By: Dr. Brian Gannon
School has started, and so have the headaches, insomnia and belly pains for many children. Anxiety that interferes with daily life occurs in up to 30% of children at some point before they turn 18, and in many the main symptom is a physical complaint such as headache.
So what’s a parent to do?
1 – Most children will not tell their parents they are nervous or worried. Until about age 15, they still think very concretely, so they don’t have much insight into their emotions or understand the reasons they feel the way they feel. For example, a 6-year-old may have trouble sleeping for weeks after a grandparent dies, but she may not realize the connection in her own mind, so why would she mention it to you? Unless a trusted adult asks probing questions about her thoughts while going to bed and about her dreams at night, it may never be clear that the child is afraid of death.
2 – Keep a diary of the symptoms. Regardless of the details, if you suspect your child is having a physical complaint caused by nerves, this can be very helpful for you, your child, and the doctor. It may be as obvious as a child who has a headache whenever there is a test in a certain subject. Or the pain may be every day at a different time, without a clear pattern. If you can find a trigger, then it becomes easier to ask the child about events that may be causing a fearful response, such as a bully on the playground, or a learning disability that makes a certain subject more difficult for him.
3 – Most parents, doctors, and patients want to find a physical cause for a physical complaint. But resist the need to push too far on this. If simple testing and questioning does not raise a red flag for some specific physical diagnosis, then most vague pains in school-aged children and early adolescents turn out to be related to fear or anxiety. The appropriate treatment is counseling, not CT scans or multiple medicines. Headaches, for example, fall into very distinct categories for doctors. If your child’s headache pattern does not fit into these neat categories, then it is way more likely to be from nerves than from a brain tumor. Some testing is generally warranted, depending on the pains, but trust your doctor’s judgment if she recommends limiting the testing. Prolonged investigation may just play into the child’s fantasy about having something worth being scared of. And helpful mental health treatment can end up being delayed unnecessarily.
OK. Now I know my kid has an anxiety problem. What do I do now?
First, don’t be scared of counseling, for the child and all the caregivers (stepparents, grandparents, whoever is relevant in the child’s life). This can run a huge spectrum from common fears or learning problems, all the way to panic attacks or crippling obsessive symptoms. Most parents are not experts in dealing with these things and helping children cope with difficult issues. So seek help to get advice on what you can do as a parent to be supportive.
Here are some tips for helping children and teenagers with fears and worries.
1 – Get it out in the open. As long as it’s a secret, it has much more power to hurt your child. The sooner your child sees, for example, that he can actually master that pesky spelling list without being afraid of the test, the faster he will be able to face the fear of failure and be empowered by standing up to the fear.
2 – Many kids have less clear-cut anxiety, without a definite trigger. For them, everyday events may loom large in their minds and interfere with sleep or even waking thoughts. Find an exercise that helps the child feel powerful over the worries. Here is one example: write down every night the individual worries and place them in a box. Then seal up the box and give it away. Some would say put it in God’s hands, others would bury it in the garden to fertilize the roses. The details don’t matter; the important thing is to tweak the concept so it helps your child realize there will always be things we can’t control, but that’s ok.
3 – For children too young to put their fears into words, try art therapy. When your child complains of a headache before school, take a few minutes to draw with her. Suggest drawing what makes you happy, then what makes you sad or upset. You may be surprised how eloquent she may be in pictures, and this gives you something to focus on in helping her face the fears.
One last thought: remember that school is your child’s primary job, and if he is trying to avoid it, there could be a big problem that he is not sharing with you. Take the time to listen carefully. It could make both your lives much richer, and bring you closer together as a family.