Childhood fears

It’s normal for children to feel afraid at times. Fear is an emotion that can help kids be cautious. Things that are new, big, loud, or different can seem scary at first. Parents can help kids feel safe and learn to feel at ease.

It’s normal for children to show signs of anxiety, worries and fears sometimes. In most cases, anxiety in children and fears in childhood come and go and don’t last long.

In fact, different anxieties often develop at different stages. For example:

• Babies and toddlers often fear loud noises, heights, strangers and separation.
• Preschoolers might start to show fear of being on their own and of the dark.
• School-age children might be afraid of supernatural things (like ghosts), social situations, failure, criticism or tests, and physical harm or threat.

Babies and young children don’t tend to worry about things. For children to be worried, they have to imagine the future and bad things that might happen in it. This is why worries become more common in children over eight years of age.

Children also worry about different things as they get older. In early childhood, they might worry about getting sick or hurt. In older childhood and adolescence, the focus becomes less concrete. For example, they might think a lot about war, economic and political fears, family relationships and so on.

Worry and fear are different forms of anxiety. Fear usually happens in the present. Worry usually happens when a child thinks about past or future situations. For example, a child might be fearful when she sees a dog and also worry about visiting a friend with a pet dog.

Is my child’s fear normal, or does my child need help?

Most kids cope with normal fears with gentle support from their parent. As they grow, they get over fears they had at a younger age.

Some kids have a harder time, and need more help with fears. If fears are extreme or keep a child from doing normal things, it might be a sign of an anxiety disorder.

Talk to your doctor if your child’s fears:

• seem extreme or last past the normal age
• cause your child to be very upset or have tantrums
• keep your child from doing things — like going to school, sleeping alone, or being apart from you
• cause physical symptoms (like stomachaches, headaches, or a racing heart) or your child feels breathless, dizzy, or sick.

Common childhood fears

What children feel afraid of changes as they grow. Some fears are common and normal at certain ages.

For example:

• Infants feel stranger anxiety. When babies are about 8–9 months old, they can recognize the faces of people they know. That’s why new faces can seem scary to them — even a new babysitter or relative. They may cry or cling to a parent to feel safe.
• Toddlers feel separation anxiety. At some time between 10 months and 2 years, many toddlers start to fear being apart from a parent. They don’t want a parent to leave them at daycare, or at bedtime. They may cry, cling, and try to stay near their parent.
• Young kids fear “pretend” things. Kids ages 4 through 6 can imagine and pretend. But they can’t always tell what’s real and what’s not. To them, the scary monsters they imagine seem real. They fear what might be under their bed or in the closet. Many are afraid of the dark and at bedtime. Some are afraid of scary dreams. Young kids may also be afraid of loud noises, like thunder or fireworks.
• Older kids fear real-life dangers. When kids are 7 or older, monsters under the bed can’t scare them (much) because they know they’re not real. At this age, some kids begin to fear things that could happen in real life. They may have a fear that a “bad guy” is in the house. They may feel afraid about natural disasters they hear about. They may fear getting hurt or that a loved one could die. School age kids may also feel anxious about schoolwork, grades, or fitting in with friends.
• Preteens and teens may have social fears. They might feel anxious about how they look or whether they will fit in. They may feel anxious or afraid before they give a report in class, start a new school, take a big exam, or play in a big game.

Types of anxiety in children

Children experience several types of anxiety. A child might have only one type of anxiety, or she might show features of several of them.

Social anxiety in children

Social anxiety is fear and worry in situations where children have to interact with other people, or be the focus of attention. Children with social anxiety might:

• believe that others will think badly of or laugh at them
• be shy or withdrawn
• have difficulty meeting other children or joining in groups
• have only a few friends
• avoid social situations where they might be the focus of attention or stand out from others – for example, talking on the telephone and asking or answering questions in class.

Separation anxiety in children

Separation anxiety is the fear and worry children experience when they can’t be with their parents or carers. Children with separation anxiety might:

• protest, cry or struggle when being separated from their parents or carers
• worry about getting hurt or having an accident (they might worry about their parents or themselves)
• refuse to go to or stay at day care, preschool or school by themselves
• refuse to sleep at other people’s homes without their parents or carers
• feel sick when separated from their parents or carers.

Generalized anxiety in children

Children with generalized anxiety tend to worry about many areas of life – anything from friends at playgroup to world events. Children with generalized anxiety might:

• worry about things like health, schoolwork, school or sporting achievements, money, safety, world events and so on
• feel the need to get everything perfect
• feel scared of asking or answering questions in class
• find it hard to perform in tests
• be afraid of new or unfamiliar situations
• seek constant reassurance
• feel sick when worried.

When to be concerned about anxiety in children?

Most children have fears or worries of some kind. But if you’re concerned about your child’s fears, worries or anxiety, it’s a good idea to seek professional help.

