Anxiety, by Age

In one sense, anxiety is the same thing all through childhood. It’s the body’s signal that it has decided something is dangerous, in a child who doesn’t yet have the experience or the words to switch that signal off again. What changes between four and eighteen is what the worry is about, and what she has to get on with while it’s going on.

That’s why anxiety is so confusing for parents. The four-year-old who won’t be put down doesn’t look like the same problem as the fifteen-year-old who won’t get on the bus. They look entirely different, and the cause is entirely different. Strategies that helped at four can stop helping at ten, and the ones that help at fifteen would have terrified the four-year-old.

So this is a guide to all of it, age by age. Each section covers a band of years: the kinds of worry that come up at that age, what tends to help, and when to ask a counsellor for help. At the end of each one we name the chapters in this library that go deeper.

Most of what’s described here is normal worry, in the strict sense of the word. Normal doesn’t mean small. When the people around a child respond to it well, normal worry is how a young brain learns that the world is mostly safe, and that she can cope with the parts that aren’t. The adults around her can’t take the worry away; their job is to stay calm while it passes. That’s true at four, eight, twelve and sixteen.

Ages four to seven · the small, whole-body worry

When a four-year-old decides that going to the loo at school is dangerous, she is telling you, with the full force of her body, that part of her felt unsafe in a place she couldn’t leave. It comes out as a stomach ache, a tantrum at drop-off, not being able to sleep alone, or refusing to be parted from a parent more fiercely than the situation seems to call for. Children this age don’t separate themselves from the worry. For as long as the wave lasts, it takes them over completely.

At this age, what helps is mostly to do with your body.

A child this age can’t reason her way out of the wave, because the part of the brain that does that is still developing. What she can do is ride it out next to an adult who isn’t afraid of it. This is co-regulation: lending her your calm until her own nervous system can manage by itself. It’s the single most reliable intervention for early-years anxiety. In practice it means sitting on the floor with her, at her level, with a slow voice and relaxed shoulders. It also means giving her time, which children this age can feel, and which adults often find harder to give than they expect.

What doesn’t help at this age is interrogation. A four-year-old who is told to use her words and say what’s wrong often doesn’t have the words yet. “But why are you upset?” is usually a question she can’t answer. A better question is one you mostly ask yourself: “What does she need right now to calm down?” The answer is almost always less stimulation, someone familiar to lean against, and time to settle at her own pace.

When to ask a counsellor. If the worry has reorganised the household. If bedtime has stopped working for weeks rather than nights. If a child is regressing, in toileting or in speech, around an anxious moment that was not there before. If the worry has started to limit what the child will try, beyond the usual cautiousness of this age. A short conversation with someone who specialises in the early years is rarely wasted. It often costs less than parents fear, and it can save a year of muddling.

If you want to read more about this age, the chapter to go to is Big Feelings and Co-Regulation. It’s built around the broken-banana moment that is so typical of these years.

Ages eight to eleven · when the rumination begins

Somewhere around eight, worry starts to work differently. The whole-body wave is still there at bedtime and on the morning of a test, but something new comes with it: the child begins to think about the worry. She rehearses it and runs the scene over in her head. She asks the same question four times in a row. She heard the answer; it just didn’t settle the worry for long. This going over and over is called rumination. At this age it’s what drives the worry, and it’s exhausting, for her and for the people around her.

School also asks more of her at this age. Friendship groups shift and the work gets longer. A Year 4 child notices, for the first time, that she finds maths harder than her best friend does. By Year 5, for families facing the eleven-plus, the exam has begun to organise the household. Anxiety that lived in the body in the early years now starts to attach itself to particular things: tests, friendship pairings, the Sunday evening before a school week, the seven minutes before a piano lesson.

Two things help at this age, and they can feel slightly contradictory.

The first is the company of an adult who takes the worry seriously without getting caught up in it. A nine-year-old who tells you she’s worried about being last in line at lunch wants you to understand that the worry is real, and also to see that you aren’t going to react with the same intensity she feels. A reply like “But that’s silly, you’ve got nothing to worry about” dismisses the worry. A reply like “Yes, that does sound difficult. What would you like to do about it?” makes her slightly bigger than the worry.

