Anxiety Medication For Children: Its Safety And Precautions
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In This Article
Is anxiety medication for children safe?’ You may understand in the below post that talks about when to give them. Anxiety is a common psychological defense mechanism that the human body uses to protect itself from danger. Disorders due to anxiety are caused mainly due to an altered perception of and response to fear and stress. These perceptions instill the urge to escape and avoid similar situations, at times to the extent that it may impair day-to-day functioning (1).
Read on to know about anxiety medication for children, their safety, side effects, and precautions.
Anxiety In Children
Some fears and worries, such as thoughts of being separated from their parents, are typical in young children. They usually outgrow these fears as they grow older. If they persist and start interfering with their daily activities at home or school, it is a concern and requires medical attention. The four main types of anxiety disorders include (2):
- Separation anxiety: Fear of being separated from parents
- Phobias: Fear of a thing or situation (i.e. dogs, cats, closed spaces)
- Social anxiety: Fear of facing many people at a time in school or gatherings
- General anxiety: Worrying about bad things that may happen
Symptoms of anxiety disorder may include the sudden onset of sweating, heart pounding, shortness of breath, shaking, feeling dizzy, fatigue, stomach ache, or headache.
Age At Which Children May Take Anxiety Medications
Research shows that anti-anxiety medications work better in children aged seven years or older when used with psychotherapy (3). Anti-anxiety medication should only be given when prescribed by a doctor. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends behavioral therapy as the first-line treatment for childhood anxiety with mild symptoms. Moderate to severe intensity anxiety disorder may need medications (4).
Anxiety Medications For Children
Medications that benefit anxiety were initially used to treat depressive disorders and were classified as antidepressants.
Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) are the classes of drugs that are preferably used to treat general anxiety disorder in children. Duloxetine (an SNRI) is the only FDA-approved medication for childhood anxiety disorders (5). Other drugs, such as tricyclic antidepressants (TCAs) and benzodiazepines, are less common choices for children (6).
The table below elaborates the various drugs used to treat childhood anxiety (3).
| Class | Medication with brand name | Usual dose range (mg/day) |
| SSRI | Citalopram/Escitalopram (Celexa/ Lexapro) | Starting with 10/5 up to 40/20 |
| Fluvoxamine (Luvox) | 100-300 | |
| Sertraline (Zoloft) | 25-200 | |
| Fluoxetine (Prozac, Sarafem) | 10-60 | |
| Paroxetine (Paxil, Pexeva) | 10-50 | |
| SNRI Noradrenergic agent | Venlafaxine ER (Effexor) | 37.5-225 |
| Duloxetine (Cymbalta) | 30-120 | |
| Atomoxetine (Strattera) | 10-100 | |
| Tricyclic antidepressants | Clomipramine (Anafranil) | 75-250 |
| Benzodiazepine | Alprazolam (Xanax) | 0.5-1.5 |
| Clonazepam (Klonopin) | 0.5-3 | |
| Lorazepam (Ativan) | 1-2 | |
| Atypical anxiolytic | Buspirone (Buspar) | 15-60 |
| Antihistamine | Diphenhydramine (Benadryl, Banophen, Diphenhist) | 12.5-50 |
| Doxylamine (Unisom, WalSom) | 12.5-50 | |
| Hydroxyzine (Atarax) | 25-50 |
Source: American Academy of Child and Adolescent Psychiatry
Usually, the medications are started at the lowest dose and gradually increased based on how the child responds to it and the side effects. The child may show improvement after two to four weeks, and the best treatment dose is often identified over 8-12 weeks.
The dosing of anti-anxiety medications in children shall be decided by the doctor depending on age, body weight, and medications already used by the child. Some additional considerations regarding medications for anxiety include (3):
- Occasional intense episodes of anxiety: Clinicians may prescribe benzodiazepines (lorazepam, clonazepam) for a short duration for specific anxiety episodes such as giving a speech or performing on stage. Antihistamines (diphenhydramine and hydroxyzine) and beta-adrenergic blockers (propranolol) may also be prescribed for the said purpose.
- Occasional sleep problems: Physicians may use additional medications if the child has problems sleeping properly even after anxiety issues are resolved. Melatonin, antihistamines, sedative-antidepressants (mirtazapine), or adult insomnia medications (zolpidem, zaleplon) may be prescribed based on the physician’s discretion if behavioral approaches to improve sleep do not work.
Side Effects Of Anxiety Medicines For Children
Anti-anxiety medications work by modulating the effects of various neurotransmitters, such as serotonin, noradrenaline, or histamine, in the central nervous system and are not free of side effects. Some common adverse effects of these drugs include (7):
- Headache
- Sleepiness
- Insomnia
- Diarrhea
- Dry mouth
- Nausea and vomiting
- Decreased appetite
- Stomach pain
- Restlessness
- Increased heart rate
- Muscle pain
- Weight gain (more common) or loss
Serious side effects that require immediate medical attention are (3):
- Abnormal heart rhythm with TCAs, SSRIs, and antihistamines
- Seizures with antihistamines
- Withdrawal symptoms with benzodiazepines if suddenly discontinued after prolonged use.
