Ask the expert: My 4-year-old son asks constantly if we will be knocked down? Or die?

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Q My partner works away and my four-year-old son struggles with this. He clings to me and is doing this more now than ever before, despite the fact that his dad has been away since he was born.

He had a teacher in preschool (when he was aged two to three) and he loved her. She left the school to move with her family. His cousin has moved overseas. He is an only child and his cousin was a sort of brother to him. He was very upset by these losses.

He has what I believe to be heightened anxiety and I can't go anywhere without him screaming, roaring or freaking out. Sometimes he is just pure sobbing and seems very frightened.

He asks constantly if we will be knocked down? Or fall into the water? Or die? He doesn't want to eat for me or go to the shop with me or, well, there is a long list of things. He constantly apologises and says sorry a hundred times a day for the smallest of things. He seems worried and stressed and very frustrated all the time.

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I try to reassure him about everything but I also get stressed and raise my voice to him. It's heartbreaking and soul destroying for me. I'm just worn out from it all and so is he. It's a lot for a four-year-old boy.

A Your son’s level of anxiety does sound severe and you are right to try to take steps to address it. While lots of four years olds have a tendency towards worry and anxiety, this appears to be much more exaggerated for your son.

Given the losses he has experienced in his short life – his father working away, his preschool teacher leaving and his cousin not being there, and so on – it is understandable that he might feel great anxiety at being separated from you.

At the heart of this anxiety is a fear that he might lose you as well as the other people he has lost and this fear has now begun to affect other areas of his life. In addition, when a child has experienced lots of losses, it is normal for them to cling to the parent who is there caring for them and to seek their constant reassurance.

Anxiety meltdown

Dealing with high levels of anxiety and meltdowns is hard work for both children and parents, and it is easy to feel overwhelmed and to become anxious or stressed in response. However, in helping your son, the key thing is to try to respond in a calm, empathic way.

Though your son might be “losing it” in the height of an anxiety meltdown, you want to respond calmly. You become the still point in the middle of his storm.

By being calm, you express a belief to him that he can cope and get through this with your help and by being empathic, you help him to not feel bad about his feelings and to begin to understand them.

Calm the storm

When your son is at the height of an anxiety meltdown, the goal is to help him calm down. Different things work at different times.

Sometimes he might need a cuddle or to be held in a hug as you gently reassure him, repeating, “It’s okay, it will all be fine.” Or you can guide him in how to relax –“Let’s take a gentle breath now, it will all be fine.”

Sometimes, it might be useful to take a break for a minute and give him some space – “You sit there and relax, I’ll be back.” Then you do something else in the room for a minute before returning to him.

His feelings

At lower levels of anxiety it is important to help your son express his feelings so he can learn to understand them. For example, if he says he is worried about being knocked down when you go out, you might first listen to his feelings and gently explore them (what makes you say that?) before reassuring him by saying: “That is unlikely to happen because we will be safe holding hands.”

Limiting worries

It is important not to spend too much time talking about his worries. While you might listen and reassure him, you move on to something else after a few minutes.

One of the best techniques that many families use is to have a designated worry time once a day with children. This means for 15-20 minutes a day you will let them talk in detail about their worries helping them problem solve, and so on.

Outside this time you will not talk about their worries and instead distract them with other fun things – “We are not talking about that now, let’s go play with your Lego.” The goal is to put boundaries on his worries and help him learn to interrupt them.

Preventing worries

Over time, you can also aim to teach your son lots of good techniques to manage worries such as doing fun breathing exercises, listening to relaxing music, or having a ritual of putting his worries into a box at night, and so on.

There are also lovely children’s books you can read together about small animals managing worries and becoming braver, and so on.

In addition, it is important to remember that he is still very young and, as he gets older and more mature, he should be much more able to manage his anxiety.

You can help this happen by creating as much stability in his life as possible and by building his confidence in different areas in his life.

If problems continue, do consider getting help from a child mental health professional who should be able to advise you further.

Dr John Sharry is a family psychotherapist and co-developer of the Parents Plus Programmes. He will be delivering courses on Positive Parenting for teens in in Cork on Saturday, March 12th, and a series of talks on promoting self-esteem and overcoming anxiety in children in Dublin on Mondays starting on April 11th See solutiontalk.ie for details.