Dr. Martin began her naturopathic practice at Fusion Chiropractic & Integrative Health in Toronto, where she works alongside other integrative healthcare providers.She has pursued additional training in clinical nutrition, women’s health and perinatal care, pediatric care, and mindfulness based clinical skills.Dr. Martin devotes her practice to helping women and their families to improve their health and wellbeing.
Dr. Martin is licensed to practice Naturopathic Medicine in Ontario, where she is a member of the College of Naturopaths of Ontario.She is also a member of the Ontario Association of Naturopathic Doctors, the Canadian Association of Naturopathic Doctors, the Pediatric Association of Naturopathic Doctors, and the Association of Perinatal Naturopathic Doctors.
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Everyone experiences anxiety at some point in their life. It can act as a motivator to help achieve goals, increase awareness of stressful situations, and even help to protect us from potential danger. But when children feel anxious, is it normal? Anxiety can be a normal part of your child’s development as they move through the different ages and stages of their life. Some fears are natural, and can help your child protect themselves. For example, if your child were playing in a field, and saw a bear approaching, anxiety in that circumstance would be protective, as it would likely prompt your child to avoid the bear and leave the area.
There are commons anxieties that children may experience throughout different ages. Infants and toddlers may become anxious or apprehensive when they meet new people, younger children may be afraid of the dark, and as their imagination grows, they may develop fears of imaginary things such as monsters in their closet. Many children develop anxiety when they are exposed to new things that bring a sense of uncertainty. For some, this might happen the first time they take a school bus, or during their first day at school, for others it may happen during their first trip to the dentist, their first time getting in a pool or lake, or perhaps even the first time that they see a barking dog. Starting a new activity or being in a new situation or environment can trigger some anxiety in most kids, but more often than not, they quickly overcome it as soon as they adjust to the new situation. For kids with anxiety, however, symptoms can be more uncomfortable and may start to impact their behavior and willingness to try new things.
There are many factors that impact anxiety, some of them include: genetics, parenting styles, whether or not your child has experienced a negative or traumatic life event, the environment at home or school, and your child’s specific learning experiences. Children born to parents who have anxiety disorders or mental health concerns have a higher risk of developing anxiety issues themselves. They may also learn how to respond in an anxious way if their parents or caregiver shows anxiety. On top of this, children can also develop anxiety in response to high stress, or situations that they interpret as being stressful; this can be common among older kids who are faced with complex school schedules, tests and lots of extracurricular activities.
First, let’s talk about what happens to the body
There are a few things that can happen to the body when anxiety occurs. The two main situations that can cause anxiety are anticipating a stressful situation or actually being in a stressful situation. The body reacts in very distinct ways to anxiety by eliciting the fight, flight or freeze response. The fight, flight or freeze response is the body’s automatic way of coping with stressors to protect against danger or threats. For example, if you were walking and saw a bear approaching, you might stop and freeze, being quiet until it passes by, or if it were to threaten you, you may run or fight back. Even though there may not be any danger, the body can trigger this system with anxiety, or by anticipating a potentially stressful situation. Imagine if you were walking in an unknown forest, and you know that there is a chance that you could see a bear; this might be enough to trigger the fight, flight or freeze response, whether you encounter a bear or not.
The fight, flight or freeze response affects the body in a few ways, by:
- Increasing the breathing rate, which can lead to a sensation of lightheadedness for some kids;
- Increased the heart rate, to send more blood to the muscles to prepare them for fight or flight, which can result in the sensation of heart palpitations;
- Increasing muscle tension, as the muscles get ready to freeze or spring into action;
- Decreasing digestive function, which may result in an upset stomach or nausea;
- Increasing body temperature, which can lead to sweaty palms, underarms or forehead, and;
- Dilating the pupils to let in more light and improve vision.
It’s important to remember that how a child responds to a potential or actual stressor will depend on their individual interpretation of the situation. For one kid, seeing a butterfly might be a magical thing, but for another, whose first exposure to flying bugs might have involved a bee sting, a butterfly might be interpreted as a very scary thing that will hurt them.
It can be difficult for kids to recognize when they feel anxious – to parents it might look like they’re acting out behaviorally. So how do you know when anxiety has apprehended your little one?
