Anxiety means feeling worried, nervous or fearful. We all experience anxiety at times and some anxiety can be helpful. For example, feeling some anxiety before a test, interview or public-speaking can help motivate you to prepare for it.
When someone is threatened or in actual danger, their body has as an alarm system to keep them from harm. It triggers your “flight-fight-freeze” response that helps prepare the body to defend itself. It might have you run from the situation ("flight"), yell or fight back ("fight"), play dead or stay very still ("freeze").
In the absence of immediate danger, our body's 'fight-flight-freeze' response can still get triggered. For example, for some people having to get up and speak in front of a group of people can trigger the body's alarm system in the same way as if there were a real danger.
Anxiety disorders are one of the most common mental health challenges among children.
It's normal for children to have fears as they go through development. For example, many young children are afraid of the dark, afraid of monsters, or have a hard time being away from their parents.
Children and youth often have many more fears than adults, this is normal as they try to make sense of their world. Most childhood fears are normal and go away eventually. It is important to think about age and what is common when considering whether anxiety is becoming a problem.
How do I know?
What does anxiety look like in children and youth?
Below are some examples of what children and youth may experience when they feel anxious:
Worried thoughts, often about something bad happening
What if Mom doesn't pick me up from school?
What if I throw up?
Will everyone laugh at me?
Feelings in the body
Racing or pounding heart
Shallow or fast breathing, hard to breathe
Stomach "butterflies" or stomach aches
Headaches
Dizziness
Tense muscles
Behaviours
Avoiding situations, people or objects, or refusing to go places or do things
Seeking a lot of reassurance from parents or others
Temper tantrums or meltdowns
Crying
When does anxiety become a problem? How do I know if it's an anxiety disorder?
Anxiety becomes a problem when it gets in the way of the child or youth's ability to participate in day to day life. For example, children who are so worried about being away from their parents that they are starting to miss school. Another sign that anxiety is becoming a problem is when a child is experiencing a high level of upset or distress over a period of time.
Specifically, it is important to think about:
the amount of anxiety the child is feeling
the level of anxiety
how long it's been going on
how much the anxiety is getting in the way of how they function
how distressing it is for the child and for the family
When the anxiety happens too often and gets in the way of doing things at home, at school or with friends, it's important to seek help.
Anxiety disorders are one of the most common mental health challenges among children and youth. Anxiety comes in different forms, and often children are anxious about more than one thing. Children with other challenges like learning difficulties or challenges paying attention, among other things, are somewhat more likely to experience anxiety than children without those difficulties.
Types of Anxiety Disorders
There are five types of anxiety disorders in children and youth.
Separation Anxiety Disorder
It's normal for young children to have fears about being left with someone new, but they are usually able to get used to the situation. A child with separation anxiety continues to have a hard time being away from caregivers. For example, for some children even being in a different room in the same home can provoke anxiety. This fear gets in the way of children doing things by themselves when they otherwise would be capable of doing so.
Children with separation anxiety disorder may:
refuse or avoid going to school
call many times to be picked up early
cry and cling to a caregiver
throw tantrums
avoid going to bed at night or use delay tactics at bedtime
avoid play-dates and sleepovers
refuse to be babysat
express worries that something bad might happen to the caregiver
complain of physical symptoms like tummy aches before, during and after separation
Social Anxiety Disorder (or Social Phobia)
Children and youth with social anxiety disorder have a strong fear of embarrassing themselves and of other people thinking badly of them. For example, they may worry about wearing the "wrong clothing" or doing or saying the wrong thing. They can at times feel deeply uncomfortable as if a spotlight is on them or they are the centre of attention, even when that is not the case.
Children and youth with social anxiety disorder may feel deeply uncomfortable when, or avoid completely:
talking to classmates or adults
going to social events like birthday parties or school dances
using the telephone or texting with friends
giving presentations or talking in front of groups
eating in public or using public bathrooms
in more extreme cases, going to school at all
Specific Phobias
Children and youth with specific phobias are scared of certain situations or objects. Their fear is stronger than the actual danger posed by these situations or objects. They try hard to avoid contact with what they fear. They may ask repeated questions, or for excessive reassurance when they have to confront one of the following:
insects or animals: dogs, spiders, snakes, beetles, bees
environment: dark, storms, heights, water
specific situations: transportation (riding in cars, flying in airplanes), enclosed spaces (elevators, tunnels), bridges
medical or physical: needles, going to the dentist, hospitals, vomiting, choking
It is common for children to be fearful or anxious about needles, whether getting a vaccine, medication or having blood drawn. Luckily, there are many evidence-based strategies to help manage needle anxiety that your child may experience.
