By Dr Khutso N. Sebetseba — Paediatrician | Pocket Paediatrics with Dr K
The child has headaches; or stomach aches; or suddenly refuses to go to school.
Perhaps they’re irritable, tearful, struggling to sleep, or asking the same question repeatedly.
Most parents don’t walk into a consultation saying, “I think my child has anxiety”; and that’s exactly why we sometimes miss it.
Anxiety is one of the most common mental health conditions affecting children and adolescents worldwide. The World Health Organization estimates that approximately 1 in 7 adolescents lives with a mental health disorder, with anxiety disorders among the most prevalent. Yet many children with anxiety remain undiagnosed because their symptoms don’t always look the way adults expect.
Unlike adults, children rarely say, “I’m anxious.” Instead, they often show us: through behaviour; through their bodies; and sometimes through symptoms that send parents searching everywhere except the child’s emotional wellbeing.
One of the most common examples is recurrent abdominal pain. In paediatric practice, many children who present with frequent tummy aches ultimately have no identifiable medical cause. That doesn’t mean the pain isn’t real. Anxiety can activate the body’s stress response, affecting the gastrointestinal system and causing very real physical symptoms.
The same rings true for headaches, nausea, fatigue, difficulty sleeping, and even changes in appetite. This is why a child who has undergone multiple blood tests, scans, or specialist consultations may occasionally leave with something unexpected: a discussion about anxiety.
Children may also express anxiety through behaviours that are often misunderstood. The child who refuses school may not be “difficult.” The child who constantly seeks reassurance may not be “attention-seeking.” The perfectionist who becomes distressed over small mistakes may not simply be “high achieving.” Sometimes these behaviours are signals of a nervous system that is working overtime.
Modern childhood is not necessarily easier than previous generations imagined it would be. Children are navigating academic pressures, competitive activities, social media, friendship challenges, family stressors, and a world that often feels overwhelming. Even younger children are exposed to more information and stimulation than ever before.
A common misconception is that anxiety only affects teenagers. In reality, clinically significant anxiety can occur in children of all ages, including those in primary school. Research suggests that approximately 1 in 14 children and adolescents worldwide lives with an anxiety disorder, with children sometimes receiving a diagnosis as early as 3 or 4 years of age. This makes anxiety one of the most common paediatric mental health conditions. Many younger children are never formally identified because they present with tummy aches, headaches, clinginess, sleep difficulties, or school refusal rather than verbalising their worries directly.
The good news is that anxiety is highly treatable. Early recognition allows children to develop healthy coping skills before symptoms begin affecting relationships, school performance, self-esteem, or overall wellbeing.
Treatment does not always mean medication. In many cases, support may include psychoeducation, behavioural strategies, improved sleep habits, counselling, family support, and learning practical tools to manage worries effectively.
As clinicians, we should remember that parental concern remains one of the strongest predictors of underlying developmental, behavioural, and mental health difficulties. If a parent says, “Something just isn’t right,” it is usually worth listening carefully.
As parents, we should remember that children do not always have the vocabulary to describe what they are feeling. Sometimes anxiety sounds like:
- “My tummy hurts.”
- “I don’t want to go.”
- “Can you stay with me?”
And sometimes it looks like tears, anger, clinginess, or silence.
Mental Illness Awareness Month reminds us that mental health is just as important as physical health. The challenge is that mental health concerns are not always visible.
The children we miss are often not the loudest, most disruptive, or most obviously distressed.
They are the ones quietly carrying worries they don’t yet know how to name.
And sometimes, helping a child starts not with finding the right test, but with asking a different question.
TEXT BOX :
- Three Questions Worth Asking
- If your child has recurring physical symptoms, ask yourself:
1. Does it happen around something specific?
(Monday mornings, tests, sleepovers, school events)
2. Have medical causes been excluded?
(Tummy aches and headaches are real — but they aren’t always physical.)
3. What changed before these symptoms started?
(A new school, bullying, friendship difficulties, family stress, illness, or a significant life event.)
Sometimes the most important symptom isn’t the headache. It’s the worry behind it.