Module 3: Mental and Emotional Challenges for Children
Stress and Anxiety in Young Children
The fight-or-flight moments
20 MINUTE READ
Published September 2024
AUTHOR
Margaret Vadiee, PhD
Contributing Editor, Licensed Psychologist
Maybe you’ve heard, “I’m scared, Mom!!” too many times to count. Or maybe you’ve seen the look on your child’s face when they appear frozen in time, clearly processing something. You know they aren’t quite feeling themselves, and want to equip yourself with knowledge to be able to support your child.
Understanding your child’s emotion
Toddlers and young children can and do experience anxiety, just like older children and adults. Parents who are equipped with an understanding of the research know how and when to help their children during normative and clinical experiences of anxiety. This guide explains what anxiety looks like in early childhood, and specific types of anxiety. You’ll learn how anxiety manifests physically in our bodies and cognitively in how it impacts how we think. We’ll help you understand when anxiety is normal and age-appropriate, and when your child may benefit from support from a mental health professional.
Breaking it down further
Anxiety is common in toddlerhood. In fact, anxiety often peaks around age 3 and some anxiety disorders are rarely diagnosed before that age. It makes sense that anxiety is common in toddlerhood when we think about how much uncertainty a toddler has. There’s much about the world that they don’t understand yet, and they are still figuring out how their parents will respond to their actions. Young children really rely on their parents for a sense of safety, stability, and security at this time¹.
Anxiety comes from somewhere. It’s not weird, random, or crazy that someone is anxious about something. It can most often be traced back to something that makes sense (even though it may or may not be factually accurate). But a parent’s job is not necessarily to turn over every stone until they have a greater understanding exactly why their child is anxious. Their job is to accept that their child feels anxious, respond based on it being a valid feeling, guide them through the often unpleasant emotional experience, and seek professional support if needed. We do not have to understand why someone is anxious to help them with their anxieties.
When is anxiety unhelpful?
Everyone, children and adults, feel anxious from time to time. Anxiety is not a “bad” emotion. Sometimes, it’s quite helpful! For example, you may feel anxious that you’ll forget your lunch in the morning so you think to write yourself a note. That note helps you remember your lunch! However, other times anxiety is unhelpful and it negatively impacts people’s school, work, family, or social life. In young children, this may behaviorally manifest by inconsolable crying, clinging, hiding, and reactive tantrums². A helpful question to ask yourself is, “Is the anxious response in proportion to the actual threat?” When anxiety is out of proportion to the actual threat or interferes with someone’s ability to go about their daily activities, they’d benefit from intervention.
Types of anxiety
There are different types of anxiety, with different perceived threats.
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The diagnostic manual for mental health in early childhood (the DC: 0-5) describes generalized anxiety as “an anxiety state that is not provoked by an immediate perceived threat but rather is linked to worries about the past and anticipatory anxiety about the future³”.
A perhaps more relatable way to describe this is “whack-a-mole anxiety.” Remember the game of whack-a-mole you may have played as a child? Right when you popped one down, another popped up. Generalized anxiety is kind of like that. It’s not really focused on any one content area, but can move around among different content areas. It’s more of a pervasive way of thinking.
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The DC:0-5 says that the“ perceived threat is actual or anticipated separation from the primary caregiver³”.
Separation anxiety is developmentally appropriate for infants and young children through approximately 18-24 months, so is often not diagnosed before then³.
Separation anxiety is expected during that age because children learn that objects and people exist even when they cannot see them, but they don’t yet understand how time works. The child knows that their parent is not with them, but doesn’t understand when they’ll be able to see them again³.
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The DC:0-5 says that the perceived threat for social anxiety is “unfamiliar people and situations³.”
Social anxiety is not simply shyness, but an excessive amount of anxiety about being around new people or in new places. Examples of anxious cognitions may be, “I’m worried they won’t like me,” or “I’m worried that I won’t know what to do there.”
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The DC:0-5 describes Selective Mutism as “fail[ing] to speak in some situations and speak normally in other situations³.”
Selective mutism is not an inability to speak, but rather a failure to speak in certain situations. For example, a child may speak normally at home but not speak at preschool. This comes from a place of intense anxiety, and not the child trying to be oppositional. It can sometimes be confused with extreme shyness. Selective Mutism often first appears around ages 3-4.
Prevalence rates
These prevalence rates for the anxiety disorders in early childhood are based on the diagnostic classification manual for mental health disorders in early childhood (DC:0-5).
