Understanding Anxiety in Children: Signs, Types, and When to Seek Help

Anxiety is the most common mental health difficulty experienced by children and adolescents in Australia, and it is also one of the most frequently misunderstood. Adults sometimes mistake anxious behaviour for defiance, attention-seeking, or overreaction, while children themselves may not have the language to describe what they are experiencing.

Understanding what anxiety looks like in children, how it differs from typical worry, and when professional support may be helpful can make a meaningful difference to outcomes. With appropriate support, most children with anxiety make significant progress.

This article provides evidence-informed general information about childhood anxiety, drawn from developmental psychology and clinical practice. It is not a substitute for professional assessment or individualised advice.

What is anxiety?

Anxiety is a normal human experience that serves an important protective function, alerting us to potential threats and preparing the body to respond. In children, some degree of anxiety is a normal and healthy part of development.

Anxiety becomes a clinical concern when it is frequent, intense, difficult for the child to manage, and begins to interfere with daily life. When anxiety leads a child to avoid situations, activities, or relationships that are important for their development and well-being, professional support is worth considering.

How anxiety shows up in children

One of the challenges of recognising anxiety in children is that it does not always look like worry. Children often express anxiety through behaviour rather than words, which means the signs can be easy to misread.

Physical signs

Stomach aches, headaches, nausea, a racing heart, and trouble sleeping are common physical manifestations of anxiety in children. These symptoms are genuine rather than fabricated, and when physical complaints consistently occur in relation to specific situations such as school mornings or social events, anxiety may well be a contributing factor.

Behavioural signs

Avoidance is one of the clearest signs of anxiety in children. A child may resist attending school, decline social events, avoid trying new activities, or seek constant reassurance from parents and carers. Separation difficulties, clinginess, and difficulty sleeping alone are also common presentations. In some children, anxiety presents as irritability, emotional outbursts, or difficulty tolerating uncertainty, which can be mistaken for defiance or emotional dysregulation rather than recognised as anxiety.

Cognitive signs

Anxious children often engage in significant worry, frequently asking what-if questions, seeking reassurance repeatedly, or catastrophising about future events. They may appear to overthink decisions or become stuck on worst-case scenarios that feel very real and immediate to them.

Common types of anxiety in children

Generalised anxiety

Children with generalised anxiety worry about a wide range of topics, including school, health, family, friendships, and the future. The worry is persistent and difficult to control, and children often describe feeling unable to relax or switch off from the cycle of concern.

Separation anxiety

Separation anxiety involves significant distress when separating from caregivers. While normal in younger children, when it persists or intensifies beyond the early years, or when it prevents normal activities like school attendance or sleepovers, it may benefit from professional support.

Social anxiety

Children with social anxiety experience significant fear of social situations, particularly those involving evaluation or scrutiny by others. This can include speaking in class, joining group activities, making phone calls, or meeting new people, and it can significantly affect a child’s peer relationships and school experience.

Specific phobias

Specific phobias involve intense fear of a particular object or situation, such as dogs, injections, vomiting, or thunderstorms. These fears can significantly limit daily life when they become severe or pervasive enough to affect a child’s participation in ordinary activities.

Panic

Panic attacks involve sudden and intense episodes of fear, accompanied by physical symptoms such as heart racing, shortness of breath, dizziness, or a feeling of losing control. While more common in adolescents than younger children, panic attacks can be frightening for both the young person and their family.

What helps anxious children?

The most well-researched psychological approach for childhood anxiety is cognitive behavioural therapy (CBT). CBT helps children understand the relationship between thoughts, feelings, and behaviour, and teaches practical strategies for managing anxiety, including gradual, supported exposure to feared situations over time.

Parent involvement is an important part of effective anxiety treatment. How parents respond to a child’s anxiety can either help the child build tolerance and coping capacity or

inadvertently reinforce avoidance. Psychological support for parents, alongside therapy for the child, often produces the best outcomes.

What parents can do at home

While professional support is important for significant or persistent anxiety, there are steps parents can take to support anxious children at home:

• Validate feelings without reinforcing avoidance: acknowledge that anxiety feels real without accommodating avoidance of important situations

• Provide consistent reassurance without excessive accommodation that removes all challenge

• Help children develop a vocabulary for their feelings so they can begin to identify and name them

• Encourage gradual approach rather than complete avoidance of feared situations

• Maintain predictable routines, which provide a sense of safety and reduce uncertainty

• Model calm coping yourself, as children learn how to handle difficult emotions by watching the adults around them

When to seek professional support

It is worth consulting a qualified child psychologist if your child’s anxiety interferes with school attendance (link to school refusal blog) or academic performance, affects their friendships or social participation, causes significant distress for the child or the family, is not improving over time with reassurance and support, or is accompanied by low mood, significant changes in behaviour, or sleep difficulties. Early support for anxiety is associated with better outcomes, as anxiety that is not addressed tends to consolidate and expand over time.

Support for your family

The team at Sydney Children’s Practice provides evidence-informed psychological assessment and therapy for children and adolescents experiencing anxiety. Our psychologists work collaboratively with children and their families to develop tailored approaches that build confidence and coping. Families are welcome to get in touch to discuss concerns or explore whether support may be helpful.

The information in this article is general in nature and is not a substitute for individualised assessment or professional advice. If you have concerns about your child, we encourage you to seek guidance from a qualified health professional.

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Bradley Bowen, MPsych (Clinical Psychology), BA (Hons I), BSc, AMusA, MAPS is a Board-registered Clinical Psychologist and Clinic Director of Sydney Children’s Practice. He has worked with children, adolescents, and families for over 25 years and has been practising as a Clinical Psychologist since 2011. Bradley has a particular interest in supporting neurodivergent children, including those with ADHD and Autism, and works using evidence-based approaches such as CBT, ACT, and Mindfulness.