Anxiety can be a shady character and can often appear in ways that don’t look like anxiety. Because of this, it can be difficult to know when your child is anxious. Anxiety has been doing its thing since the beginning of humans, and it’s brilliant at it. What it’s not so great at is announcing its presence in gentle, clear ways that preserve the capacity for any of us to meet it with a strong, steady, ‘Oh, there you are,’ and an even more powerful, ‘It’s okay, I’m safe – you don’t need to be here right now’.
Anxiety in Children – Why Does Anxiety Happen?
Anxiety is the work of a strong, healthy brain that’s a little overprotective. It comes from a part of the brain called the amygdala, which keeps us safe by getting us ready to fight for our lives or run for it. The amygdala is instinctive, so if it thinks there might be danger, it will act first and think later – and the unfamiliar, the unknown, humiliation, embarrassment, separation from important people, can all count as danger. When the amygadala is triggered, it initiates a surge of neurochemicals to make us stronger, faster, more powerful, and more physically able to deal with a threat. Sometimes, the amygdala can work a little too hard and hit the alarm button too often when it doesn’t need to. It is NOT a broken brain, but a strong, healthy, capable brain that’s working a little too hard and being a little too overprotective.
Back when the threats we humans faced were mostly physical, the most anxious of us probably would have been the most likely to survive. An anxious brain would have made us more alive to any threats, which would given us the survival edge. Now, the dangers we face are less physical threats and more psychological ones. We no longer face the possibility of being dinner for a furry predator, but we do face very real psychological threats such as failure, rejection, exclusion, humiliation, disconnection from the people we care about – and the list goes on. The brain still fires up in response to threat, exactly as it’s mean to, but when the threats are psychological stressors, the fight or flight response doesn’t serve us so well. When there is nothing to fight or flee, there’s nothing to burn the fight or flight neurochemicals that surge through us, so they build up and cause the symptoms of anxiety.
Anxiety can sound like …
When children are anxious, it can be difficult for them to articulate exactly what’s happening for them. It will be clear that something isn’t quite right, but it might not be as obvious that anxiety is behind it. Here are some of the things kids might say when they’re feeling anxious. Of course, just because they say any of these doesn’t mean anxiety is making the push, but it might. The key is to be open to the possibility, so if it is anxiety that’s breaking their stride, you can come in and provide the support they need to feel safe, secure and ready to take on the world again. If you hear any of these, notice when they happen. If they happen regularly in the same environment, before the same thing, after the same thing, and with other symptoms of anxiety (such as racey heart, sick tummy, avoidance, clammy skin, tension, headache), anxiety might be behind it. The clues will be in the regularity, timing or intensity.
1. I feel sick, like I’m going to vomit.
During anxiety, anything that isn’t absolutely essential for survival slows down to conserve energy for fight or flight. Blood flow is directed from the abdominal organs to the brain, and digestion slows. This can feel like butterflies or nausea. This is a very normal part of anxiety and completely safe, but it can feel awful. Sometimes it can lead to its own anxiety about vomiting. If this is something you tend to hear before or during similar experiences (such as separation from you or before school), and there doesn’t seem to be any other signs of illness, be open to the possibility that anxiety is behind it. Help your child make sense of what they are feeling by explaining where their nausea is coming from. Here are some words that can help:
That sick feeling is something that happens when your strong, healthy brain thinks there is something it needs to protect you from. It doesn’t mean there is anything unsafe there, but sometimes brains can get a little overprotective. This is called anxiety and it happens to lots of people. Anxiety comes from a part of the brain called the amygdala. It’s kind of like your own fierce warrior, there to protect you. If your amygdala thinks there might be trouble, it gets you ready to fight or flee the danger. Sometimes, your amygdala can be a little overprotective and get you ready for fight or flight even though there’s no need. It does this by surging your body with a special body fuel to make you stronger, faster and more powerful – kind of like a superhero. This is a great thing if there is something you need to get away from, but if there’s nothing to fight or flee, there’s nothing to burn the special body fuel surging through you and it can build up and make you feel sick.
