Fear is an emotional response that is a normal part of development and
essential to human survival. It is both protective and adaptive. In
times of danger or anticipated risk, the sympathetic nervous system
is activated and prepares the body to fight or flee the dangerous situation.
Fear is short lived, which makes it different from mood states such
as anxiety. Anxiety is often thought of as a secondary emotion in
response to a primary emotional reaction (eg, fear). For example,
people become anxious if they are fearful about a specific event,
object, or situation and anticipate negative outcomes. Anxiety requires
more cognitive capacities than fear. The fight-flight response may be
activated when anxiety and fear appear even when there is no real
danger but negative outcomes are anticipated. Such anticipatory
fear, when persistent and pervasive, extends beyond normative levels
of fear and anxiety and can be debilitating.
The focus of fear and anxiety changes over time as children explore
their world and encounter new situations and stimuli. During infancy,
fear is usually expressed as crying and limb reactivity to loud
noises and novel stimuli. As infants begin to discriminate known faces
from unfamiliar ones, stranger anxiety emerges (usually by 7–9
months of age). During this stage, the infant becomes very reactive (crying,
muscle tension, flailing limbs, etc) to unfamiliar people. Simultaneously,
bonds with primary attachment figures are typically being strengthened,
and eventually separation anxiety becomes predominant (ie, child
may cry when parent or other primary attachment figure is away even
in the presence of other familiar adults). Separation fears are
common between 1 and 3 years of age and gradually resolve by age
5 with experience that parents return after separations and a newfound awareness
that objects continue to exist even when you cannot see them. From
about 4 to 7 years of age, as children continue to become acquainted
with their surroundings and more imaginative in their thinking,
fears of new and unfamiliar situations as well as real and imagined
dangers (eg, spiders, monsters, ghosts, the dark, dogs) become more
With increased learning and exposure to information obtained
at school, children’s fears often become more reality based.
For example, fears of fires, storms, natural disasters, kidnapping,
illness, plane crashes, and crime are common during this stage.
Preadolescence and adolescence are characterized by increasing autonomy
and individuation from parents as well as greater emphasis on peer
relationships. Social comparisons, peer status, and social acceptance
become increasingly important during this time, resulting in more social
fears. Abstract thinking also becomes more developed during adolescence,
which allows the teenager to worry about many hypothetical situations
as well as issues regarding self-identity, morality, and the future.
Substantial deviations from this developmental sequence may signify
the presence of problematic anxiety.
Fears and anxiety are manifested in various ways. Some
children may appear visibly nervous. Others may hide their feelings, freeze
in a situation, or express their anxiety as anger or ...