In my clinic, I tend to see a lot of children for anxiety. They don’t come to me saying, “Dr. Bauer, I feel anxious or worried” rather they are being seen because they have mood swings and tantrums. Or they cannot sleep. They cannot separate from their parent. They may just clam up. Sometimes they appear very “oppositional,” constantly arguing or refusing to do things. Or they may have ADHD that is not getting better on current treatment. Trying to tease behavioral conditions from one another can be a challenge.

Anxiety is a highly common issue for children but also tends to go unrecognized. Some fears or worries are common for young children:  fears of the dark, spiders or being separated from parents/loved ones. It is also common for school aged children or teens to be nervous about an upcoming exam or speaking in public. In some cases, these feelings of worry helps to “jump start” rehearsing, preparation, and studying. Other times, it lead to big feelings of overwhelm. When it freezes the child or teen so much they cannot do what they need to do, that is when we become concerned about it being much more. Sometimes, it can cause children to become so upset and angry that their little inner “worry monster” comes out.

RELATED: Using “Inside Out” to Discuss Emotions with Children in Therapy (PsychologyToday.com)

Anxiety occurs in about 1 in 5 children or teens. There are a variety of different anxiety conditions, which vary in how and when it shows up most often in children/teens. Your child’s doctor can help tease out what is normal and expected versus what it more worrisome and when more education and treatment is indicated.

Preschool children are more prone to having fears of animals, being alone or the dark. This is because of how children of this age process things in their world. They have a wonderful ability to play and pretend and can imagine objects as other things (for example, a broomstick becomes a horse or the dark shadows can become monsters). School age children tend to have more fears about physical hurt, illness and school and as they mature and their ability to think more abstractly grows, teens may have fears that reflect the societal issues affecting the world at large or those that center around embarrassment and navigating tricky or awkward social situations.

Before we get into this a bit more, we should talk about the differences between fear, worry and anxiety. Fear is your body’s response to tell your brain that you must get out of a particular situation to stay safe (the “fight or flight” response). Your body sets off its inner alarm system when you notice your heart is racing, your muscles get tense, your breathing gets fast and you may start sweating. Worry are the thoughts you have when thinking (repeatedly) about a future event or outcome. You may feel on edge and your mind continually plays out what you think will happen (usually the worst case scenario). With worry, your brain is so tuned in to these thoughts that it can be hard to manage. Anxiety triggers both these negative thought patterns and bodily sensations.

So how can you help your child tame his/her inner worry monster? We all feel our worry monsters inside from time to time. We just don’t want to let him out in ways that can hurt others or stop us from trying new things.

Parents can do a lot by helping give children the words they need to express their emotions. Emotions are tricky, especially those big ones, that may be strong, negative and scary. Moreover, a child’s temperament can influence how they process their world. Kids who are more flexible and easygoing can tend to go with the flow much more easier than kids who are extremely cautious, tend to need time to warm up and are afraid to try new things.

Here are three simple steps I teach parents in the office how to begin being their child’s emotion coach:

STEP ONE: Label all emotions, positive and negative so to give your child an emotion vocabulary.

I tell parents that they will need to become their child’s “emotion coach.” Just start describing the emotions you think your child is feeling. Acknowledge these feelings by labeling it. And don’t just focus on the negative ones, focus on the positive ones too.

Try this, before reading on: think about all the emotions you can name in 30 seconds. Which ones come to mind?

I often ask kids to give me examples of what makes them happy, sad, scared and worried to begin. But there are so many other feeling words to use. I also have flashcards or flip charts of those funny faces to start the conversation with some kids.

Did you come up with Eager, Determined? Irritated, hurt? Embarrassed? Jealous? Unhappy? How about lonely, bored, restless or at ease?

Click on this link to see a list of feeling words you can start describing.

The pitfall I see happen when parents are asked to do this exercise is that they often end up asking their child how they feel. I caution you against this, especially in the heat of the moment because children throwing a tantrum are just feeling and often don’t know why they feel that way. They just don’t like the feeling and they instead fall back and show you with their bodies how they are feeling.

If you ask your child what they are feeling at this moment, you will likely get the response, “I DON’T KNOW!” or grunts, more yelling and crying. Check out my past blog post on a #reallife parenting challenge.

