By Steffi Mendoza, M.D.
Reviewed: October 2026
Some kids tell you they’re worried. Many don’t. Instead you get a stomachache every Sunday night, a ten-minute standoff at the classroom door, or the same “but what if” question for the fourth time at bedtime. With teens, it might be a phone still glowing at 1 a.m. and a kid who suddenly can’t face a group project.
Anxiety in children is one of my main areas of focus, and it often looks different from what parents expect. When I say anxiety, I mean worry or fear that is bigger or lasts longer than the situation calls for, and that starts crowding into sleep, school, friendships, or family life.
Some worry is a normal, healthy part of growing up. What I want to help you sort out is whether it has started taking up too much room. Here’s how I’d explain it if we were sitting together in my office.
How is anxiety different from ordinary worry?
A preschooler clings to you at drop-off. A second grader needs the hall light on. A seventh grader dreads her first presentation. Those worries usually come and go, and kids grow through them with time and a steady parent nearby.
The anxiety I evaluate is stickier. The Centers for Disease Control and Prevention (CDC) describes it as fears and worries that don’t go away and that interfere with school, home, or play. It can show up as fear of being apart from parents, fear of a specific thing, worry about what other people think, worry about many things at once, or panic.
The National Institute of Mental Health (NIMH) makes a point I repeat to parents often. The difference between a stage and a concern usually comes down to how long it lasts and how much it gets in the way.
And to be clear, anxiety isn’t a character flaw. It doesn’t mean your child is weak or that you did something wrong. It’s a health concern like any other, and help is available.
Anxiety in children: what parents and teachers usually see
In younger children especially, anxiety shows up in the body and in behavior long before a child has words for it. Parents and teachers often describe things like these:
- Stomachaches, headaches, nausea, or feeling “sick” before school or activities, especially when the doctor hasn’t found a medical cause
- Not wanting to go to school, birthday parties, sleepovers, or practice, or asking to come home early
- Asking the same “what if” questions over and over, or needing to know every detail of a plan
- Trouble falling asleep, wanting you close at bedtime, or frequent nightmares
- Clinginess or separation fears that seem young for their age
- Tears, irritability, or meltdowns around transitions or anything new
- Perfectionism, like erasing homework until the paper tears or falling apart over a small mistake
- Freezing or going silent in class, even when they know the answer
Any one of these can be part of an ordinary childhood. When I’m listening, the shape of things over time tells me more than any single item.
What does anxiety in teens look like?
Teenagers tend to carry anxiety quietly. Many won’t say “I’m anxious,” and some don’t recognize it in themselves. Parents are more likely to notice:
- Pulling away from friends or social plans they used to enjoy
- Intense worry about grades, college, appearance, or what others think
- Putting off assignments because getting started feels overwhelming
- Snapping at family, especially under stress
- Trouble sleeping, or staying up late on the phone to avoid being alone with their thoughts
- Episodes of racing heart, shortness of breath, or a sense that something terrible is about to happen
- Canceling plans, practices, or classes at the last minute
In teens, anxiety often travels with low mood. If your teen seems persistently sad or hopeless, or talks about not wanting to be here, please don’t wait. The crisis information is below.
When should we get help for anxiety?
There’s no bright line. These are the questions I’d ask you.
How long has this been going on? Weeks to months is different from a rough stretch around one event.
How big is the worry compared with the situation? And once your child is upset, can they come back down?
What is it getting in the way of? Think school, sleep, friendships, and family routines.
Is your child’s world getting smaller? I pay close attention to this one. Avoidance tends to feed anxiety, so a child who drops one more activity every month worries me more than a child who is scared but still going.
Is your child suffering, even while pushing through? Some kids hold it together all day at school and fall apart in the car. That still counts.
If you’re answering yes to several of these, it’s reasonable to talk with your pediatrician or a mental health professional. Asking early is not overreacting. I would much rather meet a child while the pattern is still new.
What happens when I evaluate a child for anxiety?
It starts with an unhurried conversation. I want to know when things started, which situations are hardest, how your child is sleeping and eating, how school is going, and what you’ve already tried. Parents usually know far more than they think they do.
