Anxiety and phobias are common problems in childhood. Here’s how you can help your child overcome his fears and worries.
By Dr S Mohan Raj
“No, I don’t want to get in!” she told her mother.
Her mother tried to reassure her, but Anu said ‘No’ and began crying.
The swimming coach met all the newcomers. When he saw Anu crying, he comforted her, “Don’t worry. You don’t have to get into the pool today. You can just sit in the bench and see what the others do.” The words made her feel better, and she sat on the bench with her mother. She observed that other children were hesitant but nevertheless, they climbed down, and some of them were laughing once they got into the water. Half an hour later, the coach asked Anu whether she wanted a closer look at the pool. Anu did not answer.
“Come and sit near the side of the pool. It is not deep here. You can be with your mother”, he said. Anu’s mother sat near the edge of the pool. Anu reluctantly sat near her mother and held her hand tight. She saw a few children in the pool waving at their parents.
Testing the waters: Later, Anu gingerly touched the water with her toes. Gradually, she dipped her legs, one by one, in the blue water, while sitting at the edge of the pool. By the time the class was over for the others, Anu was splashing the water with her legs and proudly looking at her mother. The next day, Anu readily went near the edge of the pool and put her foot in. The coach came, greeted her and her mother, and went to join the others. Ten minutes later, he came back and asked, “Anu, do you want to come and stand in the water where the others are? It is only chest high.” First, Anu said ‘No’, and then changed it to a reluctant ‘Yes’.
She anxiously climbed down the steps and got into the water while making sure that her mother was nearby. Other children greeted her and half an hour later, she was happily playing in the water. She watched the other children doing the swimming motions but refused to do it. The next day, after she was comfortable with the routine, the coach asked her to do the exercises everyone was doing in the water. She readily joined in.
Phobia is a condition where the child has anxiety for a specific object, situation or activity and the child actively avoids that particular object, situation or activity.
Common phobias include the fear of animals (spiders or snakes), insects, closed spaces, dark spaces, heights, public speaking and exams.
Closed spaces create intense anxiety in Pradeep and he avoids lifts. Tarun becomes anxious if he has to talk to a group of people. Though a talented writer, he was a reluctant speaker. He refused many opportunities to be a narrator for the school play or to give a speech to the class.
Children can be anxious about many things. Most childhood anxieties are normal responses to apparently threatening environment or stimuli. Children may be anxious about specific animals or insects or about specific activities like learning to swim (as Anu did), reading in front of the class or going to the next room alone.
Anxiety, to some extent, has a protective role. It keeps the child away from potential dangers. Anxiety becomes a problem only if it is prolonged, is out of proportion or if it paralyzes the child from following his routine activities.
Chandra, a class 9 student, was extremely anxious about her exams. On the morning of the exams, she was tensed. She could feel her heart racing. She thought about the consequences of faring badly in her exams.
“Mom and Dad will scold me. My friends will laugh when the marks are announced,” she thought. These thoughts made her more anxious and she developed a tension headache. She refused to write the exams, citing her headache.
Along with fear, children experience muscle tension, inability to relax and at times, tremors, sweating, palpitation, and breathlessness. The increased muscle tension in the small muscles of the head can cause ‘tension headache’. These bodily symptoms are experienced due to an increase in the adrenaline levels in response to the threatening stimuli. When a person is exposed to a threat, he has only two options. One is to fight and the other is to run away. The body responds with a surge in adrenaline and this helps in the ‘fight or flight’ response. Adrenaline increases the heart rate so that blood reaches faster. Breathing becomes rapid to get as much oxygen as possible. Muscles become tense to help fight or run away. The blood supply to the limbs is reduced, and it is diverted to important organs like the brain, lungs and kidney. As the body heats up, it sweats.
A few children have this adrenaline response to not only actual threats but also to perceived, imagined or anticipated threats. Here, the anxiety becomes an illness. Some adolescents have episodes of intense bodily symptoms of anxiety. The interval period will be normal. These are called panic episodes.
The first step is to know whether it is a normal anxiety or an anxiety disorder.
Relaxation exercises help the child to reduce anxiety. Yoga is a good relaxing exercise. Jacobson’s Progressive Muscular Relaxation, which involves alternately tensing and relaxing the muscles, is another technique that can reduce anxiety. Imagery method, in which one imagines a beautiful scenery with eyes closed and slow breathing, can also be practised by the child.
Apart from relaxation, counselling the child helps in coping with the threat and overcoming it.
Graded exposure to the threat is an excellent way to overcome most phobias. Here, the child is initially exposed to the least anxiety-provoking situation. This causes mild anxiety but it soon subsides with continued exposure. Gradually, the child is exposed to slightly more anxious situations. Anu’s coach had employed this approach.
Medicines are used only if the anxiety is severe and is disabling the child. They should be used for a short duration to help the child go through the exposure.
In some children, the anxiety is about what the parental response would be to their performance, whether it is exams or sports. If parents show unconditional love to their children, irrespective of their performance, it would reduce anxiety in a significant way.
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