Anxiety in Pre-Schoolers
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Anxiety in Pre-Schoolers
I am the parent of three daughters, 8, 4, and 4. One of my
twins seems to have panic attacks when she is overloaded. For
example, when she can't find her blankie and has looked all
over the house for it. Or when we're getting down to the wire
on getting dressed and leaving the house and she has to choose
what she's going to wear RIGHT NOW.
I know quite a bit about panic attacks on the adult side --
I've had them off and on for 20 years. I've learned how to
control mine and I know they're hereditary. But I'm fearful for
my daughter who seems to get them now perhaps once every few
Has anyone experienced this with their young child? Have any
words of wisdom for me? My husband and I can calm her down but
I just don't want her to have to go through this.
If she is truly developing panic attacks, I would really recommend you taking
her to a
psychologist or psychiatrist or behavioral pediatrician (Ann Parker) comes to
these people can evaluate if she truly is having panic attacks or just needs a
to cope with stress and hopefully can recommend some behavioral interventions
life is better ...
Sophia, pediatrician, adolescent medicine specialist
It sounds to me more like anxious behavior.
A panic attack is a very extreme form of anxiety where you feel like you are
going to die. My Aunt suffers from panic disorder. When she has a panic attack
she is absolutely terrified. Her heart rate goes up and she can hardly breath.
It sounds to me from your descrition of your daughter that it
might be mild anxiety which can be, in part, learned behavior in children. I
suffer from mild to moderate anxiety attacks. Anxiety along with panic
disorders do run in my family, but I sometimes wonder how much ''heredity'' is
also learned behavioral patterns being passed down. I grew up watching my
mother have anxiety attacks where she would overreact and worry about all
kinds of things. Sometimes she would break down in tears over very simple
problems. For me an anxiety attack often comes when I'm feeling like I'm
loosing control. I often feel in such a state that I am like a child again,
vulnerable, scared with no sense of security. I'm positive that a great deal of
coping skills are learned from my mother.
My daughter who is now 5 years old
has seen me go through quite a lot of anxiety attacks. Whenever my daughter
looses something or something doesn't work right, she freaks out, worries,
starts to cry and sometimes acts like she is ''panicking'', but really she is
having a real difficult time dealing with her feelings of anxiety. Other
than that, she is very healthy, normal and manages just fine socially and where
ever she goes. I know my daughter must have learned some of her coping skills
from me. I haven't been a good role model.
With that said, all children are
naturally emotional and don't know how to deal with their feelings. We as
parents teach our children how to deal with their emotions by being role
models. Your daughter sounds quite normal to me, but who may also need
some special guidence on how to deal with her emotions before her coping
skills become so habitual that it is a real problem later in life. The best
you can do is keep your own anxiety attacks under control, for your children's
sake. If you need extra help with your daughter, find a family therapist who
specializes in anxiety disorders.
Do any of you have advice for parents of an increasingly anxious 4
year-old boy? Our son seems to be getting more stressed about transitions
and/or group activities with each passing month. For example, he has been
attending the same preschool for nearly 2 years now, and the same
after-school classes for 4 months. Yet in the past month he has burst
into tears and become physically ill (aka thrown up) at the prospect of
attending these programs. I do not believe that anything unusual is
happening at either place -- in fact his nanny or parents are always
observing the after-school program.
We have had many conversations with our son about his anxiety. We
always try to reason with him during and after one of his episodes by asking
him what caused the anxiety and giving him tips on how to manage it.
Although he "knows" that he has no reason to be anxious, it doesn't seem to
be helping him.
Our concerns are multiple: why is he getting more anxious? what is
causing the anxiety? how can we mitigate the anxiety? how can we stop his
physical reaction to the anxiety -- as it seems to only add to his stress?
is this a phase that he will grow out of? or should we see a mental health
specialist now? how do we find a good mental health specialist?
Thanks in advance for your advice or referrals.
In response to the anxious 4 year old: I don't know anything about a
young child having anxiety, but from an adult's perspective, the attacks
can create a vicious cycle. One begins to have anxiety about having anxiety
attacks. If you decide you want to talk to a professional, Dr. Relinger's
office (building next to Alta Bates) works with children and Dr. R
specializes in anxiety.
