Mental Health

Author: Anxiety Canada

Fears are common and expected in childhood; however, for some children and teens, their fears can become very severe over time, and even develop into a phobia. A phobia is an intense and unreasonable fear of a specific object or situation. This causes an extreme anxiety response towards something that is not causing immediate danger. For example, someone may have a phobia of dogs, spiders, or elevators.

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Key Points:

• Phobias are the most common type of anxiety disorder

• Approximately 12.5% of the population will have a specific phobia in their lifetime

• On average, specific phobias begin in childhood, around the age of seven

Stories

The story of 14-year-old Jesse:

Jesse is really afraid of getting needle injections. When he was eight years old, he passed out at the doctor's office during a blood test. Since then, Jesse avoids watching or thinking about anything that has to do with blood, needles, or medical procedures. He says they make him feel like his "heart is racing" and he "can't breathe or think", and he will either "freak out" or "faint again". Before a doctor's visit, Jesse repeatedly asks for reassurance and promises from his mom that he will not need to get a shot. During his last check-up, the doctor tried to bring up the topic of getting a TB test, which would involve a little shot in the arm. When the doctor said this, Jesse got very upset and started to breathe heavily and shake. He also began crying and telling his mom repeatedly that he wanted to go home. Jesse's mom was very surprised by her son's reaction, and thinks he may have had a panic attack. She is worried that Jesse will never want to go to the doctor again.

The Story of 6-year-old Emma:

Emma is terrified of water, and won't even go near it. This includes swimming pools, lakes, and the beach. Going out fishing on the lake in the family speedboat, something the whole family used to enjoy, is now impossible with Emma. When Emma was 4 years old, the family attended a pool party. During the party, Emma wandered over towards the pool to grab a toy and was accidentally pushed in by another child. Immediately, adults rushed over and scooped her out of the pool, but for about 30 minutes afterwards she was crying and shaking. Shortly after this incident, Emma started fearing water. When her parents try to reassure her and promise her rewards for going near a swimming pool, she screams, cries, and digs her nails into her mom or dad's leg. Emma's parents have just about given up trying to get her to go near water. They worry that she won't have a chance to have fun with other kids, if this continues, and they would really like to go out on the lake or to the beach as a family again.

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What is a phobia?

Fears are common and expected in childhood. However for some children and teens, their fears can become really severe over time and even develop into a phobia. A phobia is an intense and unreasonable fear of a specific object or situation. This means having an extreme anxiety response towards something that is not causing immediate danger. Someone may have a phobia of dogs, spiders, or elevators, for example.

Phobias are different from normal childhood fears because they:

• Interfere with your child's life. For example, phobias can make it difficult for your child to go to school, be around other kids, or get involved in activities (such as going on family camping trips).
• Will not decrease with reassurance or information from others (for example, if your child has a phobia of cats, he or she will still be afraid even if you tell them that "it's OK; the cat won't jump on you").
• Are beyond your child's voluntary control.

Phobias can be really difficult for children or teens, especially when friends and family don't understand why your child is getting so upset. Also, while an adult or teen might realize that their fear is unreasonable or excessive, a younger child might not be aware of this.

For younger children, fears usually involve immediate, concrete threats. Some common phobias include:

• Spiders

• Darkness

• Loud noises

• Animals (e.g. dogs)

• Costumed characters

As children get older, they can develop other fears:

• Injections, needles

• Going to the dentist

• Natural events (e.g. weather, earthquakes)

• Heights

• Enclosed spaces (e.g. elevator, tunnels)

Children and teens with a phobia experience physical symptoms such as:

• Increased heart rate

• Sweating

• Trembling or shaking

• Shortness of breath

• Feeling of choking

• Chest pain or discomfort

• Upset stomach

• Numbness

• Chills or hot flashes

• Looking flushed

When children and teens with a phobia behave in several different ways:

• They avoid the object or situation that they fear

• They feel extremely anxious and upset when faced with the object or situations they fear (for example, being near water)

• Younger children may cry, tantrum, cling, freeze, or want to be picked up

• Older children and teens might describe their catastrophic beliefs and worst-case-scenarios e.g. "The dog will bite me!" "I'm going to fall/die!" "I will go crazy/lose control!" "I will faint!" "The needle will hurt a lot!"

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How does a phobia develop?

Research suggests that phobias can run in families, and that both genetic and environmental factors (nature and nurture) can contribute to developing a phobia. Some children and teens develop a phobia after being exposed to a traumatic or frightening event. For example, a child can develop a fear of water after nearly drowning. Other times, children can develop a phobia after receiving scary information about something, or being instructed to stay away from an object or situation. This is often done inadvertently, but not always. For example, some children may develop a phobia of an animal after a trusted adult repeatedly warns them the animal is dangerous and might bite them. Finally, a child may develop a phobia by observing others' anxious response to objects or situations. For example, a child may develop a spider phobia after watching an older sibling scream and run when in contact with a spider.

What about school phobia?

School phobia, that is, a child or teen's fear of going to school, is a fairly common term and is often considered a type of phobia. However, children can be afraid of school for many reasons. For example, they may be afraid to be away from their parents (separation anxiety disorder), to be in contact with germs in school (obsessive-compulsive disorder), to be around other students (social anxiety). In all of these cases, your child or teen is not actually afraid of the school itself, but of what could happen while at school. Because of this, the term school phobia is not accurate.

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