You might consider seeing your doctor or another health professional if:

• your child’s anxiety is stopping him from doing things he wants to do or interfering with his friendships, schoolwork or family life
• your child’s behavior is very different from children the same age – for example, it’s common for most children to have separation fears when going to preschool for the first time, but far less common over the age of eight years
• your child’s reactions seem unusually severe – for example, your child might show extreme distress or be very hard to settle when you leave him.

Severe anxiety can impact on children’s health and happiness. Some anxious children will grow out of their fears, but others will keep having trouble with anxiety unless they get professional help.

What is specific phobias?

Specific phobias are an overwhelming and unreasonable fear of objects or situations that pose little real danger but provoke anxiety and avoidance. Unlike the brief anxiety you may feel when giving a speech or taking a test, specific phobias are long lasting, cause intense physical and psychological reactions, and can affect your ability to function normally at work, at school or in social settings.

Specific phobias are among the most common anxiety disorders, and not all phobias need treatment. But if a specific phobia affects your daily life, several therapies are available that can help you work through and overcome your fears — often permanently.

If you have a specific phobia, consider getting psychological help, especially if you have children. Although genetics likely plays a role in the development of specific phobias, repeatedly seeing someone else’s phobic reaction can trigger a specific phobia in children.

By dealing with your own fears, you’ll be teaching your child excellent resiliency skills and encouraging him or her to take brave actions just like you did.

Professional treatment can help you overcome your specific phobia or manage it effectively so you don’t become a prisoner to your fears. You can also take some steps on your own:

• Try not to avoid feared situations. Practice staying near feared situations as frequently as you can rather than avoiding them completely. Family, friends and your therapist can help you work on this. Practice the techniques you learn in therapy and work with your therapist to develop a plan if symptoms get worse.
• Reach out. Consider joining a self-help or support group where you can connect with others who understand what you’re going through.
• Take care of yourself. Get enough rest, eat healthy and try to be physically active every day. Avoid caffeine, as it can make anxiety worse. And don’t forget to celebrate successes as things get better.

What causes specific phobia?

Much is still unknown about the actual cause of specific phobias. Causes may include:

• Negative experiences. Many phobias develop as a result of having a negative experience or panic attack related to a specific object or situation.
• Genetics and environment. There may be a link between your own specific phobia and the phobia or anxiety of your parents — this could be due to genetics or learned behavior.
• Brain function. Changes in brain functioning also may play a role in developing specific phobias.

These factors may increase your risk of specific phobias:

• Your age. Specific phobias can first appear in childhood, usually by age 10, but can occur later in life.
• Your relatives. If someone in your family has a specific phobia or anxiety, you’re more likely to develop it, too. This could be an inherited tendency, or children may learn specific phobias by observing a family member’s phobic reaction to an object or a situation.
• Your temperament. Your risk may increase if you’re more sensitive, more inhibited or more negative than the norm.
• A negative experience. Experiencing a frightening traumatic event, such as being trapped in an elevator or attacked by an animal, may trigger the development of a specific phobia.
• Learning about negative experiences. Hearing about negative information or experiences, such as plane crashes, can lead to the development of a specific phobia.

Specific phobia symptoms

A specific phobia involves an intense, persistent fear of a specific object or situation that’s out of proportion to the actual risk. There are many types of phobias, and it’s not unusual to experience a specific phobia about more than one object or situation. Specific phobias can also occur along with other types of anxiety disorders.

Common categories of specific phobias are a fear of:

• Situations, such as airplanes, enclosed spaces or going to school
• Nature, such as thunderstorms or heights
• Animals or insects, such as dogs or spiders
• Blood, injection or injury, such as needles, accidents or medical procedures
• Others, such as choking, vomiting, loud noises or clowns

Each specific phobia is referred to by its own term. Examples of more common terms include acrophobia for the fear of heights and claustrophobia for the fear of confined spaces.

No matter what specific phobia you have, it’s likely to produce these types of reactions:

• An immediate feeling of intense fear, anxiety and panic when exposed to or even thinking about the source of your fear
• Awareness that your fears are unreasonable or exaggerated but feeling powerless to control them
• Worsening anxiety as the situation or object gets closer to you in time or physical proximity
• Doing everything possible to avoid the object or situation or enduring it with intense anxiety or fear
• Difficulty functioning normally because of your fear
• Physical reactions and sensations, including sweating, rapid heartbeat, tight chest or difficulty breathing
• Feeling nauseated, dizzy or fainting around blood or injuries
• In children, possibly tantrums, clinging, crying, or refusing to leave a parent’s side or approach their fear

Specific phobias complications

Although specific phobias may seem silly to others, they can be devastating to the people who have them, causing problems that affect many aspects of life.

• Social isolation. Avoiding places and things you fear can cause academic, professional and relationship problems. Children with these disorders are at risk of academic problems and loneliness, and they may have trouble with social skills if their behaviors significantly differ from their peers.
• Mood disorders. Many people with specific phobias have depression as well as other anxiety disorders.
• Substance abuse. The stress of living with a severe specific phobia may lead to abuse of drugs or alcohol.
• Suicide. Some individuals with specific phobias may be at risk of suicide.

