My daughter has been at her preschool for over three months and still cries at drop off. Is this normal or should I be concerned?

My four-year-old son used to sleep through the night, but all of a sudden he is scared of the dark and cannot sleep alone. What can I do?

These questions and similar concerns related to child anxiety are very common. Feeling anxious is a normal part of a child’s emotional development, and most children bounce back easily from stressful experiences. Normative forms of anxiety begin as early as six months of age, when some infants develop a fear of strangers (1). At some point during their second year of life, many children develop separation anxiety, which can make drop off at daycare particularly stressful. It is common for children to be anxious when placed in an unfamiliar environment with unfamiliar people. The feeling of anxiety in this situation is not only developmentally appropriate; it is actually evolutionarily adaptive (2).

Anxiety is adaptive

Anxiety serves as a protective human response that warns us of potentially dangerous situations. When sights, smells, or noises indicate danger, the emotional processing center of our brain reacts. If this center of our brain interprets the signals as dangerous, the brain sends warning messages to the rest of our body. Our body reacts by entering the “fight or flight” mode, preparing to either attack the threat (“fight”), or escape the situation (“flight”). Adrenaline and other stress hormones are released into the blood stream, raising our heart rate and blood pressure. Breathing rate increases as well, preparing us for an increased need for oxygen. Blood flow to the extremities (hands, fingers, toes) decreases, directing the blood to the large muscles of legs and arms and to organs directly involved in the fighting or fleeing (heart and lungs). Once the situation is no longer perceived to be dangerous, our body stops activating these responses and returns to its previous state of functioning (3). Without the fight or flight response, our ability to understand our surroundings and protect ourselves would be greatly diminished (2).

When does anxiety become problematic?

Anxiety is no longer adaptive when the fight or flight response is triggered without the presence of a real threat in our environment. When the physiological response is inappropriate to the situation, or when the fear response remains long after the threat is over, anxiety can cause excessive distress or interfere with daily functioning (5). Research tells us that as many as 15% of preschoolers experience atypically high levels of anxiety (4). For these children, anxiety interferes with their ability to handle everyday situations, or leads them to avoid activities that most children their age enjoy. Many young children have not yet developed the verbal or self-reflective skills needed to articulate their emotions; therefore, anxiety presents differently in this group than it does in teens or adults (6). Anxiety in young children often manifests in behavioral or physical symptoms, such as:

• Frequent complaints of stomachaches, headaches, butterflies, or nausea with no clear medical explanation
• Clinging behaviors, such as following a parent or teacher and refusing to leave their side
• Refusing to participate in or avoiding activities (circle time, birthday parties)
• “Falling apart” if a situation does not go as planned or if the child can’t get something done “just right”
• Difficulty concentrating or sitting still
• Tantrums or meltdowns marked by disruptive behaviors such as crying, yelling, or fighting.

Because most children experience stress and nervousness at some point in their lives, the line between what is normal and what may be indicative of a disorder is somewhat blurry. Some children are naturally more anxious than others, but with time and support, children learn how to cope with these uncomfortable feelings.

How can I help my anxious child?

No two children are the same, and every child experiences stress differently. However, following these tips may help to relieve some of your child’s worries:

• Children often look to their parents to figure out how they should feel about a particular situation, especially in new or unfamiliar settings. Because parents provide clues to their children about how they should react, it is important for parents to be mindful of their own reactions. If parents are acting nervous, the child can pick up on that and may react in a similar way. Being aware of your own reactions and remaining available to reassure your child is key to helping her confront these situations with confidence.

• Avoiding the feared situation usually makes anxiety stronger. If your child is afraid of a particular situation, try to break it down into smaller steps, where every step feels more manageable to the child. For example, if a child is experiencing anxiety around toilet training, have him first go in to the bathroom periodically and get used to the sights and sounds of the place. Next, the child can sit on the toilet with the diaper on. When he is feeling ready (take your time!), he can try to sit on the toilet without a diaper. Take the pressure away from the desired final outcome. Having the child experience a sense of success and mastery at every step is key to keeping anxiety at bay!

