Specific phobias in children

Specific phobias are common in children and can cause significant distress and impact functioning. Fear of animals (snakes, spiders, dogs) and blood-injection-injury (blood, needles, hospitals) are known to emerge during childhood. In contrast, other situational phobias (eg fear of driving, claustrophobia) usually have a later onset during adolescence. Other specific phobias occur in children, such as fear of loud sounds (balloon popping) and costumed characters (clowns). The prevalence of specific phobias in children is approximately 10 to 35% and the mean age of onset is 5 to 12 years.

For information on diagnosing and differentiating anxiety disorders, see Overview of anxiety disorders.

Use psychological interventions (including behavioural therapy with a graded exposure component) as first-line treatment of a specific phobia. Exposure therapy (which may include relaxation strategies) is used to gradually reduce autonomic responses to feared stimuli in the management of a specific phobia. Cognitive reframing, delivered at an age-appropriate level, may also be used to address worries and fears related to a specific phobia in a child. Virtual-reality exposure is emerging as a convenient approach, but it is not clear if it is superior to real-world exposure.

Pharmacotherapy is rarely indicated for managing a specific phobia in a child. If the phobia results in extreme incapacitation and pharmacotherapy is considered, refer to a child psychiatrist or age-appropriate mental health service.