Anxiety is a widespread problem among children and adolescents. More than 20% of visits to a pediatrician’s office are due to behavior issues. More than 1/3 of adolescents and children as young as 6 years or even younger can experience feelings of anxiety.
Childhood should be a time of happiness and laughter. Unfortunately, we live in a world where even young children experience incapacitating fears that rob them of joy and playfulness. Anxiety disorder is not just being a little bit nervous on the first day of school. It is extreme fear and constant worries even about minor life challenges.
Anxiety can affect a child’s school performance, family life, and, last but not least, can cause physical symptoms. Children with anxiety can have constant aches and pains, tummy aches, headaches, poor sleep, no appetite, and they can refuse to go to school. Anxiety can cause a child to be irritable or withdrawn but also sometimes aggressive and irritable. If you think your child has anxiety, don’t wait for it to go away on its own. Most of the time, it will not resolve without help.
Stress and the “fight or flight” response:
- Many children with anxiety have a heightened response to stress. Things that stress children out can range from being tired, hungry, too hot or too cold, being nervous about a test, or making new friends. Children react to stress the same way adults do – they’re little bodies are going into a “fight or flight” response. “Fight” can look like being defiant, argumentative, or hitting other children. Children in “flight” are usually withdrawn, refusing to participate in any activities or refusing to go to school. Children are usually unable to verbalize “stress,” but they’re acting it out through their behaviors or physical symptoms. One of my little 4 years old patients told his parents who asked him why he hit a child at school that “I don’t know, my body did it.” In some extremely stressful situations, children’s response to stress can be “freeze” (not moving, not talking, refusing to interact), or even “faint.”
Diagnosis and ruling out medical problems:
- The first step in treating anxiety is to establish a proper diagnosis. Many physical problems can present as anxiety. Patients should be evaluated by a physician to rule diseases like thyroid problems or anemia, which can cause anxiety symptoms. Certain commonly used medications, like asthma or ADHD medications, can also cause anxiety.
Conventional treatment for anxiety :
- Treatment usually includes prescription medication, like selective serotonin reuptake inhibitors (SSRI). Although some patients with anxiety need SSRI, at least in the short term, these medications can have side effects, and they should not be used alone without implementing an integrative treatment plan. Some patients may want to rely solely on prescription medications to manage their symptoms, which may work briefly or in the short term, but it does not address the root cause of anxiety, and it is not a long-term solution.
Integrative, Spirit-Body-Brain treatment for childhood anxiety:
- An integrative treatment plan includes several elements that fit nicely together like the pieces of a puzzle. Prescription medications are only one piece of the puzzle. The rest includes lifestyle changes, nutrition, supplements, herbs, stress management, addressing the parent-child relationship and parents’ stress, and other interventions like massage, homeopathy, Ayurveda, and Traditional Chinese Medicine.
#1 Healthy Lifestyle:
- Make sure kids don’t get hungry or thirsty. As a pediatrician, I often write notes for the school to allow children to have snacks or drink more water.
- Keep a routine in their daily schedule. Allow for frequent breaks and do not over-book their calendar.
- Make sure they get enough sleep and establish a healthy sleep routine. Turn off all electronic devices two hours before bedtime.
- No TVs in the bedrooms. Limit screen time to less than 1-2 hrs/day. Screen addiction can sometimes present as anxiety.
- Exercise – children should play outdoors for at least one hour every day!
#2 Nutrition & Supplements:
- Eliminate stimulating drinks like sodas, “power drinks,” coffee.
- Adopt an anti-inflammatory diet, rich in vegetables, fruits, healthy fats, fish, nuts, seeds, high-quality meats.
- No processed food.
- Omega 3 Fatty Acids: extensive studies have shown the benefit of omega 3 fatty acids in several mental health disorders, especially ADHD and depression (1). As anxiety can go along with these conditions, for children and adolescents who have a diet low in omega 3, I would recommend taking a fish oil supplement.
- Probiotics, “psychobiotics,” gut-brain flora (2): more research and exciting new data are coming out in the field of gut/microbiome-brain connection. Stress hormones like cortisol and adrenaline can affect the type and function of intestinal bacteria (“microbiome”). In turn, the microbiome can produce several neurotransmitters like serotonin and GABA, which can affect the gut-brain axis. For children, I recommend starting developing a taste for fermented foods that are rich in natural probiotics and to eat lots of veggies that are rich in prebiotics, which contribute to growing a healthy microbiome. Foods rich in prebiotics are oats, artichoke, onions, garlic, apples, bananas.
#3 Herbs for childhood anxiety:
- Chamomile (3) and lemon balm (4) as teas, tinctures, or capsules.
- Regarding other herbs and supplements like valerian, Rhodiola, passionflower, L-theanine, there are few studies in adults but insufficient data in children to recommend routinely. It’s best to discuss their use with an experienced integrative pediatrician.
#4 Mind-Body Techniques & Stress Management:
- Stress management is important for the entire family, not just the child. Children quickly pick up adults’ stress levels, and this changes their neurochemistry. Some stress management or mind-body techniques are meditation (link to my meditation videos), belly breathing, guided visualizations, journaling, biofeedback, clinical hypnosis, yoga, music therapy. Children as young as 5-6 years of age can learn how to meditate.
- Other interventions that may part of an integrative treatment plan for anxiety are massage, homeopathy, aromatherapy, or ancient medical systems like Ayurveda and Traditional Chinese Medicine.
- Parents should think about supplements, even homeopathic remedies, the same way they would about a prescription medication. Discuss any supplements with an experienced, well-trained integrative medicine practitioner. Nothing that children ingest or are exposed to is always risk-free.
- Think about nutrition, lifestyle, and stress management is equally important. Kids can eat all the healthy food in the world, but if there’s any kind of consistent stressor in children’s’ lives or if they are always sleep-deprived, the anxiety symptoms are not going to improve.
- Do not either underestimate or overestimate the role stress plays in a child’s anxiety. Always rule-out medical causes (i.e., hyperthyroidism, anemia) and possible severe traumas, like abuse or bullying.
- Last but not least, perhaps one of the most important take-home messages: With all the love in the world, parents can inadvertently increase or even cause their children’s anxiety. Unless parents address their anxiety or emotional problems, children are not going to improve and thrive emotionally.
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