For a child, navigating stress and anxiety is often an extremely difficult thing to do. As parents, we sometimes find ourselves struggling as well to help our children cope and, ultimately, just feel better. We could all use a hand sometimes and this is where Dr. Zach Radcliff is here to help!

We’re pleased to introduce a Q&A with guest contributor Dr. Radcliff, a pediatric clinical psychologist, working in integrated primary care at Nemours Children’s Health in Delaware. We sat down with Dr. Radcliff to gather their “Fast Five” insights on the topic of mental health for parents with children which you can view below. We also have an upcoming discussion on this important topic! We welcome you to join our free, upcoming webinar at 6pm on Wednesday, May 22nd, 2024: How to Identify, Prevent, and Reduce Anxiety With Your Child

How can parents distinguish between normal childhood worries and signs of a more serious anxiety issue?

I often think about anxiety as a fear or worry without an apparent or obvious cause. Essentially, there’s no actual physical danger to your child, but their body is interpreting it that way and it’s making them want to escape the situation and leave. And so you see physical changes – potentially their heart beating faster, getting sweaty, or having butterflies. Kids report lots of other kinds of feelings with their bodies. So when you’re starting to hear your child say some of those feelings or you’re starting to observe those characteristics, especially if they want to leave the situation or avoid some potential trigger for anxiety, those are good signs that you’re seeing a higher level of anxiety. If you see this occur often, you may want to think about talking to a professional.

The challenge is that anxiety can look different and vary from kid to kid. We encourage families to start asking their kids about these feelings and talking about these worries or fears when they’re little. The better that communication the easier it is for them to help you better understand what’s going on inside versus what you can observe on the outside. That kind of communication is so important for healthy emotional development.

Are there specific triggers or situations that commonly provoke anxiety in children?

So we see anxiety shifting and changing as kids grow, but there are some typical anxieties that we’ll see for kids.

To start, babies might be afraid of people they don’t recognize. We know that a lot of younger kids, preschool and under, often have some “stranger danger” or a little separation-type anxiety. We see that really kick in during the toddler years. They may appear more strongly attached or more strongly upset when parents leave. Whether that’s drop off at daycare or leaving the house to go run errands.

As kids get a little bit older, sometimes we see anxiety shift from physically present or observable fears to more abstract things like monsters, ghosts, or things like natural disasters, storms, and the dark – things that start to kick in during that preschool to early school age range.

A lot of times we’ll see that these fears can be temporary or short-lived and you’re able to support your child through them at these ages without needing support from a professional. If it’s getting disruptive or having a significant impact and it’s lasting more than a couple of months, then we definitely want to be thinking about consulting with a professional.

Then certainly as kids get older they start to become more aware of other potential dangers or things like getting hurt, loss of family members, health and safety, and starting to worry about the future. Certainly, we see more of this in the teenage years as well. Also, worrying about social situations and social anxiety can kind of be a big one for some kids, and that can kind of persist throughout childhood.

Those are kind of the key types of anxiety or triggers that we’ll see in childhood and into the early adult years.

What role, if any, does the usage of electronic devices play in childhood anxiety? Is there a way, if possible, that they can be used positively?

This is a great question and an important thing to think about because we know that everyone is more connected these days. One of the things that we do see, for kids and teenagers, is they are very aware of what’s going on in the world and are much more connected to significant world events than previous generations. So it’s not necessarily the usage of the device itself, but it is being connected to the greater world around you and seeing some of that news and things like that. We know that teenagers these days are reporting significant anxiety related to things like climate change, war, famine, and things like that, as they’re kind of seeing and aware of some of those things. Again, it’s not so much that they’re using it, but it is more that they have access to that information.

The other angle that we also see related to anxiety and technology use is related to social media. We see that there can be an impact on the development of self-concept, body image, self-esteem, and other aspects of identity development. We have seen a shift in bullying and other forms of harassment to online spaces. We encourage families to monitor social media use and pay attention to their child’s connections. We are continuing to see that social media use before the age of 12 or 13 is not necessary and may have negative effects on wellbeing. This also includes the chat features in video games, which we encourage parents to also monitor.

The other thing that we think about is just turning them off at night. That’s always an important thing. Avoiding screens half an hour before bedtime and throughout the night can benefit rest and relaxation.

As far as using devices positively, there are lots of great apps out there that support kids in being able to develop health healthy coping skills to be able to find effective strategies that help them calm down, relax, or self-soothe. There are ones that do deep breathing, or ones that do what we call guided imagery or progressive muscle relaxation. Those apps can be really helpful and useful, so figuring out which one might be the best fit for your family or your kids could be a great idea. As you’re winding down in the evening and helping your kids decompress from the day, using some of those apps and doing some of that can be a really helpful, beneficial thing to do.

Can you provide examples of activities or exercises that parents can incorporate into their child’s routine to promote mental well-being?

This is a great question and one we often hear from parents when they’re coming into our office. Some of the things that I think of are as simple as having schedules and consistent routines to help your child know what’s coming next. It can also help to model relaxation. If you want to encourage your kids to do some relaxation at bedtime to help them unwind from the day, model that for them and do it with them.

Another thing that we see is beneficial is working in praise – especially praise for brave behaviors. We know that avoidance increases anxiety, whereas facing that fear can be really beneficial. One way to face fears is to do little practices throughout the week. For example, if your child is nervous about meeting new people and they’ve got a birthday party coming with some new people at it, you can practice every day during the week. Practicing things like, “How do you introduce yourself?” “How do you say hi?” You can have other people in the home role-play the different types of people they could meet from kind people to grumpy people. Teaching them some of those skills and practicing for anxiety-provoking situations is powerful.

