Surprising Anxiety Trigger 7: Something That Happened a Long Time Ago

Your daughter watches “Finding Nemo” for the first time and becomes very upset when Nemo’s mother dies at the start of the film. You comfort her appropriately, and she seems to recover. After all, children are surprisingly resilient, and your daughter will surely forget all about the scene soon. Weeks (or even months) later, your daughter starts displaying unusually severe separation anxiety. She’s reticent when questioned, but you assume something very recent has triggered her increased anxiety.

Unfortunately, though children are indeed resilient, they often become haunted by the scary things they see in life, on TV, and even in dreams. Sometimes they dwell on things that frighten them, spending days reliving their fear. In other instances, the scary event only slips into their minds when triggered by unrelated anxiety, random association, or perhaps a relevant song. Either way, children often feel embarrassed by their inability to release scary memories from the past. Encourage your child to share her feelings by listening with interest, respect, and love. Never mock a child for dwelling on old fears; you may be tempted to say “You’re still upset about that?” but it’s important that you display support instead.

If your child expresses lingering or recurrent anxiety about a minor trauma in the past, explain that it’s normal to sometimes feel stuck with a fear, and then help her address the fear directly. Humor can be helpful (“I promise not to get eaten by a fish”) if your child fears supported and respected. If your child cannot release her fear, it may be necessary to discuss the issue with your pediatrician or mental health professional.

If your child has experienced significant trauma in the past, it’s crucial that you speak to an expert as soon as possible.

Surprising Anxiety Trigger 6: Music

This is the sixth installment of the ongoing series of surprising triggers of childhood anxiety.

We all know that music can dramatically influence mood, but it’s easy to forget that songs have different effects on different people. Songs are often strongly associated with specific memories: Though I believe the song came out years earlier, “We’re Going to Be Friends” by The White Stripes conjures my senior year in high school so dramatically I get almost giddy when I hear it; 12th grade was one of the best years of my life. Alternately, I can’t listen to Sum41’s first album (and luckily wouldn’t care to anyway) because it brings me back to the anxiety and despair of eighth grade. Children have fewer things to remember, but they may also associate songs with memories. A favorite family lullaby heard while away from parents might trigger separation anxiety, or a song from a scary movie (and remember, children are often scared by seemingly benign movies) might cause sudden unease. These associative memories are too complex for most young children to express, so it’s up to parents, caregivers, and teachers to help anxious children explore their fears.

Even if you’ve never heard a song before or don’t have any strong associations to it, some music just makes you feel bad. Sometimes a piece of a lyric can be scary, or sometimes there’s a scary story being told. I mentioned before that “She’ll Be Coming ‘Round the Mountain” was agonizing for me in preschool because I took the lyrics to mean that the singer’s mother was coming but hadn’t yet arrived–and she never even gets there! Also, don’t underestimate the effects of a “plaintive melody” or a dramatic swell. For most people, the melody of the song is actually more powerful than the lyrics. (Yesterday, my roommate pointed out the story being told in “Sittin’ on the Dock of the Bay.” It’s not as whimsical as you might guess.)

If your child or student becomes distressed during a song, it may be helpful to ask the child whether she’s heard the song before, and where. Next, explain that songs can make you remember something really strongly or even just make you feel a strong emotion. Education, understanding, and training are the best tools to mitigate anxiety, so always use anxiety attacks as “teaching moments.” Then, after the anxiety has been addressed, use distraction to help your child feel normal again. And consider changing the song!

Surprising Anxiety Trigger 5: Medications

A variety of medications can cause anxiety, especially in individuals with anxiety disorders. Before giving your child even over-the-counter medications, consider the risk of increased anxiety. Because the benefits of medication sometimes outweigh the side effects, it may be necessary to coach your child through her anxiety or combat the anxiety with medication prescribed by your pediatrician.

You probably already know that stimulants, like caffeine or amphetamines, can trigger anxiety. Children with ADD/ADHD are often prescribed a stimulant as treatment. Some children with comorbid ADD/ADHD and anxiety can tolerate stimulants. Other children, especially those with Panic Disorder, may experience very rapid heart rate combined with feelings of terror. Talk to your pediatrician or psychiatrist for more information.

