What is it?

We’ve all experienced some kind of anxiety, whether it be meeting a significant other’s parents or stepping out on stage to give a big speech or perform a talent at school. Shortness of breath, clammy hands, and butterflies are all common bodily reactions to this feeling of nervousness. Soon after the task is completed, we tend to relax; our shortness of breath is gone and the butterflies fly away. For some people, however, these feelings persist even after the event, and sometimes there isn’t even an event that would cause these nerves, they just appear and linger. Anxiety is a mental health disorder that causes a lot of fear and worry in situations where there wouldn’t normally be any reason for these feelings. 

What are the symptoms?

  • Children who experience anxiety might become more clingy than usual, cry, or miss school. 
  • A common symptom is the expression of fear, where the child acts upset, scared, or they might avoid talking to people or doing certain things. 
  • Other symptoms include feeling jittery or shaky, and shortness of breath. 

Anxiety is the body’s response to a “fight or flight” situation, where the brain perceives a danger somewhere, and then releases natural chemicals into the body. These chemicals prepare us to deal with danger, and change digestion, breathing, heart rate, nerves, and muscles. The brain thinks it’s doing us a favor by protecting us from harm, but with anxiety, this part of the brain is overactive and releases these fight or flight chemicals too much, even when there is no real danger. 

Each of these symptoms varies in severity for each person, and not everyone will exhibit the same symptoms as each other. 

For example, one child could feel anxiety through feelings of fear, and might get shaky and can’t catch their breath, while another child might feel a feeling of invisible danger where they are on high alert, overwhelmed, and are jittery. If you suspect your child might be suffering from anxiety, be aware of what anxiety looks like in them, and then come to us and we’ll form a plan to help.

This video from Inside Out may help explain what anxiety feels like anxiety.

How common is it?

Around 8% of children and teens develop anxiety, and most of them show symptoms before age 21. The World Health Organization (WHO) estimates that one in every thirteen (1 in 13) people have or will develop some sort of anxiety disorder in their lifetime. In short, it’s pretty common in the general population, and it’s relatively common in children and teens. 

What are the causes?

Just like any other disorder or imbalance, there are various different reasons a person might develop anxiety.

  • Genetics
    • If someone in the child’s family has anxiety, there is a chance that the anxiety has been passed down, and kids could inherit certain genes that make them prone to anxiety.
  • Brain Chemistry
    • Genes that help process certain brain chemicals (called neurotransmitters) might be in short supply. When that happens, anxiety is likely to develop.
  • Life Events
    • Children and teens who experience a traumatic life event or a stressful situation could develop anxiety as a way to cope with the event. Such events include:
      • Loss of someone they knew or looked up to
      • Violence: They could have seen someone get hurt through an act of violence, which would make them scared to experience that again.
      • Abuse: any kind of abuse could lead to anxiety, whether the abuse is aimed towards the child or someone else.
      • Serious illness
      • Death of a loved one
  • Learned Anxiety
    • Having a parent or caregiver afraid of something might teach the child to fear or feel anxiety towards the same thing. 

Who is more at risk?

Studies have found that women are more likely to develop anxiety than men, and transgender youth experience anxiety slightly more than the average population. Additionally, those under the age of 35 that have a chronic illness are at higher risk for developing anxiety.

How do you diagnose and treat anxiety?

At FIGHT Pediatrics, we use the SCARED form, found here to diagnose anxiety. We then recommend therapy, and sometimes medication to treat anxiety. If anxiety is not treated or managed, it can persist well into adult life, and even throughout a person’s entire life. Statistically speaking, only one-third of people living with anxiety are treated for it. We aim to close the gap and maintain a healthy balance for children and teens so that they may live a happy, normal life.

What is a panic attack?

A panic attack is the sudden start of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Paresthesia (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of dying

Panic Attacks do not last forever, and they go away within twenty minutes usually. The severity of them can make it seem like they go on and on, making them even scarier. Treatment options are available for these, as they are included under the “anxiety” umbrella. Panic attacks can also mimic other kinds of illnesses such as heart attacks or thyroid problems~if your child has experienced panic attacks before, they might understand that these aren’t actually going to kill them, but in the moment it might feel like they are. 

