Anxiety on the rise
Even before the pandemic, anxiety in our country has been on the rise. Then came COVID-19—bringing with it uncertainty, lack of control and structure, isolation, economic instability, loss, and parental stress. Anxiety began to soar, especially for children.
According to a study published by the National Institutes of Health, around 22% of kids in the U.S. have anxiety—up from 7% pre-pandemic.
Anxiety is a mental health disorder involving intense worry and fear. It affects kids in many different ways. It can cause both emotional symptoms and physical ones, like muscle tension and headaches. It can also interfere with daily life, including the ability to think, focus, and remember.
Adults may not be fully aware of how children and teenagers absorb and are affected by current events. But in the case of the pandemic, they are not just absorbing the news but are directly affected by it.
Many cannot attend school and extracurricular activities in person. They’re required to participate via Zoom classes, which can bring on its own stressors. They can’t see friends and have normal social interactions. They may have fears about themselves and family members getting COVID-19.
They’re also exposed to their parents’ stressors like losing their job, juggling work and other responsibilities, and having the whole family home 24-7.
How anxiety affects children
We have a new vocabulary as parents (“Did you wash your hands right after coming inside?”; “Did you touch anyone?”). This can unintentionally cause anxiety. Notice your tone when asking these questions—make your voice neutral. Reminding them to wash their hands when they come inside should sound no different from reminding them to hang up their jacket. —Dr. Bobbi Wegner
In children, anxiety affects their emotions, thought processes, and behaviors like eating, playing, and sleep. For example, a 4-year-old says they do not want to go to school because their belly starts hurting when they get ready to leave. A teenager has trouble falling asleep and wakes up angry and irritable. A toddler hides behind their parent and refuses to leave their side.
Signs of anxiety include:
- Mood changes such as irritability, fearfulness, and/or sadness.
- Behavior changes such as clinging to caregivers, avoidance of events (like school and social situations), disrupted sleep, changes in eating and exercise habits.
- Physical symptoms such as belly aches, headaches, butterflies in the stomach, jitteriness, inability to sit still, racing heart, sweaty hands, and shortness of breath.
- Cognitive symptoms such as being unable to concentrate or having a hard time doing schoolwork or sitting still.
COVID-19 and types of anxiety disorders in kids
There are several different types of anxiety disorders with different symptoms and behaviors. Children are more likely to express their anxieties through behaviors rather than words. Here are a few of the more common ones.
Generalized anxiety disorder (GAD)
Kids are sponges and absorb messaging from all over the place. You should be the one to share information. Make sure to say it in a way that is age appropriate. —Dr. Wegner
Kids who have GAD constantly worry about many things. It can be about homework, friendships, food. It is like having a little worry bird sitting on the child’s shoulder for most of the day every day.
Covid’s impact: Anxiety can ramp up as kids have more to worry about—like hand-washing, isolating, and avoiding germs. They may experience sleep disruption, eat more or less, and be more or less active.
Separation anxiety disorder
Kids with separation anxiety disorder feel fear and worry when they separate from someone, generally a parent but could also be a sitter or relative. They cling, don’t want to go to school, avoid sleepovers, and just want to stay close to their loved one. Kids often cry, cling, try to avoid separation, and become sad and angry.
Covid’s impact: Physical distancing, more time together, and widespread fear can make it harder for kids to separate from the adults in their lives. When your child does have to go back to school, their separation anxiety may increase.
Kids with social phobia are intensely worried about being judged by others. They avoid being the center of attention, put on the spot, or going to places with other people. Going to school, raising their hand in class, or attending parties can be incredibly difficult and painful. They can become very isolated from their peers.
Covid’s impact: Their irrational fear is now rational. Being with people, in public places, at social gatherings—even at school—is now associated with illness and even death. The safe, smart decision is to avoid other people. They may also avoid Zoom calls or keep their cameras off because it can put them in the spotlight. They may try to skip online class and activities. For some kids, it has caused social phobia.
Kids with specific phobia develop an intense fear of a specific thing (like needles, reptiles, dogs, types of food, etc.). Although it is normal for kids to feel scared of the dark and nervous around new things, a specific phobia is an intense, irrational fear. Kids might cry, panic, and try to escape being near what they fear.
