Normal fears vs. anxiety with Dr. Lockhart

With everything we have to worry about in today’s world, it’s easy to lose sight of how our children can have their own big worries too. Things like getting nails clipped, night-time noises, strangers, doctors, even entering a pool can feel overwhelming to our children.

How do we help them push through their fears? Which are normal, and which are extreme? And how do we validate their feelings without making their fears worse? Jessica Rolph, your host, welcomes Pediatric Psychologist Dr. Ann-Louise Lockhart to today’s episode. She is an expert in childhood anxiety and helps parents distinguish between appropriate behavior and something that requires more attention.

Key Takeaways: 

[1:48] What should parents do and not do when it comes to soothing their children’s fears?

[3:11] What’s the optimal way to handle fear? 

[4:22] How to tackle repetitive fears?

[6:08] When does separation anxiety become a concern? 

[8:17] Where do parents draw the line between encouraging, strongly encouraging, or even making their child try something new, while also respecting their fears?

[10:35] How can we help a child push through their fear?

[13:15] Do we push through the first time they face a fear, or can gradual exposure begin the second or third time? 

[15:07] What is a normal level of apprehension towards strangers for toddlers and what is extreme? 

[18:30] How do parents avoid over-pathologizing their children?

[21:17] Where can parents get help with their questions about anxiety? 

[22:03] Dr. Lockhart suggests parents be aware of what we are consuming.

[23:33] Jessica shares the highlights of her conversation with Dr. Lockhart.

Mentioned in this episode:

Connect with Dr. Ann-Louise Lockhart on Instagram

Transcript:

Jessica: When I shared Dr. Lockhart’s specialty with our Instagram community, there was a lot of parental worry about anxiety in our children! So I decided to start our conversation by focusing on what we should and should not do when it comes to soothing their fears.

How to soothe your toddler’s fears

Dr. Lockhart: One of the biggest mistakes that parents make, including myself, is over reassurance. Over reassurance when a kid is expressing a fear is one of the biggest mistakes you can make, which actually feeds fear. What that means is that they say something like, “Well, what if I have a bad dream again, tonight, mommy?” “You’re not going to have a bad dream.” “Well, what if I do?” “Well, then we’ll check up on you.” “But what if you don’t check up on me, I have a bad dream.” “It’ll be fine.” “Well, what if I’m not fine,” and then we keep reassuring and reassuring… And it’s exhausting, because in their little minds, and they don’t realize that this is happening, because it’s on a very subconscious level, if you keep reassuring me and you’re spending so much energy trying to reassure me, there must be something to actually be afraid of, because if there wasn’t, you would stop talking. 

So that over reassurance is a dangerous cycle to get into because they just keep pulling and pulling and pulling, pulling for that reassurance, and we just keep giving it and giving it and giving it, and they just keep hearing it and they’re like, “Oh, okay, so you keep talking, so I must really need to be concerned about this because then otherwise, we wouldn’t be having this conversation.”

Jessica: So it becomes something bigger because we are in partnership with our child in making it bigger by talking about it, how should we handle this instead? What’s the optimal way to handle a fear? 

Dr. Lockhart: Well, first, we don’t want to dismiss it and we don’t want to over reassure it, and then we also don’t want to use logic. Those are all the don’ts. We don’t want to say, “Oh, you’re fine. Mommy and daddy are here, grandpa’s here, you’re fine. You’ll be safe,” even though those are true, we don’t want to go to the logic, because what we do want to do is speak to the emotion with emotion first, before reassuring and being logical. So if they say, “I’m really scared about being in my room by myself,” you respond, “Oh, you’re really scared about being in your room, you’re really nervous about being by yourself in this new house. In the room by yourself.” So you’re responding with the words they’re using, using the emotion words that they’re using, and that’s the best way to connect first, that’s a huge do, is that you empathize and you connect and you relate based on the emotion they’re sharing.

Jessica: That’s such a great tip. And then what? So let’s say that the toddler child is having kind of a repetitive fear about you, being separated from you or them not being picked up at school, for example, you won’t come for me, what do we do with these kind of repetitive fears next? 

