Anxiety in Pre-Schoolers

Archived Q&A and Reviews


Panic attacks in 4 year old?

March 2006

I am the parent of three daughters, 8, 4, and 4. One of my twins seems to have panic attacks when she is overloaded. For example, when she can't find her blankie and has looked all over the house for it. Or when we're getting down to the wire on getting dressed and leaving the house and she has to choose what she's going to wear RIGHT NOW.

I know quite a bit about panic attacks on the adult side -- I've had them off and on for 20 years. I've learned how to control mine and I know they're hereditary. But I'm fearful for my daughter who seems to get them now perhaps once every few weeks.

Has anyone experienced this with their young child? Have any words of wisdom for me? My husband and I can calm her down but I just don't want her to have to go through this.

Many thanks. Concerned Mommy

If she is truly developing panic attacks, I would really recommend you taking her to a psychologist or psychiatrist or behavioral pediatrician (Ann Parker) comes to mind. these people can evaluate if she truly is having panic attacks or just needs a better way to cope with stress and hopefully can recommend some behavioral interventions so her life is better ... Sophia, pediatrician, adolescent medicine specialist

It sounds to me more like anxious behavior.

A panic attack is a very extreme form of anxiety where you feel like you are going to die. My Aunt suffers from panic disorder. When she has a panic attack she is absolutely terrified. Her heart rate goes up and she can hardly breath. It is debilitating.

It sounds to me from your descrition of your daughter that it might be mild anxiety which can be, in part, learned behavior in children. I suffer from mild to moderate anxiety attacks. Anxiety along with panic disorders do run in my family, but I sometimes wonder how much ''heredity'' is also learned behavioral patterns being passed down. I grew up watching my mother have anxiety attacks where she would overreact and worry about all kinds of things. Sometimes she would break down in tears over very simple problems. For me an anxiety attack often comes when I'm feeling like I'm loosing control. I often feel in such a state that I am like a child again, vulnerable, scared with no sense of security. I'm positive that a great deal of my coping skills are learned from my mother.

My daughter who is now 5 years old has seen me go through quite a lot of anxiety attacks. Whenever my daughter looses something or something doesn't work right, she freaks out, worries, starts to cry and sometimes acts like she is ''panicking'', but really she is just having a real difficult time dealing with her feelings of anxiety. Other than that, she is very healthy, normal and manages just fine socially and where ever she goes. I know my daughter must have learned some of her coping skills from me. I haven't been a good role model.

With that said, all children are naturally emotional and don't know how to deal with their feelings. We as parents teach our children how to deal with their emotions by being role models. Your daughter sounds quite normal to me, but who may also need some special guidence on how to deal with her emotions before her coping skills become so habitual that it is a real problem later in life. The best thing you can do is keep your own anxiety attacks under control, for your children's sake. If you need extra help with your daughter, find a family therapist who specializes in anxiety disorders. Anon

4-year-old increasingly anxious about preschool

Dec 1999

Do any of you have advice for parents of an increasingly anxious 4 year-old boy? Our son seems to be getting more stressed about transitions and/or group activities with each passing month. For example, he has been attending the same preschool for nearly 2 years now, and the same after-school classes for 4 months. Yet in the past month he has burst into tears and become physically ill (aka thrown up) at the prospect of attending these programs. I do not believe that anything unusual is happening at either place -- in fact his nanny or parents are always observing the after-school program.

We have had many conversations with our son about his anxiety. We always try to reason with him during and after one of his episodes by asking him what caused the anxiety and giving him tips on how to manage it. Although he knows that he has no reason to be anxious, it doesn't seem to be helping him.

Our concerns are multiple: why is he getting more anxious? what is causing the anxiety? how can we mitigate the anxiety? how can we stop his physical reaction to the anxiety -- as it seems to only add to his stress? is this a phase that he will grow out of? or should we see a mental health specialist now? how do we find a good mental health specialist? Thanks in advance for your advice or referrals.