2-10%
Generalized anxiety disorder
2-10%
Separation anxiety disorder
2-10%
Social anxiety disorder
Selective mutism
0.03-0.08%
Anxiety in the body
Anxiety is not just “in your head.” There is a real physiological change in your body when you feel anxious. Your stomach can actually hurt. You may actually feel light-headed. When your body is anxious because of a perceived threat, your fight-or-flight response may be activated. The fight-or-flight response is your body preparing itself for protection. The concentration of blood in your body shifts from helping with your digestive system like it usually does to fueling your limbs to be able to fight or run away. This is why you may have a change in how your stomach feels when you feel anxious. Remember that you, as the parent, may not see the situation as a threat so it may not make sense to you why your child’s fight-or-flight response is activated. But your child perceives there to be a threat, and their body is responding accordingly. Check out the Wheel of Emotion guide for more information on the physiological manifestation of emotions. To decrease the physical discomfort, your child can use relaxation strategies. The Coping for Kids guide covers evidence-based relaxation strategies, and how to teach them to your child.
Anxiety in the brain
Anxiety is not just “in your head.” There is a real physiological change in your body when you feel anxious. Your stomach can actually hurt. You may actually feel light-headed. When your body is anxious because of a perceived threat, your fight-or-flight response may be activated. The fight-or-flight response is your body preparing itself for protection. The concentration of blood in your body shifts from helping with your digestive system like it usually does to fueling your limbs to be able to fight or run away. This is why you may have a change in how your stomach feels when you feel anxious. Remember that you, as the parent, may not see the situation as a threat so it may not make sense to you why your child’s fight-or-flight response is activated. But your child perceives there to be a threat, and their body is responding accordingly. Check out the Wheel of Emotion guide for more information on the physiological manifestation of emotions. To decrease the physical discomfort, your child can use relaxation strategies. The Coping for Kids guide covers evidence-based relaxation strategies, and how to teach them to your child.
Do I call it “anxiety” when talking about my child?
Parents sometimes wonder how they should label this feeling with their children. “Do I call it anxiety? What if my child calls it being scared? Do I correct them?” Children will use different terms: worried, nervous, scared, anxious, etc. You can use the same language that your child uses. For example, if they say that they’re nervous, that’s great! They identified their feeling and we’ll also call it feeling nervous. If they hear new terms, like anxiety, it’s okay to explain those too. As you talk about their emotional experience, we want to present information in a matter-of-fact way. You want to exude a sense of confidence as you talk about these emotions. The word “anxiety” doesn’t need to be whispered or avoided. It’s not something “bad;” it’s an emotion. If you speak about anxiety with a sense of normalcy, it will help your child feel like something is not “wrong” with them.
How can I help my child?
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It’s a common response for people to want to avoid things that they are anxious about. For example, if someone is anxious about swimming, they may not want to go to the swimming pool. Avoiding the swimming pool keeps them from having to confront the feeling of being anxious.
Parents may unintentionally help their children avoid what they are anxious about to either help their child avoid the distressing feeling or help themselves not have to manage their child’s behavioral reaction to the anxiety. For example, a child may be anxious about sleeping in their own room. The parent may unintentionally help their child avoid facing their anxiety of sleeping alone by having them sleep in their room⁴, ⁶.
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If you appear anxious when your child is anxious, it’ll likely exacerbate their anxiety. Your child is constantly paying attention to how you respond and assessing your emotional state (albeit often subconsciously). Your child can pick up on when you feel anxious, and it may confirm for them that they have something to be anxious about⁷.
What the research says
It is possible to identify anxiety symptoms in toddlerhood and early childhood⁸.
The experience of anxiety in children is real, and you can even see the impacts on brain scans. Brain scans of school-aged children who experience clinically significant levels of anxiety show that part of their amygdala (the emotion center of the brain) is enlarged⁹.
Interventions that help parents learn more about anxiety and change their response to their child’s anxiety are effective at decreasing the child’s experience of anxiety¹⁰.
There are multiple evidence-based approaches to helping young children with anxiety, including involving parents in the treatment and teaching skills to young children¹¹.
What it might look like for you
Below are vignettes describing the different types of anxiety. It can be helpful to understand the picture of what they look like, but know that it is not your job as a parent to diagnose your child. If you have concerns about your child experiencing clinical levels of anxiety, consult with a mental health professional to determine if there is a diagnosis and what treatment may help.
