It could be the first day of school or the first time at the pool or an unscheduled meeting with a gigantic dog!

There are myriad situations that make a kid feel anxious or uncomfortable. But how can a parent identify when a child is suffering from anxiety that warrants the attention of a  professional?

What is Normal Child Anxiety?

We need to begin by defining what is considered to be normal. A certain degree of anxiety in youngsters is both appropriate and desired. “It’s normal for children to have fears that come and go throughout their life,” says Tamar Chansky, Ph.D., psychologist, and author of Freeing Your Child from Anxiety (2014).

“Typically what happens is when children encounter a new situation and they need some time to learn about it, to work with it and get used to it.” A child who has never met a dog before, for instance, might be frightened of interacting with even a friendly puppy.

Deborah Gilboa, MD, a pediatrician and child development expert, adds that “anxiety may prove beneficial even in social situations. If a child witnesses a friend being teased, for instance, her anxiety in seeing such mistreatment may compel her to step in to comfort or defend her friend.”

Knowing When the Anxiety is Getting out of Hand

Experts agree that the two red flags of clinical anxiety are avoidance and extreme distress.

Texas mom Beth Teliho recalls when her son, Sawyer, began elementary school. While the first few days went fine, soon thereafter Sawyer started suffering “meltdowns” on the ride to school. “He was gasping for breath and crying, saying, ‘I can’t, I can’t,'” Beth says. “The look on his face was so desperate like he physically couldn’t go into the school.”

Sara Farrell Baker’s 5-year-old son, August, is on the autism spectrum and is saddled with sensory processing issues. He dislikes loud noises, particularly flushing toilets and the hand dryers found in public restrooms. “He would become very distraught if we were going toward a restroom,” Sara says. “Just being in an environment where he expected loud noises would get him very anxious.”

“The difference between normal anxiety and an actual anxiety disorder involves severity,” says psychologist Amy Lee, Ph.D. of the Center for Pediatric Behavioral Health of the Cleveland Clinic. “Having fears and worrying is a natural reaction to stressful or new situations for children, but it’s when the anxiety grows out of proportion that it becomes a real problem.”

5 Tell-Tale Signs of Child Anxiety

The word “anxiety” usually conjures up images of a quiet worrier, but childhood anxiety can wear many and varied masks. While not exhaustive, symptoms of child anxiety generally fall into these categories:

1. Obsessive-Compulsive Disorder

Children with OCD have either recurrent intrusive thoughts (obsessions) about specific things, often together with repetitive behaviors, or (compulsions) that they perform, such as constantly washing their hands, checking and rechecking things over and over, or repeating certain phrases or words to themselves in reaction to their obsessions.

2. Specific Phobias

Some children suffering from anxiety have specific phobias.​ Their anxiousness and worry are in response to very specific triggers, such as being left alone, a thunderstorm, spiders, or going into the shower.

Although these children often cry or cling to their parents when they feel threatened by something they are really afraid of, most children outgrow this type of anxiety disorder.

3. Unrealistic Fears

Kids prone to unhealthy anxiety have unrealistic fears. Lee adds that “they may move from one area of worry to another as they get older.”

For example:

• Toddlers may move from intense separation anxiety to anxiety over going to elementary school and meeting new children. Then, when the child reaches the teen years, the worry will focus on still another area of life.

• A young child who has a fear that something bad might happen to her parents may have trouble with falling asleep or separating, even past the toddler years.

• If your child has unrealistic worries about becoming ill or about germs, he may wash his hands excessively or constantly ask you for reassurance that he won’t get sick.

These fears are often crippling. They sometimes include extreme fear of insects, water, darkness, clowns, or just about anything else, Dr. Lee says. These worries can drive them to extreme study or practice habits, or heroic attempts to avoid social situations.

4. Some Children Can “Worry Themselves Sick”

Consistently high levels of anxiety very often lead a child to experience tangible physical repercussions, such as fatigue, stomach issues, headaches, and even rashes.

Dr. Lee asserts that children with a bona fide anxiety disorder present a lasting and consistent pattern of significant disruptions of life activities. Their anxieties extend far beyond any objective and significant danger.

To complicate things further, young children who are stricken with anxiety typically don’t even realize they are exaggerating or are being unrealistic. Even teens may not know how to express their fears, nor verify with a trusted adult that their anxiety has become disconnected from reality.

5. Panic Attacks

Although generally uncommon in smaller children, panic attacks are more common in later teen years. Aside from intense fear or discomfort, panic attacks require four or more of the following symptoms:

• A feeling of unreality or being detached from oneself

• Chest pain

• Chills or hot flashes

• Dizziness

• Feeling choked

• Fear of losing control

• Feeling short of breath

• Nausea or abdominal pain

• Numbness or tingling (paresthesias)

• Palpitations or a fast heart rate

• Sweating

• Shaking

Sometimes Child Anxiety is Deceptive

One of the challenges of helping children who are suffering is that anxiety often presents as a constellation of negative behaviors. While parents and teachers are often quick to identify the behavior problem, they are less adept at seeing the underlying anxiety that drives it.

“We tend to think of anxious children as these delicate little butterflies, but when kids are scared, they can be ferocious about trying to escape or avoid anxiety-provoking situations,” explains Eileen Kennedy-Moore, child psychologist and author of “Kid Confidence.”

The good news is that child anxiety, irrespective of its form, is often treatable, especially with early intervention. By learning to recognize the sneaky signs of child anxiety, identifying triggers of anxiety, and teaching children effective coping skills, parents and educators can empower kids to manage their anxious feelings on their own and thrive academically and socially.