Dr. Lockhart: Yes. “You are really afraid that mommy is not going to pick you up from daycare. I understand that you’re afraid, you’re not sure, this is new for you, your brain keeps telling you that this is true.” So you connect on the emotion, you use their words and you kind of elaborate, expand on it. So they’re understanding that mommy, for example, is connecting with me on what I’m saying, I hear you, so that way they don’t have to escalate to prove to you how big of a fear it is. And once you’ve done that, then you can bring in the logic or the reassurance: “Every day, the same time, mommy always picks you up, every single time. You can always trust that I will come back for you, you can always trust that myself or daddy or grandpa or uncle or whoever is going to pick you up.” So you’re going to connect with the emotion, provide the reassurance in that way, and then provide the logic and the truth of what’s going to happen, and if they keep persisting, that’s when you don’t continue to engage.

And I think that’s the hardest part, because then people feel, well, you’re ignoring your kid and you’re dismissing them, no, you’re not. They already stated and you have responded, because if you keep engaging in them, then you’re going to fall into the over reassurance, you’re going to get frustrated, they’re going to get frustrated because no amount of talking is going to provide them the relief they need in that moment when they’re having these intrusive and fearful thoughts. That’s the hard part.

Separation anxiety in toddlers

Jessica: That is so smart. I did not know these things. This is so helpful. So talk to me about separation anxiety that shows up in toddlerhood, how do you think about this, when do you start to recognize that maybe this is getting to be too big for the toddler and the parent. How do you handle things? 

Dr. Lockhart: I think a lot of parents, they get concerned about the separation part and the separation anxiety about daycare and babysitters and even going on a date or going out with friends or going on a retreat for themselves. They think that their kid is going to be traumatized or it’s going to damage the attachment. And I think it’s really important for people to understand that attachment happens within the first year of life, that a lot of the developmental stage of trust versus mistrust, which is talked about in the psychological literature, is that our secure attachment is knowing in the very early months that this person who’s taking care of me is attuned to me, they’re consistent. And they show up, they respond to me, they feed me, they clothe me, they comfort me, they sing to me, they play with me. So, when you’re talking about kids who are toddler age, a lot of that, hopefully secure attachment has been formed, so even if they’re leaving to go to daycare or you’re leaving because you’re going out with your spouse or your partner, that’s not going to damage them in some way. They’re not going to start hating you in some way, they’re not going to be detached from you because you’ve done something for yourself or because you’ve dropped them off at school or daycare.

They’re going to be fearful at that age, 10 months or two years, separation from caregiver is a common fear, but it doesn’t mean that we have to have them latched on to us because they have that fear, it means that we recognize it, we provide that reassurance, and then we provide that developmentally appropriate separation.

Create a positive association

Jessica: I’m just feeling so confident in hearing you talk about this now, this is helping me so much. Let’s get into where you draw a line in encouraging, strongly encouraging or even making your child try something new while also respecting their fears. For example, getting in the water for a swim lessons. Let’s say you really do want this for safety, for their ultimate safety, they don’t want to get into the water, they’re exhibiting fear. You’re in that moment with them. You’ve signed them up, the instructor’s there, what do you do? 

Dr. Lockhart: Yes, I think you always go back to the same things. You don’t have to use the word fear all the time, but you can say, “You are concerned about this water, you’re not sure, you’re unsure, you’re uncomfortable about being here, but mommy is right here with you, I’m here to keep you safe.” Or, “You’re here to learn how to swim. And we’re going to do this every week, three times a week,” because in the back of my mind, I paid for it. And we’re going to do this darn it. But you provide that reassurance after you’ve identified what that emotion is, and you’re basically emotion coaching them through it, the Gottman Institute talks a lot about that.

It’s okay to let your kids be afraid, but we have to make sure we’re not allowing them to escape the fear at the height of the fear, because the thing about a fear response, and this is regardless of your age, 3-83. That if you have a fear response about something, and you have this heightened, heightened alert system going on in your brain and your body, and you allow yourself to escape at that heightened state, what you’ve done now is you’ve created an association between running away from that fearful situation and then feeling the relief. 

