Dr. Jennifer Yee commonly treats children in our clinic. In this article, she focuses on anxiety in children.

What is anxiety in children?

Anxiety and fear are a normal part of childhood development. Fear and anxiety are a natural reaction to real or perceived dangers or threats. Fears and anxiety in children are usually temporary and are a way that children can learn to solve problems and manage emotions on their own and with parental and caregiver support.

Childhood anxiety disorders differ from normal fear and anxiety because they involve bigger emotional reactions (e.g. crying, tantrums, fearful behaviour such as avoidance) that last longer than typical and have been ongoing for more than 6 months. They can cause significant disruption in a child’s day to day functioning and physical, mental and emotional well-being. It is estimated that about 1 in 5 children will develop an anxiety disorder.

What are the types of anxiety in children?

There are several different types of anxiety in children. Children may experience only one type of anxiety or have aspects of several types of anxiety disorder. They can restrict what a child chooses to do (e.g. not wanting to participate in certain activities), school performance, and ability to socialize with others.

Separation Anxiety Disorder: a child with separation anxiety may be fearful of strangers and new situations when parents and caregivers are not present. Separation anxiety is a normal phase of early childhood development, beginning around 8-12 months of age and typically improving around preschool and kindergarten age. Separation anxiety disorder involves more extreme emotional distress and fears of separation and can be ongoing even as the child enters school.

Social anxiety disorder: a child may have an intense fear of interacting with others in social situations. This can happen in any environment such as school, extracurricular activities, large gatherings such as parties and also situations that involve public speaking or performance. To minimize their discomfort, children may try to avoid going to school or engaging with new people.

Generalized anxiety disorder: generalized anxiety can present as excessive fear and worry about a variety of things on a frequent or constant basis. A child may also worry about the future or the safety of loved ones and attempt to control things in a way that would minimize their anxiety. A child may also speak of feeling worried or anxious but not be able to express specific things they are worried about.

Phobias: fear is a healthy and normal protective emotional response in children; however, extreme fears or phobias that are out of proportion to the actual threat of danger, can be of concern.

Panic disorder: panic attacks present as extreme fear accompanied by physical symptoms such as heart palpitations (heart racing), shortness of breath, dizziness, nausea, and excess sweating. They can occur with specific triggers (e.g. encountering a phobia, separation from a parent or caregiver, etc.) or can appear without warning.

What causes anxiety in children?

There are many possible contributors to anxiety in children and there is typically not one specific trigger. Anxiety can develop after stressful life events such as the loss of a loved one, moving to a new home, starting a new school, or a living in a stressful home environment (e.g. conflict in the home between family members, divorce, abuse, neglect. living in poverty or being underhoused, etc.). A child’s personality can play in role, particularly in children who are more naturally sensitive, empathetic or perfectionistic. Some children may have a harder time adjusting to change and processing stronger emotions. Children who are neurodivergent (children with autism and/or ADHD) are also more likely to experience anxiety. There can also be a biological or familial tendency to be anxious.

How is anxiety in children assessed and treated naturopathically?

A naturopathic doctor can be a valuable member of the assessment and treatment team for children with anxiety. As a naturopathic doctor, I will ask questions regarding your child’s behaviour, daily life, reactions to different situations and events, and symptoms. Speaking to your child’s teacher, other caregivers or referring to a therapist or psychologist may provide more insight about how children interact in other environments and with other people. It is also important to assess for other factors such as nutritional imbalances, food intolerance reactions, sleep deprivation or poor quality sleep, developmental challenges or behavioural challenges, which could be causing symptoms or anxiety or worsening an anxiety disorder. 

Naturopathic doctors offer a wide variety of testing options for further assessment. This can involve lab work such as blood or urine tests to screen for nutritional deficiencies or to assess levels of stress hormones. Food intolerances can be screened for through an elimination diet or food sensitivity tests through the blood. A stool sample analysis would provide a detailed analysis of the gut microbiome (all living microorganism such as bacteria, fungi, viruses, immune cells, etc that line our gastrointestinal tract), which can have an impact on a wide variety of functions in the body including digestion, immunity, inflammation, mood, and behaviour.

After a thorough assessment, treatments will be recommended based on your child’s specific symptoms and needs. A treatment plan for anxiety could involve dietary adjustments, taking supplements to address nutritional deficiencies or to support a healthier microbiome, correcting sleep disruptions, and treatments to encourage a more balanced stress response and reduction in anxiety symptoms.