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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
Understand what child anxiety is, how to treat it, and how to support and encourage anxious children
Anxiety is the most common mental health condition in young children. Managing Childhood Anxiety For Dummies is the go-to resource for parents of young children who suspect their child may be experiencing anxiety but aren't sure where to start. Learn to recognize the symptoms of anxiety in kids who may be too young to explain how they're feeling and get expert advice on supporting them with proper treatment and guidance. Find answers to questions like: When is worry normal, and when it is a sign of anxiety? Which interventions are most effective for anxious kids? How can I make my home or classroom less stress inducing? Written by an experienced pediatrician, this compassionate book challenges harmful taboos about mental health and equips you with the tools you need to be a resource to any young child with anxiety.
- Learn the basics of childhood anxiety and how it's diagnosed
- Explore ways to diagnosis anxiety, treat it with proven methods, and manage the physical symptoms that often come with childhood anxiety
- Find helpful tips to create a supportive environment at home and school to foster your young child's growth and development
- Discover effective and positive strategies to help your anxious child with sleep, screen time, and sports performance
Managing Childhood Anxiety For Dummies provides essential information to assist you in supporting the children in your care. It's also invaluable for all parents and caregivers of children aged 4-11 years who have concerns about a child's persistent worrying.
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Seitenzahl: 429
Veröffentlichungsjahr: 2025
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Managing Childhood Anxiety For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Managing Childhood Anxiety For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Table of Contents
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Getting Started with Managing Childhood Anxiety
Chapter 1: Worrying About Your Child’s Worries
Defining Anxiety
Analyzing Anxiety
Looking for Anxiety in Children
Getting the Diagnosis
Exploring Treatment
Helping Your Child Where You Can
Chapter 2: Recognizing That Kids Aren’t Little Adults
Meeting the Boss: Your Child’s Brain
Appreciating Plasticity
Looking at Chemical Communicators
Discovering How Emotions Grow
Exploring Social-Emotional Milestones
Recognizing Challenges in Pediatric Mental Health
Chapter 3: Knowing Your Family Isn’t Alone
Anxious Kids Are Everywhere
Exploring the Rise in Child Anxiety
Predicting Anxiety
Accepting Your Child’s Anxiety
Chapter 4: Seeing What Anxiety Looks Like in Kids
Recognizing That Anxiety Is the Greatest Mimicker
Understanding Anxiety’s Three Parts
Noticing How Child Anxiety Differs from Adult Anxiety
Distinguishing Types of Child Anxiety Disorders
Identifying Childhood Anxiety Matters
Chapter 5: Understanding Normal Childhood Worries and Fears
Appreciating the Stress Response
Knowing It’s Normal to Worry
Tackling Fears
Chapter 6: Watching Out for Medical Mimickers
Appreciating the Brain-Body Connection
Responding to Tummy Troubles
Managing Sleepless Nights
Dealing with Nagging Headaches
Experiencing Urinary Issues
Handling Concerning Chest Pain
Taking Care of Tics (Not Ticks)
Watching Out for Thyroid Disorders
Part 2: Diagnosing Child Anxiety
Chapter 7: Visiting the Doctor
Finding a Great Pediatrician
Preparing for the Office Visit
Understanding Confidentiality
Optimizing Your Appointment Day
Avoiding “Doctor Office Don’ts”
Chapter 8: Walking Through the Psychological Evaluation
Getting Ready for a Mental Health Assessment
Understanding What a Mental Health Visit Looks Like
Expecting Difficult Questions
Exploring Alternatives to an Anxiety Diagnosis
Part 3: Treating Child Anxiety
Chapter 9: Exploring Child Therapy Options
Understanding the Importance of Therapy
Discovering How Child Therapy Works
Reframing Therapy Myths
Finding a Therapist
Affording Therapy
Setting Expectations for Therapy
Seeing What a Therapy Session Looks Like
Telling Your Child about Therapy
Distinguishing Types of Anxiety Therapy for Kids
Preparing Yourself for After the Session
Chapter 10: Anxiety Medications: What Parents Need to Know
Considering Anxiety Medications for Kids
Appreciating Principles in Medicine Management
Preparing for Your Child’s Medical Plan
Prioritizing Safety
Detailing Commonly Used Anxiety Medications
Practicing Successful Medication Habits
Addressing Common Questions and Concerns
Chapter 11: Evaluating Supplements and Nutraceuticals
Navigating the Supplement Landscape
Supplementing Smartly
Surveying Anxiety Supplements
Part 4: Parenting Your Anxious Child
Chapter 12: Analyzing Your Parenting Style and Anxiety’s Impact
Determining Your Parenting Style
Putting Your Parenting Style into Action
Linking Parenting Behaviors and Anxious Kids
Parenting with Anxiety
Avoiding Accommodation
Chapter 13: Optimizing Your Home Environment
