By Nancy L. Snyderman, M.D.

How to Help Your Anxious Child

Does your little one worry and fret? Solutions here.

Is it normal for my grade-schooler to fee! anxious?

Anxiety is a normal part of a child's behavioral and emotional development. And the older she gets, the broader her concerns become. In the early elementary years, kids often worry about school, getting along with classmates, and pleasing their parents. If your child feels she's failing at any of these, she may feel anxious. She may also react to family stress — divorce, financial troubles, illness — or issues unfolding in the world-at-Iarge. And although it's difficult to watch your child worry, it's important to note that it's normal. In many instances, anxiety has some benefits, like keeping kids alert to their world. Anxiety can encourage positive action to deal and cope with the challenges of daily life.

Are there certain kinds of anxiety common to 6- to 8-year-olds?

Absolutely. Below is a quick explanation of some of the most common:

Common fears. Six- to 8-year-olds often worry about things they've seen, done and not enjoyed, heard about from friends, studied at school, or learned about in the media. Those fears can run the gamut from shots at the doctor's office to vampires, meteors, and clowns, to an episode of The X-Files that she watched without your consent. A tornado drill at school, for example, can blossom into a fear of natural disasters. Likewise, a child may develop a fear of flying after hearing about an airplane crash on the evening news. Certain phobias are common as well, such as a fear of spiders, heights, or germs. Some children are afraid of the water, others become phobic about dogs if they've been bit or growled at.

Social anxiety. The social demands of elementary school can be challenging. Having a fight with a friend, or trying to find someone to play with at recess or someone to eat with at lunch can all cause anxiety in kids at this age.

School avoidance. If your child whines, complains repeatedly of a stomachache, and begs to skip school, it probably means she is avoiding something or someone. It might be a classmate who's been teasing her or a subject at school that frightens her — or maybe a fire safety program is coming up, which she would prefer to skip.

What can I do?

When your child becomes anxious, follow your instincts and comfort her. But don't stop there. Find ways to help your child overcome her fears and worries. These tips may help:

Talk it out. Some of your child's fears are entirely normal, and denying them would be unrealistic. Grade-schoolers, for example, may be concerned because they're not mastering their schoolwork as quickly as others. Emphasize that each child learns at her own pace, and let her know that as long as she makes her best effort neither you nor she should be disappointed.

 Helping Your Child Eat Right

Concerned about your child's weight? Start by helping him make healthier food choices.

With all the tempting ads for fat- and sugar-laden snacks, and grocery aisles overloaded with unhealthy choices, it's understandable why kids seem less than inclined to help you pick out fruits and veggies in the produce department. But you can win the battle against junk food, say experts. It's important whether or child is overweight or thin. All children need to be well fed.

Start by making healthy eating a family value, advises psychologist Kathy Kater, who counsels families on food issues and body image. Healthy eating and regular exercise should become a foundation of your family, she says, not something you do only when you want to slim down.

"We tend to think about eating in a different way than we do other important life skills," explains Kater. Take money: you might teach your kids to not waste their allowance on junky toys, but do we make the same impression on them when it comes to wasting their appetites on junk food? "Why feel like you can't teach the same lesson to children about being strong and fit?" asks Kater, author of Healthy Body Image: Teaching Kids to Eat and Love Their Bodies, Too! "What you're doing when you make proper eating part the family routine is teaching your child a lifestyle that will carry him through his entire life."

Kater has a specific approach to helping parents raise kids to have a balanced understanding of eating as fuel for strong bodies. Here are her tips:

Practice what you preach. Before springing any food changes on your children, get comfortable with changing your own food habits. Do you eat properly only when you're trying to lose weight? Do you have cookbooks with healthy recipes? Do you need to read up on serving sizes and nutritional guidelines so you can answer your child's questions? Can you explain the serious health consequences, like diabetes and high blood pressure, which can result from eating the wrong foods and not getting enough exercise? Be prepared, and you'll be a better teacher.

Be confident. "It's important for parents to say, 'I didn't realize before how important it is to eat well, but I know this is something we have to do,'" explains Kater. Parents need to show their kids (and each other) that they can make changes and be healthier. "If parents are biting their nails and making a big deal of the change, kids will pick up on that insecurity and push it for all it's worth," notes Kater.

Focus on the positive.  Avoid talking about what not to eat. Instead, focus on what the body needs for health, strength and stamina. Discuss healthy food choices you'll be adding to your diet—fresh fruits and vegetables, whole grains, low fat dairy and protein, foods with less salt—and why they're better for bodies.

Have fun with food.  Get healthy cookbooks and create delicious meals together. Enroll your child—or the whole family—in a cooking class where you learn to make colorful balanced, nutritious meals. Encourage your child to come up with his favorite high-nutrient snacks that he can make.

Call for reinforcements. Still stumped by how to prepare healthy meals or get your child to eat them? Consider consulting with a nutritionist who focuses on family-health issues. Ask your family doctor or pediatrician for recommendations.

Let him eat.  Assuming your cupboards are stocked tasty, wholesome foods—encourage your child to eat until he's full. He'll learn that healthy food is filling—and tune in to his body's natural signals indicating he's had enough.

