Common Symptoms of Anxiety in Children
Medically reviewed by Akilah Reynolds, PhD — By Sian Ferguson and Sandra Silva Casabianca on May 5, 2021
Not all kids experience anxiety in the same way. You can learn the signs and symptoms.
It’s natural and not uncommon to feel concerned about the possible symptoms of anxiety in children. Sometimes, identifying these symptoms or recognizing them as anxiety might even be difficult. In fact, if you’re wondering about some of your child’s behaviors, you may want to talk with a health professional. They can help you explore possible reasons behind your little one’s actions and attitudes. You might feel tempted to blame yourself for your child’s anxiety. However, the cause of anxiety in children is likely a combination of factors — many of them out of your control. Still, your child’s anxiety can be managed, and the potential distress they may be experiencing can be addressed and decreased.
General symptoms of anxiety in children
Everyone experiences anxiety from time to time, but not everyone experiences it the same way. Children are no exception. In some instances, anxiety in children is related to a specific event they fear to face. For example, an upcoming sports game or a big presentation at school. Other times, your child might feel anxious all the time and in most situations. When anxiety symptoms last for a while and they’re not addressed, they might become a challenge for your child or teen. According to the Anxiety Disorders Association of America (ADAA), the average age for an anxiety diagnosis in children is between 4 and 8 years old. This often coincides with the time a child starts school. But this is not the only time a child might develop anxiety symptoms. A younger child might not know how to express their emotions. An older child might feel you won’t understand them, even if they tried to explain. This is natural and not uncommon. Learning to recognize the specific symptoms of anxiety in children can help you provide the support they need and when they need it. There are a few types of anxiety disorder, and each of them can have its own symptoms.
Common anxiety disorders in children include:
- Generalized anxiety disorder (GAD)
- Post-traumatic stress disorder (PTSD)
- Social anxiety disorder
- Specific phobias
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Selective mutism
- Separation anxiety
Some children will develop symptoms of one or more anxiety disorders, but it doesn’t mean they have the condition. If the symptoms are temporary, it is likely not an anxiety disorder.
In general, symptoms of anxiety in children may include:
- needing constant reassurance
- complaining of a stomach ache or other pains, particularly before specific activities or events
- avoiding everyday situations, like school or social events
- difficulty eating or sleeping
- tearfulness without a reason
- clinginess (especially if this is a new behavior in the child)
- angry outbursts
- being fidgety or unable to rest
- difficulty concentrating
- difficulty doing chores or schoolwork
- physical symptoms like shaking or flushing
These symptoms may or may not be part of an anxiety disorder. Only a mental health professional can offer a correct diagnosis.
Generalized anxiety disorder (GAD)
Children and teenagers with GAD may experience persistent and severe worries about no specific situation or issue. These concerns are mostly about themselves and how they perform in life. Anxiety symptoms care arise suddenly and without an apparent reason, from school activities to family reunions to a friend’s party. Some of the symptoms of GAD might also appear in other anxiety disorders, which can make it challenging to diagnose.
Symptoms of generalized anxiety disorder in children and teens may include:
- avoiding new situations altogether
- worrying about the future in an unrealistic way (for example, worrying about failing school even if performing well, or worrying about the sudden death of a loved one even if they’re healthy)
- intense and excessive concern about everyday things that concern them (schoolwork or sports performance, for example)
- fear of rejection and worrying about not meeting other people’s expectations, which in some instances can look like people-pleasing
- a constant need for reassurance
- irritability, restlessness, and trouble concentrating
- frequent pains and aches without an apparent reason
Post-traumatic stress disorder (PTSD)
Children can develop PTSD after experiencing or witnessing a traumatic event. Not every child or teen who experiences a traumatic event will develop PTSD, though. A traumatic event might be something impactful, but it could also be something the child considers important.