Understanding That Anxiety Management Starts at Home
Prioritizing Sleep
Moving for Mental Health
Fueling the Anxious Body and Brain
Succeeding with Screen Time
Prioritizing Play
Leaning into Routines
Chapter 14: Thriving in School and Sports for Anxious Kids
Expecting Back-to-School Anxiety
Experiencing Anxiety in School
Refusing to Go to School
Looking at the Landscape of Today’s Youth Sports
Supporting Your Young Athlete
Teaming Up Against Sports Anxiety
Chapter 15: Implementing Behavior Management Strategies
Understanding How Behaviors Are Learned
Recognizing a Positive Parenting Household
Choosing Effective Strategies
Tailoring Strategies for Kids with Anxiety
Managing Challenging Behavior
Chapter 16: Calming Techniques and Why They Work
Calming the Brain and Body
Teaching Calming Techniques to Your Child
Exploring Calming Techniques
Putting Calming Techniques into Action
Dealing with Panic Attacks in Kids
Chapter 17: Focusing on Specific Concerns and Worries
Getting an Anxious Child to Sleep
Supplementing Sleep
Examining Anxiety in Toddlers
Changing Bodies and Anxiety
Co-Parenting an Anxious Child
Part 5: The Part of Tens
Chapter 18: Ten Ways to Support Kids Who Fear Needles
Preparing Your Child in Advance
Explaining Needles in Simple Terms
Modeling Calmness
Advocating for Pain Management
Allowing Control Where Possible
Getting the Injection First
Engaging in Distraction
Practicing Breathing Techniques
Celebrating the Accomplishment
Seeking Professional Help
Chapter 19: Ten Signs Your Child Needs Professional Help
Avoiding Things They Love
Regressing Behaviors
Missing School
Displaying Physical Symptoms
Disrupting the Family
Dropping Academic Marks
Engaging in Self-Destructive Behaviors
Choosing Isolation
Asking for Help
Receiving Encouragement from Professionals
Chapter 20: Ten Things to Say to Your Anxious Child
“I’m Here with You, and We’ll Get Through This Together.”
“It’s Okay to Feel Scared or Worried Sometimes.”
“Is This a Big Problem or Small Problem?”
“Let’s Take Slow, Deep Breaths Together.”
“What’s Making You Feel Anxious Right Now?”
“This Feeling Will Pass. It May Take a Little Time, but It Will Get Better.”
“You’re Really Strong for Facing This. I’m Proud of How You’re Handling It.”
“Let’s Think of Some Ways We Can Make This Situation Easier.”
“You’ve Handled This Before, and I Know You Can Do It Again.”
“Your Feelings Matter to Me, and I Love You.”
Appendix: Recommended Resources
Books about Childhood Anxiety
Helpful Websites about Anxiety
Index
About the Author
Connect with Dummies
End User License Agreement
List of Tables
Chapter 2
TABLE 2-1 Common Neurotransmitters and Their Functions
Chapter 5
TABLE 5-1 Characteristics of Normal Worry versus Anxiety
TABLE 5-2 Common Childhood Fears by Age
Chapter 6
TABLE 6-1 Common Causes of Chronic Abdominal Pain in Children
TABLE 6-2 Common Childhood Sleep Disorders
Chapter 8
TABLE 8-1 Common Credentials of Mental Health Clinicians for Children in the Uni...
TABLE 8-2 Commonly Used Mental Health Screening Tools in Children
Chapter 13
TABLE 13-1 Sleep Consequences in Children
TABLE 13-2 Essential Nutrients in Common Foods
Chapter 16
TABLE 16-1 Characteristics of Panic and Anxiety Attacks in Children
List of Illustrations
Chapter 2
FIGURE 2-1: A child’s brain.
Guide
Cover
Table of Contents
Title Page
Copyright
Begin Reading
Appendix: Recommended Resources
Index
About the Author
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Managing Childhood Anxiety For Dummies®
Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com
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Introduction
Let me guess why you picked up this book. Maybe you think your child is worrying too much, and you’re not sure if that’s normal. At a recent doctor’s appointment, did the doctor suggest your child’s abdominal pain or headache is from anxiety — and you’re not sure whether you believe it? Or are you one of the millions of parents caring for a young child who was recently diagnosed with an anxiety disorder, and you’re looking for all the help you can get?
No matter the reason, I’m glad that you are here. I wrote this book for you.
Millions of families all over the world are looking for ways to manage childhood anxiety. Anxiety is one of the most commonly diagnosed mental health conditions in young children today. According to 2021 data from the Centers for Disease Control, 11.3 percent of children ages 5 to 11 years old received mental health treatment in the past 12 months. Just like you, the parents of these kids are looking for ways to effectively help their children learn to live and thrive with anxiety. This book is the road map you need.
About This Book
Managing Childhood Anxiety For Dummies is designed to help parents of children ages 4–11 through the process of anxiety diagnosis and treatment. In these pages, you find a strong foundation of education, understanding, and support. What makes this book unique is that it’s written from the perspective of an experienced, board-certified pediatrician who has spent the last 20 years caring for hundreds of families just like yours. That’s me.
