Anxiety is something many children experience, and it’s important to remember that feeling worried or afraid is a natural part of growing up. Children may feel nervous when meeting new people, starting a new activity, taking a big test, or facing challenges, and these feelings usually pass once the situation is over.
Sometimes, though, anxiety can become more intense and start to interfere with daily life. When worries are persistent, overwhelming, or appear even when there’s no real threat, a child may be experiencing an anxiety disorder. Without support, this can affect a child’s confidence, school performance, friendships, and overall well-being.
You’re not alone if you’ve noticed these signs in your child. Anxiety disorders are common and will affect about 1 in 3 kids and teens by the time they reach the age of 18. Some research suggests rates have increased since the Covid pandemic. The good news is that with understanding, early identification, and the right support, children can learn to manage their worries and thrive.
As a parent and Child Psychiatrist, I understand how difficult it can be to determine the best course of action for your child’s illness. If your child is struggling, you may be wondering: Is it time to consider medication? This is a major decision that I also had to make for my own child. Fortunately, there are evidence-based, safe and effective therapeutic and medication options available.
1. Confirm Diagnosis
Before considering medication, it’s important for your child to have a thorough assessment. A pediatrician, child psychiatrist, or therapist will conduct a clinical exam to confirm that your child meets criteria for an anxiety disorder. Your provider will also screen your child for other mental health illnesses that often co-occur with anxiety disorders, for example depression or ADHD. Your provider may utilize one or more of the following screening tools:
- Screen for Child Anxiety Related Disorders (SCARED)
- Generalized Anxiety Disorder-7 (GAD-7)
- The Spence Children’s Anxiety Scale (SCAS-Child)
- Revised Children’s Anxiety and Depression Scale (RCADS)
- Patient Health Questionnaire-Modified for Adolescents (PHQ-9/A)
- Vanderbilt Assessment for ADHD
*This is not an exhaustive list of potential screening tools
As treatment progresses, your provider may repeat one or more of the screening questionnaires to determine treatment progress.
2. Treatment
- Therapy:
For most children with mild to moderate anxiety, the first line recommended treatment is therapy. Cognitive behavioral therapy (CBT) is an evidence-based treatment that helps children understand how their thoughts, feelings, and behaviors are connected and learn skills to challenge unhelpful thoughts and face their fears. Parent guidance is also recommended to help parents better understand their child’s challenges and to equip parents with the necessary skills to support their child through treatment.
- When to Utilize Medication:
Medication is usually considered when anxiety symptoms are moderate to severe or when symptoms significantly interfere with a person’s ability to participate effectively in therapy.Severe anxiety can be paralyzing and life altering. Studies have shown that a combination of medication at a therapeutic dose and therapy improve outcomes better than either alone.The most prescribed medications to treat anxiety include SSRIs (selective serotonin reuptake inhibitors), such as fluoxetine (Prozac) or sertraline (Zoloft). These have been well-studied in children and are generally safe when prescribed and monitored carefully. There are always risks to both taking and not taking medication. It is important that you discuss the risks and benefits of both options with your provider.
What happens when a child starts on a medication to treat anxiety:
- Medication doesn’t “change” who your child is; it helps reduce the anxiety so they can show up fully in school, friendships, and family life and utilize skills to better manage symptoms.
- The pace of medication will be tailored to your child’s needs: While providers often “start low and go slow,” they may move more quickly if your child’s symptoms are severe or require more urgent relief.
- While SSRIs can take 4 to 6 weeks to reach full effect, some children may begin to feel subtle improvements sooner as the dose is adjusted to meet their needs.
- Initially, you will have more frequent check-ins to monitor for side effects and improvement.
- Other medications may be added as secondary agents to support or improve the initial medication.
- Your prescribing provider and therapist will work closely together to collaborate regarding your child’s care.
- Medication may not need to be a forever treatment option. As therapy continues and a child’s brain develops, their need for medication may change. However, it is recommended that a child remain on medication for at least six months to one year after remission of symptoms to reduce the risk of relapse.
Side Effects:
Many parents worry about side effects or whether medication will change their child’s personality. Here’s what to know:
- Most side effects, such as mild stomach upset, headaches, or sleep changes, are temporary and manageable.
- Serious side effects are rare, and clinicians provide careful monitoring, including discussing the FDA’s black box warning about suicidal thoughts.
Deciding whether to use medication for your child’s anxiety is a difficult and personal choice. The first step is diagnosis and identifying a trusted provider to support you through the process, answer questions, and identify available options. There is no magic pill. However, anxiety disorders are highly treatable, and with the right care (including medication when indicated), children can learn to effectively manage anxiety and live happy and fulfilling lives.
