Anxiety in children, without the panic.

What anxiety in kids actually looks like

Most parents think anxiety in children looks like a child saying "I'm worried." But that's only one version. Often, anxiety in a child shows up as physical symptoms, anger, or avoidance rather than the word "worry."

A child with anxiety is often trying to manage something in their mind that feels threatening or unpredictable. The stomach ache, the anger, the refusal to try—those are their attempt to control or avoid the feeling.

Typical worry vs clinical anxiety

All children worry. Most children have a fear or two. The question is not "does my child ever feel anxious?" but "is the anxiety causing real difficulty and lasting longer than it should?"

A clinician will look for anxiety that:

• Persists for more than six months — not just a response to an identifiable stressor (like a house move), but a pattern that hangs on
• Causes significant distress — the child is visibly uncomfortable, not just mildly worried
• Interferes with daily life — school attendance, friendships, family activities, sleep, or eating are affected
• Is not easily reassured — you can explain that they're safe, but the worry returns moments later
• Happens across more than one situation — it's not just about dogs or thunderstorms; there are multiple triggers

A child who worries about the school exam, sleeps poorly the night before, then settles once it's over has typical, age-appropriate anxiety. A child who worries about the exam for weeks before, can't eat properly, refuses to go to school on exam day, and is still preoccupied a month later has something that warrants a conversation with a clinician.

Signs by age

Early years (ages 3–5)

At this age, anxiety is most often about separation or things that are unpredictable or look different. A preschooler with anxiety often shows these patterns:

Primary school (ages 6–12)

At school age, anxiety broadens. Children can now anticipate future threats and worry about social evaluation. Common anxieties are about school performance, social acceptance, and safety.

Teens (ages 13–17)

Teen anxiety is often about social evaluation, performance, and future outcomes. It can look like withdrawn behaviour, perfectionism, or avoidance.

When anxiety shows up as ADHD or autism

Anxiety is so common alongside ADHD that some researchers suggest it's part of the ADHD profile itself. A child with ADHD experiences the world as unpredictable—they forget instructions, they lose things, they make impulsive decisions they regret—and this constant uncertainty can drive significant anxiety. Treating one without recognising the other will only partially help.

Similarly, autistic children often experience anxiety because social rules are unclear, sensory experiences can be overwhelming, and changes to routine are genuinely disorienting. An autistic child whose anxiety isn't recognised might be seen as "inflexible" or "rigid" when actually they are trying to reduce unpredictability.

If your child shows signs of both anxiety and patterns suggestive of ADHD or autism, mention this specifically to your GP. A paediatrician will assess the full picture.

The Australian pathway

Childhood anxiety is one of the most treatable conditions in child mental health. The Australian pathway is straightforward.

Step 1: Your GP

Start here. Tell your GP what you're noticing and how it's affecting your child. Your GP can place you on a Mental Health Care Plan (MHCP, Medicare item 2715), which gives you access to subsidised psychology sessions—usually five initial sessions at $30–50 out-of-pocket after Medicare rebate, plus up to four additional sessions.

Your GP will ask about the duration, severity, and impact of the anxiety. They may also screen for depression or other factors. If your child is in severe distress or there is a safety concern, your GP can refer directly to a paediatrician or psychiatrist rather than starting with psychology.

Step 2: Psychologist (most common pathway)

A psychologist will conduct an assessment and recommend treatment. For childhood anxiety, cognitive behaviour therapy (CBT) is the gold-standard treatment. CBT teaches your child to:

• Recognise anxious thoughts and beliefs
• Test whether those thoughts are actually true
• Gradually face feared situations (rather than avoid them)
• Build confidence through small successes

CBT typically requires 8–12 sessions. Progress can usually be seen within 4–6 sessions. Your involvement as a parent is important—therapists often coach you on how to support your child's progress at home.

Some psychologists also practise Acceptance and Commitment Therapy (ACT) or exposure-based approaches, which are also evidence-based for child anxiety.

Step 3: Paediatrician (if psychology alone isn't sufficient)

If anxiety is severe, significantly impairing your child's function, or if psychological therapy alone hasn't been enough after a reasonable trial, a paediatrician can discuss whether medication might help. For severe anxiety in children, a selective serotonin reuptake inhibitor (SSRI) like sertraline or fluoxetine is usually considered first. Medication is often combined with therapy, not used alone.

Cost and access

Under the MHCP, psychology is subsidised (usually $30–50 per session after rebate). Private psychologists typically cost $150–250 per session, with rebates of $120–180 depending on the item number and your health fund extras. If your child is waiting for psychology, your GP can also discuss interim strategies to support anxiety at home.

What helps at home

Co-regulation

An anxious child's nervous system is in high alert. Your calm, steady presence helps. Sit with them. Use a slow, quiet voice. Don't rush them or make them feel they need to "just get over it." Over time, your regulated nervous system helps regulate theirs.

Avoid the reassurance trap

It's natural to reassure: "Don't worry, everything will be fine." But a child with anxiety who gets constant reassurance learns that reassurance is how they manage anxiety. The worry returns when the reassurance ends. Instead, acknowledge the worry and gradually help them build confidence by facing it.

Gradual approach, not avoidance

If your child is anxious about something, avoiding it feels good short-term but reinforces the fear. Instead, gradually approach the feared situation. If they're anxious about school, going in for 15 minutes is better than avoiding entirely. Each small success builds confidence.

Maintain routine

Predictable routines are calming for anxious children. Consistent bedtimes, regular mealtimes, and forewarning about changes help an anxious child feel more in control.

Model healthy coping

If your child hears you catastrophise or see you avoid things you're anxious about, they learn that's how you handle worry. Let them hear you say: "I'm worried about this meeting, but I've done it before and it will be fine." Show that worry is normal and manageable.

What doesn't help

Dismissing the feeling

"There's nothing to worry about" or "just stop thinking about it" doesn't work. The feeling is real to your child, even if the threat is not. Dismissing it makes them feel unseen and more alone with the worry.

Over-reassurance

Repeated reassurance ("You'll be fine," "This won't happen") temporarily calms but then creates a need for more reassurance next time. The child learns that worry is managed by seeking reassurance, not by building confidence.

Forcing exposure without support

Throwing a child who is anxious about dogs into a room with a dog (even with good intentions) can backfire. Exposure should be gradual and supported by a therapist.

Accommodating the anxiety entirely

If your child is anxious about school, completely removing school isn't the answer. Some accommodation is necessary (extra time before school, a calm entry process), but total avoidance teaches that anxiety is the boss.

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