Pediatric Specific Phobia Clinical Presentation

Updated: Aug 09, 2018
  • Author: William R Yates, MD, MS; Chief Editor: Caroly Pataki, MD  more...
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Presentation

History

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]

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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.

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