Managing Childhood Anxiety For Dummies

Natasha Burgert, MD, FAAP, is a board-certified pediatrician, national spokesperson for the American Academy of Pediatrics, and child health advocate. Dr. Burgert is a prolific writer and media contributor. She held a regular column, “Dear Pediatrician,” for two years in Forbes Health, and is a sought-after speaker and educator.

• Introduction 1Part 1: Getting Started with Managing Childhood Anxiety 5Chapter 1: Worrying About Your Child’s Worries 7Defining Anxiety 8Analyzing Anxiety 8Seeing rising rates of anxiety 9Finding the roots of anxiety 9Looking for Anxiety in Children 9Appreciating child development 9Showing, not telling 10Checking out various anxiety types 11Getting the Diagnosis 11Starting with your child’s doctor 11Considering alternative diagnoses 11Accepting your child’s anxiety 12Exploring Treatment 12Leaning into therapy 13Fueling the anxious brain 13Providing protection 13Considering anxiety medications 14Finding support at school 14Prioritizing safety 14Helping Your Child Where You Can 15Beginning with you 15Seeing it through 16Chapter 2: Recognizing That Kids Aren’t Little Adults 17Meeting the Boss: Your Child’s Brain 18The vital hindbrain 19The emotional inner brain 20The thinking outer brain 20Appreciating Plasticity 21Looking at Chemical Communicators 22Examining how neurotransmitters work 22Meeting the messengers 23Discovering How Emotions Grow 24Exploring Social-Emotional Milestones 25Toddlers (2–4 years) 27Early childhood (5–7 years) 27Middle childhood (8–11 years) 28Recognizing Challenges in Pediatric Mental Health 29Chapter 3: Knowing Your Family Isn’t Alone 31Anxious Kids Are Everywhere 32Exploring the Rise in Child Anxiety 32Advancing science 33Normalizing mental health 33Increasing screen time 34Acknowledging the pandemic effect 34Amplifying background stressors 34Increasing parental stress 35Predicting Anxiety 35Developing brains and anxiety symptoms 36Sharing genetics and epigenetics 36Appreciating child temperament 37Looking at parenting style 38Accepting Your Child’s Anxiety 38Identifying anxiety early matters 39Reframing your role 39Chapter 4: Seeing What Anxiety Looks Like in Kids 41Recognizing That Anxiety Is the Greatest Mimicker 42Introducing two different case studies 42Hunting for clues 43Looking for a chameleon 44Monitoring for misdirection 45Understanding Anxiety’s Three Parts 46Emotional 46Behavioral 47Physical 48Noticing How Child Anxiety Differs from Adult Anxiety 49Physiology 49Temperament 50Environment 51Time span 51Distinguishing Types of Child Anxiety Disorders 52Specific phobias 53Separation anxiety disorder 53Selective mutism 54Generalized anxiety disorder 55Social anxiety disorder 55Agoraphobia 56Panic disorder 57Identifying Childhood Anxiety Matters 57Chapter 5: Understanding Normal Childhood Worries and Fears 59Appreciating the Stress Response 60Finding signs of stress in kids 60Recognizing childhood stress 61Knowing It’s Normal to Worry 62Defining age-appropriate worries 63Supporting kids who worry 64Differentiating worry from anxiety 65Looking at two real-world examples 66Tackling Fears 67Maturing from imaginary to reality-based fears 67Helping a scared child 69Distinguishing fears from phobias 69Chapter 6: Watching Out for Medical Mimickers 71Appreciating the Brain-Body Connection 72Responding to Tummy Troubles 73Exploring the causes of CAP 73Introducing the ENS 74Looking for clues 75Warning signs to never ignore 77Getting the scoop on poop 77Helping tummy pain at home 78Managing Sleepless Nights 80Surveying slumbering symptoms 81Getting better zzz’s 82Dealing with Nagging Headaches 84Warning signs to never ignore 84Distinguishing headache types 85Relieving headaches at home 86Experiencing Urinary Issues 87Peeing too much 88Peeing too little 89Handling Concerning Chest Pain 90Reacting to stress 90Warning signs to never ignore 91Taking Care of Tics (Not Ticks) 92Identifying tics 92Managing tics 93Watching Out for Thyroid Disorders 95Part 2: Diagnosing Child Anxiety 97Chapter 7: Visiting the Doctor 99Finding a Great Pediatrician 100Preparing for the Office Visit 101Organizing and prioritizing 101Engaging educators 103Including all caregivers 104Asking for a private conversation 104Preparing your child 105Understanding Confidentiality 106Optimizing