Anxiety and anxiety disorders

Occasional, short-lived fears and worries are a normal part of development. Anxiety is something that everyone experiences from time to time, including children and youth.

Some children may experience separation anxiety from their parents or main caregiver. Others may have fears of the dark, storms, animals, or strangers. Teens may feel anxious before a test at school, or a job interview.

But constant and extreme forms of fear and worries that start interfering with day-to-day activities could be due to an anxiety disorder.

Anxiety disorders are the most common mental health condition in children and youth, and they are treatable. But if they are not treated, they could lead to problems in school, on the job, or with relationships. Untreated anxiety puts children and youth at an increased risk of depression, substance use, and a poor quality of life.

What is anxiety?

Anxiety is your body's natural response to stress. It's a temporary feeling of fear or worry about what's to come.

Normal anxiety reactions help protect us from danger, such as being careful when standing near a cliff. Sweating, tense muscles, a burst of energy and even anger is the body getting ready to “fight or flight”.

What is an anxiety disorder?

An anxiety disorder is when symptoms fall beyond the fears and worries you would typically expect at a child’s age and stage of development. Symptoms can cause lasting stress or interfere with a child or teen’s day-to-day functioning: They may avoid activities, friends, school, or feel too nervous or worried to do things.

When there is no danger, anxiety responses are not helpful. When the brain experiences anxiety, the calm and thinking parts of the brain are less active, which can get in the way of social interactions and school participation. The physical symptoms can be unpleasant and lead to more worries.

Types of anxiety disorders

Specific anxiety disorders, and when they typically begin	Typical fears or worries for age and stage	Symptoms or behaviours that could suggest an anxiety disorder
Separation anxiety disorder (Preschool)	Being upset or sad for a short time when separating from a parent (e.g., for child care)	Constant clinging or inconsolable crying when separating from a parent, even after a routine is familiar Physical signs, such as a headache or stomachache when separating from a parent is anticipated Constant worry about a parent being hurt of dying
Selective mutism (Preschool)	Taking time to get used to people in social situations	Being unable to talk in familiar social situations (e.g., at daycare or in school)
Specific phobia (Preschool to school age)	Being afraid of new encounters or stimuli (e.g., dogs, loud noises)	Lasting fears in routine situations that seem out of proportion, especially if they are interfering with activities or daily living
Generalized anxiety disorder (Middle school age through young adulthood)	Worrying temporarily about grades, health, or world events	Strong, recurrent worries about grades, health, or world events that get in the way of routine activities or social life Trouble sleeping, physical restlessness, irritability, trouble concentrating, or muscle tension in response to temporary, everyday stresses
Social anxiety disorder (Late school age, early teens)	Being uncomfortable or hesitant to participate or perform in social situations	Strong, repeated fears of being watched, or judged in familiar social situations Withdrawing from community or school activities they used to enjoy Experiencing new, strong, or lasting physical symptoms (e.g., heart pounding, shortness of breath, shakiness, sweating) in social interactions
Panic disorder (Teens, young adulthood)	Temporary physical responses to stress (e.g., feeling dizzy before an exam)	Strong, frequent physical symptoms (e.g., shortness of breath, dizziness, nausea), along with feeling panic or out of control Withdrawing from social activities or events due to fears of having a panic attack Worrying about poor health (e.g., fear of having a heart attack) for no reason
Agoraphobia (Late teens, young adulthood)	Feeling temporarily hesitant to use public transportation, enter a crowded or enclosed place, or be away from home alone	Avoiding 2 or more locations or social situations due to fear of not being able to escape or call for help

Symptoms of anxiety disorders

Symptoms and signs of anxiety disorders often depend on the specific disorder. The main symptom of anxiety disorders is frequent and persistent fear or worry that is out of proportion to the actual situation. Common symptoms can include:

Thoughts and feelings:

worries about school, family, the future, or other world events
trouble concentrating
feelings of panic or danger
obsessive thoughts
mind going blank

Physical symptoms:

shortness of breath
being very tired
trouble sleeping
sweating
tummy aches
nausea
frequent headaches
feeling tense
chest discomfort
pounding heart
dry mouth

Behaviours:

avoidance (e.g., social withdrawal, isolation)
defiance
irritability
restlessness
mood swings

What causes anxiety disorders?