This book is filled with what I want my patient families to know about childhood anxiety. It’s everything I wish I had time to say when a parent asks, “Dr. Natasha, I think she may have anxiety. Where do I start?” — without the constraints of a 20-minute office visit.
Of course, this book doesn’t replace the guidance and care given to you by your child’s healthcare provider. However, it will help you walk into their office prepared to ask smart questions and with a clearer sense of what you hope to achieve.
A quick note: Sidebars (shaded boxes of text) dig into the details of a given topic related to childhood anxiety, but they aren’t crucial to understanding it. Feel free to read them or skip them. You can pass over the text accompanied by the Technical Stuff icon, too. The text marked with this icon gives some interesting but nonessential information about managing anxiety.
One last thing: Within this book, you may note that some web addresses break across two lines of text. If you’re reading this book in print and want to visit one of these web pages, simply key in the web address exactly as it’s noted in the text, pretending as though the line break doesn’t exist. If you’re reading this as an e-book, you’ve got it easy — just click the web address to be taken directly to the web page.
Foolish Assumptions
As an experienced pediatrician, I understand that there are all types of families. Within these families are dynamic, kind, resilient, smart, talented kids who are deeply loved. I assume you are a parent to one of these amazing kids, and you’d do anything in your power to keep them safe and well.
I also assume that you’re busy, stressed, a little burned out, and trying to figure out what you’re going to make for dinner in the next 20 minutes. That being said, I’m going to get you to the bottom line quickly. I include explanations only where I think they’re important, and I add references if you want to go deeper on your own time.
Icons Used in This Book
Like all For Dummies books, this book features icons to help you navigate the information. Here’s what they mean.
This icon indicates summaries of key concepts, and many are repeated throughout the book. If you don’t remember anything else, you’ll want to remember these.
To highlight action steps and tools that you can use to help manage your child’s anxiety, I use this icon.
I put this icon next to science-y information that I think is cool but not necessary for you to understand the elements of a given section or chapter.
This icon calls out things that are exceptionally dangerous or important for your child’s health and safety.
Beyond the Book
There’s more than the advice in these analog or digital pages. In addition to the information and guidance on child anxiety that I offer here, there’s more on dummies.com. Find this book’s Cheat Sheet at wwww.dummies.com and search for “Managing Childhood Anxiety For Dummies Cheat Sheet.” There you find information about types of childhood anxiety, how to put together a calming kit for an anxious kid, and more.
Where to Go from Here
You can read this book from cover to cover, and I hope you do! But under the assumption that your time is limited, feel free to jump to the chapter you need the most today. Looking for a therapist, but don’t know what all the letters mean? Jump to Chapter 9. Did your child’s doctor suggest anxiety medication, and that’s freaking you out? Find my take in Chapter 10. Maybe you need help with screen time or nutrition advice. That’s in Chapter 13.
Regardless of where you start, I hope you find value within these pages. I hope it offers what you’re looking for and becomes something you reference in the future. Most importantly, I hope this book shines light on the amazing person your child is today, while also acknowledging your dedication, effort, and unyielding love that is guiding them into their future. Let’s get started.
Part 1
Getting Started with Managing Childhood Anxiety
IN THIS PART …
Find out how children are different biologically, developmentally, and emotionally from adults. Explore how these physical differences in brain form and function create natural periods of higher emotional responsiveness, which evolve over time.
Acknowledge and respect the vast number of kids and parents who struggle with anxiety. Evaluate current anxiety statistics and underlying factors that contribute to developing anxiety, making it clear that families aren’t alone. Move toward a path of acceptance and readiness to lovingly support a child through their anxiety experience.
Walk through normal child development to discover a framework critical to understanding how anxiety presents in children, including what common symptoms and behaviors of anxiety look like in kids. Distinguish normal from abnormal behaviors and see that young children don’t talk about their anxiety; they show it.
Recognize that child anxiety symptoms can include physical symptoms like stomachaches, headaches, and sleep changes. Discover ways to support a child at home with physical complaints, and look for red flags that should make parents concerned. In addition, find medical conditions that may mimic childhood anxiety.
Chapter 1
Worrying About Your Child’s Worries
IN THIS CHAPTER
Examining how anxiety presents in young children
Making a diagnosis of anxiety
Developing a comprehensive treatment plan
Anxiety is a protector and defender. Without it, we wouldn’t be able to survive or properly care for the ones we love. But when feelings of worry and fear become irrational, all-consuming, or cause us to change our behavior, that’s when anxiety becomes unhealthy and no longer performs its desired function.
In this chapter, you discover some anxiety basics, including why childhood anxiety is particularly unique. You start to think about anxiety as a medical diagnosis. Finally, you see that childhood anxiety is exceptionally treatable, and treatment starts with you.
Defining Anxiety
Childhood anxiety represents a spectrum of emotional, behavioral, and physical responses characterized by persistent worry, fear, and apprehension that exceeds developmental norms and interferes with daily functioning.
