What is the recommended medication for anxiety in an 8-year-old child?

From the Guidelines

I strongly recommend cognitive behavioral therapy (CBT) as the first-line treatment for anxiety in an 8-year-old child, rather than medication, due to its strong evidence for effectiveness and lack of potential side effects. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, both CBT and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents. However, given the potential risks and side effects associated with medication, especially in young children, CBT should be the initial approach.

Some key points to consider when treating anxiety in children include:

• The median age of onset of anxiety disorders approximates 11 years, but each anxiety disorder often onsets during a specific developmental phase 1
• Anxiety disorders are highly comorbid with each other and with other psychiatric disorders, particularly depression, but also bipolar, attention-deficit/hyperactivity disorder (ADHD), learning/language, behavior, obsessive-compulsive, eating, and substance-related disorders 1
• The decision to use medication requires thorough evaluation of the child's symptoms, their impact on functioning, and should involve shared decision-making with parents 1

If therapy alone is insufficient after an adequate trial, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine may be considered, but only under careful supervision by a child psychiatrist. Medication should be started at low doses (often 5-10mg daily for fluoxetine) and gradually increased if needed, with regular monitoring for side effects including behavioral changes, sleep disturbances, and rarely, increased suicidal thoughts 1.

It's also important to note that serotonin norepinephrine reuptake inhibitor (SNRI) medication, such as duloxetine, has some empirical support as an additional treatment option, but its use in children is limited by the availability of data and FDA indications 1. Duloxetine is the only SNRI to have an FDA indication for the treatment of any anxiety disorder (specifically, generalized anxiety disorder in children and adolescents 7 years old). However, the choice of medication for anxiety within the SNRI class may also be governed by other considerations such as pharmacokinetics, pharmacodynamics, tolerability, cost, insurance formularies, and unique risks leading to warnings or precautions 1.

From the Research

Medication Options for Anxiety in Children

• There is limited information available on the recommended medication for anxiety in an 8-year-old child from the provided studies.
• However, one study 2 discusses the use of hydroxyzine, an anti-histamine medication, in the treatment of generalized anxiety disorder (GAD) in adults, but does not provide information on its use in children.

Non-Pharmacological Interventions

• Cognitive-behavioral therapy (CBT) is a first-line, empirically supported intervention for anxiety disorders, including in children 3, 4, 5.
• CBT refers to a family of techniques that target maladaptive thoughts and behaviors that maintain anxiety over time.
• Recent strategies for enhancing the efficacy of CBT protocols are highlighted, including exposure and cognitive therapy 3, 4.

Treatment Guidelines

• The provided studies do not specifically address treatment guidelines for anxiety in children.
• However, one study 6 discusses treatment guidelines for posttraumatic stress disorder (PTSD), which may be relevant to some cases of anxiety in children.
• Trauma-focused psychotherapies, such as prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing, are recommended as first-line treatments for PTSD 6.

Efficacy of Cognitive Behavioral Therapy

• A meta-analysis of randomized placebo-controlled trials found that cognitive behavioral therapy (CBT) is a moderately efficacious treatment for anxiety disorders, including generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder (PD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) 5.
• The study found moderate placebo-controlled effects of CBT on target disorder symptoms, and small to moderate effects on other anxiety symptoms, depression, and quality of life 5.