Anxiety disorders impact the pediatric population at a rate of 1 in 12 children, with a prevalence of 1 in 4 adolescents between the ages of 13 to 18. With little support outside of anti-anxiolytic medication and behavior therapy in Western medicine, it’s beneficial to consider what integrative and complementary medicine can offer these children and families. Understanding, recognizing, and finding the appropriate supportive tools for anxiety can be paths that can change the trajectory of a child’s psychological well-being.
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What is Anxiety?
Feelings of tension or concern over perceived or actual threats that can become overwhelming are the driving forces behind anxiety. Whether it is physiological- like heart palpitations, or mental and emotional- like racing thoughts and worry- anxiety symptoms can significantly impact your life and ability to cope. Clinically, anxiety in children is considered a psychiatric disorder that is categorized into specific subtypes that are situational or can manifest based on triggers.
Anxiety Symptoms in Children and Adolescents
The most common symptoms of anxiety include both physical and behavioral manifestations. Characteristics vary depending on the type of anxiety a child is dealing with, but here are the overarching symptoms to be aware of.
Children's symptoms:
- Restlessness
- Inattention or focus
- Headaches or stomach aches
- Agitation
- Avoidance
- Crying
- Tantrums
- Refusing school
- Meldowns regarding clothing, hair, socks, and shoes
- Difficulty with transitions and settling down for sleep
Adolescent signs and symptoms:
- New onset irritability
- Avoiding fun activities that were once enjoyable
- Dropping grades or interest in activities
- Sleep issues
- Difficulty concentrating
- Risky behavior like substance abuse
- Frequent complaints of fatigue and stomach or headaches
Most Common Types of Anxiety Disorders in Children and Adolescents
Anxiety can present in a variety of ways, which has led to several types of anxiety disorders. There are seven primary conditions associated with anxiety in pediatrics, which includes: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobias (specific and social), separation anxiety disorder, and selective mutism. Here is a description of each condition and the associated features.
Generalized Anxiety Disorder (GAD)
This consists of excessive, persistent, and unrealistic worries about general areas of life. There is not one specific situation or encounter that will spark this type of anxiety. These feelings can come on during sports, in relation to school, worries about the weather, or nervousness about family members. In general, kids with this condition have difficulty shutting down their worries, concern, and invasive thoughts. This can lead to a decline in school performance due to the mind mess, and it can also impact their ability to engage and enjoy social settings. Kids with GAD often need reassurance as they can feel insecure, have self-doubt, or want to please others.
Obsessive-Compulsive Disorder (OCD)
Like all anxiety disorders, this mental health condition can affect both adults and children. In both cases, it’s a manifestation of recurrent, repetitive, and intrusive thoughts that the person must physically carry out. In children, this can present as rituals or routines such as organizing in a specific manner, counting, reading the same text repeatedly, or doing a particular activity before they can move on to the next.
Panic Disorder
Anxiety that mounts to extreme fear or discomfort can be a sign of panic disorder. This can be situational or circumstantial, but it can also come on without a trigger or warning. Symptoms of a panic attack include a racing heart, shortness of breath, and a tingling sensation felt throughout the body. Panic disorder consists of multiple accounts of panic attacks, which are sudden and intense physical and emotional symptoms in which the body reacts to intense fear and a loss of control.
Specific Phobia
When a child or adolescent fear becomes severe, excessive, and persistent, it can become a phobia. A phobia consists of irrational and heightened fears of a situation or object. The distinguishing feature of phobias from fear is there is no talking down to the child and dismantling the fear with reassurance. Kids as young as five years old can experience phobias, with some of the most common specific phobias being storms, elevators, animals, or medical procedures.
Social Phobia
In social settings, kids and adolescents can have fears that present as social anxiety. Common fears include humiliation, embarrassment, or the fear of being rejected. To compensate for this social anxiety, kids get worried when they have to perform tasks like a speech or social interaction amongst a group of people. This can impact their social life, as many kids experiencing this will avoid their social phobia, which has negative repercussions such as isolation.
Separation Anxiety Disorder
About 3% of elementary-aged children and 8% of teenager experience separation anxiety. This is a feeling of excessive distress that the child feels when separated from parents, siblings, or other close family. There is often worry involved, in which the child is concerned for themselves or the family members' well-being.
Selective Mutism
This form of anxiety can come off as shyness but is actually an underlying fear of the social expectation to talk. It can often be seen starting in pre-school up through elementary school. Children with selective mutism may freeze when expected to talk, may appear to have a stiff body posture, have a flat affect, be attached to their parents in social environments, or be slow to react in social situations.
What Are The Common Causes of Anxiety in Children and Adolescents?
