Fears and Anxiety in Children and Teenagers

What changes with age?

Young children may be uneasy about separation or particular objects and situations. Older children may worry about schoolwork, friendships or being judged. The concern is not simply that fear exists, but its strength, duration and effect on the child’s life. A difficult school morning alone does not establish an anxiety disorder.

Anxiety does not always look like worry

Some children ask repeatedly whether something bad will happen; others become irritable, withdrawn or unable to settle to sleep. Concentration can suffer. Headaches, stomach aches or a racing heart may accompany anxiety, but physical symptoms still need appropriate assessment rather than an automatic psychological explanation.

• Notice what the child has started avoiding.
• Describe changes in sleep, appetite, attendance and friendships.
• Listen to the child’s own account without assuming you know the fear.

Understanding the cause and impact

Assessment explores when difficulties began, situations that trigger them, health and development, and events at home or school. Bullying, learning demands, loss or other distressing experiences may be relevant. The clinician considers possible coexisting conditions and speaks with the child in an age-appropriate way. Questionnaires can support the conversation; they do not replace it.

Bring specific examples and school observations. Include what the child still enjoys and what helps them feel safe, as well as the activities that have become difficult.

When school becomes hard to attend

Ask what happens before, during and after school. Worry about separation, peers, noise or lessons may need different responses. Talk to the school early and agree who the child can approach for support. A practical plan should address the difficulty and help the child participate. Do not force a frightening situation without first understanding what is making it difficult.

Support and treatment options

Treatment depends on age, severity and the type of anxiety. Cognitive behavioural therapy can help children understand worry and practise coping skills. Approaching feared situations gradually may form part of a supported treatment plan. Parents play a substantial role for younger children. Medicines may be considered in selected cases by an appropriately experienced clinician, with discussion of benefits, possible adverse effects and follow-up.

At home, keep routines predictable, make time to listen and practise simple calming strategies together. Praise efforts to take manageable steps rather than demanding that the child stop feeling afraid.

When to seek professional or urgent help

Arrange assessment when anxiety is worsening, persists despite support, or interferes with sleep, school, family life or friendships. Seek urgent professional help for self-harm or thoughts of harming oneself or someone else. If there is immediate danger, a serious injury or you cannot keep the child safe, use local emergency services or attend the nearest emergency department; do not wait for a routine booking.

Common questions