So if I run away from the swim lessons and now I’m in the corner and mommy is rocking me and soothing me and playing Peppa Pig and then giving me a snack, and now I don’t have to do the swimming anymore, and now I feel better. What my brain has now paired together is, oh, being in the water is scary and dangerous, which is why I was allowed to leave because it’s unsafe, but now that I’m out of it, I’m getting all this reinforcement outside of the water, and now I feel calm. So being outside of the water and being away from there, this situation actually feels better, and so now you’ve created this association between water and fear and escape and being calm and reassured. And so we do this very unexpectedly, and we don’t realize it, because we think we’re being a good parent by letting our kids escape things, but letting them escape and avoid actually feeds anxiety.

Jessica: That is so fascinating. I am that mom, cuddling in the corner with the snack. That’s me 100%. So let’s just tease this out just a little bit more, am I putting their toes in the water, am I forcing them physically? Sometimes there’s a physical element to needing to get something done, so where do we use our bodies to help push a child through their fear or where are we going too far and they’re just too hysterical and it’s just too much. Talk to me about that edge.

Dr. Lockhart: Totally. because it can be traumatizing, right? For you as a parent and for them, because you don’t want them again, to have that negative association, now you’re like, “You’re going to do this darn it,” and they’re screaming and they’re snotting and everything, and now it’s really a negative experience and they really don’t even want to go back. So I think that’s where if you really feel like your child is just having too much of a negative reaction, for example, to the swimming situation, the swimming lessons, then I think you do gradual exposure. And a lot of anxiety treatment or intervention, a big part of it is this gradual and systematic exposure, so that means that maybe you agree to say, I know that you don’t really want to be here. Let’s just sit at the pool with our feet in the water for 10 minutes while we sing a song. Okay, now we’ve done that. Why don’t we just sit on the step in the pool for five minutes while we splash around. Okay, what if we stand in the water where the water gets to your waist for a few minutes while we blow bubbles, okay? Okay, what if we take a deep breath, put our head down.

So again, this is gradual over time or engaging in water play, making positive associations with that child in that situation where they’re fearful of, and that could be anything like going to the doctor, going to the dentist, any of that stuff. That slow and gradual exposure can be really powerful because what you’re doing is you’re trying to create new pair associations between the situation and their emotions, their feelings, and knowing, hey, I did it, I was able to put my feet in the water and it was good, everybody was happy, I was happy, and I did it. Great, and if that’s all you accomplish, that’s a huge accomplishment, because now their feet have been in the water for 10 minutes and they didn’t have a hysterical fit, and then you could do the next thing.

Jessica: That might not happen at that first swim lesson when the big, big, big hysteria, I’ll just use that word, maybe it’s an exaggeration, but it feels like that in the moment. You might take a break that time, but make an agreement next time we are going to dip your toes in the water or something, because I’m trying to not reward their fear by making them safe over in the corner with the snack, but I’m also stuck in that moment, and I love your plan of a gradual exposure. Does that gradual exposure start… Perhaps, can that happen at the next lesson? 

Dr. Lockhart: Yeah, it can. And I think it’s really important, especially if your kid has a very averse reaction, very negative reaction to that. I think then what you do is then between lessons, you have other opportunities for water play, in the backyard, in the little shallow swimming pool, in the backyard with the hose, doing other things where there’s positive associations with them in the water, even in the bathtub, doing things where they hold their breath and they go under the water. So that there’s constant reinforcement, constant positive associations between the two. And it makes a big difference. I’ve done this even like I get a lot of questions from parents whose kids don’t like going to the hospital, especially if they had a negative experience with the hospital, and I’ll say, “Okay, well, go to the hospital during times when there’s not a medical appointment, and then buy some popcorn, have a picnic, go to the gift shop, visit other people.”

Do something that’s positive, that creates a positive association, so that way every time they go, it doesn’t have to be this big reaction, it can be now a positive connection between going and feeling good about going. And so that could be with anything, the dentist, the hospital, swimming, school, day care, any of that kind of stuff, is that we’re trying to create these connections that are positive between the two things.