Something else that happens when your amygdala thinks there’s danger is that it sends a message to your body to save energy, in case you need to fight or flee. One of the ways it does this is by slowing down digestion – the process that gets the nutrients out of the food you eat. Don’t worry – this is completely safe, even though it might feel awful.
When you know that sick feeling is from your brain trying to protect you, there’s something very powerful you can do to feel better. It’s strong steady breathing. This sends a message to your amygdala that you’re safe, so it knows to stop surging you with the special body fuel. When this happens, the sick feeling will start to go away.
Strong, steady breathing will neutralise the fight or flight neurochemicals that can cause nausea. The trick is to make sure they practise strong steady breathing when they are calm, because an anxious brain is a busy brain and it will be less able to do anything unfamiliar. One way to practise is with hot cocoa breathing. Ask them to pretend they are holding a delicious cup of hot cocoa. Smell the warm, chocolatey smell for three, hold it for one, then blow it cool for three.
2. I’m not hungry.
When digestion shuts down to conserve energy for fight or flight, the need to eat gets shut down along with it. This is only temporary and will switch on again when the anxiety eases. (Unless of course you’re offering something that makes their taste buds slam the door in disgust, you know, like anything served on the yellow plate instead of the blue one.)
3. My tummy hurts.
Anxiety can hit tummies hard. With any pain, it’s always important to make sure there’s nothing else driving the symptoms but when abdominal pain doesn’t have any other physical explanation, it’s possible that anxiety is the culprit. Other clues that anxiety might be driving the pain include the timing (does it happen before or during something that is likely to trigger anxiety), and the presence of other symptoms of anxiety (racey heart, nausea, tense muscles, clammy skin, flushed cheeks, avoidance etc). The brain and gut are intimately connected. What happens in the brain can affect the gut, and vice versa. Anxiety can send signals directly from the brain to the gut, causing tummy trouble. Anxiety can also influence the gastrointestinal tract to move and contract in ways that cause pain. Tummy pain without any identifiable physical cause is so common that it has a name – functional abdominal pain. The pain is very real and can be quite severe. It’s usually around the belly button, but not always. Tummy pain that is driven by anxiety is best dealt with by continuing as usual, and not avoiding whatever might be triggering the anxiety. The brain learns from experience, so avoidance will make avoidance more likely. Similarly, brave behaviour will make a brave response more likely. Avoidance teaches the brain that the only way to stay safe is to avoid. This can shrink their world and lead to bigger problems, particularly when the anxiety is around school or separation from you.
4. I don’t want to go to school.
Anxiety doesn’t always seem rational, but that’s because it comes from a part of the brain that runs on instinct. During fight or flight, the thinking, rational part of the brain shuts down enough so as not to interrupt the fight or flight response. If the brain thinks survival is on the line, it doesn’t want you to take too much time thinking about what the options are – it just wants to get you safe. This is why school refusal can happen even when there seem to be no other issues with school, friends or teachers. When anxiety switches on, nothing else will matter and all your child will be aware of is that school feels like a big dose of trouble, even if they can’t explain why. Giving them the information about how anxiety works will help them feel safe enough to be brave enough. Again, it’s really important not to let anxiety drive avoidance. It makes so much sense to avoid the places that feel unsafe, but as the adults in their lives we need to believe that they can cope, even when everything in us is wanting to scoop them up and away from whatever is triggering their anxiety. The more they are exposed to brave behaviour – and doing things that feed anxiety is always brave – the more they will learn they can be brave when they need to.
5. Anything angry.
The ‘flight’ part of anxiety shows itself as avoidance, but there is also the ‘fight’ part which can show itself as anger or tantrums. During anxiety, the surging of fight or flight neurochemicals energise the body for fight or flight. Sometimes that energy comes out as anger. As well as this, the amygdala (the part of the brain responsible for anxiety), is also involved in dealing with big emotions. When the amygdala is highly active, as it is during anxiety, it means other emotions (such as anger) will also be switched to high volume. When kids are under the influence of an anxious brain, their behaviour has nothing to do with wanting to push against the limits. They are often great kids who don’t want to do the wrong thing. It’s not bad behaviour, it’s anxiety. When anxiety is driving behaviour, it’s important to treat the behaviour as anxiety rather than bad behaviour. Any shame kids might feel for their behaviour will only drive their anxiety harder – they want to do the right thing and they don’t want to disappoint you. This isn’t intended to give them a free pass. They still need to know where the limits are, and they still need to feel the edges of those limits but it’s important to do it gently and by giving them the information they need to make better choices. They want to do the right thing, but as with all of us, sometimes that can take a little wisdom and a lot of practice.
