This post is dedicated to the victims of the devastating earthquake in Haiti. 

“All children feel some level of anxiety,” explained Dr. Lori Evans, a child psychiatrist at the NYU Child Study Center in New York City, at the P.S. 183 PTA meeting this week. When Dr. Evans spoke, I took notes.  It’s not often that a renowned child development expert gives her time and wisdom gratis.

Here are some of the tidbits that she offered parents and educators and that I wanted to share with you: hey, sometimes it’s nice to know your kid is normal (even though he doesn’t always seem that way), or that there are simple strategies for dealing with seemingly huge problems.

• Anxiety comes in all shape and sizes. What might seem silly to parents – for example, the death of a Harry Potter character – can produce real worry in children.
• Sometimes anxiety is behind other kinds of behavior — oppositional, defiant, tantrum-throwing. The rebellious behavior could be about a child trying to avoid or escape a fear.
• Some kids somaticize their anxiety.  Stomachaches that are very real, including vomiting, can be caused by nervousness.  Parents can work with children to help them distinguish the difference between a stomachache that goes away in a couple hours, and one that lasts for days and is caused by a virus.
• Parents naturally want to reassure children when they are worried about something.  Over-reassurance, however, can breed the need for more reassurance.  Parents can teach children to say the comforting words to themselves.  For example, “What did mom say last time?” “You said I’m doing just fine.” Or, “Remember when you were afraid of dogs? What did you do to get over that?” Prompt the child to use those same coping strategies.
• Learn to distinguish between the pursuit of excellence (a behavior most parents value) and perfectionism (a behavior that can freeze a child out of worry).
• Kids read parental cues about anxiety and often mimic the emotion.  Parents can give confidence to kids by not showing worry about everything from a playground scrape to college testing.
• If a child sees you scared, it’s okay to say something like, “I was so nervous.  You were braver than me.  How did you do it?”
• We can teach kids how to handle their own anxiety by externalizing our processes:  “I was nervous about giving that speech, but then I told myself, ‘You’ll be okay,’ and then I felt better.”
• Ninety percent of people are average, but are we satisfied if our children are average? Parents inherently put pressure on children.  Our anxiety — about getting into the right school, for instance — gets translated to our children.  To some degree, and depending on our child’s personality, we need to control how much of our own anxieties we share with them.
• Some pressure can be motivating for children: “If you don’t get to school on time, you’ll get bad marks on your report card.”  However, parents need to judge their individual child.  Self-motivated children don’t need external pressure and it might even add to their internal anxiety. Understand your specific child when asking whether to put on pressure or just to say, “No big deal.”
• If your child has internal motivation, reward it.  If your child needs pushing (to practice a musical instrument, for example), it’s okay to use external motivators (rewards and punishments) to shape the behavior you need.
• Try positive motivators first, such as Grandma’s Rule (or the When-Then rule):  “When you eat your peas, then you can have dessert.”
• There is a point when we need to let our kids go. But it’s hard because kids today lead very structured lives and don’t have any experience with freedom. Find ways to give your children little freedoms when they start asking for them.  Resource: New York mom Lenore Skenazy’s book and blog and now parenting movement, Free Range Kids: “Giving children the freedom we had without going nuts with worry.”
• Give your children honest answers to questions like, “Will you die?” Let them know we all deal with uncertainties.  Reassure without lying with statements such as:  “I’m trying to keep myself very healthy.”  “Look how old grandma is.”  “I will always love you.”
• The way to get over any fear is to face it. Give your child techniques to deal with the anxiety, and then gradually overexpose the child to the fear.
• For children who are afraid of bad dreams, ask the child to retell the dream, over and over.  As we recount dreams that once seemed very scary and real, they begin to sound weirder and weirder.  Ask the child about the dream again and again, and it will even start to seem boring.
• For children who have extreme anxiety about something like going to the doctor or the dentist, try treating it with gradual exposure to the fear, working through a hierarchy.  For instance:  First look at pictures of doctors in books and online.  Then go to a doctor’s office just to pick up a brochure.  Another day spend a long time sitting in the waiting room — so long that your kid becomes bored.  Another day, ask the doctor if you can just come in to touch the stethoscope.

Dr. Lori Evans is a Clinical Assistant Professor of Child and Adolescent Psychiatry at the NYU School of Medicine, an acclaimed behavioral psychologist, and Director of Training of the NYU Psychology program. She provides clinical services to children and families and provides consultation services to many of the top schools and professionals in the New York-metropolitan area. Dr. Evans also coordinated the “Treatment of Adolescent Suicide Attempters” study at the Child Study Center. Dr. Evans has been published in Infant Behavior and Development and Child Development.

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