Focus on how food makes you feel.  Make healthy food choices a part of your discussions together. Are the changes helping everyone feel like they have more energy throughout the day? Do you feel stronger and more in control? Talk about the feelings—you can inspire each other. If kids take the time to complain, that's okay, just don't give in. This is a life lesson.

Be patient.  Putting your child on an extreme diet is the wrong way to go, says Kater. First, she urges parents to understand that health kids come in many sizes. Next, she helps families learn that healthy eating and proper exercise may take a little time to reap benefits, but eventually, they'll produce kids who are prepared to take care of their body's for life.

Overwhelmed By Obesity, Teens Are Going Under the Knife

Chelsey Lewis was a morbidly obese teen who chose to have weight loss surgery.

Seventeen-year-old Chelsey Lewis had been having health problems as a consequence of her morbid obesity, and it was affecting her life: "I was falling asleep all the time in class because of sleep apnea." She dropped out of regular high school and started taking classes online. Traditional college, she says, is out of the question, "I can't be walking around a college campus that much. It would be tiring."

Life-saving surgery

Instead, Chelsey took a different step, choosing gastric bypass surgery, hoping it will make life, and living, a little bit easier.

John Morton, MD, one of Chelsey's surgeons and director of bariatric surgery at Stanford University Hospital, puts it this way: "When someone is drowning, I don't wait to build them a bridge, I throw them a lifeline; and that's how I look at this procedure; It is life saving."

Chelsey, who was the first teen to get laparoscopic gastric bypass at Stanford's Lucille Packard Children's Hospital, says she got most nervous when she arrived at the operating room: "I lay on the table, and saw all these nurses and doctors, [and] then it got scary." The statistics are even scarier. One out of every 200 patients will die during this surgery. Chelsey, however, was fortunate. Her gastric bypass surgery was a success.

Not a quick fix

Susan Bartell, PsyD, an expert in teen weight issues, cautions that weight loss surgery is not a magic bullet for teens looking to put obesity behind them. "If you give a teenager bariatric surgery, whatever the underlying factors were that caused them to overeat will be displaced into some other part of their life," she warns, adding, "and if you haven't dealt with that—you're still going to have a kid who's in an enormous amount of emotional distress who has now had a significant surgery that they have to deal with on top of it."

Be Your Child's Best Advocate

Your child has a learning challenge. Don't let it stop him.

Carrie Manley discovered her son Will, then age 3, was having trouble learning his numbers, even with the help of flash cards. "I remember I held up a number eight and asked, 'What's this number?'" she recalls. "He looked at it and said really confidently, 'Eight!' I was so proud of him and told him so, and he said really innocently, 'Yes, Mommy, sometimes I guess—and sometimes I get it right.'"

It was devastating for Carrie, an avid reader. But Carrie decided to educate herself about learning challenges and is now her son's reading coach and biggest cheerleader. Today, Will's favorite subject is reading thanks to his mom. Now, Carrie has a job helping other kids learn their letters and numbers.

If your child has been diagnosed with a learning challenge, use these tips to help him thrive.

At home:

Deal with your feelings first.

It's hard on the child to discover he has a learning problem—but it often brings up feelings in the parent, too, including shame, confusion and denial. Don't bottle it up. Talk about it with someone you trust.

Get help as soon as possible.

Early treatment can save children from a lifetime of academic and self-esteem issues. As soon as you find your child is having a hard time reading, or doesn't recognize letters or numbers other children pick up easily, have him tested. To find out what to ask, print out 10 Questions to Ask Your Pediatrician About Your Child's Learning Challenges.

Find support.

Online message boards and community groups are great places to meet other parents of children with learning challenges, swap stories and learn strategies to get your child the help he needs. 

Get educated.

Read books and attend lectures on learning differences. The more you know about the way your child learns, the better advocate you will be. Also, make sure that both parents are equally educated on your child's learning issues and agree on treatment. It helps relieve the inevitable stress and tension.

Appeal to your child's strengths.

When you play educational games at home, try an approach that combines voice, touch and visual cues. This multiple-level approach helps children with learning differences catch up—and even surpass—their peers.

Let your kid be a kid.

Find out what your child does well, and encourage it—be it sports or drawing or turning the living room into a stage. Learning challenges shouldn't be the main focus of a child's life.

At school:

Talk to your child's school.

Ask about evidence-based effective learning programs—that is, programs based on proven science, not educational fads. They are usually done at school. Insist on whatever testing is necessary to enroll your child in these programs. Start talking to your principal a month or so into the school year, after your child has had a chance to settle into his classes.

Stay in touch with your child's teacher.

Ask for progress reports on your child. Be specific: Where is he academically, compared to his peers? Is he reading the same book's as his peers? Insist on providing your child more time to take tests, if he needs it.

Be persistent.

Bureaucracy can be slow, but your child's learning doesn't have to be, if he gets the help he needs early. If his school is not responding to your requests, keep calling, and schedule meetings with teachers and administrators.