As a pediatrician, I regularly see how anxiety uniquely manifests in children through physical complaints like stomachaches or headaches, behavioral changes such as school avoidance or tantrums, and cognitive patterns involving excessive worry. When these symptoms get big enough to pull kids away from the things they need or love to do, I become concerned that a child may be suffering from an anxiety disorder.
The importance of addressing childhood anxiety cannot be overstated. Longitudinal studies show that children with untreated anxiety are more likely to develop depression, substance use disorders, and even more severe anxiety conditions later in life. Beyond these long-term concerns, childhood anxiety immediately impacts academic performance, social development, family functioning, and overall quality of life.
There are ways to reduce the impact of anxiety’s long-term effects. This book walks you through these evidence-supported interventions, including many things you can do at home. See Parts 3 and 4.
Analyzing Anxiety
Childhood anxiety is on the rise. In fact, doctor visits for anxiety have increased from 1.4 percent in 2006 to 4.2 percent in 2018. In my private practice, I see one or two children per day for anxiety management. Multiply that by the 67,000 pediatricians in the United States alone, and you can appreciate how common anxiety disorders are in today’s youth.
Seeing rising rates of anxiety
Researchers are devoting countless hours of expertise to determine why rates of child anxiety are on the rise. Theories include increased public awareness, pandemic fallout, and social media use. See Chapter 3.
Regardless of the cause of anxiety’s rise, the message is clear: Kids are more anxious than ever before. Every child, including yours, deserves to be heard, seen, and supported if they show signs of worry and stress. Being aware of anxiety and its symptoms is the first step.
Finding the roots of anxiety
Childhood anxiety results from a blend of biological and environmental factors. Biological factors are determined by your child’s genetics, temperament, and brain development. Environmental factors refer to elements or conditions in a child’s surroundings that influence their health. You find these factors discussed in various ways throughout this book. Also, you find ways to modify or impact factors you think are triggering your child’s anxiety symptoms.
Although you cannot take anxiety away from your child, you can change the intensity and duration of their anxiety experience.
Looking for Anxiety in Children
One of the biggest challenges — and joys — of working with kids is that they are physiologically and developmentally different than adults. These inherent differences make identifying, evaluating, and diagnosing anxiety in young kids difficult.
Appreciating child development
When working with kids, it’s important to take a child’s developmental phase into account. As children grow, they pass through expected phases while acquiring increasingly complex skills, called developmental milestones. Milestone progress from infancy through young adulthood is predictable in sequence, with one skill building upon another.
If you’re looking for a comprehensive list of childhood developmental milestones, the CDC has a free, interactive app called “CDC’s Milestone Tracker.” Find additional online resources in the Appendix.
At every well-child visit, pediatricians assess social-emotional milestones. These key developmental achievements (found in Chapter 2) involve a child’s ability to understand emotions, form relationships, express feelings, and navigate social interactions in age-appropriate ways. Social-emotional milestones are especially important to assess for kids struggling with fear and worry.
If you are unsure whether your child’s behavior is normal, call your child’s pediatrician. We get questions from worried parents every day and can let you know if additional evaluation is needed.
Showing, not telling
When you’re frightened, your body surges with stress hormones, all aimed at one goal — to protect. This hormone cascade prepares your body to fight, run away, or hide from a threat. This happens in kids too, but they lack the language to express what their brain and body are feeling. Instead of using words, kids show anxiety though behaviors.
Anxiety’s uncomfortable symptoms lead to avoidance behaviors — a key characteristic in all types of childhood anxiety. Avoidance behaviors are actions kids take to escape or prevent anxiety-provoking situations. If avoidance behaviors are allowed to continue, the connection is reinforced in their brain as an effective way to avoid danger and fear, becoming a learned behavior over time.
Kids don’t tell you they are feeling anxious, they show you through changes in their behavior.
Checking out various anxiety types
If a child’s anxiety behaviors are not age-appropriate, or if they are interfering with the things the child loves to play and do, that’s when professionals consider the possibility of an anxiety disorder. In young children, some anxiety disorder types are more common than others. For details of the most common anxiety disorders in young children, including separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, and specific phobias see Chapter 4.
Getting the Diagnosis
Diagnosing a childhood anxiety disorder requires specialized assessments that consider development, cognition, and family involvement. The good news is that decades of research have focused on child anxiety identification and treatment. Today, there are evidence-supported interventions to help identify kids more quickly and guide treatment in age-appropriate ways.
Starting with your child’s doctor
An anxiety diagnosis starts with a trip to your child’s healthcare provider. During the appointment, you can share your child’s story and why you’re worried about anxiety. In turn, your child’s doctor will evaluate them for any medical conditions that may be contributing to their symptoms. The doctor can also find ways to support the physical symptoms of anxiety your child may be experiencing. For more on doctors’ visits see Chapter 7.
Not all child health providers evaluate children for anxiety. Talk with your child’s doctor to find out whether they handle mental health concerns or suggest going elsewhere for an assessment.
