Anxiety issues can start early. Very early. In fact, you can spot the signs in toddlers. Which is important because contrary to what many people believe, anxiety struggles don’t dissipate with age. Kids don’t grow out of their anxiety.

Instead, their anxiety simply morphs into other behaviors. According to Janine Halloran, a licensed mental health counselor who specializes in kids and teens, separation anxiety may turn into refusal to go to school.

Kids also start coping with their anxiety in unhelpful, unhealthy ways. For instance, they might develop specific rituals when getting out the door for school, said Katie Hurley, LCSW, a child and adolescent psychotherapist.

This is why it’s vital to intervene early. Below, you’ll learn what anxiety looks like in toddlers, along with what to do when you notice these signs.

Signs of Anxiety in Toddlers

According to child and family therapist Clair Mellenthin, LCSW, “Anxiety often presents itself as emotional or behavioral symptoms in childhood.” For instance, she said, some typical symptoms include: excessive crying, fear of being left alone, hypervigilance, food restriction and nightmares. Additional signs include:

  • Rigidity. Anxious toddlers insist that parents do things in a particular manner or order, said Natasha Daniels, a child therapist and author of the book How to Parent Your Anxious Toddler. She shared these examples: You have to tuck them in a certain way; they’ll only drink from one cup; they tell you where to stand and how to hold them. “All children love routine and structure, but anxious toddlers will implode if it is not done exactly as they require.”
  • Fear of new situations. Many toddlers feel uncomfortable in new situations, and it can take them some time to adjust. However, anxious toddlers, Daniels said, “hold onto you for dear life.” They might need you to hold them the entire time; hide behind your legs and never come out; demand to leave; or refuse to go inside, she said.
  • Intense separation anxiety. Anxious toddlers usually need to have you in sight at all times, and they’ll panic if they don’t, Daniels said. They will follow you everywhere, and have a meltdown if you need to leave without them, said Halloran, author of the Coping Skills for Kids Workbook, and founder of Coping Skills for Kids.
  • Intense tantrums. Tantrums are totally normal for toddlers. However, tantrums that take 45 minutes or more and occur regularly (not because your child is tired, hungry or overstimulated) are red flags, according to Hurley, author of several books about children, including her latest No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls.
  • Regression. Anxious toddlers tend to exhibit regressed behavior, Hurley said. For instance, if your child is potty-trained, they might have frequent accidents, or if they’re night-trained, they might wet the bed, she said.
  • Sleep issues. “Anxious toddlers have difficulty falling asleep and staying asleep, and will get up multiple times a night to seek out a caregiver and explain that they had a bad dream or they are scared,” Halloran said.
  • Repetitive behaviors. They might twirl their hair or bite their nails in order to calm their anxiety, Hurley said.
  • Excessive phobias and fears. Anxious toddlers may fear monsters, the dark, bugs and other animals, said Halloran. They may have “fears around the bathroom,” such as “getting flushed down the drain, fear of the water, fear of things in the water.” And these fears will interfere with completing daily tasks: They refuse to go into the bathroom or refuse to stay in their room and go to sleep, she said.
  • Sensitivity to sound. Anxious toddlers might cover their ears when they hear loud noises like bathroom hand dryers, Halloran said. They might “have big reactions to loud sounds like garbage trucks, vacuums, or garbage disposals. They can also be extremely reluctant in big crowds or at parties.”
  • Food issues. “Sensory issues are more prevalent in anxious toddlers and this often impacts their little mouths and body. Lumps and bumps in food will make kids gag and develop some pretty intense picky eating,” said Daniels, who also hosts the AT Parenting Survival Podcast, which focuses on child anxiety. They might only eat a few foods, refuse to try new foods or not want different foods to touch on their plate, Halloran said.
  • Physical symptoms. Daniels noted that anxious toddlers tend to get constipated more often. Hurley suggested looking for complaints of tummy aches.

“Not all anxious toddlers will exhibit all these signs, but these are some common ways that anxiety expresses itself in the toddler years,” Halloran said.

What to Do About Anxiety

If you notice any of these signs, the first step is to talk to your pediatrician. “It’s always important to rule out any medical causes of symptoms when kids are young,” Hurley said. Ask your pediatrician for recommendations for child therapists who specialize in working with toddlers.

Halloran also recommended seeing an occupational therapist because many anxious toddlers have sensory issues. “These professionals can help support your child in learning effective self-regulation and coping strategies, and give you tools you can use at home too.”

According to Hurley, “Cognitive behavioral therapy is highly effective for helping young children cope with symptoms, and play therapy can help children work through their triggers and stressors.” Mellenthin suggested finding a registered play therapist at the Association for Play Therapy:

Reading books to your child about anxiety also can be helpful. Daniels suggested Andi Green’s book Don’t Feed the Worry Bug; and for kids 5 and up, Karen Young’s book Hey Warrior and Dawn Huebner’s book What to Do When You Worry Too Much.

Having a child who’s struggling with anxiety can understandably make you anxious. You might be upset that they have to see a therapist—and delay treatment. But, as Daniels noted, denying that anxiety exists serves no one, especially not your child.

“When we intervene earlier, we help teach children how to manage their anxiety in safe and healthy ways,” Halloran said. We also equip them with effective tools that they can take with them into young adulthood and beyond.

According to Daniels, young kids can learn to name their anxiety, and use language to express their fears. They can learn how anxiety works and grows (i.e., with avoidance).

But we have to teach them.

“Anxiety comes with some wonderful traits,” Daniels said. “Anxious kids tend to be the most empathetic, intelligent, kind-hearted kids I know. They are my favorite type of people. They are true gems; we just have to teach them how to get rid of the anxiety so they can really sparkle.”