The second is unhurried, low-key exposure to the thing she’s worried about, with no dramatic confrontation. A slow walk past it, with someone she feels safe with, lets her body learn that it’s survivable after all. Avoidance is what keeps anxiety going. Every time you let her leave the room instead of going in, the worry gets bigger. Every time you help her stay in the room a minute longer than she wanted to, the worry gets smaller. Don’t apply this rigidly, though. There are days when a child has no fight left, and the kind thing is to leave the room. But over a season, the direction of travel should be towards the worry, not away from it.

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When to ask a counsellor. If the rumination is keeping the child awake on most nights for more than a few weeks. If the worry has started to insist that things which are not dangerous are dangerous, and will not be moved on it. If school avoidance has settled in. If she has begun to police you, asking you to perform reassurance rituals that grow over time. If she has dropped an activity she once loved because the worry has attached itself to it. If your own anxiety, which is understandable, has started to organise the day along with hers. Any one of these on its own is reason enough to pick up the phone.

For this age, the chapter in this library is When Reassurance Stops Working, written for the years when rumination starts. The 11+ Year goes with it, for families whose Year 5 has been taken over by the exam.

Ages eleven to fourteen · the social tier

Adolescence doesn’t arrive on a particular date. It creeps in, sometimes from late Year 6, more often through Year 7 and 8, and worry changes again with it. The test, the dog and the loo at school matter less now. The main thing she worries about is herself, as other people see her: the peer group, the group chat, the way she looked when she walked into maths that morning. That’s where her anxiety plays out now.

This is the age at which social anxiety, in its proper clinical sense, often begins to develop. It’s also when school stress, body image, comparing herself with others on social media and being left out of group chats all start to tangle together. From the outside, you often can’t tell which of these is behind it on any given day, and often she can’t either. What she can tell you, very fluently, is that the worry is real and that she doesn’t want to talk to you about it.

In many cases, what helps now is the opposite of what helped at eight.

A direct question, face to face, will almost always be deflected. A conversation side by side, in the car with the radio on and no eye contact, will sometimes go somewhere. If you can put up with not being told things, while making it clear you’re there when she wants to tell you, she will eventually come to you. If you pursue her, however lovingly, she’ll experience you as the threat her worry is already trying to manage. That’s what makes these years so hard for parents. What you most want to do, which is to know everything and fix it, is what will stop her talking to you. What keeps her talking is mostly waiting.

The other thing that helps is having one or two other adults she trusts: an aunt, a counsellor, a tutor, a coach, a head of year who knows her by name. A thirteen-year-old who has even one trusted adult outside the household, someone she can take a difficult thing to, tends to do better through these years. In our work, it’s one of the most reliable protective signs we see. Odd as it sounds, your job is sometimes to help build the support that doesn’t run through you.

When to ask a counsellor. If a child has stopped speaking up in class for a whole term and the school has noticed. If sleep is being lost across several nights a week, every week, with worry as the named cause. If the worry has started to make her turn down social events she once enjoyed. If the worry now brings physical symptoms that were not there before, such as a stomach pain that arrives every Sunday evening or a headache that always falls on a maths morning. If a child has begun to talk about herself in language that surprises you, that is sharper or more disqualifying than what you know to be true. If self-harm or persistent low mood has entered the conversation in any form. Some of those need a counsellor; some of them need a GP first.

For this age band, read Perfectionism, What to Do When School Is the Problem and When They Stop Talking to You. Between them they cover most of what early-teenage worry is about.

Ages fourteen to eighteen · the worry that looks like other things

By the middle of senior school, anxiety often doesn’t look like anxiety any more. It can look like sleeping until noon, an unfinished essay, or a flat refusal to go to a school event she has been to four years running. It can look like withdrawal or irritability. Or it can look like a teenager who has, in the last term, gone still in a way you recognise as new but can’t place.

In the late teenage years, worry and identity meet. To a Year 4 child, questions like “Who am I?”, “Who gets to know that?” and “What happens to me if the wrong people find out?” would have seemed abstract. Now she is living them, on top of the practical pressure of GCSEs, A-levels, university applications, friendship groups that are starting to get smaller and closer, sexual feelings, first relationships, and the question of what comes next, which hangs over all of it.