Considering alternative diagnoses
If an anxiety disorder is suspected, or if your child’s behaviors are unclear, tapping into the expertise of a child psychologist can be helpful. During a comprehensive psychological evaluation, your observations of your child’s behaviors will be considered, in addition to information directly gathered from your child.
Some different diagnoses that psychologists consider when evaluating a child with anxiety behaviors include the following (see Chapter 8):
Attention-deficit/hyperactivity disorder (ADHD)
Oppositional defiant disorder (ODD)
Learning challenges
Sensory processing disorder (SPD)
Autism spectrum disorder (ASD)
Up to half of children with an anxiety disorder have an additional health condition or disorder, referred to as a co-morbidity. Having more than one diagnosis can create interactions that may complicate diagnosis, treatment, and management.
Accepting your child’s anxiety
When a child is diagnosed with an anxiety disorder, families often feel overwhelmed. It’s tough to see your child struggle, and guilt or shame may arise. I encourage you to let go of these feelings — they’re not yours to hold. The sooner you release them, the sooner you can confidently support your child and work toward symptom remission.
Your child with anxiety is not broken, and there’s nothing to “fix.” Anxiety is a part of who they are and always will be. It’s another aspect of your child you’re learning about as they grow, offering you more ways to show love, support, and care.
Exploring Treatment
In recent decades, there have been significant advancements in child neuropsychology. Clinical research findings have led to more accurate and consistent diagnostic tools. In addition, advancements in brain imaging and neurobiological research have discovered ways to bring anxiety symptoms into remission.
A comprehensive anxiety management plan includes a variety of components, depending on the level of support a child requires. Parts of the medical plan may include all or some of the following.
Leaning into therapy
Cognitive behavioral therapy (CBT) is the gold standard treatment for childhood anxiety. Modern psychological therapies are also being used to treat anxiety in children. Chapter 9 explores these options in detail.
Therapy isn’t just for kids with diagnosed anxiety disorders. Children can benefit from talking with a therapist during times of transition, for emotional guidance, working through trauma or grief, or whenever emotions or behaviors start interfering with daily life.
Fueling the anxious brain
Kids need fuel to grow healthy brains and bodies, and a variety of nutritional factors are required for this work. But kids with anxiety disorders often have unique eating habits that make it more difficult to get these essential nutrients. With your doctor’s guidance, nutritional deficits can be identified and supported as part of an anxiety plan.
Providing protection
Part 4 of this book is dedicated to many things that buffer anxiety’s negative effects. These things promote healthy emotional learning, self-regulation, and relationship building. Additionally, things like sleep, nutrition, and exercise decrease the physical effects of chronic stress, leading to increased resilience and stress reduction.
Your child is unique; their anxiety is not. For all kids with anxiety, treatment plans focus on modifying the well-known biochemical and developmental pathways that reinforce fear behaviors.
Considering anxiety medications
For some children, anxiety symptoms interfere so significantly in their daily lives that therapy alone isn’t enough. Additionally, some kids are unable or unwilling to particulate in therapy. In situations like these, adding medication to an anxiety plan is medically necessary to bring their symptoms into remission.
The suggestion of an anxiety medication can make parents uneasy. In my experience, much of this apprehension is founded in personal experience, family anecdotes, concerning social media posts, or frank misinformation. Straight talk on anxiety medications is found in Chapter 10.
Anxiety treatment sometimes requires using medications to boost natural hormones and neurotransmitters. Most of these medications focus on increasing the bioavailability of serotonin — 90 percent of which is found in the gut!
Finding support at school
Kids spend most of their waking hours at school. For kids with anxiety, having dedicated plans to ensure adequate support should be part of their educational experience. These plans can include anything from allowing a child with anxiety-triggered abdominal pain to visit the school counselor during the day, all the way to creating comprehensive support plans like an Individualized Educational Plan (IEP). See Chapter 14 for more information on thriving in school.
Prioritizing safety
Although sobering and upsetting, it’s important to recognize that kids with anxiety are at increased risk of death by suicide, and the average age of suicide death is declining. Being aware of actions you can take to decrease a child’s risk of suicide is imperative when caring for any child. Don’t miss this valuable information in Chapter 10.
Helping Your Child Where You Can
One of the hardest parts of parenting is even when you try your all, you ultimately don’t have control of your child’s future. In spite of this sobering truth, you’re essential to supporting your child’s anxiety experience. This starts with managing your own emotional regulation and mental health. See Chapter 12 for details.
Beginning with you
One of the biggest things that influences your child’s experience with anxiety is you. Taking care of your own mental health isn’t a luxury — it’s a necessity. Kids are incredibly attuned to their caregivers, and if you’re overwhelmed, stressed, or emotionally drained, it becomes much harder to provide the calm, steady support they need.
If you’re struggling with anxiety, depression, grief, or other emotional stress, it affects how you parent, disrupts your ability to support your child, and raises the risk of long-term mental health challenges in your family. When you prioritize your own well-being — through therapy, self-care, or simply making time to recharge — you equip yourself to show up as the best version of yourself for your child.
