‘My child is complaining of a sore stomach’ - when it might actually be anxiety and how to tell.

Anxiety can affect people of all ages, particularly often to many people’s surprise - children. While some signs of anxiety in children may be readily apparent, others can go unnoticed, making it crucial for caregivers/teachers to be aware of both the obvious, and more subtle things to look out for. It’s helpful to be able to identify these signs so we as parents can act early – and not mistake behaviors for something that requires punishment.

As with adults, anxiety can present in a range of ways, and children may not always know exactly how to communicate about how they are feeling.

The signs to look out for may vary between different ages (a 2-year-old and a 15-year-old will likely display these signs in different ways!) but there are a few common categories of symptoms you might notice:

1. Perfectionism

Children grappling with anxiety may exhibit perfectionistic tendencies, setting unrealistically high standards for themselves. Fear of making mistakes or not meeting their own expectations can contribute to heightened anxiety levels. You might see them refuse to attempt something they know they won't get perfectly correct and be very upset any time they are not winning/excelling at something. They may also spend a lot of time comparing themselves with others.

2. Physical symptoms

Beyond emotional indicators, anxiety can manifest physically. Children may complain of stomach-aches, headaches, or other unexplained physical discomfort. Persistent complaints may signal an underlying anxiety issue.

See if you can track a pattern for when these complaints occur – for example, is it every Sunday before school? Also, try to validate the discomfort. It may be stemming from mental anxiety, but this is not the same as being ‘all in your head’.

3. Avoidance behaviors

Anxiety often leads children to avoid situations or activities that trigger their anxious feelings. This avoidance may be misconstrued as simple reluctance, but it can be a coping mechanism to manage overwhelming anxiety. Pay particular attention to children avoiding activities they used to enjoy/participate in without anxiety.

4. Changes in sleep patterns

Pay attention to alterations in a child’s sleep routine. Anxiety can lead to difficulty falling asleep, nightmares, or night sweats. Conversely, some children might sleep excessively as a way of escaping anxious thoughts. Children might also seem excessively tired – being worried is exhausting and will often be apparent this way.

5. Changes to appetite/weight loss or gain

Children who are anxious often will not eat as much, or only be interested in high calorie ‘snack’ foods. If their stress systems are activated, their body will be looking for fast and easy calories rather than feeling there is enough time to sit and eat and digest a nutritious meal.

6. Social withdrawal

Anxiety can cause children to withdraw from social interactions. While some children are naturally introverted, a sudden and pronounced change in social behavior may indicate an underlying anxiety issue.

7. Excessive worrying

While some degree of worry is normal, excessive and persistent worrying about various aspects of life, such as school, friendships, or future events, can be indicative of an anxiety disorder in children.

Is your child going over and over situations, ruminating on things that have occurred, or worrying about the future?

8. Increased sensitivity to criticism

Children with anxiety may be highly sensitive to criticism, even if it is constructive. A fear of judgement can be a powerful trigger for anxious thoughts and behaviors.

How does your child respond when you provide even kind/gentle feedback?

9. Tics or Nervous Habits

Anxiety can manifest in physical behaviors like nail-biting, hair twirling, tapping, scratching, jiggling, lip-biting, or other nervous habits. These repetitive actions may serve as outlets for anxious energy.

10. Difficulty concentrating

Anxiety can interfere with a child’s ability to concentrate. If a child who was previously attentive begins to struggle with focus and attention, it could be a sign of underlying anxiety.

11. Personality changes

This includes becoming more withdrawn, emotional and reactive etc. This can of course be developmentally normal, but worthwhile watching out for.

12. Other changes of any kind

Follow your instincts. If you feel your child’s behavior/appearance/health/interests etc. has changed in any way, there may be some increased anxiety to blame. You probably know your child better than almost anyone, so don’t dismiss your gut instinct here!

About the Author

Nadine Isler is a Registered Psychologist who specialises in treating anxiety and related conditions. She finds the human brain fascinating and loves working with people from all walks of life. She was born in Switzerland and is now based in Auckland and has two children.