- Rare respiratory depression is seen at very high doses of benzodiazepines
The FDA directs all manufacturers to add a “black box” warning statement and extended warning statements to alert users to an increased risk of suicidality (suicidal thinking and behavior) in children and adolescents being treated with antidepressant medications (8). A rare adverse effect, serotonin syndrome (excess serotonin in the body), may be caused by SSRIs, SNRIs, or TCAs, resulting in an agitated mental state with hallucinations or coma, muscle rigidity, seizures, flushing, and changes in heart rate and blood pressure (9).
Precautions While Using Anti-anxiety Medicines In Children
Below are the general precautions to be exercised while giving your child medications for anxiety.
- Make sure to inform your doctor about all other prescription drugs, OTC medications, or herbal preparations that your child is using.
- Stick to the dosage regimen and do not give a double dose for any missed dose the next day.
- Inform your healthcare provider about any side effects that your child experiences.
- Keep all types of medications out of children’s reach to avoid an accidental overdose.
Frequently Asked Questions
1. What are the natural remedies for anxiety in children?
Healthy and well-balanced food, regular sleep, exercise, yoga, and meditation are natural ways to treat anxiety in children (11).
2. Do CBD gummies calm anxiety in children?
CBD (cannabinoid) products, such as CBD gummies, have been suggested to help children manage anxiety. Oral doses of up to 25mg/kg daily would help (12).
3. What is the 3-3-3 rule for anxiety in children?
The 3-3-3 rule is a fun mindfulness technique that can help anxious children, particularly young children. It implies asking children to name three things they hear, sing, or see, which can be up to five things for older children (13).
4. Can foods treat anxiety in children?
Eating nutritious foods rich in magnesium, zinc, omega-3 fatty acids, and vitamin B can treat anxiety in children. Asparagus, probiotic foods, and foods that release neurotransmitters, such as serotonin and dopamine, could also be beneficial (14).
5. What are the long-term effects of anxiety in children?
Children with chronic anxiety may develop long-term mental health issues such as depression, substance abuse, suicidal thoughts, and physical problems such as headaches, chronic pain, digestive problems, and heart disease later in life (11).
According to the Centers for Disease Control and Prevention (CDC), anxiety affects about seven percent of children between the ages of three and seventeen years in the US (10). The AACAP recommends psychological therapies such as cognitive-behavioral therapy (CBT) as the first treatment approach for anxiety disorders in children. Medications should be used as a second measure or an adjunct to CBT for the maximum benefit of your child (4). Timely interventions through treatment could help avoid complications and persistence of anxiety into adulthood.
Key Pointers
- Anxiety disorders in children are of four types based on the cause of fear, such as gatherings or specific phobias.
- Anxiety medication has been proven to work better in children aged seven years and older.
- Some side effects of anxiety medications include insomnia, headache, and nausea.
References
- Ian Kodish, Pharmacotherapy for anxiety disorders in children and adolescents.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263391/ - Anxiety and Depression in Children.
https://www.cdc.gov/childrensmentalhealth/depression.html - Anxiety Disorders:Parents’ Medication Guide.
https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/anxiety-parents-medication-guide.pdf - Greta A. Bushnell et al. (2019), Treating pediatric anxiety: Initial use of SSRIs and other anti-anxiety prescription medications.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468981/ - Cymbalta (Duloxetine Delayed-Release Capsules) for Oral Use.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021427s051lbl.pdf - Anxiety disorders in children.
https://adaa.org/sites/default/files/Anxiety%20Disorders%20in%20Children.pdf - Dilip R. Patel et. al. (2017), Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803020/ - Suicidality in Children and Adolescents Being Treated With Antidepressant Medications.
https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications - Leslie V. Simon Keenaghan and Michael (2021), Serotonin Syndrome.
https://www.ncbi.nlm.nih.gov/books/NBK482377/ - Data and Statistics on Children’s Mental Health.
https://www.cdc.gov/childrensmentalhealth/data.html#ref - Anxiety in Teens is Rising: What’s Going On?
https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Anxiety-Disorders.aspx - Cannabidiol (CBD).
https://medlineplus.gov/druginfo/natural/1439.html - 5-4-3-2-1 Coping Technique for Anxiety.
https://www.urmc.rochester.edu/behavioral-health-partners/bhp-blog/april-2018/5-4-3-2-1-coping-technique-for-anxiety.aspx - Nutritional strategies to ease anxiety.
https://www.health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441
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