Ain Shams University

pediatric department

Master Program

2nd Semester

Concept of Anxiety

:Prepared by

Hanaa Sayed Ahmed Abdel Fattah

Under Supper Vision

Prof. Dr. Iman

Dr. Salma
Out Line

Introduction
?How Common is Anxiety
?What is Anxiety
?What is an Anxiety Disorder
Definition of anxiety
Definition of anxiety disorder
Causes Of anxiety
Types of anxiety
Level of anxiety
Anxiety Scale
Symptoms of Anxiety in Children
Development stage
?How anxiety disorders affect Children
?Kinds of Childhood Anxiety Disorders
Complication
Treatment Options for Anxiety in Children
Nursing Role
Nursing Care Plan
Advice for parents in dealing with children's
anxiety
Reference
Introduction
Children who experience fear and anxiety will tell you how they feel, but
only when they are not afraid of being embarrassed, humiliated or punished.
Parents face special challenges because children with anxiety tend to be
nervous, avoidant, annoying or exhausting. If you become frustrated and
make these children feel bad, they stop being honest and start telling you that
.they are tired, sick, "fine" or just don't care

Anxiety disorders in children are often misdiagnosed, overlooked, or

dismissed simply as a behavioral 'phase' of growing up. In fact, many
experts now believe that adult psychological disorders are often rooted in
.childhood
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?How Common is Anxiety

Approximately 1 out of 10 children suffer from an anxiety disorder. Most
children experience anxiety purely on the basis of psychological, social and
environmental influences. Twin studies of identical twins have shown that
anxiety can occur with one twin but not the other. Anxiety disorders are not
necessarily inherited although some people appear to inherit a risk or
vulnerability for an anxiety disorder from their family. Brain imaging studies
have produced minimal data to suggest there is a single defect or problem in
.the brain that causes or contributes to anxiety

Statistics on Anxiety in Children

In children, anxiety disorders are among the most common mental,
emotional, and behavioral problems. About 13 of every 100 children and
adolescents ages 9 to 17 experience some kind of anxiety disorder. Girls are
affected by these disorders more than boys. About half of children and
adolescents with anxiety disorders have a second anxiety disorder or other
mental or behavioral disorder, such as depression. In addition, anxiety
.disorders may coexist with physical health conditions requiring treatment
?What is Anxiety
Anxiety is the body’s natural alarm system. It warns of danger. There are
situations when it is perfectly normal to feel a little anxious, such as before
an important test. Anxiety has physical, mental, and behavioral aspects.
Children who are anxious usually experience some physical symptoms (e.g.,
rapid heartbeat, feeling dizzy, shortness of breath, muscle tension, or
difficulty sleeping). They also experience scary thoughts (e.g., I can't sleep
with the light off. There may be a monster under my bed and it could get
me.”) And they often express their anxiety behaviorally by avoiding
.situations, which make them uncomfortable

?What is an Anxiety Disorder

Anxiety becomes a “disorder” when the discomfort or disability it creates
significantly interferes with day-to-day living. Certain problems, such as
avoiding school, are readily apparent. However, a child may express fear in
less obvious ways. For example, physical illness, such as frequent stomach
aches for which there is not a medical diagnosis, may be a sign of anxiety.
Other signs include behaviors, which are uncharacteristic of a child, such as
temper tantrums, oppositional behaviors, or refusing to be separated from
.family members

Definition of anxiety
It is a natured human reaction that involves mind
Or body . It serves an Important basic survival function . anxiety is alarm
. system that is activated when ever a person perceives danger or threat
Un Comfortable feeling of dread that is response to extreme or prolonged *
. periods of stress
Normal human emotion and experienced in varying degree as state of *
emotional or is an initial response to psychic threat
 Definition of anxiety disorder *
It is feeling of excessive anxiety for no apparent reason or mental health
. illnesses and as such is not normal or useful

Causes Of anxiety
genetic
Some one with family member who has an anxiety disorder has a greater
chance of developing one . They may be related to genes that can affect brain
.Chemistry and the regulation of chemical called ( Neuro transmitters )

: Biological
. Involves dysregulation of neuro transmitter system
provides frame work for system development and pharmacology – -
. therapeutic intervention

: Psycho dynamic
Involves unconscious conflict . provides frame work continuum of anxiety
. responses an individual attempts to defender against anxiety

: Interpersonal -4
Involves interaction provides frame work to explain anxiety response
experienced in relation to other individual

: Behavioral -5
Involves conjoining provides frame work to explain as physiological and
cognitive responses to external stimuli

Causes of anxiety disorder

hereditary factors
brain chemistry
personality and life experience
Types of Anxiety

: Normal anxiety
Most of people feel anxiety before important event or when faced with grive
:Acute anxiety
Occur sudden by some stressful events (e.g. loss of crisis).
Chronic anxiety
Phobic Anxiety
Separation anxiety

