Illness or medical conditions can cause anxiety in children

Illness and having a medical or physical condition is not often mentioned online as a cause of childhood anxiety.

But I’ve had parents speak to me about how anxious their child’s become, and then I’ve worked with the child to help them think and talk about what’s bothering them.

In this way they can start moving towards accepting and managing the illness in a better way, with less anxiety.

Quite often the main worry is something only sideways connected to what the parent might assume. But anxiety on top of an illness or condition spoils the child’s enjoyment of the quality of life they can have.

Why does a long-term illness or medical/physical condition cause anxiety?

Child with a medical condition in a wheelchair looking anxious

Having an illness or medical/physical condition is bound to cause worry, even in a child. Perhaps especially in a child. They don’t have the responsibilities their parent has, but they do have a future, and they can compare it to what they see as other people’s futures. And it will perhaps look different in significant ways.

Why does this matter?

Anxiety is essentially a forward-looking issue:

How will I manage at big school?
Who will look after me when my parents are dead?
How will I ever get married?
Who will love me?
Will I be able to have children?
Get a job?
Travel?
Am I going to die soon?

Obviously, a younger child/toddler will not be thinking those things yet.

On the other hand, the younger child or toddler doesn’t have words to explain their fears about what doctors are doing to their bodies. No real way of understanding why parents are treating them like they have to – bandages, medicines, injections etc.

So there can be a clingy, anxious feeling coming from the young child, and parents respond with lots of hugs and cuddles that make it bearable.

As a child develops, though, and moves out into school and among friends, with playdates and sleepovers, those forward-looking worries can start to emerge.

You’ll already have become expert at trying to answer questions without saying more than you need.

You’ll already be aware, as they get older, that managing the condition can become harder as well as more of a habit. You’ll foresee difficulties and have tried preparing for them.

But sometimes their questions and fears are not expressed. Your hardest job, then, is being alert for offshoot worries that might be harming your child’s happiness – spotting them, guessing them, intuiting the situation, and starting a conversation where necessary.

It’s these worries I want to mention here.

First, let’s give illness a context

Let’s consider a random range of the kinds of illness or medical and physical conditions that can cause extra worry.

Diabetes type 1 or 2
Asthma
Eczema
Obesity that is related to another issue
Partial sightedness or vision impairment
Being confined to a wheelchair
Juvenile arthritis
Epilepsy
Cancer

As I’ve stated a few times on this website, I’m not a doctor. I have no intention of discussing these illnesses (and the many others you will have thought of) in a medical way.

I’m simply naming a few so we can discuss anxiety in the context of illness.

What anxious thoughts might emerge connected to illnesses and medical/physical conditions like these?

1 Some children will accept the treatment even if they don’t really like it. What can really make them anxious, even traumatised, is seeing the reaction of the parents and family to the illness. Parental emotion can convey to the child that the illness is a catastrophic event.

Parents sometimes blame themselves even though they didn’t cause the illness. Seeing their parents suffer in this way affects the child’s own emotions: “I must have done this to them.” This is actually a mirror image of what their parents are thinking. And you can see the wormhole of despair this thinking leads to.

2 Later, children can get upset on their own account. “Why me?” They’re unlikely to say it to their parents, but it can lead to anxiety, hopelessness and despair.

The reason is not that they have the illness or medical condition but that they realise it’s with them “forever” – and as I said, “forever” is a long time for a child.

And conversely, they may realise forever doesn't exist for them. Maybe they have a terminal illness.

3 Your child may find out or come to realise that they’re the only person in their school with this illness or condition. They have limited life experience of being accepted simply for who they are and what they’re like as a person, so they may think anxious thoughts about whether they’ll have friends or be able to join in with most activities.

They will feel different anyway if they have to go to have an injection, or sit quietly to recover from an epileptic episode, or have a reader beside them to help with eyesight problems.

If their obesity is down to some genetic factor or to do with their illness, they will be super anxious in the face of all the media messages to slim down.

4 They can be anxious about being called partially sighted, diabetic, wheelchair-bound or an epileptic, for example.

Yet, although this is definitely not who they are (they are so much more than that, and parents do try to emphasise this), some children find some relief that at least get the message out without having to find words to explain. Maybe the other children will understand why they’re like they are, and not be so stand-offish or frightened of them. Perhaps accept them better.

5 Anxiety about a medical condition or illness is likely to follow whenever a desire to be normal surfaces again. Starting school, at puberty and lots of times in between, there is an intense and renewed desire in most children to be normal. “I just want to be like everyone else.”

This can lead to self-sabotaging thoughts about not being OK and not being worth much. Every time there is a scenario where they are going to be obviously different, the anxiety kicks in about being “not normal”. Without emotional help at such times, their anxiety can get out of control and their self-worth plummets.

6 A child who is overweight or obese due to their illness may be subject to worries about going to school every single day. The illness isn’t the issue; the probable bullying, taunts, jokes and ignorant remarks are.

Children need a full range of friends to have fun with and learn about life. If, in ignorance, others target them with bullying, they miss out. Their development falters and their adult life is at risk. No wonder their thoughts can turn from anxious to “This will only end when I end”.