Some cough and cold medicines, like the decongestant pseudoephedrine (Sudafed), are also stimulants. These medications can cause increased heart rate, shaking, nervousness, and anxiety. Talk to your pediatrician before giving your anxious child pseudoephedrine or similar medications, and report side effects, especially those that are severe.

Antihistamines like Benadryl (diphenhydramine) typically cause drowsiness, but some children experience a paradoxical effect and become excited or energetic. Anxiety can also occur in this situation.

If your child has asthma, you may already have noticed that his inhaler can cause shaking and increased heart rate. If your child’s asthma medication is causing anxiety, it’s important to ensure that the child is still taking the medication appropriately, in spite of his discomfort. Talk to your pediatrician, and check back for an upcoming post about asthma and anxiety.

Oral steroids, which are sometimes used to treat persistent allergic reactions* can cause anxiety and other changes in mood. A doctor should monitor your child while she is taking oral steroids.

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*like if your mosquito bites somehow lose their minds and turn your usually beautiful leg into this monstrosity…

The above medications are some of the most likely to cause anxiety, but any drug that makes a child feel “weird,” sick, “antsy,” groggy, or dizzy can inspire panic. Warn your child about possible side effects before they start, but skip mentioning any real dangers associated with the medication. Utilize relaxation techniques and distraction while your child acclimates to new medication, and, most importantly, always discuss medication changes and effects with your doctor.

Surprising Anxiety Trigger 4: Upset stomach

Welcome to part four of my Surprising Child Anxiety Triggers series!  Today’s trigger is gastrointestinal distress, or “upset stomach.”

The stomach flu is, in my opinion, the worst (non-serious) thing ever. The worst. Worse than stubbing your pinkie toe or getting ten paper cuts. Worse than reality TV. The worst. In fact, like many children with Obsessive-compulsive Disorder, many of my compulsions were done to prevent throwing up.  Gastrointestinal distress is so horrible I’ve separated it from other illnesses and given it its own post.

If an anxious child feels sick to her stomach, two separate things can cause her to panic:

First, if she’s afraid of the stomach flu/food poisoning, she’s likely to panic if she thinks that’s what’s causing her discomfort.  In fact, she might panic even if she knows she’s only sick because she ate too much or too fast, because feeling like she’s going to throw up is terrifying no matter what. (This is especially true for children who are afraid of losing control or embarrassing themselves.) If your child or student is specifically worried about GI symptoms, teach her how to minimize her risk of upset stomach by eating slowly and calmly.  A coach or a cognitive-behavioral therapist can help create a plan to help overcome fear of stomach upset.  In the meantime, have your child or student practice slow, steady breathing, and help her minimize her discomfort by addressing the possible cause.  Note: anxiety can cause or increase nausea, so address anxiety symptoms first or concurrently.

Second, like many of the triggers on this list, GI distress can mimic anxiety symptoms.   Both panic and GI distress can cause nausea, stomach pain, lightheadedness, and increased heart rate.  Anything that mimics panic can cause panic.  In part, this is because panic is terrifying, so thinking that you’re going to panic can …make you panic.  To combat this, encourage children to relax into their panic with complete acceptance.  Say, “you’re having a panic attack.  It’s very common, and it can’t hurt you.  It’ll be over soon even if you don’t do anything.”  Remind anxious children to breath slowly (without gasping or hyperventilating) and simply allow the panic to rise and then fall.  Accepting panic is extremely difficult, even for adults, but it’s extremely effective.

Coming soon: how to coach a child through a panic attack.