6. ‘I feel really sad and I don’t know why.’ (Or just tears. Lots of tears.)
Again, the same part of the brain that is in charge of anxiety – the amygdala – also controls big emotions. When anxiety is high, sadness can be too. It isn’t necessarily a sign that something sad has happened. During anxiety, tears are a sign of a brain on high alert. Just be a strong, steady, loving presence, and know that the sadness will pass when the anxiety does. Let the tears come if they need to, and when things settle, explain how sadness and anxiety can happen together. Research has found that crying can be healing when people have emotional support, and if their tears led to a new wisdom about whatever it was that caused them to cry in the first place.
7. ‘But what if …. What if … What if.
Anxiety is the sign of a brain that is being hauled into the future. The what-ifs are an attempt by an anxious brain to stay safe by turning as many unknowns into knowns as they can. Help them to find their own scaffold between their anxious thoughts and a brave response by asking them what they think will happen. This will activate the pre-frontal cortex, which is the part of the brain that is more rational, considered, and able to calm big emotions. During anxiety, the activity in the pre-frontal cortex decreases, making it more difficult for it to influence the instinctive, emotional amygdala. You might need to prompt them by asking them to reflect on what has happened in similar situations in the past – either it’s never happened before, or if it has, they got through it. Recent research has found that the ability to inhibit worrying thoughts depends on an important chemical in the brain called GABA. One of the best ways to increase GABA is with regular exercise.
8. I need to pee … again.
The fight or flight neurochemicals can cause the need to pee. We know it happens, but it’s not clear why. One theory is that during anxiety, the central nervous system is geared to be more sensitive, so it takes less to activate the emptying of the bladder. Another theory is that during anxiety, muscles tighten and one of these may be the bladder, causing the feeling of a full bladder and the need to empty it. If this is a common symptom for your child, it can create an anxiety in itself by feeding into the worry that there won’t be the opportunity to go to the toilet if they need to. Again, explain to them how anxiety can cause this. Also let them know that when they manage the anxiety, the urge to pee will stop showing up with a grand ‘ta-da’ at the worst times.
9. I can’t sleep.
An anxious brain can get busy at any time, but its favourite time to play is when there isn’t much else going on. At bedtime, there’s nothing else to distract from anxious thoughts. Try a mindful meditation to give your child something to focus on other than their anxious thoughts. (Try Smiling Mind which is a free app, backed by loads of ongoing research.) Another way to help anxious kiddos find calm at bedtime is to give them a job to do. Ask them to put a soft toy animal next to them so they’re snuggled against it. The idea is for them to concentrate on being still and gentle enough so as not to wake their furry friend. Ask them to concentrate on their breathing and their body while they do this. This is a form of mindfulness that will help to relax their mind and body.
10. My legs hurt. My arms hurt.
During anxiety, fuel is sent to the muscles so they can fight or flee. This can make arms and legs feel tight, wobbly or achey. Explain how anxiety can cause this so they can understand that the pain is not a sign of a bigger problem. Often with anxiety, kids might not realise they’re tensing until they feel what ‘relaxed’ feels like. To help them manage their ache or tension, guide them through a progressive muscle relaxation. Starting from their feet ask them to tighten them for a few seconds, then relax. Slowly work up through the rest of the body, muscle by muscle, tensing then relaxing. This will give them a sense of what it’s like to feel relaxed … which will feel lovely.
11. But I don’t want to sit still.
Anxiety feels flighty. The fight or flight neurochemicals that surge the body during anxiety are there to get the body ready for action. When there is no need to fight or flight, there is nothing to burn off the neurochemicals that are driving your child to wriggle or squirm. When this happens, encourage your child to move – walk, run on the spot, go up and down the stairs. Let them know this will help them be the boss of their (very excellent) brain, which will help them be the boss of their restless body. When the neurochemicals start to disappear, so will the wriggles.
