks that are very frequent, severe, or accompanied by fainting
  • —Complete inability to eat, sleep, or function due to anxiety
  • —Sudden dramatic change in behavior or personality
  • —Anxiety symptoms that develop suddenly after a fever or infection (this can warrant prompt medical evaluation)

If a child expresses thoughts of suicide or self-harm, call or text 988 (Suicide and Crisis Lifeline) or go to the nearest emergency department.

This article is general health information for parents and caregivers — it is not a diagnosis, and it is not a substitute for evaluation by a qualified clinician who knows the child.

References

  1. 1.Dufton LM, Dunn MJ, Compas BE (2009). Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders. Journal of Pediatric Psychology. doi:10.1093/jpepsy/jsn064 ✓67% of children with recurrent abdominal pain met criteria for an anxiety disorder, illustrating the somatic presentation of childhood anxiety
  2. 2.Creswell C, Waite P, Cooper PJ (2014). Assessment and management of anxiety disorders in children and adolescents. Archives of Disease in Childhood. doi:10.1136/archdischild-2013-303768 ✓Anxiety disorders affect 9–32% of young people; functional impairment and severity distinguish clinical from normal developmental anxiety
  3. 3.Walkup JT, Albano AM, Piacentini J, et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine. doi:10.1056/NEJMoa0804633 ✓RCT (n=488, ages 7–17): combination therapy 80% response vs CBT 60% vs sertraline 55% vs placebo 24%; all active treatments superior to placebo
  4. 4.American Academy of Pediatrics (2024). Anxiety: Pediatric Mental Health Minute Series. aap.org. link ✓AAP recommends stepped-care approach starting with CBT; engagement over avoidance is the core behavioral management principle; SSRIs are safe and effective when added to therapy
  5. 5.Centers for Disease Control and Prevention (2024). Data and Statistics on Children's Mental Health (National Survey of Children's Health, 2022–2023). cdc.gov. link ✓Approximately 11% of US children ages 3–17 are diagnosed with anxiety — the prevalence figure cited in the aboveTheFold

5 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.