In response to the anxious 4 year old: I don't know anything about a young child having anxiety, but from an adult's perspective, the attacks can create a vicious cycle. One begins to have anxiety about having anxiety attacks. If you decide you want to talk to a professional, Dr. Relinger's office (building next to Alta Bates) works with children and Dr. R specializes in anxiety.

Can your son describe anything specific about the program that causes the anxiety? You might want to get him in to just talk a bit with a child psych specialist in order to determine what is going on with him, if you can't get anything comprehensible out of him in your current communication formats. It may be that something that the nanny sees as perfectly normal is seen as a traumatic event by your son, such as being pushed by another boy, or whatever. Remember that adults have the calluses of experience protecting their feelings about interactions with others, and children - especially emotionally perceptive ones - often do not. I have seen nannies from other cultures treat blatantly unfair and selfish behavior from one child toward another as though it were unimportant, and focus their displeasure instead on the child who protests at such behavior, instead of where it (in my view of the aggressor, at least) belongs. this does not decrease the disturbance of the child who feels unfairly treated, but rather reinforces his negative feelings, such that s/he can become the whiner the nanny started out by casting him/her as. One simple disagreement over length of time on a swing led to exactly this development in a Berkeley tot lot while my child was playing nearby -- I had to remove him eventually because when the offended child was treated as though he were the problem, he became nearly hysterical in trying to get the nanny to admit that he was not the wrongdoer.

Your description is helpful and gives a bit of a picture of the struggle that your son must be having, although in my experience it's fairly difficult to tell from an email post just what is going on to cause the response he's showing. As a therapist who works with children/families, I'm also struggling a bit with how much to actually respond via an e-mail posting, but here are a few things that I hope will be of support: --I know your son is 4, but I'm not sure where on the 4 side he is...closer to 5? just turned 4? Anxiety over separation begins to reach a peak as the child approaches 5. It's not uncommon for a super-friendly, active, socially adjusted child to begin finding monsters under the bed, mysterious killer flying squirrels in the closet, etc., at around this time. Nightmares and night terrors can increase again, too. The reasons for these fear/anxiety responses are complex and have as much to do with the child's unfolding physical development and growth as their psychological state and specific social circumstances. --If I were to see your child in my practice, I would be wondering some things to begin with: was there a kind of specific starting point to what looks like anxiety? is what looks like anxiety actually anxiety (and not depression (yes, not uncommon!); a primarily physically-based response, etc.? Anxiety is often a symptom, as you know, and the vomiting may be a symptom of the anxiety (e.g., he gets himself so worked up and upset he begins to hyperventilate, which makes him queasy, which makes him throw up), but it may also be an important symptom in and of itself and a clue to the related anxiety that may drive the vomiting. I would be wondering what else is happening with the child...when the anxiety symptoms begins at school...what helps them there a person or activity in this environment that seems to stimulate either more anxiety (or restlessness, avoidance, agitation, anger, fear) or seems to stimulate relaxation (laughing, laying around, playing, ability to leave you, etc.). In the worst case, something may be happening at the school that is harmful or scary to him that he can't tell you about (and probably he doesn't understand himself). I don't say this to alarm you, but to raise the possibility on the extreme end, of taking the tantrums, anxiety, etc., as a sign of something really wrong in his environment. I would be wondering what life is like at home, too. Don't get too worried--I'm not talking about blaming the parents, here. In fact, if his world at home is wonderful, happy, safe, secure, etc., it may in some ways make the 4-5 transition even more difficult out of the home. Kid's often try to protect their parents, too. If a child senses that his/her parents might not be okay if they leave, they can exhibit problems or try not to separate in order to allow the parents of a little child to continue being the parents of a little child (and not the parents of an increasingly autonomous preschool child). It's pretty cool, if you think about are basically altruistic, in my opinion. They want their parents to be happy, and will pretty much do whatever (in their young minds) they think will keep things in the family happy. If that means being a little kid for a while longer, they'll do it. For example, a family I worked with recently was concerned about their 5 year old saying she REALLY wanted to wear diapers again and feed from a bottle. This was her demand despite lots of good feedback from school and her being a basically happy kid at home and with friends. Over time the parents realized they were actually experiencing a deep loss over not having their adorable baby with them anymore (subtle comments about baby clothes while window shopping... talking about how cute and wonderful their daughter was as a baby, etc.). Their own felt experience was that they just LOVED their daughter through and through (including their growing independent child) and wanted to express all of it. But their child was picking up on the loss that her parents hadn't yet acknowledged and had somehow figured that if she could be a baby again, it would just make everyone happy. They all have worked it through really nicely and I must say that the child never talked with me directly about the issue; it was all done through play therapy.

