Understanding Anxiety in Children and How To Help Them Through It

Many parents will recognise the scene: a school morning that should be ordinary turns into something entirely different. There are tears at the gate, a stomach ache with no clear cause and a child who, by every measurable standard, is fine, yet is clearly not fine at all.

Anxiety in children rarely presents itself as anxiety; instead, it manifests as resistance, irritability, sleeplessness, sudden clinginess, or a sore tummy or tears on a Sunday evening. As South Africa focuses on our youth this June, we must consider the wellbeing of our young people, with mental health firmly included in that conversation.

The scale of the issue

The World Health Organization estimates that around one in seven children and adolescents worldwide, aged 10 to 19, live with a mental health condition (Sept, 2025). Anxiety disorders sit alongside depression and behavioural disorders as some of the most common. The numbers matter, but what matters more is our understanding of the disorder and how we can better support the child.

Anxiety isn’t the enemy

A useful place to start is by separating the feeling itself from the assumption that the feeling is a problem.

Anxiety is, fundamentally, a sense of worry, fear or dread that won’t always respond to reason. It is also a normal and useful human emotion. A small dose of anxiety sharpens a child’s focus before an exam. It produces the energy that gets them onto the sports field with their head in the game. It is hard-wired into our survival system. Faced with genuine danger, the quickened heartbeat, the faster breathing and the sharper senses are designed to keep us alive.

Anxiety becomes a problem when it stops being situational and starts being constant- when the alarm system that should switch off after the threat passes simply does not switch off. At that point, anxiety stops protecting and starts interfering with daily life.

One of the heaviest things many anxious children carry is not the anxiety itself but the judgement around it. So many of us were raised to believe we should not feel anxious in the first place, and that shame associated with this belief only compounds the worry. Children need to hear, clearly and often, that anxiety is normal and can be helpful. That it does not define them- it does not make them weak or bad. The moment they learn to notice it and put a name to it is the moment they start to take some control back. Awareness does not amplify anxiety; it quietly gives a child the confidence that they can cope.

A useful reminder for any anxious child: “Feelings come and go. You felt different before, and you’ll feel different again.”

What’s actually happening inside their head

To support an anxious child well, it helps to understand what is happening at the level of the brain.

Two parts of the brain do a lot of the heavy lifting here. The prefrontal cortex is the part responsible for focus, impulse control and flexible thinking – the rational executive. The amygdala is the part that processes emotions like fear – the alarm system. In a settled state, the prefrontal cortex keeps the amygdala in check, weighing up whether something is genuinely threatening.

When a harmless situation gets misread as dangerous, however, the amygdala fires the alarm. The body switches into fight, flight, freeze or fawn mode. As anxiety climbs, the brain’s executive functioning takes a hit – logic goes offline. This is why telling an anxious child to “stop worrying, it’s not that bad” rarely works. To their brain and body, the threat is entirely real. We are not arguing with their thinking. We are arguing with their biology.

What to look out for

Part of the parental task is telling the difference between developmentally appropriate fears, everyday worries, and the kind of pattern that signals an actual anxiety disorder. Anxiety in children tends to show up in three ways:

• Psychological – persistent worry, racing or obsessive thoughts.
• Behavioural – irritability, clinginess, tears, withdrawal, difficulty concentrating, changes to sleep or eating.
• Physical – stomach cramps, nausea, diarrhoea, headaches, sweating, tense muscles, a racing heart, or tingling hands.

If several of these are showing up in your child persistently and getting in the way of everyday life, that is the signal to take it seriously.

What you can do to help

Supporting an anxious child starts with the adults around them. Here are some practical approaches that work for the whole family.

• A child who is anxious or upset cannot access rational thinking. Stay calm and make them feel safe first. Then, and only then, guide them through it. Psychiatrist Bruce Perry calls this Regulate, Relate, Reason. As parents and educators, we have to learn to co-regulate ourselves first. A few useful questions to ask yourself: How do I react when I’m stressed? What is my own relationship with anxiety? Am I unknowingly adding to my child’s worry? Do I need support before I can be the support?
• Sleep, education, exercise, diet, socialisation. These are the building blocks of mental health. Get them in place and many of the smaller pressures take care of themselves.
• Avoiding the thing that scares a child offers immediate relief, but in the long run, it only feeds the anxiety. Expose your child to their fears gradually, with you alongside them.
• Externalising anxiety and naming it as something separate, such as The Worry Monster, makes it more tangible and turns it into a common enemy in the house, rather than a defining feature of who the child is. It is empowering: ‘I don’t have to do what the Worry Monster says.’
• Because anxiety is future-focused, grounding pulls a child back into the present moment. Some examples that work well:
  • The 3-3-3 Rule: Name three things you can see, three things you can hear, and three ways to move your body.
  • The Colour Game: Choose a colour and find or name everything in the room that matches it.
  • Barefoot Break: Let your child walk barefoot outside, paying attention to the ground beneath their feet, breathing deeply.
  • Breathwork: Teach slow, steady breathing. There are plenty of guided versions online that you can do together. My favourite is the physiological sigh. This involves a double inhale through the nose, followed by a long, slow exhale through the mouth.

The goal is not a worry-free childhood

Anxiety is not the enemy; it’s a normal, even necessary, human emotion. Learning to regulate emotions is a skill that children learn when they are supported by an adult. When we, as the key adult, co-regulate, they develop the metacognitive skills to regulate themselves. 

With patience, the right strategies, and steady support, we can teach our children something far more useful than a worry-free childhood. We can teach them: “I can feel anxious and still be okay.”

For more resources, visit www.bellavista.org.za