Anxiety disorders are among the most common childhood mental health concerns; the CDC reports that approximately 9.4% of U.S. children ages 3-17 meet the criteria for an anxiety diagnosis. Children with anxiety experience symptoms including frequent worry, restlessness, concentration difficulties, physical symptoms like headaches and stomachaches, sleep problems, and changes in appetite. 

Parenting a child with an anxiety diagnosis can be difficult, particularly when your child seems to become overwhelmed by simple tasks. Children with anxiety often ask for reassurance from their families and friends. For example: “Do you think I will pass the test?” “Are you sure my friend likes me?” “I won’t get sick, right?”  It’s natural as a parent to want to ease your child’s discomfort in the moment. For example, you may order for your child at a restaurant when they say they’re too scared. Counterintuitively, these behaviors, known as parental accommodation, only strengthen your child’s anxiety and avoidance. Although they may feel better momentarily, your child has missed an opportunity to learn they can handle taking steps that feel scary. Fortunately, there are practical steps you can take to support your child in facing their fears. 

Encourage your child to try things that make them anxious. Reduce accommodations that get in the way. Resist the temptation to let your child “escape.” Instead, validate their feelings and let them know you believe in them! Remind yourself that guiding your child to engage with anxiety helps them learn that they can handle fears. This lesson will help them throughout their lives!

Validate their fears and praise efforts to change, no matter how small. For example, try the following supportive statements:

I can tell this is so hard for you. You’re doing a great job being brave!

I believe in you and know you can take this step. You’ve been brave so many times.

Being worried is so uncomfortable, but it cannot hurt you.

I trust you to handle this well. You know what to do.

Reward your child when they take steps toward working on their anxiety. No step is too small! Rewards don’t have to be big or expensive. Popular examples include playing a game with a parent, a trip to the dollar store, or a special dessert. 

Model your own brave behaviors. Challenge yourself and let your child know! Parents can be wonderful examples.

Recommended Reading: Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents by Eli R. Lebowitz

Rachel Weinstock, Ph.D. is a licensed psychologist at Alvord, Baker & Associates. She earned her B.A. from Cornell University and her M.A. and Ph.D. from Georgia State University. She completed her predoctoral internship training at the Kennedy Krieger Institute and Johns Hopkins University School of Medicine. She then completed her postdoctoral fellowship at Children’s National Medical Center, with a focus on youth anxiety and related disorders. Her research interests include factors contributing to the development of anxiety disorders, as well as barriers to treatment for children with mental health concerns.

At times, you may feel you’re trapped in a cycle of negative interactions with your child. To break the cycle, it may seem logical to target the unwanted behaviors with consequences such as time outs. However, research shows that focusing on increasing positive behaviors is more effective. These two approaches may sound similar in theory, but they are vastly different in practice.

It may feel difficult to focus on improving your relationship when you’re already trapped in a negative cycle. An easy place to start is by setting up a daily routine of “special time”: a specified, uninterrupted period of time in which you join your child one-on-one in play, while allowing them to fully take the lead. Even a daily 5 minutes of special time can not only promote a secure, warm relationship between you and your child, but also help improve your child’s self-esteem, social skills, and even language skills. It’s derived from Parent Child Interaction Therapy (PCIT), an evidence-based treatment that includes two phases: a “child-directed” phase that focuses on positive behaviors, followed by a “parent-directed” phase that focuses on limit setting. Limit setting is more effective when it takes place in the context of a positive parent-child relationship.

How to Practice “Special Time”

It is important to set yourself up for success by using toys that encourage creative and safe play, while also letting you follow your child’s lead (blocks, toy cars, food and kitchen toys, crayons and paper). Avoid toys that are conducive to rough play (balls, action figures), messy play (slime, paint), games with rules, or games with little interaction (books, video games). Once you have an activity in mind, it’s time to play! To make sure your special time is truly child-led, you can follow these dos and don’ts.