So...on another road of possibilities, it may have to do with his fears about separating from you/your family and the anxiety/illness is a way that keeps you all very connected and close to each other at a time when the world is becoming a BIG place and being close to mommy and daddy is a heck of a lot better, even if you have to get physically ill to do it. Of course, being taken care of when things feel bad is something we all want when we're scared/upset. We all feel like kids (we regress to earlier behavior) when we feel vulnerable. Vomiting is a very basic response to something not being wanted internally and (hopefully) it brings those we love close. However, this doesn't mean your son is somehow controlling his anxiety and vomiting and using it consciously to manipulate your attention.

--Can you stop his reaction? I would softly suggest that the goal here might be not to stop his reaction or to reason him out of it. Again, he isn't doing it on purpose to you, he is trying to find a way to communicate something that can't be communicated right now with words. If I worked with him (or a child in a similar situation), I wouldn't talk with him about his anxiety. I would play with him. The use of play therapy in a situation like this can be very helpful and it reflects the primary way that a 4 year-old communicates with the world of others. All the themes and worries eventually come up, but its an indirect way of approaching something that may be scary and allows the child to express his/her concerns without fear of punishment for having the feelings/communicating them to others, etc.

Please do take my remarks with caution and a tablespoon of salt. I know next to nothing about your real live son or your family. These are very generic sorts of responses but I hope you find them helpful. I do think that vomiting and increasing anxiety at school is a cause for concern. I think that you wouldn't be overreacting to talk to a child and family therapist but I would certainly continue to be, as you are, in close communication with your child's teacher to determine as much as they know, what is going on at school, inside and outside the child's immediate awareness.

One last important thought: kids at 4 generally do get more anxious when we try to tell them they don't need to be anxious. Unfortunately, we mean really well, but the general message they often get is Dad (or Mom) is so worried about this really horrible thing that is really, horribly TRUE and threatening, just like I thought it was, that they are spending a LOT of time telling me not to be really horribly worried about it. In other words: PANIC! Adult reason is different than child reason (until the child can reason abstractly at around 11/12). It is a tricky thing to bring to bear with a 4 year-old, because while you can control the degree to which YOU are being completely reasonable, you cannot control the way a 4 year-old reasons things through with the reasonable information you give to them (e.g., there's nothing to worry about; I'll protect you if anything bad happens; If it were really bad, I'd know about it and do something right away; why are you so upset, honey? you REALLY love_____(school, Billy's, Grandma Rose's,us, your sister, your blankie, your toy closet, etc.).

Please feel okay to call me at the office if you want to speak further or to obtain a referral. (Michael Simon, 510 433-2959). Thanks!

Hello, it would help the group of parents here who are trying to give you advice on your problem, if you'd please describe your 4-year old's typical daily schedule. What is his normal day like? I'm reminded of a radio talk show psychologist where a caller reported that his young child was elaborately pretend-washing his hands for long periods before bedtime. The radio shrink asked what was the kid's daily schedule? Turned out the kid was involved in about a dozen athletic, music, karate, hockey, clubs, the school play, you name it, and didn't have any down time to just be a kid. So... please let us know his typical schedule so that we can make some realistic assessments for you. Good luck!

Regarding the anxious 4-year-old, if his anxiety began with school, you could arrange for a therapist to visit the school on a normal day when he is there and observe. This should be something the school is happy to do (if not, I suggest you reconsider his placement there), and it is likely to give you some new insights about what seems to be triggering his anxiety. I do think that a child who throws up because he is frightened needs to be taken seriously.