Anxiety (Worry) and anxiety-based disorders – guidance for 5-10 year olds

Anxiety is a normal human response to feeling threatened or in danger, even if that threat or danger is a thought, image or memory. Anxiety can become a real problem if the thoughts, emotions (feelings) and physical sensations are very strong, happen even when there is no real danger or if it lasts for a long time.

It’s normal for children to feel worried or anxious from time to time – such as when they’re starting school or nursery, or moving to a new area. But for some children, anxiety affects their behaviour and thoughts every day, interfering with their school, home and social life.

Separation anxiety is common in younger children, whereas older children and teenagers tend to worry more about school or have social anxiety.

In some cases children may develop an irrational fear of something specific. These are often referred to as phobias. Whilst we all experience irrational fears, with a phobia the sufferer feels extreme anxiety, even terror, at the thought of coming in contact with their feared thing or situation. The stronger the feeling of anxiety, the more likely we are to avoid the thing or situation.

Some children experience obsessive thoughts and compulsive rituals which can be distressing if they start to take over their normal lives. They tend to be more common in children when another family member has a similar problem, and they are more likely to experience these difficulties when they are under stress or during significant life changes.

• Talk to your child about their anxiety or worries. Label the emotion that the child may be feeling to show them you are taking their concerns seriously. E.g. ‘ I can see that you are feeling worried about going to school’
• If your child is seeking frequent reassurance, it could be helpful to manage this by using distraction or relaxation or mindfulness
• If your child is old enough, it may help to explain what anxiety is and the physical effects it has on our bodies. It may be helpful to describe anxiety as being like a wave that builds up and then ebbs away again.
• As well as talking to your child about their worries and anxiety, it’s important to help them find solutions. As well as talking to your child about their worries and anxiety, it’s important to help them find solutions. For example, if your child is worried about going to a sleepover, it is natural to want to tell them not to go. However, this could mean your child feels that their anxiety will stop them from doing things. It’s better to recognise their anxiety and suggest solutions to help them, so they can go to the sleepover with a plan in place.
• Be aware that although their fear may be irrational, the child feelings of stress are real to them. Challenge any irrational thoughts they might have, but don’t minimise the intensity of their feelings.
• If appropriate, set small achievable targets to help increase confidence and reward any efforts your child makes to work towards these targets.

• Anna Freud Centre – 7 ways to support children and young people who are worried
• Young Minds – Supporting your child with anxiety
• The Anxious Child Booklet: A booklet for parents and carers wanting to know more about anxiety in children and young people (Mental Health Foundation)

Recommended books for primary schools

• The Great Big Book of Feelings
• Me and my Fear
• What’s in your Mind Today
• Ruby’s Worry
• The Huge Bag of Worries

These books are available on loan from Portsmouth’s School Library Service (SLS). Please contact the SLS on school.library@portsmouthcc.gov.uk to order these books or for other recommendations to meet the needs of individuals or groups of children in your school.

The work of MHST follows the information from the book ‘Helping Your Child With Fears and Worries’ and aims to teach parents cognitive behavioural strategies to use with their child to overcome difficulties with anxiety.

OCD Youth aims to increase awareness and access to support for anyone under 25 affected by OCD. OCD Youth is run by young people with OCD, for young people with OCD. The website is full of information and advice and they organise trips and outings, run online meet-ups, produce videos and media and much more.

OCD UK’s, a national OCD charity, website also provides a wealth of information about OCD, its sub-types, possible treatments and tips to help overcome it. They also offer a parent webinar as part of a Parents Education Project, funded by The National Lottery Community Fund for parents of children with Obsessive-Compulsive Disorder.

Young Minds gives free, relevant, practical information about a range of mental health issues in children and young people. It has information about feelings and symptoms, conditions and looking after yourself. https://www.youngminds.org.uk/young-person/mental-health-conditions/ocd/

Young Minds gives free, relevant, practical information about a range of mental health issues in children and young people https://www.youngminds.org.uk/young-person/mental-health-conditions/phobias/

These are worries and anxieties that most young people will have from time to time.

Examples might be:

• Being away from home / parent
• Going to school (but settling)
• Worrying about going to bed / the dark
• Worry about something bad happening to themselves, or to a loved one
• Doing new things
• Going to unfamiliar places
• Doing things independently
• Performing in tests
• Change and uncertainty (e.g. family breakdown or conflict)
• In response to an upsetting event such as being bullied
• Being in social situations

If families or professionals are concerned that a young person is experiencing any of the issues above support is available, this includes:

Support in schools

All primary schools have a named Mental Health Lead and within schools there is a range of pastoral support available.  Schools also work with other professionals in order to gain advice and guidance on how best to support children’s social and emotional needs. These services may include the Portsmouth Educational Psychology Team, the Multi Agency Behaviour Support Team and the Inclusion Outreach team.

