What About the Kids?

It's hard enough being a phobic adult, going through life fearing metaphorical monsters under metaphorical beds. But suppose you were having the same fears in childhood, a stage of life when monsters are somehow more than metaphors and the bed they're hiding under is your very own. How can parents distinguish a passing childhood fear from a full-blown phobia? And what can they do to help? The good news for most parents — not to mention their kids — is that the majority of childhood terrors are fleeting. In a big, forbidding world that most children can't begin to make sense of, it's normal to gather up free-floating anxieties and pile them onto one comprehensible entity — dogs, sirens, the dark.

If it makes the rest of the world feel safer, this can be an effective defense mechanism. The danger comes when children's anxieties begin to assume an enormous and debilitating importance in their lives.

"Before age seven, it's common for kids to have extreme fear reactions," says psychologist Steven Phillipson, clinical director of the Center for Cognitive-Behavioral Psychotherapy in New York City. "The ability an older child or adult has to distinguish between reasonable and excessive reactions is not yet developed."

Hard as it is for parents to watch a toddler in torment, there's not a lot they can do beyond lavishing the child with plenty of loving reassurance and taking a firm but gentle hand when the object of fear — a bath, say, or the doctor — can't be avoided. It's only when extreme fears persist past age seven and significantly begin to affect the child's ability to function that clinicians become concerned. "When young children are doing well despite their fears, we don't intervene," says Phillipson. "When an older child starts to suffer at home or at school, it's time to get involved."

That therapeutic involvement is much the same as it would be for an adult phobic: gradually exposing the child to the feared object or experience and teaching him or her, eventually, to live with it. Most of the time, doctors encourage parents of phobic kids to become involved in treatment, attending sessions and walking the child through the hierarchy of exposure — provided they can resist the natural impulse to step in and stop the session when the child starts to grow fearful. "Hard as it is for parents to watch," Phillipson says, "the only way for kids to get around the pain is to go through the pain."