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11:17 AM

STAAR Stress? A Pediatrician's Tips on Helping Your Child With Anxiety

“You have plenty of courage, I am sure,” answered Oz. “All you need is confidence in yourself. There is no living thing that is not afraid when it faces danger. The true courage is in facing danger when you are afraid, and that kind of courage you have in plenty.”

L. Frank Baum, The Wonderful Wizard of Oz

Anxiety in children is a normal part of life, just like it is in adulthood. When a child is frightened, for example by a scary movie, they may have trouble getting to sleep. However, when anxiety cannot be comforted and is out of proportion with the given situation that can be a sign of an anxiety disorder in children.

Childhood anxiety occurs in about one-in-four children at sometime between the ages of 13 and 18. However, the lifetime prevalence of a severe anxiety disorder in children 13-18 is about 6 percent. Left untreated, anxiety in children can cause problems in school, at home and continue into adulthood.

Especially during this time of year, you may notice your child feeling anxious in preparation for standardized testing. 

As we approach STAAR tests in our area, we hear a lot about kids becoming anxious.

Sometimes it’s easy to spot: the outward nervousness, nail-biting, jitteriness, moodiness, irritability and outright refusal to participate in a specific activity, like school or when it's test time. Other times anxiety is not as easy to see, but can still be just as debilitating and lead to further behavioral, as well as physical, problems.

Some of the less distinct signs of anxiety can include frequent stomach aches, headaches, trouble sleeping and difficulty concentrating. It can be difficult to discern whether these symptoms are due to some kind of illness, something your child ate or an emotional stressor of some kind. There are things parents can do to better understand anxiety, including learning what is normal and what needs their attention.

“Normal” Anxiety:

Separation anxiety usually begins around 6 to 8 months of age, and we accept it as pretty much a normal stage of development. A child that had previously been happy while getting passed around to anyone and everyone, making funny noises and faces, may suddenly become a little weary of the aunt she doesn’t see regularly. This fear of a parent leaving may not subside until she is 2 to 3 years old. By then, a child will usually cry for a short period and, with some hesitance, calm down and connect with the new person. In order for children to overcome this stage of separation anxiety, they must feel safe in their home environment, trust people other than their parents, and trust that their parents will return. Parents will play a significant role in preparing their children to deal effectively with daily stresses.

Anxiety and Fear

It’s important to remember that fear is a normal human emotion. Fear is an unpleasant feeling of apprehension caused by the presence or anticipation of danger, according to New Source Counseling. But not all fear is bad. A healthy level of fear can protect our children and us from danger.

Anxiety is slightly more broad and pervasive than fear, but can still be useful when within normal levels. Anxiety is feelings of worry, nervousness or agitation, or an uneasiness of mind and body. It’s often about something that is going to happen rather than current threats. Fear is an element of anxiety, and when these emotions get out of hand they can cause serious disturbances in our children’s lives.

Remember the following four “S’s” to assess the extent to which your children’s anxiety or fear is affecting them.

  1. Surplus: Is your child’s anxiety exaggerated from what is “developmentally normal”? Is the fear or anxiety there even when the source of danger isn’t? Is it virtually impossible for them to stop the worry?
  2. Storm: Does the fear match the level of danger? Are they easily upset and out-of-control and inconsolable? Do they react negatively when you try to help?
  3. Spoiler: Is the anxiety or fear significantly interfering with everyday activities? Does it negatively impact sleep, eating, relationships, and/or activities your child used to enjoy?
  4. Stuck: Does your child’s fear or anxiety last longer than is expected? Is the fear or worry present all day, or for weeks or months? Are they having feelings like worry, panic, or agitation that will not go away?

If the answer to these questions is “yes,” it may be time to seek some help in treating your child’s anxiety or fear.


I often tell parents they are their child’s most effective preventative therapist. Every child has fear and anxiety from time to time, but a parent can comfort and give kids the skills they need to effectively deal with their worries. At the youngest ages (newborn to 2) it's important to provide a safe, positive and responsive environment. As kids grow up, separation anxiety is normal; but it's still important to prepare kids for changes and for separations from their caregiver, get them used to new people, and reassure them that they are safe and loved. When specific fears arise (fear of spiders, the dark, clowns, etc.) parents can help their children with age-appropriate discussion, educating the child about the object of their fear, precautions they can take, and possible solutions. It is important for parents to validate children’s feelings but still comfort them.

If your child worries persistently or excessively about a specific issue, like a test, teach him or her how to problem solve and take appropriate action to eliminate worries that can be controlled. It is also effective for parents to teach basic relaxation breathing and progressive relaxation or alternating between tensing and relaxing the muscles, at a young age and practice it with your children. This is a great activity to practice at bedtime. Another popular and effective coping skill which can be practiced during times of calm is known as

 “5-4-3-2-1” Coping Technique :

Breathe in for 5 seconds, hold the breath for 5 seconds, and breathe out for 5 seconds. Continue this pattern until you find your thoughts slowing down or until necessary. While focusing on breathing, focus on the following external thoughts:

5: FIVE things you see.

4: FOUR things you can touch

3: THREE things you hear

2:  TWO things you can smell

1: ONE thing you can taste

Of course, sometimes even parents and children need a little help. If these techniques still don’t seem to alleviate the anxiety – get help early!

Be sure to ask your pediatrician if a counselor or a play therapist, or even a psychiatrist or/and medication may be needed, especially if the symptoms are interfering with experiencing a childhood full of life and laughter! Research has shown that the earlier that childhood anxiety is treated, the more successful it is treated!

Assure your kids that everything will be fine and they will do great on their tests. 

Good luck!

Get to know Lanna McClain, M.D.

I've been a pediatrician since 1996 and helped open the Cook Children's Physician Network Clinic in Burleson in 2010. I grew up in Odessa, Texas and obtained both my undergraduate and Medical Degree from Texas A&M University (WHOOP!). The best part of practicing pediatrics is seeing children grow from infancy to adulthood, and impacting that life positively! I have 2 college-age children, so I’m still working on the parenthood stuff, too! Outside of the office, I enjoy reading, yoga, playing the piano ( guitar, banjo and ukulele - too!) , and boating, fishing and paddle-boarding with my husband!  New and existing Cook Children's Burleson pediatrician office patients can make an appointment by calling 817-447-445 or by clicking here. 

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