Talking to your child before, during and after the appointment:
Talking to your child about needles can help decrease their needle anxiety and make future appointments a more positive experience. Here are some tips to consider:
Talk to your child ahead of time. Surprising your child last minute with the needle appointment can make anxiety worse. Consider telling your child at least a few days in advance and talk about what you can do together to prepare for a smooth experience.
One tool to help you and your child prepare is the “My Blood Draw Plan” for children and youth, which can be used for all procedures that include needles.
Use neutral language. Talking in a matter of fact, calm and supportive way can lessen anxiety.
If your child is worried that the needle will hurt, you could say, “Some people say they don’t feel much at all, and other say it feels like a pinch. Let’s find out what it’s like for you.”
If your child is getting a vaccine, you could say, “The vaccine can help you stay healthy. The medicine will be put in your arm with a needle. You will feel a quick poke.”
Don’t apologize. Saying to your child things like “I’m really sorry you have to go through this” can make your child feel like something bad is happening and increase stress. Instead, you could say something like, “I understand that you are feeling nervous, that is okay. I’ll be right here with you”.
Acknowledge your child’s efforts. Positive recognition after the needle can help your child feel good about the skills they learned during the appointment.
Strategies to help in the moment:
A good place to start is to walk through the CARD system (Comfort, Ask, Relax, Distract). You can also play the interactive CARD game with your child to help them get ready and have some activities on hand. CARD can help decrease stress-related reactions, improve the overall needle experience, and teach lifelong coping skills.
Get comfortable. Being physically comfortable can help your child feel more at ease during the appointment.
have your child wear clothes that show the area of the body where the needle will go
if your child does not need to fast, offer your child a snack to eat ahead of time
encourage your child to bring a favourite item
give your child the option to sit up in a chair or lie down
ask your child to make their arm loose or jiggly, like cooked spaghetti
Ask questions. Encourage your child to ask any questions they may have about the procedure. Understanding what is happening at the appointment can make them feel more prepared.
What will happen on my turn?
What vaccine or test am I getting?
Can I…
have the needle in a private room?
use numbing creams or topical anesthetics? (You may need to purchase and apply the numbing cream 30 to 60 minutes prior to your child’s appointment. Ask your pharmacist about numbing creams or topical anesthetics.)
look at the needle? or look away?
Try to relax. When you are calm and use your normal voice, it helps your child feel like everything is okay. This can help your child be calmer and more relaxed.
practice calm breathing with your child (pretend to blow a bubble or blow out a candle)
encourage your child to give themselves some positive self-talk (for example: “I can do this!”)
hold your child’s hand or offer comfort in a way that works for your child
Introduce a distraction. Having something else to focus on during the appointment can help your child in the moment.
talk to your child
let your child play a game or watch a video
bring a book or magazine to read to your child or have them read themselves
let your child choose music to listen to see if there is a song they want to sing
encourage your child to daydream about fun things, or think about a favourite memory
Consider putting together a care package with your child to bring to the appointment that includes some of the items listed above in the CARD examples, such as a snack, favourite item, and book. Having items that are familiar can increase your child’s comfort level.
After the needle work, take time to celebrate the victory, even if it didn’t all go to plan. This may include a reward to recognize your child’s bravery for doing something that was challenging for them. Consider giving your child a few options and letting them choose how they would like to celebrate.
Other resources:
Check out these age-specific tips from Immunize BC on having a more positive vaccination experience:
Watch this 2 minute video for tips and strategies for reducing distress and fear in young children getting a needle: It Doesn’t Have to Hurt
My child has needle phobia, what now?
5-10% of children have needle phobia, which is a high level of fear that makes getting a needle very difficult. Needle phobia can lead to trying to avoid needles or healthcare visits. This fear may need extra attention before your child can successfully have a procedure that includes a needle. Ask your child’s doctor, local hospital, or mental health services for healthcare providers who specialize in anxiety and exposure-based therapy. If your child is preparing for school vaccinations, consider talking to their teacher or school nurse ahead of time to see what option are available to support your child.