There are biological, environmental, dietary, and physiological contributors to the development of pediatric anxiety. Genetics plays a significant role when it comes to the development of anxiety in kids. According to one study, if the child has parents with generalized anxiety disorder, they are at a seven-fold risk of developing an anxiety condition. A child's upbringing and surroundings can greatly impact their ability to manage stress and overwhelm, which are precursors to anxiety. Children who live in unstable or stressful environments or have endured physical and emotional trauma are at an increased risk of developing both anxiety and chronic pain-based conditions.
As a naturopathic doctor, I believe and have clinically seen how impactful one's diet can be on overall health. This also holds true for mental well-being. Food can influence how the brain functions, providing nutrients that allow it to sustain the jobs that are required to do. Consuming inflammatory foods, excessive sugar, caffeine, artificial sugar, synthetic food color, and foods you are intolerant to can influence health outcomes like anxiety through microbiome disruption.
Physiological dysfunction can also lead to anxiety in children. One of the main areas of concern is neurotransmitter imbalances. A deficiency in serotonin and dopamine are two key neurotransmitters that have been correlated to anxiety. These are your pleasure, reward, and “feel good” molecules that, when released from the brain, can ignite these emotions. GABA is an additional neurotransmitter that can contribute to anxiety. It’s an inhibitory molecule that provides calmness by telling the central nervous system to slow down.
When deficient in one (or all) of these, your body is missing key components that help regulate peace and contentment. Instead, there are feelings of worry and nervousness, which can manifest as anxiety. A primary contributing factor to consider when neurotransmitter imbalance is present is the health of your child’s gut due to the implications the microbiome has on the gut-brain connection. Studies have shown that when the gut flora has an abundance of beneficial microbes, psychiatric disorders can improve.
Functional Medicine Labs to Test for Root Cause of Anxiety in Children And Adolescents
Obtaining functional lab testing can assist in therapeutic interventions for your child. Here are three of the top testing options to consider.
Comprehensive Stool Test
GI-MAP stool test is an assessment tool that can evaluate the health of your child’s gut microbial flora. It looks for dozens of pathogenic microbes, as well as detecting a quantitative measurement of beneficial bacteria present. This will inform you whether or not a dysbiotic gut flora may be contributing to your child’s anxiety.
Neurotransmitter testing
Evaluating neurotransmitters and their metabolites through urinary excretion will provide valuable insight. Dopamine, serotonin, and GABA are of primary concern when it comes to anxiety, but evaluating all the neurotransmitters that contribute to health and well-being can provide a broad representation.
Micronutrient Evaluation
Absorption and utilization of vitamins and minerals are essential for neurotransmitter production and mental health. Evaluating your child’s vitamins and minerals through an at-home finger stick Micronutrient Test will provide valuable insights into any nutrient deficiencies, which will lend the way for proper dietary and supplementation recommendations.
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How to Calm Anxiety Disorders in Children And Adolescents: An Integrative Medicine Approach
Anxiety disorders in children and adolescents can be treated with a range of complementary and integrative medicine (CIM) approaches in addition to traditional therapies. CIM approaches focus on treating the whole person and may include various techniques such as mind-body practices, herbal remedies, and dietary modifications.
Below are some complementary and integrative medicine treatments that have been used to manage anxiety disorders in children and adolescents.
Nutrition's Role in The Treatment of Anxiety Disorders in Children and Adolescents
Children need whole foods and nutrient-rich nutrition for growth, development, and well-being. Consuming a wide variety of macronutrients-fats, proteins, and complex carbohydrates with plenty of produce that spans the colors of the rainbow is foundational to their health. When it comes to mental health disorders like anxiety, kids and adolescents need fuel that harnesses optimal gut function, neurotransmitter production, and brain development.
If you're looking to follow a specific nutrition plan, the Mediterranean Diet has great evidence when it comes to supporting gut health while also providing the body with a wide variety of nutrients. This diet includes healthy fats like fish, sardines, olive oil, and nuts, antioxidant-rich fruits and vegetables, unprocessed grains, minimally processed dairy, and avoidance of artificial sugars, synthetic food coloring, overly processed meats, and refined foods.
In addition to this way of eating, incorporating foods that will help boost neurotransmitters would be beneficial. Foods high in zinc, like seafood, pumpkin seeds, and lentils, will help increase GABA, while foods high in vitamin B6 will help in the production of both GABA and serotonin. Examples of vitamin B6-containing foods are chickpeas, salmon, chicken, and bananas. Since the amino acid tryptophan is a precursor to serotonin, consuming foods like turkey, egg, potatoes, wild rice, and strawberries would be beneficial. While diet is not the only integrative approach to anxiety, it can be a helpful part of their health.
Cognitive-Behavioral Therapy (CBT) For Treating Anxiety Disorders In Children And Adolescents
Therapeutic intervention in the form of cognitive-behavior therapy is the first therapy used in conventional medicine. Sessions with a trained therapist involve the child or the child and parents. The focus is on how thoughts affect mood and behavior. The intervention involves teaching the child how to modify their thought patterns, which can change behavior patterns. On average, a CBT last 12 to 20 weeks, with additional sessions as needed to reinforce this brain training.