Being mentally healthy does not mean being happy. It means having emotions that are appropriate for the moment and managing those emotions well.
Seeing it through
Your child needs you. They need you to show them what mental wellness and healthy emotional regulation look like. They need you to be objective and clear. They need you to get them the support they need today, the next day, and the next.
I know this isn’t easy. Supporting your child with anxiety may be exceptionally challenging for you right now because of your own personal health history, the current relationship with your child, or another significant barrier. But I also know taking one small step forward can reveal a path you may not be able to see from where you are standing. Together, we move ahead.
Chapter 2
Recognizing That Kids Aren’t Little Adults
IN THIS CHAPTER
Discovering unique brain growth during childhood
Communicating with neurotransmitters
Observing emotional growth and social-emotional milestones
Uncovering challenges in pediatric mental health
On the first day of pediatric residency training, doctors are taught the pediatrician’s “golden rule”: Kids aren’t little adults. Throughout this book, I hope to convince you of this truth. Children are growing, shape-shifting individuals whose biology and physiology are different from grown adults. Learning about and respecting these differences is one way you can better understand and love your child for who they are today.
If you are struggling to make sense of your child’s emotions and behavior, digging deeper into basic childhood development can be eye-opening. Many parents overestimate their child’s emotional abilities at different ages, expecting more self-regulation than their brain development allows. As kids grow, their emotional regulation improves but only as fast as their brain matures. When parents misjudge this, it often leads to unchecked frustration and relational stress.
Understanding developmental phases helps you show compassion for both your child and yourself on the tough days. When you see certain behaviors, you’ll have the framework to understand what your child may be experiencing or trying to communicate. Along the way, this approach can guide you in raising an emotionally mature young adult.
In this chapter, you find out about basic brain growth during early childhood. I call out relevant chemical communicators that are used by the brain and nervous system. Using this framework of basic neurobiology, I explain how emotions develop and why children are more emotionally expressive than adults. Finally, I summarize the reasons why working with pediatric mental health is challenging to physicians and parents alike.
Meeting the Boss: Your Child’s Brain
Starting at the top — your child’s brain — is key to discussing mental health. As your body’s boss, the brain controls all the voluntary and involuntary actions of the central nervous system (CNS). The CNS is a communication highway, connecting the brain to the body. From the thoughts in your mind to how your organs function, the CNS is involved in nearly everything you do, think, and feel.
If you strung all the nerves in an adult human body end to end, the strand would be 45 feet long.
The brain is organized into different parts, each with a specific job. To handle all the amazing tasks it performs throughout life, the brain develops and operates in a hierarchy of complexity, which I describe in the following sections. As you grow, your brain progresses from managing basic tasks to handling more complex ones. Along the way, the connections required for advanced thinking and emotional processing are strengthened.
Your brain is not like your kid’s brain. Different stages of life are directly influenced by the slow development and organization of brain functions over time. Although kids’ brains have more neurons, or brain cells, the communication between neurons is not well organized, and some brain areas don’t fully function until many years after birth.
Brain development takes a long time. Mature brain connections happen slowly over many years. Taking the time to become familiar with the function of your child’s brain as they grow increases your compassion and understanding for the emotional behaviors you observe in your child.
The vital hindbrain
The human brain is divided into three main sections: the hindbrain, the inner brain, and the outer brain. Interestingly, the growth and maturity of these brain parts happens in a specific order, and all brain growth starts in the hindbrain.
The hindbrain is essential for life. Think of the hindbrain as your body’s behind-the-scenes control room. It controls all the body’s basic functions that you don’t have to think about, like keeping your heart beating and lungs breathing. It also helps with smooth body movements, so you don’t fall over.
Even before you’re born, the hindbrain is managing body systems. Because its job is so foundational, the hindbrain develops before any other brain parts form. This step-by-step growth ensures that basic functions are in place before developing any advanced abilities.
The emotional inner brain
Next, the inner brain begins to mature. This area is directly connected to the hindbrain and is present at birth. The inner brain includes the emotional processing part of the brain, called the limbic system. The limbic system is responsible for integrating our senses and processing information regarding our body’s homeostasis — or balance.
Additionally, the limbic system holds the amygdala — a small but mighty brain part that is responsible for the expression of fear, aggression, and defense behaviors. The amygdala also plays a role in the formation and retrieval of emotional and fear-related memories, and it’s the brain structure most implicated in pediatric anxiety disorders.
The thinking outer brain
The last part of the brain to functionally develop is the thinking brain, or cortex. When you envision the classic image of the brain’s squiggly, rope-like surface, the cortex is what you see. It’s connected to both the inner brain and hindbrain and makes up the thickest part of the brain.
The cortex is responsible for all the higher functioning that makes us human. It processes information from our five senses, helping us to interpret the world around us while keeping us safe. Complex pathways in the cortex signal our muscles to walk, write, or wave to a friend. The cortex also helps us understand words, whether reading a book or having a conversation.
