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Overview of Anxiety Disorders in Children

by Josephine Elia, MD

Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances.

  • There are many types of anxiety disorders, distinguished by the main focus of the fear or worry.

  • Most commonly, children refuse to go to school, often using physical symptoms, such as a stomachache, as the reason.

  • Doctors usually base the diagnosis on symptoms but sometimes do tests to rule out disorders that could cause the physical symptoms often caused by anxiety.

  • Behavioral therapy is often sufficient, but if anxiety is severe, drugs may be needed.

All children feel some anxiety sometimes. For example, 3- and 4-year-olds are often afraid of the dark or monsters. Older children and adolescents often become anxious when giving a book report in front of their classmates. Such fears and anxieties are not signs of a disorder. However, if children become so anxious that they cannot function or become greatly distressed, they may have an anxiety disorder. At some point during childhood, about 10 to 15% of children experience an anxiety disorder.

People can inherit a tendency to be anxious. Anxious parents tend to have anxious children.

Anxiety disorders include


Many children with an anxiety disorder refuse to go to school. They may have separation anxiety, social anxiety, or panic disorder or a combination.

Some children talk specifically about their anxiety. For example, they may say “I am worried that I will never see you again” (separation anxiety) or “I am worried the kids will laugh at me” (social anxiety disorder). However, most children complain of physical symptoms, such as a stomachache. These children are often telling the truth because anxiety often causes an upset stomach, nausea, and headaches in children.

Many children who have an anxiety disorder struggle with anxiety into adulthood. However, with early treatment, many children learn how to control their anxiety.


  • Symptoms

Doctors usually diagnose the disorder when the child or parents describe typical symptoms. However, doctors may be misled by the physical symptoms that anxiety can cause and do tests for physical disorders before an anxiety disorder is considered.


  • Behavioral therapy

  • Sometimes drugs

If anxiety is mild, behavioral therapy alone is usually all that is needed. Therapists expose children to the situation that triggers anxiety and help the children remain in the situation. Thus, children gradually become desensitized and feel less anxiety. When appropriate, treating anxiety in parents at the same time often helps.

If anxiety is severe, drugs may be used. A type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine or sertraline, is usually the first choice (see Table: Drug therapy).

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