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Part 2 · 12 min read

When Worry Takes Over: Anxiety Disorders in Children and What Helps

Reviewer: Ayşegül Yel, Clinical Psychologist · 2026-10-31

Every school morning at about twenty to eight, Maya's stomach starts to hurt. By the time her shoes are on she is crying, and by the school gate she is clinging to her father's coat. On weekends the stomachaches vanish. Her parents have tried everything they can think of: reassuring her, letting her stay home "just this once", promising a treat if she goes in. Each of these helps for a day, and then the mornings get harder. If this sounds familiar, you are not alone, and you are not doing it wrong. Anxiety is the most common mental health condition in childhood, and it is also one of the most treatable. This guide explains what an anxiety disorder is, why the things that feel most helpful can quietly keep it going, and what the evidence says works.

At a glance

What it is, and what it isn't

Anxiety is not a malfunction. It is the body's alarm system, designed to keep us safe: the racing heart, the tight stomach and the urge to get away are all part of preparing to face or escape danger. Every child has this alarm, and many fears are a normal part of growing up. The NHS notes that separation anxiety is very common between about 6 months and 3 years, that preschoolers often develop fears of animals, insects, storms, water or the dark that fade by themselves, and that many children feel anxious before a new school or an exam.

An anxiety disorder is what happens when the alarm becomes too sensitive. It goes off when there is no real danger, it rings too loudly for the situation, and it does not switch off. The NHS describes the turning point simply: anxiety becomes a problem when it is very strong or getting worse, does not go away, and gets in the way of everyday life, stopping a child from doing things they would otherwise enjoy.

The main types you may hear about are:

Obsessive-compulsive disorder, post-traumatic stress and selective mutism are closely related to anxiety, but they are now treated as separate conditions with their own approaches.

How it can look at different ages

Children rarely say "I feel anxious". More often, anxiety shows up in their bodies and their behavior. The NHS lists signs such as these:

Notice the anger on that list. An anxious child who is pushed toward something frightening may scream, hit or slam doors. From the outside this looks like defiance; on the inside it is fear.

Why it happens

Anxiety disorders grow from a mix of nature and experience.

Parents get drawn into avoidance with the very best intentions. Researchers call this family accommodation: answering the same worried question for the tenth time, sleeping in the child's bed, ordering for them at restaurants, driving a different route to avoid a dog, letting them stay home. Each of these relieves distress in the moment, which is exactly why every loving parent does them. Over time, though, they can send the message "you can't cope with this, so I'll do it for you". The good news is that this means parents have real power to help, as we will see below.

How it is assessed

Start with your doctor. A pediatrician or family doctor can check for physical causes of symptoms such as stomachaches, palpitations or poor sleep, and refer you to a child mental health specialist.

What happens. A child psychiatrist or clinical psychologist will talk with you and your child, separately and together, about what the fears are, when they started, what your child avoids and how much it affects school, friendships, sleep and family life. They will often use standardized questionnaires completed by you, your child and sometimes teachers. They will also look for conditions that often travel with anxiety, such as low mood, attention problems or learning difficulties, because these change the treatment plan.

What helps the assessment. Bring a two-week record of when the anxiety shows up, what your child avoids and what you currently do to help. Be honest about the accommodations; clinicians are not judging, and this is exactly the information they need. Only a qualified professional can say whether your child has an anxiety disorder; recognizing signs here is a reason to ask, not a diagnosis.

Treatment: what the evidence supports

Cognitive behavioral therapy is the first-line treatment. The 2020 AACAP guideline recommends CBT for children and teens aged 6 to 18 with separation anxiety, social anxiety, generalized anxiety, specific phobias and panic disorder, and the UK's National Institute for Health and Care Excellence (NICE) recommends individual or group CBT for children and young people with social anxiety, with parents involved. CBT for anxiety usually runs for a few months of weekly sessions and teaches children three things:

Parents can be the treatment. A 2020 randomized trial by Lebowitz and colleagues at Yale tested a program called SPACE (Supportive Parenting for Anxious Childhood Emotions), which works only with parents. Parents learned to respond to their child's anxiety with both acceptance and confidence, and to reduce accommodation step by step. It worked as well as CBT delivered to the child directly. This matters for children who refuse to see a therapist, and it shows how much parents can change.

Medication has a place in some cases. For moderate to severe anxiety, or when CBT alone has not been enough, the AACAP guideline recommends that a child psychiatrist may consider medication, and suggests that combining it with CBT may work better than either alone. In the 2008 CAMS trial, the combination helped about 8 in 10 children. NICE, by contrast, does not recommend routinely offering medication to children and young people with social anxiety. Whether medication is right is a medical decision made with your child's doctor, weighing benefits, side effects and monitoring.

Working with school. For school-related anxiety, a plan agreed with the teacher, such as arriving a few minutes early, a trusted adult at the gate or a quiet place to calm down, works far better than either forcing attendance or allowing long absences.

What helps at home

  1. Validate the feeling, then show confidence. Two messages together are more powerful than either alone: "I can see you're really scared about this. And I know you can handle it." Acceptance without confidence keeps a child stuck; confidence without acceptance feels like being dismissed.
  2. Explain the wave. The NHS suggests describing anxiety as a wave that builds up and then goes away again. "Your alarm is ringing loudly right now. If we wait, it will start to get quieter. It always does."
  3. Build a fear ladder together. Break the feared situation into small steps. For a child afraid of sleepovers: talk about a sleepover, then visit the friend's house, then stay until bedtime, then sleep over with a parent's number on speed dial. Practice each step until it feels easier, then move up.
  4. Step back from accommodation slowly, and say so. Choose one accommodation to reduce, tell your child in advance and stay warm about it: "I've been answering your questions about the trip over and over, and I don't think it's helping you. I'll answer once, and then I'll trust you to handle the worry." Expect a protest at first; it usually fades within a week or two.
  5. Praise brave behavior, not the absence of fear. "You were nervous and you went in anyway. That was brave." Children learn that courage means acting while afraid.
  6. Keep routines and watch your own reactions. Predictable mornings and bedtimes calm an anxious nervous system. Children also read our faces; showing calm, even when you feel anxious too, is part of the treatment.

Myths and facts

"If my child is scared, the kindest thing is to keep them away from what scares them." In the short term, yes. In the long term, avoidance is what keeps anxiety alive. Kindness here means helping your child face fears in small, supported steps, never forcing them into a situation without preparation.

"Reassurance will calm them down." One clear answer can help. But anxious children often ask the same question again and again, and each answer brings only seconds of relief before the next "what if". Endless reassurance can become another form of accommodation.

"They'll grow out of it." Many ordinary childhood fears do fade. But an anxiety disorder that has lasted for months and is limiting your child's life is unlikely to simply disappear, and the earlier it is treated, the less of childhood it takes away. Treatment for anxiety is among the most successful in child mental health.

When to get help right away

Seek help promptly, rather than waiting, if your child:

If your child talks about wanting to die or you believe they are not safe, call your local emergency number or go to the nearest emergency department, and stay with them.

In one sentence

Anxiety disorders are common and very treatable, and the most effective help, whether from a therapist or from you, gently guides a child toward what they fear in small steps rather than helping them avoid it.

Sources

General information, not a diagnosis or medical advice. Only a qualified professional can assess a child.