Your Appointment Day 107Avoiding “Doctor Office Don’ts” 109Chapter 8: Walking Through the Psychological Evaluation 111Getting Ready for a Mental Health Assessment 112Selecting a mental health clinician 112Preparing for the visit 114Explaining the visit to your child 114Understanding What a Mental Health Visit Looks Like 115Structured interview 116Standardized rating scales 117Cognitive and academic testing 118Feedback and recommendations 119Expecting Difficult Questions 119Social determinants of health 120Adverse childhood experiences 120Positive childhood experiences 121Exploring Alternatives to an Anxiety Diagnosis 122Attention-deficit/hyperactivity disorder (ADHD) 122Depression 122Learning disabilities 123Neurodiversity or autism spectrum disorder 123Obsessive-compulsive disorder (OCD) 123Oppositional defiant disorder (ODD) 124Perfectionism 124Sensory processing issues 124Part 3: Treating Child Anxiety 125Chapter 9: Exploring Child Therapy Options 127Understanding the Importance of Therapy 128Discovering How Child Therapy Works 128Reframing Therapy Myths 130“Therapy didn’t work for me, so it won’t work for my kid.” 130“Won’t a pill work faster? Let’s do that.” 131“Can’t I do this at home? I’ve been to therapy and know how it works.” 131“They don’t want to go to therapy, so we need something else.” 132“Therapy is making kids weaker.” 132Finding a Therapist 133Affording Therapy 134Setting Expectations for Therapy 135Seeing What a Therapy Session Looks Like 136Mapping out the phases of therapy 136Choosing online versus in-person 137Telling Your Child about Therapy 138Distinguishing Types of Anxiety Therapy for Kids 139Cbt 139Act 140Dbt-c 140SPACE training 140Pcit 141Play therapy 141Emdr 141Preparing Yourself for After the Session 142Chapter 10: Anxiety Medications: What Parents Need to Know 143Considering Anxiety Medications for Kids 144Understanding how medications work 144Knowing when medication is needed 145Finding a prescriber 146Appreciating Principles in Medicine Management 146Building a partnership 147Respecting individuality 147Targeting symptoms 147Recognizing that pills are not skills 148Starting low and going slow 148Sticking to one change at a time 148Preparing for Your Child’s Medical Plan 149Knowing your family history 149Inquiring about insurance 149Practicing how to swallow a pill 149Defining your goals 150Prioritizing Safety 150Straight talk: Suicide and kids 150Understanding the risk 151Reducing access to means 151Storing medications and other substances 152Maintaining bedroom safety 153Completing safety planning 153Detailing Commonly Used Anxiety Medications 154Selective serotonin reuptake inhibitors (SSRIs) 154Serotonin-norepinephrine reuptake inhibitors (SNRIs) 158Alpha-agonists 159Antihistamines 160Practicing Successful Medication Habits 161Prioritizing safe storage 161Normalizing a routine 162Avoiding self-administration 162Expecting frequent follow-up visits 163Looking toward your goals 163Addressing Common Questions and Concerns 163“I don’t want to turn my kid into a zombie.” 164“I don’t want medicine to change who they are.” 164“Don’t kids become dependent on these medications?” 164“These medications never worked for me Why will they work for my kid?” 165“I’ve heard these medications aren’t FDA-approved for anxiety Is it safe to use something ‘off label’?” 165“My kid is so young; will they need this forever?” 166“What about long-term side effects?” 166“What if the medications don’t work?” 166“This dose is the same that their father is on Isn’t that too high?” 167“What about lab work?” 167Chapter 11: Evaluating Supplements and Nutraceuticals 169Navigating the Supplement Landscape 170Distinguishing pharmaceuticals from supplements and nutraceuticals 171Using supplements with kids 172Supplementing Smartly 173Starting with supplements 173Understanding risks 174Making better choices 175Surveying Anxiety Supplements 177Omega-3 blends 177Vitamin d 178Magnesium 178Iron 179Zinc 180Complex B vitamins 181Probiotics 181Amino acids 182Lavender 182Saffron 183Ashwagandha 183Cbd 183Part 4: Parenting Your Anxious Child 185Chapter 12: Analyzing Your Parenting Style and Anxiety’s Impact 187Determining Your Parenting Style 188Putting Your Parenting Style into Action 189Linking Parenting Behaviors and Anxious Kids 190Contributing