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The Worried Child

June 7, 2015 | by Rifka Schonfeld

How to prevent and reduce anxiety.

Fear. Anxiety. Fright. Stress.

Are these four words all the same thing? In his book, The Worried Child: Recognizing Anxiety in Children and Helping Them Heal, Dr. Paul Foxman explains that - while related - they have slightly different meanings. Once we understand their definitions, we can figure out which feelings are unavoidable and which are controllable.

Let’s start with some definitions:

  • Fear: an instinctive reaction to clear and present danger or threat.
  • Anxiety: a state of apprehension or worry about a danger or threat that may occur.
  • Fright: state of fear when danger or threat catches us by surprise.
  • Stress: any situation (positive or negative) that requires adjustment or change.

Fear is part of our survival instincts. When faced with danger, our body goes into “fight or flight” mode. This happens without thinking: Our body takes over and prepares by tensing muscles, increasing the heart rate, sharpening vision and hearing, and intensifying breathing. All of these changes allow our body to fight the threat or run quickly from it. These physical changes, once triggered by danger, cannot be easily stopped.

Fear reactions, when not discussed and treated, can lead to anxiety.

What is the path from fear to anxiety? When children experience frequent threats or stress, this recurring “fight or flight” reaction can lead to symptoms such as difficulty concentrating, memory impairment, and anxiety. In other words, anxiety is the fear of fear. Anxiety tends to develop after a child experiences a trauma. At first, they have the fear reaction, but the lasting repercussions may include persistent worry, concern or dread. Fear reactions, when not discussed and treated, can lead to anxiety.

Below is a partial list of “external” causes for anxiety mentioned in Dr. Foxman's book. An external cause is something that happens in the child’s environment, rather than within the child himself. Some of them might be surprising:

  • If the child sees a weapon or experiences violence, even not directed at him.
  • If a piece of personal property is stolen from the child.
  • If the child is violently ill or experiences a serious injury.
  • If a parent is ill and incapacitated in some way.
  • If the child suffers sexual or physical abuse.
  • If the child is a victim of bullying, or witnesses someone being bullied.
  • If the child lives through a natural disaster, terrorist attack or war.
  • If an immediate family member dies or is suddenly absent.

In addition to these external triggers of anxiety, there can also be internal triggers. Internal triggers are situations that occur within the child himself. Strong emotions can trigger anxiety: If a child experiences extreme anger or extreme excitement, these emotions within the body can feel like a fear reaction (rapid heart rate, tense muscles, etc.). As a young child, it is hard to distinguish between external danger and strong internal emotions. Therefore, children who go from “low to high” and back again can develop anxiety.

Another internal trigger can be negative cognitive patterns such as perfectionism, pessimistic thinking, and all-or-nothing thinking. These repeated thoughts can lead a child to develop high levels of anxiety about the future or their self-worth.

When the Stress Comes Out

Dr. Foxman cites three ingredients that explain how, why, and when anxiety develops in children.

First, a child may have biological sensitivity or inherited characteristics that predispose him/her to anxiety.

Second, a child may develop an anxious temperament based on early life experience. Those with an “anxiety personality profile” have some of these characteristics:

  • Strong sense of responsibility
  • High standards of achievement
  • Difficulty relaxing
  • Tendency to please others
  • Difficulty with assertiveness
  • Oversensitivity to criticism and rejection
  • Tendency to worry

Third, stress induces this anxiety to come out. Stress is the “when” piece of the puzzle, inducing anxiety when changes need to take place.

Foxman created the following chart:

Biological sensitivity + Family and Childhood Experience –&gy;
Anxiety Personality + Stress –&gy;
Strong Reactions –&gy;

Various anxiety disorders in children include separation anxiety disorder, avoidant disorder, overanxious disorder, social phobia, post-traumatic stress disorder, obsessive compulsive disorder, and panic disorder. While some worry and anxiety is normal, it becomes problematic if it interferes with the child’s daily functioning. If you find your child struggling with anxiety on a frequent and intense basis, getting him evaluated will help him and you live happier lives.

We can control ourselves, but not those around us.

Whether your child is suffering from an anxiety disorder or just plain old anxiety, many things can be done to help control the anxiety. As a general rule, distinguish between what is in your control and what is out of your control. We can control ourselves, but not those around us. Unpredictability and uncertainty are associated with anxiety. So you choose how to spend your time, how to maintain your relationships, how to care for your children, and live according to your core values.

Some other tips:

Rest. When you sleep, your body relaxes. Therefore, help your child get as much sleep as his body needs.

Exercise. Exercise is great for the body and brain. Exercise relieves stress and fights anxiety. Get your child kicking a ball or running around the track.

Proper nutrition. Highly processed or sugary foods can feed anxiety. Eat foods that are high in vitamin B and low-fat proteins.

Daily routines. Routines help calm anxious children because they allow them feel in control. Establish daily routines and do your best to stick to them (without stressing out!).

Replace worry with positive and rational thinking. Help your child change his thinking. When he wants to think an anxious thought, help him transform it to a positive or rational one. With practice, this can become a way of life.

Model calm. If you are anxious, there is no way you can help your child overcome his anxiety. Therefore, work on your own anxiety. In the end, it will benefit your child as well.

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