More in this series:
Hunger
Dehydration
Illness

Surprising Anxiety Trigger 3: Illness

Various disorders and illnesses can cause symptoms similar to those of an anxiety disorder. Some of these illnesses are serious, so it’s a good idea to talk to your pediatrician. Let me start by saying this: If your child (or student) is prone to anxiety, don’t tell him that it may be caused by a dangerous medical condition! You might be thinking aloud and benignly mumble “I wonder if it’s your thyroid.” Ask yourself: does your child (or student) know what a thyroid is? Does your child know that a thyroid problem is manageable and not going to kill her? When you’re already anxious, anything that sounds like danger can trigger full panic. If you drop some medical terminology or even an unfamiliar anatomy word, explain that there’s nothing to worry about. If you are worried (say, about your child’s heart), be extra calm and keep your fears to yourself.

Even if your child’s anxiety is a symptom of an anxiety disorder and not any other medical condition, illness can be an anxiety trigger. Respiratory symptoms may inspire fears of suffocation. Shivers from a fever might remind your child of the shivers he experiences with panic attacks, and that might be enough to cause panic. If your anxious child is ill, watch for signs of panic, and explicitly remind your child that his symptoms are the result of a harmless virus (or whatever’s causing his illness) and nothing more.

More in this series:
Hunger
Dehydration
Upset stomach

Surprising Anxiety Trigger 2: Dehydration

Sometimes, late afternoon on a long day, I start to feel a little sick. I’ll notice that my heart’s beating kind of hard, and I feel a little dizzy. Maybe my hands are shaking just a little, or maybe my head hurts. Confused, I’ll struggle to identify the unpleasant but familiar sensation, and then I’ll realize–I haven’t had anything to drink all day except the milk in my morning cereal. I have a masters degree, and I sometimes forget to drink. Does your ten-year-old know the symptoms of dehydration? Whenever a child complains to me about anxiety symptoms, the first thing I do is talk them through their relaxation and coping steps, and the second thing I do is make them sllloooowwwwwlllly drink a big glass of water.

Dehydration is a serious health risk. On hot summer days or dry winter days, it’s important to encourage children to drink more than usual. Teachers should never prevent thirsty children from getting a drink of water.

The Mayo Clinic has more information about the signs and risks of dehydration.

More in this series:
Surprising Anxiety Triggers
Hunger
Illness
Upset stomach

Surprising Anxiety Trigger 1: Hunger

Welcome to the first installment of the Surprising Triggers of Anxiety in Children series.  When your child or student exhibits the symptoms of anxiety, you may assume that something frightening has occurred.  However, anxiety can be triggered by a variety of surprising situations.  This series discusses many of those triggers.

Today’s surprising trigger is hunger.

Why does hunger sometimes cause anxiety in children?  Intense hunger can cause dizziness, increased heart rate, shaking, and irritability.  Hypoglycemia, or low blood sugar, can cause both psychological and physical symptoms of anxiety.  Healthy humans do not experience hypoglycemia simply because they have missed a meal or waited too long to eat.  Hypoglycemia is diagnosed by a doctor.  If you suspect that your child suffers from hypoglycemia, contact your pediatrician.

A phenomenon called Idiopathic Postprandial Syndrome is often called hypoglycemia, but this syndrome is not actually characterized by low blood sugar.  The term “idiopathic” basically means “unexplained,” and “postprandial” means after eating.  Idiopathic Postprandial Syndrome is the name used to describe a pattern of feeling shaky and irritable an hour or two after eating.  Idiopathic Postprandial Syndrome is fairly common, and it can definitely trigger anxiety.  It may actually be related to anxiety disorders.  Very little information is available about Idiopathic Postprandial Syndrome, and some of the information that is available is inaccurate or misleading.  It’s possible that the symptoms of Idiopathic Postprandial Syndrome are related to sudden drops in blood sugar (as opposed to the unhealthily low blood sugar levels present in individuals experiencing hypoglycemia).

If you suspect that hunger is triggering anxiety in your child or student, suggest a healthful snack.  Make sure the child eats slowly; anxiety can cause nausea.  Some people believe that choosing “low glycemic index” snacks that minimize spikes in blood sugar can minimize mood instability.  Unfortunately, nutrition and metabolism are both extremely complex and misunderstood sciences, so you may want to play around with different snacks or ask your pediatrician for advice.  As always, make sure your child understands that anxiety and its symptoms cannot actually cause harm.