Supporting children with anxiety

How to support children with anxiety in primary school – practical SEMH strategies, classroom tips, and information on our Calm me anxiety programme.

Anxiety is one of the most common social, emotional, and mental health (SEMH) needs in primary school children. It can show up as physical complaints, emotional outbursts, school avoidance, or withdrawal – and often goes unrecognised.

For children, anxiety isn’t just ‘worry’ – it’s an overwhelming response to feeling unsafe or unsure, even in a nurturing school environment. Supporting children to understand their feelings and learn to manage them is essential for their wellbeing and educational success. Creating a compassionate environment where children feel safe to express themselves and learn coping strategies is essential for fostering resilience.

Signs and symptoms of anxiety in children

Physical symptoms

  • Frequent headaches, tummy aches, nausea, dizziness, digestive issues, or unexplained aches and pains.

  • Panic symptoms such as a rapid heartbeat or palpitations or panic attacks (intense periods of fear) including breathlessness, light-headedness, and chest pain, a tight chest or difficulty breathing.

  • Shaking or trembling.

  • Feeling light-headed, dizzy or faint.

  • Excessive sweating or hot flushes.

  • Dry mouth or lump in the throat.

  • Muscle tension, especially in shoulders and jaw (and teeth grinding).

  • Difficulty concentrating or completing tasks, restlessness or inability to sit still.

  • Emotional dysregulation or shutdown.

  • Frequent trips to the bathroom or accidents.

  • Refusal to attend school or Emotional School-Based Avoidance (ESBA).

Anxiety explained

Anxiety is an emotion that presents as unease or inner turmoil, often manifesting as a fear or dread about future events. It’s distinct from fear, which is a reaction to an immediate threat or danger. While anxiety is common in adults, it can have a profound effect on children, leading to stress, emotional discomfort, and disruption to their everyday lives. Because anxiety is experienced differently by each child, early recognition, reassurance, support and intervention, are important.

Mental and emotional symptoms

  • Persistent worry, even with no clear reason for concern, fear of worst-case scenarios or feeling ‘on edge’ all the time.

  • Low mood or withdrawal from friendships or play, or activities they usually enjoy.

  • Recurrent thoughts about past negative experiences (rumination).

  • Fear of social judgment or making mistakes in front of others.

  • Feeling disconnected or like they’re ‘watching themselves.’

  • Avoidance of group work, speaking out, or taking risks.

›  Read more about how ESBA presents and the key signs to look for

Suspensions among students

How anxiety affects children

Children with anxiety may experience both mental and physical challenges.

  • Physical effects: Anxiety activates the body’s ‘fight or flight’ response, causing the release of stress hormones like adrenaline. This can result in rapid breathing, muscle tension, headaches, and stomach issues. Prolonged anxiety can also lead to chronic physical complaints like fatigue or unexplained pain.

  • Mental effects: On a cognitive level, anxiety can affect a child’s ability to concentrate, make decisions, and even maintain healthy relationships. The child might constantly worry about the future, feel disconnected from reality, or experience periods of intense dread, leading to a decrease in overall wellbeing.

Why early intervention in school matters

Primary schools play a crucial role in helping children identify and manage anxiety. Trusted adults, safe spaces, and predictable routines are protective factors that reduce emotional overwhelm.

With whole-school approaches and targeted anxiety interventions, children can build the skills they need to regulate emotions, ask for help, and feel secure in their learning environment.

Practical school-based strategies

Create emotional safety

  • Ensure all key staff such as teachers, pastoral staff, ELSAs, and TAs have a shared understanding for a collaborative approach.
  • Designate trusted adults: Ensure trusted adults are identified to take a special interest, and build a relationship with the child.

  • Implement strategies: such as ‘meet and greet’ in the mornings, as well as check ins throughout the day or at trigger times with a trusted adult.

  • Safe quiet spaces: ensure calm corners or quiet zones are identified where the child can go, with the trusted adult, to help manage anxiety or for self-regulation.

  • Ensure consistent routines: with predictable transitions and visual timetables.

  • Ensure the child feels listened to and understood.

  • Participation in an SEMH programme: to support the child such as the Hamish & Milo Calm me Programme.

Foster a sense of belonging – circle of care

  • Peer support or friendship circles: help the child build strong, supportive friendships by facilitating opportunities for positive social interactions, like small group activities or peer mentoring.
  • Positive roles of responsibility: to help build the childs confidence.

  • Ensure all children are taught about anxiety: through age appropriate PSHE to foster understanding and reduce stigma.

Provide personalised support

  • Individual plans: create a personalised plan in collaboration with the parents/carers and trusted adults for handling the child’s anxiety and triggers (e.g. coming to school, tests, friendship difficulties). Detail helpful strategies, safe spaces, sensory activities and coping techniques. Identify interests, roles of responsibility and create a plan that helps the child become involved and able to manage anxious feelings.

  • Flexible expectations around tasks and classroom participation.

Children’s Mental Health Week
Hamish & Milo Calm me Drawing my worries Calm Me, Drawing my worries Manor Junior School

Practical coping strategies for children with anxiety

  • Deep breathing: teaching children simple deep-breathing techniques can significantly help calm the nervous system during moments of anxiety. A common method is belly breathing, where children inhale deeply through their nose, feeling their belly expand, and exhale slowly through their mouth.

  • Grounding techniques: can help children manage intense feelings and emotions by bringing them back to the present moment for example the 5-4-3-2-1 method: Ask the child to identify 5 things they can see, 4 things they can touch, 3 things they can hear, 2 things they can smell, and 1 thing they can taste.