Even if your child doesn’t have a needle phobia, needle-related procedures may be challenging due to stimulating or busy environments. This may be the case for children who are neurodiverse or have neurodevelopmental challenges. When you book the appointment, ask whether there are any accommodations to make the needle experience more positive.
Blood work support programs in BC:
Child Life Specialists at BC Children’s Hospital (BCCH) provide the Poke Practice Program to support children and youth with anxiety, developmental delays or autism to complete blood work. Note, this service is not available for vaccine support.
Lifelabs has developed specific blood work practices as part of their Serving Customers with Autism program. This program was developed to deliver a safe and positive experience to increase the chance of success.
Generalized Anxiety Disorder (GAD)
Children and youth with GAD experience frequent worries that are difficult to control. They tend to ask a lot of “what if...” questions and look for a lot of reassurance from others (for example, are you sure I should pick that one? Are you sure my homework is perfect?). People often describe them as “worrywarts.” Rather than having a specific area they fear, children and youth with GAD tend to have worries that span multiple topics. In addition to worry, it is common for children and youth with GAD to have physical symptoms like tense muscles or stomach aches, difficulty falling asleep, and have trouble concentrating when they are worried. Procrastination can also be common as children and youth struggle to do things 'perfectly'. Specific areas of worry tend to be:
school performance
doing things perfectly
what people think of them
bad things happening (disaster, environmental concerns, disease, war, robbery, accident)
health or illness (getting cancer, AIDS, the flu)
safety and well-being of loved ones (family, friends, pets)
everyday stressors (being on time, what to wear, where to go, family finances)
Panic Disorder
A panic attack is a relatively short, intense feeling of anxiety or dread accompanied by multiple physical symptoms (dizziness, racing hear, shortness of breath, shaking, nausea) and triggering catastrophic thoughts like "I'm going crazy" or "I'm going to die". Sometimes there is a clear trigger for a panic attack (for example, a test, getting a needle). However, children and youth with panic disorder can have panic attacks that seem to come out of nowhere. A key part of panic disorder is a fear of future unexpected panic attacks. Children and youth with panic disorder may feel extreme fear in certain places or situations that they associate with having panic attacks, like crowded places or enclosed spaces such as elevators. This fear, called "agoraphobia", may lead them to avoid those places or situations.
How does child/youth anxiety impact families?
When children and young people experience significant anxiety, this will often impact how families interact with each other on a daily basis. "Family accommodation" refers to the ways in which family members (caregivers, siblings, extended family) may change or adapt their own behaviours as a response to the child or young person's anxiety symptoms.
Family accommodation can take many forms, including:
providing reassurance
being constantly available by phone or text
immediately "rescuing" the child from anxiety-provoking situations
making major changes to family routines, or minimizing daily responsibilities and expectations.
While most family members accommodate anxiety with very good intentions as a way to reduce the young person's immediate distress, family accommodation can make their anxiety worse over time.
What can be done?
The good news is there are ways to overcome and better manage anxiety so that it doesn't get in the way of life. There are two main treatments that research shows often helps children or youth with an anxiety disorder.
1. Cognitive behavioural therapy (CBT) is a structured type of therapy that focuses on teaching children and families how to:
Identify and challenge anxious thoughts
Practice facing scary situations by taking one step at a time
Promote bravery in their children and change patterns of family accommodation
2. Medicationsare sometimes a useful component of treating children and youth with anxiety.
Tips to help children with anxiety
Work towards having regular routines (morning, school, homework, bedtime).
Try and be clear with your expectations. Implement consequences that are realistic for the child's age.
Notice your child's feelings and support your child to identify them.
Model the positive ways you identify your own feelings and solve problems.
Try and focus on your own calm when your child is anxious.
Give specific praise and rewards, even for small steps in facing fears
Plan ahead for times that may be difficult (getting to school, returning to school after breaks) by starting early with small steps towards the goal
Talk to your doctor and get help from a mental health professional by:
Getting a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community).
contacting your Employee Assistance Plan (EAP), if you have this option.
Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.
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Call 1-800-SUICIDE (1-800-784-2433) for the BC Suicide Prevention and Intervention Line. Available in over 140 languages using a language service.
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Call or text 988 for the National Suicide Crisis Helpline. Available in English and French.
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