What Can You Give A Child for Anxiety?

The anxiety drugs for children are roughly the same as those for adults, with dosages adjusted. Medication is only started for children if talk therapy has failed to alleviate the anxiety.

Anxiety disorders are a common type of psychiatric disorder, characterized by anxiety or fear that does not go away over time. 

Feelings of fear or distress are common in children, but when they become persistent or extreme, a child may be suffering from anxiety. About 4.4 million children aged 3 to 17 years have been diagnosed with anxiety. 

Types of anxiety in children can include: 

• Separation anxiety: Fear of being separated from their parents 
• Phobias: Extreme fear focused on a specific thing or situation, such as insects, animals, or going to the doctor 
• Social anxiety: Fear of school and other places where people are present
• General anxiety: Worry about the future and about bad things happening 
• Panic disorder: Repeated episodes of sudden, unexpected, and intense fear accompanied by symptoms such as heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty 

Symptoms of anxiety in children may include: 

• Fear
• Worry
• Irritability
• Anger
• Trouble sleeping/nightmares
• Fatigue
• Headaches
• Stomach upset
• Heart pounding, trouble breathing, dizziness, shaking, or sweating (panic disorder)
• Refusal to attend school 
• Being overly clingy 
• Panic or tantrums at times of separation from parents 
• Avoiding social situations 
• Few friends outside the family 
• Repetitive, unwanted thoughts (obsessions) or actions (compulsions) 
• Low self-esteem and lack of self-confidence 

There are numerous possible causes of anxiety disorders, such as:

• Genetic factors
• Environmental factors such as early childhood trauma
• Known or unrecognized medical condition 
• Substance-induced, such as from use of over-the-counter (OTC) medications, herbal medications, and drugs of abuse

Anxiety disorders are often diagnosed with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association provides diagnostic criteria for an anxiety disorder. 

Lab studies to diagnose or exclude medical conditions that may cause anxiety disorders include:

• Complete blood cell (CBC) count
• Chemistry profile
• Thyroid function tests
• Urinalysis
• Urine drug screen

Tests to rule out central nervous system (CNS) disorders that can cause anxiety include:

• Electroencephalography (EEG)
• Lumbar puncture
• Brain computed tomography (CT) scan
• Magnetic resonance imaging (MRI) of the brain 
• Neurologic consultation 
• Positron emission tomography (PET) scan

Tests to rule out heart conditions that can cause anxiety include:

• Electrocardiography (ECG) 
• Treadmill ECG

Tests to rule out infectious causes of anxiety include:

• Rapid plasma reagent test
• Lumbar puncture (CNS infections)
• HIV testing

Other tests to rule out other physical causes of anxiety include:

• Arterial blood gas analysis 
• Chest X-ray

Treatment for anxiety disorders in children may consist of a combination of psychotherapy and medication. 

The first-line treatment for children with mild anxiety disorders is psychotherapy such as

• Cognitive Behavioral Therapy (CBT), which teaches skills and techniques a child can use to reduce anxiety
• Dialectical behavioral therapy (DBT), which emphasizes taking responsibility for one’s problems and helping children examine how they deal with conflict and intense negative emotions

For a child who has severe symptoms of anxiety, or if they have not responded well to psychotherapy, medications may be used such as:

• Serotonin and norepinephrine reuptake inhibitors (SNRIs) 
  • Duloxetine (Cymbalta) is approved by the FDA to treat childhood anxiety disorders
  • Venlafaxine ER (Effexor XR) is “off-label” use (not approved by the Food and Drug Administration for that specific use)
• Selective serotonin reuptake inhibitors (SSRIs) are used “off-label” for childhood anxiety disorders 
  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Escitalopram (Lexapro)
• Benzodiazepines for severe episodes or specific experiences such as fear of flying, for short-term use 
  • Lorazepam (Ativan) 
  • Clonazepam (Klonipin)
  • Alprazolam (Xanax)
• Antihistamines for short-term use
  • Diphenhydramine (Benadryl) 
  • Hydroxyzine (Atarax, Vistaril) 
  • Doxylamine (Unisom)
• Beta-blockers may be used for performance challenges such as public speaking events
  • Propranolol (Inderal) 
• Sleep medications
  • Melatonin
  • Antihistamines
  • Antidepressants that sedate like mirtazapine
  • Medications marketed for insomnia in adults such as zolpidem (Ambien) and zaleplon (Sonata)
    • These medications have not been extensively studied in children
• Tricyclic antidepressants
  • Imipramine (Tofranil) 
  • Clomipramine (Anafranil)
• Anti-anxiety drugs such as buspirone (BuSpar)