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Pediatric Specific Phobia Clinical Presentation

  • Author: William R Yates, MD, MS; Chief Editor: Caroly Pataki, MD  more...
Updated: Dec 04, 2015


Behaviorally, phobias manifest as the need to escape or avoid the feared object or situation. The fear may be expressed somatically by tremor, feeling faint or actually fainting, nausea, diaphoresis, rapid heart rate, increased blood pressure, and feelings of panic. Children may present with crying, tantrums, clinging, or immobilization.

Parents of children with anxiety disorders typically have a higher than average incidence of anxiety disorders in their histories. Similarly, children whose parents have a specific phobia display a higher rate of specific phobia than do control subjects.

Children with anxiety disorders are more likely to display distorted and maladaptive thoughts, but whether these negative thoughts are causes or consequences of their fears is unclear.

Specific phobia may be associated with problems with peers, family, and school, difficulties that may negatively affect self-esteem. Unlike adults, children may not acknowledge that their fear is excessive or unreasonable. (See Workup.)

Self-medication by adults with alcohol and drugs, which has been reported with some anxiety disorders, is not commonly reported in patients with specific phobia.[7]


Physical Examination

Physical examination may be helpful in documenting evidence of autonomic hyperactivity common in specific phobia. Signs of autonomic hyperactivity may include increased blood pressure, increased heart rate, diaphoresis with sweating palms, or mydriasis. However, autonomic hyperactivity may be sporadic and not present during the physical examination. Physical symptoms such as headaches or stomachaches are commonly seen in children with anxiety disorders, including specific phobias.

Physicians may elect to use a targeted physical examination to aid in ruling out a physical cause for prominent specific physical complaints in individual cases.

Contributor Information and Disclosures

William R Yates, MD, MS Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.


Kerim M Munir, MD, MPH, DSc Director of Psychiatry, Division of General Pediatrics, Developmental Medicine Center, Children's Hospital Boston

Kerim M Munir, MD, MPH, DSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Chet Johnson, MD Professor of Pediatrics, Associate Director and Developmental-Behavioral Pediatrician, KU Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies; Assistant Dean, Faculty Affairs and Development, University of Kansas School of Medicine

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Sandra L Friedman, MD, MPH and Marilyn T Erickson, PhD, to the development and writing of the source article.

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