Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders. 

Anxiety 

When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include 

• Being very afraid when away from parents (separation anxiety) 
• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias) 
• Being very afraid of school and other places where there are people (social anxiety) 
• Being very worried about the future and about bad things happening (general anxiety) 
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder) 

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed. 

Depression 

Occasionally being sad or feeling hopeless is a part of every child’s life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When children feel persistent sadness and hopelessness, they may be diagnosed with depression. 

Examples of behaviors often seen in children with depression include 

• Feeling sad, hopeless, or irritable a lot of the time 
• Not wanting to do or enjoy doing fun things 
• Showing changes in eating patterns – eating a lot more or a lot less than usual 
• Showing changes in sleep patterns – sleeping a lot more or a lot less than normal 
• Showing changes in energy – being tired and sluggish or tense and restless a lot of the time 
• Having a hard time paying attention 
• Feeling worthless, useless, or guilty 
• Showing self-injury and self-destructive behavior 

Extreme depression can lead a child to think about suicide or plan for suicide. For youth ages 10-24 years, suicide is among the leading causes of death. 

Some children may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a trouble-maker or lazy. 

Treatment for anxiety and depression 

The first step to treatment is to talk with a healthcare provider such as your child’s primary care provider, or a mental health specialist, about getting an evaluation. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that healthcare providers routinely screen children for behavioral and mental health concerns. pdf . Some of the signs and symptoms of anxiety or depression in children could be caused by other conditions, such as trauma. Specific symptoms like having a hard time focusing could be a sign of attention-deficit/hyperactivity disorder (ADHD). It is important to get a careful evaluation to get the best diagnosis and treatment. Consultation with a health provider can help determine if medication should be part of the treatment. A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. The school can also be included in the treatment plan. For very young children, involving parents in treatment is key. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for anxiety may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears so as to help them learn that bad things do not occur. 

Treatments can also include a variety of ways to help the child feel less stressed and be healthier like nutritious food, physical activity, sufficient sleep, predictable routines, and social support.