Can your son describe anything specific about the program that causes
the anxiety? You might want to get him in to just talk a bit with a
child psych specialist in order to determine what is going on with
him, if you can't get anything comprehensible out of him in your
current communication formats. It may be that something that the
nanny sees as perfectly normal is seen as a traumatic event by your
son, such as being pushed by another boy, or whatever. Remember that
adults have the calluses of experience protecting their feelings about
interactions with others, and children - especially emotionally
perceptive ones - often do not. I have seen nannies from other
cultures treat blatantly unfair and selfish behavior from one child
toward another as though it were unimportant, and focus their
displeasure instead on the child who protests at such behavior,
instead of where it (in my view of the aggressor, at least) belongs.
this does not decrease the disturbance of the child who feels unfairly
treated, but rather reinforces his negative feelings, such that s/he
can become the "whiner" the nanny started out by casting him/her as.
One simple disagreement over length of time on a swing led to exactly
this development in a Berkeley tot lot while my child was playing
nearby -- I had to remove him eventually because when the offended
child was treated as though he were the problem, he became nearly
hysterical in trying to get the nanny to admit that he was not the
Your description is helpful and gives a bit of a picture of the
struggle that your son must be having, although in my experience it's
fairly difficult to tell from an email post just what is going on to
cause the response he's showing. As a therapist who works with
children/families, I'm also struggling a bit with how much to actually
respond via an e-mail posting, but here are a few things that I hope
will be of support: --I know your son is 4, but I'm not sure where on
the "4" side he is...closer to 5? just turned 4? Anxiety over separation
begins to reach a peak as the child approaches 5. It's not uncommon for
a super-friendly, active, socially adjusted child to begin finding monsters
under the bed, mysterious killer flying squirrels in the closet, etc., at
around this time. Nightmares and night terrors can increase again, too.
The reasons for these fear/anxiety responses are complex and have as much
to do with the child's unfolding physical development and growth as their
psychological state and specific social circumstances.
--If I were to see your child in my practice, I would be wondering
some things to begin with: was there a kind of specific starting point to
what looks like anxiety? is what looks like anxiety actually anxiety (and
not depression (yes, not uncommon!); a primarily physically-based
response, etc.? Anxiety is often a symptom, as you know, and the vomiting
may be a symptom of the anxiety (e.g., he gets himself so worked up and upset
he begins to hyperventilate, which makes him queasy, which makes him
throw up), but it may also be an important symptom in and of itself and a
clue to the related anxiety that may drive the vomiting. I would be
wondering what else is happening with the child...when the anxiety symptoms
begins at school...what helps them subside...is there a person or activity
in this environment that seems to stimulate either more anxiety (or
restlessness, avoidance, agitation, anger, fear) or seems to stimulate
relaxation (laughing, laying around, playing, ability to leave you, etc.).
In the worst case, something may be happening at the school that is harmful
or scary to him that he can't tell you about (and probably he doesn't
understand himself). I don't say this to alarm you, but to raise the
possibility on the extreme end, of taking the tantrums, anxiety, etc.,
as a sign of something really wrong in his environment. I would be
wondering what life is like at home, too. Don't get too worried--I'm not
talking about blaming the parents, here. In fact, if his world at home is
wonderful, happy, safe, secure, etc., it may in some ways make the 4-5
transition even more difficult out of the home. Kid's often try to
protect their parents, too. If a child senses that his/her parents might not
be okay if they leave, they can exhibit problems or try not to separate
in order to allow the parents of a little child to continue being the
parents of a little child (and not the parents of an increasingly autonomous
preschool child). It's pretty cool, if you think about it...kids are
basically altruistic, in my opinion. They want their parents to be
happy, and will pretty much do whatever (in their young minds) they think
will keep things in the family "happy." If that means being a little kid
for a while longer, they'll do it. For example, a family I worked with
recently was concerned about their 5 year old saying she REALLY wanted to
wear diapers again and feed from a bottle. This was her "demand" despite
lots of good feedback from school and her being a basically happy kid at
home and with friends. Over time the parents realized they were actually
experiencing a deep loss over not having their adorable baby with them
anymore (subtle comments about baby clothes while window
shopping... talking about how cute and wonderful their daughter was as a
baby, etc.). Their own felt experience was that they just LOVED their
daughter through and through (including their growing independent child)
and wanted to express all of it. But their child was picking up on the
loss that her parents hadn't yet acknowledged and had somehow figured that
if she could be a baby again, it would just make everyone happy. They all
have worked it through really nicely and I must say that the child never
talked with me directly about the issue; it was all done through play
So...on another road of possibilities, it may have to do with his
fears about separating from you/your family and the anxiety/illness is a
way that keeps you all very connected and close to each other at a time
when the world is becoming a BIG place and being close to mommy and daddy
is a heck of a lot better, even if you have to get physically ill to do it.
