My third-grade daughter is seemingly always anxious and even has separation anxiety when she is away from home. She used to enjoy playdates and was so carefree. What is going on? Is this normal?


Dear Reader, 


  Based on your description of your daughter’s previous carefree behavior, you are right to be alarmed by the sudden change. While shyness alone is not a cause for concern, it can be a red flag if that shyness is a new behavior. Anxiety should not be taken lightly, but luckily it is highly treatable. It’s important to be able to identify the signs so that you can take the necessary steps toward a more worry-free childhood. 


Evaluate Behavior 


  The distinction between whether a child’s fears are normal or signify a larger problem comes down to the degree of functional impairment they are causing. In other words: What extent is your child’s worrying keeping her from doing things she previously enjoyed? Is she having trouble maintaining friendships? Is it limiting the things you expect a girl her age to do? The more a child is accommodating fears by restricting activities, the more likely it is that there is a need for intervention.        


  Evaluating behaviors should always be done in the context of your child’s past behaviors. If your child has always been shy, then anxiety about certain social activities would be less alarming. 


  You should also be aware of physical symptoms that anxiety can produce. A child’s frequent complaining of headaches and stomach aches — with no vomiting or fever — can be a sign. 


Identify Potential Causes 


  Has there been an event in your family or child’s life that could have triggered anxiety? Examples could include relocation, a divorce, or the passing of a family member or friend. A parent’s anxiety can also rub off on a child. If a parent is stressed out about an event such as a job loss, the child could be absorbing some of those feelings. 


  After a stressful or emotional event, it is normal for a child’s anxious behaviors to last a couple of weeks. If they last longer, then it is recommended that you consult with your pediatrician. 


  It is important to talk to your child and share your observations about her changes in behavior, as there could unfortunately be a traumatic event of which you are not aware. Ask her if anything has happened that has bothered her, and ask her what in particular she is worried will happen. This conversation is best had at a time when your child is experiencing these worries. 






Treat 


  While it is difficult to see your child experience anxiety, the good news is that it is highly treatable with cognitive behavioral therapy. Doctors may recommend medication in more severe cases.


  Even if you are not certain whether anxiety is present, it would be wise to mention your concerns to your pediatrician or even schedule a consultation with a cognitive behavioral therapist. Doing so does not commit your child to a lifetime of therapy, but can arm your child with long-lasting coping tools. Therapists may recommend guiding your child through a workbook like Coping Cat, which has an 80% success rate. You can also learn more by viewing the American Academy of Child and Adolescent Psychiatry’s “Facts for Families” informational sheet, available on its Website at aacap.org. 


  Children will have worries, but it’s important to distinguish typical childhood concerns, such as fear of the dark, from signs of greater anxiety that needs treatment. You know your child best, and should consider whether these behaviors are new and obstructive to your child’s lifestyle. Any concerns should prompt a conversation with your child and your pediatrician, and you should consider a session with a cognitive behavioral therapist. Anxiety is treatable, and needed treatment should not wait. 


This article is not a substitute for advice from a medical professional who has seen your child. If you have concerns about your child’s health, please notify your pediatrician. 


Christopher Bellonci, M.D., Floating Hospital for Children at Tufts Medical Center





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