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Helping Kids Deal with Anxiety and Stress

Posted on May 06, 2019

Jennifer Katzenstein, Ph.D., ABPP-CN, is the director of psychology and neuropsychology at Johns Hopkins All Children’s Hospital. As a pediatric neuropsychologist, she deals with a variety of patients who are impacted by anxiety and stress, which she discusses in this week’s On Call for All Kids.

What are signs and symptoms of anxiety?

Signs and symptoms of anxiety include agitation, restlessness, inattention or changes in school performance, headaches, stomachaches, avoidance, tantrums, crying, irritability and difficulties with transitions. In addition, perfectionism and frustration when things do not go as planned, as well as difficulties with sleep and changes in appetite can be signs as well. Excessive worry, nervousness and asking more questions are also symptoms.

What current stressors kids are exposed to?

Kids are exposed to stressors at school, at home and in social media. Increasing pressure being placed on thinking about getting into college, getting perfect grades and by observing others on social media also contribute. In general, we are more stressed out as parents, trying to balance work and home routines, and all of this can contribute to how we are feeling and our levels of anxiety.

My child is worried all the time. Will it go away?

If your child is worried all of the time, and it is preventing normal functioning, such as doing tasks at home and getting to school, it is definitely time to seek additional support. Sometimes kids may “grow out” of fears and anxiety, but if that worry is impacting daily functioning, it is time to seek support!

What can I do to help my child?

The goal is to help our children manage anxiety and provide ways to help support their overall anxiety development. Express positive expectations that are also realistic, and keep routines consistent to the extent possible. Maintain positive communication, and ask open-ended questions that can’t be answered with just a “yes” or “no.” Also, don’t allow the child to completely avoid the situation that causes anxiety, but also keep the anticipatory period for these situations short. Also, try to model healthy anxiety and coping, and show your child when you are feeling anxious, and how you model it for yourself. Staying calm as parents is key as well.

Who do I call if I think my child has anxiety?

If you are concerned your child has anxiety, a great first step is to reach out to his or her pediatrician. At that appointment, describe what concerns you have about your child. Ask for names of trusted psychologists and/or therapists who work with children with anxiety. You can also call your insurance carrier for a list of providers, as well as ask friends and family if they have a trusted provider for counseling, too.

At home, maintaining structure and routine will be important, as well as finding times for you to have a few minutes with your child to talk and catch up on their day. Starting to learn deep breathing exercises together, and even starting meditation can be helpful, and there are great apps for kids for each of these!

What will happen at the first appointment with a therapist?

At the first appointment with a psychologist or therapist, you and your child will be asked many questions about medical history and the symptoms your child is experiencing, as well as questions about school and your family. It is important to share your concerns about your child’s behavior with this provider. 

What should I ask at the first appointment?

Make sure to ask about the therapist’s experience working with children and children with anxiety. In addition, ask about the type of therapy they are using to treat the anxiety and stress, and it is important that the therapist is using terms such as “cognitive behavioral therapy” and “evidence based treatments.”

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit each Monday for the latest report.

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