So what can you do to help your child?

Try to deal with your own emotions and anxieties first, before dealing with theirs. Even if you cry in private (which is perfectly understandable, of course!), they’ll pick up on your distress – and your distress worries them. You are their safety, their caregiver, and their anchor amid the turmoil of having this illness or condition. So just bear it in mind. As many times as possible, try channelling energy into helping them whenever the emotion starts to get the better of you. This will also transmit it to your child.

When a child has an illness – whether life-shortening or life-threatening – it’s easy to slip into doing things for them. But it’s possible they can do some things for themselves. So discover as many of these things as possible and let them try. It’s a bonus for their mental health: they need empowering. And a child who feels empowered in any small way can usually manage their anxieties and worries far better.

Answer only as much as they ask and no more, until next time they ask. You need to be honest but not too detailed until you know that’s what they're asking for. This should help with their anxieties about their illness. As they get older they may want to know more. Keeping pace with them will help them. It’s probable that a younger child wouldn’t understand anything way over their heads anyway, but it’s best to be careful, as their imaginings can be wild and completely wrong.

Apart from these things that you can do, here are a three suggestions for things that they can do to work on their anxieties, according to what their situation is. You may need to adapt according to their age as well.

Stroke a soft toy. Children who have an illness or medical condition may need to calm themselves as certain times – perhaps before treatment or an injection or a visit to a consultant. Often they find that stroking a soft toy is soothing.

And they need to self-sooth before trying to tell you what’s worrying them. That’s because when they’re upset or anxious, their thinking brain cuts out. Words won't come that make any sense to you!

Obviously, with a younger child, you may never get the words from them, but you can tell if they're uptight about something. A life-size small dog or cat stuffed toy is good for this exercise because you can make up stories about it and pretend the child is soothing the toy. It doesn’t matter: the touch is happening either way. That’s just a little trick to help them agree to do it!

Play a guessing game. If your child can’t say what's making them anxious, play a game. Ask them if you can have three guesses as to what is troubling them (about their illness or about what’s happening now, whatever). They’ll agree. They always do. They like to outwit you!

It’s likely you can get it right on your third guess. (Don’t win too soon!) And if not, ask them to say hotter or colder (closer or further away) about your last guess so you can adjust it and try again.

? ? ? >>hot? Cold?

After a while, throw your hands up and admit defeat, saying, “Tell me then!” Most children will. That’s the moment to start listening carefully before you answer, or reassure, or provide a solution.

You could ask what they want to do about the worry. But it’s a way of getting closer to the anxiety problem without getting too serious.

Make a life-check circle

This is good for ongoing illnesses and conditions because it keeps track of things over a longer period and covers more of life by default.

If this is the sort of thing your child might find interesting to try out, draw one yourself to start with and label it with these labels (but not the green lines!).

If your child agrees to repeat it in future, you could ask them which sections they want to include. Or you could just draw the circle and sections and suggest these as examples verbally and let them choose straight away. Only you know how to use this idea with your child.

The scale is 1 to 10, marked in twos, but being exact doesn’t matter when drawing their (green) lines in. What matters is they give it some thought and assess their score for that section for that day. Or week. Or whatever you want.

You can then ask of each section in turn: “What makes that (for example) a 5 instead of a 4 or a 6?”

And there you have it: a conversation point – something to work on and agree about.

If that goes well, you can try asking after each section: “What would push the score up 1 point?” This way they get to suggest their own way of improving things for themselves.

An example: let’s suppose the “friends” section has scored 8, as here. (This is a less threatening one to start on as it scores quite well.)

Why is it not a 7? “I have loads of best friends.”

Why is it not a 9? “Um, well I have to be at home every night in case I have a hypo. Then I miss out on sleepovers and all the fun”

What could we do to make that a 9? “Could I have two friends sleep over here? You could explain what might happen to me and then their parents wouldn’t mind.”

[That’s invented. I don’t have a child in the house with type 1 diabetes. But you get the idea. And I’ve used this circle many times in successfully helping children.]

There are lots of other ideas to help reduce anxieties in children with ongoing illnesses and medical/physical conditions in my Strategies section. Have a browse.

Research on the impact of vision impairment on children's mental health

Added 18-08-2022

The Opthalmology Times recently published a report on some research carried out by non-profit Orbis International. I think it shows up a little of what I've been saying above.

The second of their two studies was a meta review of many studies of children with eye problems and how it affected their mental health.

The conclusion was that children with visual impairment have higher rates of depression and anxiety than their peers without this impairment. It kind of sounds obvious. They

participate fully in fewer activities perhaps,
often have lower academic achievement (especially if any possible correction is delayed) and
are often more socially isolated.

Depression and anxiety symptoms improved after treatment or an early intervention.

It's worth a read for the detail in the article if you have a child with myopia, strabismus or other ocular impairment.

An article about children with cancer – and their anxiety

If your child has cancer – or had cancer and is now an adolescent – this can have many effects on their development going forward.

A consultant psychiatrist shares thoughts on these possibilities on The Health Site. You may find it interesting to quickly remind yourself about the complex stress, social difficulties, and the possibility of anxiety about any painful medical procedure at the time and in future.