The concerning part of stigma surrounding mental health topics is that nearly one in five U.S. adults lives with a mental illness (52.9 million in 2020), and—even more alarmingly—one in six U.S. children suffers from mental illness.

A common and well-known mental health condition is anxiety. In the U.S., 9.4% of children aged 3-17 years (approximately 5.8 million) were diagnosed with anxiety in 2016-2019. Untreated anxiety leaves children at increased risk of substance abuse, making early identification incredibly important.

You may wonder if your child has anxiety and whether or not you should approach a psychiatrist. What do we look for in our kids when anxiety is suspected?

Identifying Anxiety

1. Difficulty sleeping: Often, kids with anxiety will have a lot of anxious thoughts that keep them awake. Naturally, children with long-lasting sleep disturbances will experience a decline in their academic performance, and become increasingly irritable.

2. Angry Outbursts: Anxiety presents in a variety of ways partly because the behavioral manifestations are based on responses to a person’s environment. Some children experiencing anxiety may shrink away from situations while others will demonstrate unmanageable outbursts.

3. Lack of focus: When children worry a lot, it can make it hard to concentrate in school. This can often cause similar symptoms to ADHD-inattentive type. Children with anxiety are often caught up in their own thoughts, which may be interpreted as not paying attention or “spacing out.” Parents often do bring children to outpatient settings concerned about their child’s sudden decline in academic performance. Even in the strongest students, anxiety combined with poor coping strategies can result in poor grades.

4. Avoidance: It’s normal to avoid situations that make us uncomfortable, and children are no different. In children, avoidance of stressful environments, such as school or camp, may manifest as the child complaining of illness. Avoidance brings temporary relief and provides a short-term benefit in removing anxiety-inducing stimuli.

5. Tummy problems: The occasional stomach ache or headache in adults and children is usually no cause for alarm; however, persistent symptoms without medical cause can be a clear indication of anxiety. For example, a child may complain of tummy aches before a test, before performances or parties. It’s important that we understand that children with anxiety are not fabricating these symptoms.

Anxiety is like an iceberg. What we see in a child’s behavior on the surface is just a small fraction of the underlying anxious thoughts. There are many emotions and past experiences that children may be struggling with, which is why it’s important to seek out professional help for children experiencing anxiety or any of the above symptoms. Addressing the source of anxiety and identifying events that elicit it will be the most beneficial. Though this can be hard to understand as a parent, it’s always important to take the time to talk to children to understand the reasoning behind their behavior. Asking questions is one of the most effective ways to show children a parent cares.

Treatment: There are many options out there to help control anxiety in children. The first step is to work collaboratively with your child’s doctor to rule out any medical conditions that could be causing their symptoms. Once a medical condition is ruled out and anxiety is suspected, it’s important to explain to the child that what they are experiencing is simply their body’s response to a situation that their brain is misperceiving as a threat or dangerous situation.

In children with severe anxiety causing disturbance in their day-to-day functioning, the treatment of choice is generally therapy along with medications.

Therapy: Though medications do help with controlling anxiety, many experts will first choose behavioral therapy treatment. The first line behavioral treatment for anxiety is known as cognitive behavioral therapy (CBT). CBT helps children stop avoiding their fears through two components:

1. Cognitive part: Helps a child identify beliefs around events and circumstances.

2. Behavioral part: Teaches the child to adjust their reactions and behaviors when they experience anxiety.

Medication: Starting children on medication is a source of concern for many patients. It’s important to understand that therapy is always the first line of treatment and medication is only used when deemed necessary, such as in cases of severely debilitating anxiety that has been resistant to therapy.

Dr. Sruthi Madhava is a first-year psychiatry resident at St. Mary’s Hospital in Passaic. She finished her medical school at M.S. Ramaiah Medical College in India. She enjoys traveling, cooking and going on long walks with family and friends.

Dr. Suzanne Lind is a board-certified child and adolescent psychiatrist practicing at St. Mary’s Mental Health Center as well as St. Mary’s Hospital in Passaic. She attended RWJ School of Medicine, where she completed her intern year. She subsequently completed residency training at Thomas Jefferson and Fellowship in child and adolescent psychiatry at NYU. She lives with her husband and two children in New Jersey. She enjoys traveling, spending time with her family and pets, as well as gardening.

Sheindel Ifrah Goldfeiz is a third-year medical student at TouroCOM-Harlem and COO-CFO of the Jewish Orthodox Women’s Medical Association (JOWMA). She completed a BA in special education and subsequently earned her post-baccalaureate in basic health sciences at Temple University. Sheindel resides in Passaic with her husband and two kids and enjoys spending time with her family and exercising.

St. Mary’s General Hospital offers multiple behavioral health services:

Outpatient Clinic: We accept most private and public insurance. Our staff includes a psychiatrist, APN, social workers, and more.

Day hospital programs for ages 11-plus. Day hospital programs occur Monday-Friday for weeks to months, can provide transportation, run all year long, and offer individual, group and family therapy, as well as medication management and school interventions.

Mental Health Center of Passaic for patients >10 years of age.

Emergency Services: Children may be taken to the St. Mary’s emergency room for mental health crisis evaluation.

PerformCare in the state of New Jersey provides in-home resources, mobile outreach and case management.

JOWMA is a 501(c)(3) nonprofit organization dedicated to providing accurate and accessible community health education resources to the Orthodox Jewish community.