Out-of-Control Kids: What to Do When Drugs and Alcohol Are a Scary Reality

Suspect a serious drug or alcohol problem in your teen? Here, an expert sheds light on the best ways to get your child help—and how you can be the parent he needs.

When it comes to dealing with an out-of-control teen who is abusing drugs or alcohol, sometimes you need to have someone give it to you straight. Felipe Amunategui, PhD, director of psychological education and training in the Division for Children and Adolescents at University Hospital in Cleveland, gives every concerned parent something to consider: the intensity of the problem will make you act in ways you never believed you would—or could.

"Parents often find themselves getting very angry and feeling hopeless, and reacting out of those emotional states in ways they wouldn't otherwise," explains Dr. Amunategui, who has dealt with teen substance abuse for 25 years. To avoid that emotional pitfall, he says, it's important to assess the severity of the problem.

Obviously, a parent should be concerned about any alcohol or drug use, and should address it with the child. But fairly infrequent, social use is very different from serious abuse, and should be handled differently. To try to gauge the best approach for your situation, talk to a qualified drug-addiction counselor; ask your pediatrician or family doctor for recommendations. The expert will help you determine whether you're dealing with serious abuse, and not (just) social use. (Dr. Amunategui notes that your teen's social use might not even register on your radar.)

If you conclude that your child is in serious trouble, you may need to follow some extreme guidelines, notes Dr. Amunategui. Below, he outlines important steps, but cautions that they must be implemented with the help of the drug counselor. "This kind of stance becomes justified only after someone who's knowledgeable about this stuff says [your teen's use] has indeed crossed the line between social use and abuse or dependency," he says.

Step One: Acknowledge the problem.

Dr. Amunategui notes that one of the biggest mistakes parents make is burying their heads in the sand to avoid acknowledging signs of substance abuse. (If you see marijuana or drug paraphernalia in your child's room, if you notice his mood or behavior suddenly changing for no apparent reason, if he's hanging with a group of kids whom you don't trust or know, or if he suddenly loses interest in school activities he used to love, you should be concerned. Start by taking him to your pediatrician or family doctor for a complete physical, with possible inclusion of certain tests (see below). Talk to your doctor in advance to let him know of your concerns. A good doctor should make time to talk to you.

Step Two: Ask for drug-specific tests.

Most family physicians will know what to look for and how to confirm your suspicions of drug use. This includes a urine test that screens for alcohol, marijuana and other substances. If the test comes up positive even once, you should have your child see a counselor or therapist specializing in substance abuse. Your doctor may want to talk to your child privately; be open to it.

Step Three: Get professional treatment.

Find a professional experienced with both mental-health and substance-abuse problems in teenagers. Why? According to Dr. Amunategui, teens with substance-abuse problems—especially those who start using before age 13—often are dealing with challenges like depression, anxiety or attention-deficit disorder. These issues should also be addressed, and treated. You can find a counselor through referrals from your doctor, a local community mental health board or federal Web sites like the Substance Abuse and Mental Health Services Administration www.samhsa.gov .

Once your child gets into therapy, explains Dr. Amunategui, your job isn't done. The counselor may ask you to participate in family therapy, and you may want to attend Alcoholics Anonymous or Narcotics Anonymous meetings to support your teen, and to make sure that the environment is appropriate.

Best ways to help your child recover

Now that you've gotten your teen help, check out Dr. Amunategui's tips on what to say and how to act to keep your child on a road to recovery:

Avoid angry threats. It's natural to be angry with a substance-abusing teen—he lies, he steals, he may not talk to you. But you can't convince him to stop by threatening or intimidating him. "If that worked, we wouldn't have this problem because that's the knee-jerk reaction of all parents," Dr. Amunategui explains.

Trust your gut and take a stand. "A lot of parents, because of their own substance use as teens, feel like they don't have the right to tell their teens what to do," notes Dr. Amunategui, "but you do. Trust your judgment." Tell your teen you won't tolerate substance abuse. If he has a serious problem, all bets are off. At this point it's appropriate to search his room, ask for urine tests to make sure he's complying and limit visits to and from friends. Let him earn back your trust and his freedom—don't give them away for free.

Dodge the war of words and will. You want to treat your teen as the smart person you know he is—but you can't use intellectual arguments to get him out of his addiction. Expect your teen to debate ("But all my friends are doing it!"), to scream at you, and to use guilt ("I can't believe you don't trust me!"). Don't engage. The more he bucks, the more likely you're on the right track, explains Dr. Amunategui.

Know you're in it for the long run. Surely you can relax after a few months or a year of vigilance, right? Wrong, says Dr. Amunategui. It takes adults an average of six stints in rehab to kick a habit—and it's tougher for kids who start using before age 13. Hunker down for the long haul.

Keep the focus on the family, not your abusing child.There's a reason some 12-step groups call addiction a family illness—it infects everyone. A substance-abusing teen can fray family bonds and strain marriages and stir up your relationships with friends. Now may be the time to get counseling for yourself, or you and your spouse; it may be offered as part of your child's treatment. Dr. Amunategui also suggests attending 12-step groups like Families Anonymous and Alanon. Those groups are designed to give support and understanding to families of addicts. The advice and support can be invaluable.