Be understanding when talking to your child about anxiety and panic attacks, because they can’t help feeling these things. Given the chance, they probably would rather not be anxious altogether. 

What are situations that would make anxiety worse?

Some people’s anxiety is triggered by an event or by a situation, so it’s helpful to know what triggers your child has in order to better help them manage their anxieties. 

  • Someone might be claustrophobic, or afraid of being in small, tight spaces. For them, large crowds have the potential to set off their anxiety. 
  • A teen might have lived through a traumatic event and developed anxiety at loud, sudden sounds. Fireworks on the Fourth of July and New Years might trigger their anxiety into a panic attack. 
  • A child might have socialized anxiety that causes them to avoid social interactions, meaning that introducing them to a room full of new people could send them crying and clinging to their parent’s leg. 

If your child has situation-specific anxieties, work with their therapist and treatment to help alleviate their fears. Ask about avoidance behaviors in their treatment plans~ should they work to avoid the situations that trigger the anxiety altogether, or should they try to expose themselves little-by-little to overcome the anxiety? Your child’s safety is our #1 priority, so doing these things should be their choice, and they should want to follow the treatment plan and course of action. 

What can I do as a parent?

  • Set Clear Expectations
    • The future is uncertain, and there is little we can do to change that uncertainty. We don’t know if our child’s fears of failing a test are going to come true or not, and we don’t know if they’re going to interact with social interactions they would rather not interact in. What we can do is set expectations that are attainable. Instead of saying “I’m sure you’ll ace this test!” try saying “you studied hard, and no matter what the outcome is, I’m proud of you for putting effort into this.” “if you go to the birthday party and want to leave right away that’s fine, just say hello to the birthday girl first and give her the present. Then we can go home, okay?” What you are doing in this situation is expressing confidence that they’re going to be okay, they will be able to manage it, and that, as they face their fears, the anxiety level will drop over time. This gives them confidence that your expectations are realistic, and that you’re not going to ask them to do something they can’t handle.
  • There’s No Avoiding It
    • Removing the thing that makes your child anxious or fearful is a short-term coping mechanism that will make them feel better, but will also teach them to avoid the thing altogether. For example, a child is afraid of dogs because they were bitten in the past. When walking down the road, up comes a dog on a leash, but the child becomes fearful anyways. Taking the child to the other side of the road will only validate their fears and they will learn to avoid all dogs in the future because it makes them feel better. This is a short-term effect, but the long term is that they might have a panic attack when they come into sudden contact with a dog, no matter how harmless. One of the ways to combat this is to bit-by-bit expose them to dogs in a controlled environment where there is no danger to the child at all. This will teach the child that there is little to be afraid of or anxious. Having great memories and experiences will often replace the fear and anxiety that was associated with the dogs. 
  • Let Your Child Worry
    • No one’s fear has ever been stopped by saying “it’s okay!” or “don’t worry!” Instead, validate your child’s feelings while not validating the ideas behind them.
      • “I don’t like going to school, there are too many people there, can I stay home?”
      • “I can see that you’re anxious, do you want to talk about it?”
      • “I just get very nervous and my tummy has bad butterflies when I’m around all those people and what if they judge me or what if they just don’t like me?”
      • ”I hear what you’re saying, and I’ve felt the same, too. What do you think you should do when you’re around lots of people and your tummy starts to get bad butterflies?”
    • Formulate a game plan for what to do when your child starts to feel anxious. We recommend breathing exercises and calming motions. 
  • Reframing
    • Lots of people get caught up in the “what ifs” and the word “can’t”. Take some time with your child and focus on moving through these things, and showing them that it’s okay and normal to think of these things, but that it’s important to move through them eventually get beyond them. Here are some things that can help you have this conversation!
      • Name a worry floating around in your brain right now.
      • What is the worry telling you?
      • Let’s break it down and see if that worry is 100% right.
      • How can we take that worry thought and change it to a positive thought?
  • Back to the Basics
    • Maintain a healthy schedule and lifestyle! It’s a simple yet effective change that is beneficial to everyone!
      • Eat healthily
      • Have a good sleep schedule
      • Drink water!
      • Exercise!
      • Downtime to calm down
  • Empathize Often
    • Be understanding that what they are going through is a scary thing for them and that it can be difficult to go through their daily schedule with anxiety weighing on them.