Here are some of the most common signs and symptoms of anxiety to look out for:
- Avoiding new places or social situations
- Clinging to parents in certain situations
- Compulsive behavior
- Excessive shyness
- Excessive worry or unrealistic fears
- Excessive worry about their body and body functions
- Feeling very hot or cold
- Muscle tension
- Rapid heart rate or a sensation of heart palpitations
- Rapid breathing or holding their breath * this should be assessed by a healthcare professional promptly to rule out other potential causes such as asthma
- Redoing tasks and insisting on getting things just right
- Shaking or trembling
- Stomach aches
- Throwing tantrums
- Trouble falling asleep or staying asleep
- Worrying excessively about their performance
When can anxiety be a problem?
There’s no doubt that most of you may have seen some of these signs in your child at some point in their life. What toddler doesn’t eventually throw a tantrum or have trouble falling asleep at some time? Normal childhood anxieties should pass as a child moves into their next stage of development. If your child becomes stuck with a certain situation or fear, it may be time to consult their primary care doctor (naturopathic doctor or family physician). The Centre for Disease Control has reported that 3% of children in the US live with a diagnosed anxiety disorder. Without early identification and treatment, some forms of anxiety disorders could end up causing a lifetime of suffering.
One key thing to consider is whether or not your child is more anxious or worried than other kids their age. If so, chances are it’s time to look into things further.
Red Flags to Watch Out For
If your child is displaying any of the following signs and symptoms, it’s important to have them assessed promptly.
- Avoiding people, and won’t talk to others even if they’ve known them a while
- Becoming hysterical, hyperventilating or passing out from fear or worry
- Change in general mood, or becoming more irritable
- Coming to extreme conclusions that the worst will happen
- Constantly seeking reassurance
- Crying before going to school
- Difficulty controlling their worry
- Displaying signs of obvious emotional distress
- Excessive anxiety or worrying occurring most days about number of things
- Frequent crying, screaming or lashing out
- Frequent headaches or stomach aches
- Frequent tantrums
- Rapid breathing or holding their breath
- Inconsolable worrying most of the time
- Poor performance at school
- Refusing to go to school
- Refusing to socialize or join in on social or fun activities due to fear
- Refusing to leave a parent’s side in any situation
- Refusing to try new activities
- Refusing to go to bed without a parent beside them, or refusing to sleep in their own bedroom
- Sudden or frequent panic attacks
- Trouble falling asleep or staying asleep due to excessive worry
- Verbalizing that they are worthless, incapable or unlovable
Have your child assessed
Please note that the information in this article is not intended to diagnose or treat your child. If your child is displaying any signs or symptoms of anxiety, it’s always best to have them assessed by their primary care doctor to determine the best course of treatment. If your child has experienced any trauma, physical abuse or sexual abuse, consult their primary care doctor right away – therapy should be initiated without delay to increase their coping skills and to minimize the worsening of symptoms. A referral to a child psychologist or child psychiatrist will likely be an important aspect of their care.
Addressing anxiety with naturopathic approaches
While anxiety isn’t necessarily something that can be outgrown, there are several ways that it can be managed naturally. Since you can’t eliminate every stressful situation that your child will encounter, it’s ideal to teach them how to manage their anxiety and to function in stressful situations in a healthier way. The following eight approaches can be considered for managing anxiety.
1. Start by talking to your child about their anxiety when they’re not feeling anxious
Young children may not be able to recognize when they are feeling anxious, and that alone can be very scary for them as they are experiencing it. Explain in simple terms what anxiety is, and how it can protect them in certain situations. In the simplest terms, it’s helpful to use the example of an angry bear. Some children respond well when the anxiety is given a funny name that they can relate to, such as the Worrywart, or the Fearful Fox. Sometimes making light of the situation and providing your child with a way to name what they’re experiencing can help them to identify and relate to it when it’s happening to them.
2. Address the anxiety and avoid reinforcing it
While this may seem like a no-brainer, there are many ways that parents unknowingly reinforce anxious situations to their children. For example, if you know that your child is scared of going to the dentist, try to control any stress or anxiety that you might be anticipating about the next appointment. If your child notices you acting stressed, it may end up reinforcing to them that they should be anxious about it. Your child will look to you for cues on how to manage the situation. Whenever possible, shorten the time span that your child may experience anxiety. If your child worries about going to the dentist, don’t tell them about the appointment the day before, this gives them that much more time to worry about it. Be mindful of where you discuss your child’s anxiety; children are very perceptive and if they hear you talking to your partner or a friend on the phone about their anxiety, this might reinforce the behavior, or make them feel more anxious about it.
