Managing Anxiety in Children: What Parents Can Do

Quick answer. Anxiety in children usually looks like stomach aches, refusal, or anger rather than spoken worry. The most useful thing a parent can do is the opposite of what feels natural: stop trying to make the fear go away, and start helping the child do the feared thing in small, planned steps. Endless reassurance and letting them avoid both make anxiety stronger over time. For mild worry, that approach at home is often enough. For anxiety that is interfering with school, sleep, friendships, or family life, the first-line treatment is cognitive behavioral therapy, and a parent-only program called SPACE works as well when a child will not attend. If your child talks about not wanting to be alive, call or text 988 today.

Key takeaways

Children rarely say “I’m anxious.” They say their stomach hurts, they refuse, they get angry, or they cling.
Worry is normal. Anxiety becomes a problem when it is persistent, shows up in more than one setting, and gets in the way of ordinary life.
Avoidance is the engine. Every avoided situation brings relief, and relief teaches the brain that the fear was justified.
Reassurance works for about a minute and then makes the next request for reassurance more likely.
Reducing family accommodation is part of treatment, and there is a parent-only treatment built on it that performed as well as child therapy in a randomized trial.
Small brave steps, planned in advance and agreed with the child, are the home version of what a CBT therapist does.
A child overwhelmed by noise, light, or touch can look anxious. If the environment is the problem, treating it purely as anxiety misses the cause.
Cognitive behavioral therapy is first-line. In the largest trial most children improved with CBT alone, and CBT combined with an SSRI helped the most.
Urgent: any talk of not wanting to be alive, or of hurting themselves. Call or text 988.

What does anxiety look like in a child?

It rarely looks like worry. A five-year-old does not say “I have anticipatory anxiety about the transition to kindergarten.” She says her tummy hurts, and it does hurt, because anxiety is a body state before it is a thought.

The physical version: stomach aches and headaches with no medical cause, nausea in the morning, trouble falling asleep, waking in the night, tiredness, needing the bathroom repeatedly before leaving the house.

The behavioral version: refusing to go somewhere or do something, clinging, asking the same question again and again, needing you in the room to fall asleep, taking a very long time to get ready, freezing or going quiet in new settings.

The version parents most often miss: anger. An anxious child who is pushed toward the feared thing often explodes rather than crumples. A meltdown at the school gate, a slammed door before the party, “I hate you” on the way to the appointment. From the outside it reads as defiance. From the inside it is fear with nowhere to go.¹

Anxiety is also common. National survey data put current diagnosed anxiety at 7.1% of US children aged 3 to 17 — roughly one in fourteen — and the true rate is higher because many are never assessed.² It is not a rare condition or a sign of something unusual in your family.

Is it normal worry or an anxiety problem?

Every child worries, and some fears are developmentally expected: separation distress in toddlers, fear of the dark in preschoolers, worry about performance and friendships in school-aged children, self-consciousness in adolescents. These come and go, and most children pass through them with ordinary support.

Three questions separate typical worry from anxiety that needs attention:¹

How long? Weeks to months, not a rough few days.
How many settings? Home and school and friendships, not just one.
How much does it get in the way? Missing school, avoiding activities the child used to enjoy, sleep disrupted most nights, family plans reorganized around the fear.

If the answer to all three is “a lot,” the strategies below still apply, but read the section on when to get help and act on it. Persistent, cross-setting, interfering anxiety is a treatable condition, and waiting for a child to grow out of it usually means waiting while avoidance gets more entrenched.

Why does avoiding scary things make anxiety worse?

Because avoidance works, briefly. A child who dreads the birthday party stays home and feels immediate relief. The brain files that away: the party was a threat, and escaping it kept me safe. Next time the party feels more dangerous, not less, and the relief of skipping it feels more necessary.¹

This is the core mechanism, and understanding it changes what “helping” means. Helping is not removing the feared thing. Helping is making the feared thing small enough to approach, and then approaching it.