You can remember the dos with the acronym PRIDE:

• PRAISE: Praise appropriate behavior – and be specific! (e.g., “Great job building such a tall tower”)
• REFLECT: Reflect appropriate talk (e.g., Child: “I drew a cat.” Parent: “Yes, you drew a cat!”)
• IMITATE: Imitate appropriate play (e.g., Child: Drawing a flower. Parent: “I’m going to draw flowers just like you.”)
• DESCRIBE: Describe appropriate behavior – act as a “sportscaster” for your child’s play (e.g., Child: Making a tower. Parent: “You’re making a tower!”)
• Be ENTHUSIASTIC!

These allow your child to lead the play while showing that you approve of the activity and are interested in what they are doing.  As for the don’ts, the goal is to avoid using any commands (“Hand me that block”), questions (“What are you drawing?”), and critical statements (“That’s not what a cow says”) during the designated special time, as these can interfere in your child’s ability to lead play. Try your best to ignore any attention-seeking negative behaviors. However, if your child becomes aggressive or destructive, then it is time to stop special time.

Special Time with Teens

Special time is most used with younger children; however, you can still do a variant of special time with your teenager–it will just have to look a bit different. While spending one-on-one time with your teen (preferably an activity of their choice), make no corrections or criticisms and give no directions. Or, take a moment to observe your teen doing something they enjoy (e.g., working on an art project, watching a basketball game on TV) and casually provide some positive attention. Show genuine interest in what your teen is doing and ask to join.

It helps to take a more subtle approach that makes less of a “to-do” out of special time. For example, PRIDE skills can be implemented in more age-appropriate ways by using validation (communicating to another person that their thoughts, feelings, and behaviors are understandable to you in a particular situation) more than straightforward praise. Additionally, the activity may be less restricted by the above recommendations; for example, games with rules may be more feasible with a teen.

Don’t worry if your teen rejects your initial attempts–this response may shift over time as they realize your motives are genuine. Taking a more passive approach with your teen may also help, by initiating time together without drawing too much attention to it. Founder of Hand in Hand Parenting, Patty Wipfler, has come up with some creative ideas for this, such as: take a book to read in the same room in which your teen is doing their homework; join your teen in their room to really listen to their favorite music; or sit with your teen while they eat their after-school snack. The goal is to pay attention to your teen in a “low-key” way and to look for ways to offer your approval, no questions asked.

The more consistently and predictably you practice special time with your child, the more likely you are to see improvements in your child’s behavior over time. If at any point your child’s behaviors become overly interfering with day-to-day functioning, it may be time to check in with your pediatrician.

Dr. Lindsay Myerberg is an RAB Research Fellow and licensed clinical psychologist at Alvord, Baker and Associates, LLC, in Rockville, MD. Dr. Myerberg earned her PhD from Temple University and completed her clinical internship at the University of Maryland Medical Center Child & Adolescent Inpatient Unit. Dr. Myerberg has provided evidence-based treatments for children, adolescents, and adults in a variety of settings and is actively involved in research evaluating cognitive-behavioral interventions for youth.

Illness and death are a natural part of life, and we’ve all–kids included–been surrounded by far too much of both during the COVID-19 pandemic. Many parents struggle with how to broach these difficult subjects, especially when it comes to speaking with younger children.

Although every story is different, the questions parents ask me tend to have a whole lot in common. Below is a sample of those I hear most frequently–followed by my best advice after 30 years of practicing pediatrics and being a mom.

Should I tell my children that Grandma is sick? They’ve always been very close, and I don’t want them to be scared.

We love our children so much; we wish we could protect them from the painful things in life. But honesty and openness are always the best route with children. Kids are very good at intuiting when there is sadness or stress in a family. Hearing whispers behind closed doors causes way more anxiety for them than facing sad or even scary truths—especially if you answer any questions they raise in a frank and calm way, using age-appropriate language.

Even with very young children, the explanation should be direct and clear. It’s good to start with something to prepare them such as: “I want to talk with you about something that is sad.” That prepares them for hearing something hard. For example: “Grandma is very sick and her heart isn’t working anymore. The doctors feel she will die very soon.” Then you wait, allowing time for the information to sink in and to assess your child’s response. You can be there to hold them, love them, answer any questions, and accept any response they may have. You can let them know you are sad and that it is ok to cry or not to cry.