This could include witnessing or experiencing:
- natural disasters
- wars or violent crimes
- serious accidents
- the loss of a loved one
- assault or abuse
- severe illness or injury
- long-standing and intense parents’ divorce
- sudden neglect and abandonment
The symptoms of PTSD in children may take months to develop, which might make it difficult for you to recognize.
Some possible symptoms are:
- avoiding triggers (anything that could remind them of the event)
- sweating, shaking, or any other strong reaction when reminded of the event
- panic attacks
- intense sadness
- being jumpy around loud noises
- withdrawal from loved ones or best friends
- sudden anger or irritability
- hypervigilance (for example, staying on high alert about their surroundings)
- denial of the events
- difficulty focusing on a task
- restlessness and hyperactivity
Social anxiety disorder
Symptoms of social anxiety in children and teens can include fear of being rejected and feeling embarrassed in front of others. Your child or teen might appear overly concerned about what others think or say about them, for example. They could look anxious and nervous about social situations with adults or other children, like at birthday parties or school. Your child might also develop a fear of talking to others, meeting new people, or even “being there” in front of others.
Other symptoms of social anxiety in children may include:
- shaking, sweating, wetting themselves, flushing, or gasping for air when in social situations
- avoiding all social situations, including school
- clinging to parents or loved ones during social events or when out and about
- being extremely quiet or silent, particularly when addressed
- fear of public speaking or performance (like playing in front of others)
- concern about how they look
A phobia is an intense fear of a specific object or situation. You might not understand it at first, because it could be a common object or place. However, for your child, it might be the source of intense fear.
Common phobias in children include:
- animals (either specific animals or all animals)
- the dark
- thunder and lightning
- specific people or types of person
- specific situations
- specific places (like the closet or a basement)
It’s not uncommon for children to fear something they perceive as a threat or something they don’t understand. This is typical in younger children. It usually goes away as they get older. A phobia, however, is more of a terror that your child experiences when exposed to something specific. Your attempts to calm them are not fruitful, and the anxiety symptoms don’t decrease as the child gets used to the object or situation. Usually, phobias in children can last 6 months or longer.
OCD is a condition that comes with intrusive thoughts, feelings, and terrors. These obsessions might make your child behave in certain ways to relieve the anxiety they cause. The behaviors and the obsessions might not be clearly associated. For example, your teen might be obsessed about a loved one dying. They think about it all the time and this causes them great distress. As a result, they persistently clean their shoes, even if brand new. The association might not make sense to you, but cleaning the shoes might make your teen feel safer, or they think it will prevent anything from happening to you. This association might not even be obvious to your child. They just feel like cleaning their shoes once and again, particularly when they’re feeling distressed.
Some obsessions your child might have include:
- making a mistake
- being contaminated by something in the environment
- good fortune
- safety or health of a loved one
- matching clothes or everything
Some accompanying compulsions might include:
- washing, cleaning, and organizing
- redoing things
- repeating words or actions
- constantly checking on the status of something (is the door closed? Is the light off?)
- organizing things based on particular patterns (colors or sizes)
- avoiding specific numbers
Some children might have a challenging time talking about their intrusive thoughts or fears. They might also try to hide their rituals or make them less evident when you’re around. This is because even though they experience the emotions, they might not understand them. This, in turn, could make them feel guilty or ashamed.
Other symptoms of OCD in children might include:
- social withdrawal
- irritability or outbursts
- difficulty making decisions or choosing between options
- feeling overwhelmed when asked to choose
- looking anxious or angry when something is moved or changed in their room
- spending a long time getting ready or doing other activities
- requesting others to use specific words or skip certain numbers or places
Panic disorder is characterized by repeated and unexpected moments of intense fear and physical symptoms called panic attacks. The condition is possible but not common in younger children.