: Level of anxiety

mild
Physiologic
vital signs normal
. minimal muscles tension
pupil normal , constricted
pupil normal , constricted
Cognitive perceptual
perceptual filed is board
. Awareness of multiple environmental
Thought may be random , but controlled
Emotional behavior
. feeling comfort and safety
relaxed , calm appearance and voice
performance is automatic habitual behavioral
 moderate
Physiologic
vital signs : high slightly
. labile affect
cognitive perceptual
perception narrowed
Attentive
Emotional behavior
feeling of readiness and challenge
. engage in competitive activity and learn new skills

Sever
Physiologic
. Fight or flight response
. Increased vital signs
Diaphoresis increased
. Urinary Urgency
– Diarrhea – dry mouth
Cognitive perceptual
. perceptual filed greatly narrowed
. Problem solve difficult
Selective attention
Emotional behavior
. feel depressed
.Agitated or irritable
panic
Physiologic
person pale Bp
. muscle coordination
pain hearing sensations stimulate
Cognitive perceptual
. Perceptual filed closed
. Improbably thinking process
Emotional behavior
Lose of Control , angry – Cry In active
Anxiety Scale
.It was used to assess Anxiety level
It consists of 21 statements and measures all aspects of Anxiety as the
following

parameters Statement’s number

feeling of sadness-1 13 ,12 , 17 , 14 ,9

muscular tension-2 7 ,5 , 4 , 2

confusion-3 6,1

Ego weakness-4 8,6,3

:the items were summed the Anxiety level was divided in to

NO Anxiety 0-
Mild Anxiety 1< 8-
Moderate Anxiety 8 < 15-
Sever Anxiety 15 < 21-

Symptoms of Anxiety in children

restlessnss
Nausea
Headache
Poor concentration
Fatigue
Irritability
Muscle tension
Troubles or fights within friend circle
Trouble sleeping
Sleep disorders
Sweating
Chest Pain
Chills or hot flashes
Dizziness
Numbness
Shaking
Feeling choked
Feeling of being detached from oneself
Feeling of losing control
Being in constant fear
Tingling
Escaping from situation
Aversion from activities
Being anti-social
Low self esteem
Being over critical
Freezing
Clinging
Tantrums

:Development stage
Infant
Anxiety results from frustration in feeling process as punishment, each infant
.need five basic emotional needs
.Love and security
Suckling pleasure
.Feeding
Sensory stimulation
Warmth and comfort
The need should be satisfied by his mother or caregiver to him to develop
.sense of trust
If the needs are not met the Child will be frustrated and anxious and the
senses of mistrust are developed
 Toddler
The conflict between his desire and demand of his environment is becoming
too much
Child will develop sense autonomy

Preschool
:Cause anxiety in this stage
look of satisfaction of needs ( security – independence – guidance – learning
– language )
.Fear from dark
.Loss of parent's love
.Fear from animal
.Fear from physical injury
.Loss of one or both parents
.Being left alone especially at bed time
.Separation from his parents
Symptoms
.Insomnia, headache, stomach pain, personality, problems
Thus sucking, encorporesis, bad language

School age
-: Causes
Separation ,( hospitalization , School )
.Fear from injury or pain
The school age child is concerned with body disability and death. He is more
relaxed about having a physical examination or having his eyes or ears
.examined, but are uncomfortable with type of sexual examination
 Adolescence
The coping skills learned is childhood continued to be practiced and refined
.through out adolescence
: Symptoms
Running away from home
Anger and aggression

?How anxiety disorders affect Children

Anxiety disorders in children can affect relationship building and that can
cause embarrassment and isolation. This can lead to shyness and timidity,
pervasive feelings of inadequacy, and sleep disorders. It can also reduce
confidence levels necessary to do even simple tasks such as completing
.homework assignments

?Kinds of Childhood Anxiety Disorders

:Separation Anxiety Disorder

Developmentally inappropriate and excessive anxiety concerning being
separated from home or from those to whom a child is attached (usually
.parents)

Panic disorder
Repeated panic attacks consisting of periods of intense fear or discomfort in
which several physical symptoms (e.g., racing heart, sweating, trembling,
shortness of breath, choking sensation, dizziness, nausea or stomach ache,
etc.) develop abruptly and reach a peak in a short period of time. Children
are not always able to express the fear well and may describe their attacks
.”with terms like “a yucky feeling

Panic Disorder with

Agoraphobia
Panic attacks accompanied by anxiety about being in places or situations
from which escape may be difficult or embarrassing or in which help may
not be available in the event a panic attack occurs. This condition is more
common in adults

:Specific Phobia
Marked and persistent fear that is excessive or unreasonable and is •
triggered by the presence of a specific object or situation (e.g., animals,
heights, blood or injury, tunnels, driving, flying, etc.). Temporary specific
phobias (e.g., fears of the dark or strangers) are common in childhood, but
.phobias, which persist, can be problematic

:Social Phobia
Persistent fear of social situations (e.g., parties), performing in front of •
others or other situations in which the person is the center of attention and
fears he or she may do something embarrassing or humiliating or may
experience the disapproval of others. Children may express social anxiety
by crying, tantrums, freezing, or shrinking from social situations or
unfamiliar people. Severe shyness may be a sign of social phobia

