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Column originally published Mar 25, 2014

Severe Anxiety In A Young Child

Question: Our nine-year-old son has very severe anxiety. When he was a toddler, he had such severe separation anxiety that I was not able to leave him with anyone, not even his father or grandparents. He worries about anything and everything. If I have to go out, he would be calling my cellphone almost every 5 minutes. He worries about us getting sick, although we have been always healthy. He is terrified of germs: he washes his hands constantly, and he has to sing his special song when he washes them. If we interrupt him, he will have to start all over again. There are many more examples that I cannot list them all here. I know that I have a lot of anxiety and obsession since I was a little girl, and it runs through my husband’s family also. That is why we have tried very hard to avoid showing him our worries, but obviously this has not worked well. His anxiety has taken over our family life completely, and it is getting worse. We have tried counselling, which has not made much difference at all. I have been taking a medicine which helps me greatly. Is it too young for him to take medicine?


You are right, your son has severe anxiety. It started when he was a little toddler. Although all young children have some separation anxiety when they have to be separated from their primary caretaker (who is often the mother), your son clearly was more severe than most children. Separation anxiety usually improves after a few months, when children learn that their mother is going to come back after a while. Instead of getting better, your son changed to calling you on your cellphone when you are out. He is still having separation anxiety at nine, which is not normal at all.

Over the years, I have seen many children with anxiety. Most of the time, the problem is relatively minor and can be addressed with reassurance. Many children are afraid of the dark; keeping a night-light on in the bedroom or hallway can solve the problem. However, if she will not sleep unless a parent stays with her the whole time until she falls asleep can be difficult, when there are other children at home, and parents are busy with many tasks to take care of at night.

Most children are afraid of needles; they cry when they need a blood test or a vaccine. It is very different if he is so worried about the blood test that he keeps asking about it for days, or cannot fall asleep because it is going to happen the next day, or have belly pain and vomiting from his worries. It is normal if she cries when she sees a needle coming, and may need someone to hold her arm still because she is scared. However, it is more serious if she kicks up a huge fight, and requires several adults to restrain her, or if she passes out when she gets a vaccine.

In short, all of us worry about different things to varying degrees. You may not enjoy standing up in front of the class to read something, and may feel butterflies in the stomach, or stumble on a few words or rush through the reading. However, it is far more serious if you get into a panic attack and become pale, sweaty, shaky, hyperventilate, or get sick and throw up.

Normal degree of nervousness helps us to think before we act. When the worry escalates, it can interfere with a person’s everyday life. Sometimes anxiety happens as a result of past experience. After slipping off the road because of icy condition can make me nervous driving in winter time. However, there are those who never want to learn to drive because they are too nervous. Severe anxiety can affect a person’s growth and well-being, and it needs to be addressed as a medical condition.

Most would agree that the first approach to treat anyone with anxiety is counselling. This can be very helpful, but unfortunately, may not be successful. When I see children with severe anxiety, almost always one or both parents also have significant anxiety. Many are already on medications, and they often wish that they had seek medical help much sooner.

The group of medicine that is used for anxiety is called selective serotonin reuptake inhibitor, also known as SSRI. These medications help the chemicals called neurotransmitters in our brain. In addition to reducing anxiety, they are also effective for depression.

In the past few years, there was concern about SSRI. Some children reported having thoughts of self-harm. As a result, Health Canada issued warning about using SSRI in children and youths. Many family doctors heeded the warning, and stopped prescribing SSRI completely. There have been documented suicides in depressed youths who didn’t receive SSRI.

In Nov 2013, Canadian Paediatric Society (CPS) published a statement about the use of SSRI for children and youth with anxiety and depression. This provides physicians, both family doctors and paediatricians, support to prescribe SSRI when clinically indi- cated. Although these medications are usually safe, some children may experience side effects and require monitoring. Follow up is important to gradually adjust the dose of medicine until anxiety and depression are well controlled.

Your son is not too young to take SSRI medications. You need to see a paediatrician or a child psychiatrist who is familiar with anxiety and its treatment. Monitor him for side effects, and talk to him frequently. If he has thoughts of self-harm, you need to contact the physician right away.