Anxiety disorders are the most common mental health conditions in children, affecting approximately 1 in 8. Yet most children with anxiety never receive treatment — partly because anxiety often looks like behavior problems, physical complaints, or school refusal rather than "worry," and partly because children often can't articulate what they're experiencing.
Separation anxiety — intense distress at separation from caregivers, most common in younger children. Generalized anxiety — excessive worry about many domains (school performance, family, health, world events). Social anxiety — fear of social situations, often presenting as school refusal or mutism. Specific phobias — intense fear of specific objects or situations (dogs, vomit, needles, storms). Selective mutism — inability to speak in specific situations (school, public) despite speaking normally at home.
Children rarely say "I'm anxious." Instead they show: repeated stomachaches or headaches with no medical cause; frequent requests to stay home from school; avoidance of activities they used to enjoy; reassurance-seeking behavior; sleep difficulties; irritability and emotional outbursts; and "worst case" thinking. In toddlers, anxiety often appears as clinging, tantrums, or sleep disruption.
Cognitive Behavioral Therapy adapted for children is the gold standard — specifically approaches involving gradual exposure to feared situations. Parents are typically included as co-therapists. SPACE (Supportive Parenting for Anxious Childhood Emotions) treats childhood anxiety through parent behavior change alone. For severe anxiety, SSRIs have evidence in children and adolescents.