Anxiety in children: how it shows up, and what helps

How it actually shows up

Physical complaints are the commonest presentation: recurring stomach aches, headaches, nausea, needing the toilet often — typically on school mornings and before tests, and typically absent at weekends. The pain is real; the cause is anxiety.

Behaviour is the second disguise: irritability, anger, refusing to go somewhere, clinging, tantrums in an older child, or freezing and going silent. Anxious children are often labelled naughty or stubborn.

Other signs: trouble falling asleep, nightmares, constant reassurance-seeking, perfectionism and distress at mistakes, avoiding new situations, nail-biting, hair-pulling, appetite changes, and regression to younger behaviours.

Common triggers in Indian childhoods: academic pressure and comparison, exams and tuition load, a strict or shouting household, family conflict, bullying, a parent's illness or job loss, a house move or school change, and a recent frightening experience.

What helps at home

Take the feeling seriously and name it: 'you look worried about tomorrow's test.' Dismissing it ('there's nothing to worry about', 'don't be silly') teaches the child to stop telling you, not to stop worrying.

Do not accommodate the anxiety away. Letting a child skip school, avoid the party, or sleep in your bed every night brings relief tonight and strengthens the anxiety tomorrow. Support them in doing the hard thing in small steps instead — ladders, not leaps.

Teach the body skills: slow breathing out longer than in, counting five things they can see and hear, tensing and releasing muscles, cold water on the face. Practise them when calm, not only in crisis.

Reduce the load where it is genuinely excessive — school plus three tuitions plus classes leaves no space. Protect sleep, physical play and unstructured time; all three lower anxiety measurably. And check what the adults are modelling: an anxious household teaches anxious responses.

School refusal

School refusal is anxiety, not laziness — and the longer the absence runs, the harder returning becomes. The aim is a rapid, supported return rather than a long break.

Find the specific fear: bullying, a shouting teacher, an exam, a friendship loss, toilets, being separated from a parent, or something that happened on the bus. The general 'I don't want to go' almost always has a specific story underneath.

Work with the school: a phased return, a named safe adult, a place to go when overwhelmed, exemptions where needed. Keep mornings calm and matter-of-fact, and avoid long negotiations at the gate.

When to see a doctor

Seek professional help if anxiety: lasts more than a few weeks; stops the child doing normal things (school, friends, sleeping alone, eating); causes daily physical symptoms; involves panic attacks; or comes with low mood, withdrawal, self-harm or talk of not wanting to live. Any mention of self-harm or suicide is an emergency — take it seriously, stay with the child, and get help the same day; Tele-MANAS on 14416 answers round the clock and 112 is the emergency number.

Also see a doctor to rule out physical causes of recurrent stomach aches and headaches — anxiety is a diagnosis made after a look, not instead of one. Treatment works: talking therapies, particularly CBT, are effective for childhood anxiety, and are available through paediatricians, child psychologists, school counsellors and the District Mental Health Programme.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My child complains of stomach ache every school morning but is fine on Sundays. Is he pretending? — Almost certainly not. The pain is genuine — anxiety produces real physical symptoms. The pattern tells you the cause is at school, and that is what needs investigating.

Q: Isn't some pressure necessary for children to perform? — A little challenge helps; chronic pressure does not. Indian children carry unusually heavy academic loads, and rates of anxiety, sleep loss and self-harm in adolescents reflect it. Ambition and psychological safety are compatible; ambition and fear are not.

Q: Will therapy make my child dependent or 'label' them? — Therapy for childhood anxiety is usually short, practical and skills-based, and it works. The label people fear is far less costly than years of untreated anxiety shaping a child's choices.

Q: My family says I am spoiling him by taking this seriously. — Anxiety is a medical condition, not a character flaw or a discipline failure. Taking it seriously is the treatment. You do not have to win the argument at home to get your child the help they need.