Anxious Child, Ages 1 to 3

Anxiety is a normal part of your child's behavioral and emotional development. Toddlers often get uneasy when separated from their parents or introduced to strangers. Fears of the dark, the toilet, animals, and loud noises (such as fireworks or thunderstorms) are all common, even signs that your toddler's development is on track. Between the ages of 1 and 3, your child may go through a number of anxious periods as he responds to changes in his environment or routine.

Why is my toddler so anxious?

As your child learns more about the world, he learns that things can go wrong. Bees can sting, playmates may take his toys, and parents sometimes leave for hours at a time. In addition, as he becomes more sensitive to what goes on around him, he may react to stresses that you don't even think he's aware of. He may have a nightmare after overhearing a fight between you and your partner, refuse to go to daycare if you're ill, or get upset if there's a substitute teacher at preschool. He may even have physical symptoms, complaining that he's dizzy or his stomach hurts. Such distress is normal, and over time he'll stop reacting so strongly.

Are there specific kinds of anxiety that toddlers experience?

Yes, here are some types of anxiety common to children between the ages of 1 and 3:

• Separation anxiety. Though it peaks at 18 months, separation anxiety returns for occasional spells well into the preschool years. Your child worries you'll go away and feels intense fear when you leave the room or hand him over to another caregiver; he may cling to you or sob and scream until you come back.
• Stranger anxiety. Your child reacts to new faces, no matter how friendly, by crying and clinging; he may continue to be scared and fuss until the stranger leaves. Though stranger anxiety is strongest in the first year of life, toddlers may experience recurring episodes.
• Phobias. Your child is terrified of certain things or situations, such as a neighbor's dog or riding in the car. The fear may have arisen from an actual incident, such as being cornered by a dog or seeing a car accident. It's also common for children to have a phobia about one kind of animal in particular, such as snakes or lions, even if they've never seen one.
• Daycare or school phobia. Your child refuses to go to school, crying and pleading with you not to make him or throwing tantrums as you depart. He may plead illness, usually with such vague complaints as, "My tummy aches." This may be a manifestation of separation anxiety, or it may arise from a more specific fear, such as that of being bullied or teased.
• Shyness. Your child becomes alarmed or withdraws around new people or in new situations. If your child is naturally timid, he may become fearful about joining a play group or taking a gymnastics or music class.

All of these anxieties are normal during this period, and -- with the possible exception of shyness -- your child will outgrow them in time.

How can I tell if my child is overly anxious?

Generally speaking, you should be concerned if your child's fears or constant worrying begin to hamper his ability to participate in preschool, family, or social activities. Another sign of trouble is if your toddler's trepidation doesn't dissipate with reassurance from you.

When should I get help for my child's anxiety?

According to the American Academy of Pediatrics, you should consult your pediatrician if your child's anxiety is:

• Interfering with family activities
• Preventing him from making friends
• Becoming an excuse to stay home from daycare or school
• Disrupting his sleep habits
• Resulting in compulsive behavior

Your pediatrician will examine your child to see if there's an underlying physical problem, such as poor hearing or vision, that could be causing his anxiety. If not, the doctor may refer you to a family counselor or child psychiatrist, who can look for behavioral, emotional, or learning disorders.

Once the family counselor or child psychiatrist has uncovered why your child is so anxious, you'll work out a treatment plan. This may include behavioral therapy, family therapy, psychotherapy, and medication, if necessary, to calm your child and help him get a grip on his fears.

What can I do?

When your child is anxious, follow your instincts -- cuddle and reassure him. But don't stop there; be creative about helping your child resolve his worries. These tips can help:

