You may be afraid of being afraid

Psychiatry, psychosomatics & psychotherapy

Expression and symptoms of various forms of anxiety

Fear of darkness, monsters etc.

If children are afraid of the dark, being alone, storms, animals, monsters or strangers, parents can first take away the threat of the acute fearful state through comforting affection and physical closeness. In the next step, you can offer your child to work together to get to the bottom of the cause of the fear. Addressing their children's fears will best help them understand and overcome their fears.

If parents are unable or no longer able to reduce their children's fear to a "normal" level through discussions and affection over a longer period of time, they should seek help from the child and adolescent psychiatrist.

Around 3 to 6% of children experience so-called night terrors (Pavor nocturnus). These usually occur one to four hours after falling asleep. The night terrors startle the children out of their deep sleep with a scream. You are drenched in sweat, unresponsive and your heart is racing with fear. Often they cannot be touched and lash out. Then, just as suddenly, they sink back into a deep sleep and, unlike nightmares, cannot remember anything the next morning.

This sleep disorder leaves no damage and is usually not related to a mental disorder, but to the development of the central nervous system (CNS). A kind of overexcitation of the not yet fully developed nervous system during sleep triggers a night terrors. Overtired or sick children are more likely to develop night terrors. Medication or sleeping in an unfamiliar environment can also provoke a night terrors.

Parents should talk quietly to their child, reassure them that they are safe and make sure they cannot be injured. Waking up a child during this phase does not make much sense, as it is then disoriented, confused and difficult to fall asleep again. The seizures can be reduced through regular bedtime times, the reduction of stress or fatigue and the introduction of sleep rituals.

If the nocturnal seizures occur frequently, parents should report them to their pediatrician. If necessary, he can refer to a child and adolescent psychiatrist. Especially in preschool age, a shock at night can indicate unresolved problems and fears in the child.

Children between around 7 months of age and pre-school age may be afraid of separating from their mother, especially in unfamiliar surroundings. In the majority of cases, this is part of a normal development process. However, when children begin to constantly control the mother's presence or refuse to go to kindergarten or school (avoidance of school), this indicates problematic separation anxieties. Separation anxiety may be preferred after a stressful event such as the death of a pet or relative, a change of kindergarten / school, or a move to a new environment. If the fears are pronounced or intensified and the daily activities and experiences of childhood - such as being temporarily separated from parents, regular school attendance, and making friends - are influenced, the parents should get a professional assessment by a child and adolescent psychiatrist perceive.

A child or adolescent with severe separation anxiety might have the following abnormalities:

  • Constant thoughts and fears about your own safety and / or that of your parents
  • Avoidance of kindergarten / school attendance
  • Avoiding visiting friends alone
  • Frequent stomach pain and other physical ailments
  • Strong fear of spending the night outside of the parental home
  • Very affectionate behavior at home
  • Panic or seizures ("Koller", "Rappel") when separated from the parents

A child and adolescent psychiatrist should be consulted if these signs show. More information on separation fears among school children can be found in the article “School avoidance”.

Between the ages of 6 and 12 years of age (parallel to school entry) there may be fears of performance, i.e. worries about unattainable performance requirements and social anxiety (social phobia) that is associated with shyness in social contact with classmates or teachers. These fears can also add to an existing fear of separation or loss. The child is afraid of real situations, namely humiliation, embarrassment or aggression from other children, a poor performance in school.

At Performance fears Affected children show pronounced fear of exams and failure. The children are less afraid of the exam situation, but rather their mental image of impending failure. They are excited, worried, and prone to extremely pessimistic assumptions that they will not make it or that they will be embarrassed long before an exam is due. Feelings of hopelessness and despair, a worried and depressed mood dominate. Typical physical (or psychosomatic) signs are abdominal pain, nausea, diarrhea on the morning of the exam day, headache, sweating, tremors, urination, sleep and concentration disorders. For some young people there is a “blackout” right during the exam; suddenly they can no longer think or concentrate properly. With this form of test fear, the fear of failure before the test is completely or largely absent.

S.socially fearful children typically take a back seat in many areas of life where they fear being scrutinized and failing to meet the expectations of others. The social fears can cause stressful physical and mental side effects in the respective situations. In addition to complaints such as palpitations, tremors, sweating, dizziness, nausea or shortness of breath, some fear that they will vomit.

The anxiety symptoms lead to the fact that social situations or situations with performance demands are associated with increased emotional stress and are avoided in order to spare oneself the associated unpleasant sensations. If school-age children or young people give in to this impulse, this fear of school is followed in some cases by avoidance. More information on school anxiety among children and adolescents can be found in the article “School avoidance”.

If these fears are pronounced, a child and adolescent psychiatrist should be consulted.

Panic disorder is a common anxiety disorder in older teenagers, but it can also occur in childhood. People with panic disorder experience repeated, unexpected or situation-related panic attacks with accompanying physical symptoms such as "palpitations" or a feeling of suffocation. The attacks can last from minutes to hours and often occur without warning. Panic disorder in children and adolescents should be treated by a specialist in child and adolescent psychiatry.

Children with depression often suffer from anxiety as well. Depressed kindergarten children often show severe separation anxiety and reduced independence, while older children fear death and preoccupy themselves with it. In addition to fears, depressed children have other symptoms, for example they sometimes cry for no apparent reason, do not trust themselves, appear depressed and / or irritated. Depression in children or adolescents should be clarified and treated by a specialist in child and adolescent psychiatry.
More information on depression in children and adolescents can be found in the article "Depression".


Technical support: Prof. Dr. med. Johannes Hebebrand, Essen (DGKJP)