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Doctor and Patient


Generalized Anxiety Disorder

Anxiety in Children

It is normal for us to have feelings or emotion: Joy, sadness, anger, anxiety etc. We learnt to control our emotion so that our daily activities or work will not be affected.

Feeling anxious is normal when we face new challenges, something that we afraid of, or facing uncertainty. The duration of anxious feeling is usually short lasting, and seldom affect our body physically. However, if such emotion persists for long time and affects our body or functioning, then we probably need to seek help. Anxiety does not only affect adults, it can occur in children too. However, children’s presentation could be very different from adults and hence seldom being noticed. Children can develop different types of anxiety during different stages of development.

Different types of anxiety includes:
(1) General Anxiety Disorder

Child worries about a lot of things or activities, and their worries may not be reasonable or may be excessive. Examples includes excessive worries about going to new place, joining extracurricular activities. Some might have unreasonable worries about family members or friends, about their safety or health. Their worries may not be controlled even after reassurance by parents. Some children may have affected sleep, physical complaints such as abdominal pain, headache or inattention problems at school.

(2) Social Anxiety

Stranger anxiety is a normal developmental milestone at around age of 9 months to distinguish familiar people from strangers. Stranger anxiety usually improves as the child grows up. However, children with social anxiety persistently afraid or showing excessive nervousness when meeting strangers or joining social activities. They may avoid interactions with strangers, joining social activities such as birthday parties, or afraid to perform.

(3) Separation Anxiety

Children usually are more attached to their parents or care takers, however, if the attachment are not appropriate to their developmental stages or are excessive, they may have problems of separation anxiety. Children may be presented with excessive clinging or nervousness even if they were about to separate with their parents for a short while or in familiar environments.

(4) Selective Mutism

Children persistently refuse to speak in certain environment (such as school), while they are comfortable to speak normally in familiar environment (usually home). This is not caused by language delay or other social communication problems.

(5) Specific Phobia

Children presented with excessive fear when encounter specific things or situations, such as animals, insects, needles, dark environments.

Children with anxiety usually avoid facing the things or situation that triggers their worries. When they were forced to face such things or situations, they may have emotional outburst: throwing temper, screaming or crying.

Those with more severe symptoms might have physical complaints, such as abdominal pain, headache, sleep problem or feeding problems. They may have difficulties in staying focus in school or while doing homework, and easily feel tired as they are persistently under stress.

How does anxiety affect child’s development?

Children with anxiety are usually more passive and they tend to have more negative thoughts. They are less readily to explore new things or activities. These negative feelings may affect their learning, social development, and daily activities. Some children may have frequent physical complaints. Their worries might not be easily noticed, and child may not be able to express their emotions verbally. Parents should watch out for their change in behaviours. If they noticed their child easily have emotional outburst in certain situations, or frequent physical complaints, they should be alert that these symptoms might be cause by anxiety.

The anxiety problems of many children may not be identified in childhood, these symptoms will persist into adulthood and affects their work and daily activities. The chance of depression is also higher in this group of patients.

Is anxiety in childhood common?


Anxiety in childhood is not uncommon. The prevalence of anxiety in children is around 10% from local and international data. Girls are more affected than boys.

What are the causes of anxiety?

Anxiety is caused by physiological, psychological and environmental factors. Children with family history of anxiety are at higher chance. Children who easily nervous and tends to have more negative thoughts are at higher risk of anxiety. Their upbring, nurturing environment, coping strategy of failure or fear also contribute to the risk. Persons with anxiety are found to have imbalance of neurotransmitter in brain such as noradrenaline and serotonin.

What are the treatments of anxiety?

The treatment for anxiety includes cognitive behavioural therapy (CBT) and medication. For children, especially younger children, cognitive behavioural therapy is the mainstay of treatment. For older children with more severe symptoms, combined approach may be considered.

Our thoughts, feelings and behaviour affect each other. Cognitive behavioural therapy involves analysis of thoughts, feelings and behaviours. During the therapy, therapist challenges child’s way of thinking and their behaviours, and apply them in real situations. It also involves helping child to develop coping skills to face their fear by repeated practice, so as to modify their maladaptive coping behaviour.

Medications usually take weeks to have effect, they are only reserved for older children with more severe symptoms that cannot be satisfactory managed by cognitive behavioural therapy. Medication needs to be prescribed by doctor and monitor their responses.

What shall parents do if child is suspected to have anxiety problems?

Parents can seek advice from their paediatrician or clinical psychologist. For those children with identified anxiety problems, appropriate service or counselling will be arranged. School psychologists can also provide individual supports to children and teachers.


If feelings of anxiety have been disrupting your life for a long period of time, you develop other mood or physical symptoms, such as:

  • Poor sleep

  • Depression

  • Worsened immunity

  • Use a lot of tobacco, alcohol or drugs to fight anxiety, which leads to more physical problems

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