With older kids and teens, I spend time talking with them directly, too. Input from teachers helps, and so does a check with the pediatrician for medical contributors.
I’m also listening for what else might be going on. Anxiety often overlaps with attention difficulties, low mood, sleep problems, or learning differences, and a good plan has to account for all of it.
Then we build that plan together. For many children, therapy and skill-building sit at the center. Family support, school coordination, and basics like sleep, movement, and nutrition usually play a part.
When it’s appropriate, medication may be one tool we talk about, and any decision is one we make together after I’ve answered your questions. I explain more about this whole-child approach in What Is Integrative Psychiatry?
What can I do at home while we wait?
None of this is a treatment plan, just things I share with parents to make the waiting easier.
Listen before you fix. Naming a feeling often takes some of the sting out of it.
Stay calm, even if you have to borrow the calm for a minute. Children take their cues from our steadiness, and your tone matters more than finding perfect words.
Keep the days predictable. Regular sleep, meals, and morning and evening routines help an anxious body settle.
Validate the feeling without agreeing with the fear. You can say “That sounds really scary” and “I believe you can handle this” in the same breath. Both are true.
Notice brave steps, even small ones, and praise the effort rather than the result. And look after yourself. Parenting an anxious child is tiring, and your own rest counts.
Could it be ADHD or school anxiety instead?
Sometimes it’s both. Anxiety and ADHD can look surprisingly alike, since either one can make it hard to focus, finish work, or sit still. If attention has been a question in your family, my post ADHD in Children: A Parent’s Guide walks through how I sort these apart.
School is another place anxiety likes to hide, and Sunday-night stomachaches are sometimes the first clue. I’ll be writing a separate post on school refusal and school anxiety soon.
Seeing me in Frisco or by telehealth
I care for children ages 4 to 11, adolescents 12 to 21, and young adults 22 to 45. I see families in person at my office at 5300 Town and Country Blvd #240 in Frisco, and by telehealth for patients who are physically located in Texas or Colorado at the time of each visit.
My practice is private-pay, and I provide superbills you may be able to submit to your insurance. You can read more about how I work, including fees, on How I Serve, and find answers to common questions on my FAQs.
Frequently asked questions
How do I know if my child’s anxiety is “normal”?
Ordinary worry is usually tied to a specific situation and fades with time or reassurance. Worry that lasts weeks to months, feels out of proportion, or has your child avoiding school, friends, or activities is worth talking over with a professional.
Can anxiety really cause stomachaches and headaches?
Yes. Many children, younger ones especially, feel anxiety in their bodies first. I still want your pediatrician to check for medical causes, because a child can have both.
Should I push my child to face their fears?
Gently, and in small steps. Facing fears a little at a time is often how children build confidence, while forcing something overwhelming tends to backfire. A therapist or clinician can help you find the right pace.
When is it time to see a child psychiatrist for anxiety?
I’d consider it when anxiety is persistent, intense, or affecting several parts of life, or when it hasn’t improved with the support already in place. It also makes sense when attention or mood concerns seem mixed in, or when you have questions about whether medication could be one part of a plan.
Let’s talk
If any of this sounds like your family, you don’t have to figure it out alone. The first step is simply a conversation.
You can request a free 15-minute consultation, and we’ll talk about what your child needs and whether we’re the right fit.
In crisis? Call or text 988. For emergencies, call 911 or go to the nearest ER. This office is not monitored for emergencies.
Sources
- Centers for Disease Control and Prevention (CDC): Anxiety and Depression in Children
- National Institute of Mental Health (NIMH): Children and Mental Health: Is This Just a Stage?
Office of Steffi Mendoza, M.D. · Child, adolescent, and young adult psychiatry
5300 Town and Country Blvd #240, Frisco, TX 75034 · Serving Frisco, Plano, McKinney, and the DFW area
Telehealth available for patients physically located in Texas or Colorado at the time of the visit.
This article is for general education and is not a diagnosis or a substitute for an individual evaluation.
In crisis? Call or text 988. For emergencies, call 911 or go to the nearest ER. This office is not monitored for emergencies.