All children have fears in their lives, but some are very serious and can be debilitating. Here we explain the difference between fears and phobias, and how they are best treated.
Izzy Kelly is seven-and-a-half years old and for as long as her mom, Catherine, can remember, she’s had a fear of puppies and small dogs. When she sees one, she freezes and starts screaming. She also has a new phobia of dragonflies and when she saw one outside her closed bedroom window, she had an anxiety attack (tears, screaming, shaking and hyperventilating) and refused to return to her bedroom for over half an hour.
Izzy’s phobia is not uncommon. It’s believed that up to 9.2% of children and adolescents* are believed to experience some type of phobia. Our expert and educational psychologist, Claire Maher explains that a childhood phobia is a fear that kids have which causes distress and interferes with daily functioning. It is out of proportion to the perceived threat, but is typically outgrown by adolescence or adulthood.
Commonly, kids are often afraid of the dark, being away from their parents, the “monster” under the bed, being with strangers, being forgotten at school (or abandoned), animals, and thunderstorms. “These are typically fears, but can be classified as phobias if they persist unusually past certain developmental stages and interfere with one’s functioning,” says Maher.
She explains that humans are born with only two innate fears – the fear of falling and the fear of loud noises. The rest of these fears/phobias are learnt or come about due to a particular genetic predisposition.
The Diagnostic and Statistical Manual (DSM 5) lists five broad categories of phobias. These are:
- Fears related to animals
- Fears related to natural environments (heights, thunder, darkness, water)
- Fears related to blood, injury or medical conditions (needles, broken bones)
- Fears related to specific situations (elevators, driving, aeroplanes)
- Other (choking, drowning, loud noises)
According to Maher, phobias can be genetically rooted, or as a result of the environment and stimulus. A child who is naturally shy may be more susceptible to having phobias. A child with a personal or familial history of psychological challenges may also be at risk for developing phobias. Lastly, traumatic experiences can contribute to phobias. For example, a child who is bitten by a dog may be fearful of every dog they encounter, irrespective of the level of danger it poses to the child.
Maher explains that symptoms of phobias will be similar to anxiety disorders such as generalised anxiety, or in the moment, panic attacks. People might present with physical and/or emotional symptoms. These include:
- Breathing difficulties
- Chest pain or tightness
- Sense of being overwhelmed
- Feeling of needing to escape
- Heightened anxiety and fear
Maher says that a phobia differs from a fear in how much anxiety it causes a child, and how long a child is fearful of something. “A phobia interferes with a person’s daily functioning, instead of it being short-lived, and in response to a particular threat or perceived threat. With a phobia, the anxiety and fear are out of proportion to the threat.”
“… humans are born with only two innate fears – the fear of falling and the fear of loud noises. The rest of these fears/phobias are learnt or come about due to a particular genetic predisposition.”
Refilwe (not her real name) knows well about the “disproportionate” anxiety and fear. Her eight-year-old daughter, Naledi (not her real name) has a phobia of snails. Refilwe says her daughter doesn’t have a mild reaction to snails, like having a shudder or saying ‘eeeuw gross’. Rather, she experiences terror, and screams and cries so hard that she has difficulty breathing. She will also try to climb up an adult for ‘safety’.
To help Naledi with her snail phobia, Refilwe says she has to prepare her ahead of time. “We remind her it’s been raining, and that snails love the rain and will come out to play. We remind her that snails are small and she is large and they can’t hurt her. I try to show her they are harmless by picking them up off the path and putting them in the bushes. Sometimes it calms her and sometimes it doesn’t but I think consistently prepping her, remaining calm ourselves and leading by example, does help.”
“I think with age and higher reasoning and lots of positive reinforcement, she has gotten much better at dealing with her phobia. We are about to go into rainy season now and we are already talking about snails and how harmless they are. We also look up facts about them and stories that may have snails in them, and we’re hoping that these will help ease her.”
Children with phobias that they do not outgrow, and which continue to affect their lives, may require some professional input and intervention. Maher says that while psychotherapy is always useful for exploring root causes of phobias, cognitive behavioural therapy would be most useful to help a child develop new pathways and thought patterns about their phobias, and to develop strategies on how to manage them.
As parents, we need to take our child’s fears seriously, for their sake, but at the same time, we do not want to play into them and exacerbate them. A child who is afraid of dogs needs to be encouraged by parents to learn that not all dogs will bite, and that it is okay and safe to walk on the same side of the road as a dog that’s on a leash. This is not preventative, but assists in alleviating the phobia.