Within many schools, pastoral support may be provided by Emotional Literacy Support Assistants (ELSAs)

ELSAs are teaching assistants in schools who have been trained by Educational Psychologists to work with children who are showing a wide range of emotional or social needs for example; anxiety, low self-esteem, problems with anger etc. Through individual (and small group) support programmes ELSAs help children to develop their social and emotional skills.

Support will also include Mental Health Support Teams (MHST’s) who are available in all primary schools. 

MHST’s support children and young people with mild to moderate mental health problems. The approach they use in primary schools focuses on supporting parents with cognitive behavioural strategies to use with their child to overcome difficulties with anxiety. Time is spent on reflecting on what works best for the family and guiding parents in adapting strategies to meet their child’s individual needs as well as providing opportunity for practice.

The school should make contact with MHST for consultation and support for MHST referral where appropriate.

For professionals such as GP’s they should encourage families to link in with the school-based support described above.

The CAMHS Single Point of Access is also available for consultation and advice.

Available Monday to Friday, 9am – 5pm. Contact 0300 123 6632.

The degree to which a young person worries appears out of context or disproportionate to the reason why they might be worrying. Episodes of anxiety might be more frequent or prolonged and cause the young person distress, or might have some mild impact on their ability to cope with everyday life such as going to, or coping at school, seeing friends or taking part in leisure activities.

Examples might be:

• Fears that something bad might happen to themselves, or someone else
• Worry about not coping
• Worry about performance in tests or the future
• Worries related to being bullied, or experiencing regular conflict or distress, either at home or school
• Worries about what others might think, say, or do
• Worries about negative judgements by others, or social rejection/exclusion
• Specific Phobia e.g. fear of dogs that impacts on day-to-day life
• Repetitive behaviours e.g. excessive hand washing, counting, checking windows and doors. That are beginning to impact on day-to-day life.

If families or professionals are concerned that a young person is experiencing any of the issues above support is available, this includes:

Support in schools

All primary schools have a named Mental Health Lead and within schools there is a range of pastoral support available.  Schools also work with other professionals in order to gain advice and guidance on how best to support children’s social and emotional needs. These services may include the Portsmouth Educational Psychology Team, the Multi Agency Behaviour Support Team and the Inclusion Outreach team.

Within many schools, pastoral support may be provided by  Emotional Literacy Support Assistants (ELSAs)

ELSAs are teaching assistants in schools who have been trained by Educational Psychologists to work with children who are showing a wide range of emotional or social needs for example; anxiety, low self-esteem, problems with anger etc. Through individual (and small group) support programmes ELSAs help children to develop their social and emotional skills.

Support will also include Mental Health Support Teams (MHST’s) who are available in all primary schools. 

MHST’s support children and young people with mild to moderate mental health problems. The approach they use in primary schools focuses on supporting parents with cognitive behavioural strategies to use with their child to overcome difficulties with anxiety. Time is spent on reflecting on what works best for the family and guiding parents in adapting strategies to meet their child’s individual needs as well as providing opportunity for practice.

The school should make contact with MHST for consultation and support for MHST referral where appropriate.

For professionals such as GP’s they should encourage families to link in with the school-based support described above.

Children can also be referred to Hampshire Youth Access (HYA) for play-based counselling. A referral can be made by a GP, CAMHS or MHST.

The CAMHS Single Point of Access is available for consultation and advice.

Available Monday to Friday, 9am – 5pm.

Contact 0300 123 6632

These anxieties are severe and enduring which may need specialist support. These cause significant distress to a child and significantly disrupt daily coping such as school/ college, socialising, and even self-care activities (e.g. sleep, bathing, eating).

Despite trying advice and support in the previous help sections the young person still experiences anxiety symptoms.

• Strong unwavering beliefs that something bad might happen, or that there is danger
• Repeated, intense and overwhelming “what if” thoughts that are catastrophic in nature
• Repetitive behaviours e.g. excessive handwashing, counting, checking windows and doors. That are significantly impacting on day-to-day life.
• Specific Phobia where the impact on functioning is significant and/ or there are associated risks with the avoidant behaviours.

If families or professionals are concerned that a child is experiencing any of the issues above support is available, this includes

Child and Adolescent Mental Health Service (CAMHS)

If families or professionals are concerned that a child is experiencing severe and enduring mental health issues that are impacting daily life then they can contact CAMHS Single Point of Access for consultation and advice.

Following on from this consultation if indicated CAMHS will require a written referral from a professional (this can include any professional that knows the child).  Once a referral is received into the CAMHS single point of access team they will aim to contact the family by phone to further triage the concerns. The outcome of this triage may be that the child is offered an initial appointment for further assessment, the outcome may also be signposting to other services mentioned earlier in this guidance.

CAMHS provide evidenced based treatment for mental health disorders. This can include medication and talking therapies on a 1-2-1, group or family basis. They offer face-to-face, web based, and telephone support on a needs-led basis.

Available Monday to Friday, 9am-5pm

Please contact: 0300 123 6632