No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.
I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…
6 ways to Help Your Anxious Child:
- Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
- Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
- Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
- Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
- Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
- Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.
I’m curious about how to judge between “normal” nerves/anxiety for a 4 year old and when I should recognize I have an anxious child. So far my child does avoid participating in activities but she does express worries about not wanting to go beforehand. The other component is that I know I have anxiety issues and am in CBT for it. I guess I’m having trouble navigating my child’s emotional landscape right now.
I don’t want to avoid something I should try to help with or and create an issue where there isn’t one.
You wrote that you meet with a group of parents of anxious children it sounds like to brainstorm. Is that a resource you can share?
Wendy Sue Swanson, MD, MBE says
There are groups that convene with children for anxiety.
Look here: https://www.seattlechildrens.org/clinics-programs/psychiatry-and-behavioral-medicine/resources/
And expand the tab that says “Anxiety” for group info:Audience: Ages 6–18 (split into 2–3 separate groups, based on age)
Locations: Bellevue and Main Campus
Number of sessions: 9
Date and time: Tuesdays from 5–6 p.m.
Format: Child and parent groups offered at the same time (parent/caregiver attendance is required unless child is not attending)
Read more (PDF).
Kathy Melman says
I applaud that you are learning CBT anxiety management strategies. You can apply the same principles and strategies that you are learning to help with your possibly anxious child. I also want to share some recommended websites and books that you and other parents might find helpful.
International OCD Foundation https://iocdf.org/
Anxiety and Obsessive Compulsive Disorder (OCD)Books:
Tamar Chansky, PhD
Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias Tamar Chansky, 2004
Freeing Your Child from Anxiety: Revised and Updated Edition: Practical Strategies to Overcome Fears, Worries, and Phobias and Be Prepared for Life–from Toddlers to Teens, 2014
Freeing Your Child from Obsessive Compulsive Disorder, 2000
Freeing Yourself from Anxiety: 4 Simple Steps to Overcome Worry and Create the Life You Want, 2012
John March, MD
Talking Back to OCD: The Program That Helps Kids and Teens Say “No Way” — and Parents Say “Way to Go”, 2007
Ron Rapee, PhD and colleagues
Helping Your Anxious Child: A Step-by-Step Guide for Parents, 2008
Parenting Your Anxious Child with Mindfulness and Acceptance, 2009
Selective Mutism Recommended Resources:
Helping Your Child with Selective Mutism: Practical Steps to Overcome a Fear of Speaking, McHolm, Cunningham, & Vanier, 2005.
Ellen Kuwana says
I love this article!
My only comment is that even in Seattle, a large city,it is very difficult to get in to see a child psychologist for CBT. We had to go out of network so our insurance covers very little of the hourly fee. And the place we went to (and are still going to) has a 5-month wait list.
It would be ideal if any child with a serious illness could be seen by a child psychologist at Seattle Children’s during (and after) their treatment. I feel like this is in place for cancer care as part of the protocol, but not for other chronic conditions or serious conditions that contribute to anxiety.
Mental health parity with physical illness is wonderful to have written into the law, but until the healthcare capacity catches up to the need, it isn’t something happening in actuality, I feel.
Wendy Sue Swanson, MD, MBE says
Thanks for your comment — so thoughtful and such an incredible idea. Will ping some folks on the psych team and see what they can provide regarding standards for therapy and options for psychological support before/after procedures, etc.
Kathy Melman says
You are correct that finding a well trained, CBT anxiety therapist for your child can be very challenging even in Seattle. Your patience, persistence and prioritizing this care helped make this happen for your child. There is work to be done to increase the availability of this care in our community. I also agree with your vision of having psychologists as part of the treatment teams. At Seattle Children’s, we now have pediatric psychologists embedded in Cancer Care, Cardiology transplants, Gastroenterology, and Pain. Here’s a link to a recent CHILD article about this care. https://child.childrens.sea.kids/Resources_and_Information/For_All_Staff/InHouse/2016_Articles/With_a_Psychologist_on_His_Care_Team_Prom_Was_Just_What_Jehnoahs_Doctor_Ordered.aspx
In outpatient Psychiatry and Behavioral Medicine clinics, we do prioritize seeing patients who are treated at Children’s for serious and/or chronic medical conditions.
Meredith Piscitelli says
Dr. Swanson, I think so highly of you and agree with you more often than not. I think I just don’t understand what kind of ‘anxiety’ you are writing about here. I cannot believe what torture you are advising parents to put these poor children through. If they really have this disease of anxiety, it’s something they cannot control, since its a chemical imbalance in their brains.
I don’t recall if I had it as a child, however, I do recall my first attack at 25. It seemingly came out of nowhere. As I was driving down an uncrowded suburban street, suddenly I felt like my head was exploding, with springs shooting out of it. I was shaking uncontrollably and could only hold the wheel tightly, turn the radio on VERY loud and sing with it at the top of my lungs, and get to home as fast as possible. Once there, I went to bed and waited, curled up, until it passed, which took about an hour, and then I slept for 2 hours. I was misdiagnosed with depression and put on various meds which never helped. I have now been properly diagnosed, and properly medicated, for the last 12 years and life is finally, happily, worth living.
Children can be afraid of many things and I do believe in education(CBT is what you call it, I guess), and lots of hugging, loving acceptance. Just remember, with anxiety disease, there are times when it’s too overwhelming for them to bear and holding them until the episode is over is what’s needed.
Do you ever advise medication for the children? Like diabetics need to know how to use insulin for their well-being, isn’t there something for anxiety-cursed children?
Are we talking the same language of ‘anxiety’ or have I missed it completely?
I suffered with mine, un-medicated, for too many years and I am so saddened seeing the children go through it.
Wendy Sue Swanson, MD, MBE says
Hi Meredith. The treatment for anxiety that we discuss on the podcast (and tips from Dr Melman that I highlighted on the blog post here) are the gold standard for children with anxiety. Cognitive Behavior Therapy (CBT) and exposure therapy guided by a psychologist and supported by parents and families who help children learn to cope with anxiety and situations that provoke feelings of anxiety in their lives.
What you describe in your comment may be panic attacks — something we didn’t address in the podcast.
And yes, sometimes children are also given medicines for anxiety. Low dose fluoxetine is a common treatment, in combination with psychologist support.
Martha Johnson says
I used to read your blog post, most of the time and it helps to gain more knowledge not just in health stuff but also in psychological matters. Can you post an article regarding on hearing loss and why some aging adults are experiencing it. Thanks you much. Best regards.
Martha Johnson says
*thank you so much