What are the different types of anxiety? What ages do they affect?

  • Generalized Anxiety Disorder
    • What it is:
      • Chronic anxiety, exaggerated worry, and tension, even when there is little or nothing to provoke it.
    • What age it can begin:
      • The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.
  • Panic Disorder
    • What it is:
      • Characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
    • What age it can begin:
      • Panic disorder usually begins in adulthood (after age 20), but children can also have panic disorder 
  • Specific Phobias
    • What it is:
      • Fears associated with specific places or things, animate or inanimate. Phobias of heights, tight spaces, clowns, and spiders are among the most common ones. 
    • What age it can begin:
      • While some phobias develop in childhood, most seem to arise unexpectedly, usually during adolescence or early adulthood.
  • Social Anxiety Disorder
    • What it is:
      • Overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation – such as a fear of speaking in formal or informal situations, or eating or drinking in front of others – or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.
    • What age it can begin:
      • The average age of onset for social anxiety disorder is during the teenage years. Although individuals diagnosed with social anxiety disorder commonly report extreme shyness in childhood, it is important to note that this disorder is not simply shyness.
  • PTSD
    • What it is:
      • a serious potentially debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault, or other life-threatening events.
    • What age it can begin:
      • PTSD can develop at any stage of life after a traumatic life event.
  • OCD
    • What it is:
      • People with OCD experiences obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images, or urges that cause distress or anxiety. Compulsions are behaviors that the person feels compelled to perform in order to ease their distress or anxiety or suppress the thoughts. Some of these behaviors are visible actions while others are mental behaviors. Common obsessions include concerns about contamination, cleanliness, aggressive impulses, or the need for symmetry. Common compulsions include checking, washing/cleaning, and arranging. 
    • What age it can begin:
      • Anytime from preschool to adulthood, though the most common times are ages 10-12 and late teens through adulthood.
  • Separation Anxiety
    • What it is:
      • Children who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.
    • What age it can begin:
      • How long separation anxiety lasts can vary, depending on the child and how a parent responds. In some cases, depending on a child’s temperament, separation anxiety can last from infancy through the elementary school years.
      • Separation anxiety that affects an older child’s normal activities can be a sign of a deeper anxiety disorder. If separation anxiety appears out of the blue in an older child, there might be another problem, like bullying or abuse.

Deep Breathing Resources

  • The app Calm gives breathing tips, meditation time, and sleep guidance
  • This Youtube Deep Breathing video
  • This Meditation video
  • This Meditation yoga video
  • This mindful video
  • This guided meditation video
  • A “24/7 lofi hip hop radio – beats to study/chill/relax” playlist


Spotlight On

Karam Mounzer, MD

Dr. Mounzer identified two major gaps in the care of patients with HIV/hepatitis C (HCV) co-infection, and the complexity of multidrug-resistant HIV treatment. He is involved with many clinical trials focusing on drug development and better understanding of HIV immunopathogenesis with the Wistar Institute. He is involved in teaching and mentoring.

Learn More about Spotlight On
Dr. Karam Mounzer

Dr. Mario Cruz

Dr. Mario CruzDr. Cruz is a board certified pediatrician who serves as the Medical Director for our Pediatrics and Adolescent Health Center. He has presented and/or published in the fields of community violence and domestic violence prevention, quality improvement, behavioral health, curriculum development and mentorship. In 2019 he received the Greater Philadelphia Social Innovation Award for Innovations in Healthcare.

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