Fears
Marilyn Augustyn
I. Description of the problem. Fear is an unpleasant emotion with cognitive, behavioral, and physiological components. It occurs in response to a consciously recognized source of danger, either real or imaginary. From an evolutionary perspective, fear is a key to survival.
A phobia is a persistent and compulsive dread of and preoccupation with the feared object or event. Phobias may interfere with the child’s functioning in a way that fears do not.
A. Epidemiology.
Fears are present at various times in the lives of all children.
Between 2-6 years, most children experience more than four fears.
Between 6-12 years, they experience an average of seven different fears.
Fears often peak at the age of 11 years and then decrease with age.
Studies of identical twins suggest a genetic predisposition to fearfulness in some children.
Females report fears more often than do males.
Mothers often underreport (by up to 40%) the fears of their children.
Unconfronted fears are more likely to persist.
Phobias are seen in 7% of adults (disabling phobias in 2%); the prevalence in children is unknown.
B. Familial trends.
1. Fearful, anxious parents tend to have fearful, anxious children, probably through a combination of genetic predisposition and social learning.
2. Simple phobias appear to run in families, although individuals rarely share the same specific phobic stimulus.
C. Etiology/contributing factors.
1. Environmental.
a. Although fears in childhood reflect a universal developmental tendency, the onset often relates to a triggering event. For example, a child may become fearful of dogs following a startling experience with an unleashed large dog. The (perhaps) innate human fear of large animals is intensified by a developmental level that does not allow a nonthreatening explanation of the event.
b. New stimuli from the media join the roster of later childhood fears (e.g., school violence, sexual abuse, environmental toxins, terrorist attacks) even as old ones have dissipated (e.g., the communists). Sensationalistic news flashes during commercial breaks from programming can often heighten children’s fear of exposure.
c. Significant fears may reflect an accurate assessment of a truly harmful situation or represent a displacement of feeling from another environmental stressor (e.g., physical or sexual abuse).
2. Developmental. Fears change and evolve as cognitive development becomes more sophisticated. Fear of falling and loud noises are the only fears children have at birth. The emergence of other common fears reflects a child’s increasing awareness of the world around him. Early childhood fears center on the environment. Exposure to real world dangers intensifies and expands fear. Table 43-1 provides the timing of selected fears throughout early development.
II. Making the diagnosis. The most useful way to differentiate a fear from a phobia is the degree to which the fear interferes with the child’s daily activities (Table 43-2). If the child is developing normally in all other aspects, most often the behavior is a simple fear. If the fear impinges on important activities, it may have progressed to a phobia and requires specialized attention.
A. History: key clinical questions. The primary care clinician must determine if the symptoms represent a simple fear, a response to significant environmental pathology, or a displacement of other stresses in the child’s life.
1. “Does your child’s fear interrupt his or her daily schedule more than three times per day?”
Table 43-1. Common fears in childhood and adolescence
Age (Years)
Fear
1
2
3
5
7
9
12
14
Separation
X
X
X
Noises
X
X
Falling
X
X
X
Animals/insects
X
X
X
Toilet training
X
X
Bath
X
X
Bedtime
X
X
X
Monsters/ghosts
X
X
Divorce
X
Getting lost
X
X
Loss of parent
X
Social rejection
X
X
X
War
X
New situations
X
Adoption
X
X
Burglars
X
X
Injections
X
X
X
X
X
X
X
X
Sexual relations
X
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