Stranger anxiety in toddlers

Jessica: I love it. We do have books as tools, at Lovevery, where we make books, previewing the doctor’s appointment, previewing the dentist appointment, previewing even the scary thing like pooping for the first time in the potty, we preview that through living, a lived experience of another child, a story that they can relate to and the child gets through their fears and successful. So I think that also just giving them those tools to see ahead and talk about something ahead of time. I love your idea of visiting the hospital ahead of time, if your child has a lot of appointments coming up. These are great ideas. One question that I had is around what is the normal level of apprehension for toddlers to have towards strangers? So I know the stranger anxiety shows up, how do we tell what’s normal and what feels extreme? 

Dr. Lockhart: That’s a great question, and it’s a very hard question because a lot of people who currently have toddlers who have been born in isolation because of the pandemic. So a lot of what I’m seeing with toddlers is excessive, given my pre-COVID viewpoint of what toddler strange anxiety should look like. So I’m seeing a lot of toddlers who have a big, apparently looks like an exaggerated response to separation and strangers, but it’s because so many families were on lockdown, so many families were in isolation, so many families stayed at home and didn’t travel, the kids weren’t in day-care, they didn’t have babysitters, they didn’t see family members. So now when they see a new person, they’re kind of freaking out because again, why? Because of avoidance. For health reasons, we avoided situations, but also regardless of the reason why, avoidance still feeds on anxiety, feeds off of anxiety. So because a lot of our toddler-age kids right now, were born in a world and have grown up the past two years in a world where they weren’t interacting with people, they’re going to have an exaggerated response.

So I think we have to remember that and keep that in mind, because a lot of kids are going to have this big response and we have to remember, Okay, yes, well, my child has not been around people frequently, or we haven’t done a lot of traveling, or we haven’t done day care up until now. So it’s going to take longer because of the… They didn’t get to create a habit of being separated, they didn’t get to create a habit of being around other people other than their family unit.

When to be concerned

Jessica: That makes so much sense. And I think just having compassion for ourselves in this really tricky time as our children adjust is really important too.

So much of this has been, how can we as caregivers and parents help support our children through this? There’s a question sometimes that can linger in the back of our mind, Does our child have anxiety? Is this normal? And I think we’ve touched a little bit on this. How do we avoid over-pathologizing our children? And there’s so many connections with anxiety, ADHD, sensory processing disorder, oppositional defiant disorder, there’s all these things, and so when do we worry, when to relax, I know this is a very hard question to answer, but remembering that our audience is primarily of parents of children between birth and age 4? 

Dr. Lockhart: Yeah, that’s a great question. And it’s such a hard question. I speak to… I have a lot of colleagues who will reach out to me as well too, and ask those same questions too, because it’s so often we’re in this mode of treating a disorder or a diagnosis, and so you tend to see things from that lens, but I think parents are getting a lot of those fear messages too, and they think there’s everything, every turn, there’s something wrong with my kid. So first I would say is trust your gut that even if you’re not an expert in the field of psychology or occupational therapy or speech and language pathology, or child development, you’re still an expert on your child.

Okay, is…  Does something feel off? The other thing I think we have to ask is, does my life feel like it’s always in a disruptive chaotic state because of my child’s behaviors or emotions.

Because, yes, kids will go through phases, especially at the age group we’re talking about, 2 to 4 can be very tough for a lot of kids and parents. Because they are finding their voice and they’re becoming more independent and they realize they’re individual, separate from you, and so they go through the “mine” and “no” phase because now they can wipe their butt on their own, feed themselves and walk without your assistance, so it can be really hard, but if it feels so hard all the time, that is not typical, it should not be that way. Do I dread when they wake up every morning? Every time they come home from daycare, am I not looking forward to when they wake up from a nap? Those are all things we have to pay attention to because that should not be the case that you’re always walking on egg shells and afraid of your kid even showing up at home.

Jessica: Yeah, and I want to just help parents, I think that it’s also the persistence, right? It just needs to persist for weeks, if not… Many weeks, months, maybe. I did have a situation with my daughter where I really needed outside help, and I saw a child psychologist, we were going through a really hard time together when she was 3 and 4, she was really destructive, taking my things, nicking them and destroying them, and it was so hurtful and I also didn’t know how to react and I think I was making it worse. And it was extreme, and I could tell I was extreme because it just… It did feel like my gut was telling me this is really not a typical behavior, and the psychologist really helped me work through this. Who do we get help from? Where do we even go with this kind of question around anxiety, where do we get help? 