12. But I can’t do it!
Anxiety can drive perfectionism. Anxiety comes from a brain that thinks there might be trouble – and humiliation, failure – or anything that might come from making a mistake counts as trouble. The key is to provide opportunities for your child to learn they can fail, fall or stumble – and still be okay. When they don’t do as well as they expected, make it about what they’ve learned from the experience (and there will be great learnings they can be applauded for), rather than focusing on the loss. It’s about nurturing their mindset towards recognising the opportunities, lessons or growth, rather than the losses. Also, be mindful of how you deal with your own failures. Are you able to laugh off your mistakes or failures? Can you extract the wisdom without dwelling on the loss? Kids will always learn what they see more deeply than what they are told.
13. I want to stay with you.
There is nothing wrong with your kiddos wanting to stay close, but it becomes a problem when it starts causing problems. Separation anxiety is driven by a fear that something might happen to you while you are away from them. The fear of leaving you will be real, but it will also be temporary. Their anxiety will ease as soon as they have the opportunity to realise you aren’t there and that they are still okay so the sooner this can happen, the sooner they can find calm. Their distress on separation from you might keep happening for a while, and although this is distressing for both of you (I’ve been there), that distress comes from the emotional memory of the actual point separation. Our emotional memories are powerful, and they are triggered automatically and instantly. If drop-offs are distressing, these memories will be powerful and easily activated whenever they are in the same situation. The good news is that the brain learns from experience, so the more experience they have with finding calm after saying goodbye, the quicker they’ll learn that they’ll soon feel okay. This is why it’s so important not to drag out a tough goodbye, and I know how tough they can be (and I’ve also dragged them out – we’re only human and it’s going to happen). When they become upset, let them know that you understand how difficult it can be. It’s important that they feel validated. Then, give them a cuddle and then let the goodbye be quick and confident. If you hesitate, they’ll hesitate too. Similarly, if you believe they’ll be okay, they’ll be more likely to believe it too. Their brain is telling them they aren’t safe – they need ‘borrow’ your calm and your belief that they can cope and do brave, hard things.
14. I’m tired.
Anxiety can keep kids awake at night with intrusive thoughts, and the physiology of anxiety can be exhausting. Putting themselves out there when everything in them is telling them to retreat is tiring – and brave. Mindfulness will help strengthen them against anxiety and the physical consequences that come with it. Mindfulness lowers activity in the amygdala (the initiator of anxiety) and increases activity in the pre-frontal cortex (the ‘calm down, we’ve got this’ part of the brain).
15. Nobody wants to play with me.
This might be a sign of an issue in the playground, but it can also be a sign of an anxious child who is holding back. Kids with anxiety will often hold back from including themselves in the playground, at least until they feel safe with a group. When it isn’t clear whether or not they’ll be accepted (however kind the other kids are), anxious kids will more likely wait until they’re asked, because any threat of being misunderstood or rejected will feel too big. Importantly though, kids who are anxious are often very well-liked by their peers. Their sensitivity, empathy and emotional intelligence makes them pretty great friends to have – and once they’ve connected with them, other kids know it too. All those other kids need is the opportunity to know them.
And finally …
Children and teens will always know when something isn’t right inside them, but sometimes it can be hard to find the words. As the adults in their lives who love them, the feelings of helplessness when we see them struggling can be seismic. When we can understand what’s happening, we can start to give them the safety and comfort of helping them to make sense of what they are experiencing. By doing this, we can steady the ground beneath them so they can feel safe enough and brave enough to keep exploring their world, influencing it, and establishing their very important place in it.
‘Hey Warrior’ is the book I’ve written for children to help them understand anxiety and to find their ‘brave’. It explains why anxiety feels the way it does, and it will teach them how they can ‘be the boss of their brains’ during anxiety, to feel calm. It’s not always enough to tell kids what to do – they need to understand why it works. Hey Warrior does this, giving explanations in a fun, simple, way that helps things make sense in a, ‘Oh so that’s how that works!’ kind of way, alongside gorgeous illustrations. (See here for the trailer.)