to child anxiety 191Protecting against anxiety 192Reflecting on your parenting behaviors 193Parenting with Anxiety 193Anxiety intercepts your parenting effectiveness 194Anxiety intensifies your child’s experience with anxiety 194Anxiety makes your emotional interpretations inaccurate 194Anxiety is contagious 195Anxiety changes your parenting memories 195Anxiety interferes with your relationships 195Anxiety steals your parenting joy 195Anxiety is worth treating 196Avoiding Accommodation 196Discovering your accommodation behaviors 197Stopping accommodation 198Chapter 13: Optimizing Your Home Environment 199Understanding That Anxiety Management Starts at Home 200Prioritizing Sleep 200Appreciating the need for sleep 201Knowing that sleep impacts the whole family 203Noting sleep differences in anxious kids 204Bedsharing with anxious kids 204Committing to healthy bedtime habits 206Moving for Mental Health 209Embracing the outdoors 209Energizing family movement 210Fueling the Anxious Body and Brain 211Connecting anxiety and food issues 212Making small changes 213Succeeding with Screen Time 214Acknowledging interference 216Constructing safer screen time at home 217Prioritizing Play 219Balancing types of play 219Valuing play for anxious kids 220Avoiding overscheduling 220Leaning into Routines 221Distinguishing routines from schedules 221Building home routines 222Chapter 14: Thriving in School and Sports for Anxious Kids 223Expecting Back-to-School Anxiety 224Experiencing Anxiety in School 225Identifying school anxiety 226Supporting anxious kids in the classroom 226Refusing to Go to School 227Understanding school refusal 228Helping a child with school refusal 228Looking at the Landscape of Today’s Youth Sports 229Reaping the benefits of organized sports 229Examining anxiety in organized sports 230Supporting Your Young Athlete 231Keeping the fun in sport 231Encouraging physical literacy 232Choosing variety as long as you can 232Prioritizing recovery 232Modeling emotional control 233Handling the car ride home 233Teaming Up Against Sports Anxiety 235Looking for signs 235Managing sports anxiety 235Chapter 15: Implementing Behavior Management Strategies 237Understanding How Behaviors Are Learned 238Recognizing a Positive Parenting Household 239Building relationship 240Paying attention and empathizing 240Prioritizing safety 241Honoring developmental skills 241Promoting social-emotional learning 241Creating and enforcing boundaries 242Avoiding punishments and preparing consequences 243Using clear communication 244Prioritizing space for self-care 244Choosing Effective Strategies 245Tailoring Strategies for Kids with Anxiety 246Searching for context 246Creating consistency 248Clarifying “zero tolerance” 248Calming first 249Modeling imperfection 249Avoiding avoidance 250Catching your child being brave 250Managing Challenging Behavior 251Chapter 16: Calming Techniques and Why They Work 253Calming the Brain and Body 254Managing anxiety with self-regulation 254Building self-regulation skills 255Teaching Calming Techniques to Your Child 255Timing matters 256Learning together 256Using co-regulation 256Trusting the process 257Exploring Calming Techniques 257Breath control 257Grounding 258Cognitive engagement 260Putting Calming Techniques into Action 261Dealing with Panic Attacks in Kids 263Dissecting what happens to the body during a panic attack 263Identifying panic 264Appreciating panic’s uniqueness 265Supporting your child during a panic attack 266Chapter 17: Focusing on Specific Concerns and Worries 269Getting an Anxious Child to Sleep 270The Yale Program 271The bedtime pass 271Camping out 272Scheduling check-ins 273Supplementing Sleep 274Melatonin 274Iron 275Magnesium 275L-theanine 276Examining Anxiety in Toddlers 276Understanding toddler fears 277Remembering your role 277Taming toddler anxiety 278Watching out for concerning signs 279Changing Bodies and Anxiety 279Co-Parenting an Anxious Child 282Focusing on your child 282Informing and communicating 282Handling drop-offs and pick-ups 283Parenting in your own home 284Part 5: the Part of Tens 285Chapter 18: Ten Ways to Support Kids Who Fear Needles 287Chapter 19: Ten Signs Your Child Needs Professional Help 295Chapter 20: Ten Things to Say to Your Anxious Child 301Appendix: Recommended Resources 307Index 313