GENERALIZED ANXIETY
Betty is 4.5 years old. Her parents have always thought of her as a bit of a worrier, but it seems to have only gotten stronger in the last year or so. She struggles to decide which stuffed animal to take with her when she runs errands with her mom because she is concerned about hurting the other stuffed animals’ feelings. She doesn’t want to be in a dark room by herself for fear of something lurking in the corner. She’s terrified during thunderstorms when she hears the thunder roll or sees the lightning strike. During these moments of anxiety, her heart races and she gets a knot in her stomach. She has thoughts like, “I’m worried my stuffed animal will be so sad and never want to snuggle with me again,” “I have a bad feeling there’s a monster hiding behind my dresser that my mom didn’t spot,” and “I worry about the safety of my family and our house during thunderstorms.” Her parents have recognized the pattern of anxiety and have been focusing on not letting her avoid what she is anxious of. For example, when Betty tries to negotiate to take multiple stuffed animals with them to run errands, Betty’s mom holds the limit that she can only take one.
SEPARATION ANXIETY
Jackson (3.5 years old) struggles to be away from his dad, who drops him off for preschool in the morning. He cries and cries and cries. His dad is almost surprised that such a young child can produce so many tears; it breaks his heart a little as he sees Jackson’s distress. His dad knew that the transition to preschool would take some time as Jackson adjusted, but it’s been several months and Jackson’s behavior hasn’t changed. When Jackson knows he has preschool, he starts to fear that he’ll never see his dad again. He doesn’t think he can make it through the school day without his dad. Jackson’s dad knows that it helps Jackson if he keeps a calm presence. Jackson’s dad uses his own coping strategies so he is able to stay engaged, present, and calm during Jackson’s expression of emotion.
SOCIAL ANXIETY
Lily is 5 years old. Her favorite place to be is home. She loves playing with her parents and her older sister. But it’s not just her love of playing with her family that makes her want to stay home. When Lily is in a new place, she feels like she freezes up. Her heart pounds through her chest and she feels like she is going to start crying any second now. She tries to hold the tears in because she doesn’t want anyone to notice. She doesn’t really feel like herself. She’s worried about what to do, how to play, and who to interact with, even though her peers tend to enjoy spending time with her. Lily has been asking to stay home more and more recently. She’s continued to request to not go to her sister’s soccer games. Her parents have encouraged her to continue to attend despite her anxiety, so she doesn’t inadvertently learn that her sister’s soccer games should be avoided.
SELECTIVE MUTISM
Marco is 4 years old. He has a younger sister whom he loves to play with at home. You can find Marco and his sister talking and laughing in the backyard anytime they are free. He talks to his parents too! But when Marco is at school, he’s completely silent. The teachers really haven’t heard him say much at all. The teachers try to encourage Marco to talk to them or his peers at school, but Marco does not. His teachers reach out to his parents to meet about Marco’s lack of speech at school. They express concern that Marco has a delay with regard to language production. Marco’s parents know that he’s able to speak because he does so at home with no concerns. His parents seek support from a mental health professional, who provides education on Selective Mutism and works with Marco to decrease his anxiety.
About the author
Margaret Vadiee, PhD
Dr. Margaret Vadiee is a Licensed Psychologist and a former Adjunct Clinical Assistant Professor at Southern Methodist University in the Psychology Department.
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Nutritionists • Adult mental health • Couples mental health • Infant & child mental health • Sleep coaching •
When to get
expert support
If you think you need expert support, this is a great reason to pop into office hours. Sometimes you might need more support, and that's okay!
You, as the parent, may benefit from seeking expert support to build out your toolkit to support your child through their experience of anxiety.
Your child may benefit from meeting with a mental health professional if they are experiencing excessive anxiety.
If your child is consistently avoiding people, places, or things, they may benefit from consultation with a mental health professional.
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ZERO TO THREE. (2016). DC:0-5: Diagnostic classification of mental health and developmental disorders of infancy and early childhood. Washington, DC.
Rapee, R., Wignall, A., Spence, S., Cobham, V., & Lyneham, H. (2022). Helping your anxious child: A step-by-step guide for parents. New Harbinger Publications.
Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond. Guilford Publications.
ZERO TO THREE. (2016). DC:0-5: Diagnostic classification of mental health and developmental disorders of infancy and early childhood. Washington, DC.
Rapee, R., Wignall, A., Spence, S., Cobham, V., & Lyneham, H. (2022). Helping your anxious child: A step-by-step guide for parents. New Harbinger Publications.
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Qin, S., Young, C. B., Duan, X., Chen, T., Supekar, K., & Menon, V. (2014). Amygdala subregional structure and intrinsic functional connectivity predicts individual differences in anxiety during early childhood. Biological psychiatry, 75(11), 892-900.
Anticich, S. A., Barrett, P. M., Gillies, R., & Silverman, W. (2012). Recent advances in intervention for early childhood anxiety. Journal of Psychologists and Counsellors in Schools, 22(2), 157-172.
Luby, J. L. (2013). Treatment of anxiety and depression in the preschool period. Journal of the American academy of child & adolescent psychiatry, 52(4), 346-358.