Health & Wellbeing: Dealing with children's anxieties

Anxiety – a feeling of fear or unease – is something that, thankfully, we now acknowledge and talk about as a society. But how can early years practitioners support young children through natural anxiety and recognise when additional help is needed?

‘Anxiety is a sense of worry or fear that everyone has at some point in their life,’ says Abi Miranda, head of early years and prevention at Anna Freud. ‘Anxiety has effects on the body like changes to our breathing, changes to our heart rate, stomach aches or flutters, fatigue, and nausea.’

She says anxiety can look different in young children and depends on factors such as their personality, neuro-developmental needs and stage of communication. ‘A pre-verbal child will not be able to articulate that they are anxious, but it may be observable in behaviour like not wanting to leave their caregivers, excessive crying, avoiding particular situations, or physical behaviour, like hitting out at others,’ explains Miranda. ‘Children who have developed their communication systems may be able to express their feelings, or they may be able to identify bodily sensations such as a tummy ache that indicate that they are worried. It is important to remember that fear looks different in people, and that some children may seem more withdrawn, whereas others may display a more aggressive response as a sign that they are struggling to cope with feelings of worry or fear.’

Other signs of anxiety in children, identified by NHS Scotland, include:

• Finding it hard to concentrate.
• Not sleeping, or waking at night with bad dreams.
• Not eating properly.
• Quickly getting angry or irritable, and being out of control during outbursts.
• Always crying.
• Being clingy all the time.
  
  

WHY WE GET ANXIOUS

Anxiety is often seen as negative, but it is not necessarily a bad thing. Miranda explains that it serves an evolutionary purpose by driving us to avoid danger and to seek safety – feeling anxious can actually help us to focus or take extra care in some situations. ‘It kickstarts processes in our bodies that prepare us to escape from threats, to fight, but it can also cause us to shut down or freeze,’ says Miranda. ‘Additionally, when we feel unsafe, we feel less able to assert our own opinions and views, tending to go along with others, which is known as a fawn response.’

There are many occasions in modern life that can cause even the youngest of children to feel anxious. ‘Young children can experience fears or worries about their relationships, about things in their environment, and changes in their lives can also cause anxiety. For example, young children experience separation anxiety at different points of their development where they become fearful of being apart from their main caregivers,’ says Miranda. ‘Young children can also develop fears and phobias such as being afraid of the dark, and of particular animals, to name some examples. A change such as moving house or starting pre-school or school can cause a child to worry.’

She says that anxiety is an expected part of a child’s development and demonstrates that their understanding of the world is increasing. These anxieties tend to resolve themselves. ‘Typically, children are able to seek comfort from trusted adults when they are feeling anxious, and as they get older, they become increasingly able to self-soothe,’ says Miranda.

WHEN TO SEEK HELP

While it is normal to feel anxiousat times, it can become problematic when it prevents children from enjoying their everyday life. ‘If a child’s anxiety is preventing them from doing things like going out with their family, interacting with other familiar adults and children, or playing, and reassurance from people closest to them is not helping, these are signs that their anxiety is becoming an issue,’ cautions Miranda. ‘A child’s anxiety can also impact family functioning, which means the adults start to adapt their lives to fit around the child, accounting for their fears. This sometimes happens gradually so it can be difficult to notice.’

She says that practitioners are well-placed to support anxious children because they often know the children in their setting in great depth, but adds, ‘It is important that practitioners are able to look after their own wellbeing so that they can respond to the child in a calm and empathetic way.’

New guidance from the Department for Education on supporting babies and young children with their mental health (see Further information) explains how practitioners can support positive mental health in early years children. Advice on anxiety includes:

• Let them know that you are there to listen and help with their worries – always take a child’s anxiety seriously.
• Reassure them and help them to find solutions – perhaps suggest a different way of looking at the worry.
• Prepare them for change – talk to them about the positive aspects of the new experience.
• Help them cope with separation anxiety – encourage parents and carers to say goodbye in an upbeat way and offer cuddles and gentle distractions.

Miranda says pre-school children can be shown how to use techniques such as box breathing (see Further information) or yoga to calm them when anxious. She also highlights the importance of encouraging all children to make good use of outdoor areas as a way to help them regulate their emotions.

Communication with parents is also important, to discuss concerns around a child’s anxiety and talk about strategies that can be used to support them both in the setting and at home. ‘It is important for practitioners to use a “watchful waiting” approach to see how the child responds to their support, otherwise the practitioner may themselves start to worry about whether they are doing enough,’ adds Miranda. ‘It is helpful to talk to colleagues when feeling stuck about how to help a child, as sometimes, support from a professional outside the setting might be needed.’

Suggested books

Sharing a picturebook with a trusted adult can help children to feel safe, which may encourage them to talk about their worries. You could try:

• Little Mouse’s Big Book of Fearsby Emily Gravett – Many young children will identify with the little mouse who uses the book to document his fears, from loud noises and the dark to being sucked down a plughole.
• The Worrysaurus by Rachel Bright and Chris Chatterton – An engaging story about a dinosaur who is full of fears and ‘what ifs?’. It introduces useful ways of coping with emotions.
• The Huge Bag of Worries by Virginia Ironside and Frank Rodgers – Wherever Jenny goes, her worries follow her in a big blue bag. She wants them to go, but who will help her?
• Jabari Jumps by Gaia Cornwall – Despite being scared, Jabari faces his fears and jumps. Join in the jubilant celebration with Jabari’s sister and dad at the end.
• Ruby’s Worry by Tom Percival– Ruby’s worry gets bigger and bigger every day until it makes her sad. A story about how talking and sharing our problems can help.
• The Great Big Book of Feelings by Mary Hoffman and Ros Asquith – Explore many feelings in this sympathetic and entertaining book.
• Tappity-Tap! What Was That? by Claire Freedman and Russell Julian – One dark, stormy night, Owl, Mouse and Rabbit hear a knock on the door. They feel very afraid…
• Grobblechops by Elizabeth Laird and Jenny Lucander– Who hasn’t been anxious about the monster under the bed? In this retelling of an ancient story, Amir is reassured by his dad that he need not be afraid.
  
  

FURTHER INFORMATION

• Anna Freud: https://www.annafreud.org
• ‘Mental health for early years children’, Department for Education: https://bit.ly/3v16lUb
• Box breathing: https://www.calm.com/blog/box-breathing