It also means that a lot of loving, instinctive parent behavior — letting them skip, speaking for them, checking for them, staying in the room — feeds the cycle. That is not a parenting failure. It is the trap anxiety sets for every parent, and there is a specific way out of it, below.

What should I say when my child is anxious?

Two things at once: that you take the feeling seriously, and that you believe they can handle it.

Try	Skip
“That sounds scary. What’s the scariest part?”	“There’s nothing to worry about.”
“Your body’s telling you it’s nervous. That’s what nerves feel like.”	“You’re fine, stop it.”
“You don’t have to feel brave to do a brave thing.”	“Just be brave.”
“I know you can get through this, and I’ll be right here after.”	“Okay, you can skip it.”
“Let’s figure out one small step.”	“We’ll deal with it later” (and then never).
“I’m not going to answer that one again. What could you tell yourself instead?”	“Yes, for the tenth time, it’s safe.”

The pattern is: name the feeling, do not argue with it, and hand the child a piece of the problem small enough to hold. “It’s nothing to worry about” tells a child their body is lying to them. “That sounds scary and I think you can do it” tells them the fear is real and survivable, which is both true and the thing they need to learn.³

Keep it short. Long conversations about the fear, at the moment of the fear, tend to become reassurance in disguise.

Does reassuring my child help or make it worse?

In the moment, it helps. Over weeks, it makes things worse.

Reassurance is the most common form of family accommodation. “Are you sure the door is locked?” “Yes.” “Are you sure?” Each answer brings a second of relief and teaches the child that relief comes from you, not from their own capacity to sit with uncertainty. The questions come faster, and your answers work for less time.³

The way out is not to refuse abruptly. It is to name what is happening and shrink it: “I’ve already answered that one. I’m going to stop answering it now, because I know you can handle not knowing for sure. I’m here.” Expect the first few times to be worse. That is the anxiety discovering the old route is closed. It gets better after that.

What is family accommodation, and how do I reduce it at home?

Family accommodation is everything a family does to reduce a child’s distress in the moment: repeated reassurance, letting them skip, speaking for them at the counter, sleeping in their room, checking the closet, rearranging plans, arriving late so they can avoid the hallway crowd. It is close to universal among families of anxious children, and it is done out of love.³

It also maintains the anxiety. In children with OCD, higher family accommodation is linked to worse treatment outcome, and outcomes improve when accommodation falls.⁴ For childhood anxiety disorders more broadly, a treatment built entirely on changing the parents’ accommodation — SPACE, Supportive Parenting for Anxious Childhood Emotions — was compared head-to-head with child CBT in a randomized noninferiority trial. Parents who received SPACE, with no direct child treatment at all, saw outcomes as good as children who received CBT.³

That trial matters for two reasons. It means reducing accommodation is not a side note; it is an active treatment. And it means a parent can do real work even when a child refuses to go to therapy, which is common.

At home, the approach SPACE formalizes looks like this:

Pick one accommodation. Not all of them. The one that costs the family the most, or the one that is easiest to change.
Tell the child in advance. “Starting Monday, I’m not going to lie down with you until you fall asleep. I’ll sit by the door for five minutes, then check on you every ten.” Sudden withdrawal of support increases distress and teaches nothing.
Pair it with support. The SPACE formula is a statement that acknowledges the fear and a statement of confidence: “I know this is hard for you, and I know you can handle it.”
Hold the line calmly. The first nights are harder. That is expected and not a sign it is failing.
Then pick the next one.

If the anxiety is moderate or severe, do this with a therapist rather than alone. The GAD page covers how anxiety in children is diagnosed and treated.

How do I help my child face fears in small steps?

This is the home version of what a CBT therapist does. The clinical name is graded exposure; the parent version is a brave ladder.

Take one fear. Write the goal at the top of a list and something the child can almost certainly do at the bottom. Fill in four rungs between. Each rung should be a little harder than the last, and the child should have a say in the order. Then do the bottom rung, repeat it until it is boring, and move up.