• Acknowledge the fear. Some of your toddler's worries are entirely normal, and denying them would be unrealistic -- for example, his fear of losing you. Tell your child that this idea scares you as much as it does him and that's why you watch him so closely. Remind him that when you drop him off at the babysitter's, you always pick him up again. And assure him that you look after your own safety, too.
• Talk it out. Toddlers have active imaginations and limited vocabularies, so they may have trouble describing what they're frightened of. See if your child can tell you how he feels. Is he sad, angry, scared? Does that monster in the closet have big feet or lots of teeth? Does he hate every dog or just the one next door? Helping your child find the words can move him toward conquering his fears.
• Practice separation. Teach your toddler how to leave you -- willingly -- through a little role-playing. Set a kitchen timer for one minute and go out of the room while your toddler stays behind with the "tick-tock clock." When the bell rings, come back. Or you can stay in the room and he can leave. As he becomes more comfortable, increase the time you're apart. This peekaboo exercise develops an understanding of sequence, so that he'll know what to expect when you say, "I'm going now, and I'll see you later."
• Don't demand toughness. Your toddler already is tough, in ways you probably don't appreciate. How many times a day does he pick himself up after falling down? How often does he sleep alone, something you may have trouble doing when your spouse is out of town? Some parents believe their toddlers have to learn to be hardy so that they don't become "dependent," not realizing children are naturally developing autonomy during these years. So don't force your toddler to do something that terrifies him, such as pet a large dog. It will only make him fear you and feel bad about himself. Eventually he will grow out of this fear and many others besides.
• Use your imagination. Laughter and whimsy go a long way toward curing ills, including anxiety. If your toddler fears thunderstorms, make up a story (the ancient Greeks did) about a magical being who makes lightning bolts. If your toddler won't take a bath because he thinks he'll get sucked down the drain, put a small plastic chair in the tub, get a couple of colorful sponges, and spray him with a shower attachment. After a week or so of this, you can fill the tub a couple of inches deep ("just to warm your toes"). Gradually increase the amount of water. You might also invite one of his friends over to take a bath, then see if your toddler will get in with his pal.
• Ease nighttime fears. Your child may worry that monsters are hiding in the closet or bad dreams are waiting under the bed. Reassure him that you'll keep the monsters and bad dreams away, and make his room as inviting and comfortable as possible. You can even post a funny sign on the closet that says, "No monsters allowed." Get him a cheerful nightlight so he can orient himself if he wakes. Establish a bedtime routine and stick to it, making sure he has time for a bath, a story, and some quiet moments before the lights go out. Avoid arguments and battles before bed, so he goes to sleep feeling calm. And don't let your child watch TV at bedtime. While it may appear to lull him, it can have the opposite effect; unexpectedly disturbing images may stir up anxiety as he tries to fall asleep.
• If your child wakes from a nightmare, tell him that it was a dream and not something real, then stay with him until he's calm enough to get back to sleep. If he has a recurring bad dream, talk with him about it, preferably during the day when he won't find it as frightening. What is the dream about? Is there something he can do in his dream to help himself? For example, a child who dreams about being chased by a scary person might "get" a dog, who can then chase this person away. If your child believes that the bad guy who's coming to get him can fly, walk through walls, and do other things that defy his ability to protect himself, you can use his magical thinking to your advantage: As you wave a magic wand or spray him with a magic potion (water in a spritz bottle will do), tell him he's now shielded from harm.
• Prepare your child for new situations. If your child has a shy attack as you head out to join a party or play group, talk to him beforehand about where you're going. Mention that some new people will be there and that the place may be new to him. You might describe the group or the house or park so he has an idea of what to expect. Ask how these plans make him feel -- shy, sad, scared? Encourage him to bring along a favorite blanket, stuffed animal, or toy that would comfort him. Having a "lovey," or attachment object, can be helpful for your child at this age. Also, try to get him to tell you his fears in advance. Is he worried about being teased by bigger kids? Did he see something at a previous party -- kids hitting a piñata with sticks, for example -- that scared him? Finally, once you get where you're going, give your child some time to adjust, even if that means spending the first half of the party in your lap.

References

American Academy of Child and Adolescent Psychiatry. Facts for Families: The Anxious Child. http://aacap.org/cs/root/facts_for_families/the_an...

American Academy of Child and Adolescent Psychiatry. Facts for Families: Children Who Won't Go to School (Separation Anxiety). http://aacap.org/cs/root/facts_for_families/childr...

Nemours Foundation, KidsHealth. Anxiety, Fears, and Phobias. http://kidshealth.org/parent/emotions/feelings/anx...

Image credit: Ann in the UK/Shutterstock