Recently, a parent asked me to answer this question. He wanted to understand when his child’s frequent worrying should be evaluated by a mental health practitioner or a primary care provider. In these tense and confusing times, it’s easy to confuse normal feelings of nervousness with more debilitating anxiety. Here are two basic definitions that can clear up any questions you may have.
Feeling nervous is different that feeling anxious in terms of intensity, frequency and focus. Nervousness, like anxiety, is experienced cognitively and physically but it doesn’t stop you from doing something. Nervousness is a temporary feeling of insecurity related to specific concerns about a new or stressful situation. Usually these concerns go away once you’ve mastered the tasks associated with that situation or lived through and managed it successfully. You’ll feel nervous with a flutter in your stomach or some perspiration about doing something like getting a flu shot or going to see a friend for the first time in months, but you’ll do these things anyway.
Anxiety disorders are more debilitating and persistent, reflecting repeated all or nothing thinking, negative expectations of events and an inability to tolerate uncertainty. They can be related to general or specific fears that don’t go away despite positive experiences of successfully overcoming them. Although anxiety 
can be adaptive by helping us prepare for real danger, anxiety disorders involve the experience of a natural emotion at an inappropriate time and to an excessive degree. Sometimes there can be episodes of fear or worry in the absence of a genuine threat. Whether it’s a true emergency or a false alarm, anxiety disorders distort your perceptions and create uncomfortable bodily states including racing heart rate and shortness of breath.
Most people try to avoid whatever triggers the anxiety which, outside of crisis management, actually makes it worse. Instead, it’s most helpful to identify what triggers your anxiety, your typical, distressful reactions and brainstorm alternative responses. The goal for reducing anxiety is learning how to tolerate the discomfort that comes from uncertainty and realistically assess the safety of a given situation. For example, your child may be very anxious about being stung by a bee, refusing to spend any time outside. You will have to work with her to go outdoors slowly, by increasing the minutes she successfully tolerates the fresh air each day. We want her to learn that she can worry about bee stings and live through her fear. She’ll likely need to create and use self-calming phrases such as “I don’t see any bees around me,” “Bees want pollen” or “A sting will hurt less than getting my ears pierced.” She’s learning to how to manage her anxiety and you are supporting her budding confidence. 
Whether your child or teen is dealing with nervousness or anxiety, they need to figure out a strategy for self-soothing. You won’t always be there to reassure them that things will be okay. Practice some phrases and calming behaviors outside of challenging situations so they’re familiar enough for kids to summon up when needed.
