Anxiety and Fears

Learn whether your child’s fears are typical or if they might be signs of anxiety that’s impacting their ability to thrive. Photo by  Evie Shaffer  on  Unsplash

Learn whether your child’s fears are typical or if they might be signs of anxiety that’s impacting their ability to thrive. Photo by Evie Shaffer on Unsplash


Fears and Anxiety in Infants, Toddlers and Children

Does your child often seem shy and fearful around new people? What about specific fears, perhaps of bugs, flying objects, loud sounds, or new situations? Or do you have a baby who has trouble sleeping, can’t be put down, or seems like they are constantly crying?

Many children experience persistent, specific fears and worries that impact their ability to complete daily tasks, perform in school, or have thriving peer relationships. I use a compassionate, gentle, play-based model tailored to your child’s needs when it comes to treating anxiety. Some children begin to experience symptoms of anxiety as early as age 2, and if you are concerned that your child is “tightly wound,” “highly sensitive” or has difficulty staying regulated when the unexpected occurs, you might benefit from an assessment to insure you child’s needs are met.

What’s Normal?

Types of fears and anxiety can change across development. It’s normal for infants and toddlers to have fears, but if they don’t resolve and seem to keep children from living a happy, regulated life and routine, consult an expert!

Infants show fearful and shy behaviors by 18 months of age. Fears can develop as children face new experiences and challenges. For example, walking also tends to increase fear of heights (Bertenthal et al., 1984). At about 4-9 months we start to see our babies show a fear of strange adults and separation. This fear usually peaks at 18-24 months and then declines. A fear of strangers and peers peaks 20-29 months and then declines. Then, we often see older children with fears of imaginary creatures.


Behaviors at 0-12 Months Can Predict Later Anxiety Disorders in Children

Toddler Behavior linked to later anxiety disorder

  1. Behavioral Inhibition (shy, shutting down, avoidance) in response to new situations or strangers

Behavioral inhibition may be an early risk factor for anxiety disorders and are seen more often in children of parents with anxiety disorders. Research also shows that anxiety tends to run in families (Biederman, Faraone et al., 2001; Biederman, Rosenbaum, Bolduc, Faraone, & Hirshfeld, 1991; Hettema et al., 2001),

Anxiety Disorders, Panic Disorders, and Major Depressive Disorder all increase by 2x in the child who shows behavioral inhibitions. Also, children who are extremely shy or inhibited in early childhood may develop social phobia and other anxiety disorders at older ages.

2. Behaviors in response to separation and reunion

In year 1 of life, the child becomes attached to caregivers. If they are not near, the child will seek out the caregiver by crying, clinging, or attempting to move towards the caregiver. If the child experiences moments in which they perceive their anxiety is not soothed, they may develop anxiety that is not helpful or adaptive. This child develops an ongoing perception about their caregiver and is said to have an insecure attachment. The child whose anxiety is consistently soothed (from the child’s point of view and sense) is less likely to develop chronic anxiety.

An insecurely attached child has learned that “threatening situations can’t be resolved” and as a result is often more anxious in situations that aren’t even dangerous.

Infants who were insecurely attached at 18 months were more socially anxious at 8-9 years old (Bohlin, Hagedell, Rydell, 2000)



Types of Anxiety Disorders in Early Childhood

  • Separation Anxiety Disorder

    A. Developmentally inappropriate and excessive anxiety concerning separation from home or from those to

    whom the individual is attached, as evidenced by three (or more) of the following:

    1. Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.

    2. Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures.

    3. Persistent and excessive worry that an untoward event will lead to separation from a major attachment

    figure (e.g., getting lost or being kidnapped).

    4. Persistent reluctance or refusal to go to school or elsewhere because of fear of separation.

    Note: In young children, this may appear as

    (a) fear or subjective anxious affect related to leaving home for day care or school,

    (b) anticipatory fear or subjective anxious affect related to day care or school situation, or

    (c) the child stays out of day care or school because of fear, anxiety, or emotional disturbance.

    5. Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home

    or without significant adults in other settings.

    6. Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep

    away from home.

    7. Repeated nightmares involving the theme of separation. (Note: in preverbal or barely verbal children, there

    may be frightening dreams without recognizable content.)

    8. Repeated complaints or expression of physical symptoms (such as headaches, stomachaches, nausea, or

    vomiting) when separation from major attachment figures occurs or is anticipated.

    9. Persistent preoccupation or worrying about the whereabouts of attachment figures (e.g., looking out a window

    or stopping play).

    B. The duration of the disturbance is at least four weeks.

    C. The onset is before age 18 years.

    D. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or

    other important areas of functioning. Note: In young children, the disturbance may cause parents to significantly

    modify their behavior to modify the child’s behaviors.

    E. The disturbance does not occur exclusively during the course of . . . (no change from DSM-IV).

  • Specific Phobia:

    Infants and toddlers can actually meet the DSM criteria for specific Phobia. Extreme, disabling fear

  • Disorder of Inhibition/Avoidance

    Table 18.3 Disorder of Inhibition/Avoidance

    A. Excessive shrinking from contact with and persistent reluctance to approach unfamiliar people or novel

    stimuli (e.g., new toys, new smells, new tastes, new sounds, new situations).

    B. Exposure to unfamiliar people or to novel stimuli almost invariably provokes the behaviors in A which may

    also be expressed in crying, tantrums, freezing, or shrinking from the situation.

    C. Desire for social involvement with familiar people (family members and peers the person knows well) and

    generally warm and satisfying relations with family members and other familiar figures.

    D. The situations in A are avoided or else are endured with intense anxiety or distress.

    E. The avoidance, anxious anticipation, or distress in the situation interfere significantly with the child’s normal

    routine, functioning, play, or social activities or relationships, or there is marked distress concerning

    these reactions.

    F. Symptoms occur for a period of 3 months or longer.

    G. The avoidance is not due to the direct physiological effects of a substance (e.g., a medication) or a general

    medical condition and is not better accounted for by another mental disorder (e.g., separation anxiety disorder,

    post-traumatic stress disorder, social phobia).


    Generalized Anxiety Disorder

    Excessive worry or anxiety occurring more days than not about many different topics or events. It is difficult to control the worry. It has been occurring for a least 6 months. For children they also need to be experiencing either restlessness, difficulty concentrating, irritability, or changes in their sleep patterns. (e.g. are they concerned about getting dirty, damage to their toys, refusal to do something benign (like take a bath) for fear of getting hurt.