:Obsessive-Compulsive Disorder
Persistent thoughts, impulses, or images which are intrusive, unwanted and
cause marked anxiety or distress and which the person attempts to neutralize
by engaging in repetitive behaviors (such as hand washing, ordering,
checking) or mental acts (such as praying, counting, or repeating “good”
.thoughts or words silently)

:Posttraumatic Stress Disorder

Children that have experienced, witnessed, or been confronted with an event
that involved actual or threatened death, serious injury, or threat to the
physical integrity of themselves or others may experience depression,
anxiety, and other disturbing symptoms long after the traumatic event. Also,
they may persistently re-experience the traumatic event in the form of
repetitive play, nightmares, flashbacks, or re-enacting a theme relating to the
.trauma

:Generalized Anxiety Disorder

A general tendency to worry excessively about a variety of concerns.
Common symptoms are restlessness, fatigue, difficulty concentrating,
.irritability, muscle tension, and disturbed sleep

:If left untreated, anxiety disorders in children can lead to

)complication(
low self esteem
poor performance at school or increased absences
substance abuse
poor social skills
impaired relations with adults
anxiety disorder in adulthood

Treatment Options for Anxiety in

Children
Children and adolescents with anxiety disorderscan benefit from a variety of
treatments and services. Following an accurate diagnosis, possible treatments
:include

Cognitive behavioral therapy, in which young people learn to deal with fears
by modifying the ways they think and behave

Relaxation techniques

Biofeedback (to control stress and muscle tension)

Family therapy

Parent training

.Medication
Nursing Role
Promote physical needs (diet, rest, exercise, fresh air) -1
Good observation -2
Divert patient attention or mind by changing topic of conversation -3
Encourage relaxation and contact with others -4
.Group activities -5
Provide love and care needed -6
Psychotherapy which help to understand the illness -7
Recreating therapy -8
Encourage parent to room in -9
Help parents and others understanding the behaviors of separation -10
anxiety and suggest ways of supporting the child

: Nursing Care Plan

:Assessment
.Complete history from the parents
.Assess the anxiety behavioral
Assess the psycho-social environment of the family
.Psychiatric evaluation
Nursing diagnosis
Anxiety related to real or perceived thread to physical integrity or self –
concept
Out Came
Help patient to recognize the anxiety and use effectives coping strategies
Intervention
Establish and maintain trust with the client while using active listening and
.showing empathy and respect
.Recognize and manage your own anxiety or negative feeling
.Identify the type and significant of stressor in the client's life
.Encourage client to participate in activity
.Encourage proper nutrition and direct client to record dietary in take
Nursing diagnosis
.In effective individual coping related to inadequate coping strategies
Out come
.Demonstrate problem solving and decision making skills to manage
Intervention
Assess client stressor
Assess Client's development level and functional capacity to determine
.ability to cope with anxiety
Identify any chemical substances and potentially compulsive behaviors that
the client might be using to suppress anxiety
Observe and monitor the client's behavior

Nursing diagnosis
Participate in activities that enhance interactions and decrease social
.isolation

Intervention
Encourage client to discuss and analyze reasons for and feeling about social
.interaction
Encourage client to identify what causes the anxiety that inhibits social
.interaction
.Assess Client's use of coping skills and defense mechanisms
.Assess client's communication skills

: Nursing diagnosis
Self esteem disturbance related to perceived
: Out Come
.Demonstrate ability to cope with anxiety situation
-: Intervention
Establish a trusting supportive relationship with client
.Set up opportunities for Client to interact socially with others
Collaborate with clients to describe self-image and identify any factor that
threaten that self image
Encourage patient to participate in activity
Advice for parents in
dealing with children's
anxiety
When you know your child will face a major change such as moving or
starting anew school. Prepare her for the transition with low. Stress visits to
become familiar with the environment and people. She will encounter.
Practice new routines, and add some fun rituals that are familiar to the child.
Shopping for new school supplies or reeducation a new bed room give
.children some thing special to look forward to
Most parents experience anxiety at one time or another. Model positive risk
– taking and coping strategies for managing anxiety, and your child will
learn from your example. Encourage your child to take some risks to learn
.how to over come anxiety and feel more competent
Don't force a child to confront head-on a deeply held fear. You can make the
situation worse. take your cue from the rapeutic practices that introduce
elements of the fearful situation to the child gradually , always in a
supportive , safe environment
Listen to your child's concerns , and let him see that you are taking steps to
address his expressed needs in your planning and expectation .During your
conversations about his concerns, you can give him practical information to
. counteract irrational fears and worries
Realize that children's anxiety may be expressed through behaviors such as
aggressions, tantrums, defiance , or school avoidance . you may not make the
connection atfirst , but you should consider anxiety as a cause when your
. child exhibits negative behavior
Take steps to protect your child from the dangers of violence in the home
and community emotional , physical , and sexual abuse cause irreparable
haram to a child . if you face these issues in your family or community , you
must find a way to keep your child safe
: Reference
Nelson Text Book of pediatrics , Lenson.B.k, adams .W.G, 17th edition ,
copy right 2004 , ISBN , Page ( 81 : 84 )
http://www.kathyeugster.com
http://www2.massgenral.org
http://childparenting.about.com
http://wikipedia.com
www.yahoo.com-
www.youtube.com-