Example: afraid of dogs

Goal — Pet a calm dog on a leash
Stand next to a calm dog on a leash while the owner holds it
Watch a dog from across a park for five minutes
Watch a dog through a window
Watch dog videos for five minutes
Start here ↑ — Look at photos of dogs together

Rules that make it work:

The child helps build it. Exposure by ambush is not exposure; it is a betrayal, and it makes the next attempt harder.
Stay on a rung until the anxiety comes down on its own. Leaving while it is still high teaches escape. Staying teaches that the feeling peaks and passes.
Praise the trying, not the outcome. “You stayed at the window the whole time” beats “See, it wasn’t so bad.”
Small rewards are fine. A sticker chart for a six-year-old is not bribery; it is a wage for hard work.
Expect the anxiety to protest. Tears at rung two are not a reason to stop. Panic that does not come down after twenty minutes is a reason to drop back a rung.

Cognitive behavioral therapy for children is built around this, with a trained clinician choosing the rungs and coaching the parent.⁵ For a fear that is contained and mild, a ladder at home is often enough. For a fear that has been spreading — one avoided thing becoming five — a therapist will get there faster.

Is it anxiety or sensory overload?

A child who melts down in the grocery store, refuses the birthday party, and cannot tolerate the school cafeteria might be anxious. They might also be a child whose nervous system registers ordinary sound, light, and touch as painful, which is called sensory over-responsivity. From the outside the two look the same. They need different responses.

Sensory over-responsivity is not rare and it does not travel alone. In a representative sample of 925 children aged 7 to 11, 16% of parents reported that at least four tactile or auditory sensations bothered their child, and elevated sensory over-responsivity was associated with higher rates of co-occurring internalizing problems — the category anxiety belongs to.⁶

The distinction that matters at home is this: if the child is calm in the same social situation when it is quiet, and distressed when it is loud, the environment is doing the work. Reducing it — ear defenders, a quieter table, leaving before the peak — is the right move, and pushing the child up an exposure ladder toward a loud room will not teach their nervous system anything except that loud rooms hurt.

If the child is distressed by the idea of the situation regardless of how it turns out, and calms once they are in it, that is the anxiety pattern, and the ladder is the right tool.

Many children are both, and the two feed each other: a child who has been overwhelmed by a setting learns to dread it. When you cannot tell, the guide to telling sensory overwhelm from anxiety walks through it, and a pediatric occupational therapist can assess the sensory side directly.

Do routines, sleep, and exercise help with anxiety?

They help a child cope. They do not treat an anxiety disorder, and it is worth keeping those two things separate so that “we’ve tried everything” does not mean “we’ve tried routines and exercise.”

Predictable routines reduce the number of unknowns a child has to manage in a day, which lowers the baseline. Consistent sleep matters because a tired child has less capacity for anything hard, and anxiety and poor sleep run in both directions.¹ Physical activity reliably improves mood in the short term and gives a wound-up body somewhere to go. None of this is controversial and all of it is worth doing.

Two cautions. First, calm-down techniques like deep breathing can quietly become another accommodation if a child learns that the breathing exercise is required before they can do the hard thing. Use them as a tool the child owns, not a ritual the fear demands. Second, an earlier version of this page advised limiting sugar and caffeine to reduce anxiety. There is no good evidence for a sugar–anxiety link, and that advice has been removed.

What if my child refuses to go to school?

Treat it as urgent in the ordinary sense: not a crisis, but a problem that gets harder every day it continues. School avoidance driven by anxiety escalates fast. A Monday off becomes a week, the return becomes the feared thing, and the child’s world shrinks to the house.¹

What helps:

Get the school involved in the first week. A counselor, a reduced first day, a quiet arrival before the crowd, a named adult to go to. Schools have seen this before.
Aim for attendance, not comfort. Half a day at school, distressed, is a rung on the ladder. A full day at home, calm, is a step backward.
Don’t make home nicer than school. A child who stays home to screens and snacks has been handed a reason to stay home.
Look for the specific fear. It is rarely “school.” It is the reading-aloud slot, the bus, the bathroom, a particular child. A specific fear can be laddered; “school” cannot.
Rule out the sensory version. A cafeteria, a gym, a fire drill can be the trigger for an over-responsive child, and the fix is the environment, not exposure.

