A Guide to Understanding Anxiety in Toddlers

Anxiety is a natural emotion that we learn to experience as early as infancy. But what happens when a toddler’s anxiety is beginning to impede their daily life? Caroline E. Kerns, PhD, and Miller Shivers, PhD, psychologists within the Lurie Children's Little Ones Program, break down signs of an anxiety disorder by age, share advice on how parents can help their toddler through feelings of anxiety, and point out signs that professional help might be beneficial.

Years 1-3: Pre-School Jitters and Bedtime Fears

During this period, a child commonly begins to spend more time away from the parents, especially if they attend daycare or pre-school. This can cause a spike in anxiety, some typical symptoms of which include crying, clinging during goodbyes. A toddler may also feel anxious before and during bedtime, and experience a common fear of the dark or a fear of being apart from parents.

“To help parents deal with these normal fears, we recommend parents have their child practice being away from them for short periods of time,” says Dr. Kerns. “If a child is anxious about starting daycare or pre-school, ease into the routine by asking a grandparent or family member to babysit the child for a couple hours, then extend it to longer periods of time.”

A parent may also do a trial run in the classroom before the child spends a full day there to help them get familiar with the situation and practice a healthy goodbye and reunion. Rather than prolong the goodbye or “sneak away” when the child is distracted, let your toddler know that you are leaving, when you will return, then share a quick hug and kiss before leaving.  

Years 3-4: Wild Imaginations—and Tantrums

This is the age when imaginations go wild. In addition to realistic fears such as loud noises, it’s common for toddlers to fear ghosts, monsters and other figures from their imaginations. Anxiety can also be expressed as a tantrum, crying, freezing behavior, anger, avoidance, or irritability, since toddlers lack the language and emotional regulation skills to explain and cope with how they’re feeling.

One key is to establish a soothing, predictable bedtime routine—including checking under the bed together for monsters, if need be—according to Dr. Kerns. Pay attention to whether the routine seems to help calm your toddler’s anxiety. If weeks go by without improvement, it may be a sign of an anxiety disorder starting to develop, Dr. Kerns says. If your toddler has difficulty staying in his or her own bed throughout the night, do your best to stay neutral. “Offer gentle encouragement for the child to stay in bed. Say, ‘I’ll walk you back to your bed now,’ and institute a check system where you check on the child every 5 minutes. Then extend the time between checks as the child gets comfortable being in their own space.”

When a tantrum strikes, cooler heads prevail. Try to model a calm approach to the anxiety-provoking situation. “If it feels like the tantrums are very frequent and it’s getting to the point where it’s impairing child or parent functioning, we recommend seeking help,” Dr. Kerns says.

Years 4-5: More Rational Fears Set In

By this age, your toddler will have an easier time distinguishing between reality and make-believe, but still some fears of ghosts may coexist with anxiety about more realistic things, such as school, family and health. The general guidelines for dealing with normative anxiety in this period are providing comfort and reassurance, while helping your toddler face the situation that is making him or her anxious.

“Help your child label and verbalize the feelings before, during and after they experience them,” Dr. Kerns says. “This helps them build an emotional vocabulary as they age, and helps them understand you can have more than one feeling in any given situation.” In doing this, you will help provide a foundation for healthy emotional development and normalize anxiety as an emotional we all experience. Let your toddler talk about his or her fears, and share some of your own when appropriate. You may also read stories about children who feel anxious for fictional but helpful examples of how they face fear and feel brave doing so.

In addition to promoting healthy conversations, it’s important to limit the amount of scary content kids are exposed to during this period. Take advantage of parental controls online and monitor the news you listen to in the car or at home. If your child hears unsettling things at school, allow them to share their response, discuss it with them, and reassure them that they are safe in the moment. 

When Should You Worry?

While every child will experience anxiety from time to time, be aware of heightened, prolonged distress at the prospect of an unsettling experience, Dr. Kerns warns. “As an example, a child with normative anxiety will go to a doctor’s appointment and start to feel anxious when he or she realizes they are about to get a shot. A child with an anxiety disorder, on the other hand, will realize they are going to the doctor’s office next week, and fixate on their anxious feelings before, during and after it happens.”

Parents should also pay attention to any functional impairment caused by a child’s anxiety at school or at daycare, with peers or in the family. Generally, toddlers can be expected to be engaged at school or daycare, play with their peers and coexist with their family’s routines. In the case of an early childhood anxiety disorder, however, parents typically have to go to greater lengths to help their child avoid triggers, such as large social gatherings.

If day-to-day life is impaired by anxiety, a mental health expert may be able to help parents find coping strategies and develop a step-by-step plan for families to function in the face of anxiety.

How Can You Be a Better Parent to an Anxious Toddler?

• Explore your feelings. If your child’s anxiety causes you to feel angry or embarrassed, be aware of your reactions and mindful of how you might curtail negative emotional responses, Dr. Shivers says.
• Consider your tolerance for “bad” behavior. While no parent wants to endure a tantrum, how long can you tolerate the situation before rushing to solve the problem or shutting down? Pay mind to what triggers you.
• Adjust your expectations for child. If you expect perfect behavior in every situation, you will always feel let down. If you can adjust your expectations, you can change your outlook on your day-to-day life.
• Be confident in managing your child’s behavior. Rather than asking, “Do you think you can do this?” say, “You can go to the birthday party. We’re all going to go.”

In-the-Moment Coping Techniques:

• Validate your child’s feelings and emotions. Name the feelings and let them know it’s OK to experience negative feelings. Acknowledge that anxiety is difficult, but you’re proud of their effort.
• Promote independence. “Kids need negative experiences so they can learn to cope,” Dr. Shivers says. “If your child is upset about going to birthday parties, take them anyway. They can sit by you for a while; the key is to stay in the situation until they begin to relax, which is the hardest part. You may want to rescue child when they’re upset but if they stay long enough, they will learn they can get upset, calm down, and by the time they eat cake it will turn out OK. You have to let them experience the good at the end.”
• Break down new routines into manageable steps that the child understands and remembers.
• Praise and reward the efforts. Any little step your child does, tell them that you are proud and/or offer a small, tangible reward like a sticker.
• Planned ignoring works to lessen behavior. Kids won’t whine or tantrum without an audience. Try to keep a neutral facial expression and manage your outward reaction so you don’t inadvertently give attention to negative behavior (and reinforce it).

Coping with anxiety is all about finding the set of tools that work for your child on a case-by-case basis. “Above all, remember you’re responding to the anxiety, not the child,” Dr. Shivers says.

Lurie Children's Little Ones is a comprehensive program for children ages birth to four years old in the Pritzker Department of Psychiatry and Behavioral Health. Learn more. 

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