Instead I coach parents to put a label on it, in the moment. This helps children tie the word to what they are feeling in their bodies in the moment so that hopefully the next time they will be able to tell you how they feel.

Some kids are super sensitive and don’t like the attention, especially when talking about their emotions. If you find labeling your child’s emotions causes your child to become even more upset, try to label emotions/feelings of characters in books, while watching TV together or better yet, sharing your own experiences.

“When I was driving home today, I was so frustrated when the traffic was so bad. I don’t like sitting still in traffic, especially after a long day at work. But I couldn’t get there any faster so instead I concentrated on taking a few deep breaths and blowing away my frustration. And you know what? I felt better after that third slow deep breath.”

STEP TWO: Teach your child how to take a deep breath using Kleenex!

Teach your child a coping strategy they can begin to use in the moment. I like to teach kids how to do deep breathing because it doesn’t cost any money and you take your breath with you, so you can access it anywhere. At home, at school and in public. Yet it is something inside you that you don’t have to show others what you are doing.

Have you ever asked your child to take a deep breath? Believe it or not, if you don’t teach your child how to do it, they often end up taking those quick rapid shallow breaths that will cause them to hyperventilate and pass out. Those are NOT the breaths I am talking about. This is where my “superman” technique comes in handy.

First ask the child what superhero they like that has a cape. Think Superman, Supergirl, Batman, Powderpuff Girls or even Teenage Mutant Ninja Turtles. Then when they have told you their choice, take a kleenex tissue and hold it in front of your face. Tell them they have been chosen to help (insert superhero of choice) fly today because everyone needs a little help. “We need to help Supergirl fly today. She was busy all night and is very tired, but she knew you were the right person to help! Let’s see if you can make her cape fly for a long time by taking a very slow deep breath. Let me show you and then you show me what you can do.”

Slowly and deeply take a deep belly breath and make the Kleenex fly by gently blowing air from your lungs. Kids love watching you do this and cannot wait for their turn. I then have the child join me so we can do it together and then I let them show their parent how they can do it all by themselves.

Parents should do this exercise with their child during a relaxing time to start (like right before bedtime). Make sure you praise your child’s efforts, “Wow! You are really making Supergirl’s cape fly a long time! Way to go!”

STEP THREE: Bring it all together

Now, the next time your child is feeling strong negative emotions bring the skills above all together and say, “I see you’re starting to get frustrated right now. You remember what we practiced to help Supergirl fly? Let’s take our deep breaths right now!” (You don’t need to go and run and get the tissue if you know your child knows how to take the deep breath).

Parents show their child how and when to use their new coping strategy by coaching them through the process. You bring this all together for them by reminding them what they can do instead.

This step is important and especially effective BEFORE your child loses his/her temper or starts feeling the rage.

If your child loses control, stop talking and stay close. Don’t do anything as long as your child is safe and not hurting themselves or others. When your child calms down, turn your attention back to him/her and say gently, “You were feeling really frustrated but you calmed down. You got through it. It wasn’t easy but you did it.”

Acknowledgement of the fact that they calmed down is KEY. It helps reinforce what you do want and that is helping them tame their inner worry monster.

Request to download my handout in English or request my handout in Spanish.

If you want both handouts, you will need to click on both links as I maintain them as separate lists.

PLEASE NOTE: I have now started collecting emails for each handout I give out free so that should I make any changes, you will be sent the new handout to your inbox instantly!

I feel that being able to update and revise the handout is important as things may change in clinical practice.

I hope you enjoy these brief tips and tricks to begin to help tame your child’s inner worry monster.

If you haven’t seen some of my favorite children’s books to use with children who worry, check out Jonathan James & the What if Monster and Dealing with Feeling Worried

RELATED: Anxiety Disorders in Children (HealthyChildren.org)

RELATED: Signs Your Young Child Might be Struggling with Anxiety (Understood.org)

RELATED: School Avoidance Tips for Concerned Parents (HealthyChildren.org)

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Written by

Nerissa Bauer

I am a behavioral pediatrician, consultant, child advocate and blogger. I am a wife, mommy to 2 amazing children and a golden retriever. Love cooking, travel, reading, tap and creating.