If a child has missed more than a week or two for anxiety, or refuses outright, that is a reason to see a mental health clinician rather than keep trying alone.

When should my child see a professional, and what treatment works?

See someone when anxiety is persistent, shows up in more than one setting, and interferes with ordinary life. Also see someone when what you are doing at home is not moving things after a few weeks, when the list of avoided things is growing, or when you find yourself organizing the family around the fear. Getting help early is easier than getting help late; the ladder is shorter.

Your pediatrician is the usual first step. The US Preventive Services Task Force recommends screening for anxiety in children and adolescents aged 8 to 18, so raising it is expected rather than unusual.⁷ From there the referral is to a mental health clinician: a psychologist, a licensed counselor, a child psychiatrist.

What treatment looks like. Cognitive behavioral therapy is the first-line treatment for anxiety disorders in children.⁵ It is structured, usually around 12 to 16 sessions, and its center is the same graded approach to feared situations described above, with a clinician choosing the steps and coaching both child and parent. In the largest trial of childhood anxiety treatment, which enrolled 488 children aged 7 to 17 with separation, social, or generalized anxiety, 59.7% were rated very much or much improved with CBT alone, 54.9% with the SSRI sertraline alone, 80.7% with both together, and 23.7% with placebo.⁵ The combination helped the most; CBT alone helped most children.

If your child will not go. SPACE, the parent-only program described earlier, was as effective as child CBT in a randomized trial.³ Ask specifically for a clinician trained in it. You do not need your child’s cooperation to start treating their anxiety.

Medication. SSRIs are used for moderate to severe anxiety, alongside therapy rather than instead of it, and the decision belongs to a prescribing clinician who knows your child.⁵ Never start, stop, or change a dose without medical guidance.

The GAD page has more on how childhood anxiety is diagnosed and treated, and DrSensory’s guides to CBT for anxiety and how DBT helps with emotional dysregulation explain what the therapies involve.

What is urgent, and what can wait?

Get help today

Your child talks about not wanting to be alive, wanting to disappear, or hurting themselves. Call or text 988 (the Suicide and Crisis Lifeline; free, confidential, 24/7, and for you as well as your child). If they are in immediate danger, call 911.
Your child has stopped eating or sleeping for more than a couple of days.
A sudden, marked change in behavior or functioning with no obvious cause.
Panic that does not come down: chest pain, difficulty breathing, or a child who cannot be reached for more than an hour. Rule out a medical cause.

Book a routine appointment

Worry that has lasted more than a month and shows up at home and school.
Physical complaints — stomach aches, headaches — that a doctor has checked and found no cause for.
School refusal, even partial.
A growing list of things your child will not do.
You have been running a ladder at home for several weeks and nothing has shifted.
You realize the family’s week is organized around the anxiety.

Frequently asked questions

What are the signs of anxiety in a child?

Physical complaints with no medical cause (stomach aches, headaches, morning nausea), trouble sleeping, refusing activities, clinging, repeated reassurance-seeking, and, very often, anger or meltdowns when pushed toward the feared thing. Spoken worry is the least common sign in younger children.

Is it normal for a 7-year-old to worry a lot?

Some worry is expected at every age. It becomes a concern when it lasts weeks or more, appears in more than one setting, and interferes with school, sleep, friendships, or family life. Those three markers matter more than the age.

Should I let my child avoid things that scare them?

Occasionally, briefly, yes; every child has hard days. As a pattern, no. Avoidance brings relief that teaches the brain the fear was justified, so the fear grows. The alternative is not forcing; it is breaking the feared thing into steps the child agrees to and can do.

How do I stop reassuring my anxious child without being cold?

Name it and shrink it: “I have answered that one. I am going to stop answering it now, because I know you can handle not being sure. I am right here.” That acknowledges the fear and expresses confidence at the same time. The first few times are harder; then it gets easier.

What is SPACE treatment for anxiety?