Behind your forehead is a specific area of the outer brain called the prefrontal cortex (PFC). This area helps you make decisions, solve problems, stay focused, and control your emotions and impulses. The PFC also works with the inner brain to make memories, recognize faces, and make sense of how you’re feeling. Find all the brain parts in Figure 2-1.
By the age of three, the brain’s rapid growth gets it to about 90 percent of adult size, but the body is only 15 percent of adult size.
© John Wiley & Sons, Inc.
FIGURE 2-1: A child’s brain.
Appreciating Plasticity
One of the coolest aspects of brain development is the concept of plasticity — or rapid periods of brain growth and learning. Think of it like this: Your brain is a super-flexible, constantly changing map. As you learn new things, gain new experiences, or even recover from injury, the brain can make new connections or re-route existing ones to help it work better.
As you age, the degree of plasticity changes. Our brain becomes less sensitive to new experiences and less likely to change or adapt. For example, by the age of three, the regulatory functions of the hindbrain are unlikely to change. However, also at the age of three, there are cortical functions that have not even begun to grow. So don’t worry; old dogs can learn new tricks.
The cortex remains plastic throughout life, and life experiences continue to mold and change the thinking brain, no matter your age. The brain is continually creating meaningful representations of experiences and sensory information from events, allowing you to create memories — optimizing your ability to survive, adapt over time, and make many of the things that make you, you!
In children, the quality of brain growth and connections is determined by their environment and stimulation. As a child’s brain grows, it reflects the needs of the individual. In other words, children literally reflect the world in which they grow up. Providing a loving, nurturing environment that promotes connection with caring adults is the best way to optimize the critical early years of brain growth.
Looking at Chemical Communicators
As the physical parts of the brain develop, the individual neurons communicate with each other using neurotransmitters — or chemical messengers. Neurotransmitters are made and released by neurons in order to carry a message to a target cell: another neuron, a muscle cell, or a gland. In the following sections, I explain how they work and describe different types.
Examining how neurotransmitters work
When a neuron wants to send a message, it releases neurotransmitters into the space between it and the target cell, called the synapse. Think of it like throwing a message across a gap. On the other side, the target cell receives the message when the neurotransmitter attaches to its receptor, like a key fitting into a lock. Once the neurotransmitter is attached to the receptor, the message is sent along and causes the target cell to do an action.
There are many types of neurotransmitters, each with a special job. Excitatory neurotransmitters are like a “green light,” causing neurons to fire and spread the brain’s message to nearby cells. Inhibitory neurotransmitters are a “red light” for brain signals, trying to slow down or stop messages from being passed along. The balance between excitatory and inhibitory neurotransmitters is important to manage the brain’s signals, regulate emotions, and promote body functions.
Communication from neuron to neuron happens with insane speed. It’s estimated that some neurons can transfer messages at speeds of up to 275 miles per hour. That means a pain signal from your pinky toe can reach your brain in as little as 0.01 second.
After a neurotransmitter has done its job, it becomes biologically inactive. Some neurotransmitters are recycled into the original neuron to be used again later. Other neurotransmitters are broken down by enzymes so they don’t keep sending messages. Most simply drift away, lessening their ability to create any action. This process happens quickly and continuously throughout your CNS, helping everything work smoothly.
An imbalance of neurotransmitters in your brain can cause problems. An overload of neurotransmitters can make the brain send too many signals. This may lead to anxiety, problems with focus or concentration, or even some types of seizures. When there is a low level of neurotransmitters, the brain does not send enough signals, possibly causing depression, difficulty moving, or trouble sleeping. The brain needs just the right amount of each neurotransmitter to keep things functioning correctly.
Meeting the messengers
Neurotransmitters are the target of many mental health medications. For more about these medications and their effect on neurotransmitters, see Chapter 10. Table 2-1 summarizes the most common chemical messengers involved in emotional development and anxiety.
TABLE 2-1 Common Neurotransmitters and Their Functions
Name and Effect
Details
Epinephrine — fight or flight
Excitatory signal that is produced in stressful situations. Increases heart rate, breathing, blood pressure, and blood sugar. Leads to physical boost and heightened awareness.
Norepinephrine — concentration
Excitatory signal that affects attention and focus, decision-making, and alertness. Also involved in the stress response. Contracts blood vessels, increasing blood pressure and heart rate.
Serotonin — mood
Inhibitory signal that regulates mood, sleep, digestion, anxiety, and pain. Can affect a large number of neurons at the same time. Influences other neurotransmitters. Too little makes you feel sad or unmotivated.
Dopamine — pleasure
Both an excitatory and inhibitory signal that is wide-reaching. Plays a role in the body’s reward system, helping with focus, concentration, mood, and motivation. Low levels cause slow movement, like in Parkinson’s disease or depression. Increased levels can result in aggression or competitive behavior. Involved in addiction.
GABA — chill pill
Inhibitory signal that calms nerve signaling. Regulates the brain to prevent problems with concentration, sleep, and anxiety. Also contributes to motor control and vision.