  • Visualisation: encourage the child to imagine a peaceful, happy place when feeling anxious. This can help distract them from stressful thoughts.

  • Mindfulness and sensory activities: simple mindfulness exercises, such as paying attention to the present moment or focusing on physical sensations (e.g, feeling their feet on the ground), can help the child manage overwhelming emotions.

  • Positive self-talk and emotional vocabulary: teach children to challenge anxious thoughts by replacing them with positive, reassuring statements like “I am safe” or “I can handle this.”

  • Participation in a Hamish & Milo Calm me Programme group: involve the child in a small group that through the programme activities, encourages discussion, expression and creates a circle of care to learn social and emotional skills to manage anxiety.

About Emotional School-Based Avoidance (ESBA)

ESBA occurs when a child feels emotionally unable to attend school due to anxiety, emotional or mental health difficulties.  It’s not about refusal or defiance – it’s about emotional overwhelm. Left unsupported, it can impact learning, friendships, and self-esteem.

The underlying reasons for ESBA can be complex and are often due to several factors, rather than one single cause. Special educational needs, trauma and childhood adversity often play their part. Children experiencing ESBA often show a combination of emotional, behavioural, and physical signs including:

  • Intense anxiety or dread about going to school or even when school is mentioned.

  • Emotional outbursts when asked to go to school (crying, dysregulated behaviours such as anger or lashing out or flight behaviours, running away, hiding, or freezing).

  • Persistent anxious thoughts and ‘what if’ worries about attending school, interacting with peers, or separating from home; clinginess or refusal to leave parent/carer.

  • Repeated lateness or frequent absences or ‘feeling ill’ with no identifiable cause or medical reason.

  • Withdrawal, low mood or signs of depression (e.g. sadness, hopelessness).

  • Avoidance of school-related tasks (e.g. homework, or group activites).

  • Perfectionism or fear of mistakes, or fear about being unable to cope leading to task avoidance.

  • Irritability or emotional hypersensitivity over small triggers.

  • Seeming disconnected or overwhelmed by classroom noise, pace, or social dynamics.

These signs often reflect a child’s internal struggle with feeling unsafe, overwhelmed, or disconnected in the school environment. With relational support and appropriate interventions, children can regain a sense of safety and re-engage.

Strategies for ESBA in the school environment

Relational school culture, staff awareness and communication

  • Ensure that all school staff are relational in their approach and that relational practice is at the heart of the school culture.

  • Ensure all staff are aware and understand the implications of ESBA, the approach and know how to recognise signs, respond to children and parents and know how to signpost or refer to key staff within school.

Create a safe emotional space

  • Trusted adult: ensure meet and greet with a trusted adult at the start of each day and ‘check-ins’ to reassure, focus on emotional safety and to foster a sense of belonging.

  • Safe quiet spaces: ensure calm corners or quiet zones are identified where the child can go, with the trusted adult, to help manage anxiety or for self-regulation.

  • Ensure the child feels listened to and understood.

Develop a partnership approach with home

  • Encourage open communication without fear of any judgement.

  • Build relationships to ensure emotional safety for parents and carers as well as the child.

  • Form a collaborative plan.

  • Listen to the parent/carers and value their perspective.

Create flexible timetable plans

  • Partial days, staggered starts, or gradual return-to-school plans can help ease anxiety.

  • Focus on activities the child enjoys and gradually build up to joining in more.

  • Special roles of responsibility to foster a sense of purpose and interest e.g. watering plants, feeding school pets etc.

  • Involve them in a Hamish & Milo Calm me Programme to help create a circle of care, a sense of belonging and join in activities that help think about, express and manage anxious feelings and to learn social and emotional skills.

In-class support

  • Ensure a sense of belonging and relational practice.
  • Ensure relational practice is enhanced by the teacher and pastoral staff.
  • Make reasonable and considered adjustments for work completion.
  • Be creative in engaging the child through the curriculum, sensory activities and presentation e.g. record ideas instead of speaking out loud or writing ideas down.
  • Focus on successes and build confidence.

Circles of belonging

  • Create circles of friends or a peer mentor to help develop a sense of togetherness and belonging.
  • Encourage activities with another key child to support and prevent a sense of isolation.
  • Give play opportunities and support where need be with a trusted adult.

Understanding ESBA and recognising its signs early can significantly impact a child’s ability to feel supported and self-regulate with the support of trusted adults in school and partnership work with parents. All children need to feel safe to express themselves, to feel that they belong and are welcome in school and that school can be a fun place to be.

How our Calm me programme helps

Our Calm me programme helps children to be able to think about what anxiety is and how it may affect them. Enabling children to begin to understand and recognise the signs of anxiety within themselves and others helps them to know they are not alone with these feelings. Having helpful ways to express, regulate themselves and share their thoughts can be powerful in helping children feel understood and able to survive through difficult times.

Calm me is a small-group intervention, and through the discussion and activities, the children will:

  • Recognise and notice the sensations in their body and how they are feeling inside
  • Understand what’s happening in their body and mind when they are worried or anxious
  • Develop self-regulation skills for when they are feeling worried
  • Develop the language to express how they are feeling and know how to ask for help
  • Discover safe ways to feel calm and ask for help

Delivered through discussion, storytelling, and creative activities, Calm me creates a circle of care where children feel seen, safe, and supported.

Child Feeling Sad
Hamish & Milo Session Plans Calm me

Hamish & Milo – created for busy schools

Our programmes teach and embed transferable emotional literacy skills that are vital in both class and life.
All our wellbeing programmes resources are:

  • Time-saving for SENCOs and pastoral staff
  • Ready-to-use with age-appropriate scripts and activities

  • Designed to embed social and emotional literacy across the school