Research shows that the recovery rate from anxiety in children and adolescents with the implementation of CBT varies from 35% in those with social anxiety to 54% in those with other primary anxiety conditions. Utilizing therapy in conjunction with integrative medicine may be the best approach for your child to overcome anxiety.
Supplements and Herbs Used in The Treatment of Anxiety Disorders in Children And Adolescents
There are many supplements and herbs available to help children and adolescents manage their anxiety.
Probiotics for Anxiety
Improving gut health is a critical initiative for anxiety to improve neurotransmitter production. Evidence that probiotics can improve anxiety is becoming more abundant and utilized in functional medicine. With a wide variety of probiotics on the market, Lactobacillus and Bifidobacterium are the most relevant psychobiotic species utilized to modulate neurotransmitters.
Ashwagandha for Anxiety
This botanical is an excellent choice when it comes to stress modulation, which plays a role in children and adolescents feeling anxious. The literature shows that this plant has anti-inflammatory properties as well as the ability to relieve anxiety by increasing GABA receptor function. Dosing of this herb varies and should be advised by a practitioner that is trained in the use of botanical medicine.
Chamomile Tea
Traditionally chamomile is used as a calming herb. This has also been studied as a treatment option in mild-moderate generalized anxiety disorder. It’s been widely used as a tea to help kids relax and sleep. An ideal consideration would be to incorporate chamomile tea into your young child or adolescent nighttime routine. For children under 5, the dosing recommendation is half a cup of chamomile tea.
L-Theanine for Anxiety
Tea leaves contain the amino acid L-Theanine. This plant induces calmness, which can be supportive for someone experiencing anxiety. It also modulates neurotransmitters, which helps the brain modulate neurotransmitter use. A safe dose for children is 100-200mg per day. As always, you should consult with your integrative practitioner for an appropriate recommendation for your child.
Magnesium for Anxiety
Over 300 enzymatic processes in the body need magnesium as a co-factor. It comes in eight forms, with magnesium glycinate being the most relevant form when it comes to anxiety. Obtaining magnesium from foods, oral supplementation, or transdermal application are viable options. For children, dosing children ages 4 to 18 years old ranges from 130mg to 410mg.
Aromatherapy for Treatment of Anxiety Disorders in Children And Adolescents
Essential oils are a powerful aromatherapy tool in the alleviation of anxiety. Pure essential oils that have been shown to be beneficial for anxiety are lavender, orange, peppermint, and ginger. Diffusing one or a blend of these essential oils as part of a calming routine for your child can assist them with the associated feelings of anxiety.
Acupressure for Treatment of Anxiety Disorders in Children And Adolescents
Traditional Chinese Medicine (TCM) is an integrative medicine field that uses acupuncture and acupressure to treat the body's energy associated with physical, mental, and emotional manifestations. The pressure point Extra-1 also known as Yin Tang, is commonly used to help lower stress and reduce anxiety. Apply slight pressure to this point between your child’s brows may be a simple at-home treatment. The recommended administration is light pressure between the eyebrows (and above the nasal bridge), moving in a circular motion for 2 to 3 minutes.
EFT Tapping for Treatment for Anxiety Disorders in Children And Adolescents
EFT is short for Emotional Freedom Technique. It’s been coined as “psychological acupressure” as the application is similar to acupressure with the added tapping motion. Theoretically, the process is a combination of CBT and acupressure. During the treatment, you would help your child bring up an uncomfortable thought or action that induces anxiousness. Then the child applies EFT while having this thought or feeling at the forefront. There are nine primary EFT tapping points on the body and face that can be utilized to help the body process stressors and thoughts. Working with a practitioner to find which spots or patterns work best for your child could provide them with a tool during their healing process.
Yoga and Meditation for Treatment of Anxiety Disorders in Children And Adolescents
Mind-body practices like yoga and meditation have proven to be effective in reducing stress and anxiety. For teens, 15 minutes of daily meditation practice for at least three weeks has been shown to help their brains become less reactive and more responsive to anxiety provocation. Yoga has also been utilized to help with self-regulation of emotions, which helps with managing bodily sensations. There are a variety of mind-body programs for kids, and finding one in your local area that resonates is the best course of action.
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Summary
Nervousness, shyness, and separation anxiety can be common childhood experiences. It’s when these feelings become pathological signs and symptoms that impact their activities of daily living that consideration of one (or multiple) of the seven anxiety disorders should be considered. Finding a team of practitioners, from a behavioral psychologist to a yoga instructor and/or a naturopathic doctor, can provide you with a well-rounded set of tools to assist your child in overcoming anxiety.
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