Covid’s impact: Specific fears are often focused on germs, so you may notice an increased fear involving germs and touching. Keep an eye on whether your child is washing their hands more than suggested, avoiding leaving the house, and not seeing people when socially distant.
How to help kids with anxiety during the pandemic
We are in a cultural trauma right now. Maintaining a safe and caring relationship with our children buffers anxiety. Forget about the perfectly home-cooked meal, lower your expectations, and prioritize connecting with your child, even if for just 15 minutes of undisrupted time. —Dr. Wegner
Pay attention to behavioral changes
Significant changes in behavior, like sleeping, eating, and exercising, may be signs of stress or anxiety.
So is extreme avoidance of germs and socializing. Are they washing hands more than is recommended? Is your child not wanting to see friends in socially distant ways? Are they not leaving the house? Does your child’s anxiety seem similar to other kids’ their age?
Help your child understand the news
Children often make up their own worst-case scenarios. It's important that you help them understand what the risks are and correct any misconceptions they may have. For young children, keep them from hearing too much news and conversations about COVID-19 and job stressors.
Take care of your own emotional needs
Build in time for yourself even at the cost of a “to do.” Go for a walk, take a bath, or listen to music or podcast to get some mental space. Maintain a socially connected life by seeing friends in physically distant ways as well as virtually.
Create a daily routine
Most children have lost their structure. A routine helps reduce anxiety by giving them a sense of certainty and consistency. Create a daily schedule that includes play time, school time, meals, outdoor time, exercise, etc. Encourage your child to go outside and move their body for at least 30 minutes a day.
Remind children they are safe
It’s important to reassure children that when you follow the recommended safeguards, they will likely be okay. Manage your own worry and fear as they will watch you for clues on how to feel. Worrying about the disease does not make us safer. Also remind your kids that this will pass.
Validate your child’s worries
Try saying something like, “It is okay to feel scared. Many people feel that way right now. I feel that way sometimes too. Feel your feelings and then let them go. We are staying safe by wearing our masks, washing our hands, and physically distancing.”
Meditation can help reduce anxiety. Try to teach meditation when your child is not feeling stressed. Lie on the floor and do belly breathing. Put a stuffed animal (or their hand) on your child’s belly and have them breathe in for 6 seconds and out for 6 seconds, watching the stuffed animal (or hand) rise and sink.
There are also meditation apps for tweens and teens. Try them together as a shared activity.
Reduce Zoom anxiety
Let your kids know that you understand that it can feel weird and uncomfortable to do school online. Give them breaks, if necessary. Young kids may benefit from holding something comfortable (like a favorite stuffed animal). Older kids can use a stress ball.
It’s important to figure out whether your child is turning the camera off during Zoom classes because it is creating anxiety or if they’re just doing it so they’re free to do other things during class.
Ease separation anxiety
When your child goes back to school, separation anxiety may be worse because of all the family time they’ve had.
- Empathize with the emotion (“All this change is so hard to keep up with, and now it is hard to go back!”).
- Validate their feelings (“I feel it too. I love being with you.”).
- Make expectations clear (“Although I love being home with you, we all have to get back to our normal routines”).
- Remind them of what they missed about school during quarantine.
You will get through it
Although it feels scary, confusing, and overwhelming, it will get better. There is hope—and a vaccine on the way. We just need to stay strong, be positive, and look toward the future.
When a therapist can help
Some anxiety and nervousness is normal and part of the human experience—particularly right now. But your child may need to see a therapist if the feelings and behaviors are more extreme.
Try to assess how often your child feels anxious and how intense the feelings are. Ask yourself how distressing is the anxiety to your child and/or family and how disruptive it is.
There is no hard and fast rule. If you think the anxiety is disruptive to the child, it is probably worth speaking to a mental health provider.
If you need help finding a clinician, ask your pediatrician, call your insurance company (there is often a behavioral health number on your insurance card), or check www.PsychologyToday.com for local resources.
There are different treatment approaches for anxiety, but almost all therapies include:
- Helping the child understand what is triggering the anxiety.
- Helping the child change the way they are thinking about the trigger.
- Helping the child manage and face the trigger more effectively.
- Helping parents understand how they might be contributing to the anxiety and how to build a calmer environment (i.e., decreasing marital arguing etc.).