Anxiety symptoms (eg, fears about harm to self or loved ones; distress when child is asked to engage in feared activity; somatic complaints associated with fears) are common in children and adolescents; at some life stages and in some circumstances, a certain level of anxiety is developmentally appropriate.
Anxiety symptoms may be features of 1 of 6 anxiety disorders or may cause functional impairment in the absence of a diagnosable disorder. Anxiety-like symptoms are a frequent response to trauma (physical or psychological) and can be features of posttraumatic stress disorder (PTSD), acute stress disorder, or adjustment disorder.
Validated tools are available to screen for mental health symptoms generally, anxiety symptoms specifically, posttraumatic stress specifically, and impaired functioning, and to assess the effect of the child’s problem on caregivers; results lead to further discussions with the child and family.
A child who feels anxious often has a parent who feels anxious or depressed; care of the parent is integral to helping the child.
Pediatric clinicians can provide meaningful intervention, even in the absence of a diagnosis, through expressions of hope, empathy, and support to the child and family; encouragement of healthy habits and reducing overall stress; emphasis on coping with or gradual exposure to feared activities, rather than avoiding them; and brief interventions derived from cognitive behavioral therapy (CBT).
Refer for full diagnostic evaluation and evidence-based care (CBT, plus medication for certain disorders) or comanage care with a mental health specialist if
The child has severe functional impairments at school, at home, or with peers.
Multiple symptoms of anxiety occur in many domains of life.
The child or parent is very distressed by the symptom or symptoms.
There are co-occurring behavioral problems (especially if combined with shyness).
Anxiety was preceded by serious trauma or symptoms suggesting PTSD, acute stress disorder, or adjustment disorder.
The child seems to have panic disorder or obsessive-compulsive disorder (OCD), both of which require specialized treatment.
Anxiety occurs in a child with autism spectrum disorder (ASD).