For some children, the information will sink in slowly, and you will need to keep coming back to explore how they feel. Sometimes with younger children, tackling these topics is more accessible through play, perhaps using dolls or toys to act out different emotions and responses. Sometimes children, even older children, may not want or be able to talk right away. Let them know this is ok. Keep going back to ask how they are feeling and if they want to talk or just spend time together. Sometimes just having a parent there and feeling a non-verbal loving connection is what your child needs if they are not ready or able to talk.

How do I tell my child that someone has died?

Once again, I think it’s important to use clear and honest language. Euphemisms can sometimes be scarier for children because they are harder to understand than clear language. And it’s important to remember that when there is a death, children’s worries are going to focus on the living people they love the most. They may ask questions that suggest that they are worried about you–it is ok to reassure them that you are very healthy and so are they.

Sometimes it is appropriate to let kids know that what happened is no one’s fault; kids will sometimes feel guilt or engage in magical thinking (i.e., unrealistic reasoning to make sense of difficult experiences) around a death. Because of their vivid imaginations and because they often feel they have enormous power to make both good and bad things happen in the world, children’s magical thinking is very common and can be quite intense. They may, for example, worry that something they or someone else said or did (or didn’t do) was the cause of the death. It is very important to talk about these thoughts so they do not lead to excessive worry and shame.

As painful as it is to see your child suffer, it is important to be there with their pain and not rush to try to make them feel better. Pain and sadness are a part of life; we want to open the door for our children to tolerate and be with all of their difficult emotions.

Is it okay for my child to see me grieving?

Yes! It is okay for a child to see a parent cry. It is okay for a parent to say, “I am feeling sad.” At the same time, it’s important to try to keep your child’s life as consistent as possible, even when you are deeply grieving. They will be fearful if they feel a parent is so distraught that they are unable to take care of them in their usual way. Reassure your child that although there is sadness and grief in your life right now, you have each other and will get through this together. Keeping routines as close to normal as possible in terms of bedtime, meals, and family rituals is important to give them a feeling of safety and a sense that life will go on. You can read more about understanding and honoring your own grief here.

Should I bring my child to a funeral?

I think this depends on the child’s maturity level. Sometimes images from a funeral can be very scary to young children (i.e. seeing the body, dirt getting shoveled on a coffin) and you may decide that it is better not to have a smaller child attend. Older children may want to participate in the family ritual, and it can be very connecting and healing for them. If you decide that it’s better for your young child not to attend, you may want to have your own separate family ritual, so that your child has the chance to process the death and feel connected in a warm and comforting way.

What if my child won’t talk about the death of a loved one–even someone really close?

Sometimes parents worry that their child is not even reacting to the news of a death and is continuing to live their life as though it never happened. It is important to realize that children may need time to process the event. Continue to try to connect with your child to find out whether there are any big feelings that they are hiding or burying, but don’t push. Accept all responses and do not have expectations that your child should react in any particular way. As difficult and painful as it is to talk about death with a child, it is important for our kids to know that we are there for them to talk about anything. (And we’re there for them when they don’t want to talk.) We want them to know that we are not retreating from hard topics. Butsometimes the best way to “be there” is just to be there, without looking for more.

What if my child asks me a question I can’t answer? Or that I don’t want to answer?

Sometimes it’s hard to know how to answer a question your child asks you. It is always okay to say, with any type of question, “I am going to think about how to answer that best and get back to you.” (A great technique for buying yourself some time before answering any question!) This gives you an opportunity to think things through, and if you are still unsure, you can ask a trusted friend or relative, or your pediatrician. Remember: You are not expected to know all the answers, but you do want your children to know that they can ask you anything.

Dr. Dana Kornfeld serves on the board of Resilience Across Borders. Dr. Kornfeld is an Associate Clinical Professor of Pediatrics at The George Washington School of Medicine. She practices pediatrics, with a specialty in adolescent medicine, at the Pediatric Care Center in Bethesda, Maryland.

