Today I am planning a short-ish article (famous last words), and it is an article I have wanted to write for a while. It is a really big topic though, and there are many sides to it.
Anxiety. I have said it before, and I’ll say it again – it is an absolute beast. It is common, it is disabling, it is impairing, it makes you feel absolutely lousy, it makes you miserable. People use this term for when they’re feeling nervous or unduly worried about something – but anxiety is the term we health professionals use for when the feeling persists even when the trigger is removed.
It literally can affect every aspect of your life. Here, let me name just a few examples (I’ve inserted some links too to previously written articles),
- Emotional regulation
- Concentration and attention
- Work (and ability to start or complete tasks)
- Physical feeling of wellbeing (eg abdominal pain, nausea, palpitations, breathlessness etc)
… and this is only to name a few.
So we’ve had some great articles from our resident psychologist Dr Jenni (of Brilliant Minds Psychology) about specific types of anxiety. She has written about exam stress in teenagers ( for parents and for teenagers themselves) and separation anxiety. But there are many more types of anxiety including (but not limited to):
- Performance anxiety
- Generalised anxiety
- Social anxiety disorder
- Specific phobias
- Panic disorder
Dr Jenni has given us some fabulous strategies in her other articles, that we can use as parents to help our children if they are suffering from anxiety. Finding a competent, paediatric psychologist (or in some cases Mental Health Trained Occupational Therapist), who has the ability to build a good relationship with your child will be instrumental in effectively treating their anxiety.
Guidelines state that in treating all children under 7 years with anxiety, psychotherapy is FIRST LINE. In a large proportion of cases, medication-based therapy can be avoided altogether if regular and effective psychotherapy sessions are undertaken first. As many parents of my patients will attest, recommending sessions with a child psychologist is what I do first line for ALL children who present with anxiety – not just those under the age of 7.
Today I wanted to write an article to talk about what your paediatrician (or local kid-friendly GP) has to offer in terms of contributing to the valuable psychological therapy that your child’s psychologist/OT/counsellor already performs.
Your GP and/or paediatrician is often the first health professional to evaluate your child for anxiety. It may be that you have presented to them with a different concern (eg learning difficulties, behavioural problems), and that anxiety has either surfaced as a symptom in the history, or is a diagnosis deduced by your physician given other aspects of the story.
I can’t speak for all doctors, but I will sometimes interview the patient on their own(especially if they are teenagers or tweens) as sometimes kids feel more comfortable talking about things they are worried about when their parents are not in the room. I then interview the parents on their own, because sometimes there are things that parents want to say to me that they don’t want their kids to hear for fear of damaging their self-esteem, embarrassing or upsetting them.
Don’t be afraid to ask your doctor to speak to them in the absence of your child in the room if there is something particularly sensitive you want to talk about (eg history of bullying at school, struggles with friendships, parental separation, history of abuse etc).
The way your physician (or therapist) relates to your child is something unique to that clinician. Sometimes personalities hit off from the start, other times they just don’t gel – but don’t worry. If you decide to try another doctor or therapist – paediatricians (and psychologists/OT I am sure) are used to that and will not take offense. I for one, would much prefer that you and your child feel comfortable with and have confidence in your treating doctor than pushing on with ineffective sessions because of a personality clash or an inability to build rapport. As the old saying goes, “No use floggin’ a dead horse” – and no use wasting your money on such sessions either.
Something your paediatrician will do that your psychologist will not, is have a think about whether or not there are other medical reasons that might potentially explain your child’s anxiety. These things might include, thyroid disease, heart problems (eg an irregular heart rhythm for example), iron deficiency and/or anaemia, hormonal issues or other medical illnesses. We will be looking for physical signs of these things when we examine your child, and then we may order some blood tests or other investigations to look for or rule out these things.
The other thing that I can do (that your psychologist cannot do) is talk to you about and potentially prescribe medication to help with anxiety. Lots of parents are (ironically) very anxious about using anti-anxiety medications (which we call “anxiolytics”) – and this is completely reasonable. No medication comes without side effects and it is important to weigh up the pro’s and con’s before deciding either way. I see it as my role to talk to you about what these medications are, which ones are safe to use in children, and what we can expect if we start a medication like this (ie how long it will take before we see an effect, what the possible side effects might be, what dose we will use etc). I will only offer medication if I felt that your child had something to gain from its use and I will also try to answer any questions that you might have about such treatment.
As I mentioned above, I generally do not use medication as first line treatment in anxiety in children. Even in cases where we do move quickly to using medication, it is always instituted WITH regular psychotherapy – because there is no use taking a medication to reduce anxiety, unless the child is taught and learns the strategies of how to reduce and control their own anxiety when it next occurs. I never pressure parents into using medication in their children – it has to be a decision that they come to on their own, being fully aware of the risks and potential benefits and evaluating these in the context of their own child. I will continue to support both the child AND their parents regardless of what their decision is, but more than likely will push harder for your child to engage with a good psychologist for regular sessions.
Many parents worry that once their child is on an anxiety-medication, that they will “never get off it again.” In many cases this is not true. In most cases where I have come to an agreement with parents to trial a medication, we generally say that we treat for a minimum of 6-12 months. Stopping anxiolytic medication prematurely can increase the risk of relapse. Having said this, we would OPT to cease prematurely if the child was experiencing intolerable side effects from the medication. When instituted together with therapy, most children will improve and come off the medication after this amount of time; keeping in mind that if a child has a predisposition to anxiety (strong family history or a known anxious personality), then they are at higher risk of having anxiety again and potentially needing medication at some later stage in life.
Now this article is already a LOT longer than I meant it to be, but I hope you have found it helpful.
If any of you are interested, please let me know in the comments below and I can follow up with an article about the medications that we use for anxiety in children and cover how they work, and what the potential side effects are.
Till next week, stay chill
For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/