Discovering How Emotions Grow
Mature emotional regulation depends on strong, two-way connections between the thinking brain (the prefrontal cortex) and the emotional brain (the amygdala). This process happens incredibly slowly in humans, with the prefrontal cortex still maturing into adulthood. It’s believed that the slow process is intentional, allowing humans to leverage an extended period of plasticity.
In an adult, a mature prefrontal cortex can consciously process an emotion and refine the emotional response before the emotion is expressed. In this way, communication between the prefrontal cortex and amygdala results in more tempered and organized emotional expression. Kids, however, don’t have this brain connection.
Because the emotional brain matures first, kids are less able to use the cortex to regulate their emotions. Emotional signaling arrives intensely and unfiltered into the amygdala, resulting in a more emotionally charged response. Throughout childhood, the slow maturation of the cortex-to-amygdala pathway creates a neurodevelopmental “tug-of-war.” The amygdala usually wins.
As a child’s brain grows, there’s a physical and chemical imbalance between your child’s emotional center and their undeveloped higher brain functions. This results in emotional dominance left unchecked by the rational thinking brain.
Despite their underdeveloped emotional systems, kids can learn how to regulate their emotions. How do they do this? By watching you!
Throughout childhood, your child relies on you as their de facto prefrontal cortex. In times of stress or fear, your reaction provides physical and behavioral cues as to how they should be managing the same situation. This process, called social referencing, helps your child navigate uncertainty before they have experience and maturity within themselves.
Expressing a calm demeanor not only soothes your child’s stress, but it also shapes how they will perceive and handle fear in the future. When you stay cool as a cucumber, and your child mirrors that behavior, their brain lowers its amygdala activity. This not only provides your child with immediate soothing, but also makes the development of permanent fear memories less likely.
When a parent can’t model calm during a time of stress, a child’s stress response is escalated. In addition, a visibly scared parent signals to a child that a situation is dangerous or unmanageable, reinforcing fear. In this way, social referencing is one way to explain how anxiety can spread from parent to child. Discover other parental behaviors that may contribute to — and protect against — child anxiety in Chapter 12.
Exploring Social-Emotional Milestones
Parents and pediatricians monitor the expression of brain growth by watching for developmental milestones, or key skills and behaviors that most children can do at certain ages. Developmental milestones serve as a guideline to monitor a child’s growth and help identify any areas of challenge or delay.
Most parents think of developmental milestones simply as a checklist of items their child needs to achieve. Starting to roll over a few weeks early or being the first of the cousins to say “mama” are points of parental pride. But when children don’t reach milestones as expected, the checklist can turn into a list of frustrations and worries.
Despite being the pinnacle of parental comparison, developmental milestones are more than just a checklist. They are the physical expressions of brain growth. All the brain things — structure, parts, chemical messengers, cell signaling — need to be working and growing for a child to gain progressive skills. The order of process is predictable because of the way that the brain grows, from hindbrain to emotional brain to thinking brain.
Milestones don’t reflect a specific date or “goal.” Developmental milestones are a sequence of predictable steps during childhood development that reflect a range of progress over time. As indispensable as the developmental milestones are for every parent and pediatrician — and this is important — hitting the benchmarks “on time” is less critical than seeing continued forward progress in a child’s developmental path.
The developmental process cannot be sped up or slowed down; it takes time and happens over the years. Pediatricians watch for consistent, forward progress as a child grows, and they offer additional support to kids who need help meeting their personal growth goals. Just like milestones for walking and talking, the brain parts and pathways to understand and interpret emotions also follow a predictable path. In turn, there are observable and expected social-emotional milestones as children grow. These gains are intricately linked to cognitive development, so I include both in the following lists of developmental milestones.
As you examine any developmental checklist, keep in mind that developmental “rules” don’t apply to all kids, and development isn’t predestined. The path each child takes is predicable yet unique. Pediatricians are experts in watching kids grow at their own rate and pace, and within their own ability. The goal is to anticipate and prepare for the next phase, while appreciating the phase your child is in. If you’re ever concerned about your child’s developmental progress, your pediatrician should be your first call.
Toddlers (2–4 years)
The task of toddlerhood is to develop basic social and emotional skills. During these years, toddlers begin to show a wider range of emotional expression, such as joy, anger, frustration, and empathy. However, they struggle to express these emotions verbally. This can lead to behaviors like temper tantrums as they learn to assert their independence within necessary safety boundaries. Kids in this age range typically achieve the following social-emotional milestones in the approximate order, over time:
Engages in symbolic pretend play, substituting objects for other things
Has bedtime fears and nightmares
Initiates interactions with a few peers
Understands simple rules
Is able to talk about emotions and situations that elicit them
Identifies rules for problem-solving, trying solutions before getting frustrated
Generalizes rules from one situation to another, sometimes incorrectly
Offers comfort to another person who is hurting
Expresses guilt for misbehaving
Understands moral themes (right and wrong) in stories