3. Help them breathe when they’re feeling anxious
While your child is feeling anxious, their brain and body is being flooded with stress hormones – this can temporarily stand in the way of their ability to think clearly and rationally, and can hinder their ability to understand you when you try to help them. Mindful breathing techniques are a great way to empower your child to manage their anxiety; the best part is, they can be done anywhere. Mindfulness involves focusing on the present moment, most often by noticing the breath; it can be very helpful for recognizing what is going on in our minds and bodies. Teaching your child mindful breathing techniques can them to learn to calm their breathing, reduce the levels of stress hormones circulating in their body, and help them to return to a calmer state. Studies have found mindfulness techniques to be helpful in assisting children to focus their attention and become less reactive.
With practice, your child can learn to incorporate mindful breathing techniques into their daily life to use when needed. It’s best to start practicing breathing techniques for one to three minutes while they feel calm, and when are comfortable with the techniques and can perform them with minor prompting, you can remind and guide them to use it when they feel anxious. Many anxious children find mindful breathing techniques to be very helpful, as it can give them a sense of control over their body and their feelings. The best part is – they can be used anytime, anywhere. The following two approaches are easy to teach to kids (and parents!).
Breathe with the Belly Balloon
- Start by asking your child to sit or lie down in a comfortable position, and to close their eyes if they’re comfortable doing so (if not, their eyes can remain open). Ask them to listen to your voice and to try what you say to do. It’s important to remind them that it’s okay if they’re not able to do it the first time, and that you will work on it together.
- Ask them to rest their hands on their belly, on either side of their bellybutton.
- Ask them to start by feeling how their belly expands like a balloon when they breathe air in, and how the belly balloon gets smaller as they breathe air out. Ask them to just notice this for a few breaths, to let them get familiar with their own breathing. Depending on their age, if they’re very young, continue to guide them with your voice. As they continue to breathe, ask them to slowly make their belly balloon bigger by taking deeper breaths in.
- If they’re able to, you can ask them to silently and slowly count to three as they inhale to make their belly balloon bigger, pausing for a brief moment to notice the size of the belly balloon before counting to three as they exhale and shrink the belly balloon. If they are very young, you may need to help them to slowly count in time with their own breath. The extra step of counting can be helpful in distracting their mind from the anxiety-provoking situation. It’s hard for the mind to think of other things while it’s busy counting, breathing and noticing the belly balloon!
- It’s ideal to encourage belly balloon breathing at least once daily for 1-3 minutes at a time. Right before bed is ideal to encourage restful sleep. The next time that your child is anxious, prompt them to use their belly balloon by asking them: “I’m noticing that you’re starting to look anxious, why don’t we try the belly balloon for a minute?”
Breathe with Hand Tracing
- Ask your child to stretch out their hand. With the index finger of the opposite hand, beginning at the outside base of their thumb, slowly trace up the thumb. As they slowly trace up their thumb to the tip, instruct them to slowly take a breath in through their nose, pausing for a brief second when they reach the top of the thumb, then instruct them to slowly exhale as they continue to trace down the other side of the thumb.
- Repeat the tracing and breathing for each remaining finger until they have traced their whole hand.
- Ask your child how they feel once they have done tracing one hand.
- Repeat with the other hand if desired.
- Encourage your child to use hand tracing once a day, or whenever they display anxiety.
4. Validate Their Feelings.
Rather than trying to downplay their fears by telling them there’s nothing to be afraid of, it’s important to validate their feelings to help them recognize what they’re experiencing. If they’re afraid, respect that, help them to verbalize it, and let them know that you’re there for them and that you will help them through their anxiety. Ask your child open-ended questions (“how do you feel when you see the dog?”) about how they’re feeling about the situation to encourage them to notice and express their feelings in a constructive way.