Book List for Families Dealing with Loss

• Tear Soup: A Recipe for Healing after Loss by Pat Schweibert & Chuck Deklyen
• When Dinosaurs Die: A Guide to Understanding Death by Laurie Krasny & Mark Brown
• I Have a Question about Death: A Book for Children with Autism Spectrum Disorder or Other Special Needs by Arlen Grad Gaines & Meredith Englander Polsky
• Stones For Grandpa by Renee Londner & Martha Aviles
• Lifetimes: The Beautiful Way to Explain Death to Children by Bryan Mellonie & Robert Ingpen
• Straight Talk about Death for Teenagers: How to Cope with Losing Someone You Love by Earl Grollman
• The Fall of Freddie the Leaf: A Story of Life for All Ages by Leo Buscaglia
• Something Very Sad Happened: A Toddler’s Guide to Understanding Death by Bonnie Zucker & Kim Fleming

As another year draws to a close, you may find yourself in a reflective mood. This process of looking backward and forward can be particularly painful if you are grieving. These past two years have brought unprecedented loss. Loss of the lives of people we love, loss of income, loss of opportunity, loss of social contact. Grief is the emotional and psychological reaction to loss. It is accompanied by feelings of sadness and a longing to see, talk to or simply be with who we’ve lost once again. While the grief process can seem unbearable, it is possible to lighten the burden.

There is no right way to grieve

The process of grieving is individual—there is no road map showing you the “correct” path. The pain of longing can feel insufferable and the desire to have some relief is overwhelming. However, you can’t hurry the process. There are no shortcuts. Do not critique your process, do not judge your feelings. Whatever you are experiencing during this time is true. Avoid the temptation to compare how you are “doing” with how others seem to be managing. Grant yourself the permission to feel the profound sadness of loss and resist the temptation to restrict it.

Feelings are often irrational

You may notice that you can become overwhelmed with feelings that come out of the blue and make no sense. Emotions are not rational. Guilt and regret are two emotions that can be especially difficult to manage. You may find yourself ruminating about events that you wish you had done differently. Guilt and regret will make you say things like “I should have done more” or “Why did I say (or not say) that?” To extract yourself from this regret loop, change the “I should have” to “I wish.” Statements that include “should have” come with shame whereas wish statements reflect the humble fact that we cannot control the past. Guilt and regret arise when we focus on the things that did not go in the direction that we wanted. It is important to acknowledge these memories, but know that they are a small part of the more complete picture that captures the more loving aspects of your relationship.

Making a new relationship with the one who has died

If what you are grieving is the loss of a loved one, know that even though their body has departed, you can continue the relationship in a new form. Just as there is no right way to grieve, there is no right way for the relationship to continue. Remain open and know that it is possible. In my own life, after my mother died, I continued to be in contact with a dear friend of hers. In our conversations, we shared stories about my mother, revealing attributes about her that were unknown to the other. Knowing my mother more fully has allowed my relationship with her to strengthen in a new and beautiful way.

Offering support

Many people worry about what to say to people who are grieving. Most experts agree that what you say is not as important as simply saying something. Many people who have suffered a loss want to talk about that person endlessly while others are uncomfortable talking. You can start with “Are you OK talking about him/her?” If the answer is yes, you can prompt with questions like: “What were they like?”  “What made you love them so much?” “What about them made you giggle, cry, feel proud?” Grief is a lonely process that can be easier to endure with support from others. Do not be afraid to offer that support.

Additional resources

For Children:

• Cry, Heart, but Never Break: A Remarkable Illustrated Mediation on Loss and Life by Glenn Ringtved
• The Invisible String by Patrice Karst
• The Fall of Freddie the Leaf by Leo Buscaglia, PhD

For Teens:

• Straight Talk about Death for Teenagers by Earl Grollman
• Modern Loss: Candid Conversations about Grief by Rebecca Soffer and Gabrielle Birkner

For Adults

• The Year of Magical Thinking by Joan Didion
• How to Go on Living When Someone You Love Dies by Therese Rando PhD
• Bearing the Unbearable by Joanne Cacciatore, PhD

Dr. Anne Hayes is a certified Child and Adolescent Psychiatrist in private practice in Bethesda, MD. Dr. Hayes completed medical school, residency, and fellowship training at Georgetown University. She worked in the community mental health setting for many years before transitioning to a full-time private practice.