Supportive Parenting for Anxious Childhood Emotions is a treatment delivered only to parents. It teaches them to reduce accommodation and respond supportively. In a randomized trial it was as effective as CBT delivered to the child. It is an option when a child refuses therapy.

Does CBT work for children with anxiety?

Yes; it is the first-line treatment. In the largest trial, 59.7% of children were rated very much or much improved with CBT alone, compared with 23.7% on placebo. Adding the SSRI sertraline raised the response to 80.7%.

How do I know if it is anxiety or sensory overload?

Ask whether the setting or the idea is doing the work. A child calm in a quiet version of the situation and distressed in a loud one is reacting to the environment. A child distressed by the prospect and calm once inside is showing the anxiety pattern. Many children are both, and an occupational therapist can assess the sensory side.

My child refuses to go to school because of anxiety. What do I do?

Involve the school in the first week, aim for partial attendance rather than none, keep home from becoming more appealing than school, find the specific fear so it can be laddered, and see a mental health clinician if it goes past a week or two.

Can anxiety cause stomach aches in children?

Yes, and it is one of the most common ways anxiety shows up. A doctor should still check for medical causes; when none is found, anxiety is a frequent explanation.

Does deep breathing help kids with anxiety?

It can help a child settle in the moment. It does not treat anxiety, and if a child learns they cannot do the hard thing until they have done the breathing, it has become an accommodation. Use it as a tool the child owns, not a required ritual.

Do I need a diagnosis before getting help?

No. A pediatrician can assess and refer without a formal diagnosis, and a therapist will assess as part of starting treatment.

When is childhood anxiety an emergency?

Any talk of not wanting to be alive or of self-harm: call or text 988 immediately, or 911 if there is immediate danger. Also urgent: not eating or sleeping for days, or a sudden marked change in functioning.

Anxiety in children: signs, treatment, and what helps — the condition, diagnosis, and treatment
Is it sensory or is it anxiety? — telling the two apart
CBT for anxiety: what parents and adults should know
How DBT helps manage emotional dysregulation
Social anxiety in children

Sources

Walter HJ, Bukstein OG, Abright AR, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2020;59(10):1107–1124. doi:10.1016/j.jaac.2020.05.005 (PMID 32439401)
Ghandour RM, Sherman LJ, Vladutiu CJ, et al. Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. Journal of Pediatrics. 2019;206:256–267.e3. doi:10.1016/j.jpeds.2018.09.021 (PMID 30322701). Among children aged 3–17, 7.1% had current anxiety problems.
Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK. Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child & Adolescent Psychiatry. 2020;59(3):362–372. doi:10.1016/j.jaac.2019.02.014 (PMID 30851397)
Merlo LJ, Lehmkuhl HD, Geffken GR, Storch EA. Decreased family accommodation associated with improved therapy outcome in pediatric obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology. 2009;77(2):355–360. doi:10.1037/a0012652 (PMID 19309195). A pediatric OCD study, cited here only for the OCD-specific claim.
Walkup JT, Albano AM, Piacentini J, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine. 2008;359(26):2753–2766. doi:10.1056/NEJMoa0804633 (PMID 18974308). 488 children aged 7–17; rated very much or much improved: combination 80.7%, CBT 59.7%, sertraline 54.9%, placebo 23.7%.
Ben-Sasson A, Carter AS, Briggs-Gowan MJ. Sensory over-responsivity in elementary school: prevalence and social-emotional correlates. Journal of Abnormal Child Psychology. 2009;37(5):705–716. doi:10.1007/s10802-008-9295-8 (PMID 19153827). A representative sample of 925 children aged 7–11; elevated sensory over-responsivity was associated with higher co-occurring internalizing problems.
US Preventive Services Task Force. Screening for Anxiety in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(14):1438–1444. doi:10.1001/jama.2022.16936 (PMID 36219403). Screening recommended for ages 8 to 18 (B recommendation).

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. If you are worried about your child’s safety, call or text 988. Never start, stop, or change a dose without medical guidance.