5. Address Avoidant Behavior
Address any avoidant behavior and talk about it. Avoidant behavior has been viewed to be responsible for minimizing a child’s direct and prolonged exposure to a stressor or situation, and as a result, may interfere with your child’s ability to learn that a situation was actually harmless in the first place. If your child were to run away every time they saw a dog, how would they ever gain the opportunity to learn how fun loving and cuddly some dogs can be? On the other hand, it’s also important not to force your children into situations where they feel anxious – this might only increase their anxiety. A gradual approach can be helpful. Take baby steps. Start by providing your child options to gently expose them to anxiety provoking situations in a more comfortable manner. A first step could include reading a book about dogs or looking at pictures, and a next step could be going to a dog park and watching dogs from a distance, or through the window of a parked car. The next step might be to get close to dogs, but to just watch them silently. Point out curiosities of the dog – a wagging tail, perhaps – for your child to observe. A next step could be watching mommy or daddy pet the dog. Work with your child at whatever stage they’re at, but lead through example. If your child is displaying a phobia – a persistent and specific fear of an object or situation that is accompanied by avoidant behavior – it will be important to consult their doctor.
6. Explore What Could Happen
It’s important to share realistic expectations and to talk with your child about what could happen. Let your child know that their anxiety might not resolve, but they will gradually learn to manage it so it becomes more comfortable to live with over time. Most kids are more afraid about what could happen, especially in new situations, so providing them with age-appropriate information about anxious situations can often be helpful. For example, in a child who is anxious around dogs, providing them with some of the following information may be helpful for them: “Being around dogs can be interesting, let’s talk about what could happen when we’re around them. What if the dog barks and makes noise? That’s how they talk, we will just watch him if he’s noisy. If they’re wagging their tail? That means they’re happy. What if the dog starts jumping? That can mean that they want to play, they will sometimes jump when they’re excited. If it starts to jump, we’ll back away until it’s calmer. What if it starts to sniff you? Dogs like to smell people to learn more about them. If you want, we can hold out your hand so it can smell you. What if the dog growls? Dogs growl when they are scared or angry, and it means that they need more space. If the dog growls, we will back away and leave it alone so no-one gets hurt. When we visit the dog, I’ll stay beside you to help out if you need me, and if you get scared, we can go to a calm space together.”
For older children, it can be helpful to assist them to reframe their worries. For example: if they’re worried that they will fail their first test, even though they have been studying regularly, it can be helpful to assist them in reframing their worry by exploring all of the possible outcomes. What if they pass the test? What if they don’t finish the test? What if they don’t know some of the answers? What if they fail the test? How bad would that be? Would they have to undergo a make-up test? How much is the test worth in their overall class mark? Knowing that you’ll be okay if they don’t end up with a perfect result and that you’ll be proud of them for trying their best is often enough to reassure kids, and that that can go a long way in alleviating anxiety. Planning for the worst-case scenario can often be helpful for your child to understand that the world won’t end if something bad does happen.
7. Plan Ahead
Planning ahead to alleviate any anxiety can be helpful in certain situations. Help your child prepare for new experiences. Is this your child’s first trip to see a dentist or optometrist? In some cases, it can be helpful to bring them in the day before to see the office and meet their new doctor. This might help to reduce any anxiety as they get to see and adjust to the environment. Many healthcare professionals offer meet and greet appointments for children to help increase their comfort level.
8. Consider Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a therapeutic technique used by many healthcare providers, including many naturopathic doctors to help children who are experiencing anxiety. It helps to challenge negative thoughts in order to alter behavioral patterns and to treat certain types of anxiety. It essentially aims to correct unhelpful thinking and behavior to alleviate the discomfort that a child experiences. It starts by exploring the interactions between thoughts, feelings and behavior, and aims to correct any unhelpful thinking and behavior to address specific problems like anxiety. CBT has been shown to be very effective for addressing anxiety in children. Different protocols are used, depending on the form of anxiety being addressed. CBT can help to teach children new behavioral approaches and strategies to address any maladaptive or unrealistic anxious thoughts. CBT treatment generally involves twelve weeks or more of weekly treatment, and parents are involved in helping children to apply new skills at home and school. There is approximately a 70-80% positive response rate in children who use CBT to address anxiety, with results that can last a lifetime. Modified forms of CBT have been shown to be helpful in children as young as 3 years of age. Consider speaking with your naturopathic doctor about whether or not CBT could be helpful for your child.
There are many other types of approaches that naturopathic doctors use to address anxiety, including dietary approaches and the use of specific nutrients and herbal treatments. One of the most important dietary approaches that you can consider for addressing behavior in your child is to balance their blood sugar. Check out this great article by Dr. Maggie Luther on how to improve your child’s behavior with blood sugar control. Speak with your naturopathic doctor about which treatment options might be appropriate for your child.