It’s not clear, but there are many possible risk factors or causes of anxiety disorders. They may include biological (e.g., our genes), psychological, and social or environmental factors (e.g., school problems, home environment, life changes).

How is an anxiety disorder diagnosed?

Anxiety disorders can be diagnosed by a trained health care provider. They will ask you and your child questions and listen carefully to understand how your child’s anxiety interferes with their ability to do everyday things.

There is no medical test for an anxiety disorder.

How are anxiety disorders treated?

The most common and effective approaches to managing anxiety can include psychoeducation (conversation and exchange of information), psychotherapy (e.g., parenting programs, cognitive behavioural therapy [CBT], and family-based interventions), and medications.

Is it possible for my child to have more than one anxiety disorder?

Yes. A child or teen can have more than one anxiety disorder. For example, they can have both generalized anxiety and social anxiety disorders. It is also common to have one anxiety disorder go away, and a different type appear later.

Anxiety disorders can also occur with other conditions, such as school problems/learning disabilities, depression, attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), tics or Tourette Syndrome, autism spectrum disorder (ASD), and eating disorders.

How can I help my child?

Parents and caregivers can play a big role in helping children manage their anxiety. Here are some examples:

Help your child recognize, acknowledge, and name their feelings, including how they feel physically.
Avoid avoidance. For strong emotions and sensitive topics, try “You look worried. Is something on your mind?”, or “It sounds like you’re really angry. Would you like to talk about that?”
Empathize and validate anxieties but try not to reinforce them. Try “I know you’re feeling scared, AND I know you’re brave to do this”.
Connect and maintain secure attachment. Participate in child-led, free play with younger children, and stay aware of, and involved with, teens:
- Spend one-on-one time together.
- Know and show interest in who their friends are.
- Encourage extra-curricular activities.
Foster self-confidence through effective praise:
- Say “You…” instead of “I…”
- Be specific about how they have earned your attention.
- Recognize brave, helpful, or kind acts as soon as possible after they happen. For younger children, notice brave behaviours—no matter how small.
Encourage opinions and choices. Accept growing independence in older children and promote and celebrate good decision-making and problem-solving.
Break the task of facing anxiety into small, practical steps, and positively reinforce each one.
Reward attempts, and compliment process as much as end results. Focus on strengths rather than weaknesses.
Model coping skills and techniques such as deep breathing, muscle tension relaxation, mindfulness, distraction, and positive self-talk.
Prevent avoidance by using gentle but firm encouragement.
Be involved with schooling. If your child or teen has anxiety, help teachers understand its sources and related behaviours. For example, explain that when your child avoids classroom tasks or appears oppositional, this is likely due to anxiety. Make sure that necessary supports or accommodations are in place.
For young children showing signs of child care or school avoidance:
- Prepare the night before so mornings are not rushed and stressful.
- Encourage bringing a favourite toy from home to ease transition.
- Take time for a warm goodbye but avoid repeated goodbyes.
In heated family moments, take time to:
- Calm down before speaking.
- Speak slowly and clearly rather than loudly.
- Be respectful of beliefs and feelings.
- Be assertive rather than aggressive.

When should I call a doctor?

Caring for a child with a lot of anxiety can be scary and challenging. Talk to your child’s health care provider if:

their fears are starting to interfere with their normal daily activities, such as attending school, playing sports, or making friends.
they often seem very anxious.
they often have physical symptoms, like headaches, stomach aches, muscle/joint pain, or excessive fatigue.

Information for parents from Canada's paediatricians