The Many Manifestations of Anxiety in Young Children and Creative Strategies for Addressing It

In today’s unpredictable world it is not surprising that young children are experiencing high levels of anxiety even in stable and highly responsive home environments. Children experience anxiety through a myriad of symptoms and often can’t recognize these collective groups of symptoms as anxiety. Therefore, their ability to articulate their anxiety as well as the root of this generalized anxiety can be severely limited. This article will explore four common manifestations of anxiety in young children and provide strategies that help address these symptoms as well as the root of the anxiety itself.

Manifestations of Anxiety

1. Excessive Attentional Needs

2. Physical Symptoms

3. Excessive Fear and Resistance to Change

4. Anger and Aggression

Excessive Attentional Needs

During periods of anxiety the amount of attention a young child needs from their caregiver often increases. While all young children need ample attention to feel secure in their family unit, when a child is experiencing anxiety their need for attention can often seem bottomless. Meeting these attentional demands can sometimes feel overwhelming to caregivers who are working, single parents, and/or experiencing anxiety themselves.

The following are examples of attentional needs that may be manifesting from anxiety:

- Following the caregiver around the house

- Not wanting to play alone even for short periods

- Asking for help with things they can do independently

- Crying or whining to get their needs met instead of using language

- Severe and persistent separation anxiety (after the age of 3yrs) when a parent leaves the house or at bedtime

- Constantly acting silly or making jokes especially if the caregiver is showing signs of distress

- Requiring excessive physical touch (for example refuses to stop hugging a caregiver while they are making dinner)

- Behaviors that require caregivers to intervene (such as making a big mess)

Strategies for the anxious attention seeker:

A ‘Kissing-Hand’ Separation Ritual: Read The Kissing Hand by Audrey Penn with your child. Have your child help you trace your hand onto construction paper. Draw a heart in the center of the hand and cut it out. Use this in a ritual when you separate from your child. For example, when you leave for work give your child kisses on both their hands. Say “Mommy loves you.” And then give them the construction paper cut out of your hand to hold onto.

Emphasize Play Dates: Ensure that your child knows you are committed to designating time just for them especially during busy and chaotic times. At the beginning of the day, plan a time for you and your child to play together distraction free. Write them a note inviting them to a “play-date.” For example, give your child a note at breakfast that says ‘Me+You, right before dinner, in your play kitchen.’ Keep this commitment to your child and be sure to give them your full attention during this time (if possible leave your cell phone in another room).

Physical Symptoms

Anxiety commonly manifests itself in the body. Children, especially those who do not have the language to express their anxiety may express it through physical complaints and other physical indicators. The following are ways anxiety can manifest itself through physical symptoms.

- Inability to focus on age-appropriate play

- Overactivity

- Underactivity

- Stomach complaints

- Headaches

- Persistent physical pains that vary and do not seem to have a cause (they say their foot hurts, then an hour later their stomach hurts, then an hour later their finger hurts)

- Changes in appetite

*It is important to consult your child’s health care provider if your child has persistent physical pain symptoms or significant changes in appetite or activity level. *

Strategies for addressing physical symptoms of anxiety:

Create an exercise menu: Exercise is a key strategy in managing anxiety. To create an exercise menu come up with a list of about 5-6 exercise choices that your child always has the option to engage in. (Examples: Ride a bike, Cosmic Kids Yoga, Run laps around the house, Dance party, Play basketball, Jump on a trampoline). Invite your child to help you create this list and then draw a picture of each menu item. Glue the pictures on a piece of cardboard and invite your child to choose from their exercise menu each day to create a daily exercise habit.

Sensory Strategies: Incorporate a variety of sensory strategies into your child’s day. Massage their hands, face, or ears at the onset of a headache or stomach ache. Invite your child to engage in regulating activities such as taking a warm bath with essential oils or swinging on a swing when you see signs of dysregulation. Have a wide variety of activities that provide manual sensory input (playing with playdough, mud, sand, shaving cream, water, ect) available to your child. Consult an occupational therapist or other health care provider to see if your child could benefit from a weighted vest or blanket.

Excessive Fears and Resistance to Change

Underlying generalized anxiety can manifest itself most obviously through excessive fear, exaggerated fear responses (even when the stimulus is non-threatening), and a resistance to change. Examples include:

Exaggerated fear responses to mildly or non-threatening stimuli (excessive fear during a thunderstorm)

Fear responses at the mention of frightening stimuli (crying at the mention of a bee)

-Fear of new activities

-Distress at changes in the routine

-Repetitive questions along the lines of “What are we doing later?” “What is coming next?” “What will happen when we go to ___?”

-Frequent Nightmares

Strategies to support children with excessive fears and resistance to change:

Act it out: Pretend play is a powerful way in which children can express and process fear. Engage in pretend play with your child to act out their fear schemas. For example, if your child is afraid of thunderstorms, play a game of ‘house’ in which your child is a parent and has to comfort their doll baby during a pretend thunderstorm. You can also pretend play new activities such as going to the doctor or getting a haircut to help your child know what to expect during these activities.

Prepare your child for change: It may seem counterintuitive to emphasize a scary change before it happens but it gives your child time to process and express that fear before the actual event. For example, if your child is fearful of going to the doctor start counting down five days in advance. Five days before, tell your child about the upcoming appointment. Four days before read books about going to the doctors. Three days before, invite your child to engage in doctor related dramatic play. Two days before tell your child a story about a time you went to the doctors. One day before, talk to them about exactly what will happen at the doctors in sequence (“We will get in the car and drive to the doctor’s office. We will get there and wait in the waiting room. We will go into the examination room and a nurse will come in. They will ask questions and check your weight and height.” Ect, ect.). On the day of the appointment make sure they know what time they will be going and give them occasional count downs (We are going in an hour, we are going in ten minutes, we are going in 5 minutes).

Worry Box: Read the book Worry Box by Suzanne Chiew with your child. Then invite them to make and decorate their own worry box. When they come to you with worries, invite them to write them down or illustrate them and put them in the box.

Anger and Aggression

It is common for children to unconsciously mask their anxiety through anger and aggression. Expressions of anxiety-related anger can include:

-Throwing or breaking objects in responsive to a stressful event (i.e. they overhear parents arguing)

-Aggression in response to demands to engage in non-preferred activities or routines

-Seemingly unprovoked anger or aggression

Strategies for addressing anxiety-related anger:

A cozy space: Designated a place in your house for a cozy space/calm down corner. Invite your child to help you gather big pillows, stuffed animals, and other soothing items for this space. Redirect them to this space when they start showing signs of anger or aggression.

Teach calm down strategies using books by Gail Silver. Read Ahn’s Anger and Stepping Stones by Gail Silver with your child. Talk about the strategies Ahn uses in each of the books to manage his anger. Invite your child to practice these strategies.

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