Of course, being taken care of when things feel bad is something we all
want when we're scared/upset. We all feel like kids (we "regress" to
earlier behavior) when we feel vulnerable. Vomiting is a very basic response
to something not being wanted internally and (hopefully) it brings those
we love close. However, this doesn't mean your son is somehow
"controlling" his anxiety and vomiting and "using it" consciously to
manipulate your attention.
--Can you stop his reaction? I would softly suggest that the goal
here might be not to stop his reaction or to reason him out of it. Again,
he isn't doing it on purpose to you, he is trying to find a way to
communicate something that can't be communicated right now with words.
If I worked with him (or a child in a similar situation), I wouldn't talk
with him about his anxiety. I would play with him. The use of play therapy
in a situation like this can be very helpful and it reflects the primary
way that a 4 year-old communicates with the world of others. All the
themes and worries eventually come up, but its an indirect way of approaching
something that may be scary and allows the child to express his/her
concerns without fear of punishment for having the
feelings/communicating them to others, etc.
Please do take my remarks with caution and a tablespoon of salt. I
know next to nothing about your real live son or your family. These are
very generic sorts of responses but I hope you find them helpful. I do
think that vomiting and increasing anxiety at school is a cause for concern.
I think that you wouldn't be overreacting to talk to a child and family
therapist but I would certainly continue to be, as you are, in close
communication with your child's teacher to determine as much as they
know, what is going on at school, inside and outside the child's immediate
One last important thought: kids at 4 generally do get more anxious
when we try to tell them they don't need to be anxious. Unfortunately, we
mean really well, but the general message they often get is "Dad (or Mom)
is so worried about this really horrible thing that is really, horribly TRUE
and threatening, just like I thought it was, that they are spending a LOT
of time telling me not to be really horribly worried about it. In other
words: PANIC!" Adult reason is different than child reason (until the child
can reason abstractly at around 11/12). It is a tricky thing to bring to bear
with a 4 year-old, because while you can control the degree to which YOU are
being completely reasonable, you cannot control the way a 4 year-old reasons
things through with the reasonable information you give to them (e.g.,
there's nothing to worry about; I'll protect you if anything bad
happens; If it were really bad, I'd know about it and do something right
away; why are you so upset, honey? you REALLY love_____(school, Billy's,
Grandma Rose's,us, your sister, your blankie, your toy closet, etc.).
Please feel okay to call me at the office if you want to speak further
or to obtain a referral. (Michael Simon, 510 433-2959).
Hello, it would help the group of parents here who are trying to give
you advice on your problem, if you'd please describe your 4-year old's
typical daily schedule. What is his normal day like?
I'm reminded of a radio talk show psychologist where a caller reported
that his young child was elaborately pretend-washing his hands for long
periods before bedtime. The radio shrink asked what was the kid's daily
schedule? Turned out the kid was involved in about a dozen athletic, music,
karate, hockey, clubs, the school play, you name it, and didn't have any
"down time" to just be a kid. So... please let us know his typical
schedule so that we can make some realistic assessments for you.
Regarding the anxious 4-year-old, if his anxiety began with school,
you could arrange for a therapist to visit the school on a normal day when
he is there and observe. This should be something the school is happy to
do (if not, I suggest you reconsider his placement there), and it is
likely to give you some new insights about what seems to be triggering his
anxiety. I do think that a child who throws up because he is
frightened needs to be taken seriously.
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