Parents at this stage often feel they can no longer read their child the way they used to. That’s fair, and doing your best to read her anyway is most of the job. If you can stay curious without interrogating her, be around without making it a demand, and keep the long view in conversations she treats as short ones, you’re doing most of what a parent can do at this stage.

What helps at this age is acknowledging plainly what is hard, without rushing to fix it. A sixteen-year-old who is told she’ll be fine, when she doesn’t feel she will be, hears that you don’t see her. A sixteen-year-old who is told in plain terms that this is a hard time, and that you’re going to be alongside her through it, has been seen. That’s what lets her work the problem out in the end, often without you having a hand in it.

The other thing that helps is professional support she has had a say in choosing. A counsellor you pick and present as the solution is much less likely to work out than a list of three that you offer and she chooses from. The worry is trying to take away her ability to make her own choices, and recovery has to be built out of those choices.

When to ask a counsellor, in this band. If the worry has begun to run the young person’s day, in the sense that what she does and where she goes is being decided by what she is willing to face. If sleep has gone for weeks. If eating has changed in a way that has not changed back. If alcohol or other substances have entered the picture as a way to manage feeling. If a parent has heard, even once, language about being a burden, about not wanting to be here, about wishing they were not. If a young person is asking, even obliquely, for help. None of these need the parent to handle alone. All of them are reason enough to ask.

For this band, read Eating and Control, When Your Child Is Working Out Who They Are, When They Stop Talking to You and Body Image, which go deeper into the late-adolescent years.

What stays the same, across all the ages

Three things don’t change between four and eighteen.

The first is that the worry is real. In any clinically useful sense, it isn’t a problem of willpower or attitude. An anxious child’s body is telling her, with the full force of equipment that evolved over hundreds of thousands of years, that something is wrong. Her body is often wrong about the size of the thing, but she really is scared.

The second is that the company of a calm adult is the most reliable intervention at every stage. The four-year-old needs you close, the fifteen-year-old needs you in the next room, and the eighteen-year-old needs you on the phone. What doesn’t change is that she needs you calm. You can be afraid for your child and still be calm with her. No app or technique replaces this, and the techniques work best when it’s in place.

The third is that worry can be worked with. Children come into therapy worried and leave less worried. Parents come in feeling defeated by it and leave better equipped. Looking back, the anxious years of childhood aren’t the ones that defined the child. They were the years she learned what to do when her body told her something was bigger than it was.

When to ask, in plain terms

At every age, the sign that worry has tipped from normal into clinical is roughly the same: the worry has begun to make decisions for her. It is choosing what she will try, where she will go, who she will speak to, what she will eat and when she will sleep. When that has been happening for weeks, not days, and when the everyday support around her has not been able to shift it, that is the time to put your hand up.

Putting your hand up doesn’t mean booking a course of therapy that day. Often it means a short call to the school’s pastoral lead, your GP, or a private counsellor who knows the age group. Most of those conversations end with some advice and a wait-and-see plan. Some end with a referral. Either way, you’ve done the right thing.

You don’t have to deal with your child’s worry on your own, and nor does she.

NOTES

1. Lebowitz, Eli R. Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents. Oxford University Press, 2021. The SPACE programme developed at Yale: how loving accommodation keeps an anxious avoidance in place, and how a parent can step back from it, gradually and supportively, one accommodation at a time.

Where to go further

Eli R. Lebowitz, Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents This is the SPACE programme, developed at Yale, written up for parents. It’s the clearest single account we know of how loving accommodation can keep an anxious avoidance in place, and of what a supportive response looks like instead. It’s the right next step if your child is younger or of primary-school age.

Daniel J. Siegel and Tina Payne Bryson, The Whole-Brain Child The clearest writing we know on co-regulation and on name it to tame it, the approach that underpins any conversation with an anxious child. It’s the book to reach for at the early-years and primary end of this chapter.

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A chapter from The Parent Book, by the therapists at Kensington Square Therapy. Registered with the BACP and the NCPS.