Anxiety disorders are the world's most common mental disorders, affecting 301 million people in 2019, as reported by the World Health Organization and 5.8 million children, according to the Centres for Disease Control.
While occasional worry is a common human experience, anxiety disorders manifest as intense and excessive fear and apprehension.
Dr Michael Mbiriri, a clinical psychologist, defines anxiety as "that excessive fear that something bad might happen."
Yvonne Ngani, a psychologist, highlights that from 6 months to 2 years, children with anxiety tend to be teary when the parent or caregiver is leaving them or doing something that they don't like or when something happens that hurts.
"It can start to develop from 2 years. If it wasn't assessed at an early age, then it will continue over time. It might be severe at a later age compared to earlier ages," Ms Ngani says.
What are the signs?
Ms Ngani elaborates that when normal fear becomes anxiety, the child showcases signs such as trouble going to sleep, waking up at night, wetting their bed, becoming irritable and worrying about something in their head which sometimes the child doesn't know about.
"Some of them lack concentration, most of the time they are thinking about something that happened or are anticipating what might happen. In the midst of this, their minds get carried away," she adds.
Dr Mbiriri highlights other symptoms such as psychosomatic complaints. He explains:
"Psychosomatic illness is a situation where they complain of headache or stomach ache but when they go to the hospital, you realise that there is nothing like that. This comes as a result of processing stress," Dr Mibiri says.
Children with anxiety may also exhibit social withdrawal, reluctance to play with others and declining academic performance. They might develop aversions to school, complain of physical ailments and show signs of fear and defensiveness.
"Generally, children are playful. You might realise your child doesn't want to play or your child is withdrawn and wants to play alone. Perhaps the child is also performing poorly in school," Dr Mbiriri says. "Sometimes children develop anxiety because of bullying, you realise the child doesn't want to go to school, especially in the mornings."
Negative thoughts
Ms Ngani explains that children with signs of anxiety tend to dwell more on negative thoughts than positive ones.
"They tend to avoid things that make them feel anxious and tend to not want to do it. Let's say they have exams in school, it is normal for everyone to be a bit tense. However, for a child with anxiety, the feeling is so overwhelming that they can't control it. Sometimes they can't even show up for a school day because of the feeling of tension and 'what ifs'," she says.
Genetic predisposition plays a role with melancholic personalities (tending to be calm and quiet) being particularly susceptible. "This can also come as a result of genetic predisposition -- there are some people who are predisposed to anxiety," Dr Mbiriri explains.
He explains that one very obvious cause of anxiety is traumatic experiences.
"For example when the child witnesses the father beating the mother or vice versa or witnessing an accident, or the death of a loved one," he says.
"He or she may have gone through sexual abuse, bullying, emotional abuse or physical abuse, like corporal punishment or other stressful environments," says Dr Mbiriri.
Ms Ngani explains that this might also happen when a child is raised in an ACE environment (Adverse Childhood Experiences). "Maybe the child went through a lot of emotional neglect. Maybe when the child fell down or got burnt, the reactions of the caregivers/parents wasn't good, so getting these kinds of feelings over and over again from caregivers/parents, the child won't know how to behave," she explains adding that this might lead to the child being easily overwhelmed with emotions.
Dr Mbiriri says practical strategies to manage and prevent childhood anxiety include providing opportunities for children to express and release stress through play. "We should minimise passive leisure and encourage active leisure. We should encourage them to be more active in games," he says adding that creating a supportive and nurturing environment and helping them avoid abusive or bullying behaviours is also a way to prevent anxiety, in addition to assuring them and taking them to therapy.
"Handle them like any other person and accept them, walk this journey with them and tell them it is okay for them to feel what they are feeling," Ms Ngani says. "Celebrate everything that they do well, all their small wins and try to make them feel good."
She adds that by fostering a nurturing environment, providing emotional support, and teaching children how to manage their emotions, parents and caregivers can play a vital role in preventing and managing childhood anxiety.