If your child has panic disorder, they might experience:
- frequent panic attacks
- constant worry about future panic attacks
- fear of doing certain things, like going to school or parties, because they’re afraid of having a panic attack
Symptoms of panic attacks may include:
- shortness of breath or choking sensation
- chest pain
- fears of dying
- numbness or tingling throughout
- intense fear or terror without a specific cause
If your child has selective mutism, they may feel unable to speak in some instances or in front of certain people. On the other hand, in situations where they feel safe, they’ll communicate effectively. Selective mutism is sometimes part of the symptoms a child with social anxiety will show. Many children living with this type of anxiety are communicative, expressive, playful, and active when they’re in what they perceive as a secure setting. When exposed to a social situation, though, they can become mute or start whispering to specific people only. This is, of course, not a conscious choice children make. Staying silent is how they cope with the distress they experience in this situation.
Not every child will show the same symptoms, other than selective silence, but some of the other possible signs include:
- staying motionless
- shaking and sweating
- lose all facial expressions
- clinging to one person
- replacing verbal communication with gestures or head motions
The main sign of selective mutism is a significant behavioral change, particularly a lack of verbal communication, when in a social situation. Typically, selective mutism affects children 4–10 years old.
A child with separation anxiety has an intense fear of being away from home or loved ones. In social situations, your child might be extra clingy with you or another caregiver. They might also try to avoid situations where they’ll be away from you, such as school.
Common symptoms of separation anxiety in children may include:
- difficulty sleeping
- refusal to stay alone even if it’s in their own room
- excessive and intense fear about something happening to their loved ones
- difficulty separating from parents or caregivers, even if for a short period of time
- physical symptoms when being away from home or from loved ones
For these symptoms to be considered separation anxiety, they must be present for at least 4 weeks and not be related to a specific event (for example, an illness or injury a caregiver suffered.)
As with adults, there are many factors that could lead a child to develop anxiety.
A few contributing factors include:
- preexisting conditions (both physical or mental)
- genetic predisposition
- biological factors
- early experiences (abandonment, significant changes, loss of a loved one)
- living with someone who has an anxiety disorder
- emotionally unavailable caregivers
Experiencing anxiety in some situations is natural and sometimes even necessary. If your child has undergone a recent change — like moving to another city — it’s usual they might feel unsure about their new surroundings. Feeling anxious about the first day of school, an important game, or a trip is also natural for most children and teens. If the anxious behaviors are isolated or related to “first times” only, you might not need to feel concerned. If your child is overcoming these fears and replacing them with coping methods, the anxiety might have been temporary.
If your child’s anxiety is persistent, severe, or affecting their everyday life, consider talking with a mental health professional. Symptom intensity and duration are two key aspects to keep in mind. Does your child repeatedly feel or act in the same anxious way? Are they anxious in only some instances, but it’s been a long time in between those instances? A podiatrist or children’s therapist might be able to assess your child’s symptoms and advise you on the next steps to take.
Sometimes, anxiety symptoms in children are misinterpreted as attention deficit hyperactivity disorder (ADHD) symptoms. In other cases, both conditions coexist. Many children with ADHD develop anxiety disorders because ADHD can affect a child’s ability to regulate emotions. It might also make tasks and events, like homework or social occasions, more stressful. This could lead to anxiety. It might also be difficult for a child with anxiety to focus on a task or concentrate on one thing at a time. This is also a typical symptom of some types of ADHD. For this reason, anxiety can sometimes be misdiagnosed as ADHD. In this case, talking with an expert can help you. You’ll want to write down specific behaviors your child has in most situations. You may want to observe how they behave at home, parties, school, restaurants, church, and other spaces they may frequent. The more information you gather yourself, the easiest it’ll be for a health professional to guide you. Allowing your child or teen to have space and time to express themselves, if possible for them, is also advisable.
Symptoms of anxiety in children can be concerning if you don’t understand what’s happening. Feeling this way is natural and not uncommon. Because there are many types of anxiety disorders in children, there’s not one unique list of symptoms. Most children with anxiety disorders will act differently in social settings or specific situations. Observing your child’s behaviors at home and when out and about can help you identify some of the signs of anxiety. This, in turn, might make it easier for a health professional to pinpoint the cause of your little one’s behaviors.