• If your child struggles with leaving you, try to keep your good-byes short and sweet. The anxiety stems mostly from the anticipation of the goodbye, so do your best not to drag it out. Sticking to a predictable, quick drop-off routine will help your child know what to expect.

• Prepare your child for transitions. Giving a child a heads-up, or a “five-minute warning” before changing activities will allow her to begin to mentally prepare for change. You can also ask your child to tell you in her own words, what she will be doing next. Naming the activity that is about to happen may ease some apprehension about transitioning and will allow the child to feel more in control of the situation.

• Help your child learn mindfulness and relaxation skills by practicing with him. Find a moment to close your eyes, clear your mind, and focus on taking a few calm breaths. Use this time to observe your thoughts, feelings, and sensations. Taking a few minutes every day to calm down with a few slow breaths can leave both you and your child feeling refreshed and better able to handle stressful situations.

For more relaxation tips, mindfulness exercises, and suggestions for how to help a child struggling with anxiety, check out the following resources:

www.childmind.org/en/posts/articles/2010-11-24-how-parent-anxious-kids

www.huffingtonpost.com/sarah-rudell-beach-/8-ways-to-teach-mindfulness-to-kids_b_5611721.html

www.mindfulparenthappychild.com/resources/

Watching your child struggle with anxiety is not easy for any parent. Remember that you are your child’s biggest ally in helping her handle stressful situations. Reassuring your child that it is O.K. to worry, while also supporting her in developing the skills needed to manage anxiety will help your child feel more competent when faced with the challenges of growing up.

References:

(1) Brooker, R. J., Buss, K. A., Lemery-Chalfant, K., Aksan, N., Davidson, R. J. and Goldsmith, H. H. (2013), The development of stranger fear in infancy and toddlerhood: normative development, individual differences, antecedents, and outcomes. Developmental Science, 16: 864–878. doi: 10.1111/desc.12058

(2) Ana G. Gutiérrez-García and Carlos M. Contreras (2013). Anxiety: An Adaptive Emotion, New Insights into Anxiety Disorders, Dr. Federico Durbano (Ed.), ISBN: 978-953-51-1053-8, InTech, DOI: 10.5772/53223. Available from: http://www.intechopen.com/books/new-insights-into-anxiety-disorders/anxiety-an-adaptive-emotion

(3) Fight-or-flight response. (2016). In Encyclopedia Britannica. Retrieved from http://academic.eb.com.ezproxy.library.tufts.edu/EBchecked/topic/206576/fight-or-flight-response

(4) Côté, S. M., Boivin, M., Liu, X., Nagin, D. S., Zoccolillo, M. and Tremblay, R. E. (2009), Depression and anxiety symptoms: onset, developmental course and risk factors during early childhood. Journal of Child Psychology and Psychiatry, 50: 1201–1208. doi: 10.1111/j.1469-7610.2009.02099.x

(5) Muris, P. (2006). The pathogenesis of childhood anxiety disorders: Considerations from a developmental psychopathology perspective. International Journal of Behavioral Development, 30(1), 5-11. doi:10.1177/0165025406059967

(6) Vasey, M. W., Crnic, K. A., & Carter, W. G. (1994). Worry in childhood: A developmental perspective. Cognitive Therapy and Research,18(6), 529-549. doi:10.1007/BF02355667

Acknowledgments

This article was prepared with the invaluable help of Lindsay Rosen, a second year graduate student at Tufts University’s Eliot-­Pearson Department of Child Study and Human Development. Lindsay is passionate about understanding and improving the lives of individuals affected by various neurodevelopmental and psychological issues. Her ultimate goal is to work as a clinical psychologist and assist families through evaluation and treatment. Lindsay is currently interning at Growing Minds, LLC, where she helps Dr. Dashevsky gather research-­based literature on topics or clinical issues that arise in the course of Dr. Dashevsky’s work with children and families.