As far as other general well-being type things, we know that being well-rested can make it easier to face fears and manage anxiety. So it is important to have good, healthy sleep routines and make sure that your children are getting enough sleep. Most kids that are elementary school age or younger probably should be getting 10 or more hours of sleep. It’s not until we get to the late teenage years that we think about 7 to 9 hours being the appropriate amount. Generally, even into the early teen years, we’re thinking 9 to 11 hours. So it helps to try to make sure they’re getting good rest.

Having some sort of regular physical activity is also hugely beneficial, especially if you can get outside. For one, it’s a change of scenery and they’re not just sitting in the house or school all the time. The more that you can get out, be active, and certainly participate in group activities, sports, or events the better. Additionally, a lot of social support helps kids feel more connected and more engaged. We know that even introverts benefit from social connections. They may need time to decompress after social events, but we know that everyone benefits from that social connection as well as being active. Examples can be things like camp, whether it’s a sports camp or a camp for something else, or just going to some sort of group event at the library on the weekend. Whatever it is, get them connected and involved. Those are some really simple ways to be able to regularly support their overall well-being and mental health.

How can parents best support a child who is experiencing that, experiencing an anxiety-inducing situation in the moment?

First, if you’re seeing a lot of physical symptoms (hyperventilating, panic, changes in breathing,  getting sweaty, or getting cold and clammy), help them to center themselves and calm down. If you’re practicing relaxation skills regularly, it’s easier to be helpful in these moments. If you’ve done tons of deep breaths, it’s easier to utilize deep breathing in that moment and do it together.

A lot of times we are thinking, “What are relaxation skills that you two can do together?” and, “How do you model and come alongside your child to support them through that moment.” So again, if you’re seeing those physical symptoms, doing some level of targeted relaxation can be really beneficial, whether that’s taking deep breaths, grounding (using your senses to pull yourself back into the current moment), or other relaxation strategies that maybe you’ve identified as being helpful or working.

For some younger kids, sometimes distraction is the best thing. Finding a way to divert their attention from that thing that they’re anxious about and maybe coming back to it later. Distraction or diversion can be an OK strategy for younger kids; however, I think as kids get older, we actually want to help them face that fear in that moment.

Additionally, think about some helpful coping thoughts. For some kids, it can be helpful to ask them, things like, “How likely is that to happen?” Sometimes kids have fears about things that have never happened in their life. You can remind them that this is something that’s never happened. It’s happened 0% of the time. Sometimes I even figure out how many days the kid has been alive and talk to them about like, “Wow, you’ve been alive for thousands of days and never had this happen, so it’s probably not going to suddenly happen now.” So sometimes talking through that can be helpful for some kids in that way.

Other kids like to have a coping thought or mantra. Something along the lines of, “I’m okay… I’m safe,” or, “My parents are here and we’re going to be fine.” Sometimes just having one or two brief sentences that they can repeat to themselves or remind themselves of in that moment can be really helpful too to help shift some of that thinking away from some of those anxious thoughts.

The last thing I think of is if, you’re going into an anxiety-provoking situation, sometimes be ready with a reward system. We think of rewards as being really effective if you’re planning it out beforehand. If you’re doing it in response to a behavior and trying to stop that behavior or change that behavior, then it gets a little blurry – like a bribe. That said, a reward where you’ve said beforehand, “We’re going to go to this event and stay for 30 minutes. If you’re, able to get in the car and go without arguing, then you earn part of the reward. Then you’ll get another part of the reward if you go in and you’ll get the last part of the reward if we stay for 30 minutes.”

Those types of reward systems can also set you up for success and help head off some of that potential anxiety by getting them excited to be brave and to feel brave in that situation. Over time, you see that you won’t need those rewards as much because kids will find that they can handle this thing now, have that self-confidence, and be proud of themselves for kind of continuing to be able to do something and finding that it’s not as scary or not as stressful as it used to be.

Closing thoughts:

I think, overall, we expect that kids are going to have anxiety. We know that there’s going to be things that they worry about. We know that there are things as parents you worry about and think about for your kids, so model that healthy approach to dealing with anxiety, and talk about things that you’re both worried about. Starting those discussions early and often can be a powerful way to support your kids throughout their development. We know parents are the best people to support their kids with anxiety and so we very much love to have parents connected and involved. We know that you can do it.

Additional Helpful Resources:

Books Resources (These books are interactive self-help books designed to guide 6–12-year-olds and their parents through the cognitive-behavioral techniques most often used in the treatment of various psychological concerns):

• Treatments That Work – Anxiety
• “Breaking Free of Child Anxiety and OCD” by Eli R Lebowitz, PhD.
• “Helping Your Anxious Child,” by Rapee, Spence, Cobham, and Wignall
• “Freeing Your Child from Anxiety” by Chansky
• The What-to-Do Guides for Kids by Dawn Huebner offers several workbooks to help address several childhood concerns, such as anxiety, negativity, and rigidity.

Online Resources:

• www.anxietybc.com (excellent resource for coping strategies and more information about CBT). Within this site, the URL www.anxietybc.com/anxiety-PDF-documents provides helpful “how to” documents for parents and home management tips.
• Childmind.org/topics/concerns/anxiety/: high-quality information on evidence-based treatment and ways for parents to learn about how to help and offer support for forms of anxiety ranging from test anxiety to OCD.
• www.copingcatparents.com (information for parents of children with anxiety)
• The American Academy of Child and Adolescent Psychiatry’s fact sheet about childhood anxiety (https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Anxious-Child-047.aspx)
• The Anxiety Disorders Association of America (http://www.adaa.org)
• KidsHealth (http://www.kidshealth.org).

Apps (All apps are free to download but some have paid features):

• Finch
• Reflectly
• MySelf
• Calm
• Moshi Kids
• 3 Minute Mindfulness
• Breathe 2 Relax
• Headspace