Anxiety in Kids: The Many Faces of Worry

In clinic I’m often tasked with discovering the root of a problem with many potential causes — headache, stomach pain, sleep problems, social struggles, anger outbursts, and more.

While these can each have many underlying causes, they also have one common potential cause: anxiety.

Anxiety can be a sneaky little trickster. It doesn’t always look like a worried child wringing their hands and saying, "I’m scared."

Sometimes, it dresses up as a tummy ache before school, a sudden aversion to birthday parties, or an epic meltdown over the "wrong" socks.

Because anxiety in kids can show up in so many ways, it often goes unrecognized.

Let’s take a look at what anxiety can look like at different ages so you can recognize and address it. This isn’t all-inclusive, but it gives you a good idea of the different ways anxiety can show up at various ages.

The Toddler & Preschool Years

This age group is still learning how to express emotions, so anxiety often appears in physical ways or through sudden shifts in behavior.

• Clingy Koalas: Your once-independent explorer now refuses to leave your side, clinging to you like a baby koala.

• The Costume Conundrum: Freaks out if you try to put them in anything other than their favorite superhero pajamas or now worn-out t-shirt.

• Shadow Monsters: Develops a sudden, intense fear of the dark or other non-dangerous threats (like the vacuum, which has been in the house their entire life but is suddenly terrifying).

• Sleep Struggles: Fights bedtime with “another book” or “one more drink of water” requests, wakes up frequently, or insists on sleeping in your bed.

The Elementary School Years

Now that kids are in school, social and academic pressures start to ramp up. Anxiety may take on new disguises.

• The Achey Scholar: Complains of a headache or tummy ache before school but magically recovers on weekends and snow days. These pains are real, but not due to an illness or physical condition. They’re much more common at the beginning of the week or after a school break. These pains can happen with any stressful trigger, even things you might think are exciting adventures but are new or uncommon for them.

• The Perfectionist: Erases their homework 20 times because "it’s not right" or refuses to try new things unless they are sure they can do it perfectly.

• The "What If" Machine: Asks constant, escalating "what if" questions — "What if I forget my lunch? What if I get lost? What if a meteor hits the playground? What if there’s a burglar?"

• Sudden Social Ghosting: Used to love playdates, but now avoids them, preferring to stay home. They may also stop participating in class or struggle in crowds or gatherings.

• Sleep Struggles: Has trouble falling asleep due to racing thoughts, frequently wakes up worried, or starts having nightmares. Of course they don’t always tell you why they’re not sleeping well, they might simply sneak into your bed or beg for you to stay with them as they fall to sleep. They can be masters of “one more…” at bedtime.

Early Adolescence

Hormones + increasing academic and social pressures = prime time for anxiety to shape-shift yet again.

• Avoidance & Procrastination: Puts off homework or projects because starting them feels overwhelming, leading to last-minute panics and tears.

• The "I Don’t Care" Act: Acts indifferent about everything to avoid failure—"I didn’t really want to make the team anyway."

• The Overthinking Detective: Analyzes every interaction—"Why did she say ‘hi’ like that? Was he mad when I texted that? Should I have said something different?"

• The Rage-Quitter: Melts down over a minor setback, like a bad test grade or a lost video game, because they were already full of unspoken stress.

• Wandering Mind: Worries take up space in the brain, making it hard to focus on what’s important at the moment.

• Sleep Struggles: Stays up late overthinking, dreads going to bed because of anxiety, or complains of fatigue due to restless sleep.

The Teen Years

Teens can be great at hiding anxiety, sometimes even from themselves. Anxiety during adolescence typically centers on changes in the way their body looks and feels, social acceptance, and conflicts about independence. It might show up in unexpected ways.

• The Over-Scheduled Overachiever: Signs up for every club, sport, and AP class because they feel like they have to do it all to be successful.

• The Perfectionist: Might struggle to start a project because they want to have a great final product but aren’t sure it will be good enough. They may seem to procrastinate until the last minute — when they have no choice but to start — but this leads to outbursts and tears that they won’t have enough time.

• The Hermit: They may feel awkward in social situations, seem shy around others, and prefer to stay in their room alone.

• The Night Owl Insomniac: Stays up way too late, overthinking conversations and worrying about the future.

• The Self-Control Boss: May seem to have ultimate self-control, but at the risk of personal health and well-being. They may only eat healthy foods “to be healthy” but restrict calories to the detriment of their health. They may spend too many hours at the gym or at any activity they feel is important, neglecting other important aspects of their life.

• The "Everything is Fine" Pretender: Says they’re "fine" but starts withdrawing from activities, friends, or family without explanation.

• The Masker: Doesn’t talk about worries, but may complain of headaches, stomachaches, or other ailments. They may struggle with weight changes, attendance problems, poor focus, and sleep deprivation.

• The “I Can Handle It Myself” Denier: In an attempt to diminish or deny their fears and worries, they may participate in risky behaviors, use drugs or alcohol to be more comfortable in social situations, or engage in impulsive sexual behavior.

• Sleep Struggles: Has difficulty falling or staying asleep, uses screens late at night to distract from worry, or sleeps excessively to escape stress.

How Parents Can Help

If any of these examples sound familiar, know that you’re not alone. Parenting an anxious child can feel like an emotional roller coaster, but with support and patience, you can help your child build resilience and use tools effectively to manage stressors.

Regardless of how anxiety presents itself, the key is to validate your child’s feelings and help them develop coping skills.

• Self-Care Routines: Everyone needs to balance work/school, family commitments, social activities, exercise, nutrition, and sleep. Parents can help establish routines that support healthy habits.

• Screen-Time Management: Screens are necessary in many ways in today’s society, but there are inherent risks that can be mediated. The AAP has a Family Media Plan Tool to help every member of the family use screens more wisely.

• Label the Feeling: "It sounds like you're feeling worried about school. That makes sense — it can be a lot sometimes!"

• Support Calm Problem-Solving: Instead of "Don't worry!" try "Let’s figure out one small thing we can do about this."

• Encourage, But Don’t Push: Help them face fears in small steps rather than forcing them into overwhelming situations.

• Teach Relaxation Techniques: Deep breathing, mindfulness, and even silly strategies like "wiggle your worry out" can help. There are free apps, such as Smiling Mind and Insight Timer, that can help you practice mindfulness together. They each have child-specific meditations as well as ones for adults.

• Know When to Seek Help: If anxiety is interfering with daily life, schedule an appointment with your pediatrician or family physician to discuss potential underlying medical conditions leading to symptoms, complete anxiety and depression screenings, and to find out who they recommend if therapy is indicated. You can also check out Effective Child Therapy — it has many resources on how to pick the right therapist. Find the button on their Home page to Locate a Psychologist Near You — there are several online search engines to try! Therapy can be very effective, but if things aren’t improving after several sessions, have the therapist send a summary of their findings to your physician and schedule an appointment to discuss things with them.

Anxiety in kids isn’t always easy to spot, but once you recognize it, you can help them manage their worries in a healthy way. Recognition and proper management can save time and money going down the rabbit hole doing expensive medical testing or simply watching a child suffer.

Next time I’ll cover when medical conditions can look like anxiety — a reason to start with your physician if you have concerns.

And don’t forget to take a deep breath yourself — you’ve got this!