Dr. Lockhart: For a lot of people, I think the first stop is often going to be their child’s pediatrician, because hopefully they know the best because they’ve been following them for a while, and often with most insurances, if that’s what you’re using, the first stop is usually a referral by a pediatrician. And really documenting your concerns, keeping a running list of what are the things that you’re concerned about, whether you think they’re ridiculous or not, whether you think you’re overreacting or not, I think you should just write those things down.

Jessica: This is so helpful, thank you so much, Dr. Lockhart, is there anything else that we should be sharing with parents related to this topic? 

Dr. Lockhart: I think parents need to be aware of what they’re consuming. I’m seeing this more and more. I think we’re at a place in life that I love, there’s so much information out there, but I think parents are getting overloaded with information, and so I think I would really encourage parents to be very intentional about the information that you’re consuming and reading from books, podcast, blogs, articles, social media, because you don’t want to get to a place where you’re consuming so much information trying to find out answers about your kid that it’s creating shame and guilt and projection of your concerns on to your kid. And I think we have to be intentional about what we’re looking at, so that the stuff that you’re looking at actually uplifts you and encourages you rather than makes you feel defeated and like a bad parent, so even the stuff that… The people that I follow, the accounts that I follow, I try to be very intentional about it because it really can bring you down, it can really make you feel bad about it. So I think I really want to encourage parents, especially as parents of zero to 4-year-olds, I mean it’s going to be more and more as more and more information is out there, be very intentional about that information, so that way you are helping yourself rather than making yourself feel bad.

Jessica: We take so much care and love every to make sure that we’re providing positive, helpful information, and we know you do too, so you can follow Dr. Lockhart at Instagram and it’s just been wonderful having you here with us today.

Dr. Lockhart: Thank you for having me Jessica.

Takeaways:

Dr. Lockhart had so many great tips on how to support our children through their fears. 

1. Some parents are afraid that a screaming toddler at drop-off means attachment will be damaged. This is not the case. By toddler age, your child’s secure attachment has been formed. Our child’s attachment stems from knowing in the very early months that this person is going to show up, respond to me, feed me. So rest assured your connection remains strong even through separations. 
   
2. One of the biggest mistakes parents make when a child is expressing a fear, is over-reassurance. It can actually reinforce the fear. Dr Lockhart says, don’t start with logic: “You’re fine, Mommy and Daddy are here.” Instead, speak to the emotion with emotion first. Respond to “I’m scared being in my room by myself,” with “You’re scared of being by yourself. I understand, this is a new room for you.” Empathize, connect and relate. Then, you can bring in the logic: “You can be sure that I will be just down the hallway.” If they persist, resist engaging anymore. That only reinforces the fear. 
   
3. Letting your child escape and avoid an uncomfortable situation actually can feed the anxiety, because they will associate the swimming lesson — let’s say — with danger, and the escape with safety. Engage gradually and offer positive associations instead. Try putting your feet in the water and say to your child: “You’re unsure about getting in the pool. But Mommy is here with you, and you’re here to learn how to swim.” You’ve identified the emotion, and now you coach them through it. 
   
4. Dr. Lockhart is seeing toddlers with excessive stranger anxiety post-Covid because so many families have been isolated during the pandemic. Avoidance feeds anxiety, so continue your efforts to gradually expose them to a wider circle of people.
   
5. When to worry, when to relax? Trust your gut. It’s normal to be scared and second guess yourself, but allow your instincts to prevail. Even though it’s uncommon for kids to be diagnosed with anxiety under age 5, ask yourself: Does my life feel like it’s always in a disruptive or chaotic state because of my child’s behavior and emotions? Is this behavior persistent? Does your child feel like an outlier when compared to their peers? If it feels like you’re perpetually walking on eggshells, consider getting professional help. The first stop can be your child’s pediatrician. 

You can learn more about your child’s development on the Lovevery blog.