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13:32 PM

Understanding and Helping Your Child's Anxiety. A Pediatrician Looks at Cognitive Behavioral Therapy.

By Michelle Bailey, M.D.

It’s natural for parents to want to protect their children when they are distressed. But when it comes to anxiety, taking kids out of anxiety-provoking situations may not always be the right answer.

In fact, we should make a distinction between positive stress and clinical anxiety. Understand that an episode of anxiety/fearfulness/avoidance isn’t limited to a full blown clinical anxiety disorder.

Positive stress (like fears of taking a test, or going down a slide, etc.) is actually vital to normal child development and for teaching a child coping skills and the resiliency in learning to fail and then try again.

If a child’s anxious responses are expanding or not improving, however, they need to seek the help of a psychologist or therapist who can help assess the scope of the problem and craft a unique treatment plan that may include Cognitive Behavioral Therapy (CBT).

The psychologists we spoke to for this article found the parent often have an underlying anxiety disorder that may be untreated. While CBT is one very helpful treatment option (and one that is very applicable for straightforward anxiety in older teens and adults), kids are very different and there may be other factors mitigating the anxious response.

By attempting to protect your children from these situations, you may actually be enabling them to avoid and escape the situation. Then kids never learn to work through the root cause of their anxiety.

Here are 5 quick facts to remember:

Fact 1: Your child may not be happy or comfortable all of the time, and this is OK.

Fact 2: It’s difficult to see your child frustrated or disappointed, and this is also Ok.

Fact 3: Your child WILL get angry with you, and this is OK

Fact 4: Your child WILL say mean things to you, and this is also OK

Fact 5: You do not need to rush to fix it/ make it better.

Fact 6: Your child’s anxious behavior is NOT a reflection on you as a parent.

Anxiety affects 25% of children ages 13 to 18. Let untreated, anxiety can lead to depression, academic underachievement, poor social skills and substance abuse.

Sometimes, it’s difficult for parents to recognized anxiety. Kids can become easily frustrated with changes, have meltdowns, over-react, be difficult to soothe, be very reactive, struggle with transitions, be easily embarrassed, not be able to tolerate feedback/criticism, etc.

Parents (or others), may see these emotions as an anger, mood or ADHD issue, when there can be more to it, and testing can be helpful to decipher it.

One of the best treatments for anxiety is Cognitive Behavioral Therapy (CBT) from a licensed behavioral health specialist, and has proven to provide better symptom reduction than medication for most children. While licensed psychologists play an important role in behavioral health, in terms of providing psychological testing, as well as therapy, our licensed professional counselors at Cook Children’s are vital as well in providing and teaching very creative and useful coping skills every day.

When choosing a CBT therapist, make sure they use “exposure” technique. The goal of CBT is to teach people how to help themselves through anxiety-provoking situations, not to escape or avoid them.

Cognitive Behavioral Therapy will help the parent too, as a child with anxiety affects the entire family unit. There is no “cure” for anxiety, but there are resources to learn to manage it differently. Don’t take away the opportunity to experience bad things, or your child will become emotionally fragile and never be able to handle anything.


  • Teach by example and be aware of your own feelings/ actions
  • Praise the effort
  • Don’t reward the wrong behavior
  • Plan 15-30 minutes a day of one-on-one time
  • Allow 30 minutes of decompression time after school with activity the child needs: either physical activity or calm activity
  • After a tantrum, talk about it, learn to problem solve
  • Find something to be grateful for in a bad situation/ outcome

Much like a peanut allergy is the body’s over-sensitivity to peanuts, anxiety is an over-sensitivity to worry. Anxiety can include:

  • Overestimating danger
  • Expecting the worst

Physical symptoms such as palpitations, difficulty breathing, stomach upset, trouble sleeping and attempting to avoid any perceived anxiety-inducing situation.

To learn more about Cook Children's Behavioral Health services, click here.

Get to know Michelle Bailey, M.D.

I’m a board-certified pediatrician, passionate about ensuring the well-being of patients ranging from newborn through late teens.

I attended medical school at the University of Oklahoma (Boomer!), and completed my pediatric residency in Houston.

Since the completion of residency I’ve worked in outpatient clinics and enjoy not only caring for my young patients, but becoming a part of every family by building long-lasting, trusting relationships. While I treat common and not-so-common childhood infections and diseases, I especially have a passion for asthma and allergies, nutrition, and ADHD along with other learning disorders.

I’m married and we have a rescue dog named Jack. When not at work, I enjoy attending cultural events and traveling. To make an appointment with Dr. Bailey, click here or call 682-303-1000.

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