There’s not much that’s more troubling as a parent than observing your child struggle to express complex feelings and emotions. At any age, the emotions that manifest as big, loud, and somewhat disruptive behaviors usually garner more attention than the ones that make a child shrink into the shadows, but both extremes are hard to witness and harder for parents to help their children address in a productive way. As parents, we all want our children to be well adjusted and have amazing coping skills. Unfortunately, our reality sometimes is our worst roadblock on the road to self-awareness. The early exposure young children have now to our fast-paced, technology-driven, instant-gratification-focused, perfection and performance-based world often prevents them from having time to fully process one emotion before jumping to the next. This distraction can lead to emotional disconnect, and then things get complicated.
Anxiety is a normal part of being human. It’s part of the “fight or flight” instinct, and we need it because in usual amounts it’s protective. Infants startle easily and fear strangers. Toddlers are often uncomfortable in the dark, fear imaginary creatures and don’t like being separated from their loved ones. School-aged children fear injuries, germs and natural events like thunderstorms, hurricanes or wildfires. Adolescents worry about social status, school performance and their health. All of this is normal. What becomes “not normal” is when the balance gets tipped and fear overtakes reason. This happens frequently — about 10-20% of kids will struggle with anxiety at some point in childhood. What’s really tricky is that the trigger or the tipping point isn’t always obvious to us until it’s too late.
Anxiety is a great mimic
For so many children, emotional unrest is impossible to put into words. It shows up, instead, as everything from tummy aches, sleep problems, headaches, shortness of breath, dizziness, chest pain, muscle tension, trouble swallowing, back pain, fatigue, nausea, heart palpitations, GI distress and beyond. These symptoms necessitate careful medical consideration by the pediatrician, and sometimes a medical cause is identified. It’s when the medical workup is normal that the true hard and introspective work begins, because it’s at this point that the anxiety comes to light.
So what’s next?
Parents often ask us in clinic what the “next steps” are to helping their child cope with complex feelings and emotions. For some kids, simply acknowledging the anxiety is enough. Others respond well to certain self-management techniques that focus on stress-management and relaxation. We find the following workbooks and websites to be particularly helpful if you have a motivated child and don’t mind doing some homework as a family:
- What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner
- The Anxiety Workbook for Kids: Take Charge of Fears and Worries Using the Gift of Imagination by Robin Alter and Crystal Clarke
- The Anxiety Workbook for Teens by Lisa Schab
- The Anxiety Survival Guide for Teens by Jennifer Shannon
If you have a technologically advanced tween or teen, the following Apps might be helpful:
- Headspace (meditation techniques for stress relief)
- Self-Help for Anxiety Management (anxiety tracking and toolkit)
- Pacifica (mood and thought tracker, provides tools for handling stress and anxiety)
Of course, there’s a limit to what parents and children can reasonably address together, and that’s when a pediatrician might refer a child to a psychologist for targeted therapy. One strategy that works very well for younger children is Cognitive Behavioral Therapy (CBT). This technique essentially helps children realize that their thoughts influence their feelings, and that their feelings influence their actions. By improving the basis of the initial thought, subsequent feelings and behaviors are re-framed, often in a more positive light. The goal, essentially, is to help children develop a coping skills “toolkit” that they can fall back on throughout their lifetime as there will invariably be many future stressors to threaten their emotional balance.
The question of medication is often broached at some point along a parents’ journey in helping a child overcome anxiety, and there is much data to suggest that an actual combination of medication and therapy has the greatest success in helping a child achieve mastery over their worries. If you feel that your child would benefit from a medication evaluation, please discuss this with your pediatrician.
How can we help?
At Carithers Pediatrics, we thrive on taking care of babies, teens and every child in between. We know that each age and stage brings with it some special challenges, and as parents ourselves, we know how personal those challenges can be. For 75 years, Carithers has been providing care to children in the Jacksonville community, and we are proud to have 3rd or 4th generation patients entrusting us with their care. We are especially equipped and trained to treat all medical conditions as well as psychological conditions like anxiety and depression. We partner well with our community psychology and psychiatry colleagues to work for the best outcomes for our patients, and see a huge benefit for these kids with a team-based approach. Please contact us if you’d like to learn more!
About Dr. Dudley
Dr. Dudley grew up as a patient at Carithers Pediatrics and joined the group in 2013 after finishing her pediatric training in Boston. She has two young sons, one of whom struggles with anxiety and Apraxia of Speech, and she is passionate about helping children with speech and language delays find their voice.