Understanding Anxiety in Children: More Than Just Worry

Anxiety is one of the most common concerns I hear from parents. But what many people don’t realize is that anxiety doesn’t always look like worry.

Sometimes it looks like control.

Sometimes it looks like defiance.

Sometimes it looks like physical symptoms or developmental regression.

In this post, we’re going to break down the many different ways anxiety can show up in children—because understanding it is the first step toward supporting it effectively.

Anxiety & the Developing Nervous System

In my work, most of the children I see have a retained Moro reflex—the infant version of the fight-or-flight response.

Babies are born with a highly sensitive stress response that should mature over time into something more mature and dynamic. When that process doesn’t fully happen, children can grow up with a nervous system that is:

• Overreactive

• Oversensitive

• Mis calibrated to their environment

  
  

And one of the most common outcomes of that is chronic anxiety.

This is why anxiety isn’t just a “mental” issue—it’s deeply rooted in the body and nervous system.

The Many Faces of Anxiety

Anxiety is a broad term that can show up in many different ways. Below are the most common categories I see in practice.

1. Emotional & Cognitive Symptoms

These are often what people think of first when they hear “anxiety,” but even here, it can be subtle.

Children may experience:

• Persistent or vague worry

• Catastrophic thinking (expecting the worst)

• Intrusive or repetitive thoughts

• Difficulty letting go of ideas or fears

• Hypervigilance (always on high alert)

• Low frustration tolerance

• Big emotional reactions to small triggers

• Frequent overwhelm or shutdown

• Difficulty with transitions

• Black-and-white or rigid thinking

Many of these children feel like their “stress cup” is always full.

2. Behavioral & Control-Based Symptoms

This is where anxiety is often misinterpreted as behavior problems. When a child’s internal world feels chaotic, they often try to control their external world.

This can look like:

• Avoiding people, places, or activities

• Refusing to participate

• Perfectionism

• Procrastination driven by fear

• Rigid routines or rituals

• Controlling others (especially siblings)

• Frequent reassurance-seeking

• Difficulty making decisions

These behaviors aren’t about defiance—they’re about seeking safety and control.

3. Obsessive-Compulsive Patterns

These behaviors are often attempts to self-soothe or create predictability.

Examples include:

• Repetitive behaviors (checking, counting, lining things up)

• “Just right” behaviors

• Intrusive thoughts paired with rituals

• Fear of germs or excessive handwashing

• Repeating questions

• Body-focused behaviors like:

  • Nail biting

  • Hair pulling

  • Skin picking

  • Chewing or sucking

These are often labeled as “bad habits,” but they are actually nervous system coping strategies.

4. Physical (Somatic) Symptoms

Anxiety doesn’t just live in the mind—it lives in the body.

Common physical symptoms include:

• Chronic stomachaches or nausea

• Headaches

• Muscle tension (especially jaw and shoulders)

• Restlessness or hyperactivity

• Fatigue

• Rapid heart rate

• Shallow or irregular breathing

• Dizziness

• Constipation

• Stool withholding

For many kids, their body is the loudest expression of their anxiety.

5. Sleep Disturbances

Sleep and stress are deeply connected.

Anxiety can show up as:

• Difficulty falling asleep

• Frequent night waking

• Nightmares or night terrors

• Fear of sleeping alone

• Early waking with anxiety

• Restless sleep

• Bedtime resistance

6. Sensory & Nervous System Dysregulation

These are very common in children with retained reflexes and developmental delays.

You may see:

• Sensitivity to noise, light, textures, or environments

• Being easily startled

• Difficulty calming once upset

• Seeking or avoiding sensory input

• Alternating between hyperactivity and shutdown

This is classic nervous system dysregulation.

7. Regression & Developmental Shifts

These symptoms can be especially confusing or frustrating for parents.

They may include:

• Sudden clinginess

• Loss of previously mastered skills

• Increased dependence

• Baby-like behaviors (like baby talk)

• Increased whining or emotional intensity

These are often signs that a child is overwhelmed—not misbehaving.

8. Social & Relational Symptoms

Anxiety often shows up in how children relate to others.

This can look like:

• Fear of being watched or judged

• Avoidance of social situations

• Difficulty speaking in groups

• Hyper-awareness of others’ reactions

• Selective mutism (in more extreme cases)

9. Aggression, Defiance & “Oppositional” Behavior

Some children respond to stress with a fight response.

This can include:

• Irritability or anger

• Yelling, hitting, or explosive behavior

• Defiance or refusal

• Power struggles

• Overreactions to small situations

These behaviors can be the hardest to manage—but they are often rooted in stress, not intention.

10. Common Fears in Children

Children with anxiety often experience intense fears, including:

Environmental Fears

• Storms, weather, darkness, shadows

Animals & Insects

• Bugs, dogs, or fear of being harmed

Body & Safety

• Injury, doctors, choking, vomiting, dying

Separation & Existential Fears

• Being alone

• Losing a parent

• Fear of death or loss

Bathroom-Related Fears

• Toilets, showers, hand dryers

Sensory-Based Fears

• Loud noises, crowds, textures

Imagination-Based Fears

• Monsters, ghosts, being watched

Control & Predictability

• New situations, mistakes, uncertainty

Movement-Based Fears

• Heights, falling, swinging, biking

What All of This Means

Even though anxiety can look very different from child to child, internally the experience is often the same: the body's response to threat is mis calibrated. The nervous system is working overtime to keep the child safe - even when their isn't real danger.

The Good News

The brain—and especially the stress response—is incredibly adaptable. It is constantly learning from our environment and experiences how best to function. This means that it can learn to function better. Children are not stuck. Anytime I see a child who is struggling with a lot of anxiety symptoms my first recommendation is to test for a retained Moro and other early developmental delays.

I am a huge fan of working developmentally. The brain and body develop in a very orderly way and if an older child still has their Moro reflex we know that problems with their stress response started early in their development. Focusing on those early pieces allows the rest of the brain and body to "catch-up". Getting the body to function properly also make any other therapies we do more effective.

I have many other blog posts about the Moro and specific anxiety symptoms. If you are concerned about your child feel free to fill our a screening questionnaire and set up a free phone consult to discuss options for them.