Specific phobias diagnosis

Diagnosis of specific phobias is based on a thorough clinical interview and diagnostic guidelines. Your doctor will ask questions about your symptoms and take a medical, psychiatric and social history. He or she may use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Specific phobias treatment

The best treatment for specific phobias is a form of psychotherapy called exposure therapy. Sometimes your doctor may also recommend other therapies or medication. Understanding the cause of a phobia is actually less important than focusing on how to treat the avoidance behavior that has developed over time.

The goal of treatment is to improve quality of life so that you’re no longer limited by your phobias. As you learn how to better manage and relate to your reactions, thoughts and feelings, you’ll find that your anxiety and fear are reduced and no longer in control of your life. Treatment is usually directed at one specific phobia at a time.

Psychotherapy

Talking with a mental health professional can help you manage your specific phobia. Exposure therapy and cognitive behavioral therapy are the most effective treatments.

• Exposure therapy focuses on changing your response to the object or situation that you fear. Gradual, repeated exposure to the source of your specific phobia and the related thoughts, feelings and sensations may help you learn to manage your anxiety. For example, if you’re afraid of elevators, your therapy may progress from simply thinking about getting into an elevator, to looking at pictures of elevators, to going near an elevator, to stepping into an elevator. Next, you may take a one-floor ride, then ride several floors, and then ride in a crowded elevator.
• Cognitive behavioral therapy (CBT) involves exposure combined with other techniques to learn ways to view and cope with the feared object or situation differently. You learn alternative beliefs about your fears and bodily sensations and the impact they’ve had on your life. CBT emphasizes learning to develop a sense of mastery and confidence with your thoughts and feelings rather than feeling overwhelmed by them.

Medications

Generally psychotherapy using exposure therapy is successful in treating specific phobias. However, sometimes medications can help reduce the anxiety and panic symptoms you experience from thinking about or being exposed to the object or situation you fear.

Medications may be used during initial treatment or for short-term use in specific, infrequently encountered situations, such as flying on an airplane, public speaking or going through an MRI procedure.

• Beta blockers. These drugs block the stimulating effects of adrenaline, such as increased heart rate, elevated blood pressure, pounding heart, and shaking voice and limbs that are caused by anxiety.
• Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety you feel. Sedatives are used with caution because they can be addictive and should be avoided if you have a history of alcohol or drug dependence.

Lifestyle and home remedies

Ask your doctor or other health care professional to suggest lifestyle and other strategies to help you manage the anxiety that accompanies specific phobias. For example:

• Mindfulness strategies may be helpful in learning how to tolerate anxiety and reduce avoidance behaviors.
• Relaxation techniques, such as deep breathing, progressive muscle relaxation or yoga, may help cope with anxiety and stress.
• Physical activity and exercise may be helpful in managing anxiety associated with specific phobias.

Helping your child cope with fears

When your child is afraid, you can help by doing these things to help your child cope with fears:

• Comfort your infant, toddler, or very young child by saying, “It’s OK, you’re safe, I’m here.” Let your child know you’re there to protect them. Give hugs and soothing words to help your child feel safe.
• As your child grows, talk and listen. Be calm and soothing. Help your child put feelings into words. Help kids try new things.
• Talk openly about fears. Let your child know that everyone has scary thoughts and feelings sometimes, but some do more than others. Don’t trivialize the problem or belittle your child for being afraid. Instead, talk to your child about his or her thoughts and feelings and let your child know that you’re there to listen and to help.
• Help your baby get used to a new person while you hold him and let him feel safe. Soon, the new person won’t seem like a stranger anymore.
• Let your toddler be apart from you for short times at first. When you need to part from your child, say you’ll be back, give a hug and a smile, and go. Let your child learn that you always come back.
• For your young child who’s afraid of the dark, have a soothing bedtime routine. Read or sing to your child. Let your child feel safe and loved.
• Help your child slowly face fears. For example, check together for under-bed monsters. With you there to support her, let your child see for herself there’s nothing to fear. Help her feel her courage.
• Limit the scary images, movies, or shows kids see. These can cause fears.
• Don’t reinforce specific phobias. Take advantage of opportunities to help children overcome their fears. If your child is afraid of the neighbor’s friendly dog, for example, don’t go out of your way to avoid the animal. Instead, help your child cope when confronted with the dog and show ways to be brave. For example, you might offer to be your child’s home base, waiting and offering support while your child steps a little closer to the dog and then returns to you for safety. Over time, encourage your child to keep closing the distance.
• Model positive behavior. Because children learn by watching, you can demonstrate how to respond when confronted by something your child fears or that you fear. You can first demonstrate fear and then show how to work through the fear.
• Help kids and teens learn to prepare for challenges, like tests or class reports. Let them know you believe in them.

If your child’s fears seem to be excessive, persistent and interfere with daily life, talk with your child’s doctor for advice on whether professional diagnosis and treatment are indicated.